Reflections on Treatment Options
History and Philosophy of Psychology, First Edition. Man Cheung Chung and Michael E. Hyland. © 2012 Man Cheung Chung and Michael E. Hyland. Published 2012 by Blackwell Publishing Ltd.
13
History of Clinical Psychology and Philosophy of Mental Health
People who are mentally ill sometimes engage in deviant behaviour, that is, behaviour that would be described in common terms as ‘odd.’ There are two ways of interpreting that deviant behaviour. One way is to interpret it not as illness but as a morally wrong set of behaviours. The person is ‘normal’ and the only problem is that what they are doing is wrong. Such ‘wrong’ behaviour has to be controlled. The other way of interpreting the deviant behaviour is as illness, and so the emphasis is on treating the illness rather than controlling the behaviour. In essence, these two interpretations differ over whether deviant behaviour is labelled as ‘bad’ or ‘mad’. These two interpretations have co-existed at the same time in history, at least until about 200 years ago. If the person is ‘bad’ then they should live in the community but suffer the consequences of their atypical behaviour – unless they are dangerous in which case they need to be locked up. If the person is ‘mad’ then they need to be treated by therapies.
The history of clinical psychology is so closely linked to psychiatry that the two need to be considered at the same time (Porter, 1987, 1988, 1991). The difference between psychology and psychiatry is one of training. Psychiatrists are trained in medicine, so the psychiatric approach to mental illness follows the medical tradi- tion, or at least, the medical tradition of the time. Medical treatment of mental illness has a history of more than two thousand years. By contrast, psychologists have a psychological training, and their approach to mental illness can also be con- sidered as part of the psychological tradition of the time. Psychological treatment of mental illness is comparatively recent. Neither the medical nor psychological traditions have remained static, so the relationship between the two changes over time. Over time there have been various ‘tensions’, sometimes between different psychiatrists, sometimes between different psychologists and sometimes between psychiatrists and psychologists. These tensions include:
Chung_c13.indd 270Chung_c13.indd 270 11/25/2011 8:49:55 PM11/25/2011 8:49:55 PM
Chung, M. C., & Hyland, M. E. (2012). History and philosophy of psychology. Retrieved from http://ebookcentral.proquest.com Created from ashford-ebooks on 2019-10-07 21:11:42.
C op
yr ig
ht ©
2 01
2. J
oh n
W ile
y &
S on
s, In
co rp
or at
ed . A
ll rig
ht s
re se
rv ed
.
Clinical Psychology and Philosophy of Mental Health 271
a. a tension between religious and a natural science interpretation of mental illness;
b. a tension between the Hippocratic system and the system of modern Western medicine;
c. a tension between a biological versus a psychological interpretation; d. a tension between psychoanalytic versus behaviourist interpretations.
Religion Versus Natural Science
The Greek physician Hippocrates (460–377 BC) was born of a family of priest- physicians but rejected the current superstitious belief that illness, including mental illness was the work of the gods, and could be cured by superstitious charms and prayers. He suggested an empirical method in understanding illness, but also believed in a spiritually restoring principle or essence that the physician could use to effect a cure (Alexander & Selesnick, 1966; Bynum, Porter & Shepherd, 1985; Jackson, 1986; Maher & Maher, 1985a). He believed that the brain was the source of epilepsy and dementia and provided a variety of cures, including bleed- ing, but also a variety of lifestyle and dietary recommendations. The technique of bleeding a patient was not invented by Hippocrates himself – it can be traced back to ancient Egyptian medicine.
The assumption of Hippocratic medicine that disease was caused by an imbal- ance of bodily humours was accepted in the west for the next two thousand years. There are four bodily humours: black and yellow bile, phlegm and blood. Ayurvedic (i.e. traditional Indian) and traditional Chinese medicine also adopted similar assumptions that disease was caused by an imbalance – an imbalance of three doshas in the case of Ayurvedic medicine and of the five elements in traditional Chinese medicine (Deng, 1999). The consequence of these assumptions is that mental illness is located firmly within a biological conceptualization of illness, and that mental illness is not seen as separate from physical illness. For example, Hippocrates believed that hysteria was a purely female complaint and caused by a wandering uterus (the Greek word hysterion means uterus). Galen, who was a phy- sician during the 1st century AD (he was born in Turkey but often described as a Roman physician), transmitted and extended Hippocrates’ ideas throughout the Roman Empire and believed that mental and physical disease were linked. For instance, he believed that melancholia (depression) in women caused breast cancer.
