Transcript History - School District of Cambridge

Treatment of
Psychological Disorders:
Then and Now
History of Psychological
Treatments – Prehistoric Times
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Scientists have identified a
method possibly used to
treat mental illness between
1,000 B.C. and 3,000 B.C.,
called trephining.
Prehistoric humans most
likely identified the cause of
disturbed behavior as “evil
spirits.”
Trephination: was the
drilling of holes in the skull
as a means of releasing “evil
spirits” that were trapped
inside the head, causing
abnormal behavior.
Hospital of St. Mary of Bethlehem
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The hospital was originally created
in 1247 for poor people, and by
1403 began to house people
called “lunatics.”
In the next few centuries, the
inhumane and chaotic housing
of the psychologically disturbed
came to be known as “bedlam”, a
derivative of the hospital’s name.
The hospital quickly became
overcrowded and the residents
more uncontrollable. The hospital
employed chains and
punishment to control patients.
It was common for rich Londoners
to visit the hospital and pay to be
allowed to walk around staring at
the patients, simply for
amusement.
“The Rake's Progress – Scene in Bedlam”
Life in the Asylums
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William Battie also advocated the use of "therapeutic"
asylums.
Many of the mentally ill were being treated in prisons or other
inappropriate institutions. Asylums, however, continued to
be known for their dehumanizing conditions.
In the 18th century, an asylum in Newcastle, England, housed
both sexes together tethered in chains in a dungeon-like
atmosphere.
In 1845, Esquirol reported on the inhumane aspects of the
asylum environment: "If the patient's violence is extreme, he is
fastened onto his bed and his movements are brought under
control with a straitjacket....How many manic patients have
become paralyzed through being fastened too long on their
bed or in an armchair."
Treatments included agents such as opium or camphor mixed
with vinegar. In more extreme cases moxa, a flaming pitch
applied to the head, was used. Esquirol also suggested that:
"You can, if you wish, substitute for an iron heated in the fire,
an iron heated in boiling water."
In England as well as in the United States, patients would
be placed on display on Sunday for the curious to view.
Development of the Moral
Philosophy of Treatment
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Philippe Pinel (1745-1826) became
chief physician at La Bicetre’s ward
for the mentally ill in 1793. Pinel is
considered historically to be a
primary figure in the movement for
humanitarianism.
He emphasized keeping case
histories of patients and developed
the concept of "moral treatment",
which involved treating patients with
kindness and sensitivity.
Pinel removed the chains of the
people imprisoned at La Bicetre
(symbolically celebrated in the
painting)
He argued that they must be treated
as sick human beings rather than
evil beasts.
Many patients who had been
incarcerated for years were restored
to health and eventually
discharged from the hospital.
Other Advocates of the Moral
Philosophy of Treatment
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Benjamin Rush
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He is considered the father of American
psychiatry as he instituted a more
scientific approach, and made many
changes that improved the conditions for
the mentally ill.
The fact that he was a founding father,
politician, and signed the Declaration of
Independence gave him the power to
institute reform.
However, his methods of treatment were still
inhumane and ineffective. He believed
bloodletting, purging, and terrifying were
beneficial.
Benjamin Rush (cont.)
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Rush used some crude
devices to treat the
mentally ill; none of which
were very effective. The
circulating swing (top left)
was used to spin depressed
patients at high speeds.
The tranquilizer chair (top right)
was used to calm people
suffering from mania.
The crib (bottom) was widely used to
restrain violent patients.
Rush also felt that frightening the patient was beneficial.
Some subjects were told repeatedly of their impending death,
and then placed in a casket with holes that was submerged in
water for several minutes. Rush’s favorite treatment was
bleeding. He felt that many mental disorders were caused by
a buildup of blood in the brain.
Other Advocates of the
Moral Philosophy of
Treatment
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Dorothea Dix
In 1841, Dix was asked to teach a
Sunday school class at a local prison
in Massachusetts.
 She was shocked to see mentally ill
patients locked up with prisoners in
dark, unheated, and filthy rooms.
 Throughout her lifetime, she spoke to
state legislatures and succeeded in
reforming prisons and the
treatment of people with
psychological disorders.
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Dorthea Dix
(1802-1887)
Other Advocates of the
Moral Philosophy of
Treatment
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C.W. Beers
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Clifford Whittingham Beers (1876-1943),
a Yale graduate, suffered a mental
breakdown and was confined to an
asylum from 1900-1903.
