A+Brief+History+of+Psychopathology

Early human explanations of psychopathology were anything but scientific. Previous to the era of scientific study, events not attributable to human action were considered within the realm of the supernatural. Distraught psychological states were no exception. What we know today to be the result of faulty processes within the brain, were for many years considered to be the work of angry gods or possessing demons. Demonology, the concept that an evil spirit can influence the behavior and health of individuals, existed as a belief in a diverse group of ancient cultures including: the Hebrews, Greeks, Babylonians, Egyptians, and early Chinese. Treatment for such a condition involved exorcism, a ritualistic casting out of demons, and took the form of complex prayer rituals, the drinking of primitive concoctions, or even fasting and flagellation (Kring et al., 2010).

Treatment of mental illness via exorcism dates back to the very dawn of civilization. In ancient Mesopotamia, both physical and mental ailments were considered the work of demonic possession. As described in ancient Assyrian texts, Babylonian priests would destroy an effigy of the afflicting demon while reciting a series of complex prayers in order to alleviate the patient from their possession. Hindu scriptures also contain accounts of evil spirits inflicting damage upon humans and historical evidence suggests that the Persian religious leader, Zoroaster, conducted exorcisms. In addition, Homer, Socrates, and Plato all referenced the existence of demons and Dionysian cults would actually induce voluntary possession during hedonistic wine and sex rituals. Perhaps the most famous exorcist of all time was Jesus Christ, with twenty-six allusions to exorcism appearing in the New Testament (Bancroft, 1998). The most recognizable form of exorcism in Western culture exists to this day in the form of the Roman Ritual of the Catholic Church.

One would expect that this approach to psychopathology would be relegated to the annals of history, but even in more recent times such superstitions still persist. Psychologist Dr. Edith Fiore (1987) published The Unquiet Dead, examining the effects of spiritual attachment on mental health. Fiore contends that out of an examination of 30,000 cases, 70% of patients exhibit signs of spiritual attachment (Bancroft, 1998). While the scientific basis for such a conclusion is highly debatable, the fact that a scientist in the post-modern era would even consider such a position seems to evidence the pervasiveness of this cultural superstition.

Antiquity, however, presented more than just supernatural explanations for psychopathology. While supernatural explanations dominate history, early rational approaches would lay the groundwork for modern study. By the fifth century B.C., Greek physician Hippocrates began explaining mental and physical illness through the apparatus of the human body, rather than the supernatural. Hippocrates refuted the prevailing notion of his time that psychological disturbances were sent by the gods as punishment. Instead, he espoused that mental illness was the result of a faulty physical process and could be treated the same as the common cold. Hippocrates was among the first to regard the brain as the organ relative to behavior and consciousness, and as a result hypothesized that disturbed mental states were the result of brain abnormalities. Hippocrates divided psychological disorders into three main categories: mania, melancholia, and phrenitis. These disorders were thought to be associated with an imbalance of bodily fluids. An excess of phlegm, for example, was thought to correlate to a lack of energy. Too much black bile was associated with symptoms of melancholia and too much yellow bile was related to irritability. A person with a rapidly changing temperament was thought to have an excess of blood. Although these theories proved to be untrue, the work of Hippocrates began to make the task of treating those with mental disorders that of physicians, rather than priests. His keen observations on behavior made natural solutions more viable than their supernatural counterparts and in place of exorcism his patients were often prescribed rest, sobriety, and a careful diet (Kring et al., 2010).

The works of Hippocrates greatly influenced another key Greek physician, Claudius Galen. The death of Galen in the late second century A.D. is considered the end of the classical era in medical study, as Galen is regarded as the last great physician before the setbacks of the Dark Ages (Kring et al., 2010). Through dissection, Galen was among the first to study parts of the brain, the spinal cord, and spinal nerves. He demonstrated that through tying off laryngeal nerves the ability to speak is diminished. In addition, he was able to identify the role that specific nerves play in specific body locomotion by severing nerves and noting the varying levels of paralysis. Galen was among the first to utilize scientific experimentation, rather than speculation, to explain nervous system functions. Like Hippocrates, Galen believed that an imbalance in the four fluids could cause psychopathology, but where Hippocrates believed that the imbalance was uniform throughout the whole body, Galen believed it to be organ-specific. Galen developed many drugs from the herbs that he encountered in his travels, and is believed to be one of the first to attempt to treat mental disorders using medication (Galen of Pergamum, n.d.).

