Section Learning Objectives

• Describe prehistoric and ancient beliefs about psychological disorders.
• Describe Greco-Roman thoughts on psychological disorders.
• Describe thoughts on psychological disorders during the Middle Ages.
• Describe thoughts on psychological disorders during the Renaissance.
• Describe thoughts on psychological disorders during the 18th and 19th centuries.
• Describe thoughts on psychological disorders during the 20th and 21st centuries.
• Outline the use of psychoactive drugs throughout time and their impact.
• Outline Freud’s theories and approaches to psychological disorders.
• Describe and provide examples of the various defense mechanisms

As we have seen so far, what is considered a psychological disorder is often dictated by the culture/society a person lives in, and unfortunately, in the past people afflicted with psychological disorders were often treated inhumanely. In this section, we will examine how past societies viewed and dealt with psychological disorders.

1.3.1. Prehistoric and Ancient Beliefs

Prehistoric cultures often held a supernatural view of psychological disorders and saw them as the work of evil spirits, demons, gods, or witches who took control of the person. This form of demonic possession was believed to occur when the person engaged in behavior contrary to the religious teachings of the time. Treatment by cave dwellers included a technique called trephination, in which a stone instrument known as a trephine was used to remove part of the skull, creating an opening. They believed that evil spirits could escape through the hole in the skull, thereby ending the person’s mental affliction and returning them to normal behavior. Early Greek, Hebrew, Egyptian, and Chinese cultures used a treatment method called exorcism in which evil spirits were cast out through prayer, magic, flogging, starvation, noise-making, or having the person ingest horrible-tasting drinks.

1.3.2. Greco-Roman Thought

Rejecting the idea of demonic possession, Greek physician, Hippocrates (460-377 B.C.), said that mental disorders were akin to physical disorders and had natural causes. Specifically, he suggested that they arose from brain pathology, or head trauma/brain dysfunction or disease, and were also affected by heredity. Hippocrates classified mental disorders into three main categories – melancholia, mania, and phrenitis (brain fever) and gave detailed clinical descriptions of each. He also described four main fluids or humors that directed normal functioning and personality – blood which arose in the heart, black bile arising in the spleen, yellow bile or choler from the liver, and phlegm from the brain. Mental disorders were believed to occur when the humors were in a state of imbalance such as an excess of yellow bile causing frenzy/mania and too much black bile causing melancholia/depression. Hippocrates believed psychological disorders could be treated as any other disorder and focused on the underlying pathology.

Also important was the Greek philosopher, Plato (429-347 B.C.), who said that people with psychological disorders were not responsible for their own actions and so should not be punished. He emphasized the role of social environment and early learning in the development of psychological disorders and believed it was the responsibility of the community and their families to care for them in a humane manner using rational discussions. Greek physician, Galen (A.D. 129-199) said psychological disorders had either physical or mental causes that included fear, shock, alcoholism, head injuries, adolescence, and changes in menstruation.

In Rome, physician Asclepiades (124-40 BC) and philosopher Cicero (106-43 BC) rejected Hippocrates’ idea of the four humors and instead stated that melancholy arises from grief, fear, and rage; not excess black bile. Roman physicians treated psychological disorders with massage and warm baths, with the hope that their patients be as comfortable as possible. They practiced the concept of “contrariis contrarius”, meaning opposite by opposite, and introduced contrasting stimuli to bring about balance in the physical and mental domains. An example would be consuming a cold drink while in a warm bath.

1.3.3. The Middle Ages – 500 AD to 1500 AD

The progress made during the time of the Greeks and Romans was quickly reversed during the Middle Ages with the increase in power of the Church and the fall of the Roman Empire. Psychological disorders were yet again explained as possession by the Devil and methods such as exorcism, flogging, prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to try to rid the person of the Devil’s influence. In extreme cases, the afflicted were confined, beaten, and even executed. Scientific and medical explanations, such as those proposed by Hippocrates, were discarded at this time.

Group hysteria, or mass madness, was also seen in which large numbers of people displayed similar symptoms and false beliefs. This included the belief that one was possessed by wolves or other animals and imitated their behavior, called lycanthropy, and mania in which large numbers of people had an uncontrollable desire to dance and jump, called tarantism. The latter was believed to have been caused by the bite of the wolf spider, now called the tarantula, and spread quickly from Italy to Germany and other parts of Europe where it was called Saint Vitus’s dance.

