Foundations and Early
History of Clinical
Lecture Preview
 Early Conceptions of Mental Illness: Mind and Body
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
 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
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
 too much yellow bile
resulted in a choleric
(angry, irritable)
 too much black bile
resulted in a melancholic
(sadness, hopelessness)
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
 Treatment for mental
problems should include
talking and the use of
 The use of logic is one of
the major principles of
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
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.
The photographs were taken in Samsun Archaeological
Museum by Bahar Baştuğ.
Malleus maleficarum (1510)
 written by two Dominican priests was witch-hunt
Saint Thomas Aquinas
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
 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.
Despite the medical developments, treatment was bad.
St. Mary of Bethlehem Hospital in London— Bedlam (1547)
was opened. Cures included ice water (hydrotherapy) and
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
 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
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
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
 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
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
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
 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
 Many of his principles are still used today.
 a multidisciplinary team approach .
 He was interested in preventing problems before they
The Influence of Binet’s Intelligence Test
 Alfred Binet (1857 -1911), a French
scientist, founded the first
psychology laboratory in France, in
 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
 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
 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
The U.S. Army asked from the APA
an appropriate test for the military
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
The Wechsler-Bellevue → WAIS
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.
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
 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
 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

The Influence of World War II