THE HISTORY OF CLINICAL
PSYCHOLOGY
SUBTITLE
OR, THE REASON
FOR WHY THERE IS
A STIGMA AROUND
MENTAL HEALTH
CLINICAL PSYCHOLOGY!
• It’s super new (even younger than psychology itself, which is already young)
• Only in 18th Century that we started trying to…like…care for people who were mentally ill.
• Clinical Psychology was accepted into psychology in 1896, which gives it a breezy 126 year history
• However, now it’s probably the most important branch of Psychology (in 2002 the Clinical Psychology
division of the APA had over 7000 members)
• The objective of this presentation is to briefly run you through the history of clinical psychology from
early ideas to just before Freudian psychoanalysis
BACK IN MY DAY…
• Clinical Psychology tries to help people who
are mentally ill, either through treatment, or
teaching of coping strategies or both
• Really ancient Greek and Roman physicians
were actually pretty progressive about
mental illness and did make an attempt to
understand it and help people with it.
• However, by 1652 the basic explanation for
why people were mentally ill was that they
were being punished by God – Martin Luther
describes the ‘feebleminded’ as ‘godless’
people, possessed by the devil and having
neither reason, nor souls
• For someone with an anxiety disorder, this
feels a little bit harsh
CLINICAL PSYCHOLOGY AND WITCHCRAFT
• Witchcraft became associated with mental illness after
the trial of Joan of Arc in 1431
• The definitive witchfinder’s handbook was called the
Malleus Maleficarum (“The Witch Hammer” – extremely
metal)
• Indeed, the book was so metal that Carl Binz in the 19th
Century said:
“It is…so insane, so raw and cruel, and it leads to such
horrible conclusions, that never before or since did such
a unified combination of horrible characteristics flow
from the human pen.”
• This was a pretty poor review of the book, but at the time
it was published, people loved it
• Went through 28 editions, at a time when printing was
expensive, difficult and slow.
THE WITCH HAMMER (DEROGATORY)
• Was intended to improve society (ironically)
• Written by two German Priests
• Three sections: “proof” that witches exist is part 1,
ways to recognize witches is part 2, how to
interrogate witches is part 3
• Part 2 categorizes the behavior of witches and,
when examined, the descriptions of witches
included experiencing delusions, hallucinations,
manic and melancholic episodes, catatonia and
paranoia. (Hothersall, 2004)
• Based on their description in the book – most
psychologist would diagnose these ‘witches’ with
mental illness – not a pact with the devil.
• From the 15th through 17th centuries ~200-500 000
witches were executed in Europe, 85% of whom
were women
EARLY MENTAL INSTITUTIONS
• So, needless to say, the ‘everyone who is
mentally ill is a witch’ form of mental health
care did not lead to amazing outcomes
• If you were lucky enough to not be tried as a
witch, you were either arrested or ‘fools’
towers,’ ‘fools homes,’ or ‘lunatic asylums’.
• First asylum to be opened with royal assent
was St. Mary of Bethlehem, often shortened
to bedlam which is also the origin of the
English word
• Terrible conditions, inmates were chained,
whipped, subject to bloodletting, spun
violently amongst other things
• Asylum workers were not paid, but could earn
money by charging visitors to tour the asylum
(Hothersall 2004)
FROM DICKENS:
“The newsman brought to us daily accounts of a regularly accepted and received system of loading the
unfortunate insane with chains, littering them down on straw, starving them on bread and water, denying
them their clothes, soothing them under their tremendous affliction with the whip, and making periodical
exhibitions of them at a small charge, rendering our public asylums a kind of demoniacal Zoological
Gardens” (Dickens, 1865)
‘CURES’ FOR MENTAL ILLNESS
• Bloodletting!
• Suspending you from a basket over a table where other people are eating while denying you food!
• Dumping as many as a hundred buckets of ice-cold water on you while you’re in chains!
• Strapping you to a bed that is rotating at ~100RPM (the ‘whirling cure’)
• Withdrawing a bunch of blood from your body and replacing it with blood from a calf! (yes, this actually
happened in 1667, although it wasn’t a regular treatment usually)
REFORMING THE SYSTEM
• Lots of people to talk about here, but I’m going to focus on
Phillipe Pinel (1745 – 1846)
• Pinel proceeded to absolutely overturn the entire institution of
mental health care in France
• Basically, he wanted to figure out how to actually heal the
‘insane’ but basically every expert that existed at the time
were mostly worthless (Hothersall 2004)
• Eventually landed on Joseph Daquin (d. 1815) who believed
that (prepare for shock and awe) the insane were sick people
who needed treatment (very much in the medical model of
mental illness
• “To look at a madman and be amused was to be a moral
monster.” (Daquin, 1941)
PINEL FLIPS THE TABLE
• Pinel worked with Daquin and started pubishing a
bunch of papers. In 1793, he becomes the director of
the Bicetre asylum in Paris (at this point, the asylum
had archers patrolling the walls to prevent patients
from escaping)
• Pinel was confused and horrified and noted that
“everything presented to [him had] the appearance
of chaos and confusion.” (Hothersall 2004)
• Pinel’s first step? Stop chaining up the patients.
• This did not impress the revolutionary council who
basically said that that was tantamount to going to
the zoo and letting all the animals loose
• The council let him do it though, on the assumption
that it would fail and that Pinel would be the first
victim
LA BICETRE
• Weirdly, being kind and understanding to patients instantly ‘cured’ many of them
• First person he unchained was an English soldier who had been at the center for forty years.
• Pinel asked him to be calm and not hurt anyone and unchained him, at which point he became a model patient, helped care for
other people, and was released in two years
• Another patient, Charles Chevigne was a former soldier kept in chains due to his legendary strength and violent nature
• Pinel freed him and later saved Pinel’s life when a mob stormed the asylum and accused him of turning dangerous lunatics
loose, harboring membors of the bourgeoisie, poisoning the wells and causing a cholera epidemic (Zilboorg and Henry, 1941)
• In the years before Pinel’s arrival – in 1792 57 of the 110 people admitted died in a year
• In 1793, 95 out of 151 died
• In the first two years of Pinel’s administration, the ratio of deaths to admissions was 1:8 - a reduction of about 50% from the
previous years
LA SALPETRIERE
• After fixing the Bicetre, Pinel got a transfer to the Salpetriere
which was the asylum for women.
• The Salpetriere had basically all the same problems as la
Bicetre when Pinel arrived except that the asylum workers
were also very frequently sexually assaulting the prisoners –
so same but worse.
• Similar results at la Salpetriere as Pinel had achieved at la
Bicetre
• In public lecture Pinel delivered perhaps his most famous
quotation outlining his principles of moral treatment
• “First no cruelty, no humiliation. Use physical force only to
prevent the patient harming him or herself or someone else,
but not for punishment. Second, get as accurate a case
history as possible. Third, encourage work and social
relations. Finally, most powerful and unscientific, do your
best to understand the patient as an individual human being.”
(Pinel, in Karon, 1999)