Early Clinical Psychology

1. Early Clinical Psychology

2. Clinical psychology is relatively new • Why? • Titchner and others saw mental health to be outside of what psychology was to study • Conflict between the medical model and psychological model of mental health. • Medical model – there are naturally occurring causes for all illnesses including mental illnesses • Example – Emil Kraepelin

3. Emil Kraepelin • Studied with Wundt but attempted to classify mental illnesses according to what caused them, their symptoms, and their treatment - 1883 • Mania • Depression • Dementia praecox • Manic depression • Neurosis – mild disorders • Most disorders were not curable and caused by biological factors

4. Psychological Model • Lightner Witmer: • 1897 – founded the first psychological clinic • 1907 – developed the first clinical journal The Psychological Clinic • He was trained as a scientist, and believed that clinicians should be trained as scientist and apply psychological science to treatment of mental illness

5. Psychological Model • Psychological model would not become extensively accepted until Freud, an M.D. adopted a non-medical model of mental illness • WWII also gave impetus because there was not enough psychiatrists to treat the large numbers of people needing mental health services

6. History of clinical psychology • Treating and counseling patients a very recent profession • Mental illness always considered part of medicine • No doctoral programs in clinical psychology before WWII

7. Early history of mental illness • Basic issue : no outward signs of injury or illness – strange or bizarre behavior with no visible cause • Trephination – cutting holes in the skull to let evil spirits out • Primitive cultures used other supernatural cures • Early Greeks performed ceremonies to please the gods so they would leave the individual alone

8. Early history of mental illness • Greek and Roman physicians removed mysticism from medicine and looked for physical causes • Decline of Greek and Roman civilizations resulted in a return to mythology and demonology • Exorcism of evil spirits returned

9. Middle ages and mental illness • The dominant Christian church concerned about the contention between God and the devil for people’s souls • Since no cause could be seen for mental illness, voluntary possession by the devil was proposed as the cause

10. This solution solved two problems • People feared he mentally ill for two reasons: • 1. Their strange behavior scared people • 2. People were scared they could develop these bizarre behaviors • Solution became these people voluntarily consorted with he devil; I do not • They need to be executed so they won’t hurt others

11. “Treatment” of mentally ill • Get the people to confess their sins of consorting with the devil. They have to confess so use torture • After getting a confession, execute them for their sins

12. “Treatment in 18th and 19th century not much better • Us of large institutions or asylums to housed mentally ill; emphasis was on protecting the public not to treating the mentally ill • Institutions largely paid for by allowing tourist to pay to walk through the asylum and watch the crazy people

13. Treatments in 18th and 19th century • Starvation and tormenting • Water cures • Whirling • Bloodletting – most prevalent

14. The return to mental illness having natural causes • 1790’s Paris • Philippe Pinel – changed the treatment of people in the major asylum in Paris • Pinel not the first to remove chains from patients it had happened din Italy 8 years earlier • Pinel instituted many of the basic medical philosophies to mental health

15. Philosophy Of Pinel • 1. Do no harm – ended bloodletting, whirling, etc. • 2. Use minimal restraint necessary – least restrictive environment needed to maintain safety and order • 3. Provide humane conditions • 4. Eliminate physical abuse • 5. These people are sick not criminals • 6. Most important for psychology – not all illnesses had biological causes

16. Going against the prevailing Zeitgeist • Prevailing opinion was that mental disorders were the result nontreatable physical causes – lock people up and chain them so they could do no harm • Pinel reviewed records, observed patients, talked to patients, and realized many did not need to be chained or locked up

17. Going against the prevailing Zeitgeist • Why was Pinel allowed to have the greatest success in the history of psychopathology and treatment? • He took over the operation of the two principle insane asylums in Paris during the French revolution (1797) • The country was in such chaos people let him do what he wanted • He was successful so when the chaos decreased, things couldn’t return to the way they were

18. Treatment in Britain and the U.S. • Tukes and others were successful in developing small private institutions in Britain • Dorthea Dix and others successful in reforming many institutions in the U.S • Most large institutions tended to emphasize protecting the public at the expense of treatment • Greatest change in treatment has resulted from the development of psychoactive drugs