As previously mentioned, understanding and treatment of psychopathology would greatly regress following the close of the classical era. As the Roman and Greek cultures declined, and the Church grew in influence, a return to supernatural explanation took place. The role of the physician became the duties of the monks, as it related to mental illness. In place of physical remedies, those suffering from mental disorders were prayed over and touched with relics. In addition, monks would create potions for patients to drink during the varying phases of the moon. As a result of this regression in human understanding of psychopathology, individuals with psychiatric disorders would frequently roam the countryside homeless, impoverished and worsening in condition (Kring et al., 2010).media type="youtube" key="a3WmH2Hs4aw?version=3" height="349" width="425" align="right"

Although tame by European standards, early American history includes a famous witch hunt of its own in Salem, Massachusetts. In early 1692, eight young girls developed a series of bizarre symptoms including disordered speech and convulsions. These girls began accusing the townspeople of witchcraft as a means to explain their strange disorders and as a result one hundred and fifty people were convicted of witchcraft. Of that number, twenty of them were put to death. Today it seems rather unlikely that what these girls were experiencing was the result of some supernatural process and historians speculate that, if not a psychological disorder, accidental drug use may have been at play. During this time, rye grain was often stored in damp barns and it is postulated that this could have resulted in the growth of ergot, a fungus used in the synthesis of LSD. Younger people would have consumed more of the ergot as proportional to their body weight and this would explain some of the hallucinatory behavior reported during this time (Levinthal, 2010). At any rate, rational explanations such as a social outbreak of psychopathologies, or of accidental drug poisoning, dominate the historical perspectives on this event and purport physical causes rather than supernatural ones.

Towards the latter portion of the Middle Ages, physical causes of mental disorders began to become the prevalent ideology once again. As local governments asserted more authority over their immediate jurisdiction, rather than deferring to the local church office, hospitals began opening to house the mentally ill. That the Renaissance ushered in a new appreciation for classical studies also contributed to an influx of previously abandoned medical knowledge. This change in paradigm concerning the mentally ill once again shifted the care of those suffering from psychopathologies from the cleric back to the clinician. By the fifteenth century, leprosy was no longer an epidemic in Europe and the leprosarium that used to house lepers became asylums for the mentally ill (Kring et al., 2010).

In the second half of the Middle Ages, insane asylums were created for the same purpose as today: to sequester those who are ill of mind and who may be of harm to themselves or others from the rest of the population. However, unlike today, the facilities, treatment, and care are significantly different than those of today. The asylums were more in league with prisons than mental health institutions in the sense that they were abhorrently filthy and the inmates were chained up. Then in 1792, the chains were removed from the inmates, and much to the amazement of the skeptics of the time, the unchaining of these “animals” was a success (Gray, 2007). It was found in this experiment that a clean, sun-lit room facilitated recovery in the mentally ill and many people who were considered hopeless were able to leave the asylums as rehabilitated members of society.

Some of the treatments in the asylums were as inhumane as the conditions in which inmates were kept and were more akin to torture than a remedy. One such “treatment” involved a rotating device upon which the patient would lie and be rotated around at high speeds. In another treatment, the patient was flung around in the air in a harness to “calm the nerves”. And perhaps the most painful was a procedure where the patient’s head was branded with a red-hot iron. This was supposed to bring him to his senses (Gray, 2007). It also did not help that the general public did not understand mental illness and its causes and the patients of asylums were immensely feared.

The 1900s brought around the practice of Psychosurgery, or Lobotomy. The word “primitive” does not even begin to do justice to the extent to which the procedure was unsafe and unproven to be effective. Blades used to cut into the brain would often break and remove blood vessels and brain tissue upon their removal. The technique required two people, one to control the blade, while the other crouched in front of the patient, like a baseball catcher, using his knowledge of the internal map of the brain to give instructions such as “up a bit”, “down a fraction”, or “straight ahead” (History of Psychopathology, n.d.). Despite its uncouth methods, lobotomy seemed to work. Patients, who exhibited symptoms such as anxiety, depression, and paranoia, after lobotomy, exuded a sense of calm and tranquility. However, virtually no follow up was conducted to determine the success of such procedures, perhaps in fear that in the future, patients would again become unstable and lobotomy would be discredited as a treatment for psychopathology. Unfortunately, after the First World War when soldiers were returning home with shell shock and were swelling the asylum population. Because of this influx, lobotomy began to make fiscal sense. A mere lobotomy could be performed for only $250 while it could cost $35,000 or more a year to maintain a patient in a mental health facility (History of Psychopathology, n.d.).

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With such an abundance of mental disorders, there was always a need to classify them, but there was no clear solution as to which were to be included and how to organize such a list. Military psychiatrists treating soldiers during World War I linked their disorders to traumatic experience. The many different classification systems that were developed over the past two millenniums have differed in their relative emphasis on phenomenology, etiology, and course as defining features (American Psychiatric Association, n.d.). We now have the Diagnostic and Statistical Manual of Mental Disorders (DSM) with four versions, each newer and more relevant than the last. The DSM-III edition brought sweeping changes. The environmental view was replaced with the biomedical model and was influenced more by researchers than by clinicians (Wiig, 2006). The DSM is an impressive compendium of mental disorders and with the much-anticipated DSM-IV, our understanding of the mentally ill and how they came to be, by even the general public, continues to grow. Gone are the days of hot iron branding and the primeval practice of lobotomy, as the DSM and introduction of medication have forever changed the way the world looks and treats the mentally ill.