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Psychology History entry

Published by cliamb.li, 2014-07-24 12:27:58

Description: T
he definition of psychology has changed as the focus of psychology has
changed. At various times in history, psychology has been defined as the
study of the psyche or the mind, of the spirit, of consciousness, and more recently as the study of, or the science of, behavior. Perhaps, then, we can arrive
at an acceptable definition of modern psychology by observing the activities of
contemporary psychologists:
■ Some seek the biological correlates of mental events such as sensation, perception, or ideation.
■ Some concentrate on understanding the principles that govern learning and
memory.
■ Some seek to understand humans by studying nonhuman animals.
■ Some study unconscious motivation.
■ Some seek to improve industrial-organizational productivity, educational
practices, or child-rearing practices by utilizing psychological principles.
■ Some attempt to explain human behavior in terms of evolutionary theory.
■ Some attempt to account for individual differences among people in such
area

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476 CHAPTER 14 series correctly for the rest of their lives. Gauss’s effects; this is the memory trace. The next time we experience and Katona’s experiment thus supported experience a cat, the memory process elicited Wertheimer’s belief that learning and problem solv- interacts with the already existing trace from the ing based on Gestalt principles has many advantages first experience. The conscious experience will over rote memorization or problem solving based be the result of both the present memory process on formal logic. and the trace of previously related experiences. Furthermore, a trace “exerts an influence on the process in the direction of making it similar to the MEMO R Y process which originally produced the trace” (Koffka, 1935/1963, p. 553). Although the Gestaltists emphasized the tendency According to this analysis, we are aware of and for the energy in the brain to organize itself into remember things in general terms rather than by simple and symmetrical patterns in their accounts of specific characteristics. Instead of seeing and re- learning and perception, they did not deny the im- membering such things as cats, clowns, or portance of experience. They maintained that the elephants, we see and remember “catness,”“clown- tendency toward perceptual organization and cog- ness,” and “elephantness.” This is because the trace nitive equilibrium is derived from the fact that the of classes of experience records what those experi- brain is a physical system and, as such, distributes its ences have in common—for example, those things activity in the simplest, most concise configuration that make a cat a cat. With more experience, the possible under any circumstances. What the brain trace becomes more firmly established and more organizes, however, is provided by sensory experi- influential in our perceptions and memories. The ence, and this provides an experiential component individual trace gives way to a trace system, which to Gestalt theory. Another experiential component is the consolidation of a number of interrelated ex- is apparent in the Gestaltists’ treatment of memory. periences. In other words, a trace system records all Of the three founders of Gestalt theory, Koffka our experiences with, say, cats. The interaction of wrote the most about memory. traces and trace systems with ongoing brain activity (memory processes) results in our perceptions and Memory Processes, Traces, memories being smoother and better organized than they otherwise would be. For example, we and Systems remember irregular experiences as regular, incom- Koffka assumed that each physical event we expe- plete experiences as complete, and unfamiliar ex- rience gives rise to specific activity in the brain. He periences as familiar. Trace systems govern our called the brain activity caused by a specific envi- memories of particular things as well as of general ronmental event a memory process. When the categories. For example, the memory of one’s own environmental event terminates, so does the brain dog, cat, or mother will tend to be a composite of activity it caused. However, a remnant of the mem- memories of experiences that occurred over a long ory process—a memory trace—remains in the period of time and under a wide variety of brain. Once the memory trace is formed, all subse- circumstances. quent related experience involves an interaction be- Like everything else addressed by Gestalt the- tween the memory process and the memory trace. ory, memory is governed by the law of Prägnanz. For example, when we experience a cat for the first That is, we tend to remember the essences of our time, the experience creates a characteristic pattern experiences. The brain operates in such a way as to of brain activity; this is the memory process. After make memories as simple and symmetrical as is pos- the experience is terminated, the brain registers its sible under the circumstances.

GESTALT PSYCHOLOGY 477 LEWIN’ S F IELD TH EORY dent in psychology today. (See Patnoe, 1988, for a number of interviews with prominent experimental Born on September 9 in Mogilno, Germany, Kurt social psychologists who were either directly or in- Lewin (1890–1947) received his doctorate in 1914 directly influenced by Lewin.) from the University of Berlin, under the supervi- sion of Stumpf. After several years of military ser- Aristotelian versus Galilean vice, for which he earned Germany’s Iron Cross, Lewin returned to the University of Berlin where Conception of Science he held various positions until 1932 and where he Lewin (1935) distinguished between Aristotle’s worked with Wertheimer, Koffka, and Köhler. view of nature, which emphasizes inner essences Although Lewin is usually not considered a founder and categories, and Galileo’s view, which empha- of Gestalt psychology, he was an early disciple, and sizes outer causation and the dynamics of forces. For most of his work can be seen as an extension or Aristotle various natural objects fall into categories application of Gestalt principles to the topics of mo- according to their essence, and everything that tivation, personality, and group dynamics. members of a certain category have in common Lewin was a visiting lecturer at Stanford defines the essence of members of that category. University in 1932 and from 1933 to 1935 at Unless external forces interfere, all members of a Cornell. In 1935 he became affiliated with the category have an innate tendency to manifest their Child Welfare Station at the University of Iowa as essence. For example, all elephants would, unless a professor of child psychology. In 1944 he created interfered with by accidental circumstances, mani- and directed the Research Center for Group fest the essence of elephantness. In this world of Dynamics at the Massachusetts Institute of distinct classes, internal forces drive the members Technology. Although Lewin died only three years of the classes to become what their essence dictates after starting his work on group dynamics, the in- they must become. Aristotle saw individual differ- fluence of this work was profound and is still evi- ences as distortions caused by external forces inter- fering with an object’s or organism’s natural growth tendencies. He emphasized the common attributes that members of a certain class possess, not their differences. According to Lewin, Galileo revolutionized science when he changed its focus from inner cau- sation to a more comprehensive notion of causa- tion. For Galileo the behavior of an object or organism is determined by the total forces acting on the object or organism at the moment. For ex- ample, whether a body falls or not—and if it falls, how fast—is determined by its total circumstances Association and not by the innate tendency for heavy bodies to fall and light ones to rise. For Galileo causation springs not from inner essences but from physical Psychological forces; thus, he eliminated the idea of distinct cate- gories characterized by their own essences and their American own associated inward drives. The interaction of natural forces causes everything that happens; there are no accidents. Even so-called unique events are Kurt Lewin

478 CHAPTER 14 totally comprehensible if the dynamic forces acting marized his belief concerning psychological facts in on them are known. his principle of contemporaneity, which states For Lewin (1935) too much of psychology was that only those facts that are currently present in still Aristotelian. Psychologists were still seeking in- the life space can influence a person’s thinking ner determinants of behavior, such as instincts, and and behavior. Unlike Freud and others, Lewin be- still attempting to place people in distinct catego- lieved that experiences from infancy or childhood ries, such as normal and abnormal. Lewin also saw can influence adult behavior only if those experi- stage theories as extensions of Aristotelian thinking ences are reflected in a person’s current awareness. —for example, a theory that says average two- Not only does a person’s life space reflect real year-olds act in certain ways and average three- personal, physical, and social events, but it also re- year-olds in other ways. Any theory attempting to flects imaginary events. If a person believes he or classify people into types was also seen as exempli- she is disliked by someone, that belief, whether it is fying Aristotelian thinking—for example, a theory true or not, will influence his or her interactions that characterizes people as introverts or extroverts. with that person. If we believe we are incapable According to Lewin, when Galileo’s conception of of doing something, we will not attempt to do it, causation is employed, all these distinct categories regardless of what our true capabilities are. For vanish and are replaced with a conception of uni- Lewin subjective reality governs behavior, not versal causation (the view that everything that oc- physical reality. One could be physically in a class- curs is a function of the total influences occurring at room but mentally pondering a forthcoming social the moment). engagement. If so, one would be oblivious to what In psychology, switching from an Aristotelian was going on in the classroom. Again, Lewin be- to a Galilean perspective would mean deemphasiz- lieved that a person’s thinking and behavior at any ing such notions as instincts, types, and even given moment are governed by the totality of psy- averages (which imply the existence of distinct cat- chological facts (real or imagined) present, and that egories) and emphasizing the complex, dynamic totality constitutes a person’s life space. forces acting on an individual at any given moment. According to Lewin, if a need arises, the life For Lewin, these dynamic forces—and not any type space is articulated with facts that are relevant to of inner essences—explain human behavior. the satisfaction of that need. For example, if one is hungry, psychological facts related to obtaining and ingesting food dominate one’s life space. Life Space Some facts facilitate the satisfaction of the need Probably Lewin’s most important theoretical con- (such as having money, the availability of food) cept was that of life space. A person’s life space and some facts inhibit its satisfaction (having other consists of all influences acting on him or her at a urgent commitments, being on a very restrictive given time. These influences, called psychological diet). Often two or more needs can exist simulta- facts, consist of an awareness of internal events neously, and the articulation of the life space can (such as hunger, pain, and fatigue), external events become quite complex. The life space, then, is dy- (restaurants, restrooms, other people, stop signs, and namic, reflecting not only changing needs but also angry dogs), and recollections of prior experiences dominant environmental experiences such as hear- (knowing that a particular person is pleasant or un- ing a doorbell ring or a person cry for help. pleasant or knowing that one’s mother tends to say yes to certain requests and no to others). The only Motivation requirement for something to be a psychological fact is that it exist in a person’s awareness at the Like the other Gestaltists, Lewin believed that peo- moment. A previous experience is a psychological ple seek a cognitive balance. We saw how Köhler fact only if one recalls it in the present. Lewin sum- used this assumption in his explanation of learning.

GESTAL T PSYCHOLOG Y479 Lewin used the same assumption in his explanation tasks than the completed ones. Her explanation of motivation. According to Lewin, both biological was that for the uncompleted tasks the associated and psychological needs cause tension in the life tension is never reduced; therefore, these tasks re- space, and the only way to reduce the tension is main as intentions, and as such they remain part of through satisfaction of the need. Psychological the person’s life space. The tendency to remember needs, which Lewin called quasi needs, include uncompleted tasks better than completed ones has such intentions as wanting a car, wanting to go to come to be called the Zeigarnik effect. According a concert, or wanting to go to medical school. to Leonard Zusne (1995), it is unfortunate that Doing her doctoral work under Lewin’s super- Zeigarnik’s name has become associated only with vision, Bluma Zeigarnik (1927) tested Lewin’s the Zeigarnik effect. More important is the little tension-system hypothesis concerning motivation. known fact that she was essentially the “mother” According to this hypothesis, needs cause tensions of clinical psychology in the Soviet Union. that persist until the needs are satisfied. It was A year after Zeigarnik did her research, Maria Lewin’s custom to have long discussions with his Ovsiankina (1928), who was also working with students in a café while drinking coffee and snack- Lewin, found that individuals would rather resume ing. Apparently, the tension-system hypothesis oc- interrupted tasks than completed ones. Her expla- curred to him asa result of an experience he had nation for this was the same as the one for the during one of these informal discussions. As Zeigarnik effect. Marrow (1969) reports, On one such occasion, somebody called Conflict for the bill and the waiter knew just what everyone had ordered. Although he hadn’t Although the fact that human tendencies often kept a written reckoning, he presented an conflict was discussed by Plato (see Chapter 2), St. exact tally to everyone when the bill was Paul (see Chapter 3), and Spinoza (see Chapter 6) called for. About a half hour later Lewin and was made the cornerstone of psychoanalysis by called the waiter over and asked him to Freud (see Chapter 16), it was Lewin who first in- write the check again. The waiter was in- vestigated conflict experimentally (see, for example, dignant. “I don’t know any longer what Lewin, 1935). Lewin concentrated his study on you people ordered,” he said. “You paid three types of conflict. An approach-approach your bill.” In psychological terms, this in- conflict occurs when a person is attracted to two dicated that a tension system had been goals at the same time, such as needing to choose building up in the waiter as we were or- from two attractive items on a menu or between dering and upon payment of the bill the two equally attractive colleges after being accepted tension system was discharged. (p. 27) by both. An avoidance-avoidance conflict oc- curs when a person is repelled by two unattractive In her formal testing of Lewin’s hypothesis, goals at the same time, such as when one must get a Zeigarnik (1927) assumed that giving a subject a job or not have enough money or study for an task to perform would create a tension system and examination or get a bad grade. An approach- that completion of the task would relieve the ten- avoidance conflict is often the most difficult to sion. In all, Zeigarnik gave 22 tasks to 138 subjects. resolve because it involves only one goal about The subjects were allowed to finish some tasks but which one has mixed feelings, such as when having not others. Zeigarnik later tested the subjects on a T-bone steak is an appealing idea but it is one of their recall of the tasks, and she found that the sub- the most expensive items on the menu or when jects remembered many more of the uncompleted marriage is appealing but it means giving up a great

480 CHAPTER 14 deal of independence. The types of conflict Lewin Consequently, housewives were encour- studied can be diagrammed as follows (where p aged to buy more accessible products, such symbolizes a person): as brains, liver, kidneys, and heart and other animal organs not generally consid- Goal 1 Goal 2 ered to be food items. He used two methods—the first was lecturing on the + ! p ! + Approach–Approach merits of the food, their nutritional values, Conflict how they could be tastily prepared, and so − ! p ! − Avoidance–Avoidance on. The second method involved group Conflict discussion. The same materials were pre- ± $ p Approach–Avoidance sented in both cases. In the group discus- Conflict sion, there was participation by the mem- bers on the pros and cons of trying and After Lewin, the next significant research on eating and preparing such substances. In a conflict was performed by Neal Miller (1909– follow-up study only 3 percent of the 2002) as part of his highly regarded effort to pre- lecture group took up the suggestions, cisely define and evaluate a number of psychoana- while 32 percent of the discussion group lytic concepts within the context of learning theory changed their food habits by trying the (see, for example, Dollard and Miller, 1950; N. E. formerly unpopular products. Lewin con- Miller, 1944, 1959, 1964). cluded that in the discussion group more forces were made available for a change in behavior. (pp. 261–262) Group Dynamics In another study, Lewin, Lippitt, and White In his later years, Lewin extended Gestalt principles (1939) investigated the influence of various types to the behavior of groups. According to Lewin, a of leadership on group performance. Boys were group can be viewed as a physical system just as the matched and then placed in (1) a democratic group, brain can be. In both cases, the behavior of individ- in which the leader encouraged group discussion ual elements is determined by the configuration of and participated with the boys in making decisions; the existing field of energy. Therefore, the nature (2) an authoritarian group, in which the leader made or configuration of a group will strongly influence all decisions and told the boys what to do; or (3) a the behavior of its members. Among the members laissez-faire group, in which no group decisions were of each group, there exists what Lewin called made and the boys could do whatever they wanted. a dynamic interdependence. Lewin’s studies of The researchers found that the democratic group group dynamics led to what are now called en- was highly productive and friendly, the authoritar- counter groups, sensitivity training, and leadership ian group was highly aggressive, and the laissez-faire institutes. group was unproductive. Lewin et al. concluded Lundin (1991) describes one of Lewin’s studies that group leadership influenced the Gestalt charac- of group dynamics: terizing the group and, in turn, the attitude and The concept of group dynamics has led to productivity of the group’s members. several avenues of research. During World When Lewin died suddenly on February 11, War II, Lewin conducted a number of 1947, of a heart attack, he was at the height of his experiments that attempted to alter group career and influence. He was only 57 years old at decision-making. At the time, certain food the time of his death and had been in the United products, such as meat, were rationed. States for only 12 years.

GESTALT PSYCHOLOGY 481 T HEIM PA C TOFG EST AL T [Gestalt psychology] enriched American PSYCHOLOGY psychology greatly and did much to counter the attractions of extreme behav- iorism. If Gestalt psychology has today lost Like any school in psychology, Gestalt psychology its identity as a school of thought—and has had its share of criticism. Critics have said that very few of Koffka’s, Köhler’s, many of its central terms and concepts are vague Wertheimer’s, or Lewin’s students call and therefore hard to pin down experimentally. themselves Gestalt psychologists—it is not Even the term Gestalt, the critics say, has never because the mainstream of American psy- been defined precisely. The same is true for the chology has swamped their ideas. Rather, law of Prägnanz for insight and for cognitive equilib- their work has done much to redirect this rium and disequilibrium. As might be expected, the mainstream, which adopted many of their behaviorists attacked the Gestaltists’ concern with points of view. Few other migrating sci- consciousness, claiming that such a concern was a entific schools have been as successful. regression to the old metaphysical position that had (p. 1263) caused psychology so many problems. Following a discussion with Köhler on Gestalt psychology, the In a thoughtful chapter titled “Rediscovering illustrious neuropsychologist Karl Lashley said, Gestalt Psychology,” Henle (1985) discusses several “Excellent work—but don’t you have religion up important relationships that exist between Gestalt your sleeve?” (Henle, 1971b, p. 117). Despite these psychology and contemporary cognitive psychol- and other criticisms, however, Gestalt theory has ogy. Murray (1995) also discusses those relation- clearly influenced almost every aspect of modern ships. We will have more to say about the influence psychology. Sokal (1984) said the following about of Gestalt psychology on contemporary cognitive the influence of Gestalt psychology: psychology in Chapter 20. SUMMARY Attacking both the structuralists and the behaviorists chology, which emphasizes the conscious acts of for their elementism, the Gestaltists emphasized perceiving, sensing, and problem solving instead cognitive and behavioral configurations that could of the elements of thought; and the emergence of not be divided without destroying the meaning of field theory in physics. those configurations. Gestalt is the German The 1912 publication of Wertheimer’s article word for “whole,”“totality,” or “configuration.” on the phi phenomenon usually marks the found- Antecedents of Gestalt psychology include Kant’s ing of the Gestalt school of psychology. The phi contention that sensory experience is structured phenomenon indicates that conscious experience by the faculties of the mind; Mach’s contention cannot be reduced to sensory experience. Koffka that the perception of space form and time form and Köhler worked with Wertheimer on his early are independent of any specific sensory elements; perception experiments and are usually considered Ehrenfels’s observation that although form qualities cofounders of Gestalt psychology. Wertheimer as- emerge from sensory experience, they are different sumed that forces in the brain distribute themselves from that experience; J. S. Mill’s notion of mental as they do in any physical system (symmetrically and chemistry; James’s contention that consciousness is evenly) and that these force fields interact with sen- like an ever-moving stream that cannot be divided sory information to determine conscious experi- into elements without losing its meaning; act psy- ence. The contention that force fields in the brain