After his recovery, he aroused new concern
for mentally ill individuals when he published
a study of his experience titled A Mind That
Found Itself (1908).
Beers was responsible for founding the
National Committee for Mental Hygiene,
which worked to prevent mental illness
and ensure humane treatment.
Recap: Methods of Treatment
Throughout History
Time
Reformer
Stone Ages
Fourth Century
B.C.
Hippocrates
(460-377 B.C.)
Fifteenth
Century
Technique
Purpose
Trephining
Drill hole in head to let evil spirits out of
the body
Rest, Exercise, Abstinence from alcohol
and sex
Restore balance of fluids or "humors" in
body
Exorcism, Torture, Hanging
Release evil spirits
Eighteenth
Century
Philippe Pinel
(1745-1826)
Reform at Bicetre Asylum in Paris,
released patients from chains, classified
different types of psychological
disturbances
Restore humanity to patients
Nineteenth
Century
Dorothea Dix
(1802-1887)
Separated mentally ill from prisoners,
established state mental hospital system
Give good care
Twentieth
Century
Clifford Beers
(1876-1943)
National Committee for Mental Hygiene
(1909), Research
Improve conditions in mental hospitals
Eclectic orientation of therapists
Return patients to society
And then
along came
Freud…
Modern Therapies
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Experts estimate that there may be over 400 different
approaches to treatment, although they can be classified into
major categories.
Psychotherapy
 Involves an emotionally charged, interaction between a
trained therapist and a mental patient.
• Insight therapy involves pursuing increased insight
regarding the nature of the client’s difficulty and sorting
through possible solutions (“talk therapy”).
• Behavior therapy is based on the principles of learning,
with behavior therapists working to alter maladaptive habits
and change overt behaviors.
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Biomedical Therapy
 Uses drugs or other procedures that act on the patient’s
nervous system, treating his or her psychological disorders.
An Eclectic Approach
 Uses various forms of healing techniques depending upon
the client’s unique problems.
Who Seeks Treatment?
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According to the recent U.S. Surgeon General’s report on
mental health (1999), about 15% of the population
uses mental health services in a given year.
The two most common presenting problems are anxiety
and depression.
People vary considerably in their willingness to seek
treatment, with women more likely to seek help than
men, and people with higher educational levels doing
so more frequently.
Medical insurance is also related to treatment-seeking;
having it increases the likelihood.
Many people who need help don’t seek it, and the
Surgeon General reports that the biggest roadblock is the
“stigma surrounding the receipt of mental health
treatment."
Figure 15.2: Therapy utilization
rates.
Olfson and colleagues (2002)
gathered data on the use of
nonhospital outpatient mental
health services in the United
States in relation to various
demographic variables. In regard
to marital status, utilization rates
are particularly high among those
who are divorced or separated.
The use of therapy is greater
among those who have more
education; in terms of age,
utilization peaks in the 35–44 age
bracket. Females are more likely
to pursue therapy than males are,
but utilization rates are extremely
low among ethnic minorities.
(Data from Olfson et al., 2002)
Figure 15.1: Treatment seeking for various disorders.
In a study of the extent to which people seek treatment for psychological disorders, Wang
et al. (2005) found that only a minority of people promptly pursue treatment for their
disorder. The data summarized here show the percentage of people who obtain professional
treatment within the first year after the onset of various disorders. The percentages vary
depending on the disorder, but all the figures are surprisingly low. (Data from Wang et al.,
2005)
Who Provides Treatment?
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There are a variety of “helping professions” available:
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Psychologists who provide psychotherapy may have degrees in clinical or
counseling psychology, specializing in the diagnosis and treatment of psychological
disorders and everyday behavioral problems. Both types must earn a doctoral
degree (Ph.D., Psy.D., or Ed.D.), which requires 5-7 years beyond a bachelor’s
degree. Admission to Ph.D. programs in clinical psychology is very competitive,
about like getting into medical school.
Psychiatrists are medical doctors who specialize in the diagnosis and treatment of
psychological disorders. They are, at present, the only psychotherapy
administering profession to be able to prescribe drugs, although psychologists are
lobbying for prescription rights (given appropriate training).
Clinical social workers generally have a master’s degree and are increasingly
providing a wide range of therapeutic services as independent practitioners.
Psychiatric nurses may hold a bachelor’s or master’s degree and often play a
large role in hospital inpatient treatment.
Counselors are usually found working in schools, colleges, and assorted human
service agencies. They typically have a master’s degree and often specialize in
specific areas, such as vocational or marital counseling.