340 Clinical Psychology
called the father of scientific psychiatry because he introduced
case histories and maintained records for his patients and
because he tried to develop a nosology, advocated humane
treatment for the mentally ill. A famous picture of Pinel “strik-
ing off the chains” of an unfortunate patient is depicted in
many books on abnormal psychology and psychiatry. Con-
trary to legend, Pinel was not the first to unchain the insane.
In England, a Quaker tea merchant, William Tuke (1732–
1822), established the York Retreat, where kindness and de-
cency in a rural setting were provided for the disturbed. In
Italy, Vincinzo Chiarugi opposed restraints and cruel mea-
sures, and in the United States, Eli Todd urged physicians
to practice moral treatment and established the Retreat in
Hartford. Social reformers, such as Dorothea Dix, advocated
the building of mental hospitals to provide humane care for
the mentally ill, and during the nineteenth century more than
30 state institutions, as well as asylums in Europe, were
erected as a direct result of her efforts.
By the middle of the nineteenth century, moral treatment
was being employed at a number of mental hospitals amid
enthusiastic reports of high recovery and discharge rates.
During this same period, the profession of psychiatry was
also growing. The Association of Medical Superintendents of
asylums for the insane, the precursor of the American Psy-
chiatric Association, was founded in 1844, about the same
time as similar organizations were founded in France and
England. Its major publication was the American Journal of
Insanity,which became the American Journal of Psychiatry,
now in 2002 is in its 159th consecutive year of publication.
Breakthroughs were occurring in the scientific determina-
tion of the etiologies of a variety of mental disorders. In
1826, the French physician Antoine L. Bayle found an asso-
ciation between general paresis of the insane, a psychotic
condition that led to dementia and paralysis, and chronic
inflammation of the meninges. Richard von Krafft-Ebing’s
experiments demonstrated that paresis was caused by
syphilis. Sergei Korsakov reported the harmful effects of
chronic alcoholism on brain functioning. Karl Wernicke stud-
ied the effects of lesions in different areas of the brain and
different forms of language disturbances or aphasias. It
seemed to Emil Kraepelin, and to many other psychiatrists,
that what was needed was the determination of the syn-
dromes of specific disorders, research into their etiologies
and their natural courses, and the development of their spe-
cific treatments. For a detailed review of this period, see
Alexander and Selesnik’s History of Psychiatry (1966).
Therefore, toward the end of the nineteenth century, the at-
titude toward moral treatment changed. Mental hospitals
began to be seen mainly as custodial institutions for the men-
tally ill, who required further scientific study until appropriate
treatments could be determined. It was suggested that the
improvement rates for moral treatment had not been scientif-
ically determined and were probably grossly exaggerated.
Lower rates of improvement with moral treatment were
reported, and its defenders attributed these to a more intransi-
gent and difficult patient population and to a newer genera-
tion of psychiatrists who lacked the zeal and conviction of
earlier practitioners (Levine, 1981). Sound familiar? Addi-
tional research, it was generally agreed, for this and other
questions, would soon settle matters.
The major neurosis at this time was hysteria, whose symp-
toms had an annoying similarity to those of many neurologi-
cal disorders. Jean-Martin Charcot, a leading neurologist
of his day, used a cast of hysterics who had been previ-
ously hypnotized to demonstrate to his colleagues that all
the various symptoms of hysteria—paralyses, crying spells,
anesthesias—could be produced and modified under hypno-
sis. Charcot concluded, incorrectly, that there was an intimate
relationship between hysteria and hypnosis and thus those
who could be hypnotized either had hysteria or were predis-
posed to develop this neurosis (Goetz, Bonduelle, & Gelfand,
1995). An interested spectator at some of Charcot’s demon-
strations in 1885 was the Viennese neurologist Sigmund
Freud (1856–1939).
Freud had gone to Paris to learn the latest thinking about
the treatment of hysteria. An older colleague of Freud’s, Josef
Breuer, had become involved in an interesting case, in which
the patient suggested talking about problems. This talking
seemed to be of help, and Charcot’s hypnotic demonstrations
supported Freud in his belief that whatever the etiology of
hysteria, the symptoms could be treated and reduced by ver-
bal means. By 1892, Freud abandoned hypnosis in favor of a
“concentration” technique, in which the patient was directed
to try to recall all memories in connection with a symptom.
By 1895, Freud was talking about “psychical analysis,” or
“psychoanalysis,” and his relationship with Breuer was close
to an end (Breuer & Freud, 1895/1955; Gay, 1988).
Within the first decade of the twentieth century, Freud was
rapidly developing psychoanalysis as a theory of personality,
which he regarded as his contribution to psychology; as a
method of treatment, which he believed was of limited use
because of its expense, duration, and the few analysts avail-
able; and as a way of doing research. He had achieved inter-
national recognition and had adherents throughout Europe
and in the United States. In 1909, the eminent developmental
psychologist G. Stanley Hall invited Freud to come to Clark
University to address a gathering of American psychologists
who would be participating in the celebration of the school’s
20th anniversary. One of the members of that audience was
William James.