482 CHAPTER 14 determine consciousness was called psychophysical the law of Prägnanz. Experience activates a brain isomorphism, and the contention that brain activity activity called a memory process, which lasts as is always distributed in the most simple, symmetri- long as an experience lasts. After the memory pro- cal, and organized way was called the law of cess terminates, a trace of it remains, and that mem- Prägnanz. The term perceptual constancy refers to ory trace influences subsequent memories of similar the way we respond to objects or events as the objects or events. Eventually, a trace system devel- same even when we experience them under a ops that records the features that memories of a wide variety of circumstances. certain type have in common. After a memory According to the Gestaltists, the most basic per- trace—and to a larger extent, a trace system—is ception is that of a figure–ground relationship. established, the memory of a specific event is deter- Perceptual principles that cause the elements of per- mined by the memory trace and by the trace system ception to be organized into configurations include of similar experiences, as well as by one’s immediate continuity, by which stimuli following some pat- experience. tern are seen as a perceptual unit; proximity, by Lewin was an early Gestaltist who believed that which stimuli that are close together form a percep- psychology should not categorize people into types tual unit; similarity, by which similar stimuli form a or emphasize inner essences. Rather, he believed perceptual unit; inclusiveness, by which a larger psychology should attempt to understand the dy- perceptual configuration masks smaller ones; and namic force fields that motivate human behavior. closure, by which incomplete physical objects are He believed that such a shift in emphasis would experienced psychologically as complete. The switch psychology from an Aristotelian to a Gestaltists distinguished the geographical (physical) Galilean model of science. According to Lewin, environment from the behavioral (subjective) envi- anything influencing a person at a given moment ronment. They believed that the behavioral envi- is a psychological fact, and the totality of psycho- ronment governs behavior. logical facts that exists at the moment constitutes a The Gestaltists viewed learning as a perceptual person’s life space. Lewin believed that both bio- phenomenon. For them, the existence of a problem logical and psychological needs create a tension that creates a psychological disequilibrium, or tension, persists until the needs are satisfied. The Zeigarnik that persists until the problem is solved. As long as effect, or the tendency to remember uncompleted there is tension, the person engages in cognitive tasks longer than completed ones, supported trial and error in an effort to find the solution to Lewin’s theory of motivation. Lewin observed the problem. Problems remain in an unsolved state that intentions often conflict, as when one wants until insight into the solution is gained. Insightful two desirable things at the same time, wants to learning is sudden and complete; it allows perfor- avoid two undesirable things at the same time, or mance that is smooth and free of errors. Also, the wants and does not want the same thing at the same person retains the information gained by insight for time. With his work on group dynamics, Lewin a long time and can easily transfer that information showed that different types of group structures cre- to similar problems. The application of a principle ate different Gestalten that influence the perfor- learned in one problem-solving situation to other mance of group members. similar situations is called transposition. Gestalt psychology played a major role in di- Productive thinking involves the understanding recting the attention of psychologists away from of principles rather than the memorization of facts insignificant bits of behavior and consciousness or the utilization of formal logic. The Gestaltists and toward the holistic aspects of behavior and con- believed that reinforcement for productive thinking sciousness. As with functionalism, many of the basic comes from personal satisfaction, not from events features of Gestalt psychology have been assimilated outside oneself. They thought that memory, like into modern psychology, and therefore Gestalt psy- other psychological phenomena, is governed by chology has lost its distinctiveness as a school.

GESTALT PSYCHOLOGY 483 DISCUSSION QUESTIONS 1. Summarize the disagreements that the more important in determining behavior? Give Gestaltists had with Wundt’s experimental an example. program, the structuralists, and the behaviorists. 12. How did the Gestaltists explain learning? In 2. Differentiate the molecular approach to psy- your answer, summarize the characteristics of chology from the molar approach. insightful learning. 3. Describe similarities and differences that existed 13. What is transposition? Summarize the Gestalt between the positions of Kant, Mach, and the behavioristic explanations of this Ehrenfels, James, and the act psychologists, on phenomenon. one hand, and the Gestaltists, on the other. 14. For Wertheimer, what represents the best type 4. Explain what is meant by the contention that of problem solving? Contrast this type of Gestalt theory used field theory as its model problem solving with rote memorization and and that empirical-associationistic psychology logical problem solving. used Newtonian physics as its model. 15. Summarize the Gestalt explanation of memory. 5. What is the phi phenomenon? What was its Include in your answer definitions of memory importance in the formation of the Gestalt process, memory trace, and trace system. What school of psychology? does it mean to say that memory is governed 6. What is meant by the contention that Gestalt by the law of Prägnanz? analysis proceeds from the top down rather 16. For Lewin, how does psychology based on than from the bottom up? Aristotle’s view of nature differ from psychol- 7. Contrast the Gestalt notion of psychophysical ogy based on Galileo’s view of nature? Give an isomorphism with the constancy hypothesis. example of each. 8. What is the law of Prägnanz? Describe the 17. What did Lewin mean by life space? Include in importance of this law to Gestalt psychology. your answer the definition of psychological fact. 9. What is perceptual constancy? Give an exam- 18. Summarize Lewin’s theory of motivation. In ple. How did the Gestaltists explain the per- your answer, distinguish between needs and ceptual constancies? quasi needs. 10. Briefly define each of the following: figure– 19. What is the Zeigarnik effect? Describe the re- ground relationship, principle of continuity, search used to demonstrate the effect. principle of proximity, principle of similarity, 20. Describe the three types of conflict studied by principle of inclusiveness, and principle of Lewin and give an example of each. closure. 21. Summarize Lewin’s work on group dynamics. 11. Distinguish between subjective and objective 22. Summarize the impact that Gestalt psychology reality. According to the Gestaltists, which is has had on contemporary psychology. SU GGE STIONS FOR FURTHER READING Gold, M. (Ed.). (1999). The complete social scientist: A Kurt Henle, M. (Ed.). (1971). The selected papers of Wolfgang Lewin reader. Washington, DC: American Köhler. New York: Liveright. Psychological Association.

484 CHAPTER 14 Henle, M. (1978). One man against the Nazis— Psychological Association. (Original works pub- Wolfgang Köhler. American Psychologist, 33, 939– lished in 1948 and 1951, respectively) 944. Ley, R, (1990). A whisper of espionage: Wolfgang Köhler and Henle, M. (1986). 1879 and all that: Essays in the theory the apes of Tenerife. Garden City, NY: Avery. and history of psychology. New York: Columbia Murray, D. J. (1995). Gestalt psychology and the cognitive University Press. revolution. New York: Harvester Wheatsheaf. Köhler, W. (1966). The place of value in a world of facts. New Sokal, M. M. (1984). The Gestalt psychologists in be- York: Liveright. (Original work published 1938) haviorist America. American Historical Review, 89, Lewin, K. (1997). Resolving social conflicts and Field theory 1240–1263. in social science. Washington, DC: American GLOSSARY Act psychology Type of psychology that emphasizes Extrinsic reinforcement Reinforcement that comes the study of intact mental acts, such as perceiving and from a source other than one’s self. judging, instead of the division of consciousness into Field theory That branch of physics that studies how elements. energy distributes itself within physical systems. In some Approach-approach conflict According to Lewin, systems (such as the solar system), energy can distribute the type of conflict that occurs when a person is attracted itself freely. In other systems (such as an electric circuit), to two goals at the same time. energy must pass through wires, condensers, resistors, and Approach-avoidance conflict According to Lewin, so forth. In either type of system, however, energy will the type of conflict that occurs when a person is attracted always distribute itself in the simplest, most symmetrical to and repelled by the same goal at the same time. way possible under the circumstances. According to the Gestaltists, the brain is a physical system whose activity Avoidance-avoidance conflict According to Lewin, could be understood in terms of field theory. the type of conflict that occurs when a person is repelled by two goals at the same time. Figure–ground relationship The most basic type of perception, consisting of the division of the perceptual Behavioral environment According to Koffka, sub- field into a figure (that which is attended to) and a jective reality. ground, which provides the background for the figure. Constancy hypothesis The contention that there is a strict one-to-one correspondence between physical sti- Geographical environment According to Koffka, muli and sensations, in the sense that the same stimula- physical reality. tion will always result in the same sensation regardless of Gestalt The German word meaning “configuration,” circumstances. The Gestaltists argued against this con- “pattern,” or “whole”. tention, saying instead that what sensation a stimulus Gestalt psychology The type of psychology that elicits is relative to existing patterns of activity in the studies whole, intact segments of behavior and cognitive brain and to the totality of stimulating conditions. experience. Ehrenfels, Christian von (1859–1932) Said that Group dynamics Lewin’s extension of Gestalt princi- mental forms emerge from various sensory experiences ples to the study of group behavior. and that these forms are different from the sensory ele- Holists Those who believe that complex mental or ments they comprise. behavioral processes should be studied as such and not Elementism The belief that complex mental or be- divided into their elemental components for analysis. (See havioral processes are composed of or derived from also Phenomenology.) simple elements and that the best way to understand Insightful learning Learning that involves perceiving these processes is first to find the elements of which they the solution to a problem after a period of cognitive trial are composed. and error.

GESTALT PSYCHOLOGY 485 Intrinsic reinforcement The self-satisfaction that Phenomenology The study of intact, meaningful, comes from problem solving or learning something. mental phenomena. According to the Gestaltists, this feeling of satisfaction Phi phenomenon The illusion that a light is moving occurs because solving a problem or learning something from one location to another. The phi phenomenon is restores one’s cognitive equilibrium. caused by flashing two lights on and off at a certain rate. Kant, Immanuel (1724–1804) Said that what we ex- Principle of closure The tendency to perceive in- perience consciously is determined by the interaction of complete objects as complete. sensory information with the categories of thought. Principle of contemporaneity Lewin’s contention Koffka, Kurt (1886–1941) Worked with Wertheimer that only present facts can influence present thinking and on his early perception experiments. Koffka is considered behavior. Past experiences can be influential only if a a cofounder of the school of Gestalt psychology. person is presently aware of them. Köhler, Wolfgang (1887–1967) Worked with Principle of continuity The tendency to experience Wertheimer on his early perception experiments. Köhler is stimuli that follow some predictable pattern as a percep- considered a cofounder of the school of Gestalt psychology. tual unit. Law of Prägnanz Because of the tendencies of the Principle of inclusiveness The tendency to perceive force fields that occur in the brain, mental events will only the larger figure when a smaller figure is embedded always tend to be organized, simple, and regular. in a larger figure. According to the law of Prägnanz, cognitive experience Principle of proximity The tendency to perceptually will always reflect the essence of one’s experience instead group together stimuli that are physically close. of its disorganized, fragmented aspects. Principle of similarity The tendency to perceive as Lewin, Kurt (1890–1947) An early Gestaltist who units stimuli that are physically similar to one another. sought to explain human behavior in terms of the totality of influences acting on people rather than in terms of the Productive thinking According to Wertheimer, the manifestation of inner essences. Lewin was mainly re- type of thinking that ponders principles rather than iso- sponsible for applying Gestalt principles to the topics of lated facts and that aims at understanding the solutions to motivation and group dynamics. problems rather than memorizing a certain problem- solving strategy or logical rules. Life space According to Lewin, the totality of the psychological facts that exist in one’s awareness at any Psychological facts According to Lewin, those things given moment. (See also Psychological fact.) of which a person is aware at any given moment. Mach, Ernst (1838–1916) Observed that some mental Psychophysical isomorphism The Gestaltists’ con- experiences are the same even though they are stimu- tention that the patterns of activity produced by the brain lated by a wide range of sensory events. The experienc- —rather than sensory experience as such—causes mental ing of geometric forms (space forms) and melodies (time experience. forms) are examples. Quasi needs According to Lewin, psychological rather Memory process The brain activity caused by the than biological needs. experiencing of an environmental event. Trace system The consolidation of the enduring or Memory trace The remnant of an experience that re- essential features of memories of individual objects or of mains in the brain after an experience has ended. classes of objects. Molar approach The attempt to focus on intact mental Transposition The application of a principle learned in and behavioral phenomena without dividing those phe- one learning or problem-solving situation to other sim- nomena in any way. ilar situations. Wertheimer, Max (1880–1943) Founded the school Molecular approach The attempt to reduce complex of Gestalt psychology with his 1912 paper on the phi phenomena into small units for detailed study. Such an phenomenon. approach is elementistic. Perceptual constancy The tendency to respond to Zeigarnik effect The tendency to remember uncom- objects as being the same, even when we experience pleted tasks longer than completed ones. those objects under a wide variety of circumstances.

15 ✵ Early Diagnosis, Explanation, and Treatment of Mental Illness WHAT IS MENTAL ILLNESS? Although the condition we now refer to as mental illness has existed from at least the beginning of recorded history, the terms used to describe that condition have varied. Today, besides the term mental illness, we use such terms as psychopa- thology and abnormal behavior. At earlier times, terms such as mad, lunatic, maniac, and insane have been used. Although the terms have changed, all refer to more or less the same type of behavior. As W. B. Maher and B. A. Maher (1985) explain, The old terms meant pretty much the same thing as the new terms re- placing them. “Mad,” for example, was an old English word meaning emotionally deranged and came in turn from an ancient root word meaning crippled, hurt; “insanity” comes from the root word “sanus” or free from hurt or disease, and thus “insane” means hurt or unhealthy; “lunacy” refers to the periodic nature of many psychopathological con- ditions and perhaps was originally intended to differentiate periodic madnesses from those in which the state was chronic and unremitting; “mania” refers to excess of passion or behavior out of control of the reason. (p. 251) When the behavior and thought processes thought to characterize mental illness are examined, several recurring themes become evident. In describing these themes, we follow W. B. Maher and B. A. Maher (1985). 486

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 487 Harmful Behavior treme, as when extreme fear, sadness, or joy are displayed in situations where much more moderate Normal individuals possess a powerful motive to levels of these emotions are considered appropriate, survive, and therefore behavior contrary to that the person is often suspected of being mentally dis- motive, such as self-mutilation or suicide, is consid- turbed. Inappropriate or exaggerated emotional re- ered abnormal. There have been cultural settings, sponses have been and are standard criteria used in however, in which harming oneself was considered labeling a person as mentally ill. desirable, such as when in Japan committing hara- kiri was viewed as a way of restoring lost personal or family honor. Also, there have been cultural set- Unpredictable Behavior tings in which injuring another person or persons Sudden shifts in one’s beliefs or emotions have also was sanctioned, such as in 17th- and 18th-century traditionally been taken as signs of psychopathol- Italy, when castrating a child with musical talent to ogy. For example, the person who is happy one prepare him for an operatic career as a castrato was moment and sad the next or who embraces one an acceptable practice; or during warfare, when conviction only to have it displaced by another in killing the enemy was encouraged. But generally, a short period of time has been and is considered to behavior that is harmful to oneself or others has be at least emotionally unstable. If such rapid shifts been and is viewed as abnormal. in moods or beliefs persist, the person is often char- acterized as mentally ill. Unrealistic Thoughts and Perceptions What these criteria of mental illness all have in common is that they define abnormality in terms of If a person’s beliefs or perceptions differ markedly the behavior and thought processes of the average from those considered normal at a certain time and person in a community. Of course, the characteristics place in history, those beliefs and perceptions are of this average person will vary according to the mo- taken as signs of mental illness. Using today’s termi- res of his or her culture, but it is always the average nology, we say that people are having delusions if person’s beliefs and behavior that have been used as a their beliefs are not shared by other members of frame of reference in determining mental illness. the community. For example, it is considered de- Right or wrong, using the experiences of the lusional if a person believes that he or she can be average members of a community as a frame of refer- transformed into some type of animal, such as a ence in defining mental illness is as operative today as wolf or a cat. Similarly, people are considered ab- it has been throughout human history. This means normal if their perceptions do not correspond to that two categories of people are susceptible to being those of other members of the community. Today labeled mentally ill: those who for one reason or an- we call such perceptions hallucinations. An example other cannot abide by cultural norms and those who would be a person seeing a bountiful crop where choose not to. (For more on the tendency to brand others see only dust or dirt. Both false beliefs (delu- extreme nonconformists as mentally ill, see Szasz, sions) and false perceptions (hallucinations) have 1974; Vatz and Weinberg, 1983.) traditionally been taken as representing unrealistic contact with reality and therefore as abnormal. Inappropriate Emotions EARLY EX PLANATIONS OF When an individual consistently laughs when the MENTAL ILLNESS mores of a community dictate that he or she should cry or cries when he or she should laugh, that per- The proposed explanations of mental illness that have son is often branded as mentally ill. Likewise, if a been offered throughout history fall into three general person’s emotional reactions are considered ex- categories: biological, psychological, and supernatural.

488 CHAPTER 15 Biological Explanations being attacked by an animal or an enemy, or over- eating or drunkenness—to mysterious forces enter- Generally, biological explanations ofabnormal behav- ing the body. People did not distinguish between ior constitute the medical model of mental illness. mental and physical disorders but believed both to This model assumes that all disease is caused by the be inflicted on a person by some mortal or immortal malfunctioning of some aspect of the body, mainly being. Supernatural explanations of all illness (includ- the brain. The bodily abnormalities causing mental ing mental) prevailed until the time of the early illness can be inherited directly, as was supposed to Greek physicians,suchasAlcmaeonand Hippocrates. be the case with “natural fools,” or a predisposition The Greek naturalistic approach to medicine was toward mental illness could be inherited, which could highly influential until the collapse of the Roman be activated by certain experiences. In one way or Empire in A.D. 476. From that time until about the another, constitutional factors have almost always 18th century, supernatural explanations of diseases of been suggested as possible causes of mental illness. all types prevailed. Also, included among the biological explana- Although the supernatural model of mental tions of mental illness are the many events that can illness was popular during the Middle Ages, it interfere with the normal functioning of the body. would be a mistake to conclude that it was the only Such events include injuries; tumors and obstruc- model: tions; ingestion of toxins; polluted air, water, or food; disease; excessive physical stress; and physiolog- Although notions of demonology flour- ical imbalances such as those caused by improper diet. ished in medieval religious, lay, and even medical speculation, rational and naturalis- Psychological Explanations tic theories and observations continued to be influential. This is evident in the histor- A psychological model of mental illness pro- ical, biographical, medical, legal, and poses that psychological events are the causes of creative literature of the times. Explanations abnormal behavior. Here, psychological experi- of psychopathological behavior were not ences such as grief, anxiety, fear, disappointment, confined to demon possession; they em- frustration, guilt, or conflict are emphasized. The braced a diversity of ideas derived from mental stress that results from living in an organized common sense, classical medicine and society has always been recognized as a possible ex- philosophy, folklore and religion. In me- planation of mental illness; how much psychologi- dieval descriptions of mental illness there is cal explanations were stressed varied with time and most typically an interweaving of state- place. As is the case today, biological and psycho- ments variously implying natural (biologi- logical explanations of mental illness most often ex- cal and psychological) and supernatural isted simultaneously. More often than not, it was causation. It is difficult to assess which was believed that psychological events influenced bio- considered most important; it is also logical events, and vice versa. In more recent times, difficult to discern what was intended to however, tension has arisen between those accept- be taken literally and what metaphorically. ing the medical model of mental illness and those (W. B. Maher and B. A. Maher, 1985, accepting the psychological model. We will say p. 283) more about that tension later in this chapter. Biological, psychological, and supernatural ex- planations of mental illness have almost always ex- Supernatural Explanations isted in one form or another; what has changed In primitive times, people attributed most ailments through history is how one type of explanation not caused by obvious things—such as falling down, has been emphasized over the others.

