History of Mental IllnessHistory of Mental Illness

By Stacy ClarkBy Stacy Clark

Classical UnderstandingsClassical Understandings Early Greek Literature & MythologyEarly Greek Literature & Mythology

Homer: Iliad- AjaxHomer: Iliad- Ajax Gods blamed for the “sacred disease” Gods blamed for the “sacred disease” Healing: prayers, sacrifices to Asklepios, god of healingHealing: prayers, sacrifices to Asklepios, god of healing

DramaDrama Aeschylus, Sophocles, EuripidesAeschylus, Sophocles, Euripides Madness often results as “Psychic civil war becomes Madness often results as “Psychic civil war becomes

endemic to the human condition” and introspection begins endemic to the human condition” and introspection begins to dominate dramato dominate drama

MedeaMedea Greco-Roman customGreco-Roman custom

Violence, cannibalism, grief seen as markersViolence, cannibalism, grief seen as markers No asylums; family responsibility for careNo asylums; family responsibility for care Fear of contagion from evil spirits (Fear of contagion from evil spirits (kereskeres) ) Cure for hysteria (“wandering uterus”): marriageCure for hysteria (“wandering uterus”): marriage

Idea of “melancholy genius”Idea of “melancholy genius” Plato, AristotlePlato, Aristotle

Early MedicalizationEarly Medicalization Hippocrates (ca. 460-357 BC): natural explanation for Hippocrates (ca. 460-357 BC): natural explanation for

epilepsyepilepsy ““naturalization of madness”naturalization of madness”

“…“…the sacred disease appears to me to be no more divine nor the sacred disease appears to me to be no more divine nor more sacred than other diseases, but has a natural cause from more sacred than other diseases, but has a natural cause from which it originates like other afflictions. Men regard its nature which it originates like other afflictions. Men regard its nature and cause as divine from ignorance and wonder, because it is and cause as divine from ignorance and wonder, because it is not like other diseases.”not like other diseases.”

Mania and melancholia: excitement/depressionMania and melancholia: excitement/depression Humoral theory (usually choler, black bile)Humoral theory (usually choler, black bile) Melancholy madness sometimes seen as genius (i.e. modern Melancholy madness sometimes seen as genius (i.e. modern

ideas of bipolar creativity)ideas of bipolar creativity)

PlatoPlato Timaeus, 375 B.C.E: Physiological cause of madness, therefore Timaeus, 375 B.C.E: Physiological cause of madness, therefore possibility of treatment by medical meanspossibility of treatment by medical means Also, concept of “madness as a transcendental divine fire with Also, concept of “madness as a transcendental divine fire with the power to inspire”the power to inspire”

““Naturalistic Notions”Naturalistic Notions” Galen!!Galen!!

Mania: disease of yellow bile (the heart)Mania: disease of yellow bile (the heart) ““hot” disease called for cooling treatmenthot” disease called for cooling treatment

SoranusSoranus Mental illness caused by: “continual sleeplessness, Mental illness caused by: “continual sleeplessness,

excesses of venery, anger, grief, anxiety, or superstitious excesses of venery, anger, grief, anxiety, or superstitious fear, a shock or blow, intense straining of the senses and fear, a shock or blow, intense straining of the senses and the mind in study, business, or other ambitious pursuits” the mind in study, business, or other ambitious pursuits”

Arataeus of Cappadocia (contemporary of Galen, 150-200 Arataeus of Cappadocia (contemporary of Galen, 150-200 C.E.)C.E.) Descriptions of mental disorders (depression, mania, Descriptions of mental disorders (depression, mania,

melancholy, bipolar disorders) and epilepsymelancholy, bipolar disorders) and epilepsy– ““one believes himself a sparrow; … or they believe one believes himself a sparrow; … or they believe

themselves a grain of mustard, and tremble continuously themselves a grain of mustard, and tremble continuously for fear of being eaten by a hen.” for fear of being eaten by a hen.”