Perhaps the return to supernatural explanations during the Middle Ages makes sense given the events of the time. The Black Death or Bubonic Plague had killed up to a third, and according to other estimates almost half, of the population. Famine, war, social oppression, and pestilence were also factors. Death was ever present which led to an epidemic of depression and fear. Nevertheless, near the end of the Middle Ages, mystical explanations for psychological disorders began to lose favor, and government officials regained some of their lost power over nonreligious activities. Science and medicine were once again called upon to explain psychological disorders.

1.3.4. The Renaissance – 14th to 16th Centuries

The most noteworthy development in the realm of philosophy during the Renaissance was the rise of humanism or the worldview that emphasizes human welfare and the uniqueness of the individual. This helped continue the decline of supernatural views of psychological disorders. In the mid to late 1500s, Johann Weyer (1515-1588), a German physician, published his book, On the Deceits of the Demons, which rebutted the Church’s witch-hunting handbook, the Malleus Maleficarum, and argued that many accused of being witches and subsequently imprisoned, tortured, hung, and/or burned at the stake, had mental disturbances and were not possessed by demons or the Devil himself. He believed that like the body, the mind was susceptible to illness. Not surprisingly, the book was met with vehement protest and even banned from the church. It should be noted that these types of acts occurred not only in Europe but also in the United States. The most famous example was the Salem Witch Trials of 1692 in which more than 200 people were accused of practicing witchcraft and 20 were killed.

The number of asylums, or places of refuge for the mentally ill where they could receive care, began to rise during the 16th century as the government realized there were far too many people afflicted with psychological disorders to be left in private homes. Hospitals and monasteries were converted into asylums. Though the intent was benign in the beginning, as they began to overflow patients came to be treated more like animals than people. In 1547, the Bethlem Hospital opened in London with the sole purpose of confining those with mental disorders. Patients were chained up, placed on public display, and often heard crying out in pain. The asylum became a tourist attraction, with sightseers paying a penny to view patients, and soon was called “Bedlam” by local people; a term that today means “a state of uproar and confusion” (https://www.merriam-webster.com/dictionary/bedlam).

1.3.5. Reform Movement – 18th to 19th Centuries

The rise of the moral treatment movement occurred in Europe in the late 18th century and then in the United States in the early 19th century. Its earliest proponent was Phillipe Pinel (1745-1826) who was assigned as the superintendent of la Bicetre, a hospital for mentally ill men in Paris. He emphasized the importance of affording people with psychological disorders respect, moral guidance, and humane treatment, all while considering their individual, social, and occupational needs. Arguing that those with psychological disorders were sick people, Pinel ordered that chains be removed, outside exercise be allowed, sunny and well-ventilated rooms replace dungeons, and patients be extended kindness and support. This approach led to considerable improvement for many of the patients, so much so, that several were released.

Following Pinel’s lead in England, William Tuke (1732-1822), a Quaker tea merchant, established a pleasant rural estate called the York Retreat. The Quakers believed that all people should be accepted for who they were and treated kindly. At the retreat, patients could work, rest, talk out their problems, and pray (Raad & Makari, 2010). The work of Tuke and others led to the passage of the County Asylums Act of 1845 which required that every county in England and Wales provide asylum to the mentally ill. This was even extended to English colonies such as Canada, India, Australia, and the West Indies as word of the maltreatment of patients at a facility in Kingston, Jamaica spread, leading to an audit of colonial facilities and their policies.

Reform in the United States started with the figure largely considered to be the father of American psychiatry, Benjamin Rush (1745-1813). Rush advocated for the humane treatment of people with psychological disorders, showing them respect, and even giving them small gifts from time to time.  Despite this, his practice included treatments such as bloodletting and purgatives, the invention of the “tranquilizing chair,” and reliance on astrology, demonstrating that even he could not escape from the beliefs of the time.