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 489 EARLY APPROACHES TO THE Throughout the course of history there is a TREATMENT OF MENTAL constantly recurring list of therapies for mental illness, each related in one way or ILLNESS another to the symptoms of and/or the supposed causes of the pathology. Although Psychotherapy is any attempt to help a person ideally therapies are devised to effect with a mental disturbance. As mentioned earlier, cures, they are often merely palliative, in- common themes characterize behavior that is con- tended to relieve symptoms whilst the dis- sidered abnormal. Common themes also run ease process does or does not run its course. through all forms of psychotherapy: And although therapies have often been derived from theories of causation, at times No matter what its form, cost or setting, all the theories of causation have been con- that is meant by psychotherapy is the service trived to rationalize the treatments used. that one human being, a helper, renders Therapies have been developed by physi- another, a sufferer, toward the end of pro- cians, priests, psychiatric and psychological moting the latter’s well being. The common specialists, interested laymen, charlatans, elements in both ancient and modern forms and quacks; the therapies vary accordingly. of psychotherapy are a sufferer, a helper, and Treatments in general have been under- a systematized ritual through which help is taken to meet the patient’s need, to meet the proffered. Although the specific purposes in needs of the patient’s family or friends or consulting a psychotherapist are as numer- community to do something for or about ous and unique as the individuals who seek the patient, to solve social problems pre- such help, the basic reasons have always sented by the patient’s condition. been to obtain assistance in (1) removing, Treatment therefore may not be primarily modifying or controlling anxiety, depres- intended to be therapeutic. The patient may sion, alienation, and other distressing psy- be placed under custodial care in order to chological states, (2) changing undesirable protect the patient from his or her own self patterns of behavior such as timidity, over- neglect or abuse or the consequences of aggressiveness, alcoholism, disturbed sexual poor judgment; to allow time for rest, relationships, and the like, or (3) promoting freedom from responsibility, proper diet to more positive personal growth and the de- effect improvement; to protect others from velopment of greater meaning in one’s life the violence, problems, embarrassment, or through more effective personal function- inconvenience caused by the patient—or all ing, or through the pursuit of new educa- of the above. (W. B. Maher and B. A. tional, occupational, recreational, or other Maher, 1985, p. 266) goals which will better allow expression of the individual’s potential. (Matarazzo, 1985, p. 219) In any case, if an honest effort was made to treat mental illness, the treatment used was deter- Although it may be true that ideally all versions mined largely by beliefs concerning its cause. If it of psychotherapy address the needs of the “suf- was believed that mental illness was caused by psy- ferer,” it is also true that not all versions of psycho- chological factors, those factors were addressed dur- therapy have been successful in doing so. In ing the therapeutic process. If it was believed that addition, individuals with mental illness have often supernatural or biological factors caused mental ill- been treated or confined, not so much for their ness, the therapeutic process was conducted own benefit as for the benefit of the community: accordingly.

490 CHAPTER 15 The Psychological Approach or her ways, and it is the therapist’s job to help him or her to do so. When psychological factors such as fear, anxiety, frustration, guilt, or conflict were viewed as the causes of mental illness, treatment was aimed at The Supernatural Approach those factors. Methods used throughout history to If it was believed that evil forces entering the body address psychological factors thought to be respon- caused illness, then a cure would involve removing sible for mental illness include having the individual those forces. In attempting to coax the invading observe (such as by watching a drama) or personally forces from an inflicted person’s body, the primitive reenact the traumatic experience in order to create medicine man would use appeal, bribery, rever- a catharsis (purging the mind of disturbing emo- ence, and intimidation—and sometimes exorcism, tions); having the person listen to relaxing music; magical rituals, and incantations. offering support, reassurance, and love from author- In his famous book The Golden Bough (1890/ ity figures or relevant others; analyzing dreams, 1963), Sir James Frazer (1854–1941) discussed thoughts, and motives; and attempting to teach sympathetic magic, which, for primitive humans, the “sufferer” new and more effective skills to en- was extremely important in the explanation and able better coping with personal or interpersonal treatment of ailments. Frazer distinguished between problems. Today the last method would exemplify two types of sympathetic magic: homeopathic and behavior therapy. contagious. Homeopathic magic was based on Somewhere between the psychological and su- the principle of similarity. An example of homeo- pernatural explanations of mental illness was the pathic magic is the belief that what one did to a 18th-century belief in natural law. Generally, nat- model or image of a person would affect that per- ural law is the belief that you get what you deserve son. Contagious magic, which was based on the in life: principle of contiguity, involved the belief that Philosophical ideas about human society what was once close to or part of someone would were, in the eighteenth century, affected continue to exert an influence on that person. For by the concept of “natural law.” Accord- example, having an article of clothing that belonged ing to this view there were certain natural to a person whose actions one was trying to control consequences to behavior such that actions would increase the likelihood of success. Thus, if long regarded as sinful, such as drinking, two things were similar or were at one time con- gambling, or whoring, naturally led to nected, they were thought to influence one another madness, disease, and poverty. The alco- through sympathy. Using these principles, a medi- holic with delirium tremens or the patient cine man would sometimes mimic a patient’s symp- in the terminal stages of syphilis-induced toms and then model a recovery from them. Frazer paresis could thus be seen as suffering an (1890/1963) indicated that, to the individuals using inevitable and natural outcome of their them, these magical techniques must have appeared own behavior. On the other hand, wealth, to be very effective: health, and prosperity came from habits of A ceremony intended to make the wind industry, sobriety, and the like; the rewards blow or the rain fall, or to work the death of were not to be seen as “prizes” given for an enemy, will always be followed, sooner good behavior, but as natural effects of this or later, by the occurrence it is meant to behavior. (B. A. Maher and W. B. Maher, bring to pass; and primitive man may be 1985, p. 303) excused for regarding the occurrence as a The implications for psychotherapy are clear. direct result of the ceremony, and the best To alleviate suffering, the patient must change his possible proof of its efficacy. Similarly, rites

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 491 observed in the morning to help the sun to was performed on living people thousands of years rise, and in the spring to wake the dreaming ago is a matter of considerable speculation. One idea earth from her winter sleep, will invariably is that it was performed to treat skull fractures or to appear to be crowned with success, at least relieve pressure from brain tumors. There is evidence in the temperate zones; for in these regions that, in some cases, trepanned skulls had first been the sun lights his golden lamp in the east fractured. However, perhaps the most widely ac- every morning, and year by year the vernal cepted belief concerning trepanation is that it was earth decks herself afresh with a rich mantle used to treat headaches, convulsions, and mental dis- of green. (p. 68) orders. Finger (1994) says, “These disorders were likely to have been attributed to demons, and it is Primitive humans, then, saw most illness as conceivable that the holes were made to provide caused by evil forces or spirits entering the body. the evil spirits with an easy way out” (p. 5). This view of illness was simply an extension of how primitive people viewed everything: The Biological Approach Wind was destructive; hence he [the primitive human] assumed an angry being As early as 3000 B.C., the Egyptians showed great who blew it to attack him. Rain was sent proficiency in treating superficial wounds and set- by spirits to reward or punish him. Disease ting fractures (Sigerist, 1951). Even for ailments was an affliction sent by invisible super- with unknown causes, the Egyptians used “natural” human beings or was the result of magic treatments such as vapor baths, massage, and herbal manipulations by his enemies. He ani- remedies. They believed, however, that even the mated the world around him by attributing influence of these natural treatments, if there was to natural events the human motivations one, was due to the treatments’ effect on evil spirits. that he knew so well from his own sub- The emphasis was clearly on mysterious forces and jective experiences. Thus it was logical to magic. Even the early Greeks, prior to physicians him to try to influence natural events by like Hippocrates, believed that a god inflicted men- the same methods he used to influence tal illness upon a person for impiety. The Bible human beings; incantation, prayer, threats, perpetuated this belief, which had much to do submission, bribery, punishment and with how patients with mental illness were treated atonement. (Alexander and Selesnick, until modern times. 1966, p. 9) Hippocrates (ca. 460–377 B.C.) was among the first to liberate medicine and psychiatry from Bleeding a patient or removing a section of his or their magico-religious background. As we saw in her skull were apparently also widely used to allow Chapter 2, the Greeks, starting with Thales, had a evil spirits to escape from the body. Thousands of tendency to replace mystical explanations with nat- prehistoric human skulls have been found through- uralistic explanations. Hippocrates applied the nat- out the world with man-made openings in them. uralistic outlook to the workings of the human These skulls display an opening made by chipping body. In addition to believing that physical health away at it with a sharp stone, a procedure known as was associated with a balance among the four hu- trepanation. The photograph on the next page mors of the body (see Chapter 2), the Hippocratics shows two trepanned skulls. Concerning trepana- implicated the brain as a source of mental health or tion, Finger (1994) says, “The fact the holes often illness: exhibit smooth margins and clear signs of healing provides convincing evidence that this sort of surgery Men ought to know that from the brain, was conducted on living subjects and was not just a and from the brain only arise our pleasures, sacrificial or funeral rite” (p. 4). Just why trepanation joys, laughter and jests, as well as our

492 CHAPTER 15 showing skulls Prehistoric #56220 Peru image Puntillo, Museum from Upenn trepanation, Prehistoric skulls showing trepanation sorrows, pains, griefs and tears. Through it, cians, and prescribing treatments such as baths, fresh in particular, we think, see, hear, and dis- air, and proper diet, the Hippocratics identified sev- tinguish the ugly from the beautiful, the eral mental illnesses—for example, hysteria, the bad from the good, the pleasant from the mental illness that was to become so important in unpleasant. … It is the same thing which Freud’s work. Hysteria is a term used to describe a makes us mad or delirious, inspires us with wide variety of disturbances such as paralysis, loss of dread and fear, whether by night or by sensation, and disturbances of sight and hearing. day, brings sleeplessness, inopportune mis- The Hippocratics accepted the earlier Greek and takes, aimless anxieties, absentmindedness, Egyptian contention that hysteria is a uniquely fe- and acts that are contrary to habit. These male affliction. Hystera is the Greek word for things that we suffer all come from the “uterus,” and it was believed that the symptoms brain, when it is not healthy, but becomes of hysteria are caused by the uterus wandering to abnormally hot, cold, moist, or dry, or various parts of the body. Although later proven suffers any other unnatural affection to false, this view of hysteria represents the biological which it is not accustomed. (W. H. S. approach to explaining mental illness. Jones, 1923, Vol. 2, p. 175) The naturalistic and humane treatment of pa- tients lasted through the time of Galen (ca. It was the condition of the brain, then, that A.D. 129–199), who perpetuated and extended determined whether a person was mentally normal the Hippocratic approach to medicine. Also, as or abnormal. Because abnormalities developed we saw in Chapter 2, Galen expanded the when the brain was too hot, cold, dry, or moist, Hippocratic theory of humors into one of the first therapy involved providing those experiences that theories of personality. When the Roman Empire returned the brain to its normal limits. fell in A.D. 476, however, the humane and rational Besides arguing that all ailments had natural treatment of physical and mental disorders essen- causes, claiming that nature healed and not physi- tially fell with it.

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 493 The Return of the Supernatural of the 14th century, such activities were typically Approach viewed as remnants of paganism and were discour- aged with relatively mild sanctions and punish- When the Romans came to power, they adopted ments. During this period, the existence of witches much of the Greek emphasis on knowledge and (those in consort with the devil) and witchcraft (the reason even though they were more concerned evil work performed by witches) were taken for with law, technology, and the military than were granted by almost everyone in Europe, especially the Greeks. With the collapse of the Roman eastern Europe. Eventually, however, the church Empire came an almost complete regression to the became so concerned with witches and their evil nonrational thinking that had characterized the deeds that a wholesale, institutionalized persecution time before the Greek naturalists: of them was begun. The result was a reign of terror that gripped Europe for about three centuries. The collapse of the Roman security system According to Zusne and Jones (1989), the produced a general regression to belief in European persecution of witches occurred mostly the magic, mysticism, and demonology between 1450 and 1750, with its peak around from which, seven centuries before, men 1600. had been liberated through Greek genius. On December 9, 1484, Pope Innocent VIII … The psychiatry of the Middle Ages can issued a papal bull (an official document) that au- be scarcely distinguished from prescientific thorized the systematic persecution of witches. In demonology, and mental treatment was his bull, the Pope authorized Heinrich Kramer synonymous with exorcism. … In medie- and James Sprenger, both Dominican priests and val exorcism Christian mythology and professors of theology, to act as inquisitors in north- prehistoric demonology found a quaint ern Germany. To guide their work, Kramer and union. (Alexander and Selesnick, 1966, pp. 50, 52) Sprenger wrote Malleus Maleficarum (The Witches’ Hammer, 1487/1971). The papal bull of 1484 ap- Although W. B. Maher and B. A. Maher peared as the preface, giving the book great author- (1985) refer to the therapeutic practices that oc- ity. Also included was a letter of endorsement curred during the Middle Ages as eclectic, the em- signed by members of the theology faculty from phasis was on exorcising demons. Even with this the University of Cologne; this too added to the emphasis, however, several hospitals scattered book’s authority. Indeed, the Malleus became the throughout Europe treated the old, the sick, and official manual of the Inquisition. In his introduc- the poor. Evidence also suggests that in many tion to the Malleus, Montague Summers said, “The cases, individuals who had mental illness were Malleus lay on the bench of every judge, on the treated alongside those who were physically ill desk of every magistrate. It was the ultimate, unar- (Allderidge, 1979). Still, the preferred explanation guable authority. It was implicitly accepted not of mental illness during the Middle Ages was a su- only by Catholic but by Protestant legislature” pernatural one, and the preferred treatment was (1971, p. viii). Translated into several languages, some form of exorcism. Even with the preoccupa- the Malleus went through 30 editions by 1669— tion with demons and exorcism, however, witch and this at a time when bookmaking was very dif- hunts were not typical during the Middle Ages. ficult and literacy was very low. Clearly, the Malleus Witch hunts occurred primarily during the was one of the most popular and influential books Renaissance and the Reformation (Kirsch, 1978). of the time. The Malleus begins by attempting to prove the Witch Hunts. Magic, sorcery, and witchcraft existence of devils and their hosts, witches. The have been practiced since the dawn of human his- Malleus also indicates that if the authors’ arguments tory. In Christian Europe, prior to about the middle do not convince the reader, he or she must be the

494 CHAPTER 15 victim of witchcraft or a heretic. The second part of unsuccessful in eliciting a confession, more extreme the book describes how pacts with the devil are measures could be employed, such as the applica- made and consummated, the various forms witch- tion of a red-hot iron or boiling water (Kramer and craft can take, and how those suffering from witch- Sprenger, p. 233). Eventually, most of the indivi- craft can be cured. In general, all disorders, both duals convicted of being witches confessed to physical and mental, whose origins were not swearing allegiance to the devil, eating the flesh of known (and that was most) were believed to have infants, attending witches’ sabbaths, or having sex- a supernatural origin; that is, they were assumed to ual intercourse with the devil. After confessing, be caused by witchcraft. The list of such disorders some of the convicted committed suicide, which included loss of sensory or motor functions, sexual was taken as further confirmation of their guilt dysfunction (including impotence, sterility, lust, (Kramer and Sprenger, p. 224). The confessions, prostitution), hallucinations, visions, mutism, appa- of course, reinforced the beliefs upon which the ritions, drunkenness, melancholy (depression), and witch hunts were based. J. B. Russell (1980) con- somnambulism. Suggested treatments of the be- cludes that “only 10% [of those convicted] persisted witched included exorcism, confession, prayer, rep- in denying their guilt to the moment of death” (pp. etition of holy scripture, visits to holy shrines, and 79–80). Most convicted of being witches were participation in church ceremonies. burned, but others were hanged or beheaded. Much of the Malleus is concerned with sexual Clark (1997) estimates that in Europe between matters. It describes in detail how female witches 1450 and 1750 over 200,000 people were accused (who were the vast majority) copulate with incubi of witchcraft and 100,000 of them were executed. (male demons) and how male witches copulate Of those executed, approximated 80% to 85% were with succubi (female demons). Considerable atten- women. It should be noted, however, that arriving tion is paid to how witches interfere with human at an accurate count of individuals executed because procreation. Of special interest was how witches of their presumed involvement in witchcraft is ex- could deprive men of their penises or make them tremely difficult, if not impossible. In fact, evidence nonfunctional. It was generally believed that sinful suggests that the numbers often given are greatly individuals were much more susceptible to witch- exaggerated (Trevor-Roper, 1967). For example, craft than were individuals without sin, and Harris (1974) places the number of executions at abnormal behavior was generally taken as a sign of about 500,000. In any case, as recently as 1692, sinfulness. One of the most grievous sins was sexual twenty people were condemned as witches and lust, which invited possession by a devil or the in- sentenced to death in Salem, Massachusetts, and fluence of a witch. Because, according to the the last legal execution of a condemned witch oc- authors, women have stronger carnal desires than curred in Glarus, Switzerland, in 1782 (Trevor- men, they are much more likely to be witches or Roper, 1967). The preoccupation with witches to be bewitched. Not surprisingly, the Malleus was and witchcraft during the Renaissance and consistently harsh on women. According to Ruiz Reformation clearly illustrates how conceptions of (2002, lecture 17), there was also a political aspect mental illness vary with the Zeitgeist. In most places to the witch craze because most accused of being today, witch hunting itself would be perceived as witches in Protestant villages were Catholic and reflecting mental illness. most accused in Catholic villages were Protestant. During the Renaissance, when advances were There may also have been an economic aspect be- being made on so many other fronts, witch hunting cause the property of those convicted of being was widespread, and astrology, palmistry, and magic witches was confiscated and sold. were extremely popular. Also, conditions were bad The final section of the Malleus describes how for those with mental illness. As we have seen, in- witches are to be forced to confess, tried, and pun- dividuals with mental illness were generally as- ished. If interrogation and mild punishment were sumed to be bewitched individuals, and they either