– Criticized Dionysian frenzies as disgracefulCriticized Dionysian frenzies as disgraceful

• Greek ideas dominated medical thought for centuries, Greek ideas dominated medical thought for centuries, providing basis for medieval European and Islamic thoughtproviding basis for medieval European and Islamic thought

Biblical ExamplesBiblical Examples

Madness as divine punishment: Madness as divine punishment: Deuteronomy 6:5, “The Lord will smite Deuteronomy 6:5, “The Lord will smite thee with madness”thee with madness”

King NebuchadnezzarKing Nebuchadnezzar New Testament examples of Jesus New Testament examples of Jesus

healing demonic possessionhealing demonic possession

Non-Western AntiquityNon-Western Antiquity HinduismHinduism

Goddess Grahi (“she who seizes”)Goddess Grahi (“she who seizes”)

IndiaIndia Dog-demonDog-demon

Mesopotamia and BabylonMesopotamia and Babylon Spirit invasion, the evil eye, demonic power, Spirit invasion, the evil eye, demonic power,

breaking of taboos led to mental disorderbreaking of taboos led to mental disorder ““If at the time of his possession his mind is If at the time of his possession his mind is

awake, the demon can be driven out; if at the awake, the demon can be driven out; if at the time of his possession is not so aware, the time of his possession is not so aware, the demon cannot be driven out.” ~Assyrian text, demon cannot be driven out.” ~Assyrian text, 350 B.C.E.350 B.C.E.

Early Christianity: “Holy Madness” vs. Diabolic Early Christianity: “Holy Madness” vs. Diabolic PossessionPossession

Supernatural forces battled for possession, Supernatural forces battled for possession, leading to despair, anguish, etcleading to despair, anguish, etc

““Madness of the Cross”- “ecstatic revelations of Madness of the Cross”- “ecstatic revelations of saints and mystics”saints and mystics” But cause usually diabolic, spread by heretics, But cause usually diabolic, spread by heretics, witchcraftwitchcraft Anatomy of MelancholyAnatomy of Melancholy (1621): Richard Burton (1621): Richard Burton

(Oxford): sick people particularly susceptible to (Oxford): sick people particularly susceptible to Devil, “true author of despair and suicide”Devil, “true author of despair and suicide”

Religious TreatmentsReligious Treatments Spiritual treatment for unclean spirits: masses, Spiritual treatment for unclean spirits: masses,

exorcism, pilgrimages (Catholicism)exorcism, pilgrimages (Catholicism) Insane cared for in religious hospitals, housesInsane cared for in religious hospitals, houses Prayer, counsel, Bible reading (Protestantism)Prayer, counsel, Bible reading (Protestantism)

Madness as HeresyMadness as Heresy Reformation and Counter-ReformationReformation and Counter-Reformation

Political purposes of diagnosisPolitical purposes of diagnosis ““False doctrine and delusion formed two sides of the False doctrine and delusion formed two sides of the

same coin: the mad were judged to be possessed, and same coin: the mad were judged to be possessed, and religious adversaries were deemed out of their mind.”religious adversaries were deemed out of their mind.”

Madness as Blaspheming against GodMadness as Blaspheming against God Mental anguish bringing sinners to acute spiritual crisis, Mental anguish bringing sinners to acute spiritual crisis,

leading (hopefully) to recoveryleading (hopefully) to recovery Conversion narrative of George Trosse (b.1631)Conversion narrative of George Trosse (b.1631)

Witch HuntsWitch Hunts Late 15Late 15thth cent, peak around 1650 cent, peak around 1650 Unusual speech and behavior sign of consorting with Unusual speech and behavior sign of consorting with

the Devil; satanic the Devil; satanic maleficiummaleficium (malice) (malice) Over 200,000 people (primarily women) executedOver 200,000 people (primarily women) executed Led to popular and official skepticism of the doctrine of Led to popular and official skepticism of the doctrine of

demonic possessiondemonic possession

Skepticism of WitchcraftSkepticism of Witchcraft Johannes Weyer (1515-1588): Johannes Weyer (1515-1588): De Praestigiis De Praestigiis

