A History of Psychological Treatment

Mental health awareness has never been more prominent. Conversations about anxiety, depression, and therapy flood everyday life with more and more people beginning to treat mental illness seriously. Yet the treatments that a student learns, or passively listens to while playing Tetris in AP Psychology, are only the tip of the iceberg. What came before CBT, before Freud, before deinstitutionalization, or even the infamous lobotomy?

The answer is a long and deeply questionable journey.

Ancient civilizations had surprisingly varied approaches. The ancient Greek physician Hippocrates argued that mental illness originated in the brain rather than in the gods, a remarkably scientific conclusion for a society from such a long time ago(“Hippocrates”; Kleisiaris et al.). However, at the same time, the Greeks also championed the “wandering uterus” theory, proposing that a displaced uterus roaming the female body caused a condition they called hysteria (“History of Mental Illness”). As you see, Greek treatments were a mixed back.

The Middle Ages were even worse. Theories of demonic possession led to treatments like exorcism, flogging, prayer, and relic-touching, framing suffering as a moral failing rather than something medical(“Historical Perspectives”; Pies). It wasn’t until the 18th century’s Moral Treatment Movement, which emphasized humane care and basic human dignity, that things began to improve.

The most interesting chapter begins in the 19th century. Before understanding it, it’s important to know the context. The 1800s were defined by industrialization, scientific ambition, and an urgent need to prove that medicine was a serious, legitimate discipline. Doctors were not superstitious medievalists. They were men of reason and progress, determined to find valid physical causes for psychological disorders and thus, used many crazy techniques.

Railway spine, coined by British surgeon John Eric Erichsen in 1866, described lingering symptoms in passengers after train accidents, and was widely debated as either a spinal concussion or a psychological condition (Davidson; “Railway Spine”). Neurasthenia, introduced by New York neurologist George Beard in 1869, was a diagnosis that covered fatigue, anxiety, headaches, and depressed mood, with such a large definition catching people as if they were Pokémon (Beard; “Neurasthenia”). Drapetomania was a “disorder” invented in 1851 by Dr. Samuel Cartwright to demonize enslaved Black people who attempted to escape, with “treatments” that included whipping and toe amputation (Cartwright; “Drapetomania”). Hysteria remained a conveniently flexible label applied almost exclusively to women, often for the very hysterical act of expressing emotions (“History of Mental Illness”). Masturbation was also treated as a medical disorder during this period and was blamed for conditions ranging from insanity to physical disease, prompting elaborate interventions from physicians (“Treating Mental Illness”). Unfortunately, 19th century psychology was very focused on social control along with science.

So what did doctors actually do about these conditions? Hydrotherapy was a common treatment based on the idea that water could shock the nervous system back to health. This ranged from a nice, therapeutic bath to something reminiscent of waterboarding, depending on the doctor’s enthusiasm (“Hydrotherapy, Encyclopedia”; “Healing Waters”). Then there was rotational therapy, developed from a design by Erasmus Darwin, grandfather of Charles Darwin, in which a patient was strapped into a chair suspended from the ceiling and spun very fast, because of the theory that rotation might calm the nervous system (Wade et al.; “Bethlem”). Physician William Hallaran later modified the device to spin four patients at once at up to 100 rotations per minute, just like a Beyblade (“Bethlem”). The ideals of the Moral Treatment Movement were clearly a distant memory.

And of course, there were the surgeries. Dr. Henry Cotton, medical director of New Jersey State Hospital at Trenton from 1907 to 1930, was convinced that mental illness was caused by hidden bodily infections, and his solution was to remove them (Scull; “Henry Cotton”). Teeth, tonsils, spleens, colons, ovaries, and other organs were taken from patients (“Henry Cotton”; Scull). Patients died, with mortality rates reportedly as high as 30–45 percent (“Henry Cotton”), which should have been an obvious sign that the cures did not work. Cotton remained fully convinced he was doing a good job.

It is difficult to read psychological history without feeling lots of horror. We really have come a long way. Today’s treatments, grounded in research, ethics, and real neuroscience, are built on lessons from centuries of getting it wrong. Recognizing just how wrong we once were is perhaps the most important reminder of how seriously we must take the work of getting it right.

By. Daniel Song

Works Cited

https://en.wikipedia.org/wiki/Mental_illness_in_ancient_Greece

https://pmc.ncbi.nlm.nih.gov/articles/PMC4263393/

https://nobaproject.com/modules/history-of-mental-illness

https://socialsci.libretexts.org/Bookshelves/Psychology/Psychological_Disorders/Abnormal_Psychology_(Cummings)/02:_Perspectives_on_Abnormal_Behaviour/2.01:_Historical_Perspectives_on_Mental_Illness

https://www.psychiatrictimes.com/view/psychiatrys-ancient-origins

https://hekint.org/2022/07/07/herbert-william-page-and-the-railway-spine-controversy/

https://en.wikipedia.org/wiki/Railway_spine

https://www.nlm.nih.gov/hmd/topics/diseases-of-mind/bio-george-beard.html

https://en.wikipedia.org/wiki/Neurasthenia

https://www.apaf.org/library-archives/galleries/central-state-hospital-exhibit/dr-samuel-cartwright/