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 495 roamed the streets or were locked up in “lunatic heavenly bodies could influence one’s harmony asylums.” One such asylum was the St. Mary of with nature and therefore one’s health. As bizarre Bethlehem Hospital in London. Established in as these suggestions were, they tended toward nat- 1247 as a priory, it was converted to a mental asy- uralistic explanations of mental disorders and lum in 1547 by order of Henry VIII. Coming to be away from supernatural explanations. One of known as Bedlam because of the Cockney pronun- Paracelsus’s maxims was, “Keep sorcery out of ciation of Bethlehem, this institution was typical of medicine” (Webster, 1982, p. 80). Paracelsus de- such places at the time. Inmates were chained, nounced the cruel treatment of women brought beaten, fed only enough to remain alive, subjected before the Inquisition as witches, saying, “There to bloodletting, and put on public display for are more superstitions in the Roman church than visitors. in all these women” (Ehrenwald, 1991, p. 195). If the term spiritual is replaced by psychological, the fol- lowing statement by Paracelsus has a modern ring to it: “There are two kinds of diseases in all men: GRADUAL IMPROVEMENT IN One of them material and one spiritual. … Against material diseases material remedies should be ap- THE TREATMENT OF MENTAL plied. Against spiritual diseases spiritual remedies” ILLNESS (Ehrenwald, 1991, pp. 195–196). According to Alexander and Selesnick (1966), Even during the 16th century, when witch hunts Paracelsus was the second physician to argue against and trials were very popular, a few courageous peo- labeling individuals as witches; Agrippa had been ple argued that “witches” were not possessed by the first. Not only did Cornelius Agrippa (1486– demons, spirits, or the devil. They argued that the 1535) argue against witch hunts, but he also saved type of behavior “witches” displayed was caused by many individuals from the ordeal of a witch trial. In emotional or physical disorders. One such individ- 1563 Agrippa’s student Johann Weyer (1515–1588) ual was the ill-tempered, flamboyant Swiss physi- published The Deception of Demons, in which he cian Philippus Paracelsus (1493–1541). Paracelsus claimed that those labeled as witches or as be- argued that an understanding of nature should witched were actually mentally disturbed people. come from experience and not from the blind Weyer’s Deception was a carefully written, well- allegiance to ancient philosophy as was often exem- documented, step-by-step rebuttal of the Malleus plified by the Scholastics. He noted that herbal Maleficarum. He referred to witch burning as remedies employed by common people were often “Godlessness” and condemned theologians, judges, effective in curing disorders. Being an alchemist, he and physicians for tolerating it. Weyer became speculated that it was the chemical composition of known to his contemporaries as a crusader against such remedies that explained their effectiveness, and witch hunting, and this was enough for him to be he performed empirical studies to determine which considered weird, insane, or even a witch. chemicals could cure specific ailments. Incidentally, The view that “witches” were actually people in one of his many chemical experiments Paracelsus with mental illness also found support from mixed sulfuric acid and alcohol, thus creating an Reginald Scot (1538–1599), who wrote Discovery early harmless anesthetic (Finger, 1994, pp. 160– of Witchcraft (1584/1964), and from the Swiss psy- 161). Although Paracelsus rejected demonology, chiatrist Felix Plater (1536–1614). In his book he did believe in a “universal spirit” that permeated Practice of Medicine, Plater outlined several different nature. When people were in harmony with this types of mental disorders, including consternation, spirit, they were healthy; when they were not, foolishness, mania, delirium, hallucinations, convul- they were unhealthy. Paracelsus believed that things sions, drunkenness, hypochondria, disturbance of such as chemicals, magnets, and the alignments of sleep, and unusual dreams. The arguments of such

496 CHAPTER 15 people were eventually effective. In 1682, for ex- chained and guards patrolled the walls to prevent ample, Louis XIV of France abolished the death escape. Pinel asked for permission to release the penalty for witches. Although mental illness in- prisoners from their chains, and although the creasingly came to be viewed as having natural authorities thought Pinel himself was insane for rather than supernatural causes, it was still poorly having such a wish, they reluctantly gave him per- understood, and people with mental illness were mission. Pinel proceeded cautiously. Starting in treated very poorly—if they were treated at all. 1793, he removed the chains from a small number Bloodletting was still the most popular way of treat- of inmates and carefully observed the consequences. ing all ailments, including mental disorders, and The first inmate to be unchained was an methods were devised for inducing shock in pa- English soldier who had once crushed a guard’s tients. One such method was to spin patients very skull with his chains and was considered to be a rapidly in a chair; another was to throw several violent person. Once released from his chains, the buckets of cold water on chained patients. man proved to be nonviolent, and he helped Pinel Physicians would often report dramatic improve- care for the other inmates. Two years later, the ment in the condition of a patient following such soldier was released from Bicêtre. Pinel gradually treatments. These dismal conditions for people with removed more inmates from their constraints, im- mental illness lasted until the end of the 18th proved rations, stopped bloodletting, and forbade century. all harsh treatment such as whirling an inmate in a chair. In his book A Treatise on Insanity, Pinel said of bloodletting, “The blood of maniacs is sometimes Philippe Pinel so lavishly spilled, and with so little discernment, as Philippe Pinel (1745–1826) came from a family to render it doubtful whether the patient or his of physicians and received his medical degree in physician has the best claim to the appellation mad- 1773 from the University of Toulouse. Upon be- man” (1801/1962, p. 251). ginning his practice, Pinel was so upset by the greed In addition to unchaining inmates and termi- and insensitivity of his fellow physicians that he nating bloodletting and harsh treatment, Pinel was moved to Paris, where he concentrated on treating responsible for many innovations in the treatment that city’s poor people. Pinel became interested in of mental illness. He segregated different types of mental illness when a close friend became afflicted patients, encouraged occupational therapy, favored with a mental disorder and Pinel could not treat bathing and mild purgatives as physical treatments, him. He read the existing literature on mental ill- and argued effectively against the use of any form of ness and consulted with the so-called experts, find- punishment or exorcism. In addition, Pinel was the ing the information on mental illness essentially first to maintain precise case histories and statistics worthless except for the work of Joseph Daquin on his patients, including a careful record of cure (1733–1815). Daquin believed that mental illness rates. was a natural phenomenon that should be studied Under Pinel’s leadership, the number of inmate and treated by means of the methods of natural deaths decreased greatly, and the number of inmates science. Pinel and Daquin became close friends, cured and released increased greatly. His success at and Daquin dedicated the second edition of his Bicêtre led to his 1795 appointment as director of book Philosophy of Madness (1793) to Pinel. La Salpêtrière, the largest asylum in Europe, hous- Pinel began writing influential articles in which ing 8,000 insane women. Following the same pro- he argued for the humane treatment of people with cedures he had followed at Bicêtre, Pinel had mental disturbances. In 1793 he was appointed di- equally dramatic success. When he died of pneu- rector of the Bicêtre Asylum, which had been an monia in 1826, he was given a hero’s funeral at- institution for the insane since 1660. Upon touring tended by not only the most influential people in the facility, Pinel found that most inmates were Europe but also hundreds of ordinary citizens,

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 497 Medicine of Library National the of Courtesy © Pinel releasing the insane from their chains including many former patients at the Bicêtre and then his grandson ran the retreat. His great grand- La Salpêtrière asylums. son, Daniel Hack Tuke (1827–1895), was the first Partially because of Pinel’s success and partially in the family to receive medical training, and he because of the Zeitgeist, people throughout Europe became a prominent psychiatrist during the and the United States began to argue for the hu- Victorian period. mane treatment of the mentally disturbed. In In 1788 Italian physician Vincenzo Chiarugi Britain, William Tuke (1732–1822), a Quaker and (1759–1820) was appointed superintendent of a prosperous retired tea and coffee merchant with Ospidale di Bonifazio, a newly opened hospital no medical training, visited a lunatic asylum and for mental illness in Florence. Even before Pinel, was horrified by what he saw. He dedicated the Chiarugi had argued that those with mental illness remaining 30 years of his life to improving the should be spared physical restraint and harsh treat- plight of those with mental illness, and in 1792 ment. He also provided work and recreational ac- he founded the York Retreat. At the retreat, de- tivities for his patients and recorded detailed case signed more like a farm than a prison, inmates were histories. Chiarugi’s advice for dealing with mental given good food, freedom, respect, medical treat- illness has a particularly modern ring to it: ment, recreation, and religious instruction. Tuke lived long enough to see his retreat become a It is a supreme moral duty and medical obligation to respect the insane individual model for institutions for people with mental illness as a person. It is especially necessary for the throughout the world. After his death, his son and

498 CHAPTER 15 person who treats the mental patient to contended, they should never be on display to the gain his confidence and trust. It is best, public for the purposes of inhumane curiosity and therefore, to be tactful and understanding amusement. Despite his many enlightened views, and try to lead the patient to the truth and Rush still advocated bloodletting and the use of to instill reason into him little by little in a rotating and tranquilizing chairs. He believed that kindly way. … The attitude of doctors and bloodletting relieved vascular congestion, that ro- nurses must be authoritative and impres- tating relieved the patient’s congested brain, and sive, but at the same time pleasant and that strapping a patient’s arms and legs in a so- adapted to the impaired mind of the pa- called tranquilizing chair calmed the patient. tient. … Generally it is better to follow the patient’s inclinations and give him as many Dorothea Lynde Dix comforts as is advisable from a medical and practical standpoint. (Mora, 1959, p. 431) Also in the United States, Dorothea Lynde Dix (1802–1887) in 1841 began a campaign to im- It is interesting to note that although both prove the conditions of the mentally ill. Unhappy Pinel and Chiarugi argued forcefully for the hu- home circumstances had forced Dix to leave her mane treatment of the mentally ill, their work home when she was only 10 years old, and when was guided by different conceptions of mental ill- she was 14, she began her career as a schoolteacher. ness. Pinel’s work was guided primarily by the psy- Later, illness caused her to give up her full-time chological model of mental illness, and Chiarugi’s teaching position and take a position teaching fe- work was guided primarily by the medical model male inmates in a Boston prison. It became clear to (Gerald, 1997). Dix that many of the women labeled and confined as criminals actually had mental illnesses, and so Dix began her 40-year campaign to improve the plight Benjamin Rush of those with mental illness, traveling from state to Benjamin Rush (1745–1813) had among his state and pointing out their inhumane treatment. friends Thomas Jefferson and John Adams, and he Within a 3-year period, Dix visited 18 states and served as surgeon general of the army under George brought about institutional reforms in most of Washington. As a member of the Continental them. In 1841, when Dix had begun her campaign- Congress, he was one of the original signers of ing, mental hospitals housed only about 15% of the Declaration of Independence. Rush had many those needing care; by 1890, that figure had risen strong convictions: he argued for the abolition of to about 70%. To a large extent, the improvement slavery; he opposed capital punishment, public was due to Dix’s efforts. punishment, and the inhumane treatment of pris- During the Civil War, Dix served as the oners; he advocated the education of women; and Union’s superintendent of female nurses; after the he argued for a greater emphasis on practical infor- war, she toured Europe seeking better treatment of mation in school curricula. people with mental illness. While in Europe, Dix In 1812 Rush, who is often referred to as the visited with Queen Victoria and Pope Pius IX, first U.S. psychiatrist, wrote Medical Inquiries and convincing both that these patients were in dire Observations Upon the Diseases of the Mind, in which need of better facilities and treatment. For more he lamented that people with mental illness were details concerning the life and work of Dix, often treated like criminals or “beasts of prey.” see Viney (1996). Instead, he urged that patients be unchained and As a result of the efforts of such individuals as no longer punished. They should experience fresh Pinel, Tuke, Chiarugi, Rush, and Dix, patients air and sunlight and be allowed to go for pleasant with mental illness began to receive better treat- walks within their institution. Furthermore, Rush ment than they had during the Middle Ages and

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 499 brain and nervous system, their symptoms, and their treatment. Some categories of mental disorders that Kraepelin listed, such as mania and depression, had been first mentioned by Hippocrates 2,300 years earlier. Some other categories of mental illness Kraepelin listed were dementia praecox, character- ized by withdrawal from reality, excessive day- dreaming, and inappropriate emotional responses; Akron paranoia, characterized by delusions of grandeur of or of persecution; manic depression, characterized University by cycles of intense emotional outbursts and passive states of depression; and neurosis, characterized by Archives—The relatively mild mental and emotional disorders. Kraepelin’s friend, neurologist Alois Alzheimer Psychology (1864–1915), observed that a general loss of mem- ory, reasoning ability, and comprehension some- © times accompanies old age. It was Kraepelin who dubbed this condition Alzheimer’s disease. Dorothea Lynde Dix Kraepelin believed that most major mental illnesses, such as dementia praecox, are incurable because the Renaissance. However, this treatment involved they are caused by constitutional factors. When only the patients’ physical surroundings and main- the Swiss psychiatrist Eugen Bleuler (1857–1939) tenance. Effective treatment for mental illness itself found that dementia praecox could be successfully was still lacking. Alexander and Selesnick (1966) treated, he changed the name of the disease to speculate that there were three reasons for the pa- schizophrenia, which literally means “a splitting of tients’ poor treatment, even after it was no longer the personality.” believed that they were possessed by demons. The The list of categories of mental illness that reasons were ignorance of the nature of mental ill- many clinicians, psychoanalysts, and psychiatrists ness, fear of those with mental illness, and the wide- currently use as a guide is found in The Diagnostic spread belief that mental illness was incurable. The and Statistical Manual of Mental Disorders, published work of such individuals as Kraepelin, Witmer, and by the American Psychiatric Association (2000). the early hypnotists dramatically improved the un- This manual, referred to simply as DSM, is a direct derstanding and treatment of mental illness, and it is descendant of Kraepelin’s earlier work. Although to that work that we turn next. Kraepelin’s classifications brought order to an oth- erwise chaotic mass of clinical observations, his work is now seen by many as standing in the way Emil Kraepelin of therapeutic progress. People do not fall nicely Emil Kraepelin (1856–1926), a German psychia- into the categories that he created, nor are the trist who did postdoctoral research with Wundt, causes for their disorders always physical in nature, attempted to do for mental disorders what Wundt as Kraepelin assumed they were. Still, Kraepelin and his colleagues attempted to do for sensations— went a long way toward standardizing the catego- classify them. In 1883 Kraepelin published a list of ries of mental illness and thus making communica- mental disorders that was so thorough it was tion about them more precise. adopted the world over and has lasted until recent For an overview of the many problems associ- times. He based his classification of mental diseases ated with attempting to categorize mental illnesses, on what caused them, how much they involved the see Sadler, Wiggins, and Schwartz, 1994. For

500 CHAPTER 15 their effects on such behavioral tasks as writing and speech. According to Schmied, Steinberg, and Sykes (2006), Kraepelin was an important pioneer in the field now known as psychopharmacology. Medicine Lightner Witmer of Lightner Witmer (1867–1956) earned his doctor- ate under Wundt. He was born on June 28 into a Library prominent Philadelphia family. Witmer earned National his bachelor’s degree from the University of the Pennsylvania in 1888 and then took a position of teaching history and English at Rugby Academy, © Courtesy a secondary school in Philadelphia. He remained there for two years while taking classes in law and political science at the University of Pennsylvania. Emil Kraepelin After taking a class from James McKeen Cattell, Witmer resigned his position at Rugby and entered evidence of the growing dissatisfaction with DSM graduate school. Cattell put Witmer to work study- and suggested alternatives to it, see Beutler and ing individual differences in reaction times. He in- Malik, 2002. tended to earn his doctorate under Cattell, but when Cattell moved to Columbia, Witmer went Kraepelin and Psychopharmacology. The use to Leipzig for his advanced degree. Witmer’s train- of psychoactive drugs has been reported in the ear- ing at Leipzig coincided with Titchener’s. liest historical records. For example, the benefits of In the fall of 1892, Witmer returned from using such drugs as alcohol, opium, and hemp have Europe to a faculty position at the University of been recorded by ancient Egyptian, Greek, Pennsylvania, where he taught courses and con- Roman, Babylonian, Chinese, Hindu, and Arabic ducted research as an experimental psychologist physicians. Although most such reports are con- in the Wundtian tradition. He remained at cerned with the medicinal properties of drugs, there Pennsylvania for 45 years. The APA was also are also reports of using drugs to gain access to spir- founded in 1892, and Witmer became a charter itual entities or as part of religious rituals (Schmied, member, along with such individuals as William Steinberg, and Sykes, 2006, p. 145). Perhaps less James, G. Stanley Hall, and James McKeen known is that Kraepelin was among the first, if Cattell. (Incidentally, Witmer was the last charter not the first, to systematically study the effects of member to die.) In 1894 the university created spe- drugs on various cognitive and behavioral func- cial courses for public school teachers, and Witmer tions. In the early 1880s, while studying in became involved in those courses. One teacher’s Wundt’s laboratory, he studied the effects of “poi- description of the problem a student was having sons,” such as alcohol, on various mental functions. learning to spell strengthened Witmer’s developing Upon leaving Leipzig to take his academic post at belief that psychology should provide practical in- Dorpat, he and his assistants continued to study formation. The student was a 14-year-old boy who what, in 1892, Kraepelin called pharmacopsychology had what would probably be diagnosed today as (Schmied, Steinberg, and Sykes, 2006, p. 146). The dyslexia. Witmer decided to work with the student, effects of alcohol, morphine, caffeine, and other and this marked the beginning of his career as a drugs on such intellectual tasks as comprehension, clinical psychologist. Soon he offered a special association, and memory were quantified as were course on how to work with students who were

