1.3 How Was Abnormality Viewed and Treated in the Past?

In any given year, as many as 30 percent of the adults and 19 percent of the children and adolescents in the United States display serious psychological disturbances and are in need of clinical treatment (Merikangas et al., 2013; Kessler et al., 2012, 2009, 2007, 2005). The rates in other countries are similarly high. Furthermore, most people have difficulty coping at various times and go through periods of extreme tension, dejection, or other forms of psychological discomfort.

It is tempting to conclude that something about the modern world is responsible for these many emotional problems—perhaps rapid technological change, the growing threat of terrorism, or a decline in religious, family, or other support systems (Gelkopf et al., 2013; North, 2010) (see PsychWatch below). Although the pressures of modern life probably do contribute to psychological dysfunctioning, they are hardly its primary cause (Wang et al., 2010). Every society, past and present, has witnessed psychological abnormality. Perhaps, then, the proper place to begin our examination of abnormal behavior and treatment is in the past.

Ancient Views and Treatments

Expelling evil spirits The two holes in this skull recovered from ancient times indicate that the person underwent trephination, possibly for the purpose of releasing evil spirits and curing mental dysfunctioning.

Historians who have examined the unearthed bones, artwork, and other remnants of ancient societies have concluded that these societies probably regarded abnormal behavior as the work of evil spirits. People in prehistoric societies apparently believed that all events around and within them resulted from the actions of magical, sometimes sinister, beings who controlled the world. In particular, they viewed the human body and mind as a battleground between external forces of good and evil. Abnormal behavior was typically interpreted as a victory by evil spirits, and the cure for such behavior was to force the demons from a victim’s body.

This supernatural view of abnormality may have begun as far back as the Stone Age, a half-million years ago. Some skulls from that period recovered in Europe and South America show evidence of an operation called trephination, in which a stone instrument, or trephine, was used to cut away a circular section of the skull (Heeramun-Aubeeluck & Lu, 2013). Some historians have concluded that this early operation was performed as a treatment for severe abnormal behavior—either hallucinations, in which people saw or heard things not actually present, or melancholia, characterized by extreme sadness and immobility. The purpose of opening the skull was to release the evil spirits that were supposedly causing the problem (Selling, 1940).

trephination An ancient operation in which a stone instrument was used to cut away a circular section of the skull, perhaps to treat abnormal behavior.

In recent decades, some historians have questioned whether Stone Age people actually believed that evil spirits caused abnormal behavior. Trephination may instead have been used to remove bone splinters or blood clots caused by stone weapons during tribal warfare (Maher & Maher, 2003, 1985). Either way, later societies clearly did attribute abnormal behavior to possession by demons. Egyptian, Chinese, and Hebrew writings all account for psychological deviance this way. The Bible, for example, describes how an evil spirit from the Lord affected King Saul and how David feigned madness to convince his enemies that he was visited by divine forces.

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PsychWatch

Modern Pressures, Modern Problems

The twenty-first century, like each of the centuries before it, has spawned new fears and concerns that are tied to its unique community threats, environmental dangers, and technological changes. These new fears have received relatively little study. They may or may not reflect abnormal functioning. Nevertheless, they have caught the attention of the media and clinical observers. Such fears include terrorism terror, crime phobia, and cyber fear.

Terrorism Terror

Global terrorism has become a major source of anxiety in contemporary society, particularly since the September 11, 2001, attacks on the World Trade Center in New York City and the Pentagon in Washington, DC. Moreover, everyday hassles of the past have been turned into potential threats by their association with the actions of terrorists (Aly & Green, 2010; Furedi, 2007). Few people in Kenya, for example, are now able to view shopping as a simple pleasure or minor hassle, given the 2013 militant terrorist attack on the Westgate shopping center in Nairobi, in which at least 67 shoppers were killed.

