Lernmaterialien für 7. THE PSYCHOANALYSIS an der Universität Bremen

THEORY AND TREATMENT OF MADNESS

MESMERISM

HYPNOTISM

PSYCHOANALYSIS

NEO-PSYCHOANALYSIS

• Age of Enlightenment or Age of Reason (Zeitalter der Aufklärung):
  Power of human reason to understand the world and to govern human affairs 
• Man was conceptualized as a creature of reason and madness was an example of the failure of reason. 
• The mad, in much of Europe, were usually kept at home or allowed to roam
• Theory of humors (Hippocrates): Health was regulated by balance of the four humors in the body: phlegm, black bile, red or yellow bile, and blood.
  Humors were dysregulated -> Emotional and behavioral disturbances would ensue.
  Bleeding, purging, and other techniques were meant to restore this balance and return person to health
• Vincenzo Chiarugi outlawed the use of chains to restrain patients and introduced more humane treatment.

• Philippe Pinel (1745–1826), director of the Salpêtrière, instituted changes in the care of mad people
• Patients were released from shackles (Fesseln) and treated as reasonable humans -> had remarkable success

• William Tuke (1732–1822), Quaker (Freimaurer), believed that mental illness was a state from which a person could recover with the right treatment. The Retreat’s staff employed an attitude of personal care, and opportunities to engage in useful tasks to nurture their patients back to health. 
• The small size of the patient population, as it turned out, was vital to the success of the treatment.

• Regarding patients as inherently reasonable & providing humane care that would help return to their reason. Patients were expected to act reasonably and contribute their labor by completing household tasks.
  
  

Alienists: Physicians who treat the mad people in the US (mental disorders because alienated from reason)

• Benjamin Rush (1745–1813) used treatments inspired by Enlightenment ideas: Novel forms of restraint
  He used crib (Gitterbetten), in which patients had to lie still as there was no room to move -> moral treatment
  He thought that as patients calmed down, they would be restored to senses and reason would return.
• Thomas Kirkbride (1809–1883), leader of moral treatment, developed the Kirkbride Plan 

• Moral treatment was labor intensive: Required staff, give a great deal of time and attention to patients.
• Increases in patient numbers, Decreases in resources: Moral treatment developed to Simple palliative care
• Simple palliative care: Patients were fed and perhaps allowed to walk outside once a day. 
• End of the 19th century: Majority of asylums had become warehouses of the insane. 
• Alienists began desperately to search for other explanations and causes of mental disorders
  Created an opening for psychological explanations of mental disorder and a basis for treatment.

• Mesmer’s set in motion a series of developments that led to the acceptance of the notion of a
   dynamic unconscious and the possibility of altered consciousness and dissociation. 
• Human body contained a magnetic force that could be manipulated with the use of animal magnetism. 
• Later Mesmer touch patients, believing that his own magnetic force transmits into the bodies by his touch
• Mesmer was remarkably successful in Vienna until the case of Fräulein Paradis (claimed that she could see) Mesmer was forced to leave Vienna and settled in Paris in 1778 and was almost immediately successful
• His patients were initially drawn from aristocratic circles, including Queen Marie Antoinette.
• His ritual induced a ‘‘crisis’’ in the patients, where they would typically sweat, convulse, and even scream.
• The academy refused and the clergy accused him of being in consort with the devil.
• The commission consisted of Benjamin Franklin, Antoine Lavoisier, and Guillotin concluded that
   animal magnetism did not exist and that any positive results were from imagination. 

• Jean Martin Charcot (1825–1893) became the director of the Salpêtrière in 1862. 
• Was highly interested in the ‘‘anatomical–clinical’’ method: Patient’s body was examined at autopsy to determine cause of death. The pathological findings were then related back to signs and symptoms recorded, before death, to establish the disease’s distinctive clinical signs. 
• Diseases of the nervous system (multiple sclerosis)

• Charcot believed that hysteria was a functional disease of the nervous system -> described the symptoms and classified the characteristics and stages
• the ovaries (Eierstöcke) might play a significant role in the onset and cessation of hysterical fits 
• Charcot concluded that hypnotizability, could be used to treat hysteria and also indicated its presence. 
• This brought him into sharp conflict with the theories of Liébeault and Bernheim, who believed that hypnotizability was simply a form of suggestibility (Beeinflussbarkeit), a trait of the normal population. 

• Hysteria was distinctly a ‘‘female maladie’’ in the mid-to-late 19th century. 
• The cause of the female patient’s emotional distress was located in her reproductive system.
• Gynecological surgeons were more likely than Alienist and Neurologist to subscribe to this theory. 
• Pierre Janet (1859–1947) developed the theory of dissociation even further and soon came to study and publish on the occurrence of multiple personalities or those with co- consciousness.

• 1880: Freuds mentor Josef Breuer began treating a young woman “Anna O.”
  After the death of her father: Multiple personalities, speech difficulties, bizarre hallucinations
• Using hypnosis, he attempted to reach the causes of each of her symptoms, and when they were discovered and dealt with in the psychotherapy, the symptoms disappeared. 
• Catharsis method: Symptoms were result of pent-up emotions (if emotion released -> symptoms disappear) 

• 1885: Freud received a scholarship to study with the neurologist Jean-Martin Charcot  at the Salpêtrière Hospital in Paris. Liébeault and Bernheim, played a significant role in Freud’s work
• Technique of free association: By encouraging the patient to express any random thoughts that came associatively to mind, the technique aimed at uncovering unconscious. Because of its conflicts with conscious thoughts, this material was normally hidden, forgotten, or unavailable to conscious reflection.
• Theory of neuroses: Mental diseases
• Psychoanalysis can be defined both, as a theory of the mind and a method.

• Repression: Traumatic experience that could lead to anxiety -> repress any memory of the event
• Rationalization: New ways to think about disappointing or tragic events
• Projection: Attribution of negative qualities to others that are part of the person making the attribution
  When the defense mechanisms break down -> Neuroses or psychoses can result.
  
  

• Theory of the etiology of neuroses: Childhood sexuality.
  Described the development of personality in childhood as an orderly sequence of psychosexual stages, 
• Oral stage: Pleasure is associated with sucking, at the breast or even sucking one’s thumb. 
• Anal stage: Begins in the second year of life and pleasure there is associated with expulsion of the feces
• Phallic stage: Begins around age four. Sexual pleasure is derived from genitals and masturbation may begin.
  Oedipal complex: The child has sexual desires for the opposite sex parent. 

• Significance of experiences in infancy and childhood on the development of adult personality 
• Sexuality is a normal part of human behavior, a source of great pleasure and intimacy

• Medicalization of mentality came to center on notions of disordered consciousness in the work of French physicians at the Salpêtrière Hospital in Paris, such as Jean- Martin Charcot, Pierre Janet
• Sigmund Freud, formulated a nonmedical theory of mental order and disorder and developed clinical applications based on his theory; theory and technique were called psychoanalysis. 

• Background: Enlightenment discourse about madness and its appropriate treatment. 
• Moral management and Hypnosis