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 501 field of clinical psychology is to some extent occupied by the physician, especially by the psychiatrist, and while I expect to rely in a great measure upon the educator and social Akron worker for the more important contribu- of tions to this branch of psychology, it is University nevertheless true that none of these has quite the training necessary for this kind of Archives–The work. For that matter, neither has the psy- chologist, unless he had acquired this train- © Psychology ing from sources other than the usual course of instruction in psychology. … The phra- seology of “clinical psychology” and “psy- chological clinic” will doubtless strike many Lightner Witmer as an odd juxtaposition of terms relating to quite disparate subjects. … I have borrowed “mentally defective, blind, or criminally disturbed” the word “clinical” from medicine, because (McReynolds, 1987, p. 851). it is the best term I can find to indicate the In 1896 Witmer published an article titled character of the method which I deem “Practical Work in Psychology,” and in 1897 he necessary for this work. … The methods of delivered a paper at an APA convention in clinical psychology are necessarily involved Boston on the same topic in which he first em- wherever the status of an individual mind is ployed the term psychological clinic. In 1896 determined by observation and experiment, Witmer founded the world’s first psychological and pedagogical treatment applied to effect clinic at the University of Pennsylvania, only 17 a change, i.e., the development of such in- years after the establishment of Wundt’s experi- dividual mind. Whether the subject be a mental laboratory. In 1907 Witmer founded the child or an adult, the examination and Psychological Clinic journal, which was instrumental treatment may be conducted and their re- in promoting and defining the profession of clinical sults expressed in the terms of the clinical psychology. The journal continued publication un- method. (McReynolds, 1987, p. 852) til 1935. To Witmer and others, a new profession was clearly emerging, and it needed to have a name. In 1908 Witmer established a residential school In the opening article of the first issue of his journal, for the care and treatment of retarded and troubled Witmer named the profession clinical psychology children. This was the first of several such schools and described the new profession as follows: that he established. In this same year, Witmer began publishing articles that were highly critical of what Although clinical psychology is clearly re- he viewed as unscientific, or even fraudulent, ways lated to medicine, it is quite as closely related of treating mental illness. He was especially critical to sociology and to pedagogy. … An of William James because of James’s interest in su- abundance of material for scientific study pernatural phenomena. fails to be utilized, because the interest of McReynolds argues that Witmer should be psychologists is elsewhere engaged, and considered the founder or “father” of clinical psy- those in constant touch with the actual chology, but he recognizes that others may argue phenomena do not possess the training that Freud, Binet, or Rogers should be given that necessary to make the experience and ob- honor. McReynolds (1987) makes his case for servation of scientific value. … While the Witmer as follows:

502 CHAPTER 15 Witmer’s role in the formation of clinical 1996; McReynolds, 1996, 1997). As far as clinical psychology is somewhat analogous to that psychology is concerned, however, Witmer made of Wundt in experimental psychology, in three lasting impressions: that in each case the individual deliberately (a) the idea that scientific psychology, in its and self-consciously defined the existence rigorous experimental sense, can, if appro- of a new area and nurtured its early de- priately utilized, be useful in helping people; velopment, but other, later workers were (b) the conception that this help can best be responsible for giving the area greater provided through the instrument of a special depth and new directions. In Witmer’s profession (clinical psychology) that is in- case the designation of founder is based dependent of both medicine and education; primarily on the following six pioneering and (c) a commitment to the view that achievements: clinical psychology should itself be highly 1. He was the first to enunciate the idea research oriented and should be closely al- that the emerging scientific psychology lied with basic psychology. (McReynolds, could be the basis of a new helping 1987, p. 857) profession. It is important to note that Witmer was trained 2. He established and developed the first facility to implement this idea— as an experimental psychologist and never wavered in his belief that clinicians should receive rigorous a “psychological clinic,” headed by a training in scientific methodology, the type of psychologist and primarily staffed by training leading to the Doctor of Philosophy degree psychologists. (PhD). This tradition of the clinician as a scientist- 3. He proposed the term clinical psychology practitioner has only recently been challenged. In for the new profession and outlined its 1973 the APA agreed that the intense scientific original agenda. training characteristic of the PhD program is not 4. He conceptualized, organized, and necessary for clinical psychologists and established carried out the first program to train the Doctor of Psychology degree (PsyD) for those clinical psychologists in the sense he seeking training that emphasizes professional appli- defined. cations rather than research methodology. In 5. Through his founding and long-time Chapter 21, we discuss the current debate over editorship of a journal (The Psychological whether clinicians should be PhDs or PsyDs, but Clinic) specifically intended to be the as far as Witmer was concerned, clinicians should organ of the new profession, he further be scientists—scientists who apply their knowledge defined the area, publicized it, and at- to helping troubled individuals. tracted young persons to it. 6. Through his own activities in perform- ing the kinds of professional activities THE TENSION BETWEEN THE that he envisaged for clinical psycholo- PSYCH OLOGICAL AND gists, he served as a role model for early members. (pp. 855–856) MEDICAL M ODELS OF MENTAL ILLNESS Although we have concentrated on Witmer’s contributions to clinical psychology, he also made As natural science succeeded, people applied its significant contributions to school psychology and principles to everything, including humans. When special education (see, for example, Fagen, 1992, applied to humans, mechanism, determinism, and

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 503 positivism involved the search for a natural cause Some believe that unless an illness has a neuro- for all human behavior, including abnormal physiological basis, it is not an illness at all. That is, behavior. After 2,000 years, conditions had re- it is possible for a brain to be diseased and cause turned to almost the point where they had been various behavior disorders, but in such a case there about the time of Hippocrates; once again people is no “mental” illness, only an actual physical dis- were emphasizing the brain as the seat of the intel- ease or dysfunction. For example, in his influential lect and the emotions. book The Myth of Mental Illness (1974), Thomas This return to naturalism was both good and Szasz, himself a psychiatrist, contends that what bad for psychology. It was good because it discour- has been and is labeled mental illness reflects pro- aged mysticism and superstition. No longer did blems in living or nonconformity but not true ill- people use evil demons, spirits, or forces to explain ness. Therefore, according to Szasz, the diagnosis of mental illness. On the negative side, it discouraged a mental illness reflects a social, political, or moral search for the psychological factors underlying mental judgment, not a medical one. Of course, problems illness, for it suggested that a search for such factors in living are very real and can be devastating en- was a return to demonology. By the mid-19th cen- ough to require professional help. According to tury, the dominant belief was that the cause of all Szasz, psychiatry and clinical psychology are worthy illness, including mental illness, was disordered professions if they view those whom they help as physiology or brain chemistry. This belief retarded clients rather than patients and have as their goal psychology’s search for psychological causes of helping people to learn about themselves, others, mental illness, such as conflict, frustration, emo- and life. They are invalid, or “pseudosciences,” if tional disturbance, or other cognitive factors. they view their goal as helping patients recover Under the organic, or medical, model of mental from mental illness. illness, psychological explanations of mental illness Szasz argues that the belief that mental illness is were suspect. Because it was generally believed that a real illness has hurt many more people than it has all disorders had an organic origin, classifying helped. For one thing, he says, to label problems in “mental” diseases just as organic diseases had been living as an illness or as a disease implies that a per- classified made sense, and this is what Kraepelin son is not responsible for solving those problems, attempted to do. that they are circumstances beyond his or her con- The debate still exists between those who seek trol. Furthermore, Szasz, and others, observed that to explain all human behavior in terms of physiol- diagnosing a person as having a particular mental ogy or chemistry (those following a medical model) illness may encourage him or her to think and act and those who stress the importance of mental vari- in ways dictated by the diagnosis: ables such as conflict, frustration, anxiety, fear, and Such labels, conferred by mental health unconscious motivation (those following a psycho- professionals, are as influential on the patient logical model). This debate is illustrated in the ex- as they are on his relatives and friends, and it planations currently offered for alcoholism. Those should not surprise anyone that the diag- individuals accepting the medical model claim that nosis acts on all of them as a self-fulfilling alcoholism is a disease that either is inherited (per- prophesy. Eventually, the patient himself haps only as a predisposition) or results from a bio- accepts the diagnosis, with all of its surplus chemical imbalance, a metabolic abnormality, or meanings and expectations, and behaves some other biological condition. Those individuals accordingly. (Rosenhan, 1973, p. 254) accepting the psychological model are more likely to emphasize the alcoholic’s life circumstances in Kutchins and Kirk (1997) support many of the their explanation—circumstances that cause the points made by Rosenhan, 1973. stress, frustration, conflict, or anxiety from which Although most accepting the psychological the alcoholic is presumably attempting to escape. model are willing to employ the term mental illness,

504 CHAPTER 15 imal gravitation. Considering Newton’s theory of universal gravitation, this contention did not seem owner, permission. far-fetched. Schaler, by In the early 1770s, Mesmer met a Jesuit priest A. named Maximilian Hell, who told Mesmer of cures Jeffrey reproduced he had accomplished using a magnet. This was not by the first time magnets had been used to treat disor- ders. Paracelsus and others had used the same tech- © Photograph www.szasz.com, nique many years before. Mesmer himself then used a magnet to “cure” one of his patients when all con- ventional forms of treatment had failed. Next, Thomas Szasz Mesmer tried the magnetic treatment on other pa- tients with equal success. It should be pointed out that the magnetic treatment always involved telling Szasz is not; he prefers to refer to such abnormalities the patient exactly what was expected to occur. as “problems in life” or “adjustment problems.” With the success of his magnetic treatment, Farber (1993) describes the ordeal of seven indivi- Mesmer had the information he needed to challenge duals who were diagnosed mentally ill instead of one of the most famous exorcists of the late 18th having, as Szasz would say, problems in life. century, an Austrian priest named Johann Gassner As we will see in the next chapter, Freud re- (1727–1779), who claimed great success in curing ceived his medical training within the positivistic patients by “driving out demons.” Mesmer claimed tradition of Helmholtz, and he first attempted to that Gassner’s “cures” resulted from the rearrange- explain personality in terms of the medical model. ment of “animal gravitation,” not the removal of Frustrated, however, he soon was forced to switch demons. In the heated debate that ensued, Mesmer to the psychological model. It was, to a large ex- won, and exorcism as a form of “psychotherapy” tent, the work of the early hypnotists that caused suffered a major setback. As mentioned, this was Freud to change his mind, and it is to that work generally regarded as an improvement in the treat- that we turn next. ment of mental illness because Mesmer’s “cure” was natural (although fallacious) and Gassner’s was supernatural. At first, Mesmer assumed that each person’s THE USE OF H YPNOTISM body contains a magnetic force field. In the healthy individual, this force field is distributed evenly Franz Anton Mesmer throughout the body, but in the unhealthy individual it is unevenly distributed, causing physical symptoms. It is ironic that the road away from demonology By using magnets, it was possible to redistribute the and toward better understanding of mental illness force field and restore the patient’s health. included the work of Franz Anton Mesmer Soon Mesmer concluded that it was not neces- (1734–1815). Mesmer’s work was eventually sary to use iron magnets because anything he judged unscientific, but at one time his theory of touched became magnetized: animal magnetism was an improvement over the prevailing superstitions. Mesmer obtained his med- Steel is not the only object which can ab- ical degree in 1766 from the University of Vienna. sorb and emanate the magnetic force. On In his dissertation, which was titled “On the the contrary, paper, bread, wool, silk, Influence of the Planets,” he maintained that the leather, stone, glass, water, various metals, planets influence humans through a force called an- wood, dogs, human beings, everything

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 505 community accused Mesmer of being a charlatan, and he was forced to leave Vienna. He fled to Paris where, almost immediately, he attracted an enthu- siastic following. He was so popular that he decided to treat patients in groups rather than individually, and still he was effective. Patients would enter a thickly carpeted, dimly lit, fully mirrored room. Soft music played, and the air was filled with the fragrance of orange blossoms. The patients held iron rods that projected from a baquet, a tub filled with “magnetized” water. Into this scene stepped Mesmer, wearing a lilac cloak and waving a yellow wand. This entire ritual was designed to produce a “crisis” in his patients. During a crisis, a patient © Bettman/Corbis would typically scream, break into a cold sweat, and convulse. He noted that when one patient ex- perienced a crisis, others would soon do so also. Thus, treating groups increased not only Mesmer’s Franz Anton Mesmer profits (although poor patients were not charged) but his effectiveness as well. Because of what was that I touched became so magnetic that later called the contagion effect, many patients these objects exerted as great an influence who would not respond to suggestion when alone on the sick as does a magnet itself. I filled with a physician would do so readily after seeing bottles with magnetic materials just as one others respond. As was undoubtedly the case with does with electricity. (Goldsmith, 1934, exorcism and with faith healing, many of Mesmer’s p. 64) patients reported being cured of their ailments. In all these cases, the symptoms removed were proba- Finally, Mesmer found that he did not need to bly hysterical—that is, of psychological origin. As use any object at all; simply holding his hand next we have seen, hysteria refers to a number of symp- to a patient’s body was enough for the patient to be toms such as blindness, paralysis, and convulsive dis- influenced by Mesmer’s magnetic force. Mesmer orders. Exorcists, faith healers, and Mesmer all concluded that although all humans contain a mag- probably benefited from the fact that after netic force field, in some people the field is much experiencing a violent emotional episode, a pa- stronger than in others. These people are natural tient’s symptoms (especially if these symptoms are healers, and he, of course, was one of them. hysterical) will subside. By this time Mesmer’s treat- When magnetic therapy became popular, ment was filled with ritual. Father Hell claimed to be the first to have used it. As Mesmer’s fame grew and thousands came to A great dispute followed, which was covered by the his clinic, his critics became more severe. The French newspapers. During this controversy, which clergy accused Mesmer of being in consort with the Mesmer (probably unjustly) won, the term animal devil, and the medical profession accused him of be- magnetism was first used. ing a charlatan. In response to the medical profes- In 1777 Mesmer agreed to treat Maria Theresa sion’s criticisms, Mesmer proposed that 20 patients Paradies, a 17-year-old pianist who had been blind be chosen at random, 10 sent to him for treatment, since the age of three. Mesmer claimed that his and 10 sent to members of the French Academy of treatment returned her sight but that she could Medicine; the results would then be compared. see only while alone in his presence. The medical Mesmer’s interesting proposal was rejected. In 1781

506 CHAPTER 15 Queen Marie Antoinette, one of Mesmer’s many in- lectures attended by thousands, conducting empiri- fluential friends, offered Mesmer a chateau and a life- cal investigations, and treating untold numbers of ill time pension if he would disclose the secrets of his people” (Schmitt, 2005, pp. 403). The widespread success. Mesmer turned down the offer. popularity of mesmerism continued for about 20 Popularity alone did not satisfy Mesmer. What years. Among the factors leading to its demise he desperately wanted was the acceptance of the were Helmholtz’s persuasive experiments that ques- medical profession, which saw him as a quack. In tioned the existence of vital substances, such as 1784 the Society of Harmony (a group dedicated to magnetism (see Chapter 8), and the discovery that the promotion of animal magnetism) persuaded the trance could be induced without recourse to mag- king of France to establish a commission to objec- netism (see below). Nonetheless, “[The mesmerists] tively study the effects of animal magnetism. This helped define the character of psychology for their truly high-level commission consisted of Benjamin generation, showing how it was applicable to peo- Franklin (the commission’s presiding officer); ple’s lives and that it was a ‘mental science’ based on Antoine Lavoisier, the famous chemist; and Joseph obtaining ‘facts’ from demonstrable ‘experiments’” Guillotin, the creator of a way to put condemned (Schmitt, 2005, p. 422). people to death in a “humane” manner. The com- mission conducted several experiments to test Mesmer’s claims. In one experiment, a woman Marquis de Puységur was told that she was being mesmerized by a mes- merist behind a door, and she went into a crisis Although the commission’s report silenced Mesmer although there was actually no one behind the himself, other members of the Society of Harmony door. In another experiment, a patient was offered continued to use and modify Mesmer’s techniques. five cups of water, one of which was mesmerized. One such member, the Marquis de Puységur She chose and drank a cup with plain water but (1751–1825), discovered that magnetizing did not experienced a crisis anyway. need to involve the violent crisis that Mesmer’s ap- Much to Mesmer’s dismay, in its report of proach necessitated. Simply by placing a person in a August 1784, the commission concluded that there peaceful, sleeplike trance, Puységur could demon- was no such thing as animal magnetism and that any strate a number of phenomena. Although the per- positive results from treatment supposedly employ- son appeared to be asleep, he or she would still ing it were due to the imagination. The commis- respond to Puységur’s voice and follow his com- sion branded Mesmer a mystic and a fanatic. mands. When Puységur instructed the magnetized Although many people, some of them prominent, patient to talk about a certain topic, perform various urged Mesmer to continue his work and his writ- motor activities, or even dance to imagined music, ing, the commission’s findings had essentially de- he or she would do so and have no recollection of stroyed him, and he sank into obscurity. the events upon waking. Because a sleeplike trance Although Mesmer became obscure, mesmerism replaced the crisis, Puységur renamed the condition did not, especially in the United States. In January artificial somnambulism. He found that the of 1836, Charles Poyen, a Parisian, strode upon the therapeutic results of using this artificial sleep were stage of Boston’s Chauncey Hall to give the first of as good as they had been with Mesmer’s crisis a series of lectures on animal magnetism. These approach. lectures piqued the interest of members of the local With his new approach, Puységur made many intelligentsia, including Ralph Waldo Emerson, discoveries. In fact, he discovered most of the hyp- who embraced the topic enthusiastically (Schmitt, notic phenomena known today. He learned that 2005, pp. 403–404). However, Emerson was not while in the somnambulistic state, individuals are alone: “A cohort of Americans took to the practice highly suggestible. If they were told something enthusiastically, publishing materials, presenting was true, they acted as if it were true. Paralyses

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 507 and various sensations, such as pain, could be James Braid (1795–1860), a prominent Scottish moved around the body solely by suggestion. surgeon, was skeptical of magnetism, but after care- When individuals were told that a part of their fully examining a magnetized subject, he was con- body was anaesthetized, they could tolerate nor- vinced that many of the effects were real. Braid mally painful stimuli such as burns and pin pricks proceeded to examine the phenomenon systemati- without any sign of distress. Also, a wide variety of cally, and in 1843 he wrote The Rationale of Nervous emotional expressions, such as laughing and crying, Sleep. Braid explained magnetism in terms of pro- could be produced on command. It was observed longed concentration and the physical exhaustion that individuals could not remember what had oc- that followed, stressing that the results are explained curred while in a trance, a phenomenon later called by the subject’s suggestibility rather than by any posthypnotic amnesia. What is now called post- power that the magnetizer possessed. He renamed hypnotic suggestion was also observed. That is, the study of the phenomenon neurohypnology, while in a trance, an individual is told to perform which was then shortened to hypnosis (hypnos is some act such as scratching his or her nose when the Greek word for “sleep”). Braid did as much as they hear their name. After being aroused from the anyone to make the phenomenon previously trance, the individual will typically perform the act known as magnetism, mesmerism, or somnambu- as instructed without any apparent knowledge of lism respectable within the medical community. why he or she is doing so. John Elliotson, James Esdaile, The Nancy School and James Braid Convinced of the value of hypnosis, Auguste Because magnetizing a patient could, by suggestion, Ambroise Liébeault (1823–1904) wanted to use make him or her oblivious to pain, a few physicians it in his practice but could find no patient willing to began to look upon magnetism as a possible surgical be subjected to it. Eventually, he agreed to provide anesthetic.JohnElliotson(1791–1868)suggestedthat free treatment to any patient willing to undergo mesmerism be used during surgery, but the medical hypnotism. A few patients agreed, and Liébeault establishment forbade it even when other anesthetics was so successful that his practice was quickly were not available. In 1842 W. S. Ward performed a threatened by an excess of nonpaying patients. leg amputation in which the patient was magnetized, Soon Liébeault was treating all his patients with but some physicians accused the patient of being an hypnotism and accepting whatever fee they could impostor. Other physicians said that patients should afford. A “school” grew up around his work, and suffer pain during an operation because it helps them because he practiced in a French village just outside recover better (Fancher, 1990). In India, James of the city of Nancy, it was called the Nancy Esdaile (1808–1859), a surgeon with the British school. Army in Calcutta, performed more than 250 painless The school attracted a number of physicians; operations on Hindu convicts, but his results were among them Hippolyte Bernheim (1840– dismissed because his operations had been performed 1919), who became the major spokesperson of on natives and therefore had no relevance to the Nancy school. Bernheim contended that all hu- England. About this time, anesthetic gases were mans are suggestible but that some are more sug- discovered, and interest in magnetism as an anesthetic gestible than others, and highly suggestible people faded almost completely. The use of gases was much are easier to hypnotize than those less suggestible. more compatible with the training of the physicians Furthermore, Bernheim found that whatever a of the day than were the mysterious forces involved highly suggestible patient believed would improve in magnetism or somnambulism. his or her symptoms usually did so.

