Changing Minds (1) : the Self as an object of change in history

1. Changing Minds (1) : the Self as an object of change in history Professor Gwen Adshead Gwen.Adshead@southernhealth.nhs.uk

2. Acknowledgements and Apologies • Professors Joanna Woodall and Barbara Taylor; and the work of Professor Andrew Scull • Dr Morris Nitsun, therapist and artist. • Apologia 1: to set out some historical background to the process of changing minds • Apologia 2: The second is a traditional apology and plea for forgiveness for the inevitable limitations of a 1 hour lecture!

3. Changing minds • What do we mean by change? A difference across time • What do we mean by Mind? • How to relate to concepts like Self, Personality and Identity • Dan McAdams’s account of personality: • Actor, Agent and Author: the story we tell of ourselves

4. Early accounts of the Self and Mind • Abrahamic or theological accounts: the Self, the Heart, the Soul, the Will: all separate aspects of the person • Plato’s account of a Self in three parts • Mental illness: first understood as a loss of reason, caused by possession • Hippocrates: an early disease model of mind –body imbalance.

6. Hippocratic corpus • Hippocrates and other writers • A disease model of mental illness, based in the brain. • A homeostatic model: mind and body linked together by humors • Illnesses arise from disturbance of humoral regulation: much like neurotransmitter theory now • Hippocratic Corpus described mania, delirium, melancholia, anxieties, phobias and puerperal psychosis and paranoia.

8. The Humoral Model Mental illness thought due to disturbances of humors – black bile, yellow bile, blood and phlegm • Black bile: earth, cold and dry, associated with melancholia. • Yellow bile: fire, hot and dry, associated with mania. • Needed to rebalance the humors to cure people – warm, cold, purging, bloodletting, diet, activity, rest and exercise etc. • Persisted until 17th century; international acceptance and expansion.

10. An early separation • Knowing Yourself: which could be known by introspection and self-reflection: the Narcissus Myth sets out the dangers of not recognising yourself. The subject of philosophy and theology . • Madness: loss of reason and behavioural constraint. Treated by doctors. A perceived link with violence and magic/witchcraft persisted for centuries.

11. Different types of intervention • For Self-improvement there was religious belief and living a life of faith: c.f. Religious Exercises, Meditative practice, spiritual instruction. • For mental illness: the treatments associated with humoral regulation. Emphasis on organic causes: cf Aristotle’s brain drawings. First ‘hospitals’ for mental illness associated with religious foundations in 14C.

13. Early modern ideas of Self • The Self is plural: not only is there internal conflict, there may be conflict between the inner Self and the external Self that is seen by others • The rise of the Portrait: depiction of the Self as virtuous, memorable and heroic • But there is an aspect of Self that is secret, not what it seems, hard to see clearly

16. The Self, the Person, the Identity • The Self that speaks and self reflects • A Self on show • The hidden Self: often in the form of desires that cannot be spoken of • The Person who has rights and duties • Face and Appearance are distinct from Hearts and Souls • Identity: a social construct: the ‘picture’ of yourself for the world

18. Shakespeare and the modern Self • The Self that speaks and self reflects: Richard III and the 4th wall on the stage • Lear as an exploration of changes of identity as a prelude to madness • Edgar/Poor Tom/Lear: Counterfeit and True madness • Othello: madness induced by thought • ‘The mind diseased’: physicians, divines and self healing

19. 18C • Sydenham: Nerves, brain and mind • Defects or deficits in brains lead to madness • ‘Degenerate’ brains lead to otherness: madness as ‘the Other’ • Romantic movements addressing Self experience • The rise of the Secular Self: portraits become more realistic

20. St Mary of Bethlehem

21. Madhouses and psychiatry • Patients chained to the walls if violent. • Filthy living conditions, residents physically abused • Used for the violently psychotic, sometimes for morally ‘unusual’ people. • Developed as private businesses • 18C expansion: a move away from religious contexts • Organic medical models of mental illness develop in 19C: ‘degeneracy’ • “Psychiatry’ first used as a term in German in 19C • Expansion continued until late 20C then abruptly reversed

22. Moral therapy • An attempt at a personal and compassionate approach to people living with madness • People who lacked reason were not all violent and non-human • Madness was compatible with creativity, human emotions and thought • An affliction model • No psychological account

24. The English Malady • People of quality suffered with their ‘nerves’ • A problem from madness and mad houses • Dealt with in a medical manner by neurologists who prescribed ‘treatments’ • Women prescribed ‘rest’: too much stimulation or action was bad • The beginning of something psychological

25. The split continues • Neuroses dealt with by neurologists; a disorders of the intelligent, sensitive, quality. Diet, exercise, travel and rest ( not work). Entirely secular. • Psychosis dealt with by psychiatrists by admission to madhouses and ‘therapeutic regimes’: routine, work and high moral standards. Also secular • Self improvement by moral growth: religion and philosophy are distinct

26. Top 10 weird treatments • Dr Rushes spinning chair – to relieve brain congestion • Warm baths for mania, cold baths for depression. • Near drowning • Malaria for syphillis • Tooth extraction • Hysterectomies

28. William James • An account of the Self as an agency that directs attention to that which has personal meaning • Three aspects: body, social and spiritual • The spiritual self is the Core: the ‘sick soul’ • There is a public ‘I’ and a private ‘me’ • Both of these could be disturbed

29. Phenomenology • Descriptive studies of mental phenomena. • Classification and categorisations • Psychiatrists become psychologists also: describing and treating psychological phenomena which are deemed to be ‘abnormal’ • Psychological abnormality which is distinct from lack of reason

31. 20C: the effect of war • A challenge to the degeneracy model of mental distress • Strong, health males became psychologically damaged by exposure to battle stress: US Civil War, WW1 and WW2 • If psychological experience could produce disturbance of mind: then a psychology of mind was needed • Tension between organic and psychological models of ‘illness’ or abnormality

33. 20C ways of changing your mind • 1900 The beginnings of psychoanalysis: the mind that is not conscious • 1954 Drug treatments: the ablation of mental distress, disturbing thoughts, anxiety and sadness • 1950s: Brain surgeries: the rise (and fall) of lobotomy • 1960s Development of cognitive therapies, and challenge to psychoanalysis: the therapy wars begin • External change? Or internal change?

35. The Social Self • The effect of anthropological studies on psychology • Social relationships have an effect on self-presentation • Social environments affect mental ill health: ‘survivor syndrome’ in Holocaust survivors • Criticism of traditional models of medicine that excluded the subjective experience: the rise of the post-modern

36. The study of personality and personality change • A tension between fixed and changeable aspects to the personality • Genetic explanations versus social explanations • Dan McAdams’ model of the personality: the (re)actor, the agent and the author • No longer a picture of your Self but a story of your self: You narrate your own identity in the social realm

37. The Self as an object of treatment • Rise of psychological treatments where patient’s subjectivity is dominant • Challenge to medical hegemony and psychiatric control over labelling of experience and detention • Influences political movements to save money in mental health care, and promote normalisation • 1960 rise of psychological therapies and the concept of self-improvement by psychological exploration • 20C version of classical ideas: the Self becomes a Person who is located in a relational context as well as being an Individual ‘I’ • Therapy for relationships

38. Changes in amygdala function with mindfulness practice

39. And now… • A tension between mental distress as arising from persons as individual bundles of brain circuits and neuro-transmitters • And the self-experience in social contexts: carers , partners and family are crucial • Self exploration and introspection is encouraged • Meditative practices encouraged and studied • Still a split between psychology and psychiatry • Still uncertainty about the relationship between Self, Person, identity , Heart and Will

41. References