Transcript why psychoanalysis

An Overview of the History of
Psychotherapy
Timothy C. Thomason
Northern Arizona University
2012
History of Ideas about Mental
Illness (Psychological Disorder)
• Belief in magic and the supernatural
• Trephination
• Ancient Egyptians
– Imhotep was the god of medicine
– Used religious rituals, incantations, music, dance
– Used “incubation sleep” to induce healing dreams
• Babylonians
– Demonology, sorcery, the evil eye
– Used healing rituals
– Priests spoke incantations
• The first use of words to heal?
• Ancient Hebrews
– Physicians were priests
– God was said to afflict people with madness
– Demon possession, exorcism, spiritual healing
• Ancient Persians (today’s Iran)
– Demonology and spiritual healing
– Priests of Mag used spiritual healing (Magi)
• Ancient Greeks
– Asclepiades created a temple/spa with baths, a
gym, a library, and gardens.
– Hippocrates developed naturalistic, materialistic
healing. He used snakes as shock therapy.
• Origin of the cadeucus symbol (snakes on a staff).
– Galen wrote the first book on “psychiatry.”
• He is called the father of modern medicine.
• The “Dark Ages”
– Lasted 700 years from about 300 CE to 1000 CE
– Advances toward naturalistic medicine were lost
• Native Americans and indigenous peoples
worldwide
– Believed in spiritual powers, soul travel, spirit
possession, witchcraft, divination, ritual healing
• England
– Henry VIII established Bedlam, the first asylum
– Used purging and bleeding as treatments
– Sold tickets to the public to see the mad people
– The Malleus Maleficarum was written
• Austria
– Gassner and later Mesmer developed magnetic
healing
• The “Enlightenment” (around 1750):
– Mental institutions established
– Tuke used tea party treatment for mad hatters.
• France
– Pinel took off the chains; started the moral therapy
movement. His goal: “to school the passions.”
• North America
– Benjamin Rush established the first “humane”
mental hospital, used bleeding, spinning, the crib
• Early 20th Century
– Freud, Kraepelin, Pavlov, Watson, Parsons
• Mid 20th Century
– Frankl, May, Maslow, Rogers, Perls
– Skinner, Erickson, Sullivan, Kelly
• Late 20th Century
– Perls, Satir, Haley, Yalom, Ellis, Beck, etc.
The Path from Demonology to
Psychotherapy
• Johann Gassner (Swiss priest, 1775)
– The most successful exorcist of his time
• Franz Anton Mesmer (Austrian healer, 1800)
– Magnetism appears to be magical.
– Theory of animal magnetism; at first he used
magnets to heal, but then only his hands.
– He cured “possessed” people without exorcism.
– He cured psychosomatic disorders by suggestion.
– Has been called “the first psychotherapist.”
• Mesmer influenced Braid, who wrote a book
on “nervous sleep.”
• Mesmer influenced Elliotson, a British surgeon
who conducted painless operations using
“magnetic sleep.”
• Mesmerism was debunked in 1784 by a
commission that conducted scientific tests.
– Benjamin Franklin was on the commission.
The Invention of Hypnosis
• Puysegur noticed that Mesmerized patients
were very responsive to suggestion. He
abandoned magnetism and Mesmerism and
simply used suggestion. He created the term
“hypnosis” to describe his method.
• He said Mesmer’s hand movements worked by
hypnotic suggestion.
• He discovered post-hypnotic suggestion.
• Puysegur used simple commands and touches
instead of magnets or electric devices.
• He put people into a somnambulistic trance.
• He demonstrated the existence of the
unconscious.
Historical Progressions
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From the Supernatural to the Natural
From Demon Possession to Disordered Minds
From Exorcism to Mesmerism
From Mesmerism to Hypnosis
From Hypnosis to Suggestion
From the priest to the Mesmerist to the hypnotist
From the hypnotist to the psychotherapist
From the religious to the secular
From Treatment to Talking
• From acting on the patient to asking for the
patient’s cooperation.
• A good relationship is necessary for
cooperation of the patient.
• Thus, rapport became essential.
Jean Martin Charcot
• Director of the Salpetriere, Paris, 1862 (the
leading hospital in the world on mental illness)
• Treated hysteria with hypnosis.
• Hysteria = Amnesia = Neurasthenia
(different forms of a “universal neurosis”
Developed outpatient psychotherapy.
Charcot said:
• Dreams are the key to unlocking neurosis.
• Hysterical neurosis results from certain ideas
the patient has.
• Behind the ideas are feelings about sex.
• Sex is at the root of neurosis.
• These ideas influenced Freud, who wrote The
Interpretation of Dreams about this theory.
• Hypnotism was accepted as the foundation of
the new field of neurology in 1882.