The horror of terrorism Fearful shoppers at the Westgate shopping center in Kenya scramble for safety as armed police hunt the terrorist gunmen who went on a shooting spree and took hostages at the mall on September 21, 2013.
©Goran Tomasevic/Reuters/Corbis

Crime Phobia

People today are increasingly anxious about crime (Wallace, 2012; Morrall et al., 2010; Scarborough et al., 2010). Some observers note that the fear of crime—predominantly armed violence—has restructured how individuals live. Political scientist Jonathan Simon says, “[F]ear of crime can have a more powerful effect on people and neighborhoods than crime itself. Fear of crime governs us in our choices of where to live, where to work, where to send our children to school. And these choices are made with increasing reference to crime” (quoted in Bergquist, 2002). Many theorists point to disproportionate media coverage of violent crimes as a major cause of crime phobia, particularly given that crime anxiety seems to keep rising even while actual crime rates are falling (Bean, 2011; Stearns, 2006).

Cyber Fear

Many people live in fear of computer crashes, server overloads, or computer viruses (FBI, 2010). And some, stricken by a combination of crime phobia and cyber fear, worry constantly about e-crimes, such as computer hoaxes or scams, theft of personal information by computer, computer-identity theft, and cyberterrorism (Minei & Matusitz, 2012; Whittle, 2010). Several treatment programs have been developed to help people deal with such anxieties and return to carefree keyboarding (Wurman et al., 2000).

What demonological explanations or treatments, besides exorcism, are still around today, and why do they persist?

The treatment for abnormality in these early societies was often exorcism. The idea was to coax the evil spirits to leave or to make the person’s body an uncomfortable place in which to live. A shaman, or priest, might recite prayers, plead with the evil spirits, insult the spirits, perform magic, make loud noises, or have the person drink bitter potions. If these techniques failed, the shaman performed a more extreme form of exorcism, such as whipping or starving the person.

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Greek and Roman Views and Treatments

Humors in action Hippocrates believed that imbalances of the four humors affected personality. In these depictions of two of the humors, yellow bile (left) drives a husband to beat his wife, and black bile (right) leaves a man melancholic and sends him to bed.

In the years from roughly 500 b.c. to 500 a.d., when the Greek and Roman civilizations thrived, philosophers and physicians often offered different explanations and treatments for abnormal behaviors. Hippocrates (460–377 b.c.), often called the father of modern medicine, taught that illnesses had natural causes. He saw abnormal behavior as a disease arising from internal physical problems. Specifically, he believed that some form of brain pathology was the culprit and that it resulted—like all other forms of disease, in his view—from an imbalance of four fluids, or humors, that flowed through the body: yellow bile, black bile, blood, and phlegm (Wolters, 2013; Zuckerman, 2011). An excess of yellow bile, for example, caused mania, a state of frenzied activity; an excess of black bile was the source of melancholia, a condition marked by unshakable sadness.

humors According to the Greeks and Romans, bodily chemicals that influence mental and physical functioning.

To treat psychological dysfunctioning, Hippocrates sought to correct the underlying physical pathology. He believed, for instance, that the excess of black bile underlying melancholia could be reduced by a quiet life; a diet of vegetables; temperance; exercise; celibacy; and even bleeding. Hippocrates’ focus on internal causes for abnormal behavior was shared by the great Greek philosophers Plato (427–347 b.c.) and Aristotle (384–322 b.c.) and by influential Greek and Roman physicians.

Europe in the Middle Ages: Demonology Returns

Bewitched or bewildered? A great fear of witchcraft swept Europe beginning in the 1300s and extending through the “enlightened” Renaissance. Tens of thousands of people, mostly women, were thought to have made a pact with the devil. Some appear to have had mental disorders, which caused them to act strangely (Zilboorg & Henry, 1941). This woman is being “dunked” repeatedly until she confesses to witchery.

The enlightened views of Greek and Roman physicians and scholars were not enough to shake ordinary people’s belief in demons. And with the decline of Rome, demonological views and practices became popular once again. A growing distrust of science spread throughout Europe.

From 500 to 1350 a.d., the period known as the Middle Ages, the power of the clergy increased greatly throughout Europe. In those days the church rejected scientific forms of investigation, and it controlled all education. Religious beliefs, which were highly superstitious and demonological, came to dominate all aspects of life. Once again behavior was usually interpreted as a conflict between good and evil, God and the devil. Deviant behavior, particularly psychological dysfunctioning, was seen as evidence of Satan’s influence. Although some scientists and physicians still insisted on medical explanations and treatments, their views carried little weight in this atmosphere.

