Lecture 1

Dale L. Johnson

History of Abnormal Psychology

The history of abnormal psychology began when a human being noted that the behavior of another human seemed odd, wondered about it and remarked on it to another human who agreed it was odd. The behavior was abnormal, that is "away from the norm." They also noted another thing about the behavior: it was undesirable. We have no idea of the conversation of these early humans, and there is no doubt that this discussion did take place early in the evolution of humans. The conversation probably took place in East Africa, because that seems to be where humans first appeared in a form that is directly linked to our present form. There are no records of conversations or really anything about their social life. The recording of observations would have to wait until the Egyptians ad Mesopotamians (now Iraq) invented writing about 6000 years ago.

We know nothing of the early history of abnormal psychology because if observations and theories were written they did not survive. From all the evidence we have of early humans, whether the first in Africa, or the developments from there in Asia and Europe, and then to Australia and the Americas, everyone wondered about abnormal behavior at some time. People everywhere developed theories of abnormal psychology and treatments for abnormal conditions. I have done research with the Mazahua (Central Mexico), Navajo, Zuni, Apache (Southwest), Sioux (Upper Midwest), Quinault, Quileute, and Makah (Northwest) Indians, and have found that all have complex, highly functional theories of mental illnesses and treatments for most of the illnesses.

The authors of the textbook limit their discussion to European and American views of mental disorders, and without a word of explanation for this limitation. They have done so not out of ethnocentrism, but because the conception we have today of abnormal psychology has grown out of thought in Europe and America, and because this conception is now accepted world-wide as the most satisfactory and usable view of abnormal psychology. As an example, in the United States the Diagnostic and Statistical Manual Fourth Edition (DSM-IV), with which you will become acquainted, is a close cousin of the ICD-10, which was developed for international use by the World Health Organization. Mental health researchers and practitioners all over the world now use the same system for classifying mental disorders.

This system was developed in Europe and America and not in China, India, Zaire, Maori, Japan or Maya because the scientific method began in Europe, not in these other areas, and the current view of abnormal psychology is a product of the scientific method. The Africans began human life and culture, and the Chinese invented almost everything important, but although they had invented some parts of science, namely systematic observation which enabled them to achieve much in the areas of astronomy and agriculture, they did not develop a scientific method.

This was described by Bacon in his Novum Organum (1620) in England and Descartes in his Discourse on Method (1637) in France. Their insistence on the use of observation and experimentation as the ways to knowledge were the subject of tremendous intellectual excitement, but were also countered by those who defended the status quo; that is, those who believed in astrology or demon possession, and most important, existing authority. For a fascinating novel about this era see Ian Pears' Instance of the fingerpost.

The scientific method has made possible all of the advances in medicine and psychology that we now regard as basic. Without the scientific method, there would be no antibiotics, no organ transplants, no birth control pills and no effective treatments for cancer. People would still be disfigured and dying from leprosy, yellow fever, small pox, syphillis and polio. Without the scientific method the burden of mental illness would be much greater than it is today and people with serious mental illness would be in crowded hospitals instead of enjoying the greater freedom of being in in the community.

Progress in the history of abnormal psychology has benefited from the scientific method and has suffered when it has not been used. A major example of this is the long and turbulent history of psychoanalysis.

Freud's Psychoanalytic Theory

[This section is based on Hans Eysenck's, Decline and fall of the Freudian empire. New York: Viking Penquin, 1985).]

In a discussion of psychoanalysis, it is imperative that we consider the man who developed and promoted it because the method depends so heavily on his personal insights and what the he made of them.

Freud was born in Freiberg, Austria, May 6, 1856. His father had married three times and had two grown sons when Sigmund was born. He was his mother's first child of eight. He was a top student at the Gymnasium (high school and college) in Vienna and decided to study medicine at the University of Vienna. He dabbled with distinction in several medical areas and did physiological research with Ernst Bruecke. Finally, in 1882, at age 27 he began medical practice, but largely continued to do research, now on brain anatomy. All of his work with children was during this period.

