HISTORY OF CLINICAL (1)

Early Clinical Psychology

• Clinical psychology is a relatively new field in psychology.

• Historically, there was a conflict between:

  • The medical model: Views mental health issues as having natural causes.

    • Example: Emil Kraepelin's classification.

  • The psychological model: Focuses on psychological approaches to understanding mental illness.

Emil Kraepelin

• Studied with Wundt but aimed to classify mental illnesses based on their causes, symptoms, and treatments (1883).

• Major classifications included:

  • Mania

  • Depression

  • Dementia praecox

  • Manic depression

  • Neurosis (mild disorders)

• Most disorders were considered incurable and linked to biological factors.

Psychological Model

Lightner Witmer

• Founded the first psychological clinic in 1897.

  • Developed the first clinical journal "The Psychological Clinic" in 1907.

• Advocated for clinicians being trained as scientists, applying psychological science to treat mental illnesses.

Freud's Influence

• The psychological model gained acceptance due to Freud, who adopted a non-medical approach to mental health issues.

• WWII increased demand for mental health services, highlighting the shortage of psychiatrists.

History of Clinical Psychology

• Treating and counseling patients is a relatively recent profession.

• Historically, mental illness was considered part of the domain of medicine.

• No doctoral programs in clinical psychology existed before WWII.

Early History of Mental Illness

• Main issue: No visible signs of physical injuries or illnesses causing strange behavior.

• Historical treatments included:

  • Trephination (cutting holes in the skull) as a way to release evil spirits.

  • Supernatural cures in primitive cultures.

  • Ceremonies by Greeks to appease gods to avoid mental illness.

Shift to Physical Causes

• Greeks and Romans sought physical explanations for mental illness.

• The fall of the Greek and Roman civilizations led to a resurgence of mythological explanations.

  • Exorcisms became common again.

The Middle Ages and Mental Illness

• The dominant Christian church debated the struggle between God and the devil for souls.

• Proposed cause for mental illness: voluntary possession by the devil due to unseen origins of illness.

Treatment of the Mentally Ill

• This narrative solved public fears regarding mental illness.

• Two societal fears led to harsher realities for the mentally ill:

  1. Strange behaviors frightened onlookers.

  2. Fear of developing similar bizarre behaviors.

• Resulted in executions to prevent harm to others.

Treatment in the 18th and 19th Century

• Mental illness treatment remained ineffective; focus was on institutionalization rather than therapy.

• Institutions often profited from public interest by allowing tours to observe patients.

• Common treatments included:

  • Starvation

  • Water cures

  • Whirling

  • Bloodletting (most prevalent).

Return to Natural Causes of Mental Illness

Philippe Pinel

• In Paris during the 1790s, he began changing treatment in major asylums.

• Advocated for humane treatment and basic medical philosophies.

• Noted the importance of understanding mental illness beyond just biological causes.

Philosophy of Pinel

1. Do no harm (ending harmful practices like bloodletting).

2. Use minimal restraint necessary (ensure safety without excessive control).

3. Provide humane conditions for patients.

4. Eliminate physical abuse.

5. Treat patients as sick individuals rather than criminals.

6. Important for psychology: Recognized that not all illnesses had biological roots.

Pinel's Influence

• He operated during a chaotic period (French Revolution), allowing him to implement changes.

• His success led to lasting changes even after stability returned post-revolution.

Treatment Developments in Britain and the U.S.

• Figures like Tukes established small, private institutions in Britain.

• Dorthea Dix led significant reforms in U.S. institutions, yet large institutions often prioritized public safety over patient treatment.

• Key changes in treatment arose from the introduction of psychoactive drugs.

Foundations of Psychoanalysis

Franz Mesmer

• Introduced mesmerism (passively inducing trance-like states) claiming healing energy transfer.

• Was deemed useless by a Royal Commission in 1784 and was banned from Paris.

Mesmerism and Hypnosis

• Proponents in Britain demonstrated surgical procedures performed on mesmerized individuals.

• James Braid coined the term "hypnotism" in 1843.

Hypnosis in Paris

• Jean Charcot established a hypnosis clinic, influencing Freud's education on the subject.

• Under hypnosis, non-hysterical patients were shown to exhibit hysteria symptoms.

Sigmund Freud

• Graduated from medical school in 1881; nearly faced career ruin in 1885 due to cocaine advocacy.

• Despite his controversies, he struggled with nicotine addiction.

Freud and Joseph Breuer

• Treated a woman named Anna O for hysteria, reportedly curing her through hypnosis and reliving her experiences (cathartic method).

• Anna O was actually Bertha Pappenheim, who later became active in social work.

Bertha Pappenheim

• Breuer ceased treatment due to jealousy from his wife.

• Institutionalized in 1882; dependency on morphine developed while suffering from hysteria, only released late in the 1880s.

• Shifted to feminist causes and had a different narrative than Breuer and Freud's description.

Freud's Psychoanalytic Theory

• Shift from hypnosis to free association, allowing patients to freely express thoughts.

• Patients (predominantly women) discussed experiences of sexual seductions by fathers.

Seduction Theory

• Initially posited neuroses were linked to sexual abuse by fathers.

• Strayed from this as Freud doubted the prevalence of such abuse, leading to revisions.

Freud's Two Conclusions

1. Infantile sexuality is real.

2. The unconscious cannot differentiate between reality and emotional experiences.

• Treatment aimed at helping patients discern between psychic reality and actual events.

"Interpretation of Dreams"

• Proposed dreams as pathways to the unconscious mind.

• This work's success elevated Freud's prominence, influencing his theories on development and sexual energy.

Decline of Freudian Theory

• Freud's authoritative style alienated dissenters like Adler and Jung.

• Their departures centered on differing views of human nature and development.

Psychoanalysis Split

• Controversies revolved around whether biological drives could solely explain behaviors and development.

• Dissenters criticized Freud's hierarchical view of id and ego.

Anna Freud

• Freud's most loyal follower, extending psychoanalysis to children and establishing play therapy.

Adler and Jung

• Both deviated from Freud's teachings; popular yet viewed with skepticism by Freud.

• Adler promoted a more optimistic human outlook, whereas Jung's lack of scientific rigor minimized his impact in psychology.

Freud's Legacy

• Despite criticisms, Freud's theories fostered discussion and inspired new psychological developments.

• He was a significant figure in psychiatry from 1910 to 1930, but the rise of the Nazis and his personality curtailed his influence.