It is a noticeable feature of all the main traditional medical systems (Hippocratic, Ayurvedic and traditional Chinese) that lifestyle, diet and psychology are important parts of treatment, as well as herbs and other treatments (e.g. acupuncture, enemas, massage). In Ayurvedic medicine, for example, the most important therapeutic technique is meditation, and there is a clear emphasis on the need to treat the psychological state of a person in order to achieve physical cures. This link between the mental and the physical extends to recommendations for diet – a vegetarian diet is assumed to promote the ability to meditate. Not only are diets
Chung_c13.indd 271Chung_c13.indd 271 11/25/2011 8:49:55 PM11/25/2011 8:49:55 PM
Chung, M. C., & Hyland, M. E. (2012). History and philosophy of psychology. Retrieved from http://ebookcentral.proquest.com Created from ashford-ebooks on 2019-10-07 21:11:42.
C op
yr ig
ht ©
2 01
2. J
oh n
W ile
y &
S on
s, In
co rp
or at
ed . A
ll rig
ht s
re se
rv ed
.
272 History and Philosophy of Psychology
recommended according to the type of person (note: not the type of disease) but in the case of traditional Chinese medicine, dietary recommendations also depend on the weather. For example, spicy food is supposed to be better when the weather is wet and cold.
In sum, the traditional medical approach does not treat mental illness as separate from physical illness. Traditional medical practitioners do not have specialisms because they treat the whole person not the disease. Thus, in the traditional medical system, there is no such person as a psychiatrist or clinical psychologist, there is a simply a therapist working within that medical tradition. An important feature of all these traditional medical systems is that they reject supernatural explanations which have always occurred in parallel with them. They also assume that mental illness has a biological basis which is caused by an imbalance in the principles that are supposed to be in balance.
Where there are strong religious belief systems, then mental illness is assumed to have a supernatural origin. This supernatural view occurs in various guises throughout history, both in the West under the influence of the Catholic Church, and all other countries. In Africa, for example, the superstitious beliefs have led to the idea of voodoo. Underlying this view is the belief that illness (often mental and physical) is caused by another person, often a witch, and often but not always as an intention of that other person to cause harm. This view fuelled the persecution of witches that occurred between 1450 and 1750, which was officially sanctioned by the Catholic Church. Pope Innocent VIII authorized the persecution of witches in 1484 and the practice was guided by a book called Malleus Maleficarum (The Witches’ Hammer) written by two Dominican priests who acted as inquisitors in Germany. Malleus Maleficarum was used extensively by judges throughout Europe as a guide to detecting witches. Anyone who behaved oddly (i.e. the mentally ill) could be accused of being a witch, and these unfortunate individuals were tortured if they refused to confess to gruesome witches’ practices. Whether or not they confessed, these people were then killed, by burning, hanging or beheading, and their confessions fuelled further belief in the existence of witches (Trevor-Roper, 1967).
The idea that people who are mentally ill are possessed by the devil is consistent with the ‘bad’ not ‘mad’ perspective, and leads to a variety of sometimes inhumane treatments, as a way of making the devil leave the person’s body, typically involving some kind of physical pain on the basis that devils don’t like pain. Not all such treatments are inhumane. Some undeveloped tribes in Africa and South America use ritualistic ‘theatre’ where a healer, often with the help of the whole tribe, tries to drive out the devil by exhortation. However, in the West, the supernatural belief in the cause of mental illness led to the mentally ill being confined in difficult circumstances.
In the 15th century, mentally ill people were sometimes confined to a ‘ship of fools’ (Foucault, 1962, 1967). The first mental Asylum was founded in Valencia in Spain in 1409 with the explicit purpose of locking up those who were unable to live in society. In 1547 Henry VIII founded an asylum at the priory of St Mary of Bethlehem in London. This ‘hospital’ or Bedlam as it came to be known housed mentally ill people in sordid, degrading conditions (MacDonald, 1981; Scull, 1979;
Chung_c13.indd 272Chung_c13.indd 272 11/25/2011 8:49:55 PM11/25/2011 8:49:55 PM
Chung, M. C., & Hyland, M. E. (2012). History and philosophy of psychology. Retrieved from http://ebookcentral.proquest.com Created from ashford-ebooks on 2019-10-07 21:11:42.
C op
yr ig
ht…