Due to the rise of the moral treatment movement in both Europe and the United States, asylums became habitable places where those afflicted with psychological disorders could recover. However, it is often said that the moral treatment movement was a victim of its own success. The number of mental hospitals greatly increased leading to staffing shortages and a lack of funds to support them. Though treating patients humanely was a noble endeavor, it did not work for some and other treatments were needed, though they had not been developed yet. It was also recognized that the approach worked best when the facility had 200 or fewer patients. However, waves of immigrants arriving in the U.S. after the Civil War were overwhelming the facilities, with patient counts soaring to 1,000 or more. Prejudice against the new arrivals led to discriminatory practices in which immigrants were not afforded moral treatments provided to U.S. citizens, even when the resources were available to treat them.

Another leader in the moral treatment movement was Dorothea Dix (1802-1887), a New Englander who observed the deplorable conditions suffered by institutionalized people while teaching Sunday school to female prisoners. She instigated the mental hygiene movement, which focused on the physical well-being of patients. Over the span of 40 years (1841 to 1881), she motivated people and state legislators to do something about this injustice and raised millions of dollars to build over 30 more appropriate mental hospitals and improve others. Her efforts even extended beyond the U.S. to Canada and Scotland.

Finally, in 1908 Clifford Beers (1876-1943) published his book, A Mind that Found Itself, in which he described his personal struggle with bipolar disorder and the “cruel and inhumane treatment people with mental illnesses received. He witnessed and experienced horrific abuse at the hands of his caretakers. At one point during his institutionalization, he was placed in a straightjacket for 21 consecutive nights.” (http://www.mentalhealthamerica.net/our-history). His story aroused sympathy in the public and led him to found the National Committee for Mental Hygiene, known today as Mental Health America, which provides education about mental illness and the need to treat these people with dignity. Today, MHA has over 200 affiliates in 41 states and employs 6,500 affiliate staff and over 10,000 volunteers.

For more information on MHA, please visit: http://www.mentalhealthamerica.net/

1.3.6. 20th – 21st Centuries

The decline of the moral treatment approach in the late 19th century led to the rise of two competing perspectives – the biological or somatogenic perspective and the psychological or psychogenic perspective.

1.3.6.1. Biological or Somatogenic Perspective

Recall that Greek physicians Hippocrates and Galen said that psychological disorders were akin to physical disorders and had natural causes. Though the idea fell into oblivion for several centuries it re-emerged in the late 19th century for two reasons.  First, German psychiatrist, Emil Kraepelin (1856-1926), discovered that symptoms occurred regularly in clusters which he called syndromes. Each of these syndromes represented a unique mental disorder with its own cause, course, and prognosis. In 1883 he published his textbook, Compendium der Psychiatrie (Textbook of Psychiatry), and described a system for classifying mental disorders that became the basis of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) which is currently in its 5th edition (originally published in 2013, with a text revision published in 2022).

Secondly, in 1825, the behavioral and cognitive symptoms of advanced syphilis were identified to include delusions (i.e., fixed false beliefs), and were termed general paresis by French physician A. L. J. Bayle. In 1897, Viennese psychiatrist Richard von Krafft-Ebbing injected patients with general paresis with matter from syphilis spores and noted that none of the patients developed symptoms of syphilis, indicating they must have been previously exposed and were now immune. This led to the conclusion that syphilis (a bacterial infection) was the cause of the general paresis. In 1906, August von Wassermann developed a blood test for syphilis and in 1917 a cure was stumbled upon. Julius von Wagner-Jauregg noticed that patients with general paresis who contracted malaria recovered from their symptoms. To test this hypothesis, he injected nine patients with blood from a soldier afflicted with malaria. Three of the patients fully recovered while three others showed great improvement in their paretic symptoms. The high fever caused by malaria burned out the syphilis bacteria. Hospitals in the United States began incorporating this new cure for paresis into their treatment approach by 1925.

Also noteworthy was the work of American psychiatrist John P. Grey. Appointed as superintendent of the Utica State Hospital in New York, Grey asserted that mental illness always had a physical cause. As such, the mentally ill should be seen as physically ill and treated with rest, proper room temperature and ventilation, and a proper diet.

The 1930s also saw the use of electric shock as a treatment method, which was stumbled upon accidentally by Benjamin Franklin while experimenting with electricity in the early 18th century. He noticed that after experiencing a severe shock his memories had changed and in published work, suggested physicians study electric shock as a treatment for melancholia.

