HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY:THE GREEK PERIOD

<< HOW A CLINICAL PSYCHOLOGIST THINKS:Brian’s Case; an example, PREDICTION

HISTORY OF CLINICAL PSYCHOLOGY:Research, Assessment, CONCLUSION >>

Clinical Psychology (PSY401)

LESSON 04

HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY

INTRODUCTION

The history of clinical psychology, like that of many fields, is typically presented as a collection of

names and dates. It is important to understand the individuals who have shaped the field of clinical

psychology and to know when landmark events in the field occurred. Tracing the progression of the

development of the field and the individuals who have influenced it provides an important perspective

on the roots of clinical psychology as it exists today. However, the primary significance of clinical

psychology's relatively short history does not lie in names and dates. Rather, its historical importance

comes From an understanding of the factors that have shaped the field into its current form and the

forces that are likely to influence its development in the future.

Three things are striking about the history of clinical psychology. First, many of the significant events

and forces that have influenced its development have come from outside rather than from within

psychology. Second, there have been significant advances in the science of clinical psychology, in some

instances represented by breakthrough pieces of research, but most often through the slow and gradual

accumulation of knowledge across many studies. And third, clinical psychology has emerged as a

profession only recently and is still working to define its identity. More fundamental than the questions

of how and when clinical psychology developed is the question of why the science and profession of

clinical psychology developed so rapidly during the second half of the twentieth century.

The field came into being for two reasons. First, throughout history there has been a need to provide

care and services for individuals who are experiencing psychological problems, and clinical psychology

emerged in part to help meet this need. The needs of individuals with psychological problems had been

addressed in very different ways over the course of history before clinical psychology stepped in to help

fill this role. Second, some of the founders of scientific psychology in the late 1800s and early 1900s felt

that one objective of their new science should be to contribute to the welfare of others. William James,

G. Stanley Hall. and other founders of American psychology shared a belief that one of the

responsibilities of the new field of psychology was to benefit human welfare in a broad sense. Thus, a

societal need existed, and some members of the psychological community felt a responsibility to fill this

need.

As we will point out, however, the greatest growth of clinical psychology occurred during the second

half of the twentieth century, spurred by events that began during the First and Second World Wars.

EARLY APPROACHES TO MENTAL HEALTH CARE

The commitment to helping individuals in psychological distress certainly did not begin with the field of

clinical psychology. The major functions that are served by clinical psychologists today (understanding

and aiding individuals who are suffering from psychological disorders or are experiencing significant

psychological distress) were met by other individuals and institutions in societies for centuries before

the emergence of psychology as a profession. In various societies and at different points in history, who

has been responsible for meeting the psychological needs of individuals has depended on how mental

health and mental disorder have been viewed. Professions that have taken responsibility for the welfare

of individuals who suffer from psychological or psychiatric disorders have included the clergy or other

religious groups, physicians, and individuals committed to social /welfare. It is important to recognize

that psychologists have only recently joined these other groups in the field of mental health (Alloy,

acobson, & Acocella, 1999, Nolen-Hoeksema, 1998).

Clinical Psychology (PSY401)

For much of recorded history, treatment of psychological problems was carried out by religious

institutions. The treatment of mental health problems by religious methods is based in demonology, the

view that these problems are the caused by forces of evil. Writings from the Old Testament refer to

madness that is the result of punishment by God, and through-out the Middle Ages in Europe, the

church was responsible for explaining the causes of psychological disturbance and providing treatment

for it (most often in the form of punishment). For example, disturbed and disordered behavior that today

is considered evidence of psychosis (e.g.. hallucinations, delusions) used to be interpreted as evidence of

possession by the devil and was treated through exorcisms, torture, or death by burning at the stake.

An alternative to demonology emerged in the form of medical explanations of psychological problems-

the somato-genic perspective, during the Greek period.

THE GREEK PERIOD

Primitive Greeks viewed mental aberrations in magical and religious frame of reference. Several Greek

thinkers were pivotal in the early development of integrative approaches to illness, and, thus, were

precursors to a bio-psycho-social perspective.

Although he ancient Greeks felt that the gods ultimately controlled both health and illness, these

thinkers looked beyond supernatural influences and explored biological, psychological and social

influences on illness.

