Abnormal Psychology. William J. Ray

      Hippocrates is often seen as the father of Western medicine.

      GraphicaArtis/Contributor/Archive Photos/Getty Images

      Historical Considerations in Understanding Psychopathology

      In this section of the chapter, I will examine our conceptualizations of mental illness over time. I will also show you how, as we developed new scientific techniques for understanding human processes, the conceptualizations of mental illness also changed. We have gone from a worldview in which magic, including the idea that you could be possessed by spirits or demons, produced mental illness to a time in which our scientific understanding describes a complex set of processes on many levels that contribute to mental illness. Today, we have also come to see those with mental illness as whole people with both abilities and deficits. In terms of the future, there is a growing movement to allow people with mental disorders to have a greater say in their treatment. A person’s high functioning and the ability to make decisions are not totally taken away by having a mental disorder. The person is still able to describe his or her experiences and, in the best of conditions, to ask others for help. However, I am getting ahead of myself.

      Psychology seeks to describe and understand human behavior and experience. In fact, as humans, we have a long history of trying to understand ourselves. In this section, I will discuss some of the historical conceptions that have influenced psychology (see Finger, 2000, or the classic Boring, 1950, for more information). One of these conceptions is the role of the body and its involvement in our mental processes. Some of the ideas we will examine date back thousands of years yet still influence our views today.

      Ancient Greek and Roman Influences—Mental Illness Involves the Brain

      Beginning with Pythagoras in the sixth century BCE, whom we know for his theorem concerning the sides of a right triangle, there was an emphasis on identifying the underlying scientific principles that may account for all forms of behavior. Pythagoras not only coined the term philosophy, which can be translated as love of meaning or wisdom, but also began to set the stage for understanding human behavior and experience as related to internal processes and natural causes. This was in contrast to the prevailing view that human behavior and related disorders reflected the actions of the gods such as the belief that mental illness was a divine punishment. Pythagoras was one of the first to see the brain as the structure involved in human intellect as well as in mental disorders.

      In the next century, Hippocrates moved this concept to the next level with his emphasis on careful observation and a continued articulation of the idea that all disorders, both mental and physical, should be sought within the patient. Hippocrates is often seen as the father of Western medicine. His view of the brain is clearly stated in the following quote:

      Men ought to know that from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear, and know what are foul and what are fair, what are bad and what are good, what are sweet, and what unsavory; some we discriminate by habit, and some we perceive by their utility. By this we distinguish objects of relish and disrelish, according to the seasons; and the same things do not always please us. And by the same organ we become mad and delirious, and fears and terrors assail us, some by night, and some by day, and dreams and untimely wanderings, and cares that are not suitable, and ignorance of present circumstances, desuetude, and unskillfulness. All these things we endure from the brain. (Hippocrates, 400 BCE)

      Galen (130–200 CE) was a physician in the Roman Empire who influenced Western and Islamic thought until the Renaissance. Some see him as a representation of the beginning of experimentation in medicine in that he used dissection to better describe the structure and function of physiological structures. His work as a physician to the gladiators would have also given him firsthand knowledge of the consequences of trauma and its treatment.

      Galen helped emphasize empiricism, which suggests that information should be gleaned from observation.

      Wellcome Images; licensed under Creative Commons Attribution 4.0 International license, http://creativecommons.org/licenses/by/4.0

      During his lifetime, Galen wrote hundreds of treatises on science, medicine, and philosophy. He was largely a champion of empiricism, which stresses the use of direct observation as a means of gaining information. Writing in his treatise On Medical Experience, Galen (trans. 1944 by R. Walzer) stated, “I am a man who attends only to what can be perceived by the senses.”

      From chance encounters with human accidents and trauma and his anatomical work using a variety of animals, Galen carefully described the brain; the cranial nerves that are involved in sight, smell, movement, and other functions; and the nerves of the sympathetic nervous system involved in fight-or-flight reactions, among others. From his experiments with animals, Galen knew that blood was transported throughout the body. He had an early theory of how blood was changed by the organs based on the idea of spirits. Galen believed that blood was made in the liver, which gave it natural spirits. It then went to the heart where it developed vital spirits and then, with the introduction of air to the blood on the way to the brain, it was transformed into animal spirits. These animal spirits could be stored in the ventricles of the brain until they were needed. Today, we think in terms of hormones rather than spirits. Galen’s works became the encyclopedia of medicine for the next 1,500 years.

      Psychopathology in the Middle Ages

      Although the Greek and Roman periods included individuals who attempted to understand psychopathology in a more humane way, this perspective disappeared as their civilizations declined. During the Middle Ages, disease and especially mental illness was seen from a religious perspective, with the devil being a major player. That is, when someone was observed to act in strange and bizarre ways, it was assumed that the person was a witch or possessed by the devil. As such, mental illness did not exist. What existed was the devil working through individuals. This view continued in Europe until the 1800s, especially among the less educated.

      During the Middle Ages, mental illness was perceived as the work of the devil, and individuals were accused of witchcraft.

      Lanmas/Alamy

      One of the classic books in this genre was the Malleus Maleficarum (The Hammer of the Witches), published in the 1480s. This book was written by two German priests and approved by the pope. It went through a number of editions and became the handbook of the Inquisition. It explained how witches existed and flew through the air as well as how they should be tortured if they did not confess. In a “catch-22,” the captured witches were tied to a device and lowered into cold water. If they floated, they were thought to be possessed by the devil and most likely were then killed by hanging or fire. If they sank to the bottom and drowned, then they were innocent. During the interrogations, witches were not to be left alone or given clothes, since the devil would visit them or hide in their clothing. Although the writers of the time did not understand the nature of psychopathology, they did describe in some detail particular characteristics of different disorders including bipolar disorder, depression, and such psychotic processes as hallucinations and delusions.

      From the Renaissance to the 1700s—The Beginning of Modern Science

      Between the time of Galen and the Renaissance, Western science and medicine remained fairly stagnant, with little new knowledge being added. One problem during this period was that authority, which was often the Church, determined what was true or not. Since authority was able to use its own standard of truth, it was difficult to argue another position. For example, the Church was