Beginning in the 1950s, psychiatric or psychotropic drugs were used for the treatment of psychological disorders and made an immediate impact. Though drugs alone cannot cure psychological disorders, they can improve symptoms. Classes of psychiatric drugs include antidepressants used to treat depression and anxiety, mood-stabilizing medications to treat bipolar disorder, antipsychotic drugs (i.e., neuroleptics) to treat schizophrenia and other psychotic disorders, and anti-anxiety drugs used to treat some anxiety disorders.

(Source: https://www.nimh.nih.gov/health/topics/mental-health-edications/index.shtml).

Frank (2006) found that by 1996, psychotropic drugs were used in 77% of mental health cases, and spending on these drugs to treat mental disorders grew from $2.8 billion in 1987 to about $18 billion in 2001 (Coffey et al., 2000; Mark et al., 2005), representing a greater than sixfold increase. The largest classes of psychotropic drugs are anti-psychotic and anti-depressant medications followed closely by anti-anxiety medications. Frank, Conti, and Goldman (2005) point out, “The expansion of insurance coverage for prescription drugs, the introduction, and diffusion of managed behavioral health care techniques, and the conduct of the pharmaceutical industry in promoting their products all have influenced how psychotropic drugs are used and how much is spent on them.” Is it possible then that we are overprescribing these medications? Davey (2014) provides ten reasons why this may be so including individuals believing that recovery is out of their hands but instead in the hands of their doctors, increased risk of relapse, drug companies causing the “medicalization of perfectly normal emotional processes, such as bereavement” to ensure their own survival, side effects, and a failure to change the way the person thinks or the socioeconomic environments that may be the cause of the disorder. For more on this article, please see: https://www.psychologytoday.com/blog/why-we-worry/201401/overprescribing-drugs-treat-mental-health-problems. Smith (2012) echoed similar sentiments in an article on inappropriate prescribing and cites the approval of Prozac by the Food and Drug Administration (FDA) in 1987 as when the issue began and the overmedication/overdiagnosis of children with ADHD as a more recent example.

A result of the use of psychiatric drugs was deinstitutionalization or the release of patients from mental health facilities. This shifted resources from inpatient to outpatient care and placed the spotlight back on the biological or somatogenic perspective. Today, when people with severe mental illness do need inpatient care, it is typically in the form of short-term hospitalization.

1.3.6.2. Psychological or Psychogenic Perspective

The psychological or psychogenic perspective states that emotional or psychological factors are the cause of psychological disorders and represented a challenge to the biological perspective.

1.3.6.2.1. The History of Hypnosis

This perspective had a long history but did not gain favor until the work of Viennese physician Franz Anton Mesmer (1734-1815). Influenced heavily by Newton’s theory of gravity, he believed that the planets also affected the human body through the force of animal magnetism and that all people had a universal magnetic fluid that determined how healthy they were. He demonstrated the usefulness of his approach when he cured Franzl Oesterline, a 27-year-old woman experiencing what he described as a convulsive malady. Mesmer used a magnet to disrupt the gravitational tides that were affecting this patient and produced a sensation of the magnetic fluid draining from her body. This removed the illness from her body and produced a near-instantaneous recovery. In reality, the patient was placed in a trance-like state which made her highly suggestible. With other patients, Mesmer would have them sit in a darkened room filled with soothing music, into which he would enter dressed in a colorful robe and pass from person to person touching the afflicted area of their body with his hand or a special rod/wand. He successfully cured deafness, paralysis, loss of bodily feeling, convulsions, menstrual difficulties, and blindness using his technique.

His approach gained him celebrity status as he demonstrated it at the courts of English nobility. The medical community was hardly impressed. A royal commission was formed to investigate his technique but could not find any proof for his theory of animal magnetism. Though he was able to cure patients when they touched his “magnetized” tree, the result was the same when “non-magnetized” trees were touched. As such, Mesmer was deemed a charlatan and forced to leave Paris. His technique was called mesmerism, and today we know it as an early form of hypnosis.