The earliest medical or biological explanation of emotional and behavioral disorders can be found in the

writings of Hippocrates in the fourth century b.c.

Hippocrates believed that psychological problems, like physical illnesses, were caused by imbalances

in the four bodily fluids (black bile, yellow bile, blood, and phlegm). Furthermore, Hippocrates felt that

the relationship between these bodily fluids also determined temperament and personality.

Plato felt that mental illness resulted from sickness in the part of the soul that operates the head,

controlling reason.

Aristotle maintained a scientific emphasis and felt that certain distinct emotional states including joy,

fear, anger and courage impacted the functioning of human body.

Galen also used the humoral theory of balance between the four bodily fluids discussed previously as a

foundation for treatments. He thought that humans experienced one of two irrational sub souls, one for

males and one for females. He felt that the soul was the slave and not the master of the body, and that

wishes of the souls in the body resulted in health and illness.

THE MIDDLE AGES

During the Middle Ages (500-1450A.D), earlier notions regarding the relationship among health,

illness, mind, and body reemerged. The focus on supernatural influences to explain events became

commonplace. Spiritual matters such as the influence of demons, witches and sins caused diseases and

"insanity", many believed. So healing and treatment became, once more, a spiritual rather than a

medical issue.

Not every one during the middle Ages believed that good or evil spirits and demons, sorcery and

witchcraft contributed to mental illness. Some thinkers, such as Saint Thomas Aquinas felt that there

were both theological and scientific reasons of abnormal behavior.

The late 14th century French bishop Nicholas Ores-me' felt that abnormal behavior and mental illness

were due to diseases such as "melancholy" (today's depression).

Clinical Psychology (PSY401)

A Swiss physician, Paracelsus, popularized the notion that various movements of the stars, moon, and

planets influenced mood and behavior. He also focused on the biological foundations of mental illness

and developed humane treatments.

THE RENIASSANCE

During the renaissance, renewed interest in the physical and medical worlds emerged, overshadowing

previously supernatural and religious viewpoints. Interest in the mind and soul were considered

unscientific.

Morgagni discovered through autopsy that a diseased organ in the body could cause illness and death.

Andreas Vesalius emphasized scientific observation and experimentation rather than reason,

mythology, religious beliefs, and dogma.

Rene' Descartes argued that the mind and body were separate. This dualism of mind and body then

became the basis for Western medicine until recently.

As biological explanations for psychological problems emerged, medical professionals became involved

in the identification and treatment of such disorders. Unfortunately, from the 1500s through 1800s,

medical treatment of psychological problems primarily took the form of placement of individuals in

psychiatric hospitals and asylums that offered little if anything in the way of treatment. Patients were

held as prisoners in horrible conditions, little care or treatment was available, and even humane

treatment was often lacking.

In contrast to these early approaches, more recent developments in biological explanations of

psychopathology have led to major advances in diagnosis and treatment.

THE NINETEENTH CENTURY

The nineteenth century experienced numerous advances in understanding mental and physical illness,

and allowed for a more sophisticated understanding of the relationship between body and mind in both

health and illness.

IMPORTANT FIGURES INCLUDE

Louis Pasteur: He believed that disease and illness could be attributed to dysfunction at the cellular

level.

Benjamin Rush: He authored the first American text in psychiatry, positing that the mind could cause a

variety of diseases.

Franz Mesmer: He noticed that many people experiencing paralysis, deafness, and blindness had no

biomedical pathology, leaving psychological causes suspect. He also promoted the idea of "animal

magneticism" (also known as Mesmerism) the view that animals possess some kind of magnetic force

within their bodies that can help in the treatment of various physical and mental disorders. He believed

that by directing or "Re-directing" these fluids, a physician could treat the mental illness of a person.

Philippe Pinel: He did much to improve the living conditions and treatment approaches used by mental

hospitals during the nineteenth century. He wrote a book on the classification of diseases, which served

as a standard medical textbook for schools of thought on clinical medicine.

In 1793, Pinel had been appointed chief physician to Bicetre, the men's "insane" asylum in Paris. What

he saw there horrified him. Many of the patients were restrained to the walls by chains. Some had been

in restraints this way for 30 or 40 years. He removed the chains from the patients who responded

Clinical Psychology (PSY401)

favorably without violence. He also stopped purging, bleeding and blistering and replaced these with

simple psychological treatments.

