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The Role of Biology and Historical Evolution
Abnormal Psychology · Chapter 1: Foundations of Abnormal PsychologySection 1.2 · lesson 2 of 9713 min · free with a free account
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In this lesson
From supernatural accounts to compassionate care, and what each shift cost.
- Trace the major shifts in how abnormal behavior has been explained
- Separate the somatogenic tradition from the psychogenic tradition
- Explain why moral treatment worked and then eroded
- Describe deinstitutionalization and the documented shortfall
Transcript
Everything said in the video, section by section (1,822 words). Read along, or search it.
Foundations of Abnormal Psychology
The Role of Biology and Historical Evolution
Every era has believed it finally understood disturbed behavior, and every era has been wrong. Wrong in ways the next era could see clearly, and its own could not. This section traces how the explanations changed, and what changed along with them. One pattern runs through all of it, and it is the thing worth holding onto. What people believed caused a condition determined what was done about it. It also determined who was considered qualified to do it. We move from spirits, to bodily fluids, to walls, and then to reform. After that, two rival traditions mature side by side, and neither one wins. One locates the cause in the body. The other locates it in experience. Neither ever absorbed the other's evidence, which is exactly why both are still here.
Before You Begin
How to Read a History of This Field
One note before any of this history begins. This material is educational, and it is not a basis for diagnosis. Not for diagnosing yourself, and not for diagnosing anyone else. Concerns of that kind belong with a licensed professional. A second note applies to a history section in particular. Words like lunatic, madness, and insane asylum will appear in what follows. They appear only as historical usage under discussion, never as descriptions of people. And one more thing, about the attitude to bring to the explanations themselves. They were the serious work of intelligent people reasoning from the evidence they had. They are products of their era rather than occasions for ridicule, and one day, so are we.
Supernatural Accounts
What Trephination Does and Does Not Establish
Start with the earliest explanations we can recover, which were supernatural. A supernatural account locates the cause of a condition outside the natural order. In spirits, in possession, in a curse, or in divine displeasure. Accounts like these appear in societies widely separated from one another. That tells us something about how readily people reach for agency as an explanation. It tells us very little about the conditions themselves. The physical evidence usually cited is trephination, and it deserves a careful look. Trephination is cutting or scraping a hole through the skull of a living person. It is attested in prehistoric remains from several continents. The bone at the margins of many such holes shows healing, so people survived it. Sometimes more than once. But what it does not establish is why it was done. That it released an evil spirit is an inference, not a finding. Head injury fits too.
Humoral Theory
The First Systematic Bodily Account
Greek and Roman medicine made the first sustained attempt at a bodily account. Humoral theory held that health depends on the balance of four bodily fluids. Blood, phlegm, yellow bile, and black bile. Disease follows from their excess or deficiency, and that included disturbance of mood and thought. Excess black bile was held to produce the state then called melancholia. Yellow bile was held to produce states of agitation. It explained why disturbance ran alongside physical illness, and why rest and diet seemed to help. It could not explain why symptoms took the particular forms they did. Nor why disturbance so often followed an identifiable loss or event. The evidence for it would have been the four fluids themselves, observed and varying. The evidence against it was the accumulating failure to find them at all. So the theory is false. The move it made, from spirits to the body, is permanent.
A Correction
The Medieval Period Was Not What the Story Says
Now the medieval period, and a correction worth making carefully. The popular version says classical medicine was forgotten. And that demonic explanation became universal, with disturbed people routinely treated as witches. That version is largely inaccurate. Demonic explanation did exist and did matter, and exorcism was practiced. But natural explanation persisted alongside it, right through the period. Physicians went on working inside the humoral framework. Monastic and municipal institutions cared for people described as being of unsound mind. In several places the law separated disturbance arising from illness from wrongdoing. And most disturbed people were cared for by their own families, as in every era. The large witch persecutions belong mainly to the early modern period, not the medieval centuries. Those accused were identified by social position, local dispute, and accusation. So why does the exaggerated version persist? Because it makes a satisfying story of progress.
Confinement
The Asylum and the Assumption Behind It
From roughly the sixteenth century, care moved out of the family and into the institution. An asylum housed people considered unable to live in the community. The earliest ones were not founded as hospitals in any modern sense. Their purpose was custodial. Removal from public life, rather than treatment. They held the disturbed, the destitute, and the merely inconvenient, often in one building. Conditions in the worst of them were severe. Residents were chained, in unheated, unsanitary rooms. In some documented cases they were displayed to paying visitors. Here is the part that explains everything else about those places. There was no expectation of recovery, because the conditions were assumed to be permanent. Where recovery is not expected, no treatment needs justifying and no outcome needs measuring. So the cruelty was not principally a failure of kindness. It followed from a belief.