The Middle Ages were a time of great stress and anxiety—of war, urban uprisings, and plagues. People blamed the devil for these troubles and feared being possessed by him (Sluhovsky, 2011). Abnormal behavior apparently increased greatly during this period. In addition, there were outbreaks of mass madness, in which large numbers of people apparently shared delusions (absurd false beliefs) and hallucinations (imagined sights or sounds). In one such disorder, tarantism (also known as Saint Vitus’ dance), groups of people would suddenly start to jump, dance, and go into convulsions (Prochwicz & Sobczyk, 2011; Sigerist, 1943). Some dressed oddly; others tore off their clothing. All were convinced that they had been bitten and possessed by a wolf spider, now called a tarantula, and they sought to cure their disorder by performing a dance called a tarantella. In another form of mass madness, lycanthropy, people thought they were possessed by wolves or other animals. They acted wolflike and imagined that fur was growing all over their bodies.

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How might Twitter, text messaging, Instagram, Facebook, the Internet, or other technologies facilitate current forms of mass madness?

Not surprisingly, some of the earlier demonological treatments for psychological abnormality reemerged during the Middle Ages. Once again the key to the cure was to rid the person’s body of the devil that possessed it. Exorcisms were revived, and clergymen, who generally were in charge of treatment during this period, would plead, chant, or pray to the devil or evil spirit (Sluhovsky, 2011, 2007). If these techniques did not work, they had others to try, some amounting to torture.

It was not until the Middle Ages drew to a close that demonology and its methods began to lose favor. Towns throughout Europe grew into cities, and government officials gained more power and took over nonreligious activities. Among their other responsibilities, they began to run hospitals and direct the care of people suffering from mental disorders. Medical views of abnormality gained favor once again, and many people with psychological disturbances received treatment in medical hospitals, such as the Trinity Hospital in England (Allderidge, 1979).

The Renaissance and the Rise of Asylums

The “crib” Outrageous devices and techniques, such as the “crib,” were used in asylums, and some continued to be used even during the reforms of the nineteenth century.

During the early part of the Renaissance, a period of flourishing cultural and scientific activity from about 1400 to 1700, demonological views of abnormality continued to decline. German physician Johann Weyer (1515–1588), the first physician to specialize in mental illness, believed that the mind was as susceptible to sickness as the body was. He is now considered the founder of the modern study of psychopathology.

Bedlam In this eighteenth-century work from The Rake’s Progress, William Hogarth depicted London’s Bethlehem Hospital, or Bedlam, as a chaotic asylum where people of fashion came to marvel at the strange behavior of the inmates.

The care of people with mental disorders continued to improve in this atmosphere. In England, such individuals might be kept at home while their families were aided financially by the local parish. Across Europe, religious shrines were devoted to the humane and loving treatment of people with mental disorders. Perhaps the best known of these shrines was at Gheel in Belgium. Beginning in the fifteenth century, people came to Gheel from all over the world for psychic healing. Local residents welcomed these pilgrims into their homes, and many stayed on to form the world’s first “colony” of mental patients. Gheel was the forerunner of today’s community mental health programs, and it continues to demonstrate that people with psychological disorders can respond to loving care and respectful treatment (Guarnieri, 2009; Aring, 1975, 1974). Many patients still live in foster homes there, interacting with other residents, until they recover.

BETWEEN THE LINES

Literature and Abnormal Psychology

Writing during the Renaissance, Shakespeare speculated on the nature and causes of abnormal behavior in 20 of his 38 plays and in many of his sonnets.