508 CHAPTER 15 Charcot’s Proposed Explanation of abnormalities in the brain and spinal cord. He Hypnosis and Hysteria and his colleagues identified features of the spinal cord associated with poliomyelitis and multiple When Jean-Martin Charcot (1825–1893) be- sclerosis. He described a disease of the motor came the director of La Salpêtrière (the institu- neurons still referred to as Charcot’s disease. He tion where Pinel had released the patients from helped identify brain structures associated with a their chains) in 1862, he immediately converted number of behavioral and physiological functions. it into a research center. Though flamboyant, And he instituted temperature taking as a daily Charcot was considered one of the most brilliant hospital routine. Because of these and other ac- physicians in all of Europe. Space does not per- complishments, Charcot’s La Salpêtrière became a mit presenting a complete list of Charcot’s im- place of pilgrimage for physicians from throughout pressive accomplishments as a neurologist, but a the world; it became “the mecca of neurologists” sample includes the following: He carefully ob- (E. Jones, 1953, p. 207). Among those attending served his patients’ symptoms, and upon their Charcot’s lectures and demonstrations were Alfred death he correlated those symptoms with specific Binet, William James, and Sigmund Freud, who © Bettmann/CORBIS Charcot demonstrating various hypnotic phenomena

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 509 studied with Charcot from October 13, 1885, to than an organic origin. Charcot referred to the pa- February 28, 1886. ralyses he observed in his hysteric patients as “those Charcot’s interests increasingly turned to hyste- remarkable paralyses depending on an idea, paraly- ria, an ailment most physicians dismissed as malinger- ses by imagination” (Webster, 1995, p. 68). ing because they could find no organic cause for its According to Charcot, the sequence of events symptoms. Charcot rejected the popular malinger- from trauma to pathogenic ideas (ideas that pro- ing theory and concluded that hysteric patients are duce physical symptoms) to the symptoms them- suffering from a real disease. Staying within the med- selves could occur only in individuals who were ical model, however, he concluded that hysteria is inherently predisposed to hysteria. Also, as we caused by a hereditary neurological degeneration have seen, Charcot believed for many years that that is progressive and irreversible. Because both hys- only individuals predisposed to hysteria could be teria and hypnosis produce the same symptoms (such hypnotized. With hypnosis, the hypnotist’s sugges- as paralyses and anesthesia), Charcot concluded that tions created the same “annihilation of the ego” as hypnotizability indicated the presence of hysteria. did traumatic experience. Thus, Charcot’s explana- Charcot’s belief that only those people suffering tion of hysteria and hypnotic phenomena from hysteria could be hypnotized brought him combined biology (the inherited potential for hys- into sharp conflict with members of the Nancy teria) and psychology (the pathogenic ideas caused school—the former believing that hypnotizability is by trauma or suggestion). Uncharacteristically, a sign of mental pathology, the latter believing that it Charcot accepted his speculations as fact: “No is perfectly normal. The debate was heated and lasted sooner had Charcot formulated this completely for years. Toward the end of his life, Charcot admit- speculative solution to his two major scientific ted that his theory of suggestibility was wrong and problems [hysteria and hypnosis] than he began that of the Nancy school was correct. to treat it as if it were an established scientific In his effort to explain hysteria and hypnotic fact” (Webster, 1995, p. 67). phenomena, the otherwise positivistic Charcot be- By coincidence, Freud was studying with came highly speculative. He noted that several of Charcot as Charcot was formulating the preceding his hysteric patients had suffered a traumatic expe- theory. Freud accepted the theory uncritically and rience (such as an accident) prior to the onset of returned to Vienna believing that ideas could lodge their symptoms. Often the accidents were not se- in the unconscious portion of the mind where they vere enough to cause neurological damage, but could produce bodily symptoms: Charcot speculated that the accidents may have [Freud’s] experience in Paris had … a caused ideas that, in turn, caused the symptoms as- profound effect on him and he returned sociated with hysteria. Among the more dramatic not so much as a student reporting on a symptoms associated with hysteria are paralysis of study-trip as a zealot who had undergone a various parts of the body and insensitivity to pain. religious conversion. The new gospel Specifically, Charcot assumed that trauma had which he brought with him … was … the caused certain ideas to become dissociated from idea that physical illnesses could have a consciousness and, thus, isolated from the restric- purely psychological origin. (Webster, tions of rational thought. In this way an idea caused 1995, p. 100) by trauma “would be removed from every influ- ence, be strengthened, and finally become power- (Libbrecht and Quackelbeen, 1995; and ful enough to realize itself objectively through Webster, 1995, provide more detailed discussions paralysis” (Webster, 1995, p. 67). Contrary to the of Charcot’s theory of hysteria and its impact on positivistic medicine that Charcot had previously Freudian thought.) accepted, he now speculated that hysterical symp- Pierre Janet (1859–1947) was Charcot’s stu- toms (such as paralysis) had a psychological rather dent, and he agreed with his mentor that for some

510 CHAPTER 15 individuals, aspects of the personality could become As was the case with Charcot, we see much in dissociated, or “split off,” and these dissociated as- Janet’s work that anticipated Freud’s. Even the pects of the personality could manifest themselves names used to describe their methods were similar; in hysteric symptoms or in hypnotic phenomena. Janet called his method psychological analysis, Janet, like Charcot, speculated that both might re- and Freud called his psychoanalysis. The ideas of sult from the “subconscious” influence of dissoci- Janet and Freud were so similar that there was a dis- ated aspects of personality. He noticed that the dis- pute between the two over priority (R. I. Watson, sociated aspects of a patient’s personality quite often 1978). consist of traumatic or unpleasant memories, and it It is important to note that the discussion of was therefore the therapist’s task to discover these hypnosis featured in this chapter is not only of his- memories and make the patient aware of them. torical interest. The nature of hypnosis continues to Hypnosis was used to discover these dissociated be debated within contemporary psychology. For a memories, and when they were brought to the at- review of current questions and controversies con- tention of a patient, his or her hysterical symptoms cerning hypnosis see, for example, Kirsch and Lynn, often abated. (For a more detailed account of Janet’s 1995. work, see Ellenberger, 1970.) SUMMARY Although mental illness has been referred to by dif- cal and mental). He saw physical health resulting ferent names throughout history, all those names ap- from a balance among the four humors of the body pear to refer to the same types of behavior or thought and illness resulting from an imbalance among them. processes—namely, behavior that is harmful to one- He saw mental illness resulting primarily from abnor- self or others, unrealistic thoughts and perceptions, mal conditions in the brain. To regain health, either inappropriate emotions, and unpredictable behavior. physical or mental, the Hippocratics prescribed such Early explanations of mental illness fall into three naturalistic remedies as mineral baths, fresh air, and categories: biological explanations (the medical proper diets. The Hippocratics also identified a num- model), psychological explanations (the psychologi- ber of mental illnesses, including hysteria. cal model), and supernatural or magical explanations Naturalistic medicine and psychiatry character- (the supernatural model). How mental illness was ized treatment of physical and mental problems un- treated was largely determined by what its causes til the collapse of the Roman Empire, when there were assumed to be. All forms of psychotherapy, was a regression to demonology and magic. During however, involved a sufferer, a helper, and some the Middle Ages, and especially during the form of ritual. If the psychological model of mental Renaissance, those with mental illness were be- illness was assumed, then treatment involved such lieved to be possessed by evil spirits and were things as the analysis of dreams, encouragement and harshly treated. But even during this dark time in support, or the teaching of more effective coping history for those with mental illness, some people skills. If the supernatural model was assumed, then refused to believe that abnormal behavior resulted treatment consisted of such things as exorcism, incan- from possession of the person by demons, spirits, or tation, or magical ritual. If the biological model was the devil. Paracelsus, Agrippa, Weyer, Scot, and assumed, then treatment consisted of such things as Plater argued effectively that abnormal behavior proper exercise, proper diet, massage, bloodletting, had natural causes and that people with mental ill- purgatives, or drugs. Hippocrates was among the first ness should be treated humanely. Even when the to accept the biological model of illness (both physi- supernatural explanation of mental illness subsided,

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 511 however, patients were still treated harshly in “lu- tient’s body. He also believed that some people natic asylums” such as Bedlam. Not until the end of have stronger magnetic force fields than others the 18th century did Pinel, Tuke, Chiarugi, Rush, and that they, like himself, are natural healers. Dix, and others help bring about dramatically better Mesmer contended that his extraordinary powers living conditions for people with mental illness. could redistribute the magnetic fields in clients Through the efforts of these pioneers, many pa- and thereby cure them. Because of something later tients were unchained; given better food; provided to be called the contagion effect, some of Mesmer’s recreation, fresh air, sunlight, and medical treat- clients were more easily “cured” in a group than ment; and treated with respect. individually. Even after Mesmer fell into profes- In 1883 Kraepelin summarized all categories of sional disrepute, mesmerism remained influential, mental illness known at that time; he attempted to especially in the United States. show the origins of the various disorders and how Puységur discovered that placing clients in a the disorders should be treated. Kraepelin also per- sleeplike trance, which he called artificial somnam- formed pioneering research in the field that came to bulism, was as effective as Mesmer’s crisis-oriented be called psychopharmacology. One of the charter approach for treating disorders. Puységur explained members of the APA, Lightner Witmer, was this sleeplike state as the result of suggestibility. He trained as a Wundtian experimental psychologist also discovered the phenomena of posthypnotic but became increasingly interested in using psycho- suggestion and posthypnotic amnesia. Because logical principles to help people. He coined the “magnetizing” patients made them insensitive to term clinical psychology, established the world’s first pain, several physicians used it as an anesthetic. psychological clinic in 1896 (and subsequently sev- This technique was controversial, however, and eral others), developed the first curriculum designed physicians dropped it when anesthetic gases such to train clinical psychologists, and founded the first as ether were discovered. By systematically studying journal devoted to the diagnosis and treatment of hypnosis and attempting to explain it as a biological mental illness. By the mid-19th century, the medi- phenomenon, Braid gave it greater respectability in cal model of illness (both physical and mental) pre- the medical community. Members of the Nancy vailed just as it had before the collapse of the school, such as Liébeault and Bernheim, believed Roman Empire. The prevalence of the medical that all humans are more or less suggestible and model discouraged a search for the psychological therefore hypnotizable; Charcot, in contrast, be- causes of mental illness because it was believed lieved that only hysterics are hypnotizable. Unlike that such a search exemplified a return to a form most other physicians of his day, Charcot treated of demonology. Although psychological explana- hysteria as a real rather than an imagined illness. tions of mental illness became more respectable, Charcot theorized that traumatic experiences cause there was and is a tension between those accepting ideas to become dissociated from consciousness and the medical model and those accepting the psycho- thus from rational consideration. In such isolation, logical model. Szasz contends that mental illness is a the dissociated ideas became powerful enough to myth because it has no organic basis. To him, what cause the bodily symptoms associated with hysteria. is called mental illness is more accurately described In hysteric patients, hypnotism also causes dissocia- as problems in living, and individuals should have tion and thus, according to Charcot, hypnotic phe- the responsibility for solving those problems rather nomena and the symptoms of hysteria have much than attributing them to some illness or disease. in common. Charcot’s speculation that unconscious The work of Mesmer played a crucial role in ideas could cause bodily symptoms played a signifi- the transition toward objective psychological expla- cant role in Freud’s subsequent work. Like Charcot, nations of mental illness. Mesmer believed that Janet believed that aspects of the personality, such as physical and mental disorders are caused by the un- traumatic memories, could become dissociated even distribution of animal magnetism in the pa- from the rest of the personality and that such

512 CHAPTER 15 dissociation explains both hysterical symptoms and ated memory, his or her hysterical symptoms would hypnotic phenomena. Janet found that often when improve. a patient became aware of and dealt with a dissoci- DISCUSSION QUESTIONS 1. What is mental illness? In your answer, include 10. Why was Kraepelin’s listing of the various the criteria that have been used throughout mental disorders seen as something both posi- history to define mental illness. tive and negative? 2. Summarize the medical, psychological, and 11. Summarize the reasons Witmer is considered supernatural models of mental illness and give the founder of clinical psychology. an example of each. 12. Describe and give an example exemplifying the 3. What, if anything, do all versions of psycho- tension between explanations of mental illness therapy have in common? based on the medical model and those based on 4. Describe what therapy would be like if it were the psychological model. based on the psychological model of mental 13. Why does Szasz refer to mental illness as a illness, on the supernatural model, and on the myth? Why does he feel that labeling someone biological model. as mentally ill may be doing him or her a 5. Define and give an example of homeopathic disservice? and contagious magic. 14. According to Mesmer, what causes mental and 6. How did Hippocrates define health and illness? physical illness? What procedures did Mesmer What treatments did he prescribe for helping use to cure such illnesses? What was Mesmer’s his patients regain health? fate? 7. When did witch hunting reach its peak in 15. In what way could Mesmer’s techniques be Europe? How did the publishing of the Malleus considered an improvement over other tech- Maleficarum facilitate witch hunting? What niques of treating mental illness that existed at were some of the signs taken as proof that a the time? person was a witch or was bewitched? Why 16. What major phenomena did Puységur observe was it assumed that women were more likely during his research on artificial somnambulism? to be witches or bewitched than men? 17. Describe the debate that occurred between 8. In what ways did individuals such as Paracelsus, members of the Nancy school and Charcot and Agrippa, Weyer, Scot, and Plater improve the his colleagues over hypnotizability. Who finally plight of the mentally ill? won the debate? 9. What significance did Pinel have in the history 18. Summarize the theory that Charcot proposed of the treatment of the mentally ill? Rush? Dix? to explain hysteria and hypnotic phenomena. SUGGESTIONS FOR FURTHER READING Ehrenwald, J. (Ed.). (1991). The history of psychotherapy. Farber, S. (1993). Madness, heresy, and the rumor of angels: Northvale, NJ: Jason Aronson. The revolt against the mental health system. Chicago: Open Court.

EARLY DIAGNOSIS, E XP LA NAT ION, AND T REATMENT OF ME NT AL ILLN ES S 513 Kramer, H., & Sprenger, J. (1971). The malleus malefi- McReynolds, P. (1997). Lightner Witmer: His life and carum (M. Summers, Trans.). New York: Dover. times. Washington, DC: American Psychological (Original work published 1487) Association. Maher, B. A., & Maher, W. B. (1985). Psychopathology: Porter, R. (2002). Madness: A brief history. New York: II. From the eighteenth century to modern times. In Oxford University Press. G. A. Kimble, & K. Schlesinger (Eds.), Topics in the Roccatagliata, G. (1986). A history of ancient psychiatry. history of psychology (Vol. 2, pp. 295–329). Hillsdale, New York: Greenwood Press. NJ: Erlbaum. Szasz, T. S. (1974). The myth of mental illness: Foundations Maher, W. B., & Maher, B. A. (1985). Psychopathology: of a theory of personal conduct (rev. ed.). New York: I. From ancient times to the eighteenth century. In Harper & Row. G. A. Kimble, & K. Schlesinger (Eds.), Topics in the Viney, W. (1996). Dorothea Dix: An intellectual con- history of psychology (Vol. 2, pp. 251–294). Hillsdale, science for psychology. In G. A. Kimble, C. A. NJ: Erlbaum. Boneau, & M. Wertheimer (Eds.), Portraits of pioneers McReynolds, P. (1987). Lightner Witmer: Little-known in psychology (Vol. 2, pp. 15–31). Washington, DC: founder of clinical psychology. American Psychologist, American Psychological Association. 42, 849–858. GLOSSAR Y Animal magnetism A force that Mesmer and others Contagious magic A type of sympathetic magic. It believed is evenly distributed throughout the bodies of involves the belief that what one does to something that healthy people and unevenly distributed in the bodies of a person once owned or that was close to a person will unhealthy people. influence that person. Artificial somnambulism The sleeplike trance that Dix, Dorothea Lynde (1802–1887) Caused several Puységur created in his patients. It was later called a states (and foreign countries) to reform their facilities for hypnotic trance. treating mental illness by making them more available to Bernheim, Hippolyte (1840–1919) A member of the those needing them and more humane in their Nancy school of hypnotism who believed that anything treatment. a highly suggestible patient believed would improve his Hippocrates (ca. 460–377 B.C.) Argued that all or her condition would do so. mental and physical disorders had natural causes and that Charcot, Jean-Martin (1825–1893) Unlike most of treatment of such disorders should consist of such things the physicians of his day, concluded that hysteria was a as rest, proper diet, and exercise. real disorder. He theorized the inherited predisposition Homeopathic magic The type of sympathetic magic toward hysteria could become actualized when traumatic involving the belief that doing something to a likeness of experience or hypnotic suggestion causes an idea or a a person will influence that person. complex of ideas to become dissociated from conscious- Janet, Pierre (1859–1947) Like Charcot, theorized ness. Isolated from rational control, such dissociated ideas that components of the personality, such as traumatic become powerful enough to cause the symptoms asso- memories, could become dissociated from the rest of the ciated with hysteria, for example, paralysis. personality and that these dissociated components are Clinical psychology The profession founded by responsible for the symptoms of hysteria and for hypnotic Witmer, the purpose of which was to apply the princi- phenomena. ples derived from psychological research to the diagnosis Kraepelin, Emil (1856–1926) Published a list of cate- and treatment of disturbed individuals. gories of mental illness in 1883. Until recent times, many Contagion effect The tendency for people to be more clinicians used this list to diagnose mental illness. Today susceptible to suggestion when in a group than when the Diagnostic and Statistical Manual of Mental Disorders alone.

