{"id":84,"date":"2020-07-13T18:18:33","date_gmt":"2020-07-13T18:18:33","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/chapter\/mental-health-treatment-past-and-present\/"},"modified":"2022-07-26T20:05:30","modified_gmt":"2022-07-26T20:05:30","slug":"mental-health-treatment-past-and-present","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/mental-health-treatment-past-and-present\/","title":{"raw":"Mental Health Treatment in the Past","rendered":"Mental Health Treatment in the Past"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe etiological theories (supernatural, somatogenic, and psychogenic) used to explain mental illness up through the Middle Ages<\/li>\r\n \t<li>Explain modern views on mental illness, including the rationale and impact of deinstitutionalization<\/li>\r\n<\/ul>\r\n<\/div>\r\nLacking scientific information or ways to think about or approach situations, people in the past turned to other explanations for what caused mental disorders. It was common for them to believe that people with psychological disorders, or those exhibiting strange behavior, were possessed by demons or were being punished by God or gods for their sins. Following that logic, treatment involved forcing those afflicted to take part in exorcisms, suffer imprisonment, or even face execution.\r\n\r\nWilhelm Griesinger (1817\u20131868),\u00a0is remembered for initiating reforms in the treatment of the mentally ill as well as introducing changes to the existing asylum system. Griesinger believed in the integration of the mentally ill into society and proposed that short-term hospitalization be combined with the close cooperation of natural support systems. He also provided valuable insights on the nature of\u00a0<strong>psychopathic\u00a0<\/strong>or antisocial\u00a0behavior (characterized by persistent\u00a0antisocial behavior, impaired\u00a0empathy\u00a0and\u00a0remorse, and\u00a0bold,\u00a0disinhibited, and\u00a0egotistical traits)[footnote][\/footnote]. Griesinger wrote, \"Psychiatry has undergone a transformation in its relation to the rest of medicine. . . . This transformation rests principally on the realization that patients with so-called 'mental illnesses' are really individuals with illnesses of the nerves and brain.\"[footnote]Quoted in Edward Shorter (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley. p. 76. ISBN 978-0-471-15749-6.[\/footnote]\u00a0Much later, asylums were built to house the mentally ill, but the patients received little to no treatment, and many of the methods used were cruel. During the 1800s, Philippe Pinel and Dorothea Dix argued for more humane treatment of people with psychological disorders.\r\n\r\n<section><\/section><section>In the mid-1960s, the deinstitutionalization movement gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms. It is important to note that even though we have a more scientific understanding of the causes of mental disorders today, there is still much we do not know and supernatural explanations are still sometimes used even now to explain abnormal behaviors. These explanations, such as demonic possession or even that a full moon can increase the intensity of mental illness symptoms, combined with other stereotypes and misunderstandings, are potent contributors to <strong>stigma<\/strong>, meaning prejudicial attitudes and discrimination against those who experience mental disorders.<\/section>\r\n\r\n[caption id=\"\" align=\"alignleft\" width=\"413\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225134\/CNX_Psych_16_01_Goya.jpg\" alt=\"A painting depicts the inside of a mental asylum in the early 1800s.\" width=\"413\" height=\"347\" \/> <strong>Figure 1<\/strong>. This painting by Francisco Goya, called <em>The Madhouse<\/em>, depicts a mental asylum and its inhabitants in the early 1800s. It portrays those with psychological disorders as victims.[\/caption]\r\n<p id=\"fs-idp8937200\">Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals, with an emphasis on short-term stays. However, most people suffering from mental illness are not hospitalized. A person suffering symptoms could speak with a primary care physician, who most likely would refer him to a psychiatrist or to someone who specializes in therapy. The person can receive outpatient mental health services from a variety of sources, including psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel. These therapy sessions would be covered through insurance, government funds, or private (self) pay.<\/p>\r\n\r\n<h2>Ancient Views on Mental Illness<\/h2>\r\nThroughout history there have been three general theories of the\u00a0<strong>etiology<\/strong>\u00a0of mental illness:\u00a0supernatural,\u00a0somatogenic, and\u00a0psychogenic. <strong>Supernatural theories<\/strong> attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin. <strong>Somatogenic theories<\/strong> (from the Greek word <em>soma<\/em>\u00a0meaning body, therefore biological causes) identify disturbances in physical functioning resulting from either illness, genetic inheritance, brain damage, or imbalance. <strong>Psychogenic theories<\/strong> focus on traumatic or stressful experiences,\u00a0maladaptive\u00a0learned associations, and cognitions, or distorted perceptions. Etiological theories of mental illness determine the care and treatment mentally ill individuals receive. As we will see below, an individual believed to be possessed by the devil will be viewed and treated differently from an individual believed to be suffering from an excess of yellow bile. Their treatments will also differ, from exorcism to blood-letting. The theories, however, remain the same. They coexist as well as recycle over time.\r\n\r\n<strong>Trephination, <\/strong>as a treatment, is an example of possibly the earliest supernatural explanation for mental illness (Figure 2). Examination of prehistoric skulls and cave art from as early as 6500 BC has identified surgical drilling of holes in skulls to treat head injuries and epilepsy as well as to allow the evil spirits trapped within the skull, that were presumed to be causing the symptoms of mental disorder, to be released (Restak, 2000). Trephination ultimately fell out of favor as a treatment for psychological disorders.\r\n\r\n[caption id=\"attachment_2653\" align=\"alignleft\" width=\"213\"]<img class=\"wp-image-2653\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/29233453\/MAMUZ_-_Trepanation_Retzelsdorf-230x300.jpg\" alt=\"A preserved skull with a large hole on the left side of the forehead. \" width=\"213\" height=\"278\" \/> <strong>Figure 2.<\/strong> Evidence of the ancient practice of trephination.[\/caption]\r\n\r\nAround 2700 BC, Chinese medicine\u2019s concept of complementary positive and negative bodily forces (yin and yang) attributed mental (and physical) illness to an imbalance between these forces. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential (Tseng, 1973) to health and a good life.\r\n\r\nMesopotamian and Egyptian papyri from 1900 BC describe women suffering from mental illness resulting from a wandering uterus (later named\u00a0<strong>hysteria<\/strong>\u00a0by the Greeks): the uterus could become dislodged and attached to parts of the body like the liver or chest cavity, preventing their proper functioning or producing varied and sometimes painful symptoms. As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong-smelling substances to guide the uterus back to its proper location (pleasant odors to lure and unpleasant ones to dispel).