The psychological perspective gained popularity after two physicians practicing in the city of Nancy in France discovered that they could induce the symptoms of hysteria in perfectly healthy patients through hypnosis and then remove the symptoms in the same way. The work of Hippolyte-Marie Bernheim (1840-1919) and Ambroise-Auguste Liebault (1823-1904) came to be part of what was called the Nancy School and showed that hysteria was nothing more than a form of self-hypnosis. In Paris, this view was challenged by Jean Charcot (1825-1893) who stated that hysteria was caused by degenerative brain changes, reflecting the biological perspective. He was proven wrong and eventually turned to their way of thinking.

The use of hypnosis to treat hysteria was also carried out by fellow Frenchman Pierre Janet (1859-1947), and student of Charcot, who believed that hysteria had psychological, not biological causes. Namely, these included unconscious forces, fixed ideas, and memory impairments. In Vienna, Josef Breuer (1842-1925) induced hypnosis and had patients speak freely about past events that upset them. Upon waking, he discovered that patients sometimes were free of their symptoms of hysteria. Success was even greater when patients not only recalled forgotten memories but also relieved them emotionally. He called this the cathartic method and our use of the word catharsis today indicates a purging or release, in this case, of pent-up emotion. Sigmund Freud’s development of psychoanalysis followed on the heels of the work of Breuer, and others who came before him.

1.3.6.2.2. Psychodynamic Theory

In 1895, the book, Studies on Hysteria, was published by Josef Breuer (1842-1925) and Sigmund Freud (1856-1939), and marked the birth of psychoanalysis, though Freud did not use this actual term until a year later. The book published several case studies, including that of Anna O., born February 27, 1859, in Vienna to Jewish parents Siegmund and Recha Pappenheim, strict Orthodox adherents considered millionaires at the time. Bertha, known in published case studies as Anna O., was expected to complete the formal education of a girl in the upper middle class which included foreign language, religion, horseback riding, needlepoint, and piano. She felt confined and suffocated in this life and took to a fantasy world she called her “private theater.” Anna also developed hysteria which included symptoms of memory loss, paralysis, disturbed eye movements, reduced speech, nausea, and mental deterioration. Her symptoms appeared as she cared for her dying father and her mother called on Breuer to diagnose her condition (note that Freud never actually treated her). Hypnosis was used at first and relieved her symptoms, as it had done for many patients. Breuer made daily visits and allowed her to share stories from her private theater which she came to call “talking cure” or “chimney sweeping.” Many of the stories she shared were actually thoughts or events she found troubling and reliving them helped to relieve or eliminate the symptoms. Breuer’s wife, Mathilde, became jealous of her husband’s relationship with the young girl, leading Breuer to terminate treatment in the June of 1882 before Anna had fully recovered. She relapsed and was admitted to Bellevue Sanatorium on July 1, eventually being released in October of the same year. With time, Anna O. did recover from her hysteria and went on to become a prominent member of the Jewish Community, involving herself in social work, volunteering at soup kitchens, and becoming ‘House Mother’ at an orphanage for Jewish girls in 1895. Bertha (Anna O.) became involved in the German Feminist movement, and in 1904 founded the League of Jewish Women. She published many short stories; a play called Women’s Rights, in which she criticized the economic and sexual exploitation of women, and wrote a book in 1900 called The Jewish Problem in Galicia, in which she blamed the poverty of the Jews of Eastern Europe on their lack of education. In 1935 she was diagnosed with a tumor and was summoned by the Gestapo in 1936 to explain anti-Hitler statements she had allegedly made. She died shortly after this interrogation on May 28, 1936. Freud considered the talking cure of Anna O. to be the origin of psychoanalytic therapy and what would come to be called the cathartic method.

1.3.6.2.2.1. The Structure of Personality. Freud’s psychoanalysis was unique in the history of psychology because it did not arise within universities as most of the major schools of thought in our history did, but from medicine and psychiatry, it dealt with psychopathology and examined the unconscious. Freud believed that consciousness had three levels – 1) consciousness which was the seat of our awareness, 2) preconscious which included all of our sensations, thoughts, memories, and feelings, and 3) the unconscious which was not available to us. The contents of the unconscious could move from the unconscious to the preconscious, but to do so, it had to pass a Gate Keeper. Content that was turned away was said to be repressed by Freud.

