Foundations and Early History of Clinical Psychology Lecture Preview Early Conceptions of Mental Illness: Mind and Body Paradigms The Founding of Clinical Psychology The Influence of Binet’s Intelligence Test The Influence of Sigmund Freud in America The American Psychological Association and Early Clinical Psychology The Influence of World War I Clinical Psychology between World Wars I and II The Influence of World War II Early Conceptions of Mental Illness: Mind and Body Paradigms Clinical psychology has borrowed from philosophical, medical, and scientific advances throughout the centuries. In this chapter, we’ll trace the history and development of clinical psychology, from ancient times until World War I. Mind and Body Paradigms Several Greek thinkers were essential in the early development of integrative approaches to illness, and were pioneer to a biopsychosocial perspective. According to them, the gods controlled both health and illness. Greeks didn’t believe supernatural influences. The mind and body were closely interrelated. Hippocrates (460–377 B.C.) Disease was primarily the result of an imbalance in four bodily fluids including black bile, yellow bile, phlegm, and blood. The relationship between them determined personality. too much yellow bile resulted in a choleric (angry, irritable) temperament, too much black bile resulted in a melancholic (sadness, hopelessness) personality. Hippocrates (460–377 B.C.) He was sensitive to interpersonal, psychological, and stress factors that contribute to problem behavior. He helped to move from a spiritualistic toward a more naturalistic view or model of health and illness. Biological, psychological, and social factors all contribute to both physical and emotional illness → early biopsychosocial perspective Plato (427–347 B.C.) saw the spirit or soul as being in charge of the body and that problems in the soul could result in physical illness. Aristotle (384–322 B.C.) maintained a scientific emphasis. Treatment for mental problems should include talking and the use of logic. The use of logic is one of the major principles of CBT. Galen of Pergamum (A.D. 130–200) Galen also used the balance between the four bodily fluids. Brain was the center of sensation and reason. Vomiting to treat depression and bloodletting to treat diseases were common treatments. Above photograph was taken in British Museum by Bahar Baştuğ. The Middle Ages (500–1450) temporarily derailed from this scientific way, the focus on supernatural influences “insanity” were caused by spiritual matters such as the influence of demons, witches, and sin. Healing and treatment in Middle Age Became a spiritual rather than a medical way. People who were “insane” were treated by exorcism. Some were chained to church walls; some were tortured and killed. In 1484, Pope approved the persecution of “witches.” 150,000 people were executed in the name of religion. The photograph was taken in Girne Museum by Bahar Baştuğ. Trepanation The photographs were taken in Samsun Archaeological Museum by Bahar Baştuğ. Malleus maleficarum (1510) written by two Dominican priests was witch-hunt manuals. Saint Thomas Aquinas (1225–1274) there was both theological truth and scientific truth. He claimed that mental illness must have a physical cause. Paracelsus (1490–1541) A Swiss physician suggested that various movements of the stars, moon, and planets influenced mood and behavior. Paracelsus focused on the biological foundations of mental illness and developed humane treatments. The Renaissance (14th–17th centuries) New discoveries in chemistry, physics, biology, and mathematics revealed. The emphasis on scientific observation and experimentation rather than mythology, religious beliefs, and dogma provided a model for future research. New medical discoveries resulted in biomedical approach that disease, including mental illness, could be understood by scientific observation and experimentation rather than beliefs about mind and soul. Descartes (1596–1650) A French philosopher argued that the mind and body were separate. >> dualism of mind and body Mental illness was often considered a disease of the brain, and the insane was treated using the medical orientation. Bedlam Despite the medical developments, treatment was bad. St. Mary of Bethlehem Hospital in London— Bedlam (1547) was opened. Cures included ice water (hydrotherapy) and bloodletting. Above photograph was taken in British Museum by Bahar Baştuğ. The Nineteenth Century Many advances allowed for a more sophisticated understanding of the relationship between body and mind in both health and illness. Disease and illness could be attributed to dysfunction at the cellular level. The nineteenth-century discovery that germs or microorganisms can cause disease have continued to support the “Cartesian dualism” perspective of Descartes. Dualism was softened due to the influence of a belief that the mind and body were connected, not separate. Franz Mesmer (1734 – 1815) An Austrian physician, noticed that many people experiencing paralysis, deafness, and blindness had no biomedical pathology, leaving psychological causes