\r\n\r\nThroughout classical antiquity, we see a return to supernatural theories of demonic possession or godly displeasure to account for abnormal behavior that was beyond the person\u2019s control. Temple attendance with religious healing ceremonies and incantations to the gods were employed to assist in the healing process. Hebrews saw madness as punishment from God so treatment consisted of confessing sins and repenting. Physicians were also believed to be able to comfort and cure madness, however.\r\n\r\nGreek physicians rejected supernatural explanations of mental disorders. It was around 400 BC that Hippocrates (460\u2013370 BC) attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency in or especially an excess of one of the four essential bodily fluids (i.e., humors)\u2014blood, yellow bile, black bile, and phlegm\u2014was responsible for physical and mental illness. For example, someone who was too temperamental suffered from too much blood and thus blood-letting would be the necessary treatment. Hippocrates classified mental illness into one of four categories\u2014epilepsy, mania, melancholia, and brain fever\u2014and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. Mentally ill individuals were cared for at home by family members and the state shared no responsibility for their care.\u00a0<strong>Humorism<\/strong>\u00a0remained a recurrent somatogenic theory up until the 19th century.\r\n\r\nWhile Greek physician Galen (AD 130\u2013201) rejected the notion of a uterus having an\u00a0animistic soul, he agreed with the notion that an imbalance of the four bodily fluids could cause mental illness. He also opened the door for psychogenic explanations for mental illness by allowing for the experience of psychological stress as a potential cause of abnormality. Galen\u2019s psychogenic theories were ignored for centuries, however, as physicians attributed mental illness to physical causes throughout most of the millennium.\r\n<h2>Mental Health during the Middle Ages<\/h2>\r\nBy the late Middle Ages, economic and political turmoil threatened the power of the Roman Catholic Church. Between the 11th and 15th centuries, supernatural theories of mental disorders again dominated Europe, fueled by natural disasters like plagues and famines that laypeople interpreted as brought about by the devil. Superstition, astrology, and alchemy took hold, and common treatments included prayer rites, relic touching, confessions, and atonement. Beginning in the 13th century, the mentally ill, especially women, began to be persecuted as witches who were possessed. At the height of the witch hunts during the 15th through 17th centuries, with the Protestant Reformation having plunged Europe into religious strife, two Dominican monks wrote the\u00a0<em>Malleus Maleficarum<\/em>\u00a0(1486) as the ultimate manual to guide witch hunts. Johann Weyer and Reginald Scot tried to convince people in the mid-to late-16th century that accused witches were actually women with mental illnesses and that mental illness was not due to demonic possession but to faulty metabolism and disease, but the Church\u2019s Inquisition banned both of their writings. Witch-hunting did not decline until the 17th and 18th centuries, after more than 100,000 presumed witches had been burned at the stake (Schoeneman, 1977;\u00a0Zilboorg &amp; Henry, 1941).\r\n\r\nAlso during medieval times, a person with mental illness might be considered to be possessed by demons. If someone was considered to be possessed, there were several forms of treatment to release spirits from the individual. The most common treatment was exorcism, often conducted by priests or other religious figures: incantations and prayers were said over the person\u2019s body, and they may have been given some medicinal drinks. Trephining was also practiced during this time\u2014a small hole was made in the afflicted individual\u2019s skull to release spirits from the body. Most people treated in this manner died. In addition to exorcism and trephining, other practices involved execution or imprisonment of people with psychological disorders. Still others were left to be homeless beggars. Generally speaking, most people who exhibited strange behaviors were greatly misunderstood and treated cruelly. The prevailing theory of psychopathology in earlier history was the idea that mental illness was the result of demonic possession by either an evil spirit or an evil god because early beliefs incorrectly attributed all unexplainable phenomena to deities deemed either good or evil.\r\n\r\n<section>\r\n<h3>Supernatural Perspectives of Psychological Disorders<\/h3>\r\nConvents throughout Europe in the 16th and 17th centuries reported hundreds of nuns falling into a state of frenzy in which the afflicted foamed at the mouth, screamed and convulsed, sexually propositioned priests, and confessed to having carnal relations with devils or Christ. Although today these cases would suggest serious mental illness, at the time, these events were routinely explained as possession by devilish forces (Waller, 2009a). Similarly, grievous fits by young girls are believed to have precipitated the witch panic in New England late in the 17th century (Demos, 1983). Such beliefs in supernatural causes of mental illness are still held in some societies today; for example, beliefs that supernatural forces cause mental illness are common in some cultures in modern-day Nigeria (Aghukwa, 2012).\r\n<figure><\/figure>\r\n<div>\r\n<div>\r\n<div>\r\n<div class=\"textbox exercises\">\r\n<h3>Dig Deeper: Dancing Mania<\/h3>\r\n<section>\r\n<div>\r\n<div>\r\n\r\n[caption id=\"attachment_4477\" align=\"alignleft\" width=\"183\"]<a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2015\/02\/03043631\/d5035a823dc0c885913bd6135114afab.jpg\"><img class=\"wp-image-4477\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2015\/02\/03043631\/d5035a823dc0c885913bd6135114afab.jpg\" alt=\"Bosch painting depicting a man boring a hole in the top of the skull of a seated man, attempting to extract his &quot;madness&quot;\" width=\"183\" height=\"280\" \/><\/a> <strong>Figure 3<\/strong>. In <em>The Extraction of the Stone of Madness<\/em>, a 15th century painting by Hieronymus Bosch, a practitioner is using a tool to extract an object (the supposed \u201cstone of madness\u201d) from the head of an afflicted person.[\/caption]\r\n\r\nBetween the 11th and 17th centuries, a curious epidemic swept across Western Europe. Groups of people would suddenly begin to dance with wild abandon. This compulsion to dance\u2014referred to as dancing mania\u2014sometimes gripped thousands of people at a time (Figure 2). Historical accounts indicate that those afflicted would sometimes dance with bruised and bloody feet for days or weeks, screaming of terrible visions and begging priests and monks to save their souls (Waller, 2009b). What caused dancing mania is not known, but several explanations have been proposed, including spider venom and ergot poisoning (\u201cDancing Mania,\u201d 2011).\r\n<figure>\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"401\"]<img class=\"\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225107\/CNX_Psych_15_03_Mania.jpg\" alt=\"A painting shows a group of pilgrims dancing in a way that appears inconsistent and aimless.\" width=\"401\" height=\"203\" \/> <strong>Figure 4<\/strong>. Although the cause of dancing mania, depicted in this painting, was unclear, the behavior was attributed to supernatural forces.