• This lead to the hypothesis:
– If hypnosis is the same as suggestion, then why not
skip the hypnosis and just use suggestion?
One implication of this is that psychotherapy is
suggestion. But patients resist simple suggestion
because they have unconscious motivations that the
therapist has to get around. So direct suggestion
rarely works.
Pierre Janet (c. 1900)
• Trauma causes consciousness to split.
• In hypnosis the patient can recall the trauma.
• This, with cathartic emotional release, can
remove the neurotic symptoms.
• Janet’s technique was to ask patients to talk at
random to reveal their unconscious fixed ideas.
– Freud would later call this “free association.”
• Janet noticed the importance of the therapeutic
relationship.
• He noticed that simply letting patients talk
often makes them feel better.
• Talking can cure mental disorders.
• Charcot: conflictual ideas and feelings about
sex cause neurosis.
• Janet: talking with a doctor helps these ideas
and feelings come to light.
• Joseph Breuer implemented these ideas in
psychotherapy.
Joseph Breuer
• Case of Anna O. (Bertha Pappenheim).
• Dx: psychotic, anorexic, fugue, DID?
• She narrated her hallucinations in a trance-like
state. She called this process “chimney
sweeping” and “the talking cure.”
• Breuer called it the “cathartic cure.”
• While talking she re-lived the trauma and then
felt great relief.
Breuer Influenced Freud
• Neurotic symptoms result from repressed
memories of trauma (usually sexual abuse).
• The repressed emotions must be expressed.
The analyst must access the unconscious to
cure the psychopathology.
• Hypothesis: Mesmerism, hypnotism, faith
healing, and psychoanalysis all work because
they cause emotional catharsis.
The Birth of Psychoanalysis
• Breuer was Anna’s therapist.
• Freud saw Anna’s relationship with Breuer as
transference.
• Freud saw that transference cures neurosis.
• This was the birth of psychoanalysis (it
showed the importance of the therapeutic
relationship).
• The cure is not suggestion, but the therapeutic
relationship.
Meanwhile, in America . . .
• Phineas P. Quimby became the world’s leading
Mesmerist around 1850.
• He treated 12,000 patients by 1865.
• He said that faulty ideas cause neurosis:
– “all sickness is in the mind of belief”
– “the truth is the cure”
– His goal: helping patients overcome self-defeating
attitudes; his method: Mesmerism and talking
• Mesmerism slowly died out but influenced the
development of two new movements:
– New Thought Movement (self-help psychology)
• Which lead to Positive Thinking
• Which influenced the development of cognitive therapy
– Christian Science
• Which influenced L. Ron Hubbard, who created
Scientology. Auditing locates and removes the
psychic traces of past trauma that cause neurosis.
Two Approaches to Healing
• Supernatural
– gods, demons, exorcism, witchcraft, miracles,
prayer, spiritual and faith healing
– Religious confession, catharsis, ritual healing
• Natural
– Mesmerism, hypnotism, psychoanalysis, Jung,
hypnotherapy
– Secular confession, catharsis
– Talking about your problems makes you feel better
Spiritual Healing
• Magic, mythology, and demonology lead to the
development of religion.
• Religious/spiritual treatment treats the soul.
• The practitioner is the clergy.
Naturalistic Healing
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Based on secular, philosophical ideas.
Lead to the development of medicine.
Medical treatment treats the body.
Mental disorders originate in the brain.
Psychiatry treats the brain with medications.
Psychology treats the brain with words in the
context of a therapeutic relationship.
Organic vs. Functional
• Organic disorders
– Disorders of the body
– Disorders of the brain
– Psychiatrists and psychologists treat disorders of
the brain (and severe functional mental distress)
• Functional mental distress
– Distress is a result of maladaptive ways of
thinking, not brain damage or disorders per se.
– Counselors work with clients to relieve distress.
• Psychotherapy is talking in the context of a
therapeutic relationship.
• This is usually adequate to help clients relieve
mental and emotional distress.
• Psychotherapy changes the brain.
• But psychotherapy may not be potent enough
or fast enough to change brain damage or brain
disorders at the level of neuronal networks.
Functional = Organic
• Ultimately, all functional distress is organic,
since all thoughts and emotions correlate with
the firing of neuronal networks. We are
unitary, not dualistic, beings.
• But practically speaking, the
organic/functional distinction can still be
useful, just as we continue to distinguish
between body and mind.
Roots of Psychotherapy
• Ancient Greek philosophy - cognitive therapy
• Secular humanism – client-centered therapy
• Healing relationship – psychoanalysis and
client-centered therapy
• Buddhism – focusing the attention –
mindfulness therapies
• Hypnosis – Erickson’s hypnotherapy
– Haley, MRI, Strategic therapy, Solution-oriented