PSY 240 CH. 17
Historical and Contemporary Views ofAbnormal Behaviour
• There have been many changes in how we treat psychological disorders.
Historical Views of Abnormal Behaviour
• 6500 B.C. For those complaining of headaches or convulsive attacks, early shamans
(medicine men) treated the disorder by means of an operation called trephining.An area
of the skull was chipped away with a crude stone instrument until there was a hole in the
skull. The opening is called a trephine.
• The trephine permitted evil spirits thought to be causing the pain to escape. In modern
terms, it relieves pressure on the brain. There is evidence that people have survived the
• Ancient papyruses show some information on medical procedures. They often cover
internal medicine and the circulatory system, but they rely heavily on incantations and
magic for explaining or curing the diseases.
Demonology, Gods, and Magic
• Early Chinese, Egyptians, Hebrews, and Greeks often attributed behaviour to possession.
Possession could be from a good spirit (their behaviour appeared to have a religious
significance) or a bad spirit.
• Bad possessions were thought to be punishment for sins. The punishment was a
withdrawal of gods protection. Efforts were made to rid these people of the evil spirits.
• Primary treatment for possession was an exorcism,
Hippocrates’Early Medical Concepts
• Hippocrates denied that the deities and demons intervened in the development of illnesses
and insisted that mental disorders had natural causes and appropriate treatments.
• Brain was the central organ. Believed mental disorders were due to brain pathology.
• Had pointed out the importance of heredity and predisposition, as well as that head
injuries causes sensory and motor disorders.
• Had 3 classifications of mental disorders: mania, melancholia, and phrenitis (brain fever)
• The four humours were highly associated with illness. They include yellow bile (choler),
phlegm, blood (sanguis), and black bile (melancholer).
• Aperson’s temperament was determined by the 4 humours and a change in their normal
levels resulted in illness.
• Hippocrates placed an importance on dreams when looking at personality.
• Believed hysteria was due to a wandering uterus. Recommended remedy was marriage.
Early Philosophical Conceptions
• Plato studied mentally disturbed individuals and looked into ways of dealing with them.
He thought they were not responsible for their own actions and when they committed a
felony, they could not be held responsible for them.
• Plato viewed psychological phenomena as responses of the whole organism, reflecting its
internal state and natural appetites.
• His ideas regarding treatment included ‘hospital care’where the patients would be
engaged for a period of time in conversation (similar to psychotherapy nowadays). • Believed mental afflictions were the result of a deity.
2.1 Developments in Thinking: Hysteria and Melancholia through theAges
o Two common disorders across the ages: hysteria and depression
- Formerly hysteria, now conversion disorder.
- Hysteria is derived from the Greek word for uterus (hystera).
- Plato saw the uterus as being the cause of hysteria because when it went without
bearing young for a period of time, it would get upset and affect the rest of the body.
- Ancient Greeks also believed hysteria was caused by the movement of the uterus and
crowding other organs.
- Evidence of it dating back past Egyptian times.
- Later on it was noted that the symptoms differ in men and women.
- During the Spanish inquisition it was still thought that it was caused by demons and
- TeresaAvila did not support the demonic idea; she wanted equal treatment of those
affected by it.
- Philippe Pinel also thought that people would be treated fairly.
- Kraepelin (late 1800- early 1900) identified manic depression as a category of
Later Greek and Roman Thought
• In Alexandria, Egypt, pleasant surroundings were provided to mental patients. It was
thought to be therapeutic. They were provided with constant activities including parties,
dances, walks in the temple gardens, etc.
• Physicians of this time used a wide variety of treatments including diet, massage,
hydrotherapy, gymnastics, education, bloodletting, purging, and mechanical restraints.
• Galen (130-200 BCE) dissected animals and humans to learn about the nervous system.
• He divided causes into psychological and physiological.
• Causes included injury to the head, excessive alcohol, shock, fear, adolescence, menstrual
Abnormality during the MiddleAges
• First mental hospital was established in 792 CE in Baghdad.