[\/caption]<\/figure>\r\nHistorian John Waller (2009a, 2009b) has provided a comprehensive and convincing explanation of dancing mania that suggests the phenomenon was attributable to a combination of three factors: psychological distress, social contagion, and belief in supernatural forces. Waller argued that various disasters of the time (such as famine, plagues, and floods) produced high levels of psychological distress that could increase the likelihood of succumbing to an involuntary trance state. Waller indicated that anthropological studies and accounts of possession rituals show that people are more likely to enter a trance state if they expect it to happen, and that entranced individuals behave in a ritualistic manner, their thoughts and behavior shaped by the spiritual beliefs of their culture. Thus, during periods of extreme physical and mental distress, all it took were a few people\u2014believing themselves to have been afflicted with a dancing curse\u2014to slip into a spontaneous trance and then act out the part of one who is cursed by dancing for days on end.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/section><\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/section>\r\n<h2>From the Middle Ages to the Twentieth Century<\/h2>\r\nBy the 18th century, people who were considered odd and unusual were placed in asylums. <strong>Asylums<\/strong> were the first institutions created for the specific purpose of housing people with psychological disorders, but the focus was ostracizing them from society rather than treating their disorders. Often these people were kept in windowless dungeons, beaten, chained to their beds, and had little to no contact with caregivers.\r\n<figure><\/figure>\r\nIn the late 1700s, a French physician, Philippe Pinel, argued for the more humane treatment of the mentally ill. Pinel suggested that they be unchained and talked to, and that\u2019s just what he did for patients at La Salp\u00eatri\u00e8re in Paris in 1795. Patients benefited from this more humane treatment, and many were able to leave the hospital.\r\n<figure>\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"364\"]<img class=\"\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225136\/CNX_Psych_16_01_Pinel.jpg\" alt=\"A painting, set inside an asylum, depicts a person removing the chains from a patient. There are several other people in the scene, but the focus is on these two characters.\" width=\"364\" height=\"252\" \/> <strong>Figure 5<\/strong>. This painting by Tony Robert-Fleury depicts Dr. Philippe Pinel ordering the removal of chains from patients at the Salp\u00eatri\u00e8re asylum in Paris.[\/caption]<\/figure>\r\nIn the 19th century, Dorothea Dix led reform efforts for mental health care in the United States. She investigated how those who are mentally ill and poor were cared for, and she discovered an underfunded and unregulated system that perpetuated abuse of this population (Tiffany, 1891). Horrified by her findings, Dix began lobbying various state legislatures and the U.S. Congress for change (Tiffany, 1891). Her efforts led to the creation of the first mental asylums in the United States.\r\n<figure>\r\n\r\n[caption id=\"\" align=\"alignleft\" width=\"244\"]<img src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225138\/CNX_Psych_16_01_Dix.jpg\" alt=\"A portrait of Dorothea Dix is shown.\" width=\"244\" height=\"307\" \/> <strong>Figure 6<\/strong>. Dorothea Dix was a social reformer who became an advocate for the indigent insane and was instrumental in creating the first American mental asylum. She did this by relentlessly lobbying state legislatures and Congress to set up and fund such institutions.[\/caption]<\/figure>\r\nDespite reformers\u2019 efforts, however, a typical asylum was filthy, offered very little treatment, and often kept people for decades. At Willard Psychiatric Center in upstate New York, for example, one treatment was to submerge patients in cold baths for long periods of time. Electroshock treatment was also used, and the way the treatment was administered often broke patients\u2019 backs; in 1943, doctors at Willard administered 1,443 shock treatments (Willard Psychiatric Center, 2009). (Electroshock is now called electroconvulsive treatment, and the therapy is still used, but with safeguards and under anesthesia. A brief application of electric stimulus is used to produce a generalized seizure. Controversy continues over its effectiveness versus the side effects.) Many of the wards and rooms were so cold that a glass of water would be frozen by morning (Willard Psychiatric Center, 2009). Willard\u2019s doors were not closed until 1995. Conditions like these remained commonplace until well into the 20th century.\r\n\r\nEuropean psychiatry in the late 18th century and throughout the 19th century struggled between somatogenic and psychogenic explanations of mental illness, particularly hysteria, which caused physical symptoms such as blindness or paralysis with no apparent physiological explanation. Franz Anton Mesmer (1734\u20131815), influenced by contemporary discoveries in electricity, attributed hysterical symptoms to imbalances in a universal magnetic fluid found in individuals, rather than to a wandering uterus (Forrest, 1999). James Braid (1795\u20131860) shifted this belief in\u00a0<strong>mesmerism<\/strong>\u00a0to one in hypnosis, thereby proposing a psychogenic treatment for the removal of symptoms. At the time, famed Salpetriere Hospital neurologist Jean-Martin Charcot (1825\u20131893), and Ambroise Auguste Li\u00e9bault (1823\u20131904) and Hyppolyte Bernheim (1840\u20131919) of the Nancy School in France, were engaged in a bitter<span style=\"color: #ff9900;\">\u00a0<\/span>battle over the best explanation for hysteria, with Charcot maintaining that the hypnotic suggestibility underlying hysteria was a neurological condition while Li\u00e9bault and Bernheim believed it to be a general trait that varied in the population. Josef Breuer (1842\u20131925) and Sigmund Freud (1856\u20131939) would resolve this dispute in favor of a psychogenic explanation for mental illness by treating hysteria through hypnosis, which eventually led to the\u00a0cathartic method\u00a0that became the precursor for psychoanalysis during the first half of the 20th century.\r\n\r\n<b>Emil Kraepelin<\/b>\u00a0(1856\u20131926) was a German\u00a0psychiatrist.\u00a0H.J. Eysenck's\u00a0<i>Encyclopedia of Psychology<\/i>\u00a0identifies him as the founder of modern scientific\u00a0psychiatry,\u00a0psychopharmacology, and\u00a0psychiatric genetics.\u00a0Kraepelin believed the chief origin of psychiatric\u00a0disease\u00a0to be\u00a0biological\u00a0and\u00a0genetic\u00a0malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later\u00a0psychodynamic\u00a0influence of\u00a0Sigmund Freud\u00a0and his disciples, enjoyed a revival at century's end.\u00a0Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as \"symptomatic\" and to his view as \"clinical.\" This turned out to be his\u00a0paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of\u00a0<strong>syndrome\u2014<\/strong>common\u00a0<i>patterns<\/i>\u00a0of symptoms over time\u2014rather than by simple similarity of major symptoms in the manner of his predecessors.\u00a0Drawing on his long-term research, and using the criteria of course, outcome, and\u00a0prognosis, he developed the concept of\u00a0<strong>dementia praecox<\/strong>, which he defined as the \"sub-acute development of a peculiar simple condition of mental weakness occurring at a youthful age.\"\u00a0<span style=\"font-size: 1rem; text-align: initial;\">This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the\u00a0dementia\u00a0part signifying the irreversible mental decline).\u00a0As a colleague of\u00a0Alois Alzheimer, he was a co-discoverer o<span style=\"color: #333333;\">f<\/span><\/span><span style=\"color: #333333;\"><em style=\"font-size: 1rem; text-align: initial;\">\u00a0Alzheimer's disease<\/em><span style=\"font-size: 1rem; text-align: initial;\"> (thought to be a brain disease leading to dementia), and his laboratory discovered its pathological basis. This may have led to the <\/span><strong>medical model of illness<\/strong><em style=\"font-size: 1rem; text-align: initial;\">.\u00a0<\/em><\/span>\r\n\r\nAs we will discuss later in this course, in psychology, the term <em>medical model<\/em>\u00a0refers to the assumption that\u00a0psychopathology\u00a0is the result of one's biology, that is to say, a physical\/organic problem in brain structures, neurotransmitters, genetics, the endocrine system, etc., as with traumatic\u00a0brain injury,\u00a0Alzheimer's disease, or\u00a0Down's syndrome. One aspect of such a model is that an ill patient should not be held responsible for the condition. The patient should not be blamed or stigmatized for the illness.\u00a0The medical model is useful in many situations as a guide for diagnosis, prognosis, and research. However, for most mental disorders, exclusive reliance on the medical model leads to an incomplete understanding, and, frequently, to incomplete or ineffective treatment interventions.\r\n<div class=\"textbox exercises\">\r\n<h3>Link to Learning<\/h3>\r\nView this <a href=\"https:\/\/www.tiki-toki.com\/timeline\/entry\/37146\/A-History-of-Mental-Institutions-in-the-United-States\/#vars!date=1810-07-03_14:51:59!\" target=\"_blank\" rel=\"noopener noreferrer\">timeline showing the history of mental institutions<\/a>\u00a0in the United States.\r\n\r\n<\/div>\r\n<section>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/45a03d59-3021-4da3-bea5-9ca33be6695b\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/aab74ef1-6262-4421-8214-b9998ab5c763\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/46a6ea43-6de7-4212-ab80-d210c27863f4\r\n\r\n<\/div>\r\n<\/section>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>asylum:\u00a0<\/strong>institution created for the specific purpose of housing people with\u00a0mental disorders\r\n\r\n<strong>deinstitutionalization:\u00a0<\/strong>process of closing large asylums and integrating people back into the community where they can be treated locally\r\n\r\n<strong>dementia praecox:\u00a0<\/strong>a \"premature dementia\" or \"precocious madness\"\r\n\r\n<strong>etiology:<\/strong> the causal description of all of the factors that contribute to the development of a disorder or illness\r\n\r\n<strong>humorism<\/strong> (or humoralism): a belief held by ancient Greek and Roman physicians (and until the 19th century) that an excess or deficiency in any of the four bodily fluids, or humors\u2014blood, black bile, yellow bile, and phlegm\u2014directly affected their health and temperament\r\n\r\n<strong>hysteria:<\/strong> term used by the ancient Greeks and Egyptians to describe a disorder believed to be caused by a woman\u2019s uterus wandering throughout the body and interfering with other organs (today referred to as functional neurological symptom disorder, or conversion disorder, in which psychological problems are expressed in physical form)\r\n\r\n<strong>mesmerism<\/strong>: derived from Franz Anton Mesmer in the late 18th century, an early version of hypnotism in which Mesmer claimed that hysterical symptoms could be treated through animal magnetism emanating from Mesmer\u2019s body and permeating the universe (and later through magnets); later explained in terms of high suggestibility in individuals\r\n\r\n<strong>psychogenesis<\/strong>: developing from psychological origins\r\n\r\n<strong>psychopathic:<\/strong>\u00a0a\u00a0personality disorder\u00a0characterized by persistent\u00a0antisocial behavior; impaired\u00a0empathy\u00a0and\u00a0remorse; and\u00a0bold,\u00a0disinhibited, and\u00a0egotistical traits\r\n\r\n<strong>somatogenesis<\/strong>: developing from physical\/bodily origins\r\n\r\n<strong>supernatural:<\/strong> developing from origins beyond the visible observable universe\r\n\r\n<strong>stigma<\/strong>: social attitudes and prejudice against persons who are different that devalue the person or make them feel disgraced or ashamed and that can lead to exclusion or discrimination against others\r\n\r\n<strong>syndrome:\u00a0<\/strong>common\u00a0patterns\u00a0of symptoms over time\r\n\r\n<strong>trephination<\/strong>: the drilling of a hole in the skull, presumably as a way of treating psychological disorders\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe etiological theories (supernatural, somatogenic, and psychogenic) used to explain mental illness up through the Middle Ages<\/li>\n<li>Explain modern views on mental illness, including the rationale and impact of deinstitutionalization<\/li>\n<\/ul>\n<\/div>\n<p>Lacking scientific information or ways to think about or approach situations, people in the past turned to other explanations for what caused mental disorders. It was common for them to believe that people with psychological disorders, or those exhibiting strange behavior, were possessed by demons or were being punished by God or gods for their sins. Following that logic, treatment involved forcing those afflicted to take part in exorcisms, suffer imprisonment, or even face execution.<\/p>\n<p>Wilhelm Griesinger (1817\u20131868),\u00a0is remembered for initiating reforms in the treatment of the mentally ill as well as introducing changes to the existing asylum system. Griesinger believed in the integration of the mentally ill into society and proposed that short-term hospitalization be combined with the close cooperation of natural support systems. He also provided valuable insights on the nature of\u00a0<strong>psychopathic\u00a0<\/strong>or antisocial\u00a0behavior (characterized by persistent\u00a0antisocial behavior, impaired\u00a0empathy\u00a0and\u00a0remorse, and\u00a0bold,\u00a0disinhibited, and\u00a0egotistical traits). Griesinger wrote, &#8220;Psychiatry has undergone a transformation in its relation to the rest of medicine. . . . This transformation rests principally on the realization that patients with so-called &#8216;mental illnesses&#8217; are really individuals with illnesses of the nerves and brain.&#8221;<a class=\"footnote\" title=\"Quoted in Edward Shorter (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley. p. 76. ISBN 978-0-471-15749-6.\" id=\"return-footnote-84-1\" href=\"#footnote-84-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a>\u00a0Much later, asylums were built to house the mentally ill, but the patients received little to no treatment, and many of the methods used were cruel. During the 1800s, Philippe Pinel and Dorothea Dix argued for more humane treatment of people with psychological disorders.<\/p>\n<section><\/section>\n<section>In the mid-1960s, the deinstitutionalization movement gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms. It is important to note that even though we have a more scientific understanding of the causes of mental disorders today, there is still much we do not know and supernatural explanations are still sometimes used even now to explain abnormal behaviors. These explanations, such as demonic possession or even that a full moon can increase the intensity of mental illness symptoms, combined with other stereotypes and misunderstandings, are potent contributors to <strong>stigma<\/strong>, meaning prejudicial attitudes and discrimination against those who experience mental disorders.<\/section>\n<div style=\"width: 423px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225134\/CNX_Psych_16_01_Goya.jpg\" alt=\"A painting depicts the inside of a mental asylum in the early 1800s.\" width=\"413\" height=\"347\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 1<\/strong>. This painting by Francisco Goya, called <em>The Madhouse<\/em>, depicts a mental asylum and its inhabitants in the early 1800s. It portrays those with psychological disorders as victims.<\/p>\n<\/div>\n<p id=\"fs-idp8937200\">Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals, with an emphasis on short-term stays. However, most people suffering from mental illness are not hospitalized. A person suffering symptoms could speak with a primary care physician, who most likely would refer him to a psychiatrist or to someone who specializes in therapy. The person can receive outpatient mental health services from a variety of sources, including psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel. These therapy sessions would be covered through insurance, government funds, or private (self) pay.<\/p>\n<h2>Ancient Views on Mental Illness<\/h2>\n<p>Throughout history there have been three general theories of the\u00a0<strong>etiology<\/strong>\u00a0of mental illness:\u00a0supernatural,\u00a0somatogenic, and\u00a0psychogenic. <strong>Supernatural theories<\/strong> attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin. <strong>Somatogenic theories<\/strong> (from the Greek word <em>soma<\/em>\u00a0meaning body, therefore biological causes) identify disturbances in physical functioning resulting from either illness, genetic inheritance, brain damage, or imbalance. <strong>Psychogenic theories<\/strong> focus on traumatic or stressful experiences,\u00a0maladaptive\u00a0learned associations, and cognitions, or distorted perceptions. Etiological theories of mental illness determine the care and treatment mentally ill individuals receive. As we will see below, an individual believed to be possessed by the devil will be viewed and treated differently from an individual believed to be suffering from an excess of yellow bile. Their treatments will also differ, from exorcism to blood-letting. The theories, however, remain the same. They coexist as well as recycle over time.<\/p>\n<p><strong>Trephination, <\/strong>as a treatment, is an example of possibly the earliest supernatural explanation for mental illness (Figure 2). Examination of prehistoric skulls and cave art from as early as 6500 BC has identified surgical drilling of holes in skulls to treat head injuries and epilepsy as well as to allow the evil spirits trapped within the skull, that were presumed to be causing the symptoms of mental disorder, to be released (Restak, 2000). Trephination ultimately fell out of favor as a treatment for psychological disorders.<\/p>\n<div id=\"attachment_2653\" style=\"width: 223px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2653\" class=\"wp-image-2653\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/29233453\/MAMUZ_-_Trepanation_Retzelsdorf-230x300.jpg\" alt=\"A preserved skull with a large hole on the left side of the forehead.\" width=\"213\" height=\"278\" \/><\/p>\n<p id=\"caption-attachment-2653\" class=\"wp-caption-text\"><strong>Figure 2.<\/strong> Evidence of the ancient practice of trephination.<\/p>\n<\/div>\n<p>Around 2700 BC, Chinese medicine\u2019s concept of complementary positive and negative bodily forces (yin and yang) attributed mental (and physical) illness to an imbalance between these forces. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential (Tseng, 1973) to health and a good life.<\/p>\n<p>Mesopotamian and Egyptian papyri from 1900 BC describe women suffering from mental illness resulting from a wandering uterus (later named\u00a0<strong>hysteria<\/strong>\u00a0by the Greeks): the uterus could become dislodged and attached to parts of the body like the liver or chest cavity, preventing their proper functioning or producing varied and sometimes painful symptoms. As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong-smelling substances to guide the uterus back to its proper location (pleasant odors to lure and unpleasant ones to dispel).<\/p>\n<p>Throughout classical antiquity, we see a return to supernatural theories of demonic possession or godly displeasure to account for abnormal behavior that was beyond the person\u2019s control. Temple attendance with religious healing ceremonies and incantations to the gods were employed to assist in the healing process. Hebrews saw madness as punishment from God so treatment consisted of confessing sins and repenting. Physicians were also believed to be able to comfort and cure madness, however.<\/p>\n<p>Greek physicians rejected supernatural explanations of mental disorders. It was around 400 BC that Hippocrates (460\u2013370 BC) attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency in or especially an excess of one of the four essential bodily fluids (i.e., humors)\u2014blood, yellow bile, black bile, and phlegm\u2014was responsible for physical and mental illness. For example, someone who was too temperamental suffered from too much blood and thus blood-letting would be the necessary treatment. Hippocrates classified mental illness into one of four categories\u2014epilepsy, mania, melancholia, and brain fever\u2014and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. Mentally ill individuals were cared for at home by family members and the state shared no responsibility for their care.\u00a0<strong>Humorism<\/strong>\u00a0remained a recurrent somatogenic theory up until the 19th century.<\/p>\n<p>While Greek physician Galen (AD 130\u2013201) rejected the notion of a uterus having an\u00a0animistic soul, he agreed with the notion that an imbalance of the four bodily fluids could cause mental illness. He also opened the door for psychogenic explanations for mental illness by allowing for the experience of psychological stress as a potential cause of abnormality. Galen\u2019s psychogenic theories were ignored for centuries, however, as physicians attributed mental illness to physical causes throughout most of the millennium.<\/p>\n<h2>Mental Health during the Middle Ages<\/h2>\n<p>By the late Middle Ages, economic and political turmoil threatened the power of the Roman Catholic Church. Between the 11th and 15th centuries, supernatural theories of mental disorders again dominated Europe, fueled by natural disasters like plagues and famines that laypeople interpreted as brought about by the devil. Superstition, astrology, and alchemy took hold, and common treatments included prayer rites, relic touching, confessions, and atonement. Beginning in the 13th century, the mentally ill, especially women, began to be persecuted as witches who were possessed. At the height of the witch hunts during the 15th through 17th centuries, with the Protestant Reformation having plunged Europe into religious strife, two Dominican monks wrote the\u00a0<em>Malleus Maleficarum<\/em>\u00a0(1486) as the ultimate manual to guide witch hunts. Johann Weyer and Reginald Scot tried to convince people in the mid-to late-16th century that accused witches were actually women with mental illnesses and that mental illness was not due to demonic possession but to faulty metabolism and disease, but the Church\u2019s Inquisition banned both of their writings. Witch-hunting did not decline until the 17th and 18th centuries, after more than 100,000 presumed witches had been burned at the stake (Schoeneman, 1977;\u00a0Zilboorg &amp; Henry, 1941).<\/p>\n<p>Also during medieval times, a person with mental illness might be considered to be possessed by demons. If someone was considered to be possessed, there were several forms of treatment to release spirits from the individual. The most common treatment was exorcism, often conducted by priests or other religious figures: incantations and prayers were said over the person\u2019s body, and they may have been given some medicinal drinks. Trephining was also practiced during this time\u2014a small hole was made in the afflicted individual\u2019s skull to release spirits from the body. Most people treated in this manner died. In addition to exorcism and trephining, other practices involved execution or imprisonment of people with psychological disorders. Still others were left to be homeless beggars. Generally speaking, most people who exhibited strange behaviors were greatly misunderstood and treated cruelly. The prevailing theory of psychopathology in earlier history was the idea that mental illness was the result of demonic possession by either an evil spirit or an evil god because early beliefs incorrectly attributed all unexplainable phenomena to deities deemed either good or evil.<\/p>\n<section>\n<h3>Supernatural Perspectives of Psychological Disorders<\/h3>\n<p>Convents throughout Europe in the 16th and 17th centuries reported hundreds of nuns falling into a state of frenzy in which the afflicted foamed at the mouth, screamed and convulsed, sexually propositioned priests, and confessed to having carnal relations with devils or Christ. Although today these cases would suggest serious mental illness, at the time, these events were routinely explained as possession by devilish forces (Waller, 2009a). Similarly, grievous fits by young girls are believed to have precipitated the witch panic in New England late in the 17th century (Demos, 1983). Such beliefs in supernatural causes of mental illness are still held in some societies today; for example, beliefs that supernatural forces cause mental illness are common in some cultures in modern-day Nigeria (Aghukwa, 2012).<\/p>\n<figure><\/figure>\n<div>\n<div>\n<div>\n<div class=\"textbox exercises\">\n<h3>Dig Deeper: Dancing Mania<\/h3>\n<section>\n<div>\n<div>\n<div id=\"attachment_4477\" style=\"width: 193px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2015\/02\/03043631\/d5035a823dc0c885913bd6135114afab.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4477\" class=\"wp-image-4477\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/855\/2015\/02\/03043631\/d5035a823dc0c885913bd6135114afab.jpg\" alt=\"Bosch painting depicting a man boring a hole in the top of the skull of a seated man, attempting to extract his &quot;madness&quot;\" width=\"183\" height=\"280\" \/><\/a><\/p>\n<p id=\"caption-attachment-4477\" class=\"wp-caption-text\"><strong>Figure 3<\/strong>. In <em>The Extraction of the Stone of Madness<\/em>, a 15th century painting by Hieronymus Bosch, a practitioner is using a tool to extract an object (the supposed \u201cstone of madness\u201d) from the head of an afflicted person.<\/p>\n<\/div>\n<p>Between the 11th and 17th centuries, a curious epidemic swept across Western Europe. Groups of people would suddenly begin to dance with wild abandon. This compulsion to dance\u2014referred to as dancing mania\u2014sometimes gripped thousands of people at a time (Figure 2). Historical accounts indicate that those afflicted would sometimes dance with bruised and bloody feet for days or weeks, screaming of terrible visions and begging priests and monks to save their souls (Waller, 2009b). What caused dancing mania is not known, but several explanations have been proposed, including spider venom and ergot poisoning (\u201cDancing Mania,\u201d 2011).<\/p>\n<figure>\n<div style=\"width: 411px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225107\/CNX_Psych_15_03_Mania.jpg\" alt=\"A painting shows a group of pilgrims dancing in a way that appears inconsistent and aimless.\" width=\"401\" height=\"203\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 4<\/strong>. Although the cause of dancing mania, depicted in this painting, was unclear, the behavior was attributed to supernatural forces.<\/p>\n<\/div>\n<\/figure>\n<p>Historian John Waller (2009a, 2009b) has provided a comprehensive and convincing explanation of dancing mania that suggests the phenomenon was attributable to a combination of three factors: psychological distress, social contagion, and belief in supernatural forces. Waller argued that various disasters of the time (such as famine, plagues, and floods) produced high levels of psychological distress that could increase the likelihood of succumbing to an involuntary trance state. Waller indicated that anthropological studies and accounts of possession rituals show that people are more likely to enter a trance state if they expect it to happen, and that entranced individuals behave in a ritualistic manner, their thoughts and behavior shaped by the spiritual beliefs of their culture. Thus, during periods of extreme physical and mental distress, all it took were a few people\u2014believing themselves to have been afflicted with a dancing curse\u2014to slip into a spontaneous trance and then act out the part of one who is cursed by dancing for days on end.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<h2>From the Middle Ages to the Twentieth Century<\/h2>\n<p>By the 18th century, people who were considered odd and unusual were placed in asylums. <strong>Asylums<\/strong> were the first institutions created for the specific purpose of housing people with psychological disorders, but the focus was ostracizing them from society rather than treating their disorders. Often these people were kept in windowless dungeons, beaten, chained to their beds, and had little to no contact with caregivers.<\/p>\n<figure><\/figure>\n<p>In the late 1700s, a French physician, Philippe Pinel, argued for the more humane treatment of the mentally ill. Pinel suggested that they be unchained and talked to, and that\u2019s just what he did for patients at La Salp\u00eatri\u00e8re in Paris in 1795. Patients benefited from this more humane treatment, and many were able to leave the hospital.<\/p>\n<figure>\n<div style=\"width: 374px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225136\/CNX_Psych_16_01_Pinel.jpg\" alt=\"A painting, set inside an asylum, depicts a person removing the chains from a patient. There are several other people in the scene, but the focus is on these two characters.\" width=\"364\" height=\"252\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 5<\/strong>. This painting by Tony Robert-Fleury depicts Dr. Philippe Pinel ordering the removal of chains from patients at the Salp\u00eatri\u00e8re asylum in Paris.<\/p>\n<\/div>\n<\/figure>\n<p>In the 19th century, Dorothea Dix led reform efforts for mental health care in the United States. She investigated how those who are mentally ill and poor were cared for, and she discovered an underfunded and unregulated system that perpetuated abuse of this population (Tiffany, 1891). Horrified by her findings, Dix began lobbying various state legislatures and the U.S. Congress for change (Tiffany, 1891). Her efforts led to the creation of the first mental asylums in the United States.<\/p>\n<figure>\n<div style=\"width: 254px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images-archive-read-only\/wp-content\/uploads\/sites\/902\/2015\/02\/23225138\/CNX_Psych_16_01_Dix.jpg\" alt=\"A portrait of Dorothea Dix is shown.\" width=\"244\" height=\"307\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 6<\/strong>. Dorothea Dix was a social reformer who became an advocate for the indigent insane and was instrumental in creating the first American mental asylum. She did this by relentlessly lobbying state legislatures and Congress to set up and fund such institutions.<\/p>\n<\/div>\n<\/figure>\n<p>Despite reformers\u2019 efforts, however, a typical asylum was filthy, offered very little treatment, and often kept people for decades. At Willard Psychiatric Center in upstate New York, for example, one treatment was to submerge patients in cold baths for long periods of time. Electroshock treatment was also used, and the way the treatment was administered often broke patients\u2019 backs; in 1943, doctors at Willard administered 1,443 shock treatments (Willard Psychiatric Center, 2009). (Electroshock is now called electroconvulsive treatment, and the therapy is still used, but with safeguards and under anesthesia. A brief application of electric stimulus is used to produce a generalized seizure. Controversy continues over its effectiveness versus the side effects.) Many of the wards and rooms were so cold that a glass of water would be frozen by morning (Willard Psychiatric Center, 2009). Willard\u2019s doors were not closed until 1995. Conditions like these remained commonplace until well into the 20th century.<\/p>\n<p>European psychiatry in the late 18th century and throughout the 19th century struggled between somatogenic and psychogenic explanations of mental illness, particularly hysteria, which caused physical symptoms such as blindness or paralysis with no apparent physiological explanation. Franz Anton Mesmer (1734\u20131815), influenced by contemporary discoveries in electricity, attributed hysterical symptoms to imbalances in a universal magnetic fluid found in individuals, rather than to a wandering uterus (Forrest, 1999). James Braid (1795\u20131860) shifted this belief in\u00a0<strong>mesmerism<\/strong>\u00a0to one in hypnosis, thereby proposing a psychogenic treatment for the removal of symptoms. At the time, famed Salpetriere Hospital neurologist Jean-Martin Charcot (1825\u20131893), and Ambroise Auguste Li\u00e9bault (1823\u20131904) and Hyppolyte Bernheim (1840\u20131919) of the Nancy School in France, were engaged in a bitter<span style=\"color: #ff9900;\">\u00a0<\/span>battle over the best explanation for hysteria, with Charcot maintaining that the hypnotic suggestibility underlying hysteria was a neurological condition while Li\u00e9bault and Bernheim believed it to be a general trait that varied in the population. Josef Breuer (1842\u20131925) and Sigmund Freud (1856\u20131939) would resolve this dispute in favor of a psychogenic explanation for mental illness by treating hysteria through hypnosis, which eventually led to the\u00a0cathartic method\u00a0that became the precursor for psychoanalysis during the first half of the 20th century.<\/p>\n<p><b>Emil Kraepelin<\/b>\u00a0(1856\u20131926) was a German\u00a0psychiatrist.\u00a0H.J. Eysenck&#8217;s\u00a0<i>Encyclopedia of Psychology<\/i>\u00a0identifies him as the founder of modern scientific\u00a0psychiatry,\u00a0psychopharmacology, and\u00a0psychiatric genetics.\u00a0Kraepelin believed the chief origin of psychiatric\u00a0disease\u00a0to be\u00a0biological\u00a0and\u00a0genetic\u00a0malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later\u00a0psychodynamic\u00a0influence of\u00a0Sigmund Freud\u00a0and his disciples, enjoyed a revival at century&#8217;s end.\u00a0Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as &#8220;symptomatic&#8221; and to his view as &#8220;clinical.&#8221; This turned out to be his\u00a0paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of\u00a0<strong>syndrome\u2014<\/strong>common\u00a0<i>patterns<\/i>\u00a0of symptoms over time\u2014rather than by simple similarity of major symptoms in the manner of his predecessors.\u00a0Drawing on his long-term research, and using the criteria of course, outcome, and\u00a0prognosis, he developed the concept of\u00a0<strong>dementia praecox<\/strong>, which he defined as the &#8220;sub-acute development of a peculiar simple condition of mental weakness occurring at a youthful age.&#8221;\u00a0<span style=\"font-size: 1rem; text-align: initial;\">This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the\u00a0dementia\u00a0part signifying the irreversible mental decline).\u00a0As a colleague of\u00a0Alois Alzheimer, he was a co-discoverer o<span style=\"color: #333333;\">f<\/span><\/span><span style=\"color: #333333;\"><em style=\"font-size: 1rem; text-align: initial;\">\u00a0Alzheimer&#8217;s disease<\/em><span style=\"font-size: 1rem; text-align: initial;\"> (thought to be a brain disease leading to dementia), and his laboratory discovered its pathological basis. This may have led to the <\/span><strong>medical model of illness<\/strong><em style=\"font-size: 1rem; text-align: initial;\">.\u00a0<\/em><\/span><\/p>\n<p>As we will discuss later in this course, in psychology, the term <em>medical model<\/em>\u00a0refers to the assumption that\u00a0psychopathology\u00a0is the result of one&#8217;s biology, that is to say, a physical\/organic problem in brain structures, neurotransmitters, genetics, the endocrine system, etc., as with traumatic\u00a0brain injury,\u00a0Alzheimer&#8217;s disease, or\u00a0Down&#8217;s syndrome. One aspect of such a model is that an ill patient should not be held responsible for the condition. The patient should not be blamed or stigmatized for the illness.\u00a0The medical model is useful in many situations as a guide for diagnosis, prognosis, and research. However, for most mental disorders, exclusive reliance on the medical model leads to an incomplete understanding, and, frequently, to incomplete or ineffective treatment interventions.<\/p>\n<div class=\"textbox exercises\">\n<h3>Link to Learning<\/h3>\n<p>View this <a href=\"https:\/\/www.tiki-toki.com\/timeline\/entry\/37146\/A-History-of-Mental-Institutions-in-the-United-States\/#vars!date=1810-07-03_14:51:59!\" target=\"_blank\" rel=\"noopener noreferrer\">timeline showing the history of mental institutions<\/a>\u00a0in the United States.