(Morris, 2012; Dalby, 1997)

Unfortunately, these improvements in care began to fade by the midsixteenth century. Government officials discovered that private homes and community residences could house only a small percentage of those with severe mental disorders and that medical hospitals were too few and too small. More and more, they converted hospitals and monasteries into asylums, institutions whose primary purpose was to care for people with mental illness. These institutions were begun with the intention that they would provide good care (Kazano, 2012). Once the asylums started to overflow, however, they became virtual prisons where patients were held in filthy conditions and treated with unspeakable cruelty.

asylum A type of institution that first became popular in the sixteenth century to provide care for persons with mental disorders. Most became virtual prisons.

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In 1547, for example, Bethlehem Hospital was given to the city of London by Henry VIII for the sole purpose of confining the mentally ill. In this asylum, patients bound in chains cried out for all to hear. The hospital even became a popular tourist attraction; people were eager to pay to look at the howling and gibbering inmates. The hospital’s name, pronounced “Bedlam” by the local people, has come to mean a chaotic uproar (Selling, 1940). Such asylums remained a widely used form of “care” until the late 1700s.

The Nineteenth Century: Reform and Moral Treatment

As 1800 approached, the treatment of people with mental disorders began to improve once again (Schuster et al., 2011; Maher & Maher, 2003). Historians usually point to La Bicêtre, an asylum in Paris for male patients, as the first site of asylum reform. In 1793, during the French Revolution, Philippe Pinel (1745–1826) was named the chief physician there. He argued that the patients were sick people whose illnesses should be treated with sympathy and kindness rather than chains and beatings (Yakushev & Sidorov, 2013). He unchained the patients and allowed them to move freely about the hospital grounds; replaced the dark dungeons with sunny, well-ventilated rooms; and offered support and advice. Pinel’s approach proved remarkably successful. Many patients who had been shut away for decades improved greatly over a short period of time and were released. Pinel later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière.

Meanwhile, an English Quaker named William Tuke (1732–1819) was bringing similar reforms to northern England. In 1796 he founded the York Retreat, a rural estate where about 30 mental patients lived as guests in quiet country houses and were treated with a combination of rest, talk, prayer, and manual work (Raad & Makari, 2010).

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The Spread of Moral TreatmentThe methods of Pinel and Tuke, called moral treatment because they emphasized moral guidance and humane and respectful techniques, caught on throughout Europe and the United States. Patients with psychological problems were increasingly perceived as potentially productive human beings whose mental functioning had broken down under stress. They were considered deserving of individual care, including discussions of their problems, useful activities, work, companionship, and quiet.

moral treatment A nineteenth-century approach to treating people with mental dysfunction that emphasized moral guidance and humane and respectful treatment.

Dance in a madhouse A popular feature of moral treatment was the “lunatic ball.” Hospital officials would bring patients together to dance and enjoy themselves. One such ball is shown in this painting, Dance in a Madhouse, by George Bellows.

The person most responsible for the early spread of moral treatment in the United States was Benjamin Rush (1745-1813), an eminent physician at Pennsylvania Hospital who is now considered the father of American psychiatry. Limiting his practice to mental illness, Rush developed humane approaches to treatment (Grossman, 2013; Rush, 2010). For example, he required that the hospital hire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them on regular walks. He also suggested that it would be therapeutic for doctors to give small gifts to their patients now and then.

Rush’s work was influential, but it was a Boston schoolteacher named Dorothea Dix (1802–1887) who made humane care a public and political concern in the United States. From 1841 to 1881, Dix went from state legislature to state legislature and to Congress speaking of the horrors she had observed at asylums and calling for reform. Dix’s campaign led to new laws and greater government funding to improve the treatment of people with mental disorders (Davidson et al., 2010; Zilboorg & Henry, 1941). Each state was made responsible for developing effective public mental hospitals, or state hospitals, all of which were intended to offer moral treatment. Similar hospitals were established throughout Europe.

state hospitals State-run public mental institutions in the United States.

