Greetings! It has been quite some time since I wrote a blog post, but keeping in the theme of sharing some of my previous writing work, today I present an essay written some thirteen years ago this month. Enjoy!
Psychology Minor’s Essay
Throughout history, a recurring pressure has been put on humans to conform to social norms. This manifests itself in many ways; the consequence of disobeying social norms is varied. One constant though, is the labeling of those who are different as having a problem regardless of the consequences. Yet as the human race has progressed in all schools, we are far from the classification and treatment practiced in the past. As the human race evolves, so does the definition of mental dysfunction.
The Neolithic age of man was a marked time of development and is generally viewed as the point in time in which a procedure known as trephination was first used as a remedy for abnormal behavior (Prioreschi 1996). It would follow reason that to a primitive people, symptoms we recognize today as mental dysfunctions were caused by evil spirits or supernatural causes, as it is human nature to rationalize phenomena—even by utilizing a supernatural explanation. In this case, madness is simply an evil spirit using the body as host. Yet the development of what we know today as a classification system for mental dysfunction cannot be compared to those of the Neolithic peoples, due to a discrepancy in social complexity.
To further contextualize the evolving sense of mental health, or what causes mental dysfunction, one must take into account the ancient civilizations of Egypt, China, Israel and the like. These civilizations practiced exorcism, which—although similar to Neolithic views in the respect of forcing the evil from one’s body—was much less invasive than boring a hole in the patient’s skull (Comer 2005). Fundamentally, the ideas remain the same despite the act of not physically opening the head for a ‘possessor’ to leave. This approach is a good bridge to understand the transition from archaic views to more modern ideas, although it is important to mention that trephination was a technique used commonly throughout the middle ages, and is used even to this very day (Prioreschi 1996). With the incorporation of organized religion into the equation, these civilizations had both license and precedent to believe in possession and practice exorcism—a belief which transcends specific religion and one which has followed man for much of history: madness as an agent of evil deities and or demons.
On the other hand, in about 400B.C. an individual named Hippocrates was developing ideas that would later have him dubbed the “father of medicine.” In addition to publishing extensive literature about the topic of medicine, his words about the brain sewed the seeds of our modern medical approach to mental disease:
“men ought to know that from nothing else but the brain comes joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner we acquire wisdom and knowledge, and see and hear and know what are foul and what are fair, what are bad and what are good, what are sweet and what are unsavory…And by that same organ we become mad and delirious, and fears and terrors assail us…All these things we endure from the brain, in these ways I am of the opinion that the brain exercises the greatest power in the man” (Chadwick 1983).
Prior to this time the Greeks had thought that most function came from the heart (Finger 2000). This revelation influenced the thought of many doctors, notably Galen, who discovered the nervous system, and pioneered the scientific method. Out of this side of history comes the medicine with which the western world is acquainted. Though these discoveries enabled psychology to be, they merely acknowledged the brain as the source, without knowing much information about how it worked. Yet in terms of identifying what might cause one to act insane, this is the building blocks upon which psychoanalysis and biological models for mental illness were built.
Yet with the loss of this information, throughout the Middle Ages and on, it was quite common for religion to overshadow science and the popular belief in evil spirits and possession regained prominence. This is attributed largely to the stressful times of the black plague, and the heightened religious consciousness of the time. The mentally ill were generally regarded as victims of sin, demons, or witches. Any treatment was at the discretion of the clergy—with whom the sick consulted—and usually their advice would be atonement (Plante 2004). As not much was known about medicine at the time, it was the reasoning of Thomas Aquinas that re-established reason in line with religious doctrine, arguing that as a soul could not be sick, the origin of such a disease must be bodily in nature (Mclnerny 1977). Ultimately Thomas’ ideas were too progressive and he was posthumously excommunicated in 1277. Once again the church triumphed over medical rationality. Yet these ideas were not in vein, as they set the stage for the revolution into what psychiatric medicine would become.
As Europe picked itself up from the dark times of the Middle Ages, the renaissance gave rise to a renewed scientific approach to mental illness. The work of Johann Weyer—the first man to specialize in mental illness—set precedent for viewing mental illness as a physical disorder, and to be treated like other disease. Doctors like Philippe Pinel and men like William Tuke gave rise of institutions and hospitals with portions specializing in mental illness also led to an improvement in the treatment of patients (Comer 2005). Moral treatment was a concept that was not developed until the 19th century. Although patients surely weren’t being tortured as in the dark ages, it was not until relatively recently that the mentally ill engaged in such activities as discussing their problems, and resting. In this model the emphasis is clearly on rehabilitation, although socially the stigma of being ‘insane’ surely would have prevented social prominence (socially adjusted people who were ‘insane’ were and are benevolently branded ‘eccentrics’). Regardless, the rapid growth of humane mental hospitals led to shortages of funding for these institutions. Resultantly, the institutions eroded, and the candle of hope for the mentally ill was once again snuffed out.