The results of these kinds of humane reforms were startling. Before Pinel, 60 percent of the mental

patients at Bicetre died of disease, suicide or other causes within the first two years of admission. This

number went down to 10 percent under Pinel (and went down even further as reforms continued.)

In 1795, he joined Le Salpetriere, a female asylum, where he fired the keepers who were cruel and

ignorant and replaced them with personnel who were compassionate and enlightened.

Also, while there he began the practice of keeping case histories of all the patients, thereby improving

their long treatment and also serving as a basis for study of the course of mental illness well into the

century.

Under Pinel, the place of residence for the mentally ill converted from a madhouse to a hospital. His

reforms were soon copied all over Europe.

Clause Bernard: He was a prominent physician who argued for recognition of the role of psychological

factors in physical illness.

William Tuke and Dorothea Dix worked for more humane treatment approaches in mental hospitals in

United States.

Franz Alexander: He also studied the association between psychological factors and both physical and

mental illnesses.

ADVANCES IN MENTAL HEALTH CARE

Only recently, and only in some cultures around the world, have psychological problems come to be

viewed at least partly as the result of disturbances and problems in behavior (the psychogenic

hypothesis) and, as a result, have come within the purview of psychology.

One major change in thinking about and treatment of psychological problems occurred with the advent

of moral treatment in the 1800s, Led by physicians and others concerned with social reform in the

United States and Europe (e.g., Philippe Pinel in France and Benjamin Rush in the United States).

The moral treatment movement was based on the conviction that individuals with psychological

problems deserved humane care and treatment. As part of the moral treatment movement, efforts were

made to improve the inhumane conditions and methods that characterized asylums and mental hospitals

at that time.

One of the most dramatic changes in the conceptualization and treatment of psychological problems

occurred late in the nineteenth century with the emergence of truly psychological explanations of these

problems. French physicians Jean Charcot, Hippolyte Bemheim, and Pierre Janet began to

experiment with the use of hypnosis in the treatment of some psychological problems and introduced

the notion that psychological methods of treatment could be an alternative to medical and religious

approaches. Their theories led to the pioneering work of Sigmund Freud, an Austrian neurologist, who

is perhaps the best-known proponent of psychological explanations for disorders of behavior and

emotion. Freud's work has served as a base line in clinical psychology for research on the treatment of

psychological problems and the actual clinical application of this research.

THE BIRTH OF PSYCHOLOGY

Clinical Psychology (PSY401)

IN 1860, Theodor Fechner published The Elements of Psychophysics while Wilhelm Wundt

published The Principles of Physiological Psychology in 1874. These publications were the first to

indicate clearly that technique of physiology and physics could be used to answer psychological

questions.

The first laboratory of psychology was subsequently developed by Wundt at the University of

Leipzig; Germany in 1879 and with it, psychology was born.

FOUNDATION OF AMERICAN PSYCHOLOGICAL ASSOCIATION

In 1892, the American Psychological Association (APA) was founded, and G. Stanley Hall was elected

as its first president. During the beginning months and years of its roots APA was more interested in

experimental psychology as compared to Applied Psychology.

THE EMERGENCE

CLINICAL

PSYCHOLOGY

WITHIN

THE

FIELD

PSYCHOLOGY

As reflected in this brief history of the conceptualization and treatment of psychological problems, the

origins of clinical psychology cannot be tied to a single person or event. Instead, a number of

individuals responding to a variety of forces were involved in the emergence of the field in the United

States and Europe in the late nineteenth and early twentieth centuries. Because clinical psychology

involves the application of knowledge from the scientific study of human behavior, it is noteworthy that

the science of psychology preceded the profession of psychology. This order is in contrast to many other

professions in which professional practice began before the science of the field. Training in the practice

of law, for example, was carried out through apprenticeship to a practicing attorney long before formal

training programs in law were established in universities (Routh, 1994).

Similarly, medicine was practiced for centuries before the scientific basis of the field was fully

developed. The nature of medical education and training, and indeed the entire field of medicine, was

reshaped in 1910 by an influential report by Abraham Flexner (Regan-Smith, 19.98). The Flexner

Report called for the introduction of training in basic science as a component in all medical training and

education. Prior to 1910, medical practitioners were not required to be trained in science. Clinical

psychology followed the opposite path-the science of psychology was established before the application

of psychology began a precedent that has led to considerable conflict within the field.