19. Foundations of psychoanalysis • Franz Mesmer – passed magnets over people until they fell into a trance – called mesmerized • He attributed his cure as the flow of healing energy from a healthy person to an unhealthy person • 1784 – A Royal Commission ruled mesmerism useless and dangerous and banned Mesmer from Paris

20. Mesmerism and hypnosis • British proponents were able to show that some surgical procedures could be performed on mesmerized people • 1843 James Braid a British physician discovered that mesmerism was a form of deep sleep induced by suggestion which he called hypnotism

21. Hypnosis in Paris • Jean Charcot opened his hypnosis clinic and in 1885 Sigmund Freud came to Paris to learn hypnosis • Charcot demonstrated that under hypnosis, a non-hysterical person could be made to exhibit symptoms of hysteria. • Indicates that conditions of the body could be controlled by the mind • He suggested that sexual problems could be the underlying cause of hysteria

22. Sigmund Freud • Graduated from medical school in 1881 • Nearly ended his career in 1885 as a result of his use of cocaine and advocacy for the use of cocaine • Censured for advocating such a dangerous drug • Never became addicted to cocaine, but wasn’t as lucky with nicotine

23. Freud and Joseph Breuer • Treatment of Anna O a women suffering from hysteria • Reportedly Breuer cured her of hysteria through hypnosis and having her relive the experiences that led to her symptoms – a cathartic cure • Anna O was actually Bertha Pappenheim who became a social worker in Germany

24. Bertha Pappenheim • Breuer stopped treating her because his wife was jealous of the time spent with her • She was institutionalized in 1882 still suffering from hysteria • Treated with high dosages of morphine and emerged from the institution in the late 1880’s still on morphine • He eventually became engaged in the feminist movement, was a playwright , wrote books, founded schools, etc. • Very negative attitude about psychoanalysis • A very different story than the one told by Breuer and Freud in 1895

25. Freud and psychoanalytic theory • Freud abandoned hypnosis for free association • Patients spoke about whatever came into their mind • His patients – mostly neurotic women- spoke about sexual seductions by their fathers

26. Seduction theory • Neurosis caused by sexual problems resulting from sexual abuse by fathers • Later he changed the theory from actual sexual abuse to fantasies of desire for seduction by their fathers • Reason for the change still debated today • Freud – sexual abuse couldn’t be that prevalent in upper class Vienna, maybe he had suggested to his patients what he was hearing • Others – original seduction theory called scientific fairy tale by powerful physicians who pressured him to change it

27. Two basic conclusions of Freud • Infantile sexuality was a reality • When patients recall sexual memories from early childhood, the unconscious does not differentiate between truth and “emotionally charged fiction” • Treatment needed to help patients distinguish between psychic reality and actual reality

28. Interpretation of Dreams • Dreams were a direct route to the unconscious • Its popularity made him famous and led to his psychoanalytic theory of development and the role of sexual energy • Freud very popular in the U.S. despite his low opinions of America and Americans, but never well accepted in Europe

29. Decline of Freudian theory • Freud was authoritarian, dogmatic, and most important paternalistic • His followers were like his children and expected to accept his views without question • Adler disagreed with Freud’s Sexual theory of hysteria and was forced to resign from Freud’s Vienna Psychoanalytic Society in 1911 • Jung followed in 1914, both wanted to consider social and cultural factors of development

30. Two basic issues split the psychoanalysis's • 1. biological sex drive as the driving force behind all human behavior and development • The relationship between the id and the ego • Freud – the id is the master and the ego is a slave to id and superego • Dissenters objected to the slave-master relationship

31. Anna Freud • Most loyal follower of Freud • Her type of psychoanalysis became the prevalent psychoanalytic practice in the U.S. • Her lasting legacy was extending her father’s principles to the treatment of children – including play therapy

32. Adler and Jung • Particularly singled out by Freud for their “treasonist actions” • Both popular with large followings • Adler was popular because he had a more optimistic view of human nature • Jung was very influential outside of psychology, but his lack of a scientific approach made him less important to psychology

33. Freud’s legacy • While his theories have been criticized and many have been rejected, they served as a basis for thought discussion and development of new theories • A major force in psychiatry from 1910 -1930 • Rise of the Nazis did much to reduce his impact as did his personality