DaemonumDaemonum witches to be “pitied and treated, not feared and punished”witches to be “pitied and treated, not feared and punished”

Product of imaginations or hallucinogenic substancesProduct of imaginations or hallucinogenic substances Natural disasters as cause of “crimes”Natural disasters as cause of “crimes” Devil’s power somewhat limited by GodDevil’s power somewhat limited by God

Dr. Edward Jorden (1569-1632): naturalistic explanationDr. Edward Jorden (1569-1632): naturalistic explanation Hysteria: “suffocation of the mother”Hysteria: “suffocation of the mother” Womb bred “vapours” which unbalanced body, leading to Womb bred “vapours” which unbalanced body, leading to odd behavior attributed to possessionodd behavior attributed to possession Relied on Galenic conceptsRelied on Galenic concepts

Biological explanationBiological explanation Humoral theory: Obstructions, vapors as causesHumoral theory: Obstructions, vapors as causes

Misogyny remained: Witches became hysterical womenMisogyny remained: Witches became hysterical women Witch-hunting ultimately failed as tool of enforcing social Witch-hunting ultimately failed as tool of enforcing social

orderorder

Comparisons drawn between religious Comparisons drawn between religious extremists and mentally illextremists and mentally ill Result of 30 Years War (1618-48), English Civil Result of 30 Years War (1618-48), English Civil

Wars (1642-51)Wars (1642-51) Similar behavior: speaking in tongues, convulsions, Similar behavior: speaking in tongues, convulsions,

“weeping and wailings” “weeping and wailings” Zeal a sign of mental instabilityZeal a sign of mental instability

Renaissance anatomy and physiology Renaissance anatomy and physiology begin to displace Greek humoral theorybegin to displace Greek humoral theory

– Vesalius, HarveyVesalius, Harvey

Thomas WillisThomas Willis Coined term “neurologie”Coined term “neurologie” Excluded demonic possession from considerationExcluded demonic possession from consideration Biological explanation for mental illnessBiological explanation for mental illness

Enlightenment EuropeEnlightenment Europe• The rest of Europe retained beliefs in The rest of Europe retained beliefs in

possession longer than Englandpossession longer than England– by 1700, most of Europe believed in natural by 1700, most of Europe believed in natural

explanationexplanation• Elites scorned religious explanations in favor of Elites scorned religious explanations in favor of

natural causesnatural causes– Religious beliefs became concern of psychopathologyReligious beliefs became concern of psychopathology– Blame placed on Methodists for surviving popular Blame placed on Methodists for surviving popular

belief in witchcraft/possessionbelief in witchcraft/possession• Pathologization of religion in general Pathologization of religion in general

– Mainly Enlightenment free-thinkers Mainly Enlightenment free-thinkers – Philosophes (Voltaire, Diderot) saw Christianity as Philosophes (Voltaire, Diderot) saw Christianity as

function of “sick brains”function of “sick brains”

• Doctors replace clergy as healersDoctors replace clergy as healers

Reason and RationalityReason and Rationality• Rene Descartes (1594-1650)Rene Descartes (1594-1650)

Dualism: mind and body disconnectDualism: mind and body disconnect Mental illness ascribed to problems between Mental illness ascribed to problems between

mind and bodymind and body Implied that “insanity, precisely like regular Implied that “insanity, precisely like regular

physical illnesses, must derive from the body”physical illnesses, must derive from the body” Thomas Hobbes (1588-1679)Thomas Hobbes (1588-1679)

– Materialistic worldviewMaterialistic worldview• ““insanity was thus erroneous and thought caused by insanity was thus erroneous and thought caused by

some defect in the body’s machinery” some defect in the body’s machinery”

• John Locke (1632-1704): John Locke (1632-1704): – insanity delusional; caused by faulty cognitive insanity delusional; caused by faulty cognitive

processesprocesses

• Romantic ideas of madness for artists/ Romantic ideas of madness for artists/ writers: Madness as creative genius or writers: Madness as creative genius or “melancholy malcontent”“melancholy malcontent”– Shakespeare: Hamlet, King Lear, Feste (12Shakespeare: Hamlet, King Lear, Feste (12thth