514 CHAPTER 15 (2000) serves the same purpose. Kraepelin was also a pi- Posthypnotic suggestion A suggestion that a person oneer in the field known today as psychopharmacology. receives while under hypnosis and acts on when he or Liébeault, Auguste Ambroise (1823–1904) Founder she is again in the waking state. of the Nancy school of hypnotism. Psychological model of mental illness The assump- Medical model of mental illness The assumption that tion that mental illness results from such psychological mental illness results from such biological causes as brain causes as conflict, anxiety, faulty beliefs, frustration, or damage, impaired neural transmissions, or biochemical traumatic experience. abnormalities. Psychotherapy Any attempt to help a person Mental illness The condition that is said to exist when with a mental disturbance. What all versions of a person’s emotions, thoughts, or behavior deviate sub- psychotherapy have had in common throughout his- stantially from what is considered to be normal at a cer- tory are a sufferer, a helper, and some form of ritualistic tain time and place in history. activity. Mesmer, Franz Anton (1734–1815) Used what he Puységur, Marquis de (1751–1825) Found that plac- thought were his strong magnetic powers to redistribute ing patients in a sleeplike trance was as effective in alle- the magnetic fields of his patients, thus curing them of viating ailments as was Mesmer’s approach, which their ailments. necessitated a crisis. He also discovered a number of basic hypnotic phenomena. Nancy school A group of physicians who believed that because all humans are suggestible, all humans can be Rush, Benjamin (1745–1813) Often called the first hypnotized. U.S. psychiatrist. Rush advocated the humane treatment of people with mental illness but still clung to some Natural law The belief prevalent in the 18th century earlier treatments, such as bloodletting and the use of that undesirable or sinful behavior has negative conse- rotating chairs. quences such as mental or physical disease or poverty, and virtuous behavior has positive consequences such as Supernatural model of mental illness The assump- good health or prosperity. tion that mental illness is caused by malicious, spiritual entities entering the body or by the will of God. Pinel, Philippe (1745–1826) Among the first, in modern times, to view people with mental illness as sick Sympathetic magic The belief that by influencing people rather than criminals, beasts, or possessed indivi- things that are similar to a person or that were once close duals. In the asylums of which he was in charge, Pinel to that person, one can influence the person. (See also ordered that patients be unchained and treated with Homeopathic magic and Contagious magic.) kindness in a peaceful atmosphere. Pinel was also re- Trepanation The technique of chipping or drilling sponsible for many innovations in the treatment and holes in a person’s skull, presumably used by primitive understanding of mental illness. humans to allow evil spirits to escape. Posthypnotic amnesia The tendency for a person to Witmer, Lightner (1867–1956) Considered to be the forget what happens to him or her while under hypnosis. founder of clinical psychology.

16 ✵ Psychoanalysis hen psychology became a science, it became first a science of conscious W experience and later a science of behavior. Representatives of psychol- ogy’s early schools—for example, Wundt, Titchener, and James—were aware of unconscious processes but dismissed them as unimportant. The methodologi- cal behaviorists, such as Tolman and McDougall, postulated conscious but not unconscious cognitive constructs. The radical behaviorists, such as Watson and Skinner, refused even to admit consciousness into their psychology; thus, the study of the unconscious would have been unthinkable. And although Gestalt psychology was mentalistic, it concentrated entirely on phenomenological con- scious experience. How then could a psychology that emphasized the unconscious mind emerge? The answer is that it did not come from academic or experimental psy- chology. Indeed, it did not come from the tradition of empiricism and associa- tionism at all, as so much of psychology had. Rather, it came from clinical prac- tice. Those who developed the psychology of the unconscious were not concerned with experimental design or the philosophy of science; nor were they concerned with substantiating the claims of the associationists. They were concerned with understanding the causes of mental illness and using that under- standing to help mentally ill patients. By emphasizing the importance of unconscious processes as causes of mental illness (and later of most human behavior), this band of individuals set themselves apart not only from the psychologists of the time but also from the medical pro- fession. The medical profession had been strongly influenced by the mechanistic- positivistic philosophy, according to which physical events caused all illness. For example, physicians explained abnormal behavior in terms of brain damage or 515

516 CHAPTER 16 biochemical imbalance. If they used the term men- compatible with Goethe’s description of human ex- tal illness at all, it was as a descriptive term because istence as consisting of a constant struggle between conflicting emotions and tendencies. Herbart they believed that all illnesses have physical origins. (1776–1841) suggested that there is a threshold The stressing of psychological causes of mental ill- above which an idea is conscious and below which ness separated this small group of physicians from an idea is unconscious. He also postulated a conflict both their own profession and academic psychology. model of the mind because only ideas compatible Theirs was not an easy struggle, but they persisted; in with each other could occur in consciousness. If the end, they had convinced the medical profession, two incompatible ideas occur in consciousness, one of them is forced below the threshold into academic psychology, and the public that uncon- the unconscious. Herbart used the term repression scious processes must be taken into consideration in to denote the inhibiting force that keeps an incom- understanding why people act as they do. Sigmund patible idea in the unconscious. As far as the notion Freud was the leader of this group of rebels, but be- of the unconscious is concerned, Boring said, fore we examine his work, we consider some of the “Leibniz foreshadowed the entire doctrine of the antecedents of his work. unconscious, but Herbart actually began it” (1950, p. 257). Schopenhauer (1788–1860) believed that hu- mans are governed more by irrational desires than ANTECEDENTS OF THE by reason. Because the instincts determine behav- DEVELOPMENT OF ior, humans continually vacillate between being in a state of need and being satisfied. Schopenhauer PSYCHOANALYSIS anticipated Freud’s concept of sublimation when he said that we could attain some relief or escape As we saw in the last chapter, both hypnotic phe- from the irrational forces within us by immersing nomena and Charcot’s proposed explanation of ourselves in music, poetry, or art. One could also hysteria had a strong influence on the development attempt to counteract these irrational forces, espe- of Freud’s theory, but there were several other in- cially the sex drive, by living a life of asceticism. fluences as well. In fact, a case can be made that all Schopenhauer also spoke of repressing undesirable components of what was to become psychoanalysis thoughts into the unconscious and of the resis- existed before Freud began to formulate that doc- tance one encounters when attempting to recog- trine. Some of those components were very much a nize repressed ideas. Although Freud credited part of the German culture in which Freud was Schopenhauer as being the first to discover the pro- raised, and others he learned as a medical student cesses of sublimation, repression, and resistance, trained in the Helmholtzian tradition. We briefly Freud also claimed that he had discovered the review the philosophy, science, and literature of same processes independently. which Freud was aware and that later emerged in Nietzsche (1844–1900)—and later, Freud— one form or another in Freud’s formulation of saw humans as engaged in a perpetual battle be- psychoanalysis. tween their irrational (Dionysian) and rational Leibniz (1646–1716), with his monadology, (Apollonian) tendencies. According to Nietzsche, showed that depending on the number of monads it is up to each person to create a unique blend of involved, levels of awareness could range from clear these tendencies within his or her own personality, perception (apperception) to experiences of which even if doing so violates conventional morality. we are unaware (petites perceptions). Goethe Like Herbart, Fechner (1801–1887) employed the (1749–1832) was one of Freud’s favorite authors, concept of threshold in his work. More important and the major thrust of psychoanalysis was certainly to Freud, however, was that Fechner likened the

PS YC HOA NAL YS IS 517 mind to an iceberg, consciousness being the smallest Freud’s teachers at the University of Vienna when part (about 1/10), or the tip, and the unconscious Freud was in his early twenties. Brentano taught mind making up the rest (about 9/10). Besides bor- that motivational factors are extremely important rowing the iceberg analogy of the mind from in determining the flow of thought and that there Fechner, Freud also followed Fechner in attempting are major differences between objective reality and to apply the recently discovered principle of the subjective reality. This distinction was to play a vital conservation of energy to living organisms. Freud role in Freud’s theory. Under the influence of said, “I was always open to the ideas of G. T. Brentano, Freud almost decided to give up medi- Fechner and have followed that thinker upon cine and pursue philosophy (which was Brentano’s many important points” (E. Jones, 1953, p. 374). main interest); but Ernst Brücke (1819–1892), the By showing the continuity between humans and positivistic physiologist, influenced Freud even other animals, Darwin (1809–1882) strengthened more than Brentano, and Freud stayed in Freud’s contention that humans, like nonhuman medicine. animals, are motivated by instincts rather than by Karl Eduard von Hartmann (1842–1906) wrote reason. According to Freud, it is our powerful ani- a book titled Philosophy of the Unconscious (1869), mal instincts, such as our instincts for sexual activity which went through 11 editions in his lifetime. and for aggression, that are the driving forces of During the time that Freud was studying medicine personality, and it is these instincts that must be at and later when he was developing his theory, the least partially inhibited for civilization to exist. As idea of the unconscious was quite common in was the case with most scientists of his day, Freud’s Europe, and no doubt every reasonably educated view of evolution combined Darwinian and person was familiar with the concept. Hartmann Lamarckian principles. was strongly influenced by both Schopenhauer’s Representing the positivistic approach to med- philosophy and Jewish mysticism. For him, there icine and psychology, Helmholtz (1821–1894) tol- were three types of unconsciousness: processes erated no metaphysical speculation while studying that govern all natural phenomena in the universe; living organisms, including humans. His approach, the physiological unconscious, which directs the which permeated most of medicine and physiology bodily processes; and the psychological uncon- at the time, initially had a profound effect on Freud. scious, which is the source of all behavior. However, Freud soon abandoned Helmholtz’s ma- Although Hartmann’s position was primarily mysti- terialism and switched from a medical (biological) cal, it had some elements in common with Freud’s to a highly speculative psychological model in his theory, especially the notion of the psychological effort to explain human behavior. Also important unconscious. (For an account of how Hartmann for Freud was Helmholtz’s concept of the conser- influenced Freud, see Capps, 1970.) vation of energy. Helmholtz demonstrated that an Clearly then, the notions of an active, dynamic organism is an energy system that could be ex- mind with a powerful unconscious component were plained entirely on the basis of physical principles. very much part of Freud’s philosophical heritage. As Helmholtz demonstrated that the energy that we will see, other aspects of Freud’s theory—such as comes out of an organism depends on the energy infantile sexuality, the emphasis on the psychological that goes into it; no life force is left over. Taking causes of mental illness, psychosexual stages of devel- Helmholtz’s idea of the conservation of energy and opment, and even dream analysis—were not original applying it to the mind, Freud assumed that only so with Freud. Freud’s accomplishment was synthesiz- much psychic energy is available at any given time ing all these elements into a comprehensive theory of and that it could be distributed in various ways. personality: “Much of what is credited to Freud was How this finite amount of energy is distributed in diffuse current lore, and his role was to crystallize the mind accounts for all human behavior and these ideas and give them an original shape” thought. Brentano (1838–1917) was one of (Ellenberger, 1970, p. 548).

518 CHAPTER 16 SIGMUND FREUD Sigmund Freud (1856–1939) was born on either March 6 or May 6 in Freiberg, Moravia (now Pribor, Czech Republic). His father, Jakob, was a wool merchant who had 10 children. Both his grandfather and his great-grandfather were rabbis. Freud considered himself a Jew all his life but had a basically negative attitude toward Judaism as well as Christianity. Jakob’s first wife (Sally Kanner), 2003665310 whom he married when he was 17 years old, bore him two children (Emanuel and Philipp); his second wife apparently bore him none; and his Congress, third wife Amalie Nathansohn bore him eight chil- of dren, of whom Sigmund was the first. In 1968 ex- Library amination of the town records of Freiberg revealed the that Jakob Freud’s second wife was a woman of named Rebecca, about whom practically nothing © Courtesy is known. Earlier the town records indicated that Freud’s birth date was March 6, not May 6 as was Sigmund Freud claimed by the family and as has been traditionally reported as Freud’s birth date. Ernest Jones, Freud’s he came to believe it too; therefore, much of what official biographer, believed that the discrepancy he accomplished later was due, he thought, to a reflected only a clerical error, but others see it as type of self-fulfilling prophecy. Freud’s father lived having greater significance. Balmary (1979) specu- 81 years, and his mother lived until 1930, when she lates that Freud’s parents reported the birth date of died at the age of 95, only eight years before her May 6 instead of March 6 to conceal the fact that son Sigmund. Freud’s mother was pregnant with Sigmund when When Jakob’s business failed, the Freuds moved she married Jakob. Balmary believes that both first to Leipzig and then, when Sigmund was age 4, to “family secrets” (the facts that Freud’s mother was Vienna. From early on, Sigmund showed great intel- Jakob’s third wife and not his second, as the family lectual ability; to aid his studies, he was given an oil had reported, and that Amalie was pregnant when lamp and a room of his own—the only one in the she married) had a significant influence on Freud’s large household to have those things. His mother early views and therefore on his later theorizing. In would often serve him his meals in his room, and a any case, when Sigmund was born, his father was piano was taken away from one of his sisters because 40 years old and already a grandfather, and his the music bothered him. Sigmund began reading mother was a youthful 20. Among the paradoxes Shakespeare when he was eight years old, and he that young Freud had to grapple with were the facts deeply admired that author’s power of expression that he had half-brothers as old as his mother and a and understanding of human nature all his life. nephew older than he was. Sigmund was the oldest Freud also had an amazing gift for languages. As a child in the immediate family, however, and clearly boy, he taught himself Latin, Greek, French, Amalie’s favorite. Freud and his mother had a close, Spanish, Italian, and English, and later in life he be- strong, and positive relationship, and he always felt came an acknowledged master of German prose. He that being the indisputable favorite child of his entered high school at age 9 (a year earlier than nor- young mother had much to do with his success. mal) and was always at the head of his class; at age 17, Because his mother believed that he was special, he graduated summa cum laude.

PS YC HOA NAL YS IS 519 Until his final year of high school, Freud was to many of the phenomena that would occupy attracted to a career in law or politics, or even in Freud’s attention for the next 50 years), and he had the military; but hearing a lecture on Goethe’s essay been given the opportunity to study with Charcot in on nature and reading Darwin’s theory of evolution Paris. All these events were to have a significant in- aroused his interest in science, and he decided to fluence on the development of Freud’s career. There enroll in the medical school at the University of was, however, a major setback: Freud’s involvement Vienna in the fall of 1873, at the age of 17. He also with the “magical substance” cocaine. made this decision partly because, in anti-Semitic Vienna, medicine and law were the only professions The Cocaine Episode open to Jews. Although Freud enrolled in medical school in 1873, it took him eight years to complete In the spring of 1884, Freud experimented with co- the program; because he had such wide interests, he caine after learning that it had been used successfully was often diverted from his medical studies. For ex- in the military to increase the energy and endurance ample, Brentano caused him to become interested in of soldiers. Freud almost decided not to pursue his philosophy, and Freud even translated one of John interest when he learned from the pharmaceutical Stuart Mill’s books into German. company, Merck, that the price of 1 gram of cocaine According to Freud’s own account, the person was $1.27 instead of 13 cents as he had believed who influenced him most during his medical studies (E. Jones, 1953, p. 80). Freud persisted, however, was Ernst Brücke, who, along with some of his and after taking the drug himself, he found that it friends such as Helmholtz and Du Bois-Reymond, relieved his feelings of depression and cured his indi- founded the materialistic-positivistic movement in gestion, helped him work, and appeared to have no physiology (see Chapter 8). In Brücke’s laboratory, negative side effects. Besides taking cocaine regularly Freud studied the reproductive system of male eels himself, Freud gave it to his sisters, friends, collea- and wrote a number of influential articles on anat- gues, and patients and sent some to his fiancée omy and neurology. Freud obtained his medical Martha Bernays “to make her strong and give her degree in 1881 and continued to work in Brücke’s cheeks a red color” (E. Jones, 1953, p. 81). The ap- laboratory. Even though doing physiological re- parent improvement caused by cocaine in Freud’s search was Freud’s main interest, he realized that patients made him feel, for the first time, that he jobs in that area were scarce, low-paying, and gener- was a real physician. He became an enthusiastic ad- ally not available to Jews. Freud’s financial concerns vocate of cocaine and published six articles in the became acute in 1882, when he became engaged to next two years describing its benefits. Carl Koller Martha Bernays. Circumstances and advice from (1857–1944), one of Freud’s younger colleagues, Brücke caused Freud to change his career plans and learned from Freud that cocaine could be used as an seek a career in medical practice. To help prepare anesthetic. Koller was interested in ophthalmology himself, Freud went to the Vienna General and pursued Freud’s observation as it related to eye Hospital to study with Theodor Meynert (1833– operations. Within a few months, Koller delivered a 1893), one of the best-known brain anatomists at paper describing how eye operations previously im- the time, and Freud soon became a recognized expert possible could now, using cocaine as an anesthetic, be at diagnosing various types of brain damage. Freud done with ease. The paper caused a sensation and considered Meynert the most brilliant person he had brought Koller worldwide fame almost overnight. ever known. Freud deeply regretted having just missed gaining Many important events happened in Freud’s life this professional recognition himself. about this time. In addition to making the decision to With the exception of the anesthetizing effects practice medicine, Freud was making a name for of cocaine, all of Freud’s other beliefs about the sub- himself as a neuroanatomist, he had just befriended stance soon proved to be false. In 1884 he adminis- Joseph Breuer (who, as we will see, introduced Freud tered cocaine to his colleague and friend Ernst von

