making sense of abnormality: a brief history of early models of mental disorders
1. Defining Abnormal Behavior
Abnormal behavior: Patterns of behavioral, psychological, or physical functioning that are not culturally expected and that lead to distress, disability, or impaired functioning.
Determinations are culturally and historically dependent — what is abnormal varies across time and place.
Developmental stage and maturity matter — behaviors typical for a child can be abnormal in an adult.
2. Historical Themes in Understanding Mental Disorders
A. Faraway Places, Ancient Times, and Supernatural Forces
Earliest interpretations (prehistoric through early civilizations):
Cause: Evil spirits, supernatural forces.
Victims sometimes seen as innocent; purpose was to expel invader.
Treatments:
Trephining: boring holes in the skull to release spirits.
Exorcisms: prayers, rituals, frightening or punishing the spirit.
Use of magic potions (animal excrement, blood, etc.).
Also some “biological” elements: diet, exercise, rest.
Cultural examples:
Biblical accounts: Saul relieved by David’s harp; Nebuchadnezzar punished with lycanthropy for hubris.
Chinese, Egyptian, Hebrew traditions — mixture of supernatural & proto-medical remedies.
B. Birth of the Medical Tradition: The Classical Period (600–500 B.C.E.)
Greek philosophy emphasized natural—not supernatural—causes:
Plato: Reason & recollection lead to truth.
Aristotle: Knowledge comes from observation — early empirical method.
Hippocrates (“Father of Medicine”):
Mental and physical disorders from natural, biological causes.
Theory of four humors: yellow bile, black bile, blood, phlegm.
Excess yellow bile → mania/anger.
Excess black bile → depression.
Treatments: diet, purging, rest, exercise.
Galen (Roman era):
Refined humoral theory, described “diseases of the soul.”
Brain controls mental processes; biological methods + counseling.
Chinese Taoism: balance of yin (cool, dark, feminine) and yang (warm, light, masculine); moderation and harmony.
“Talking cures”: healing through reasoned dialogue and guidance, e.g., Stoic Epictetus — "Men are disturbed not by things, but by their view of them."
Legacy: Shift to natural causes prepared ground for psychiatry.
C. From Demons to Instincts: The European Tradition
Early Middle Ages (~A.D. 500–1000)
Political chaos, feudalism.
Return to supernatural explanations in Western Europe — Devil/demons as cause.
Treatments: exorcisms, magical potions.
Islamic medicine (Avicenna): humane hospital care; preserved Greek/Roman ideas.
Late Middle Ages to Renaissance
Initial secular stirrings, but Church intensified witch hunts before waning influence.
Malleus Maleficarum (“Witches' Hammer”) guided persecution; ~75% accused witches female.
Renaissance (15th–16th Centuries):
Humanism, secular learning, printing press; science gains ground.
Descartes: Mind-body as machine; study animals to understand humans.
Johann Weyer: humane treatment, rejected witchcraft claims.
Growth of asylums (“Bedlam” in London) — often inhumane conditions.
D. The Enlightenment and Moral Treatment (17th–18th Centuries)
Enlightenment: science, reason, confidence in empirical discovery.
Reformers in late 1700s (Pinel, Tuke, Rush) began moral treatment movement:
Unchained patients, kind treatment, fresh air, purposeful work.
Aim: restore dignity, teach self-control, social skills.
Dorothea Dix & mental hygiene movement:
Advocated creation of large state hospitals — but overcrowding → custodial care.
Biological model resurgence late 1800s:
Discovery: general paresis caused by syphilitic infection — biological cause confirmed.
Sparked search for other organic causes.
E. Classification Advances (Late 19th Century)
Large public institutions allowed comparison and grouping of symptoms.
Emil Kraepelin: developed systematic classification — basis for later DSM.
Eugen Bleuler: refined categories (e.g., named schizophrenia).
F. The Psychoanalytic Revolution (Late 19th – Early 20th Century)
Hypnosis (Mesmer, Charcot, Bernheim, Janet) for hysteria — suggested psychological causes possible.
Freud and Breuer:
Unconscious conflicts → abnormal behavior.
Developed psychoanalysis — talk therapy addressing unconscious.
Emergence of clinical psychology as profession in US (first clinic in 1896).
Psychologists began developing theories beyond Freud’s (behavioral, cognitive, etc.).
3. Contemporary Models of Abnormality
Today, major models include:
Biological
Psychological
Sociocultural
Diathesis-stress (interaction of vulnerability + stress)
Supernatural model largely replaced in Western contexts but persists in some cultures.
4. MAPS Connections in This History
M (Medical Model Myths): From Hippocrates to modern psychiatry, tendency to assume all disorders have internal biological causes; risk of ignoring context.
A (Attempted Answers): Some historical “symptoms” may reflect coping (e.g., spiritual visions as meaning-making).
P (Prejudicial Pigeonholes): Witch hunts and institutional stigma show destructive labeling; asylums as social control.
S (Superficial Syndromes): Early classification based on observable symptom patterns (humors, hysteria), not underlying mechanisms.
Quick Study Summary
Ancient supernatural model: Evil spirits, gods, demons; treatments like trephining, exorcism.
Classical period: Greek/Roman medicine emphasized natural causes (humoral theory); mind-body connection.
Middle Ages: Return to supernaturalism; witch hunts; Islamic medicine offered humane alternatives.
Renaissance: Rise of humanism, secular knowledge; early psychiatry; but asylums often inhumane.
Enlightenment & Moral Treatment: Science + kindness reforms; limited by overcrowding, biological shift.
Late 1800s: Classification systems developed (Kraepelin); biological discoveries (e.g., syphilis link).
Psychoanalysis: Freud’s unconscious conflict theory revolutionized psychological treatment.
Modern: Multiple models (biological, psychological, sociocultural, diathesis-stress) coexist and compete.