Night)Night)– Cervantes: Don QuixoteCervantes: Don Quixote

• Famous writers/poets suffering from Famous writers/poets suffering from madness/mental breakdownsmadness/mental breakdowns– Shelley, Byron, Rousseau, Pascal, Poe, Nijinsky, Shelley, Byron, Rousseau, Pascal, Poe, Nijinsky,

Sylvia Plath, Virginia WoolfSylvia Plath, Virginia Woolf

• Parisian avant-garde society: true art from Parisian avant-garde society: true art from mental/physical sicknessmental/physical sickness– Hashish, opium, absinthe crucial to this phaseHashish, opium, absinthe crucial to this phase– Critique of bourgeois valuesCritique of bourgeois values

• Medicalization of mental illness led to Medicalization of mental illness led to less romantic ideas about madnessless romantic ideas about madness

• St. Mary of Bethlehem (Bedlam), St. Mary of Bethlehem (Bedlam), mental hospital founded in 1247, open mental hospital founded in 1247, open to public to to public to

teach moral lessons about excessteach moral lessons about excess

• George III (1788)- fodder for satiristsGeorge III (1788)- fodder for satirists

““Fashionable Melancholy”Fashionable Melancholy”

• Nervous diseases become fashionableNervous diseases become fashionable– Seen as afflictions for privileged upper Seen as afflictions for privileged upper

classes and “refined temperaments”classes and “refined temperaments”– Hypochondria (male) & hysteria (female)Hypochondria (male) & hysteria (female)– Victorian women develop stereotype of Victorian women develop stereotype of

“depressive, hysterical, suicidal, and self-“depressive, hysterical, suicidal, and self-destructive behavior”destructive behavior”

InstitutionalizationInstitutionalization• Traditionally, insane cared for at home or in Traditionally, insane cared for at home or in

religious institutions such as Bedlamreligious institutions such as Bedlam

• Foucault: locking away of undesirables Foucault: locking away of undesirables during the rise of absolutism; method of during the rise of absolutism; method of control, not curecontrol, not cure– Led to dehumanization; positive aspects of Led to dehumanization; positive aspects of

mental illness forgottenmental illness forgotten

• Possibly oversimplified argumentPossibly oversimplified argument– Russia lack of institutions until 1850sRussia lack of institutions until 1850s– Few institutions in Portugal and rural EuropeFew institutions in Portugal and rural Europe

• Porter argues institutionalization was a Porter argues institutionalization was a function of social changes, not government function of social changes, not government

• Most institutions privateMost institutions private

• Medical oversight not required in England Medical oversight not required in England until after 1820suntil after 1820s

• Wide range of care; some helpful, others cruelWide range of care; some helpful, others cruel– Genre of patient literature exposed abuses and Genre of patient literature exposed abuses and

neglectneglect

• Around 1800, increased optimism and Around 1800, increased optimism and personal carepersonal care– Medicine, surgery, traditional methods Medicine, surgery, traditional methods

downplayed in favor of personal cure regimensdownplayed in favor of personal cure regimens

• Psychiatry develops as a method of therapy Psychiatry develops as a method of therapy for patientsfor patients

• Previous therapies relatively barbaric: Previous therapies relatively barbaric: physical restraints, purging, bloodlettingphysical restraints, purging, bloodletting

• FlorenceFlorence– Humanity of patients emphasizedHumanity of patients emphasized

• ParisParis– Revolutionary ideals led to Revolutionary ideals led to improved standard of treatmentimproved standard of treatment– Pinel: “treatment must penetrate Pinel: “treatment must penetrate to the psyche”to the psyche”– Mock trial of tailorMock trial of tailor

• Reforms, Certification of Asylums in Reforms, Certification of Asylums in England, France, USA attempted to raise England, France, USA attempted to raise quality of care quality of care – 1770s-1830s1770s-1830s

