History of Mental Disorders

History of Abnormal Behavior

500 B.C. – Ancient Times

  • Mental illness was thought to be caused by demons or animal spirits taking over the body.
    • This was also true of prehistoric man - a bronze statue formerly displayed in the Fort Worth Museum of Science and History depicted two men holding down another while using rudimentary tools to puncture his skull. The display placard read that ancient man believed that mental illness was caused by supernatural factors that may be released from the ill person's skull (description recalled from contributor's personal experience) (Buchanan, 2009).
    • Other cultures used early forms of brain surgery to cure or alleviate any number of misunderstood maladies (O'Donnell, 2010).
    • external image Brainsurgery.jpg
  • The treatment for mental illness was exorcismor torture.
    • While more cautiously approached, exorcism is still used as a means of treating misdiagnosed mental illnesses today (National Catholic Reporter, 2000).
  • Trepanning, which consisted of a small instrument being used to bore holes in the skull, would allow the evil spirits to leave the possessed person.
  • Abuse the body badly enough, and the spirit will want to leave it.
external image drill.jpg external image trepanning346x468.gif
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450 B.C. – Golden Age of Greece

Hippocrates (Greek physician, father of modern medicine)
  • Denied that deities/demons caused mental illness.
  • Viewed abnormal behavior and illness in general as having internal causes, and thus having biological natures or etiologies.
  • Has a key belief that if you took care of your body, your mind would also stay well (Hippocrates, 2010).
  • Treatment was to modify the environment (tranquil life, sobriety, exercise, and abstinence from excess).
  • Believed patients needed to choose health over mental illness.
  • Was the basis for the Hippocratic Oath
    • Physicians or healers will not deliberately harm an individual who seeks their help; they will treat anyone who comes seeking their aid; they will not give a deadly drug if the patient requests it; and they keep all information about doctor-patient professional relationships confidential (Hippocratic oath, 2010).
    • Such harms still later included:
      • Terrible conditions (patients shackled to walls or dark cells).
      • Treatment (electric shock, bleeding, spinning, restraints) used to intimidate patients into choosing health over illness.

1800s – Reforms in Mental Health Treatment

Benjamin Rush (Leitch, 1978).
  • Published the first American textbook on psychiatry, Mental Inquiries and Observations upon the Diseases of the Mind.
  • Believed the cause of mental illness was exposure to severe psychological and social stressors.
  • Treatment was "moral management", which focused on the patient’s social, individual, and occupational needs (manual labor, spiritual discussion, humane treatment).

Philippe Pinel (Enersen, 2010).
  • Frenchman and early reformer in the proper treatment of mentally ill individuals.
  • Like Rush, also believed mental illness were caused by excessive psychological and social stresses.
  • Advocated that the mentally ill be treated with sympathy, compassion, and empathy.
  • One of the founders of psychiatry.

Dorothea Dix ("Dorothea Lynde Dix", 2010).
  • Helped establish 32 mental hospitals throughout the United States.
  • 1845 - first public mental hospital in Pennsylvania Harrisburg State Hospital.
  • 1847 - first state mental institution in Illinois established.
  • 1856 - first state mental institution in North Carlina opened and named in her honor.
  • Authored bills that were intended to protect, and reform treatment for, mentally ill patients.

1900s – Modern Era

  • Major breakthrough: Discovery of biological cause of general paresis (syphilis of the brain) (Jasmin, 2008).
  • Symptoms of syphilis are paralysis, insanity, and death.
  • Treatment was to infect sufferer with malaria (high fever would kill the syphilis organism).
  • Led to increased focus on diseased bodily organs as underlying cause of mental illness.
  • Accompanied by tremendous advances in anatomy, physiology, neurology, chemistry.

Emil Kraepelin (Emil Kraepelin, n.d.)
  • Developed a classification system of mental disorders (precursor to The DSM).
  • Classified psychosis into two forms, manic depression and dementia praecox.
  • Recognized that different types of disorders had different outcomes.
  • Emphasized importance of underlying brain pathology.

Richard Freiherr von Krafft-Ebing(Kiff, n.d.)
  • Performed extensive work and research in human sexual behavior
  • Wrote Psychopathia Sexualis, the first major study of sexual perversity. This coined many terms associated with sexuality today (i.e, sadism, masochism, etc.)
  • Served as authoritative influential study of human sexual behavior until Freud.

Advances in psychological understanding of mental disorders:

Sigmund Freud (Thornton, 2005)
  • Developed psychoanalytic theory - the theory of psychological development in terms of stages throughout life.
  • Believed unconscious processes, motives, and urges are at the core of many of our behaviors and difficulties.
  • Developed the doctor-patient paradigm.
  • The doctor was viewed as being in a power position, and the patient was a sick individual who would take the doctor’s words as an unquestionable fact.

