Introduction Everyone beginning the advanced research of mental health disorders is probably aware of the large amount of methods and ideas present in the field. Such amount may suggest a picture of huge complexity. Closer examination, however, shows that although these methods differ in important ways, they also share certain themes and historical roots. Accordingly, this paper will examine some historical methods of dealing with people who have mental health problems.
In considering this history the paper will trace early connections among what have evolved into major methods; in addition, the paper will specify some major modern methods to treat patients. By referring to the history, it is possible to understand much of the contemporary scene in mental health treatment. History Mental health problems have been of considerable interest since at least the period of the ancient Greeks. Greek and Roman medical theories considered that behavioural abnormalities were related to imbalances in the four bodily fluids and malfunctioning of organs.
Hysteria, for instance, was considered to be caused by wanderings of the womb. In the time of the Middle Ages, medical theories competed with methodical theories of treatment of abnormal behaviour. Whether a mental disorder was blamed on physiological dysfunction or evil spirits, however, “treatment” often consisted of rejection, incarceration, or punishment, although more humane treatments were also evident at times (Neugebauer 483). The evident success of moral treatment created conditions to cure people who have mental health problems by modelling new state hospitals after the retreats.
By the 1860s, nevertheless, results failing to meet expectations led to renewed pessimism about mental health problems. The state hospitals, first inspired by moral treatment, became fiercely custodial. Why had moral treatment become unsuccessful? There were three important reasons: One was that the early cure rates had been inflated by statistical fallacies, such as counting every release from a retreat as a cure, even though the same patient was soon readmitted.
A second reason was that the big state hospitals were never funded well enough to provide the family-like environment that might have accounted for any success the retreats did have. A third was that the impoverished clientele of the state hospitals lacked the requisite skills and secure homes to facilitate adaptation to the outside world, should they improve while hospitalized (Neugebauer 483). The disappointment with moral treatment is thus not surprising.
Most modern methods of dealing with people who have mental health problems are offshoots of approaches to adult psychopathology. Before considering the important modern methods, however, it will be appropriate to examine approaches to treatment in the 1950s and 1960s. Therapeutic Approaches emerging in the 1950s and 1960s Behavioural, pharmacological, nondirective, and family therapies came into view as new methods of treatment of patients who have mental health problems in the 1950s and 1960s.
Rather than being guided by a traditional theory, these therapies were generated largely as specific techniques. Despite the efforts of Dollard, Miller, and others to develop ideas of learning theory and psychoanalysis, most behaviour therapies of the late 1950s and 1960s developed against psychoanalysis. For instance, in Psychotherapy by Reciprocal Inhibition, which announced the renewal of behaviour therapies, Joseph Wolpe (1958) wrote that he originally was “a staunch follower of Freud.
” But Wolpe became sceptical of the universality of the Oedipus complex and the effectiveness of psychoanalysis. Identifying concepts from Pavlov and Hull, Wolpe defined neurotic behaviour as “… any persistent habit of unadaptive behaviour acquired by learning in a physiologically normal organism. Anxiety is usually the central constituent of this behaviour, being invariably present in the causal situation…. By anxiety is meant the autonomic response pattern or patterns that are characteristically part of the organism’s response to noxious stimulation” (1958, 32-34).
Wolpe trained more favourable responses that would “reciprocally inhibit” anxiety responses to specific stimuli. In Wolpe’s major method, called systematic desensitization, patients who have mental health problems build anxiety hierarchies beginning from the things that make them most anxious down to the things that make them minimally anxious. The patient is then instructed in relaxation responses that Wolpe considers are inimical to anxiety.
Thereafter, the patient must imagine the anxiety stimuli one after another, beginning with the least harmful in the hierarchy. As each stimulus is imagined, the patient will treat anxiety with the help of relaxation responses. Although young children may not be able to accomplish everything needed for this procedure, the same principles can be used while the child is engaged in enjoyable activities (cf. , Lazarus, Davison, & Polefka, 1965). Other behavioural methods are obtained from Skinner’s operant-conditioning paradigm.
Instead of attempting to remove anxiety by pairing threatening stimuli with nonfearful responses, operant methods alter the reinforcement contingencies of the target behaviour. For instance, positive- strengthening consequences are made possible on responses that are to be made stronger, whereas negative consequences are made possible on responses that are to be made weaker. At first, behaviour therapists suggested that their techniques were strictly derived from “modern learning theory” (Neugebauer 482). However, paradoxes emerged from the apparent success of methods that were theoretically opposite.
A method called implosive therapy or flooding, for instance, is entirely opposite to Wolpe’s systematic desensitization: It presents massive doses of the feared stimuli under the assumption that anxiety responses will quickly extinguish when no harm results from facing the feared stimuli. And there is evidence that implosive therapy can work with very fearful children (e. g. , Ollendick & Gruen, 1972). Many other behavioural techniques similarly have ambiguous ties to traditional learning theories. During the 1950s, it was found that some drugs first developed for other purposes seemed to reduce psychotic symptoms in maladjusted adults.
Further improvement of these drugs led to a revolution in the care of people who had mental health problems. Main tranquilizers—such as chlorpromazine (Thorazine)—made it probable to weaken physical restraints. It helped to release violent and excited patients from hospitals. Antidepressants—such as imipramine (Tofranil)— encouraged severely depressed patients. Although the biological functioning was not well understood, the evident benefits of pharmacotherapy turned psychiatry toward psychopharmacology and away from psychoanalysis (Neugebauer 483).