• 1919thth century: huge increase in number, scale century: huge increase in number, scale of asylums in Europeof asylums in Europe– England: 10,000 in 1800 to 100,000 in 1900England: 10,000 in 1800 to 100,000 in 1900– Italy: 8,000 in 1881 to 40,000 in 1907Italy: 8,000 in 1881 to 40,000 in 1907– Probably reactions to industrialization and Probably reactions to industrialization and

urbanizationurbanization

• Non-restrictive therapy in England (Hill, Non-restrictive therapy in England (Hill, Conolly 1830s)Conolly 1830s)

• ““Work therapy” in France and GermanyWork therapy” in France and Germany

• Importance of classification and separationImportance of classification and separation– Men from women, dangerous from safe, clean Men from women, dangerous from safe, clean

from dirty, etc.from dirty, etc.

• During last third of 19During last third of 19thth century, century, pessimism about lack of ability to pessimism about lack of ability to cure patients replaces early optimismcure patients replaces early optimism

– Asylums expanded dramaticallyAsylums expanded dramatically– Many patients remained in incurable Many patients remained in incurable

statesstates– Personal care and quality begins to Personal care and quality begins to

deterioratedeteriorate• ““formal drills, financial stringency, and drug formal drills, financial stringency, and drug

routines meant to pacify, sedate, and routines meant to pacify, sedate, and stupefy”stupefy”

– Underlying social and cultural factors Underlying social and cultural factors • Economics, government paternalism, Economics, government paternalism,

scientific secularismscientific secularism

• Madness as physical disorderMadness as physical disorder• Herman Boerhaave, Friedrich Hoffmann Herman Boerhaave, Friedrich Hoffmann

– End of humoral theory and focus on liquidEnd of humoral theory and focus on liquid– Solidist physiology: solid parts of body more Solidist physiology: solid parts of body more

important than liquidsimportant than liquids– Nervous system becomes site of inquiryNervous system becomes site of inquiry– Somatic approachSomatic approach

• John Locke (1632-1704)John Locke (1632-1704)– Madness a flaw in mechanism where senses are Madness a flaw in mechanism where senses are

turned into ideasturned into ideas– Very influential in Britain, FranceVery influential in Britain, France

• Benjamin Rush (1745-1813)Benjamin Rush (1745-1813)– ““father of American psychiatry”father of American psychiatry”– Mental disorders due to “vitiated blood”Mental disorders due to “vitiated blood”– Bloodletting as best cureBloodletting as best cure

• William Cullen (1710-1790)William Cullen (1710-1790)– Used Locke’s philosophical ideas, but returned Used Locke’s philosophical ideas, but returned

to medical emphasisto medical emphasis– Psychological aspect of disorderPsychological aspect of disorder– Irritation of the nerves/excess in brain activity Irritation of the nerves/excess in brain activity

precipitated madness; insanity as a nervous precipitated madness; insanity as a nervous disorderdisorder

– Biological basis: “mental disorder grounded in Biological basis: “mental disorder grounded in neurophysiology”neurophysiology”

• By 1780, somatic system (of Boerhaave, By 1780, somatic system (of Boerhaave, etc.) out of dateetc.) out of date– Led to concern about the patient’s psycheLed to concern about the patient’s psyche– Case-history approach led to “systematic Case-history approach led to “systematic

psychological observation”psychological observation”

• Vincenzo Chiarugi (Florence, 1759-1820)Vincenzo Chiarugi (Florence, 1759-1820)– Senses and nervous systems of the body affected the Senses and nervous systems of the body affected the

mindmind– Therapy of “moral control,” doctor setting positive Therapy of “moral control,” doctor setting positive

examples for patientsexamples for patients– Mental illness acquired, not hereditaryMental illness acquired, not hereditary– Optimistic about cureOptimistic about cure

• Philippe Pinel (Paris, 1745-1826)Philippe Pinel (Paris, 1745-1826)– Similar ideasSimilar ideas– Evidence did not show structural abnormalities in Evidence did not show structural abnormalities in

autopsies of mentally ill brains; therefore, most were autopsies of mentally ill brains; therefore, most were curable through therapycurable through therapy

– Also optimistic about effectiveness of moral therapyAlso optimistic about effectiveness of moral therapy

• Jean-Etienne Dominique Esquirol (1772-1840)Jean-Etienne Dominique Esquirol (1772-1840)– Mental MaladiesMental Maladies (1838) very influential (1838) very influential– Cited biological basis of mental disorders, but focused on Cited biological basis of mental disorders, but focused on

psychosocial triggerspsychosocial triggers– Supporter of asylums; Briefly housed the Marquis de SadeSupporter of asylums; Briefly housed the Marquis de Sade

• German PsychiatryGerman Psychiatry– Unlike Britain and France, university and Unlike Britain and France, university and

research-basedresearch-based– Contentious arguments between psychological Contentious arguments between psychological

and organic theoristsand organic theorists– More investigative than therapeutic; focused More investigative than therapeutic; focused

more on diseases than patientsmore on diseases than patients

• J.C.A. Heinroth (1773-1843)J.C.A. Heinroth (1773-1843)– Mental illness caused by sinMental illness caused by sin

• ““not from the body but from the soul itself”not from the body but from the soul itself”

– Insanity a voluntary rejection of divine gift of free Insanity a voluntary rejection of divine gift of free willwill

• Ernst von Feuchtersleben (Vienna, 1806-Ernst von Feuchtersleben (Vienna, 1806-1849)1849)

– Psychiatry based on personalityPsychiatry based on personality– ““psychopathy” as disease of entire personality; psychopathy” as disease of entire personality;

modern concept of psychosis modern concept of psychosis

• PhrenologyPhrenology– Viennese anatomists Gall and SpurheimViennese anatomists Gall and Spurheim– ““seat of the mind was the brain, whose configurations seat of the mind was the brain, whose configurations both determined and displayed the personality”both determined and displayed the personality”– Appearance of bumps on the head in specific areas Appearance of bumps on the head in specific areas could determine psychological characteristicscould determine psychological characteristics

• ““Medical Materialism” buttressed by theories such as Medical Materialism” buttressed by theories such as phrenologyphrenology– Helped make psychiatry exclusive to sanctionedHelped make psychiatry exclusive to sanctioned physician-researchersphysician-researchers– Maintained physical therapies such as bleeding, purging, Maintained physical therapies such as bleeding, purging,

sedativessedatives

• Wilhelm Griesinger (Berlin)Wilhelm Griesinger (Berlin)– 1845: “mental illnesses are brain diseases”1845: “mental illnesses are brain diseases”– Underlying abnormalities/brain irritation led to worsening Underlying abnormalities/brain irritation led to worsening

(irreversible) conditions; natural slope of mental illness was (irreversible) conditions; natural slope of mental illness was deteriorationdeterioration

– Somatic explanation spurred research and led to less Somatic explanation spurred research and led to less stigmatization of patientsstigmatization of patients

– Tried to unite psychiatry and neurology in clinics; wanted to keep Tried to unite psychiatry and neurology in clinics; wanted to keep psychiatry united with medicinepsychiatry united with medicine

• Carl Wernicke (1848-1905)Carl Wernicke (1848-1905)– ““German neuropsychiatry at its apogee”German neuropsychiatry at its apogee”– Interests in disorders of language and Interests in disorders of language and speech, particularly stroke damagespeech, particularly stroke damage

• Wernicke’s aphasiaWernicke’s aphasia

– Mapping of cerebral cortexMapping of cerebral cortex– Manual of Brain Diseases (1881-3) important Manual of Brain Diseases (1881-3) important

attempt to attribute symptoms in physical attempt to attribute symptoms in physical abnormalities of brainabnormalities of brain