The Decline of Moral TreatmentBy the 1850s, a number of mental hospitals throughout Europe and America reported success using moral approaches. By the end of that century, however, several factors led to a reversal of the moral treatment movement (Kazano, 2012; Cautin, 2011; Bockoven, 1963). One factor was the speed with which the movement had spread. As mental hospitals multiplied, severe money and staffing shortages developed, recovery rates declined, and overcrowding in the hospitals became a major problem. Another factor was the assumption behind moral treatment that all patients could be cured if treated with humanity and dignity. For some, this was indeed sufficient. Others, however, needed more effective treatments than any that had yet been developed. An additional factor contributing to the decline of moral treatment was the emergence of a new wave of prejudice against people with mental disorders. As more and more patients disappeared into large, distant mental hospitals, the public came to view them as strange and dangerous. In turn, people were less open-handed when it came to making donations or allocating government funds. Moreover, many of the patients entering public mental hospitals in the United States in the late nineteenth century were poor foreign immigrants, whom the public had little interest in helping (see MediaSpeak below).

By the early years of the twentieth century, the moral treatment movement had ground to a halt in both the United States and Europe. Public mental hospitals were providing only custodial care and ineffective medical treatments and were becoming more overcrowded every year. Long-term hospitalization became the rule once again.

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MediaSpeak

Immigration and the Mentally Ill in the 21st Century

By Andrew Solomon, The New York Times, December 8, 2013

“Give me your tired, your poor, your huddled masses …” An Italian immigrant and her family arrive at Ellis Island in New York City in 1905. Today’s U.S. immigration policies for persons with mental disorders are sometimes less generous than they were more than 100 years ago.

A Canadian woman was denied entry to the United States last month because she had been hospitalized for depression in 2012. Ellen Richardson could not visit, she was told, unless she obtained “medical clearance” from one of three Toronto doctors approved by the Department of Homeland Security. Endorsement by her own psychiatrist, which she could presumably have obtained more efficiently, “would not suffice.” She had been en route to New York, where she had intended to board a cruise to the Caribbean….

The border agent told her he was acting in accordance with the United States Immigration and Nationality Act, Section 212, which allows patrols to block people from visiting the United States if they have a physical or mental disorder that threatens anyone’s “property, safety or welfare.” The [Toronto] Star reported that the agent produced a signed document stating that Ms. Richardson would need a medical evaluation because of her “mental illness episode.” …

This is not the first time such measures have been reported. In 2011, Lois Kamenitz, a Canadian and a former teacher, was barred from entering the United States because she had once attempted suicide. Ryan Fritsch, former co-chairman of the Ontario Mental Health Police Record Check Coalition, told the Star that he had heard of eight similar cases that year. After the incident, he wrote to me: “My sense is that there are a great many people being turned away….”

Ms. Richardson’s health information should never have been available to United States authorities, and many Canadians are outraged at the thought that their government may have divulged it…. Much more troubling, however, is the notion that information about a person’s depression, no matter how legitimately obtained, might have any bearing on her ability to visit the United States.

What kind of roles should mental health experts play in the development of immigration, gun, or other laws that target people with mental disorders?

People in treatment for mental illnesses do not have a higher rate of violence than people without mental illnesses. Furthermore, depression affects one in 10 American adults…. Pillorying depression is regressive, a swoop back into a period when any sign of mental illness was the basis for social exclusion…. [T]his border policy is not only unfair to visitors, but also constitutes an affront to the millions of Americans who are grappling with mental-health challenges.

Stigmatizing the condition is bad; stigmatizing the treatment is even worse…. Yet this incident will serve only to warn people against seeking treatment for mental illness…. Ms. Richardson, who attempted suicide in 2001 and as a result is paraplegic, has asserted that she has had appropriate treatment, and that she now has a fulfilling, purposeful life. We should applaud people who get treatment and manage to live deeply despite their challenges…. The president needs to speak out against Section 212 … and to put to rest the idea that people with mental health conditions who pose no danger are unwelcome in our country.

December 8, 2013, “Opinion: Shameful Profiling of the Mentally Ill” by Andrew Solomon. From The New York Times, 12/8/2013, © 2013 The New York Times. All rights reserved. Used by permission and protected by the copyright laws of the United States. The printing, copying, redistribution, or retransmission of this content without express written permission is prohibited.

