Evolution of Abnormal Psychology: 1800s to the Present

Introduction: Defining Abnormal Psychology

The study and treatment of psychological dysfunction has evolved continuously from early history to the present day. Prior to the 1800s, society believed that deviant or abnormal behaviors were caused by supernatural forces or biological factors. Treatments for psychological problems before the 18th century included exorcisms and bloodletting. Early beliefs about the origins of emotional disturbances influenced public perceptions of mental illness and shaped theories of abnormal psychology in the 19th century. Advances in medical science and the use of the scientific method influenced researchers such as Freud and Pavlov, improving theoretical knowledge and the treatment of mentally ill populations. Despite current mental health treatments and increased awareness of the etiology of psychological disturbance, people with mental disorders continue to experience difficulties including social stigma, hospitalization, homelessness, suicide, and incarceration (Barlow and Durand).

Psychological disorders are prevalent throughout the world and across a variety of cultures. In America, 30 percent of the population is diagnosed with a mental health disorder every year (Frank and Glied 20). A psychological disorder is defined as a malfunction or atypical cognitive, emotional, or behavioral functioning in human beings. A mental disorder must also involve a level of dysfunction severe enough to cause distress and impairment in social, occupational, and interpersonal relationships. The behavior must also occur at a frequency that is unusual according to cultural norms (Getzfeld 1–16). According to the American Psychiatric Association, a mental disorder is defined as follows:

In DSM-IV, each of the mental disorders is categorized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or loss of freedom. . . . Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. (American Psychiatric Association xxxi)

Early History and 19th-Century Asylum Reform

The study and treatment of mental disorders began in prehistoric times. Early humans believed abnormal behaviors were caused by supernatural forces and spirit possession. Treatments for mental illness included de-possession rituals and trepanning — a surgical technique in which holes are cut into the skull to release evil spirits. Archaeological remains of ancient human skulls show evidence of trepanning (Getzfeld 1–16). Until relatively recently, people with mental health diagnoses were perceived as morally deficient because their behavior was thought to be influenced by Satanic or supernatural forces.

Hippocrates and Galen, ancient Greek physicians, also influenced the development of abnormal psychology. Hippocrates believed the etiology of psychological dysfunction was biological. Based on theories developed by Hippocrates and Galen, people were classified as having one of four temperaments: melancholic, sanguine, choleric, or phlegmatic. Hippocrates advised patients with psychological disorders to rest, eat nutritious foods, exercise, and avoid intoxicants. He believed that mental abnormalities would diminish if the body were physically healthy (Barlow and Durand 1–26). The belief that psychological pathology has a biological basis continues to influence psychological theory.

Prior to the 1800s, because of societal beliefs that mental disorders were caused by moral deficiency and supernatural forces, mentally ill patients were incarcerated in mental hospitals or asylums. Mental patients were segregated from the rest of society and had little contact with family or other community members. Conditions inside these hospitals were inhumane — patients were beaten, tortured, starved, and often shackled. Medical treatment in mental asylums included blistering, whippings, electric shock, and drugs. Hospitals for the mentally ill were founded in the United States in the late 1700s, modeled after European institutions.

In the 1800s, mental health treatment was reformed in response to concerns about patient abuse. Philippe Pinel, a French physician, reformed mental health treatment in France, and his ideas became the basis for many modern psychosocial treatments. He advocated for the humane treatment of people with psychological disorders, proposing that psychiatric patients should receive moral therapy. He also believed that mentally ill patients should be treated with kindness and dignity and given more opportunities to interact socially with staff and community members. He suggested that healthy relationships and increased social contact would improve psychiatric symptoms.

Because of Pinel's influence and that of other reformers, the American mental health system was also transformed. In the United States, proponents of the eugenics movement introduced legislation committing people with mental illness to institutions (Barker 70–74). As a result of documented abuses within the system, reformers such as Benjamin Rush, Dorothea Dix, and John P. Gray campaigned for the reformation of psychiatric care. Benjamin Rush, a Quaker, believed mentally ill patients could be cured through a combination of manual labor, kindness, and religious discussion. John P. Gray also advocated for humane treatment, proposing that mental illness had physical causes and that psychological symptoms would diminish if physical health improved. Dorothea Dix, a former educator, informed the American public about abuses within the mental health system, campaigned for protective legislation, and worked toward the establishment of public mental hospitals. She founded the mental hygiene movement and advocated for the removal of psychologically disturbed patients from prisons and almshouses (Kemp 1–35).

In addition to these psychosocial reforms, other psychological theories and treatment modalities evolved as a result of the Industrial Revolution and the contributions of theorists such as Freud and Wundt. In the 1800s, advances in medicine — including the discovery of the biological origin of syphilis, whose symptoms include delusions and hallucinations — reinforced the idea that some psychological disturbances were biologically based (Getzfeld).

Research conducted using the scientific method allowed psychologists to develop theories about human cognition and behavior. The first psychology laboratory was founded in the 1870s in Leipzig by Wilhelm Wundt, the first experimental psychologist, who conducted experiments on the nature of consciousness. Many of Wundt's disciples went on to develop theories of cognition, intelligence testing, and abnormal psychology (Barlow and Durand).

Theoretical Foundations: Freud, Behaviorism, and Humanistic Psychology

Anton Mesmer was another researcher of the 1800s whose discoveries influenced psychological theory, particularly the work of Sigmund Freud. Mesmer discovered animal magnetism and used hypnotic suggestion to treat psychological illnesses, curing patients by delivering suggestions during therapy sessions. His work led to the development of hypnosis and its use by theorists such as Sigmund Freud and Joseph Breuer (Barlow and Durand 1–26).

In the late 19th and 20th centuries, theorists such as Freud, Pavlov, and the cognitive therapists radically changed theories of abnormal psychology. Influences from Eastern philosophical traditions such as Buddhism and yoga, as well as humanistic psychology, also transformed psychological theory and mental health treatment.

Inspired by the work of Anton Mesmer, Sigmund Freud developed psychoanalysis. His theories proposed the existence of the id, ego, and superego, and posited an unconscious mind. He believed two innate drives governed human beings — sex and aggression — and that psychological dysfunction arose from childhood traumas and infantile impulses originating in the id that were repressed into the unconscious. A client might become fixated at a developmental stage due to childhood trauma, resulting in neurosis. By safely releasing repressed unconscious material, abnormal psychological symptoms could be made to subside. Techniques developed by Freud included dream analysis, free association, defense mechanisms, and the psychosexual stages of development. His theories gave rise to the psychoanalytic movement and influenced later psychodynamic theorists such as Anna Freud and object relations theorists such as Melanie Klein. Psychodynamic theorists adopted Freud's core ideas while proposing that the earliest relationships with parents or primary caregivers were the source of conflicts in adult life, and that the innate drives in human beings included the need to form interpersonal relationships (Barlow and Durand).

In contrast to psychoanalytic and psychodynamic theories, Ivan Pavlov — the founder of behaviorism — and his disciples developed alternative theories of psychology. Pavlov theorized that human behavior was the result of conditioned and learned responses, rejecting Freud's theories of the unconscious and Wundt's theories of cognition. In his experiments, Pavlov paired stimuli, such as meat powder and a bell, to produce a conditioned response — salivation — in a dog. He later removed the meat powder and was able to invoke the same response using the bell alone. His experiments illustrated fundamental principles of learning and behavior, and his ideas regarding classical conditioning are still applied in psychological treatment and research today.

Disciples of Pavlov included John B. Watson and B. F. Skinner. Watson was the first psychologist to condition an emotion in an experimental setting, and his work led to the formulation of treatments for anxiety disorders and phobias. Skinner proposed that behavior could be predicted based on a series of observable events, and he developed theories of behavior modification using operant conditioning and schedules of reinforcement. His experiments demonstrated that behavior could be increased or diminished through the application of operant conditioning principles (Barlow and Durand 1–26).

The cognitive and humanistic psychology movements also influenced psychological theory and mental health treatment in the 20th century. Cognitive therapy was developed by Aaron T. Beck and Albert Ellis. Cognitive therapists believed the origins of mental illness lay in irrational beliefs rather than unconscious urges or observable behaviors, and they helped patients identify and dispute those beliefs. The humanist movement was founded by Abraham Maslow and Carl Rogers. Humanistic psychologists proposed that people were motivated to achieve self-actualization but were unable to do so until their basic needs — including food, shelter, and safety — were met. Carl Rogers developed person-centered psychotherapy, proposing that people with psychological dysfunction intuitively knew which form of treatment was best for them. In person-centered therapy, Rogers employed reflective listening and unconditional positive regard to help clients find their own answers to psychological problems (Barlow and Durand).

In the 20th century, scientific and medical discoveries revolutionized mental health treatment. In the 1950s, the first psychiatric medications were successfully used in the treatment of schizophrenia. With increased knowledge of biochemistry and pharmacology, mental health treatment improved significantly. Medications such as Haldol and Thorazine reduced hallucinations, delusions, and agitation in schizophrenic patients. Innovations in psychopharmacology led to the discovery of pharmacological treatments for anxiety, depression, bipolar disorder, and other diagnoses. Some psychiatric medications caused side effects including tremors, blurred vision, weight gain, impotence, and lethargy. Currently, psychiatric medications and psychotherapy are used together in the treatment of psychological disorders worldwide (Barlow and Durand).