– Concept of dominance of cerebrumConcept of dominance of cerebrum

• Neurasthenia (George Beard, 1839-1883)Neurasthenia (George Beard, 1839-1883)– Nervous breakdown because of pressure of Nervous breakdown because of pressure of

modern civilizationmodern civilization– ““nerve force” of individuals drainednerve force” of individuals drained– Struck elite, just as earlier diagnoses of Struck elite, just as earlier diagnoses of

hysteriahysteria– Stereotypically American diseaseStereotypically American disease

• German pessimismGerman pessimism– ““therapeutic nihilism born of experience bred a therapeutic nihilism born of experience bred a

new herediterianism”new herediterianism”– Asylums becoming crowded with (then Asylums becoming crowded with (then

untreatable) sufferers of tertiary syphilisuntreatable) sufferers of tertiary syphilis– Alcoholism provided quintessential modelAlcoholism provided quintessential model

• France picked up on pessimistic France picked up on pessimistic degenerative theoriesdegenerative theories– Defeat by Prussia 1870, subsequent bloody Defeat by Prussia 1870, subsequent bloody

Paris commune, bourgeois fears of social Paris commune, bourgeois fears of social unrest provoked uneasy public moodunrest provoked uneasy public mood

• Marking of “inferior” members of society Marking of “inferior” members of society promoted misogyny, racism, eugenicspromoted misogyny, racism, eugenics– Physical characteristics of people and racesPhysical characteristics of people and races– Sterilization and confinement of undesirablesSterilization and confinement of undesirables

• In US before Nazi GermanyIn US before Nazi Germany

• Psychiatry in LawPsychiatry in Law– BritainBritain

•After 1799 trial of James Hadfield, defendants After 1799 trial of James Hadfield, defendants could be not guilty by reason of insanitycould be not guilty by reason of insanity

•M’Naghten Rules established insanity defense M’Naghten Rules established insanity defense as inability to tell right from wrongas inability to tell right from wrong

– FranceFrance•““irresistible impulse” and temporary insanity irresistible impulse” and temporary insanity

((crime passionellecrime passionelle) enough to establish ) enough to establish innocenceinnocence

– Disputes between law and psychiatry led Disputes between law and psychiatry led to confusion, damaged opinion of to confusion, damaged opinion of psychiatrypsychiatry

• Patient complaintsPatient complaints– Much literature exists complaining that Much literature exists complaining that

the inmates of Bedlam were the sane the inmates of Bedlam were the sane ones; the doctors were crazy/cruelones; the doctors were crazy/cruel

– Expression in art, essay, poetryExpression in art, essay, poetry

– 1870s: attention to art produced by 1870s: attention to art produced by patients as way of diagnosispatients as way of diagnosis

– Art therapyArt therapy

– Avant-garde artists, by virtue of similarity Avant-garde artists, by virtue of similarity to patients’ work, called insaneto patients’ work, called insane•Surrealists, Expressionists, CubistsSurrealists, Expressionists, Cubists•CezanneCezanne

• Emil Kraeplin (1856-1926)Emil Kraeplin (1856-1926)– German, wanted to establish psychiatry as German, wanted to establish psychiatry as

scientific, respected fieldscientific, respected field– Dementia praecox: precursor of schizophreniaDementia praecox: precursor of schizophrenia– Loaded language such as “atrophy of the Loaded language such as “atrophy of the

emotions” suggested lack of humanityemotions” suggested lack of humanity

• Alois Alzheimer (1864-1915)Alois Alzheimer (1864-1915)– Senile dementiaSenile dementia– Geriatric researchGeriatric research

• Nazi psychiatryNazi psychiatry– Lives of mentally ill not worth itLives of mentally ill not worth it– January 1940- September 1942: 70,723 mental January 1940- September 1942: 70,723 mental

patients gassedpatients gassed– Taken from lists of leading psychiatrists and Taken from lists of leading psychiatrists and

psychologistspsychologists

• Freud (1856-1939)Freud (1856-1939)• Materialist approach, dismissive of religionMaterialist approach, dismissive of religion