At age 29 he was awarded a study grant to work with Charcot in Paris. This experience quickened his interest in psychology and he soon saw himself as a future leader in the field. In his letters to the woman he would later marry, he described himself as having "future biographers." Also at this time he discovered the pain reducing and excitement producing properties of cocaine. He found it helped him to cope with his recurring depressions.

He met Josef Breuer and began hypnotic work with a patient, Bertha Pappenheim, who was known in their writings as Anna O. He soon tired of hypnotic work and began to use a technique which had been developed in England by Galton, called free association. Freud never referred to Galton's work, but must certainly have known of it. Using the method of free association in a self-analysis, with information corroborated by his mother, Freud found that he had intense hostility toward his father and strong affection for his mother. This was the origin of his theory of the Oedipus Complex.

He wrote his first psychological book in 1900, The interpretation of dreams. He also organized the Vienna Psychoanalytic Society and began the psychoanalytic movement. He was intolerant of opposing views and got rid of those who did not agree with him in every way. C. G. Jung was the most famous of the dissenters who were expelled from his group. Freud formed a cult and psychoanalysis has remained a cult ever since, granted, with a great many factions.

Some rules for reading Freud:

1) "Do not believe anything you see written about Freud or psychoanalysis, particularly when it is written by Freud or other psychoanalysts, without looking at the relevant evidence." p. 26. Sulloway writes of "the myth of the hero in psychoanalysis." He refers to Freud's intellectual isolation; that is, that he discovered the unconscious, free association, etc., and the idea that his work was met by a hostile reception from the world. Various biographers, including Jones and Freud himself tried to give the impression that Freud's early work was ignored. This was far from true. His work received standard reviews just after their publication in many European countries. By the end of 1901, his work was well known. Furthermore, the reception was not hostile. Eminent reviewers referred to the books as "epoch-making." As to the idea that his views on sex were shocking, that is nonsense. Austrians had been reading Krafft-Ebing and others for years.

2) "Do not believe anything said by Freud and his followers about the success of psychoanalytic treatment." p.31. Freud considered his treatment of Anna O. as an example of psychoanalytic success. Anna was a twenty-one year old woman who was first seen by Breuer when she became ill following a long period of nursing her sick father. Breuer used the new "talking therapy" and Freud adopted it and continued the treatment. Breuer had stopped when Mrs. Breuer believed that the relationship with his patient was becoming too affectionate. Freud wrote that the symptoms presented by Anna were "permanently removed." Later examination (by other researchers) of hospital records revealed the symptoms continued for many years and furthermore, were not psychological at all. They were symptoms of physical illness. Her symptoms of muscular contractions, paralyses, peculiarities of vision, and coughing were found to be due to tuberculous meningitis that she had contracted while caring for her father. What makes all of this more repugnant is that there is now evidence that Freud knew at least some of the facts of this case, that she had TB, and still reported a cure with the use of psychoanalysis, and today this would be considered malpractice. There are many other similar cases.

3) "Do not accept claims of originality but look at the work of Freud's predecessors." p. 33.

The unconscious was not Freud's discovery. E. von Hartmann wrote Philosophy of the Unconscious (1100 pages) in 1868. This book refers to writings about the topic in India, by the Greeks, and others. The idea of an unconscious was very common before Freud's time. (As an example, there is the use of the idea and term in Conrad's Lord Jim).

Ebbinghaus commented on Freud's book as follows: "What is new in these theories is not true, and what is true is not new." For example, on the topic of anxiety, most of his work was taken from Janet, and on free association, most came from Galton. There is nothing wrong about building theories on the ideas held by others; what is wrong is claiming originality and ignoring the contribution of others.

4) "Be careful about accepting alleged evidence about the correctness of Freudian theories; the evidence often proves exactly the opposite." p. 35. For example, his assertion that dreams always are expressions of wish fulfillment. He argues that dreams stem from repressed infantile material, but none of his examples are of this type!