520 CHAPTER 16 Fleischl-Marxow (1846–1891), who was addicted to morphine. Freud’s intention was to switch Fleischl- Marxow, who was a prominent physicist and physi- ologist, from morphine to cocaine, believing the lat- ter was harmless. Instead, he died a cocaine addict. Soon reports of cocaine addiction began coming in from throughout the world, and the drug came un- der heavy attack from the medical community. Freud was severely criticized for his indiscriminate advocacy of cocaine, which was now being referred to as the “third scourge of humanity” (the other two being morphine and alcohol). Freud’s close association with cocaine considerably harmed his medical repu- tation. It was the cocaine episode that, to a large ex- © Bettman/CORBIS tent, made the medical community skeptical of Freud’s later ideas. Freud’s Addiction to Nicotine. Although Freud avoided addiction to cocaine, he was ad- Josef Breuer dicted to nicotine most of his adult life, smoking an average of 20 cigars a day. At the age of 38, it students. Breuer was 14 years older than Freud and was discovered that he had heart arrhythmia; his had a considerable reputation as a physician and physician advised him to stop smoking, but he con- researcher. Breuer had made an important discov- tinued to do so. Being a physician himself, Freud ery concerning the reflexes involved in breathing, was well aware of the health risks associated with and he was one of the first to show how the semi- smoking, and he tried several times to quit but circular canals influenced balance. Breuer loaned without success. In 1923, when Freud was 67 years Freud money, and when Freud married in April old, he developed cancer of the palate and jaw. A 1886, the Breuer and Freud families socialized fre- series of 33 operations eventually necessitated his quently. (It is also interesting to note that Breuer wearing of an awkward prosthetic device (which was the Brentano family’s physician.) he called “the monster”) to replace the surgically It is what Freud learned from Breuer concern- removed sections of his jaw. He was in almost con- ing the treatment of a woman, anonymously re- stant pain during the last 16 years of his life, yet he ferred to as Fräulein Anna O., that essentially continued to smoke his cigars. launched psychoanalysis. Because Breuer started treating Anna O. in 1880, while Freud was still a medical student, Freud (1910/1949) gave Breuer the credit for creating psychoanalysis: EARLY INFLUENCES ON THE DEVELOPMENT OF Granted that it is a merit to have created psychoanalysis, it is not my merit. I was PSYCHOANALYSIS a student, busy with the passing of my last examinations, when another physi- Josef Breuer and the Case of Anna O. cian of Vienna, Dr. [Josef] Breuer, made Shortly before Freud obtained his medical degree, the first application of this method to the he developed a friendship with Josef Breuer case of an hysterical girl (1880–82). (1842–1925), another one of Brücke’s former (p. 1)

PS YC HOA NAL YS IS 521 Anna O. was a bright, attractive, 21-year-old ing emotional feelings toward Anna, a process later woman who had a variety of symptoms associated called countertransference. Because of the exces- with hysteria. At one time or another, she had ex- sive amount of time involved and because his emo- perienced paralysis of the arms or legs, disturbances tional involvement in the case began to negatively of sight and speech, nausea, memory loss, and gen- impact his marriage and his other professional ob- eral mental disorientation. Breuer hypnotized the ligations, Breuer decided to terminate his treatment young woman and then asked her to recall the cir- of Anna O. Freud gave various accounts of how cumstances under which she had first experienced a Anna O. responded to Breuer’s termination of her particular symptom. For example, one symptom treatment, and eventually these accounts evolved was the perpetual squinting of her eyes. Through into a story that was widely accepted as fact. hypnosis, Breuer discovered that she had been re- According to Freud, Breuer visited Anna O. the quired to keep a vigil by the bedside of her dying day after his announced termination of her treat- father. The woman’s deep concern for her father ment and found that she had developed a hysterical had brought tears to her eyes so that when the (phantom) pregnancy and was in the throes of hys- weak man asked her what time it was she had to terical childbirth. Upon questioning, Breuer squint to see the hands of the clock. learned that it was his imaginary child that was be- Breuer discovered that each time he traced a ing delivered. Ernest Jones (1953), Freud’s biogra- symptom to its origin, which was usually some trau- pher, described Freud’s account of what happened matic experience, the symptom disappeared either next: temporarily or permanently. One by one, Anna Though profoundly shocked, he [Breuer] O.’s symptoms were relieved in this way. It was as managed to calm her down by hypnotizing if certain emotionally laden ideas could not be ex- her, and then fled the house in a cold pressed directly but instead manifested themselves in sweat. The next day he and his wife left for physical symptoms. When such pathogenic ideas Venice to spend a second honeymoon, were given conscious expression, their energy dissi- which resulted in the conception of a pated, and the symptoms they initiated disappeared. daughter. (p. 225) Because relief followed the emotional release, which in turn followed the expression of a pathogenic idea, According to Freud, Breuer was so upset by the Breuer called the treatment the cathartic method. case of Anna O. that he never again treated another Aristotle had used the term catharsis (from the Greek case of hysteria. As entertaining as Freud’s account katharsis, which means “to purify”) to describe the may be, Hirschmüller (1989) corrects the historical emotional release and the feeling of purification record: Breuer did not end his treatment of Anna that an audience experienced as they viewed a drama. O. abruptly but carefully planned it in consultation Anna O. called the method the “talking cure” or with her mother; there was no hysterical pregnancy “chimney sweeping.” Breuer found that the catharsis and therefore no need to hypnotize Anna O. and occurred either during a hypnotic trance or when leave the house in a “cold sweat”; the Breuers went Anna O. was very relaxed. to Gmunden on a family vacation, not to Venice; Breuer’s treatment of Anna O. started in their daughter was born on March 11, 1882, well December 1880 and continued until June 1882. before the Breuers went on their “second honey- During that time, Breuer typically saw her several moon”; and finally, Breuer continued treating cases hours each day. Soon after treatment had started, of hysteria, although he did probably abandon the Anna O. began responding to Breuer as if he cathartic method. were her father, a process later called transference. All emotions Anna had once expressed toward her TheFateofAnnaO. The story of Anna O. usu- father, both positive and negative, she now ex- ally ends with the revelation that Anna’s real name pressed toward Breuer. Breuer also began develop- was Bertha Pappenheim (1859–1936) and that

522 CHAPTER 16 Breuer’s treatment must have been effective be- Freud’s Visit with Charcot cause the woman went on to become a prominent As we saw in the last chapter, Freud studied with social worker in Germany. Ellenberger (1972), the illustrious Charcot from October 1885 to however, discovered that Anna O. was institution- February 1886. Until this visit, although Freud alized after Breuer terminated her treatment. was aware of Breuer’s work with Anna O., he re- Documents indicate that she was admitted into a mained a materialistic-positivistic physiologist; he sanatorium in 1882, still suffering many of the ail- sought to explain all disorders, including hysteria, ments that Breuer had treated. The records show only in terms of neurophysiology. As did most phy- that she was treated with substantial amounts of sicians at the time, Freud viewed psychological expla- morphine while at the sanatorium and that she con- nations of illness as nonscientific. As we have seen, tinued to receive morphine injections even after her Charcot assumed hysteria to be a real disease that release. Little is known about her life between the could be triggered by dissociated ideas. Taking hys- time of her release from the sanatorium and her teria seriously and proposing a partially psychologi- emergence as a social worker in the late 1880s. cal explanation of the disease set Charcot apart from However, Pappenheim eventually went on to be- most of his colleagues. Furthermore, Charcot in- come a leader in the European feminist movement; sisted that hysteria occurred in males as well as fe- a playwright; an author of children’s stories; a males. This contention caused a stir because from founder of several schools and clubs for the poor, the time of the Greeks it had been assumed that the illegitimate, or wayward young women; and an hysteria was caused by a disturbance of the uterus. effective spokesperson against white slavery and It is significant for the subsequent development abortion. Her feminism is evident in the following of psychoanalysis that Freud claimed to have over- statement she made in 1922: “If there is any justice heard Charcot say about hysteria, “But in this kind in the next life women will make the laws there of case it is always something genital—always, al- and men will bear the children” (E. Jones, 1953, ways, always” (Boring, 1950, p. 709). Although p. 224). It is interesting to note that throughout Charcot denied making the statement, Freud none- her professional life she maintained a negative atti- theless claimed that Charcot had suggested to him tude toward psychoanalysis and would not allow the relationship between sexual factors and hysteria. any of the girls in her care to be psychoanalyzed The final lesson that Freud learned from Charcot (Edinger, 1968, p. 15). was that one could go against the established medi- When Pappenheim died in 1936, tributes came cal community if one had enough prestige. Freud, in from throughout Europe, including one from as we will see, went contrary to the medical com- Martin Buber, the famous philosopher and educa- munity, but because he did not have the prestige tor. In 1954 the German government issued a that Charcot had, he paid the price. So impressed stamp in her honor, part of a series paying tribute was Freud by Charcot that he later named his first to “helpers of humanity.” The effectiveness of son Jean-Martin after him (E. Jones, 1953). Breuer’s treatment of Pappenheim and, if effective, Freud returned to Vienna and, on October 15, how much of her ultimate success can be attributed 1886, presented a paper entitled “On Male to that treatment are still being debated (see, for Hysteria” to the Viennese Society of Physicians, example, Borch-Jacobsen, 1996; Kimble, 2000; in which he presented and endorsed Charcot’s Rosenbaum and Muroff, 1984). Breuer and Freud views on hysteria. The presentation was poorly re- published Studies on Hysteria (1895/1955), in which ceived because, according to Freud, it was too rad- the case of Anna O. was the first presented, in 1895, ical. Sulloway (1979), however, indicates that the and that date is usually taken as the date of the paper was poorly received not because it was official founding of the school of psychoanalysis. shocking but because Charcot’s views on hysteria,

PS YC HOA NAL YS IS 523 including the fact that hysteria was not a disorder person was unaware could play an important role confined to women, were already widely known in that person’s behavior—confirmed what Freud within the medical community. Furthermore, the had learned from Charcot and was to become an physicians believed that Charcot’s ideas were pre- extremely important part of psychoanalysis. He also sented too positively and uncritically; there was still learned from Liébeault and Bernheim that although too much uncertainty about Charcot’s views and patients tend to forget what they had experienced techniques to justify such certitude. According to during hypnosis (a phenomenon called posthypnotic Sulloway, Freud’s account of the reaction to his amnesia), such memories could return if the patient paper on hysteria was perpetuated by his followers is strongly encouraged to remember them. This ob- to enhance the image of Freud as a bold innovator servation, too, was important to the development fighting against the medical establishment. of psychoanalysis. On April 25, 1886, Freud established a private practice as a neurologist in Vienna, and on The Birth of Free Association September 13, 1886, he finally married Martha Bernays after a four-year engagement. The Freuds Upon returning to his practice, Freud still found eventually had six children—three boys and three hypnosis to be ineffective and was seeking an alter- girls. The youngest, Anna (1895–1982), as we will native. Then he remembered that, while at the see in the next chapter, went on to become a Nancy school, he had observed that the hypnotist world-renowned child psychoanalyst and assumed would bring back the memory of what had hap- leadership of the Freudian movement after her pened during hypnosis by putting his hand on the father’s death. Freud soon learned that he could patient’s forehead and saying, “Now you can not make an adequate living treating only neuro- remember.” With this in mind, Freud tried having logical disorders, and he made the fateful decision his patients lie on a couch, with their eyes closed, to treat hysterics, becoming one of the few but not hypnotized. He asked the patients to recall Viennese physicians to do so. At first, he tried the the first time they had experienced a particular traditional methods of treating neurological disor- symptom, and the patients began to recollect vari- ders—including baths, massage, electrotherapy, and ous experiences but usually stopped short of the rest cures—but found them ineffective. It was at goal. In other words, as they approached the recol- this point that everything that he had learned lection of a traumatic experience, they displayed from Breuer about the cathartic method and from resistance. At this point, Freud placed his hand Charcot about hypnosis became relevant. When on the patient’s forehead and declared that addi- Freud used hypnosis while treating hysteria, he en- tional information was forthcoming, and in many countered several problems: He could not hypno- cases it was. Freud found that this pressure technique tize some patients; often when a symptom was re- was as effective as hypnosis, and soon he learned moved during a hypnotic trance, it, or some other that he did not even need to touch his patients; symptom, would recur later; and some patients re- simply encouraging them to speak freely about fused to believe what they had revealed under hyp- whatever came to their mind worked just as well. nosis, thus preventing a rational discussion and un- Thus, the method of free association was born. derstanding of the recovered memories. In 1889 With free association, the important phenom- Freud visited Liébeault and Bernheim at the ena of resistance, transference, and countertransfer- Nancy school in hopes of improving his hypnotic ence still occur but with the major advantage that skills. From Liébeault and Bernheim, Freud learned the patient is conscious of what is going on. Also, about posthypnotic suggestion, observing that an idea although when using free association it is often planted during hypnosis could influence a person’s more difficult to arrive at the original traumatic ex- behavior even when the person was unaware of it. perience, once attained it is available for the patient This observation—that intact ideas of which a to deal with in a rational manner. For Freud the

524 CHAPTER 16 goals of psychotherapy are to help the patient over- The fundamental point is that repressed experi- come resistance and rationally ponder early trau- ences or conflicts do not go away. Rather, they go on matic experience. This is why he said that true exerting a powerful influence on a person’s person- psychoanalysis started only when hypnosis had ality. The only way to deal with repressed material been discarded (Heidbreder, 1933). Freud likened properly is to make it conscious and thereby deal the use of free association to an archeologist’s exca- with it rationally. For Freud the most effective way vation of a buried city. It is from only a few frag- of making repressed material conscious is through mented artifacts that the structure and nature of the free association. By carefully analyzing the content city must be ascertained. Similarly, free association of free associations, gestures, and transference, the provides only fragmented glimpses of the uncon- analyst could determine the nature of the repressed scious, and from those glimpses the psychoanalyst experience and help the patient become aware of it must determine the structure and nature of a per- and deal with it. Thus, in Studies on Hysteria, Freud son’s unconscious mind. clearly outlined his belief in the importance of un- During a therapeutic session Freud had his conscious motivation. Freud and Breuer wrote patients lie on a couch while he sat out of sight be- separate conclusions to the book, and Freud em- hind them. Freud gave two reasons for this arrange- phasized the role of sex in unconscious motivation. ment: (1) It enhanced free association, for example, At the time, Freud contended that a person with a by preventing his facial expressions and mannerisms normal sex life could not become neurotic. Breuer from influencing the flow of his patients’ thoughts; disagreed, saying instead that any traumatic memory and (2) he could not tolerate being stared at for eight, (not just those that were sexual) could be repressed or more, hours a day (Storr, 1989, p. 96). and cause neurotic symptoms. The two men even- It is interesting to note that, at times, Freud dem- tually parted company. onstrated a rather cavalier attitude during his thera- peutic sessions. Early in his career he wrote a letter to his friend Wilhelm Fliess (1858–1928) while his PROJECT FOR A SCIENTIFIC (Freud’s) patient was hypnotized (Masson, 1985, p. 21). Later, he confessed to taking naps as his pa- PSYCHOLOGY tients free associated (Masson, 1985, p. 303). In 1895, the same year that Breuer and Freud pub- lished Studies on Hysteria, Freud completed Project for Studies on Hysteria a Scientific Psychology. The purpose of Project was to In Studies on Hysteria (1895/1955), Breuer and explain psychological phenomena in purely neuro- Freud put forth a number of the basic tenets of physical terms. In other words, he intended to ap- psychoanalysis. They noted that hysteria is caused ply the principles of Helmholtzian physiology, in by a traumatic experience that is not allowed ade- which he was trained, to the study of the mind. quate expression and therefore manifests itself in Freud was not satisfied with his effort, and Project physical symptoms. Therefore, symptoms could be was not published in his lifetime (it was published in taken as symbolic representations of an underlying German in 1950 and in English in 1954). Frustrated traumatic experience that is no longer consciously in his attempt to create a neurophysical (medical) available to the patient. Because such experience is model of the mind, Freud turned to a psychological traumatic, it is repressed—that is, actively held in the model, and the development of psychoanalysis was unconscious because to ponder it would provoke begun. However, Sirkin and Fleming (1982) point anxiety. Resistance, then, is a sign that the therapist out that, although Freud’s Project failed, it contained is on the right track. Repression also often results many of the concepts that were to appear in his from conflict, the tendency both to approach and psychoanalytic works. (For an interesting analysis to avoid something considered wrong. of why Freud’s Project failed, see Parisi, 1987.)

PS YC HOA NAL YS IS 525 The Seduction Theory for reasons that are still not clear, Freud abandoned his seduction theory on September 21, 1897. In On April 21, 1896, Freud delivered a paper to the most cases, he concluded, the seduction had not Psychiatric and Neurological Society in Vienna ti- really taken place. Rather, the patients had imagined tled “The Aetiology of Hysteria.” The paper stated the encounter. Freud decided that the imagined that, without exception, Freud’s hysteric patients incidents were very real to his patients and therefore related to him a childhood incident in which they just as traumatic as if they had actually occurred. His had been sexually attacked. Freud concluded that original belief remained intact: The basis of neuro- such an attack was the basis of all hysteria. He stated ses was the repression of sexual thoughts, whether his conclusion forcefully as follows: the thoughts were based on real or imagined Whatever case and whatever symptom we experience. take as our point of departure, in the end we Although Freud later claimed that his change infallibly come to the field of sexual experience. from real to imagined seductions marked the real So here for the first time we seem to have beginning of psychoanalysis, Masson (1984) be- discovered an aetiological precondition for lieves that the profession of psychoanalysis would hysterical symptoms. (Masson, 1984, be better off today if Freud had not revised his p. 259) theory: Freud went on to say, “In all eighteen cases By shifting the emphasis from an actual (cases of pure hysteria and of hysteria combined world of sadness, misery, and cruelty to an with obsessions, and comprising six men and twelve internal stage on which actors performed women) I have … come to learn of sexual experi- invented dramas for an invisible audience ences in childhood” (Masson, 1984, p. 268). of their own creation, Freud began a trend Richard von Krafft-Ebing (1840–1902), the il- away from the real world that, it seems to lustrious physician and head of the department of me, is at the root of the present day sterility psychiatry at the University of Vienna, chaired the of psychoanalysis and psychiatry through- meeting at which Freud’s paper was presented. In a out the world. (p. 144) letter to his close friend Wilhelm Fliess, Freud de- Masson concluded that Freud’s major mistake scribed how his paper was received: was changing his belief that seductions were real to A lecture on the aetiology of hysteria at the the belief that they were fantasies. We will see later Psychiatric Society met with an icy re- in this chapter that several Freudian scholars and ception from the asses, and from Krafft- researchers believe that Freud’s mistake was more Ebing the strange comment: It sounds like basic. They believe that Freud invented the mem- a scientific fairy tale. And this after one has ories of seduction that he attributed to his patients demonstrated to them a solution to a more and, therefore, whether it is assumed that these than thousand-year-old problem, a memories were of real or imagined events is “source of the Nile”! They can all go to irrelevant. hell. (Masson, 1984, p. 9) Masson (1984) suggests that the hostile recep- tion by the medical community of Freud’s paper FR EUD ’ S SELF-ANALYSIS was at least partially responsible for his subsequent abandonment of the seduction theory. Esterson Because of the many complexities involved in the (2002a), however, reviewed the historical record therapeutic process, Freud soon realized that to be and found that the so-called hostile reception of an effective analyst, he had to be psychoanalyzed Freud’s paper was greatly exaggerated. In any case, himself. Freud (1927) insisted later that to be a


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