B.F. Skinner (Vargas, 2005)
  • Father of radical behaviorism.
  • Believed that any behavior that was reinforced or rewarded would be more likely to increase or recur; any behavior that was either not reinforced or was punished would be more likely to decrease or be extinguished.
  • Created experiments which demonstrated operant conditioning. Most well known for creating the Skinner Box, a devise demonstrating conditioning of rats pressing a lever to receive food. http://www.youtube.com/watch?v=PQtDTdDr8vs.

Albert Bandura (Pajares, 2004)

Albert Ellis (Ellis et al, 2005)

Carl Rogers

  • The psychologist is seen as someone who is a skilled listener, not judgmental, and certainly not powerful nor omniscient.
  • Theorized that dysfunction begins in infancy.

Henri Laborit

History of the DSM

  • In 1918, the American Medico-Psychological Association (presently the American Psychological Association, or APA) issued the Statistical Manual for Use of Institutions for the Insane. It did not catch on.
  • In 1928, the American Psychiatric Association issued another edition but it was too narrowly focused. It looked primarily at neuroses and psychoses.
  • By World War II, the military had its own nomenclature system.
  • The World Health Organization (WHO) issued the International Classification of Diseases-6 (ICD-6); it contained a section on mental disorders but it needed modification for use in the United States.

  • The ​APA published the Diagnostic and Statistical Manual of Mental Disorders in 1952; it was based off of the ICD-6 and the military system.
  • The first DSM contained about 60 disorders and was based on theories of abnormal psychology and psychopathology.
  • Problems: DSM was criticized for its reliability and validity. The major limitation of the DSM was that the concept had not been scientifically tested. Also, all of the disorders listed were considered to be reactions to events occurring in an individual's environment. Another problem was that there really was no distinction between abnormal and normal behavior. Despite this, it gained acceptance.

  • The ​DSM-II was published in 1968 but still had criticism over its validity and reliability. Changes in the DSM-II included eleven major diagnostic categories, with 185 total diagnoses for mental disorders. Additionally, increased attention was given to children and adolescents in the DSM-II. For example the diagnostic category of Behavior Disorders of Childhood-Adolescence was presented for the first time.
  • In 1974, the seventh printing of the DSM-II no longer listed homosexuality as a disorder.

  • The DSM-III was published in 1980. This dramatically changed the field of psychology.
  • The five part multiaxial diagnostic system, still used today, first appeared in DSM-III.
  • DSM-III provided specific diagnostic criteria for 265 diagnoses.
  • Dr. Robert L. Spitzer was appointed to lead the changes to the DSM in 1974. He was largely involved in creating the discrete diagnostic categories of the DSM-III, as opposed to a dimensional model of diagnosis.
  • As with the DSM-II, many significant changes were made in the third edition of the DSM. For example, previously many of the anxiety disorders were lumped together as one diagnosis of Anxiety Neurosis. The DSM-III broke that broad diagnosis down to include many different anxiety disorders such as generalized anxiety disorder (GAD), panic disorder, agoraphobia, and social phobia. In fact, the term "neurosis" was removed from the DSM-III altogether. Furthermore, social issues came into play with the development of the DSM-III. Racism was considered as a mental disorder to be added, but after much deliberation and research was not included. Post-traumatic stress disorder was added to the DSM at this time. Also, the DSM-II category of "sexual orientation disturbance" was changed to "ego-dystonic homosexuality".

  • The revision for DSM-III was published in 1987.
  • 297 diagnoses

  • The DSM-IV was published in 1994.
  • This edition was more research based as far as criteria and diagnoses are concerned.
  • 365 diagnoses.

  • The newest revision of the DSM was published in 2000.
  • This volume is heavily research based and includes information about the etiologies of the disorder.

  • The newest revision, DSM-V, will be available in 2012, with final approved edition expected May 2013.
  • Join effort between the American Psychiatric Association, the National Institute of Mental Health, the World Health Organization, and the World Psychiatric Association.
  • Efforts began in 2000, and have involved 13 conferences with international involvement.
  • Some of the proposed changes include:
    • Modifications of various disorder spectrums, such as including Asberger's disorder within the autism spectrum;
    • Modiciations of terminology, such as replacing use of "mental retardation" with "intellectual disability";
    • Improved methods of assessment.
    • Large scale inclusion of new criteria to all aspects, with some proposed removals and integrations.
  • To learn more about many of the changes being proposed, click here.



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