Unit Five: Clinical Research and Psychology

Introduction to Clinical Research and Psychology (Unit Five)

  • Overview of the unit focusing on clinical research and the state of mental illness knowledge during the late 19th and early 20th centuries.

Understanding Madness

  • Madness, also referred to as insanity or lunacy, embodies two categories of symptoms:

    • Gross Excessiveness: Refers to aggressive, violent behavior, and dramatic emotional outbursts.

    • Overwhelming Deficiency: Involves significant lack of will, desire, or emotion in an individual.

Historical Context on Mental Illness

  • Detailed descriptions of abnormal behavior began approximately 200 years ago.

  • Key Figures:

    • Philippe Pinel (France): Provided detailed accounts of withdrawn behaviors.

    • John Haslam (England): Also documented similar behaviors as Pinel.

  • Symptoms Documented:

    1. Diminished speech and lack of interest in joyful activities.

    2. Disorganized thinking.

    3. Neglect of personal hygiene.

    4. Reports of hallucinations and bizarre ideas.

  • Onset of these symptoms typically occurred in young adults without signs of improvement.

Terminology Evolution

  • Karl Kahlbaum (Germany): Named chronic conditions:

    • Hebophrenia: Set of symptoms related to adolescent behavior.

    • Catatonia: Defined as rigid and peculiar postures accompanied by profound lack of speech.

  • Descriptions of symptoms were gradually becoming more accurate but remained vague and imprecise.

  • Recurrent labels for patients included: lunatics, feeble-minded, the insane, distracted, etc.

  • Treatment Facilities: Asylums, mad houses, jails, almshouses, fools houses, etc.

  • Psychologists and Therapists: Various titles, including alienists, medical superintendents, neurologists, and psychiatrists.

Incidence of Mental Illness

  • Documented increase in mental illness cases towards the end of the 19th century across the US and Europe.

    • Reports indicated a rise in psychiatric clinic patients by 5 to 10 times between decades.

    • By 1910, Germany had:

    • 16 psychiatric clinics and universities.

    • About 1,500 psychiatrically trained physicians.

    • Over 400 private and public mental asylums.

Factors Contributing to Rising Incidence

  1. Increase in Neurosyphilis:

    • As an STD, many avoided treatment until psychological symptoms appeared.

  2. Increase in Substance Abuse:

    • Severe addiction cases often directed to mental facilities and prisons.

  3. Rising Social Stress:

    • Attributed to urbanization, factory growth, and diminished family support systems.

Turf Battles in Mental Health Treatment

  • Debate on Authority: Who should have the authority to treat mental illness?

    • Medical doctors (MDs) claimed rights to diagnose and treat, citing financial motives to limit competition.

  • Role of Psychologists:

    • Initially pushed out from clinical facilities but later given limited privileges for conducting tests and assessments.

  • Physicians often generated findings based on chance rather than scientific rigor, leading to criticism from psychologists.

Concepts of Mental Illness at the End of the 19th Century

  • General Assumptions Established:

    1. Causes of mental illness are natural or organic, identifying structural abnormalities in the nervous system.

    2. Importance of social and psychological factors contributing to mental illness.

  • Medical doctors aligned with the biomedical model, while psychologists favored the second assumption emphasizing psychological contributions.

Historical Biomedical Model

  • Background of the biomedical approach,

    • Theory of observable psychological symptoms stemming from physiological mechanisms dating back to the 1700s.

  • Key Publications:

    • William Batty (1758): Muscular spasms leading to behavioral alterations.

    • Vincenzo Gruggi (1793): Brain lesions causing abnormal psychological symptoms.

    • I. I. Enagolne (1815): Serious depressive symptoms linked to dysfunctional organ activity.

    • Thomas Laycock (1860): Functionality of brain levels from an evolutionary standpoint.

The Clinical Pathological Method

  • A pivotal methodology involving comparisons between patients’ symptoms and brain pathology data from autopsies.

  • Notable case study: Phineas Gage, whose personality changed drastically post-accident (prefrontal lobotomy).

Treatment Techniques in the Early 20th Century

  • Varied and often unregulated treatment methods:

    • Pierre Pomme (1763): Recommended chicken soup and cold baths for fatigue and emotional emptiness.

    • General practice allowed physicians freedom in treatment choice.

  • Common practice of body 'cleansing' through laxatives, cold baths, and bloodletting.

  • Emergence of interest areas for therapists:

    1. Patient geçmişi and personal habits for better treatment decisions.

    2. The interaction dynamics between patient and therapist.

    3. Individual capacities for self-understanding and improvement.

Rise of Hypnosis in Treatment

  • James Braid (1795-1860): Coined 'neurohypnology' or the study of nervous sleep; defined hypnosis as a state of sleep caused by eyelid muscle paralysis.

  • John Eliotson: Explained hypnosis as super-concentrated memories.

  • Jean Martin Charcot: Observed hypnotizable patients often exhibited hysteria symptoms.

New Approaches to Mental Illness

  • Elwood Worcester (1862-1940): Advocated for psychological and spiritual causes of mental illness, structured his treatment into:

    1. Clinical assessment.

    2. Spiritual advice (including hypnosis and relaxation).

  • Final treatment format consisted of:

    1. Free weekly medical examinations.

    2. Weekly classes discussing health topics.

    3. Private therapy sessions conducted by clergy.

Conclusion of Unit Five

  • Overview of the evolution of mental illness understanding and treatment, with critical debates concerning roles and methodologies in clinical psychology and psychiatry still possessing relevance today.