• Avicenna fromArabia wrote The Canon of Medicine, a widely studied work. It
referenced hysteria, epilepsy, manic reactions, and melancholia.
• During the MiddleAges (c, 500-1500), treatment was mostly characterized by ritual and
2.2 Developments in Thinking: Early Views of Mental Disorders in China
o As early as 2674 BCE, Chinese medicine was focused on natural rather than superstitious
causes of illness.
o Yin and Yang, if the 2 forces balance, the person is in optimal health.
o Zang-zao was an illness that mirrored many of the symptoms of hysteria.
o Chinaman called the Hippocrates of China was Chung Ching. He based his views on
disorders from clinical cases. He believed that stressful psychological conditions could
cause organ pathologies. He utilized both drug and regaining balance as treatments. o Chinese views regressed to the supernatural.
• During the MiddleAges in Europe they thought spirits and superstitions to be related to
illness. There were 2 main events in time, mass madness and exorcism.
• Mass madness: Historically, widespread occurrence of group behaviour disorders that
were apparently cases of hysteria.
• Tarantism: Dancing mania that occurred in Italy in the thirteenth century.
• Tarantism was often attributed to the bite of a spider.
• Saint vitus dance: name given to the dancing mania (and mass hysteria) that spread from
Italy to Germany and the rest of Europe in the Middle Ages.
• Dancing was thought to be the cure for it.
• Lycanthropy: Delusions of being a wolf.
• There were outbreaks of lycanthropy as well.
• Mass mathess octhrred periodically all the way into the 17 century, reaching its peak in
the 14 and 15 centuries.
• During this peak, the plague known as Black Death was spreading.
• People could not believe that events such as this plague were of natural causes, and
therefore did not think they could control it.
• Today, mass hysteria is known as mass psychogenic illness. It typically involves sufferers
mistakenly attributing bodily changes or sensations to serious diseases.
• The symptoms have a rapid onset and a rapid remission.
• The index person (the initial person reporting the illness) may be suffering from a
genuine medical condition. People nearby hear about it, become anxious, and scan
themselves for any oddities. Symptoms in these people are normally just bodily reactions
or anxiety-related bodily sensations.
• Arecent case in 1983 occurred when a teacher thought she smelled gas. Students quickly
became aware of a gas-like smell and started experiencing the symptoms of it. The school
was evacuated, but no gas was found. It was determined to be psychological factors that
• No one is immune to it, as anyone can find themselves in a situation where something
Exorcism and Witchcraft
• Management of mentally disturbed in the MiddleAges was left to the clergy.
• For the most part they were treated with kindness, prayer, holy water, etc.
• In some monasteries though, they performed exorcisms.
• Exorcism: Religiously inspired treatment procedure designed to drive out evil
spirits or forces from a “possessed” person.
• Arecent resurgence of superstition (in Italy) has led to an increase in exorcisms
being performed today.
• Those physically possessed were considered mad whereas those spiritually
possessed were considered witches.
Toward Humanitarian Approaches • In the latter of the MiddleAges, scientific questioning re-emerged.
The Resurgence of Scientific Questioning in Europe
• Paracelsus (1490-1541) was an early critic of superstitious beliefs. He insisted that
dancing mania was a form of disease. Postulated a conflict between the instinctual and
spiritual natures of human beings, formulated the idea of psychic causes for mental
illness, and advocated treatment by ‘bodily magnetism’(hypnosis). Believed the moon
affected the brain.
• Johann Weyer was a German physician who was disturbed by the treatment of ‘witches’
and other ill. Argued against Heinrich Kramer (advocate of punishing witches) that most
(or all) of the ‘witches’were sick.
• Johann Weyer often considered the founder of modern psychopathology.
The Establishment of EarlyAsylums and Shrines
• Asylums: Historically, these were institutions meant solely for the care of the mentally ill.
• From the 16 century on, asylums grew in numbers. Early on, they were not pleasant
places; they were simply used to store ‘mad’people.