5) "In looking at a life history, don't forget the obvious." p. 37. Why did Freud change his career so drastically? By the late 1880s he had a profitable practice and a distinguished academic career. He was married and had a growing family. All this changed in the 1890s. He had been very strait-laced in his sexual attitudes. Now he seemed to overthrow all conventional sexual morality. His foremost biographer, Ernest Jones, says that from 1890 to 1900 Freud had great mood swings and a substantial neurosis. He was worried about the strange behavior of his heart and rejected his friend, Breuer, for a man, Fliess, who had a theory about "nasal reflex neurosis." It was also at this time that he accepted a messianic role, to bring the word of psychoanalysis to the people of the world. One theory of Freud's change is based on his use of cocaine at this time. It was Fliess who particularly encouraged him to use cocaine to cure his nasal reflex neurosis, and as Freud sniffed the cocaine, his nasal problems increased, as did his use of cocaine.

Freud's treatment for neurotic conditions was psychoanalysis. This required from two to twenty years of frequent therapy sessions for satisfactory outcomes. Now, after thousands of people have been in psychoanalysis there is still no evidence that it has ever had successful results. As a graduate student at the University of Kansas my migraine headaches were treated with psychoanalysis. My analyst was named Sigmund, not the Sigmund, but another from Vienna, and he had been analyzed by Fenichel, who had, in turn, been analyzed by Freud himself. My analysis was a complete failure. I never saw its relevance for my migraine headaches and did not agree that the analytic method (free association and dream interpretation) was therapeutic. The headaches were later successfully treated with medication by another doctor.

Followers of Freud developed variations on traditional psychoanalysis as a method of treatment. Only one of these has fared well in controlled clinical trials, interpersonal psychotherapy. As we will see later it has yielded good results for some disorders.

In sum, Freud's theories have taken us down a long blind alley. They have retarded progress and continue to be a serious block to the development of effective treatments for people with mental disorders. Freud created a complex and endlessly fascinating way of understanding human behavior, but a theory that was flawed in many ways. The most important flaw was most of his theories are not testable. Many of the concepts cannot be stated in scientifically testable form, and therefore, it is never clear whether the theory is valid or not.

Psychoanalytic theory has also ignored biological aspects of human behavior. Thus, there has been no consideration of genetics, brain functioning, or hormonal variations.

Although Freud developed his ideas in Austria, wrote in German and fled the Nazis to England, he found his greatest following in America, and there it exists today, largely along the East Coast. In addition, however, Freud's psychology has become part of the popular culture and it is conventional to think that psychological disorders must be caused by poor parenting, that it is healthy to express aggressive impulses, and that we tend to repress, and thus be unaware of, conflicted experiences. We shall see later that these popular ideas tend to lack scientific support.

Behaviorism

Academic America always has had reservations about psychoanalytic theory. There were other irons in the American fire, and the hottest of these was behaviorism. This grew out of the British empirical tradition of Locke, Berkeley, Hume and Mills. One of the assumptions of this tradition is that to understand behavior we must understand the environment and its influence on the individual. The tradition has also placed great emphasis on knowing through observation and experimentation.

The basic forms of behaviorism are familiar to all students who have taken a course in introductory psychology. Pavlov, a physiologist, won the Nobel prize for his work on the digestive system--how blook circulation, nervous system and enzymes interact, but he was also nominated for, but did not win, a second Nobel for his work on associative learning, also called classical conditioning. Essentially, it consists of demonstrating that responses to new stimuli are learned by association. If a dog salivates when food is presented it will also salivate to the sound of a bell if the bell and the food have been presented together several times. If being in an elevator has been accompanied by anxiety when the elevator would not move and the door would not open, then subsequently the mere sight of an elevator may elicit anxiety. Elevator and anxiety are associated through this form of learning.

Operant conditioning was first observed by Thorndike in the 1890s. He gave the term "law of effect" to the observation that if a behavior is followed by a reward it tends to occur again; satisfying things will be repeated. His work was developed by B. F. Skinner and eventually applied in the field of abnormal psychology by graduate student Teddy Ayllon and professor Jack Michael, both of the University of Houston, in their development of the token economy. More on this later.

People, and other animals, also learn by observation or modeling. A child may be afraid of dogs, not because she has been attacked by a dog but because she has seen her mother show fear of dogs.

Behaviorism has contributed greatly to our understanding of abnormal psychology largely because it is based on the methods of science, its theories are testable, and it relies on observation and experimentation.

Behavioral theory has had two major limitations: one, it has denied or minimized the role of biology in human behavior, and two, it ruled out cognitive functioning. Contemporary behavior theory has adapted slowly to better accommodate these aspects of behavior.

Humanistic Theory

It is with some regret that I now must write that humanistic theory has had little to offer the development of knowledge of abnormal psychology. I was once a devotee of the humanistic way of thinking, spent hours running encounter groups and admired the work of Carl Rogers. I read the existentialist philosopher, Sartre, assiduously and applied his concepts to the psychotherapy I was doing. I believe the Sartrian line of thought is still relevant and the method of phenomenology (dealing with immediate lived experience) is essential for the practicing clinician. However, it is philosophy and not science and therefore contributes little to the advancement of the field.

Comment on the Textbook

Freud had almost disappeared from earlier editions of the Durand and Barlow textbook, but now, giving in to pressures from some psychologists for a balanced treatment of theories, it is back. Among the parts of the theory that have been returned are the Psychosexual Stages of Development (pp.18-19). This has no value. There is no evidence that the stages have conceptual usefulness and they have played a minor and largely negative role in scientific developmental psychology. Freud's views of personality structure (id, ego and superego) have no standing in contemporary science. The idea of defense mechanisms has stood up better, but only after redefining the mechanisms and placing them in different theoretical settings.

The work of Carl Jung is perhaps of even less value in present times. Alfred Adler is almost forgotten today, but his work may be regarded as a kind of forerunner of self-efficacy theory, which is very much alive.

The author's admiration for behaviorism will be apparent throughout the book. Actually, the admiration is for application of the scientific method.

Durand and Barlow are right that humanistic psychology has failed because its proponents have not been interested in science.

Two Ways of Viewing Behavior

In the history of abnormal psychology there have been conflicting opinions as to whether we should regard biological forces as having greatest influence on behavior, or whether we should give priority to psychological or environmental forces. These two points of view were expressed in two to the themes developed in Chapter 1 of the textbook. First, however, consider four cases with rather different symptoms and try to sort them into diagnostic categories.

Four Cases (based on W. L. Bruetsch, Ch. 5, American Handbook of Psychiatry)

Case 1. A 45 year old accountant who is normally orderly in this behavior and fastidious in his dress, suddenly begins to neglect himself. He forgets appointments, wears rumpled, dirty clothes, and is not concerned with match of color or pattern. he becomes equally careless with his money, although he has a reputation of being rather tight-fisted, he now grossly over-orders at restaurants, leaves huge tips, buys things he does not need on whims, and seems unconcerned with this change in his behavior. While his family is concerned, his mood is so light and he has so many plausible explanations for his behavior, besides having a very short temper when confronted, that they let it go. Then one day, he drives through a stoplight and kills a pedestrian. He tells the police he is King Herod and cannot be arrested. he seems unconcerned about the dead pedestrian.

Case 2. Another man gradually withdraws from family and friends, and seems from his facial expression and posture, to be in deep worry. This goes on for months. Then he moans that he is going to die, prays constantly, does not sleep, and threatens suicide.

Case 3. The patient was a 34-year-old woman who had been "blinded by a sudden flash of light." She had been blinded by a car's light and knocked down by the car. On examination, she reported she could not distinguish light from dark.

Case 4. A young woman was found by her family, who lived on a western ranch, collapsed and unable to walk. Her legs seemed paralyzed. She was not treated immediately because she did not seem sick in any other way and the patient and her family thought she would recover spontaneously. She did not at all seem concerned about her paralysis.

The question is, which of these cases have an essential biological cause and which have an essential psychological cause?

Answer: Symptoms of the first two cases had a biological cause, syphilis. Symptoms of the second two cases were entirely psychological and would be regarded in Freud's time as hysteria and now as conversion disorders.

Biological

Syphilis, caused by a spirochete, treponema pallidum, is contracted through sexual intercourse. It is highly contagious. It first appeared in Europe in 1497 and was probably introduced by sailors returning from the Americas. The symptoms were sores on the genitals.