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The Early Twentieth Century: The Somatogenic and Psychogenic Perspectives

As the moral movement was declining in the late 1800s, two opposing perspectives emerged and began to compete for the attention of clinicians: the somatogenic perspective, the view that abnormal psychological functioning has physical causes, and the psychogenic perspective, the view that the chief causes of abnormal functioning are psychological. These perspectives came into full bloom during the twentieth century.

somatogenic perspective The view that abnormal psychological functioning has physical causes.

psychogenic perspective The view that the chief causes of abnormal functioning are psychological.

The Somatogenic PerspectiveThe somatogenic perspective has at least a 2,400-year history—remember Hippocrates’ view that abnormal behavior resulted from brain disease and an imbalance of humors? Not until the late nineteenth century, however, did this perspective make a triumphant return and begin to gain wide acceptance.

Two factors were responsible for this rebirth. One was the work of a distinguished German researcher, Emil Kraepelin (1856-1926). In 1883, Kraepelin published an influential textbook arguing that physical factors, such as fatigue, are responsible for mental dysfunction. In addition, as you will see in Chapter 4, he developed the first modern system for classifying abnormal behavior. He identified various syndromes, or clusters of symptoms; listed their physical causes; and discussed their expected course (Jäger, Frasch, & Becher, 2013; Zivanovic & Nedic, 2012).

New biological discoveries also triggered the rise of the somatogenic perspective. One of the most important discoveries was that an organic disease, syphilis, led to general paresis, an irreversible disorder with both physical and mental symptoms, including paralysis and delusions of grandeur (Hogebrug et al., 2013; Kaplan, 2010). In 1897, the German neurologist Richard von Krafft-Ebing (1840–1902) injected matter from syphilis sores into patients suffering from general paresis and found that none of the patients developed symptoms of syphilis. Their immunity could have been caused only by an earlier case of syphilis. Since all of his patients with general paresis were now immune to syphilis, Krafft-Ebing theorized that syphilis had been the cause of their general paresis. Finally, in 1905, Fritz Schaudinn (1871–1906), a German zoologist, discovered that the microorganism Treponema pallida was responsible for syphilis, which in turn caused general paresis.

The more things change … Patients at a modern-day mental hospital in Bangladesh eat their lunch off of the floor of their ward. Such conditions are similar to those that existed in some state hospitals throughout the United States well into the twentieth century.

The work of Kraepelin and the new understanding of general paresis led many researchers and practitioners to suspect that physical factors were responsible for many mental disorders, perhaps all of them. These theories and the possibility of quick and effective medical solutions for mental disorders were especially welcomed by those who worked in mental hospitals, where patient populations were now growing at an alarming rate.

Despite the general optimism, biological approaches yielded mostly disappointing results throughout the first half of the twentieth century. Although many medical treatments were developed for patients in mental hospitals during that time, most of the techniques failed to work. Physicians tried tooth extraction, tonsillectomy, hydrotherapy (alternating hot and cold baths), and lobotomy, a surgical cutting of certain nerve fibers in the brain. Even worse, biological views and claims led, in some circles, to proposals for immoral solutions such as eugenic sterilization, the elimination (through medical or other means) of individuals’ ability to reproduce (see Table 1-1 below). Not until the 1950s, when a number of effective medications were finally discovered, did the somatogenic perspective truly begin to pay off for patients.

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Table 1.1: table: 1-1Eugenics and Mental Disorders

Year

Event

1896

Connecticut became the first state in the United States to prohibit persons with mental disorders from marrying.

1896–1933

Every state in the United States passed a law prohibiting marriage by persons with mental disorders.

1907

Indiana became the first state to pass a bill calling for people with mental disorders, as well as criminals and other “defectives,” to undergo sterilization.

1927

The U.S. Supreme Court ruled that eugenic sterilization was constitutional.

1907–1945

Approximately 45,000 Americans were sterilized under eugenic sterilization laws; 21,000 of them were patients in state mental hospitals.

1929–1932

Denmark, Norway, Sweden, Finland, and Iceland passed eugenic sterilization laws.

1933

Germany passed a eugenic sterilization law, under which 375,000 people were sterilized by 1940.

