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

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

Professor Gwen AdsheadGwen.Adshead@southernhealth.nhs.uk

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!

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

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.

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.

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.

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.

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.

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

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

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

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

St Mary of Bethlehem

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

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

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

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

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

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

• 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

Phenomenology

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

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 thougths, 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?

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

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

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

Changes in amygdala function with mindfulness practice

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

References