1

Early Clinical Psychology

2

Clinical psychology is relatively new• Why?

– Titchner and others saw mental health to be outside of what psychology was to study

– Conflict between the medical model and psychological model of mental health.

– Medical model – there are naturally occurring causes for all illnesses including mental illnesses

• Example – Emil Kraepelin

3

Emil Kraepelin

• Studied with Wundt but attempted to classify mental illnesses according to what caused them, their symptoms, and their treatment - 1883

• Mania• Depression• Dementia praecox• Manic depression• Neurosis – mild disorders• Most disorders were not curable and caused

by biological factors

4

Psychological Model

• Lightner Witmer:– 1897 – founded the first psychological

clinic– 1907 – developed the first clinical journal

The Psychological Clinic– He was trained as a scientist, and

believed that clinicians should be trained as scientist and apply psychological science to treatment of mental illness

5

Psychological Model

• Psychological model would not become extensively accepted until Freud, an M.D. adopted a non-medical model of mental illness

• WWII also gave impetus because there was not enough psychiatrists to treat the large numbers of people needing mental health services

6

History of clinical psychology

• Treating and counseling patients a very recent profession

• Mental illness always considered part of medicine

• No doctoral programs in clinical psychology before WWII

7

Early history of mental illness

• Basic issue : no outward signs of injury or illness – strange or bizarre behavior with no visible cause

• Trephination – cutting holes in the skull to let evil spirits out

• Primitive cultures used other supernatural cures

• Early Greeks performed ceremonies to please the gods so they would leave the individual alone

8

Early history of mental illness

• Greek and Roman physicians removed mysticism from medicine and looked for physical causes

• Decline of Greek and Roman civilizations resulted in a return to mythology and demonology

• Exorcism of evil spirits returned

9

Middle ages and mental illness

• The dominant Christian church concerned about the contention between God and the devil for people’s souls

• Since no cause could be seen for mental illness, voluntary possession by the devil was proposed as the cause

10

This solution solved two problems• People feared he mentally ill for two

reasons:– 1. Their strange behavior scared people– 2. People were scared they could develop these

bizarre behaviors

• Solution became these people voluntarily consorted with he devil; I do not

• They need to be executed so they won’t hurt others

11

“Treatment” of mentally ill

• Get the people to confess their sins of consorting with the devil. They have to confess so use torture

• After getting a confession, execute them for their sins

12

“Treatment in 18th and 19th century not much better• Us of large institutions or asylums to

housed mentally ill; emphasis was on protecting the public not to treating the mentally ill

• Institutions largely paid for by allowing tourist to pay to walk through the asylum and watch the crazy people

13

Treatments in 18th and 19th century• Starvation and tormenting

• Water cures

• Whirling

• Bloodletting – most prevalent

14

The return to mental illness having natural causes• 1790’s Paris

• Philippe Pinel – changed the treatment of people in the major asylum in Paris

• Pinel not the first to remove chains from patients it had happened din Italy 8 years earlier

• Pinel instituted many of the basic medical philosophies to mental health

15

Philosophy Of Pinel

• 1. Do no harm – ended bloodletting, whirling, etc.

• 2. Use minimal restraint necessary – least restrictive environment needed to maintain safety and order

• 3. Provide humane conditions• 4. Eliminate physical abuse• 5. These people are sick not criminals• 6. Most important for psychology – not all

illnesses had biological causes

16

Going against the prevailing Zeitgeist • Prevailing opinion was that mental

disorders were the result nontreatable physical causes – lock people up and chain them so they could do no harm

• Pinel reviewed records, observed patients, talked to patients, and realized many did not need to be chained or locked up

17

Going against the prevailing Zeitgeist• Why was Pinel allowed to have the greatest

success in the history of psychopathology and treatment?– He took over the operation of the two principle

insane asylums in Paris during the French revolution (1797)

– The country was in such chaos people let him do what he wanted

– He was successful so when the chaos decreased, things couldn’t return to the way they were

18

Treatment in Britain and the U.S.• Tukes and others were successful in

developing small private institutions in Britain

• Dorthea Dix and others successful in reforming many institutions in the U.S

• Most large institutions tended to emphasize protecting the public at the expense of treatment

• Greatest change in treatment has resulted from the development of psychoactive drugs

