16 CHAPTER 1
again became overcrowded and underfunded, and moral treatment—or treatments
of any kind—were no longer provided (Porter, 2002). Sedation and management
became the new goals.Neurasthenia
By the end of the 19th century in Europe and North America, “madness” was gen-
erally seen as caused by a medical abnormality. The specifi c type of medical ab-
normality varied, however, from country to country and from decade to decade.
In the United States, the pace of life increased with the advent of the telegraph and
the railroad. More and more men and women were diagnosed with neurasthenia—
literally, nerve weakness—which was accompanied by the symptoms of low mood
and mental and physical fatigue. Treatment, administered by a physician, included
rest, sedatives, and induced vomiting or bleeding.Key Concepts and Facts About Views of Psychological Disorders Before Science
- The oldest known view of psychopathology is that it arose fro
supernatural forces, either magical or spiritual in nature. Treat-
ment included exorcism. Ancient and modern Chinese views of
psychopathology consider its cause to be blocked or signifi-
cantly imbalanced qi. The ancient Greeks attributed mental ill-
ness to an imbalance of bodily humors. The term medical model
refers to Hippocrates’ view that illness (including psychological
disorders) is due to a biological disturbance. - The Middle Ages saw a resurgence of the view that super-
natural forces cause psychopathology; prophets and visionar-
ies were believed to be possessed or inspired by the will of
God. This view persisted into the Renaissance, when mental
illness was viewed as the result of demonic possession, and
witches were thought to be possessed by, or in league with,
the devil. Treatment of the mentally ill consisted of exorcism;
those believed to be witches were burned alive. By the end of
the Renaissance, however, the mentally ill began to be treated
more humanely, and asylums were built throughout Europe;
over time, however, these asylums became a place to keep
the mentally ill poor off the street, which led to overcrowded
facilities. - In the years immediately following the Renaissance, mental ill-
nesses were thought to arise from irrational thinking, but this ap-
proach did not lead to consistent cures. Mesmer proposed that
hysteria was caused by blocked electromagnetic forces in the
body, and he developed a humane technique—mesmerism—
to unblock the fl ow. His treatment was sometimes successful,
possibly because it induced a hypnotic trance.- Beginning in the 1790s, Pinel championed humane treatment
for those in asylums in France. Based on careful observation,
he proposed that there were different types of madness, and
he used a mental treatment—reasoning with patients—to treat
mental disorders. In other European settings, patients were
given moral treatment, which centered on having them live and
work within a community in the countryside. - In the United States, Benjamin Rush initiated the effort to treat
the mentally ill more humanely; similarly, Dorothea Dix strove
to ensure that the mentally ill were housed separately from
criminals and treated humanely. However, public institutions
for the mentally ill became overcrowded and underfunded,
which reduced the amount and quality of the treatment that
was provided. By the end of the 19th century in Europe and
North America, “madness” was generally viewed as caused by
a medical abnormality. The characterization of the specifi c type
of medical abnormality varied, however, from country to country
and from decade to decade.
The Transition to Scientifi c Accounts
of Psychological Disorders
Each of the prescientifi c explanations of psychological disorders proved inadequate.
However, those who cared for and had responsibility for the mentally ill were making
their best guesses about the cause of such illness and how best to cope with those who
were affl icted. They were trying to help the individuals who experienced incredible
distress and inability to function. But because the explanations proved inadequate
over the course of time—and the responses to the mentally ill derived from them were
not satisfactory—pressure built for more effective and enduring treatments.