Treatment of Psychological Disorders: Then and Now

1. Treatment of Psychological Disorders: Then and Now

2. History of Psychological Treatments – Prehistoric Times • Scientists have identified a method possibly used to treat mental illness between 1,000 B.C. and 3,000 B.C., called trephining. • Prehistoric humans most likely identified the cause of disturbed behavior as “evil spirits.” • Trephination: was the drilling of holes in the skull as a means of releasing “evil spirits” that were trapped inside the head, causing abnormal behavior.

3. Hospital of St. Mary of Bethlehem • The hospital was originally created in 1247 for poor people, and by 1403 began to house people called “lunatics.” • In the next few centuries, the inhumane and chaotic housing of the psychologically disturbed came to be known as “bedlam”, a derivative of the hospital’s name. • The hospital quickly became overcrowded and the residents more uncontrollable. The hospital employed chains and punishment to control patients. • It was common for rich Londoners to visit the hospital and pay to be allowed to walk around staring at the patients, simply for amusement. “The Rake's Progress – Scene in Bedlam”

4. Life in the Asylums • William Battie also advocated the use of "therapeutic" asylums. • Many of the mentally ill were being treated in prisons or other inappropriate institutions. Asylums, however, continued to be known for their dehumanizing conditions. • In the 18th century, an asylum in Newcastle, England, housed both sexes together tethered in chains in a dungeon-like atmosphere. • In 1845, Esquirol reported on the inhumane aspects of the asylum environment: "If the patient's violence is extreme, he is fastened onto his bed and his movements are brought under control with a straitjacket....How many manic patients have become paralyzedthrough being fastened too long on their bed or in an armchair." • Treatments included agents such as opium or camphor mixed with vinegar. In more extreme cases moxa, a flaming pitch applied to the head, was used. Esquirol also suggested that: "You can, if you wish, substitute for an iron heated in the fire, an iron heated in boiling water." • In England as well as in the United States, patients would be placed on display on Sunday for the curious to view.

5. Development of the Moral Philosophy of Treatment • Philippe Pinel (1745-1826) became chief physician at La Bicetre’s ward for the mentally ill in 1793. Pinel is considered historically to be a primary figure in the movement for humanitarianism. • He emphasized keeping case histories of patients and developed the concept of "moral treatment", which involved treating patients with kindness and sensitivity. • Pinel removed the chains of the people imprisoned at La Bicetre (symbolically celebrated in the painting) • He argued that they must be treated as sick human beings rather than evil beasts. • Many patients who had been incarcerated for years were restored to health and eventually discharged from the hospital. 

6. Other Advocates of the Moral Philosophy of Treatment • Benjamin Rush • He is considered the father of American psychiatry as he instituted a more scientific approach, and made many changes that improved the conditions for the mentally ill. • The fact that he was a founding father, politician, and signed the Declaration of Independence gave him the power to institute reform. • However, his methods of treatment were still inhumane and ineffective. He believed bloodletting, purging, and terrifying were beneficial.

7. Benjamin Rush (cont.) • Rush used some crude devices to treat the mentally ill; none of which were very effective. The circulating swing (top left) was used to spin depressed patients at high speeds. • The tranquilizer chair (top right) was used to calm people suffering from mania. • The crib (bottom) was widely used to restrain violent patients. • Rush also felt that frightening the patient was beneficial. Some subjects were told repeatedly of their impending death, and then placed in a casket with holes that was submerged in water for several minutes. Rush’s favorite treatment was bleeding. He felt that many mental disorders were caused by a buildup of blood in the brain.

8. Other Advocates of the Moral Philosophy of Treatment • Dorothea Dix • In 1841, Dix was asked to teach a Sunday school class at a local prison in Massachusetts. • She was shocked to see mentally ill patients locked up with prisoners in dark, unheated, and filthy rooms. • Throughout her lifetime, she spoke to state legislatures and succeeded in reforming prisons and the treatment of people with psychological disorders. Dorthea Dix (1802-1887)

9. Other Advocates of the Moral Philosophy of Treatment • C.W. Beers • Clifford Whittingham Beers (1876-1943), a Yale graduate, suffered a mental breakdown and was confined to an asylum from 1900-1903. • After his recovery, he aroused new concern for mentally ill individuals when he published a study of his experience titled A Mind That Found Itself (1908). • Beers was responsible for founding the National Committee for Mental Hygiene, which worked to prevent mental illness and ensure humane treatment.

10. Recap: Methods of Treatment Throughout History

11. And then along came Freud…

12. Modern Therapies • Experts estimate that there may be over 400 different approaches to treatment, although they can be classified into major categories. • Psychotherapy • Involves an emotionally charged, interaction between a trained therapist and a mental patient. • Insight therapy involves pursuing increased insight regarding the nature of the client’s difficulty and sorting through possible solutions (“talk therapy”). • Behavior therapy is based on the principles of learning, with behavior therapists working to alter maladaptive habits and change overt behaviors. • Biomedical Therapy • Uses drugs or other procedures that act on the patient’s nervous system, treating his or her psychological disorders. • An Eclectic Approach • Uses various forms of healing techniques depending upon the client’s unique problems.

13. Who Seeks Treatment? • According to the recent U.S. Surgeon General’s report on mental health (1999), about 15% of the population uses mental health services in a given year. • The two most common presenting problems are anxiety and depression. • People vary considerably in their willingness to seek treatment, with women more likely to seek help than men, and people with higher educational levels doing so more frequently. • Medical insurance is also related to treatment-seeking; having it increases the likelihood. • Many people who need help don’t seek it, and the Surgeon General reports that the biggest roadblock is the “stigma surrounding the receipt of mental health treatment."

14. Figure 15.2: Therapy utilization rates. Olfson and colleagues (2002) gathered data on the use of nonhospital outpatient mental health services in the United States in relation to various demographic variables. In regard to marital status, utilization rates are particularly high among those who are divorced or separated. The use of therapy is greater among those who have more education; in terms of age, utilization peaks in the 35–44 age bracket. Females are more likely to pursue therapy than males are, but utilization rates are extremely low among ethnic minorities. (Data from Olfson et al., 2002)

15. Figure 15.1: Treatment seeking for various disorders. In a study of the extent to which people seek treatment for psychological disorders, Wang et al. (2005) found that only a minority of people promptly pursue treatment for their disorder. The data summarized here show the percentage of people who obtain professional treatment within the first year after the onset of various disorders. The percentages vary depending on the disorder, but all the figures are surprisingly low. (Data from Wang et al., 2005)

16. Who Provides Treatment? • There are a variety of “helping professions” available: • Psychologists who provide psychotherapy may have degrees in clinical or counseling psychology, specializing in the diagnosis and treatment of psychological disorders and everyday behavioral problems. Both types must earn a doctoral degree (Ph.D., Psy.D., or Ed.D.), which requires 5-7 years beyond a bachelor’s degree. Admission to Ph.D. programs in clinical psychology is very competitive, about like getting into medical school. • Psychiatrists are medical doctors who specialize in the diagnosis and treatment of psychological disorders. They are, at present, the only psychotherapy administering profession to be able to prescribe drugs, although psychologists are lobbying for prescription rights (given appropriate training). • Clinical social workers generally have a master’s degree and are increasingly providing a wide range of therapeutic services as independent practitioners. • Psychiatric nurses may hold a bachelor’s or master’s degree and often play a large role in hospital inpatient treatment. • Counselors are usually found working in schools, colleges, and assorted human service agencies. They typically have a master’s degree and often specialize in specific areas, such as vocational or marital counseling.