The last step bridging the old and new schools of psychological medicine is in fact as old as the Greeks. Hippocrates first linked the mind to mental illness, and his work was expounded in the late 19th century by Emil Kraepelin, a researcher who linked fatigue to mental illness. Indeed during that period in history, many new discoveries were being made, and medicine was beginning to take shape with the advent of antibiotics and anesthetics. Notably, the link between syphilis and mental illness also led to a shift in the way that mental dysfunction was viewed, the work of Dr. Richard von Krafft-Ebing, established syphilis as a cause of general paresis (Comer 2005). Although the connections were made, for many patients, biological treatments were ineffective, as the medical community had not perfected their knowledge of the human anatomy. The newly rediscovered somatogenic perspective was failing.
Yet the acceptance of biology as a possible explanation for mental illness goes hand in hand with another development, the psychogenic perspective. Just as the somatogenic perspective indicates that there are biological causes for mental illness, the psychogenic perspective names the psyche as the culprit for some maladies. In this respect, the view of the ‘mad’ becomes less hostile, although help was still far from being readily available. It is through the inspirations of psychoanalysts like Freud, that current medicine has developed it’s attitudes toward the mentally dysfunctional. Largely this is due to the lack of consideration for other peoples during the 19th and early 20th century (Jacoby 2000). Yet the argument can be made that, current medicine simply allows doctors to treat patients impersonally with the same apathy in a much neater package. In the pioneering days of psychogenic analysis, a female would often be labeled as hysterical or the like for problems that could be treated easily with counseling. It was perhaps in the best interest of the male dominant hierarchy of the time—really up until 60 years ago—to pigeonhole difficult and resistant minds into an easily classifiable system of evaluation, in which minor mental dysfunction warranted institutionalization or drugs. Yet today, society is so impressed by the ability to treat illness with drugs while avoiding confrontation, that those with serious mental problems are potentially ignored.
And so we stand at the nexus of modern medicine. The developing trend in current medicine is the over reliance on the use of medication. Perhaps in the vein of rationalism and Gecko-Roman thought—as our society is modeled after—insanity can be summed up as the lack of reason. In today’s over prescribed, morally bankrupt society one can argue that everyone suffers from some sort of existential crisis from time to time, and it is irresponsible on the part of the contemporary medical community to attempt to box in an individual just because their doctrine has a method for the treatment of their ‘illness’. At times it is hard to tell weather or not pharmaceutical companies are writing the prescriptions, or indeed the doctor’s they wine and dine on a regular basis. It speaks poorly upon society to have to own up to fundamental flaws within such an institution as medicine, yet it is in the best interest of society at large to change the paradigm on treating the mentally ill.
In evaluative terms, it is the responsibility of a medical professional to see to it that a patient gets the proper care, and that medication is a last resort. Current views are quite the opposite. A vignette may best serve to further the argument:
Josh is a 17 year old patient, whose parents brought him in after exhibiting signs of drug abuse, and standoffishness that accompanies being a teenager. After initial examination and office evaluation, it was found that Josh had a moderate depression (score 25 on BDI) and it is recommended that he be prescribed an antidepressant. If he has any further complaints, than he should call the doctor.
The problem with this scenario is that the medical community is far too confident in themselves. So sure are they in their methodology for diagnosis and treatment of any disorder, nobody will stop to question the trend which is a shame because without questioning there is no motivation for improvement. But how different is numbing one’s mind with drugs, to a lobotomy, or to pre-historic brain surgery with blunt rocks? The end result is the same when the reality is that individuals have the capacity to be rehabilitated. Commonly if one stops taking medication, they will revert to original symptoms. Society has subverted the insane in an effort to declare them cured, and as is the trend in this history, progress cannot be made, it seems, without two steps backward first.
Chadwick, J. (1983). Hippocratic Writings. Ed. G. E. Lloyd. Trans. W. N. Mann. New York: Penguin Classics.
Comer, Ronald J. (2004). Fundamentals of Abnormal Psychology. Boston: W. H. Freeman & Company.
Finger, Stanley. (2004). Minds behind the Brain : A History of the Pioneers and Their Discoveries. New York: Oxford UP, Incorporated.
Jacoby, Russell. (2000). End of Utopia : Politics and Culture in an Age of Apathy. New York: Basic Books.
Mclnerny, Ralph M. (1977). St. Thomas Aquinas California: Twayne publishers.
Plante, Thomas G. (2004). Contemporary Clinical Psychology. New York: Wiley.
Prioreschi, Plinio. (1996). A History of Medicine Vol. 1 : Primitive and Ancient Medicine. New York: Horatius P