According to Freud, our personality has three parts – the id, superego, and ego, and from these, our behavior arises. First, the id is the impulsive part that expresses our sexual and aggressive instincts. It is present at birth, completely unconscious, and operates on the pleasure principle, resulting in selfishly seeking immediate gratification of our needs no matter what the cost. The second part of personality emerges after birth with early formative experiences and is called the ego. The ego attempts to mediate the desires of the id against the demands of reality, and eventually the moral limitations or guidelines of the superego. It operates on the reality principle or an awareness of the need to adjust behavior to meet the demands of our environment. The last part of personality to develop is the superego which represents society’s expectations, moral standards, rules, and represents our conscience. It leads us to adopt our parent’s values as we come to realize that many of the id’s impulses are unacceptable. Still, we violate these values at times which leads to feelings of guilt. The superego is partly conscious but mostly unconscious. The three parts of personality generally work together well and compromise, leading to a healthy personality, but if conflicts among these components are not resolved, intrapsychic conflicts can arise and lead to mental disorders.

1.3.6.2.2.2. The Development of Personality. Freud also proposed that personality develops over the course of five distinct stages (oral, anal, phallic, latency, genital), in which the libido is focused on different parts of the body. First, libido is the psychic energy that drives a person to pleasurable thoughts and behaviors. Our life instincts, or Eros, are manifested through it and are the creative forces that sustain life. They include hunger, thirst, self-preservation, and sex. In contrast, Thanatos, or our death instinct, is either directed inward as in the case of suicide and masochism or outward via hatred and aggression. Both types of instincts are sources of stimulation in the body and create a state of tension that is unpleasant, thereby motivating us to reduce them. Consider hunger, and the associated rumbling of our stomach, fatigue, lack of energy, etc., that motivates us to find and eat food. If we are angry at someone we may engage in physical or relational aggression to alleviate this stimulation.

Freud’s psychosexual stages of personality development are listed below. Freud proposed that a person may become fixated at any stage, meaning they become stuck, thereby affecting later development and possibly leading to a psychological disorder.

1. Oral Stage – Beginning at birth and lasting to 24 months, the libido is focused on the mouth and sexual tension is relieved by sucking and swallowing at first, and then later by chewing and biting as baby teeth come in. Fixation is linked to a lack of confidence, argumentativeness, and sarcasm.
2. Anal Stage – Lasting from 2-3 years, the libido is focused on the anus as toilet training occurs. If parents are too lenient children may become messy or unorganized. If parents are too strict, children may become obstinate, stingy, or orderly.
3. Phallic Stage – Occurring from about age 3 to 5-6 years, the libido is focused on the genitals. The Oedipus complex develops in boys and results in the son falling in love with his mother while fearing that his father will find out and castrate him. Meanwhile, girls fall in love with their father and fear that their mother will find out, called the Electra complex. A fixation at this stage may result in low self-esteem, feelings of worthlessness, and shyness.
4. Latency Stage – From 6-12 years of age, children lose interest in sexual behavior and boys play with boys and girls with girls. Neither gender pays much attention to the opposite gender.
5. Genital Stage – Beginning at puberty, sexual impulses reawaken, and unfulfilled desires from infancy and childhood can be satisfied with sexual behavior.

1.3.6.2.2.3. Defense Mechanisms. The ego has a challenging job to fulfill, balancing both the will of the id and the superego, and the overwhelming anxiety and panic this creates. Defense mechanisms are in place to protect us from this pain but most are considered maladaptive if they are misused and become our primary way of dealing with stress. They protect us from anxiety and operate unconsciously, also distorting reality. Defense mechanisms include the following:

• Repression – when unacceptable ideas, wishes, desires, or memories are blocked from consciousness such as forgetting a horrific car accident that you caused. Eventually, though, it must be dealt with or else the repressed memory can cause problems later in life.
• Reaction formation – When an impulse is repressed and then expressed by its opposite. As an example, if we are angry with our boss but cannot lash out at them, we may be overly friendly instead. Another example is having lustful thoughts about a coworker that you cannot express because you are married, and so you are mean to this person.
• Displacement – When we satisfy an impulse with a different object because focusing on the primary object may get us in trouble. A classic example is taking out your frustration with your boss on your spouse and/or kids when you get home. If we lash out at our boss we could be fired. The substitute target is less dangerous than the primary target.
• Projection – When we falsely attribute our own unacceptable feelings, thoughts, desires, or motives to others. An example is when we do not have the skills necessary to complete a task but we blame the other members of our group for being incompetent and unreliable. Another example is projecting your feelings of love toward your therapist onto your therapist, believing they are in love with you.
• Sublimation – When we find a socially acceptable way to express a desire. If we are stressed out or upset, we may go to the gym and box or lift weights. A person who desires to cut things may become a surgeon.
• Denial – Sometimes life is so hard all we can do is deny how bad it is. An example is denying a diagnosis of lung cancer given by your doctor.
• Identification – When we find someone who has found a socially acceptable way to satisfy their unconscious wishes and desires and we model that behavior.
• Regression – When we move from a mature behavior to one that is infantile in nature. If your significant other is nagging you, you might regress and point your hands over your ears and say, “La la la la la la la la…”
• Rationalization – When we offer well thought-out reasons for why we did what we did but in reality, these are not the real reason. Students sometimes rationalize not doing well in a class by stating that they really are not interested in the subject or saying the instructor writes impossible to pass tests when in reality they are not putting enough effort into learning the material.
• Intellectualization– When we avoid emotion by focusing on intellectual aspects of a situation such as ignoring the sadness we are feeling after the death of our mother by focusing on planning the funeral.

1.3.6.2.2.4. Psychodynamic Techniques. Freud used three primary assessment techniques as part of psychoanalysis, or psychoanalytic therapy, to understand the personalities of his patients and to expose repressed material, which included free association, transference, and dream analysis. First, free association involves the patient describing whatever comes to mind during the session. The patient continues but always reaches a point when they cannot or will not proceed any further. The patient might change the subject, stop talking, or lose their train of thought. Freud said this was resistance and revealed where issues were.

Second, transference is the process through which patients transfer to the therapist attitudes they held during childhood. They may be positive and include friendly, affectionate feelings, or negative, and include hostile and angry feelings. The goal of therapy is to wean patients from their childlike dependency on the therapist.

Finally, Freud used dream analysis to understand a person’s innermost wishes. The content of dreams includes the person’s actual retelling of the dreams called manifest content, and the hidden or symbolic meaning called latent content. In terms of the latter, some symbols are linked to the person specifically while others are common to all people.

1.3.6.2.2.5. Evaluating Psychodynamic Theory. Freud’s psychodynamic theory has made a lasting impact on the field of psychology but also has been criticized heavily. First, most of Freud’s observations were made in an unsystematic, uncontrolled way and he relied on the case study method. Second, the participants in his studies were not representative of the larger body of people whom he tried to generalize to and he based his theory on a few patients. Third, he relied solely on the reports of his patients and sought out no observer reports. Fourth, it is difficult to empirically study psychodynamic principles since most operate unconsciously. This begs the question of how can we really know that they exist. Finally, psychoanalytic treatment is expensive and time-consuming and since Freud’s time, other forms of therapy (e.g., Cognitive Behavioral Therapy) and drug therapies have become more popular and successful. Still, the work of Sigmund Freud raised awareness about the role the unconscious plays in both normal and dysfunctional behavior and he developed useful therapeutic tools for clinicians.

By the end of the 19th century, it had become evident that psychological disorders were caused by a combination of biological and psychological factors, and the investigation of how they develop began. Today, rather than arguing for a purely biological or psychological approach to understanding psychological disorders we focus on a more integrative multidimensional approach. This contemporary approach is the focus of Chapter 2.

Chapter Recap

In Chapter 1, we undertook a fairly lengthy discussion of how psychological disorders are defined. What emerged was a general set of guidelines focused on psychological disorders as causing dysfunction, distress/impairment, and a response that is atypical or not culturally expected. We acknowledged that psychological disorders are stigmatized in our society and provided a basis for why this occurs and what we can do about it. We introduced the various members of the mental health team and defined several key terms including prevalence, incidence, course, prognosis, and treatment. We concluded with a lengthy discussion of the history of psychological disorders. It is with this foundation in mind that we move to examine contemporary models of psychological disorders in Chapter 2.