1940

Nazi Germany began to use “proper gases” to kill people with mental disorders; 70,000 or more people were killed in less than 2 years.

Information from: Fischer, 2012; Whitaker, 2002.

BETWEEN THE LINES

Lunar Myths

Although it is popularly believed that a full moon is regularly accompanied by significant increases in crime, strange and abnormal behaviors, and admissions to mental hospitals, decades of research have failed to support this notion.

(Bakalar, 2013; 2011; Schafer et al., 2010; McLay et al., 2006)

The Psychogenic PerspectiveThe late nineteenth century also saw the emergence of the psychogenic perspective, the view that the chief causes of abnormal functioning are often psychological. This view, too, had a long history, but it did not gain much of a following until studies of hypnotism demonstrated its potential.

Hypnotism is a procedure in which a person is placed in a trancelike mental state during which he or she becomes extremely suggestible. It was used to help treat psychological disorders as far back as 1778, when an Austrian physician named Friedrich Anton Mesmer (1734–1815) established a clinic in Paris. His patients suffered from hysterical disorders, mysterious bodily ailments that had no apparent physical basis. Mesmer had his patients sit in a darkened room filled with music; then he appeared, dressed in a colorful costume, and touched the troubled area of each patient’s body with a special rod. A surprising number of patients seemed to be helped by this treatment, called mesmerism (Musikantow, 2011; Dingfelder, 2010). Their pain, numbness, or paralysis disappeared. Several scientists believed that Mesmer was inducing a trancelike state in his patients and that this state was causing their symptoms to disappear. The treatment was so controversial, however, that eventually Mesmer was banished from Paris.

It was not until years after Mesmer died that many researchers had the courage to investigate his procedure, later called hypnotism (from hypnos, the Greek word for “sleep”), and its effects on hysterical disorders. The experiments of two physicians practicing in the city of Nancy in France, Hippolyte-Marie Bernheim (1840–1919) and Ambroise-Auguste Liébault (1823–1904), showed that hysterical disorders could actually be induced in otherwise normal people while they were under the influence of hypnosis. That is, the physicians could make normal people experience deafness, paralysis, blindness, or numbness by means of hypnotic suggestion—and they could remove these artificial symptoms by the same means. Thus they established that a mental process—hypnotic suggestion—could both cause and cure even a physical dysfunction. Leading scientists concluded that hysterical disorders were largely psychological in origin, and the psychogenic perspective rose in popularity.

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Hypnotism update Hypnotism, the procedure that opened the door for the psychogenic perspective, continues to influence many areas of modern life, including the fields of psychotherapy, entertainment, and law enforcement. Here a forensic clinician uses hypnosis to help a witness recall the details of a crime. Recent research has clarified, however, that hypnotic procedures are as capable of creating false memories as they are of uncovering real memories.

Among those who studied the effects of hypnotism on hysterical disorders was Josef Breuer (1842–1925) of Vienna. Breuer, a physician, discovered that his patients sometimes awoke free of hysterical symptoms after speaking candidly under hypnosis about past upsetting events. During the 1890s, Breuer was joined in his work by another Viennese physician, Sigmund Freud (1856–1939). As you will see in Chapter 3, Freud’s work eventually led him to develop the theory of psychoanalysis, which holds that many forms of abnormal and normal psychological functioning are psychogenic. In particular, Freud believed that unconscious psychological processes are at the root of such functioning.

psychoanalysis Either the theory or the treatment of abnormal mental functioning that emphasizes unconscious psychological forces as the cause of psychopathology.

Freud also developed the technique of psychoanalysis, a form of discussion in which clinicians help troubled people gain insight into their unconscious psychological processes. He believed that such insight, even without hypnotic procedures, would help the patients overcome their psychological problems.

Freud and his followers offered psychoanalytic treatment primarily to patients suffering from anxiety or depression, problems that did not typically require hospitalization. These patients visited therapists in their offices for sessions of approximately an hour and then went about their daily activities—a format of treatment now known as outpatient therapy. By the early twentieth century, psychoanalytic theory and treatment were widely accepted throughout the Western world (Cautin, 2011).