– PsychoanalysisPsychoanalysis• Oedipus ComplexOedipus Complex• Unconscious mindUnconscious mind• Repression and neuroticismRepression and neuroticism• Sexuality (esp. in children)Sexuality (esp. in children)• Ego, superego, idEgo, superego, id• Free association and dream interpretationFree association and dream interpretation

• Carl Jung (1875-1961)Carl Jung (1875-1961)– Feud with FreudFeud with Freud– Collective unconsciousCollective unconscious

• Lamarckian theoryLamarckian theory– Fascination with archetypes and mythsFascination with archetypes and myths

• Alfred Adler (1870-1937)Alfred Adler (1870-1937)– Inferiority complexInferiority complex– Importance of social relationsImportance of social relations– Important in interwar treatment Important in interwar treatment

• US focus of psychoanalytic movementUS focus of psychoanalytic movement

• Melanie Klein and Anna FreudMelanie Klein and Anna Freud– Disputes in field over relationships Disputes in field over relationships between mothers and childrenbetween mothers and children

• By 1950’s, psychoanalysis imbedded By 1950’s, psychoanalysis imbedded in American practice and societyin American practice and society– Mental disorder not confined to bad Mental disorder not confined to bad

casescases– Ordinary people suffered from neuroses, Ordinary people suffered from neuroses,

complexes, etccomplexes, etc•Alcoholism, adjustment problems, family Alcoholism, adjustment problems, family

problems, juvenile delinquencyproblems, juvenile delinquency

• Discovery of bacteria led to cures of syphilis, Discovery of bacteria led to cures of syphilis, which caused mental illnesswhich caused mental illness

• 1920s: dubious trends1920s: dubious trends– Electric shock therapyElectric shock therapy– Barbiturates and prolonged-sleep Barbiturates and prolonged-sleep – Insulin coma (schizophrenia)Insulin coma (schizophrenia)

• 1930s: psychosurgery1930s: psychosurgery– Leucotomy: separation of frontal lobes and rest of Leucotomy: separation of frontal lobes and rest of

brainbrain– LobotomyLobotomy

• 18,000 by 195118,000 by 1951

– Often made patients submissive; some able to re-Often made patients submissive; some able to re-enter societyenter society

– Well-meaning doctors, but criticized as overly Well-meaning doctors, but criticized as overly aggressiveaggressive

– Methamphetamines came into useMethamphetamines came into use

• 1940s: penicillin!1940s: penicillin!– Led to rise of pharmacologyLed to rise of pharmacology– 1949: first psychotropic (mood-1949: first psychotropic (mood-influencing) drug introduced for influencing) drug introduced for bipolar disorderbipolar disorder

• 1950s1950s– Anti-psychotic and anti-depressant drugsAnti-psychotic and anti-depressant drugs– Many could leave asylums under medical Many could leave asylums under medical

regimens with new drugsregimens with new drugs

• Valium introduced 1960sValium introduced 1960s• Prozac 1987Prozac 1987

– Increased serotonin created “feel-good” Increased serotonin created “feel-good” sensationsensation

– Within 5 years, 8 million people triedWithin 5 years, 8 million people tried

• Karl MenningerKarl Menninger– ““Gone forever is the notion that the Gone forever is the notion that the

mentally ill person is an exception. It is mentally ill person is an exception. It is now accepted that most people have now accepted that most people have some degree of mental illness at some some degree of mental illness at some time.” (1956)time.” (1956)

• More attention on milder casesMore attention on milder cases

• Anti-psychiatry movement, Anti-psychiatry movement,

• 1960s and 1970s1960s and 1970s– Supported deinstitutionalizationSupported deinstitutionalization

Sources:Sources:

• Roy Porter. Roy Porter. Madness: A Brief HistoryMadness: A Brief History. . Oxford, Oxford University Press, 2002. Oxford, Oxford University Press, 2002.

• Pictures: Wikipedia.org, Pictures: Wikipedia.org, • http://images.google.com/imgres?imgurl=http://www.gjpsy.uni-goettingen.de/gjp-http://images.google.com/imgres?imgurl=http://www.gjpsy.uni-goettingen.de/gjp-

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