• In some of the asylums, violent patients were made visible to the public for money. Many
harmless patients ended up as beggars on the street.
• People with psychiatric disorders received little in terms of appropriate care, and were
commonly placed in jails, poorhouses, or charity shelters.
• Later on, hospitals were built that were devoted exclusively to psychiatric problems.
Treatment of patients was as bad as at the other hospitals though.
• Insanity: Legal term for mental disorder, implying lack of responsibility for one’s acts
and inability to manage one’s affairs.
• The treatments were harsh because it was believed that patients needed to choose
rationality over insanity.
• Philippe Pinel (1745-18226) was a great pioneer for a humanitarian to the mentally ill.
• Pinel was placed in charge of La Bicêtre in Paris in 1792. He received the permission to
remove the chains from some inmates as an experiment to test his views that mental
patients should be treated with kindness – as sick people, not as criminals.
• His experiment proved to be a success. Chains were removed; rooms now had windows
and were well-ventilated, etc.
• Pinel spent a great deal of time talking to the patients.
• Some documents say that Jean-Baptiste Pussin had been the one to remove the chains and
employ straight-jackets instead.
Tuke’s Work in England
• William Tuke (1732-1822) established a country retreat where mental patients could live,
work, and rest.
• This retreat continued to provide humane mental health treatment for over 200 years.
Ththght its creation spawned some not too humane, overcrowded mental hospitals in the
• Samuel Hitch in 1841 introduced nurses to take care of the patients into the hospitals. It
greatly increased the quality of care provided. Moral Management in North America
• Benjamin Rush is the founder of NorthAmerican psychiatry. Rush encouraged the
humane treatment of mentally ill patients.
• He established the first course on psychiatry. Though his beliefs were tainted with
astrology, and his principle remedies were bloodletting and purgatives. He also invented
the tranquilizing chair.
• Moral management: Wide-ranging method of treatment that focuses on a patient’s social,
individual, and occupational needs.
• Moral management became common during the first part of the humanitarian movement.
It focused on rehabilitating their character rather than their physical or mental disorders.
• Moral management had a high degree of success. Though it was abandoned in the late
half of the 19 century, likely due to increased numbers of immigrants leading to
increased staff-patient hostility, the movement leaders inability to train their
replacements, and the overextension of hospital facilities.
• Mental hygiene movement: Movement that advocated a method of treatment that focused
almost exclusively on the physical well-being of hospitalized mental patients.
• The demise of moral management could also have been due to the rise of the mental
hygiene movement as well as advances in biomedical science.
• These two movements fostered the belief that all mental disorders had a biological
backing that could be cured.
Dix and the mental Hygiene Movement
• Dorothea Dix (1802-1887) was a champion for those in mental hospitals. She travelled
through the US, Canada, and Europe telling of the horrible conditions that mental patients
face in hospitals.
• Dix became an important driving force for the humane treatment of mental health
patients. She initially worked as a teacher, but tuberculosis prevented her from
continuing. She later taught in prisons, where she was first introduced to the conditions
that inmates face.
• Through her efforts, the mental hygiene movement grew in Canada and the US. She
helped to raise money to build suitable hospital to house the ill. She is accredited with
establishing 32 mental hospitals.
• Critics argue that housing them in mental hospitals goes against the mental health
movement of the time.
The Military and the Mentally Ill
• The first hospital to help those that came back from war was opened by the Confederate
Army in theAmerican Civil War.
• Doctors were being trained to screen potential soldiers for potential mental health
Nineteenth-Century Vieth of the Causes and Treatment of Mental Disorders
• In the early 19 century, mental hospitals were essentially controlled by laypersons (non-
ordained members of the church). Psychiatrists had a minimal role.
• Effective treatments were not present. They tried drugs, bloodletting, and purging.
• During the later part of the 19 century, psychiatrists gained more control and
implemented moral management. • They believed depression was caused by depletion in the bodily e