Moral Treatment
A Reform That Worked, and Then Did Not
Moral treatment was the reform movement that overturned that belief. Late eighteenth and early nineteenth century. One warning about the word moral. It does not mean virtue, but carries its older sense, psychological. The movement treated disturbed people as capable of reason, and responsive to structured environments. Philippe Pinel, working in Paris, removed chains and instituted careful record keeping and observation. William Tuke founded a rural retreat in York, run on quiet routine and occupation. Dorothea Dix, decades later in the United States, documented conditions in jails and poorhouses. Her campaign is credited with establishing many state institutions. Early reports from these settings described substantial rates of improvement. Then the reforms eroded. The reasons were structural rather than moral, and that distinction matters. Institutions grew past the scale at which individual attention was possible, and funding lagged behind. Dix created institutions that became, within decades, exactly what she had exposed. Notice that mechanism, because it is not only historical. It recurs whenever a working model is scaled without resources.
Somatogenic
General Paresis: A Bodily Cause Demonstrated
Two traditions now mature in parallel, and we take the bodily one first. The somatogenic tradition holds that disturbance arises from bodily causes. Anatomy, physiology, infection, or inheritance. Humoral theory was its first systematic form. For two thousand years the tradition lacked one thing it badly needed. A single condition where the bodily cause could be demonstrated rather than asserted. General paresis supplied it. Progressive cognitive decline, grandiose beliefs, physical deterioration, ending in death. The chain of reasoning that identified its cause is the part worth memorizing. First, association. Patients had disproportionately often contracted syphilis years earlier. That is only a correlation. Second, exclusion. A controlled inoculation study showed these patients were already infected. Third, demonstration. The organism itself was identified in brain tissue after death. So a presentation that looked entirely psychological had a specific physical cause. But keep the caution beside it. This remains the clearest case of its kind.
Psychogenic
Symptoms a Suggestion Could Create and Dissolve
Now the other tradition, which grew out of a puzzle the first could not absorb. The psychogenic tradition holds that disturbance arises from psychological causes. Experience, conflict, learning, and memory. Nineteenth century clinicians met patients with what was then called hysteria. A historical term for physical symptoms occurring with no detectable bodily lesion. Paralysis, blindness, or loss of sensation, with nothing at all to find on examination. Two observations made them theoretically important. First, symptoms followed everyday ideas about the body, not nerve distribution. A numbness stopping neatly at the wrist, where no actual nerve stops. Second, the symptoms could be removed under hypnosis, and produced under it as well. Hypnosis being a state of focused attention and heightened responsiveness to suggestion. Sit with that. A symptom suggestion can create and dissolve is not straightforwardly a lesion. Out of this work came the practice of treating psychological difficulty by structured conversation.
Side By Side
Each Tradition Fails Where the Other Succeeds
It helps to set the two traditions side by side and compare them row by row. The somatogenic core claim is bodily causes. The psychogenic core claim is experience and learning. Their evidence differs. General paresis and familial patterns on one side, hypnosis on the other. Their treatments follow directly from those claims, which is the pattern of this whole section. Physical intervention on the body, set against structured conversation about experience. Both have modern descendants, and both descendants are in daily use today. Medication, neuroscience, and genetics come down from the first. Psychotherapy comes down from the second. Now the last row, which is the whole point of the comparison. The somatogenic account cannot handle conditions that follow events and respond to talk alone. The psychogenic account cannot handle conditions with strong heritable and biological signatures. Each fails exactly where the other succeeds, and that is why the field never chose.
Medication And Policy
Deinstitutionalization, Implemented in Half
The middle of the twentieth century brought the largest single change in how care is delivered. Psychotropic medication acts on the brain to alter mood, thought, or perception. It entered widespread use from the nineteen fifties, reducing agitation and some features of psychosis. For the first time, symptoms severe enough to require confinement could be reduced enough for community living. Deinstitutionalization is the policy that followed, moving care into community settings. It rested on three arguments, and all three of them were sound. Institutions produced harms of their own, including the loss of ordinary living skills. The new medications made community living feasible, and confinement restricts liberty, which requires justification. The plan was a transfer. Beds close, and community services receive the population and the funding. The first half happened at scale. The second half did not. Provision was built more slowly, funded less generously, and distributed unevenly. The gap is still visible in homelessness, in emergency departments, and in prisons. This is not evidence that the policy was wrong. It is evidence that it was implemented in half.
One Description
Four Explanations, Four Treatments
Finish with one description, explained four different ways. It is a composite, describing no real person. Thomas is twenty-eight, and has withdrawn from those around him over several months. He speaks rarely, eats little, sleeps poorly, and is at times agitated without apparent cause. He says he is being observed, and that he deserves punishment for an unspecified wrong. There is a family history in an uncle, and he has not worked for four months. A supernatural account calls this possession, or a curse, and the treatment is ritual. A humoral account calls it excess black bile, treated with diet, bathing, and rest. A nineteenth century somatogenic account calls it a disease of the brain, citing the family history. An early psychogenic account calls it a conflict outside his awareness, treated by structured conversation. Here is the reasoning to reproduce. The description never changed, and the treatment changed four times. Each explanation was a reasonable inference from a different subset of the same facts. Today's account adds social circumstances. Whether that is progress, or this era's preference, stays open.
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