suspect. Claude Bernard (1813–1878) argued for the role of psychological factors in physical illness. Jean Martin Charcot (1825-1893) a French physician, used hypnosis to treat a wide variety of conversion disorders such as paralysis, blindness, deafness without apparent physical cause. Philippe Pinel (1745 - 1826) Pinel found moral therapy to treat patients as humanely as possible and encouraged the nurturance of interpersonal relationships. He improved the living conditions and treatment approaches used by mental hospitals. Dorothea Dix (1802–1887) a Massachusetts school teacher, During the Civil War, she acted as the head nurse for the Union Military. worked to improve treatment conditions for the mentally ill in the USA. Emil Kraepelin (1856–1926) German physician, defined the term dementia praecox to describe SCH. claimed that mental disorders were brain disorders. assisted in developing a classification system for understanding and categorizing many mental disorders. Franz Alexander (1891–1964) Studied the association between psychological factors and both physical and mental illnesses. As a specific stressor occurred, a genetically predetermined organ system responds. By repressing conflict, psychic energy could be channeled into the sympathetic nervous system, thus producing disease. While one person might repress conflict and develop an ulcer, another person might develop colitis, headache, or asthma. Eugen Bleuler (1857–1930) named firstly SCH. The Birth of Psychology Wilhelm Wundt (18321920) developed the first lab of psychology at the University of Leipzig, Germany in 1879, psychology was born. He was interested in individual and group differences in sensation and perception in various lab experiments. William James (1842 - 1910) established a psychology lab at Harvard University at about the same time with Wundt. published Principles of Psychology, the first classic psychology text. Stanley Hall established the second American psychology lab at John Hopkins University in 1883, while James McKeen Cattell established the third American lab in 1888. Hall established the first independent psychology department at Clark University in 1887. In 1892, the American Psychological Association (APA) was founded. Stanley Hall was elected its first president. Sir Francis Galton (1822-1911) Although not a psychologist, a relative of Charles Darwin, Galton was interested in statistical analysis of differences among people in reaction time, sensory experiences, and motor behavior. First testing attempts In the USA, James McKeen Cattell (1860–1944) also studied reaction time and other differences in human behavior. Pychology was founded, but psychologists were interested in empirically measuring various aspects of human behavior to better understand the mind. They had very little interest in applying their findings to help people with problems or disorders. The desire to apply these methods and principles to people was soon to result in the birth of clinical psychology. The Founding of Clinical Psychology The clinical psychology as a speciality area was born in 1896 with the opening of the first psychological clinic at the University of Pennsylvania by Lightner Witmer. Lightner Witmer (1867–1956) completed undergraduate studies at the Univ. of Pennsylvania in 1888. earned his PhD at the Univ. of Leipzig under Wundt in 1892. returned to the Univ. of Pennsylvania as the director of psychology lab. He was asked by a teacher to help her student who was not performing well in school. After assessing the child’s problem, Witmer developed a specific treatment program. He proposed that a psychological clinic could be assigned to diagnosis and evaluation, individual treatment, research, and the training of students. His colleagues disliked his idea, because, during this time, «psychology was considered a science, it shouldn’t be applied to actual clinical problems.» His contributions to the present day Many of his principles are still used today. a multidisciplinary team approach . He was interested in preventing problems before they emerged. The Influence of Binet’s Intelligence Test Alfred Binet (1857 -1911), a French scientist, founded the first psychology laboratory in France, in 1885. Binet was interested in developing tests to investigate mental abilities in children. In 1904, a French commission invited Binet and Theodore Simon, to develop a method to assist in providing mentally disabled children with appropriate educational services. Binet and Simon developed an intelligence test. The Influence of Binet’s Intelligence Test Henry Goddard learned the Binet-Simon scale while in Europe during 1908. He brought it back to the USA for translation and use. In 1916, Stanford University psychologist Lewis Terman revised the scale and renamed it the Stanford-Binet. Measuring the intellectual abilities of children became a major activity. The Influence of Freud in America Freud (1856-1939) proposed that unconscious conflicts and emotional influences could cause mental and physical illness. Freud’s 1900 publication of The Interpretation of Dreams resulted in acceptance of the