Most historians mark the origins of psychology with the development of Wilhelm Wundt's laboratory

for the study of perception and behavior in Germany in the mid 1800s. Wundt was trained as a

philosopher, and research conducted in his laboratory was novel in its attempt to study observable

processes of human sensation and perception under relatively controlled and experimental conditions.

Wundt had a major effect on American psychology through the relatively large number of Americans

who received their doctoral training in his laboratory at the University of Leipzig.

The field of psychology that began to emerge in the United States in the latter part of the nineteenth

century was an academic discipline committed to the scientific study of human behavior. The focus of

much of the early research in psychology (e.g., examination of the characteristics of color vision) had

little to do with the types of psychological problems that are the focus of clinical psychology today.

Nevertheless, many pioneers of American psychology recognized that one of the important values of

psychology would include its application to the effort to solve human problems.

One of the doctoral students who worked with Wundt was a young American named Lightner Witmer.

Formal training in psychology did not exist in the United States in the late nineteenth century, and as a

result. Witmer and others who were interested in the scientific study of human behavior had no choice

but to leave the United States and seek their education in Europe. After receiving his doctoral degree

with Wundt, Witmer returned to the United States to accept a position in the psychology department at

Clinical Psychology (PSY401)

the University of Pennsylvania, where he could continue to conduct his research on processes of

perception. The course of Witmer's work took a different turn in the spring of 1896, however, when a

schoolteacher asked for Witmer's assistance in working with an otherwise bright 14-year-old boy who

was having severe difficulty with spelling and recognizing written words (McRcynolds, 1987, 1997).

Witmer conducted a careful evaluation of the boy's problems and developed an intensive treatment

program to try to improve his reading and spelling skills. This case spurred Witmer to open the first

Psychological Clinic in 1896 at the University of Pennsylvania, designed specifically to treat children

with learning difficulties. He called for the founding of a new branch of psychology dedicated to the

goal of helping people and coined the term clinical psychology to describe this new field.

That same year, 1896, Witmer presented his ideas about the applications of psychology to the treatment

of human problems to the members of the newly formed American Psychological Association, and he

received a cool rejection at best (McReynolds. 1997; Riesman, 1976). The APA members' negative

response was due to several factors. Although there was some support for the application of

psychological knowledge to solving human problems, the majority of psychologists considered

themselves to be scientists and did not regard the role described by Witmer as appropriate for them.

They did not wish to endanger their identification as scientists, which was tenuous enough in those early

years, by moving their profession into what they felt were premature applications. Even if they had

considered his suggestions to be laudable, few if any psychologists were trained or experienced to

perform the functions Witmer proposed.

The chilly response from members of the APA is somewhat surprising given that Witmer emphasized

that clinical psychology should involve the careful application of the science of psychology. Witmer

used the term clinical psychology to refer to a method of teaching and research and not merely as an

extension of the word clinic, a place where persons are examined. Witmer persuaded the University of

Pennsylvania administration to offer formal training in clinical psychology, and its 1904-05 catalog

announced that students in clinical psychology could take courses for credit in psychology and in the

medical school.

By 1907, Witmer had been able to raise sufficient funds to establish a hospital school for the training of

mentally retarded children as an adjunct to his clinic, and to found and serve as the first editor of a

professional journal, "The Psychological Clinic". For his efforts, Witmer is now widely considered to

be the founder of clinical psychology.

In understanding the origins of clinical psychology, it is important to consider that the first

psychological clinic was dedicated to helping children with learning problems, which was a clear and

logical application of the research on human learning and memory that was being conducted by

psychologists at the time (e.g., Witmer, 1907/1996). Thus, the field of clinical psychology originated in

an attempt to apply what was being learned in the basic science of psychology at the time.

Witmer's work influenced and anticipated future developments in clinical psychology, including an

emphasis on children's academic problems, the use of active clinical interventions to improve

individuals' lives, and collaboration with other professionals (such as physicians) in providing treatment

(Routh, 1996).

Table of Contents: