The Practice of Psychology at the Interface with Medicine

1. The Practice of Psychology at the Interface with Medicine Part 1 From Enlightenment to Freud

2. What is the Background to Freud? • Enlightenment Notions of Madness • Treatment of the “Mad” or “Lunatic” • From Mesmerism to Hypnosis • Charcot: Hysteria & Hypnosis

3. Enlightenment Notions of Madness • Enlightenment (1600-1800) = “The Age of Reason” • Reason: ability of an individual mind to understand clearly what is real, true, beautiful, moral • Reason is not swayed unduly by emotion or false beliefs • Reason vs. appeal to tradition, superstition, prejudice or myth as basis of action • Those who were “mad” or “lunatics” had lost their reason • Madness was NOT an illness

4. St. Mary of Bethlehem (Bedlam) Hospital, England • Despite some abuses, medieval (AD 500-1500) treatment of mentally ill was commonly benign • The “mad” were often kept at home or allowed to roam free • Early modern treatment in asylums under government control was often neglectful. Ill treated as prisoners • “Bedlam” hospital (1547-) served as tourist attraction in 18th & 19th centuries with visits to “madmen”

5. http://wwwihm.nlm.nih.gov/ihm/images/A/13/392.jpg http://wwwihm.nlm.nih.gov/ihm/images/A/24/102.jpg Esquirol (1838) Mentally-ill woman chained in Bedlam William Hogarth: The Rake’s Progress Scene in Bedlam Inside Bedlam

6. Post-Revolutionary Reform of Hospitals The period after the French Revolution (1789) until the early 20th century was marked by some positive reforms in hospital treatment of the mentally ill • Pinel in “Revolutionary” France • William Tuke’s York Retreat in England • American Reformers

7. Philippe Pinel & Reform in France • L’Hôpital Général Bicêtre outside Paris and Salpêtrière Hospital for women in Paris were reformed after 1793 in spirit of Revolution to treat citizens more respectfully • Use of chains and “prison-like” treatment of mentally ill were ended. Patients often did better and went home. http://library.utmb.edu/portraits/pinel.jpg

8. William Tuke & the York Retreat • Tuke was an English Quaker & philanthropist • Established the York Retreat in 1796 • Principles of “moral treatment” = fresh air & countryside, kindness toward patients, exercise & good diet, music & literature, daily activities, & religious (Quaker) atmosphere • Small groups of patients (10 to 30) • Also established in USA http://www.suite101.com/files/topics/1370/files/retreat2.jpg http://www.retreat-hospital.org/media/images/bill.jpg

9. http://www.uua.org/info/Rusk-Benjamin.jpg American Reformers • Rush encouraged humane treatment in late 18th & early 19th centuries • Early psychiatrists are called “alienists” because patients were alienated from reason • Kirkbride Plan of 1850s: mental hospitals designed in orderly fashion to foster return of order to patients’ minds • By late 19th century & early 20th century, mental hospitals had become overcrowded and warehouses of the insane Benjamin Rush (1745-1813) Thomas Kirkbride (1809-1883) http://en.wikipedia.org/wiki/File: Thomas_Story_Kirkbride.jpg

10. Kirkbride Plan Hospital • Separated by sex, level of impairment • Situated in a more natural environment outside of cities, pollution, & noise • Lots of fresh air, natural light, opportunity to walk on landscaped grounds • Opportunity to work on farm & do other chores • Recreation, games, & interaction with other patients http://www.kirkbridebuildings.com/about/history.html

11. Mesmerism Mesmer • Franz Anton Mesmer (1734-1815) used magnets to treat patients in Vienna & Paris. Hysterical patients often responded to “animal magnetism” • Hysteria = sensory or motor problems without a physical or anatomical problem • Lack of sensation (paresthesia) • Inability to move (paralysis) Believed to be a woman’s illness • Royal commission in Paris concluded that “mesmerism” was not a valid treatment Magnetism Treatment in Paris http://faculty.washington.edu/chudler/gif/mesmer.jpg