psychoanalytic perspective. The Influence of Freud in America In 1909, Clark University was celebrating its 20th anniversary and Stanley Hall invited a large number of psychologists, psychiatrists, and academics for a series of lectures. In addition to Freud, Carl Jung, Otto Rank, Sandor Ferenczi, James McKeen Cattell, E. B. Titchener, and William James were invited.This conference increased the acceptance of Freud’s psychoanalytic theories in the USA. The American Psychological Association and Early Clinical Psychology During 1910s and 1920s, the APA was interested in scientific research in academic settings and was disinterested in clinical applications in the field. Clinicians felt the lack of interest and support by the APA and they decided to leave the organization. American Association of Clinical Psychologists (AACP) was founded in 1917. The AACP rejoined the APA as a clinical section in 1919. This difference of opinion between clinicians and academicians in psychology and between the applied clinical professionals and academic and scientific members of APA continues. The Influence of World War I When the USA entered the war in 1917, a large number of recruits needed to be classified based on their intellectual and psychological functioning. The U.S. Army asked from the APA an appropriate test for the military recruits. Army Alpha and Army Beta intelligence tests were developed by Henry Goddard, Lewis Terman, and Guy Whipple. The Army Alpha was a verbal test; Army Beta was a nonverbal test. The Army Alpha and Army Beta tests could be administered to very large groups of people and both literate and nonliterate adults. Clinical Psychology between World Wars I and II A testing development explosion occurred, over 500 psychological tests had been produced. These tests included both verbal and nonverbal intelligence tests, personality and psychological functioning tests, and career interest and vocational skill tests. Rorschach Inkblot Test (1921), the Goodenough Draw- A-Man Test (1926), the Thematic Apperception Test (1935), and the Wechsler-Bellevue Intelligence Scale (1939) James McKeen Cattell founded the Psychological Corporation to sell psychological tests to various organizations and professionals. Hermann Rorschach (1884-1922) In 1921, Hermann Rorschach published Psychodiagnostik, the famous inkblot test. Rorschach was a Swiss psychiatrist who died shortly after the publication of his famous test. In 1937, S. J. Beck and Klopfer published scoring procedures for the Rorschach that facilitated much more research to be conducted using the instrument. David Wechsler (1896-1981) In 1939, he developed the first comprehensive and individually administered intelligence test for adults. The Wechsler-Bellevue → WAIS Psychotherapy The early work of clinical psychologists involved psychological and intellectual testing. Psychotherapy and other treatment services were conducted by psychiatrists. Psychiatrists in the USA believed that only physicians could provide psychotherapy. In the late 1980s, psychologists won the right to be admitted as full members of American psychoanalytic institutes, resulting in their current ability to conduct psychoanalysis with patients. Unlike the psychoanalytic treatment provided by psychiatrists at the time, psychological treatment was more behavioral, reflecting the research developments in academic laboratories. John Watson (1878 – 1958) In 1920, he detailed the well-known case of little Albert who was conditioned to be fearful of white furry objects. Mary Cover Jones demonstrated how these types of fears could be removed using conditioning techniques, in 1924. Training By the early 1940s, there were no official training programs or policies regulating the field of clinical psychology. The majority of the APA membership consisted of academics primarily interested in research rather than practice applications. In 1935, the APA Committee on Standards of Training in Clinical Psychology recommended that a PhD and one year of supervised clinical experience be required to become a clinical psychologist. But the recommendation was ignored because the APA did nothing to enforce their recommendation at that time. A large group of clinicians again left the APA in 1937 to form a new organization, the American Association of Applied Psychology (AAAP). This new organization rejoined the APA in 1945. The Influence of World War II With the United States involvement in World War II, the need to assess military recruits again became serious. A committee developed a group administered intelligence test called the Army General Classification Test. The committee recommended several other tests, such as the Personal Inventory, and brief versions of the Rorschach Inkblot Test and the TAT. The Influence of World War II New tests were developed such as the MMPI as an objective personality inventory by Hathaway in 1943. In 1949, David Wechsler published the Wechsler Intelligence Scale for Children (WISC). The American Board of Examiners in Professional Psychology (ABEPP) was created to certify psychologists. This examination is now used in every state.