19

Foundations of psychoanalysis

• Franz Mesmer – passed magnets over people until they fell into a trance – called mesmerized

• He attributed his cure as the flow of healing energy from a healthy person to an unhealthy person

• 1784 – A Royal Commission ruled mesmerism useless and dangerous and banned Mesmer from Paris

20

Mesmerism and hypnosis

• British proponents were able to show that some surgical procedures could be performed on mesmerized people

• 1843 James Braid a British physician discovered that mesmerism was a form of deep sleep induced by suggestion which he called hypnotism

21

Hypnosis in Paris• Jean Charcot opened his hypnosis clinic and in

1885 Sigmund Freud came to Paris to learn hypnosis

• Charcot demonstrated that under hypnosis, a non-hysterical person could be made to exhibit symptoms of hysteria.

• Indicates that conditions of the body could be controlled by the mind

• He suggested that sexual problems could be the underlying cause of hysteria

22

Sigmund Freud

• Graduated from medical school in 1881

• Nearly ended his career in 1885 as a result of his use of cocaine and advocacy for the use of cocaine

• Censured for advocating such a dangerous drug

• Never became addicted to cocaine, but wasn’t as lucky with nicotine

23

Freud and Joseph Breuer

• Treatment of Anna O a women suffering from hysteria

• Reportedly Breuer cured her of hysteria through hypnosis and having her relive the experiences that led to her symptoms – a cathartic cure

• Anna O was actually Bertha Pappenheim who became a social worker in Germany

24

Bertha Pappenheim• Breuer stopped treating her because his wife was

jealous of the time spent with her• She was institutionalized in 1882 still suffering from

hysteria• Treated with high dosages of morphine and

emerged from the institution in the late 1880’s still on morphine

• He eventually became engaged in the feminist movement, was a playwright , wrote books, founded schools, etc.

• Very negative attitude about psychoanalysis• A very different story than the one told by Breuer

and Freud in 1895

25

Freud and psychoanalytic theory• Freud abandoned hypnosis for free

association

• Patients spoke about whatever came into their mind

• His patients – mostly neurotic women- spoke about sexual seductions by their fathers

26

Seduction theory

• Neurosis caused by sexual problems resulting from sexual abuse by fathers

• Later he changed the theory from actual sexual abuse to fantasies of desire for seduction by their fathers

• Reason for the change still debated today– Freud – sexual abuse couldn’t be that prevalent

in upper class Vienna, maybe he had suggested to his patients what he was hearing

– Others – original seduction theory called scientific fairy tale by powerful physicians who pressured him to change it

27

Two basic conclusions of Freud

• Infantile sexuality was a reality

• When patients recall sexual memories from early childhood, the unconscious does not differentiate between truth and “emotionally charged fiction”

• Treatment needed to help patients distinguish between psychic reality and actual reality

28

Interpretation of Dreams

• Dreams were a direct route to the unconscious

• Its popularity made him famous and led to his psychoanalytic theory of development and the role of sexual energy

• Freud very popular in the U.S. despite his low opinions of America and Americans, but never well accepted in Europe

29

Decline of Freudian theory

• Freud was authoritarian, dogmatic, and most important paternalistic

• His followers were like his children and expected to accept his views without question

• Adler disagreed with Freud’s Sexual theory of hysteria and was forced to resign from Freud’s Vienna Psychoanalytic Society in 1911

• Jung followed in 1914, both wanted to consider social and cultural factors of development

30

Two basic issues split the psychoanalysis's• 1. biological sex drive as the driving

force behind all human behavior and development

• The relationship between the id and the ego– Freud – the id is the master and the ego

is a slave to id and superego– Dissenters objected to the slave-master

relationship

31

Anna Freud

• Most loyal follower of Freud

• Her type of psychoanalysis became the prevalent psychoanalytic practice in the U.S.

• Her lasting legacy was extending her father’s principles to the treatment of children – including play therapy

32

Adler and Jung

• Particularly singled out by Freud for their “treasonist actions”

• Both popular with large followings• Adler was popular because he had a

more optimistic view of human nature• Jung was very influential outside of

psychology, but his lack of a scientific approach made him less important to psychology

33

Freud’s legacy

• While his theories have been criticized and many have been rejected, they served as a basis for thought discussion and development of new theories

• A major force in psychiatry from 1910 -1930• Rise of the Nazis did much to reduce his

impact as did his personality