In 1798 Haslam, at the Bethlehem hospital in London, described a pattern of symptoms (a syndrome) that made up general paresis. Some of these symptoms are present in cases 1 and 2, above. In 1805 Esquival wrote that people with this syndrome do not recover, the symptoms get worse and the person dies.

In 1825 the syndrome was named, general paresis. In 1860 Louis Pasteur developed a theory of germs to account for many illnesses. Also in 1860, post-mortem examination of people with general paresis revealed that their brains showed a typical form of deterioration. Jesperson, in 1874, theorized that syphilis and general paresis were related. Prior to this, the two sets of symptoms were regarded as evidence of separate illnesses.

Krafft-Ebing further clarified the matter in 1897 when he inoculated patients with serum from people with general paresis to see if they showed signs of syphilis. They did. In 1905 the infectious agent was identified and in 1917 Noguchi and Moore definitely linked syphilis and paresis through brain tissue studies.

Thus, researchers took from 1497 to 1913, 416 years, to understand that syphilis (the physical disease) and general paresis (the psychological symptoms) were but two aspects of the same disease. One reason the link was so hard to establish is that the early symptoms of syphilis which appear about 3 weeks after sexual contact go away and there is no apparent disease. Then, the treponemes move throughout the body and there may be another set of symptoms, low grade fever, headaches, body rash, but these could be flu or other diseases. After this, there is a latent period when there are no apparent symptoms. Some people never progress beyond this point. But for some, the treponemes lodge in the brain and the psychological symptoms appear.

There is no effective treatment for general paresis, but treating syphilis is so effective that few people today progress to general paresis. When I was a student in Kansas and working in VA hospitals most of the beds were occupied by men with general paresis. Today there are almost none.

Psychological

Cases 3 and 4 are examples of conversion disorder or until 1980, hysteria (See pp. 151-155). The word "hysteria" is the old Greek word for uterus. The ancient Egyptians believed that the symptoms shown by some women were caused by a tilted uterus. This was treated by having the woman inhale very strong vapors to straighten the uterus.

Eventually, it was realized that men could also have hysteria, although less often than women. When Freud studied with the French psychiatrists in Paris he encountered several cases of hysteria.

Case 3 was a woman who was engaged in a lesbian relationship with an older woman. Her partner began seeing another woman and the patient was spying on them when she was hit by the car. On examination no physical basis was found for her blindness. She was taken in by her contrite partner and nursed by her. She was content to stay at home with her lover. Later she was treated with hypnosis and her sight was returned. She continued to believe she had been blinded by the automobile's bright lights.

Case 4 had been alone when threatened with rape by a relative. She screamed for help, her legs folded under her and she fell to the floor. Her mother found her soon after. The doctor ascribed her condition to fright and prescribed rest until she became stronger. She moved into her parent's room, displacing her father. Neighbors visited. She received good food and much attention as an invalid. She continued in this way for 10 years when a newcomer to the area recognized the condition as hysterical and urged a psychiatric consultation. She was examined and her legs were found to be weak from disuse, but normal. Her family rejected recommendations for treatment and took her home against advice.

The cause of these physical conditions is entirely psychological as is the treatment. Freud used hypnosis at first, then his new method of using free associations and dream interpretation. He probably had some success, but in general conversion disorders or hysteria was characterized by early success and then relapse. More on this topic in chapter 5.

The point for now is that these two types of explanations seemed to be completely different--one biological and the other psychological. Now we realize they are not so different. The instigating causes are different--a bacteria in one and psychological stress in the other, but both involve both biological and psychological processes. Both involve how the person behaves, how the world is experienced, and how the brain is involved in all of this. More on this subject in Chapter 2.

It should be noted that biological causes may have psychological symptoms and psychological causes may have physical symptoms. This has been a puzzle to investigators in the history of abnormal psychology, but in unraveling the puzzle they have learned much about how abnormal behavior develops. Can what has been learned about general paresis be applied to other disorders? Perhaps so. The essential cause of schizophrenia, for example, seems to be very early in development, but for most people symptoms do not appear for 20 or more years. What is happening during this long developmental period? There is no acceptable answer for this question yet.