<\/p>\n<\/div>\n<section>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_45a03d59-3021-4da3-bea5-9ca33be6695b\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/45a03d59-3021-4da3-bea5-9ca33be6695b?iframe_resize_id=assessment_practice_id_45a03d59-3021-4da3-bea5-9ca33be6695b\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_aab74ef1-6262-4421-8214-b9998ab5c763\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/aab74ef1-6262-4421-8214-b9998ab5c763?iframe_resize_id=assessment_practice_id_aab74ef1-6262-4421-8214-b9998ab5c763\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_46a6ea43-6de7-4212-ab80-d210c27863f4\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/46a6ea43-6de7-4212-ab80-d210c27863f4?iframe_resize_id=assessment_practice_id_46a6ea43-6de7-4212-ab80-d210c27863f4\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<\/section>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>asylum:\u00a0<\/strong>institution created for the specific purpose of housing people with\u00a0mental disorders<\/p>\n<p><strong>deinstitutionalization:\u00a0<\/strong>process of closing large asylums and integrating people back into the community where they can be treated locally<\/p>\n<p><strong>dementia praecox:\u00a0<\/strong>a &#8220;premature dementia&#8221; or &#8220;precocious madness&#8221;<\/p>\n<p><strong>etiology:<\/strong> the causal description of all of the factors that contribute to the development of a disorder or illness<\/p>\n<p><strong>humorism<\/strong> (or humoralism): a belief held by ancient Greek and Roman physicians (and until the 19th century) that an excess or deficiency in any of the four bodily fluids, or humors\u2014blood, black bile, yellow bile, and phlegm\u2014directly affected their health and temperament<\/p>\n<p><strong>hysteria:<\/strong> term used by the ancient Greeks and Egyptians to describe a disorder believed to be caused by a woman\u2019s uterus wandering throughout the body and interfering with other organs (today referred to as functional neurological symptom disorder, or conversion disorder, in which psychological problems are expressed in physical form)<\/p>\n<p><strong>mesmerism<\/strong>: derived from Franz Anton Mesmer in the late 18th century, an early version of hypnotism in which Mesmer claimed that hysterical symptoms could be treated through animal magnetism emanating from Mesmer\u2019s body and permeating the universe (and later through magnets); later explained in terms of high suggestibility in individuals<\/p>\n<p><strong>psychogenesis<\/strong>: developing from psychological origins<\/p>\n<p><strong>psychopathic:<\/strong>\u00a0a\u00a0personality disorder\u00a0characterized by persistent\u00a0antisocial behavior; impaired\u00a0empathy\u00a0and\u00a0remorse; and\u00a0bold,\u00a0disinhibited, and\u00a0egotistical traits<\/p>\n<p><strong>somatogenesis<\/strong>: developing from physical\/bodily origins<\/p>\n<p><strong>supernatural:<\/strong> developing from origins beyond the visible observable universe<\/p>\n<p><strong>stigma<\/strong>: social attitudes and prejudice against persons who are different that devalue the person or make them feel disgraced or ashamed and that can lead to exclusion or discrimination against others<\/p>\n<p><strong>syndrome:\u00a0<\/strong>common\u00a0patterns\u00a0of symptoms over time<\/p>\n<p><strong>trephination<\/strong>: the drilling of a hole in the skull, presumably as a way of treating psychological disorders<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-84\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Sonja Ann Miller for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Anton Tolman for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Mental Health Treatment: Past and Present. <strong>Authored by<\/strong>: OpenStax College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:Fa0iWQ2e@5\/Mental-Health-Treatment-Past-a\">http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:Fa0iWQ2e@5\/Mental-Health-Treatment-Past-a<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/content\/col11629\/latest\/.<\/li><li>History of Mental Illness. <strong>Authored by<\/strong>: Ingrid G. Farreras . <strong>Provided by<\/strong>: Hood College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/nobaproject.com\/modules\/history-of-mental-illness\">https:\/\/nobaproject.com\/modules\/history-of-mental-illness<\/a>. <strong>Project<\/strong>: The Noba Project. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/\">CC BY-NC-SA: Attribution-NonCommercial-ShareAlike<\/a><\/em><\/li><li>Psychopathy. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Psychopathy\">https:\/\/en.wikipedia.org\/wiki\/Psychopathy<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>William Griesinger. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Wilhelm_Griesinger\">https:\/\/en.wikipedia.org\/wiki\/Wilhelm_Griesinger<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Dementia praecox. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Dementia_praecox\">https:\/\/en.wikipedia.org\/wiki\/Dementia_praecox<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Emil Kraepelin. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin#Theories_and_classification_schemes\">https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin#Theories_and_classification_schemes<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Medical Model. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Medical_model#In_psychology\">https:\/\/en.wikipedia.org\/wiki\/Medical_model#In_psychology<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-84-1\">Quoted in Edward Shorter (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley. p. 76. ISBN 978-0-471-15749-6. <a href=\"#return-footnote-84-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":4,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Mental Health Treatment: Past and Present\",\"author\":\"OpenStax College\",\"organization\":\"\",\"url\":\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:Fa0iWQ2e@5\/Mental-Health-Treatment-Past-a\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/content\/col11629\/latest\/.\"},{\"type\":\"cc\",\"description\":\"History of Mental Illness\",\"author\":\"Ingrid G. Farreras \",\"organization\":\"Hood College\",\"url\":\"https:\/\/nobaproject.com\/modules\/history-of-mental-illness\",\"project\":\"The Noba Project\",\"license\":\"cc-by-nc-sa\",\"license_terms\":\"\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Sonja Ann Miller for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Psychopathy\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Psychopathy\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"William Griesinger\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Wilhelm_Griesinger\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Anton Tolman for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Dementia praecox\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Dementia_praecox\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Emil Kraepelin\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Emil_Kraepelin#Theories_and_classification_schemes\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Medical Model\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Medical_model#In_psychology\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"1f7ec762-728b-4776-b5d7-97faec9eeec6, c54ef38c-023a-4ecf-9cb4-acceac0afef4, a34311ae-d89e-462e-95bf-2af5fcb20a89","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-84","chapter","type-chapter","status-publish","hentry"],"part":132,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/84","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":41,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/84\/revisions"}],"predecessor-version":[{"id":7466,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/84\/revisions\/7466"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/132"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/84\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=84"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=84"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=84"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=84"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}