12. Hypnotism • Trance states discovered by the Marquis de Puységur, a member of the Society of Harmony which promoted “mesmerism” • Power to enter state lay with the subject who was “suggestible” for trance. He called it “artificial or magnetic somnambulism” • James Esdaile performs 250 surgical operations in India with “mesmeric analgesia” (1845-1853) • James Braid (1795-1860 Scottish surgeon) coins term (neuro)hypnotism for trance-like state ca. 1841-43

13. Hypnosis II • Two French schools of hypnotism developed • Nancy School (Ambrose-Auguste Liébault & Hippolyte Bernheim): potential for hypnotic trance induction is ordinary human trait. Humans are suggestible. • Salpêtrière School (Jean Martin Charcot): hypnotism is associated with hysteria (not normal) and explains hysterical states which are, therefore, “real” (not faked) (see next slide) Charcot demonstrates hypnotism

14. Jean Martin Charcot • 1825-1893 • Salpêtrière Hospital: trained there as neurologist & returned as director • Made the hospital a major research center using the “anatomical-clinical” method • Believed hysteria was an inherited, functional disease of the nervous system • Linked hysteria with hypnosis which he used to treat patients & demonstrated before visiting doctors • Argued that some symptoms came from a traumatic experience that “dissociated” some ideas from consciousness & led to hysteria • Freud studied with Charcot briefly in winter of 1885-1886 http://29.media.tumblr.com/ tumblr_lcnw5pL5321qzn0deo1_500.jpg

15. Structure of Freud’s Life • b. May 6, 1856 in Moravia (part of Czech Republic) • 1860 family settles in Vienna, Austria • 1856-1886 Childhood, Education, Neuropathologist • I (1886-1900) Formulating Psychoanalysis (PA) • II (1900-1920) PA Gains Recognition • III (1920-1939) Reformulating PA & Consolidation • 1938 Freud goes into exile (Nazis seize Austria) • d. Sept. 23, 1939 in London, UK

16. 1856 May 6 Birth certificate of Sigismund Schlomo Freud Freud’s Family (ca. 1876) Amalia (mother) Jacob (father) • Middle-class Jewish family • He is gifted student • Multilingual: German, English, French, Latin, Greek, Spanish, Italian, Hebrew • Treated as special by parents

17. University of Vienna Ernst Brücke http://www.univie.ac.at/public/imguni.jpg http://clendening.kumc.edu/dc/pc/brucke.jpg Theodore Meynert http://pages.globetrotter.net/desgros/images/meynert.jpg Salpêtrière Hospital, Paris http://www.ch-charcot56.fr/images/histoire/histpsy/salpetr.jpg Freud’s Education • 1873 U Vienna medical student • 1876 Ernst Brücke’s Institute as research scholar • 1881 M.D. & continues at Institute • 1882-8 Vienna General Hospital: Surgery, Dermatology, Ophthalmology, Psychiatry (Theodore Meynert) • 1885 Privatdozent (Instructor of Neuropathology) • 1885-86 Studied in Paris with Charcot at Salpêtrière • 1886 Sets up private practice of neurology & marries Martha Bernays

18. http://psiconet.org/otros/breuer.gif http://pages.globetrotter.net/desgros/images/annao.jpg Breuer & Hysteria • 1882 Josef Breuer describes case of Anna O. (Bertha Pappenheim) to Freud • Hysteria: Hallucinations, nervous cough, immobility, paralysis, paresthesia, et al. • Breuer found she calmed down if allowed to tell her stories • Used hypnosis to facilitate storytelling • Anna O. called it the “talking cure” • 1892-1895 Freud had used hypnotism with his patients, but began to use non-directive “free association” (say what comes to mind) • 1895 Publishes Studies on Hysteria with Breuer • Freud argues that sexual feelings are behind patient’s growing attachment to therapist (transference). Breuer & others reject sexual origins of neuroses. Dr. Josef Breurer Bertha Pappenheim (Anna O.)