Phillippe Pinel (1745-1826)

Philippe Pinel was a French physician, who pioneered humane mental health treatment.

Pinel was born in Jonquières, France, into a family of physicians. Pinel himself received his medical degree from Toulouse University (Kendler, 2020). He moved to Paris in 1778 in hopes of working as a physician in the city, however, he was prevented from practising medicine due to him not receiving schooling in the city (Woods & Carlson, 1961). Therefore, Pinel remained an outcast of the Parisian medical society, and for a number of years, had to make a living by translating works and tutoring. Eventually, due to the changing social power dynamics in Paris in the 1780s, Pinel was given a position as a professor at a medical school and was also appointed the resident physician in two Paris asylums.

Pinet felt great pity for the patients of mental asylums and condemned their mistreatment (Woods & Carlson, 1961). He set out to make changes to the inhumane conditions of the filthy, brutal and un-therapeutic Parisian asylums. The state of the asylums reflected the views on mental illness at the time. It was a common belief that such illnesses could not be cured, and therefore there was no use in proper treatment. Pinet, however, did not share this view. He believed that mental illness was similar to physical illness and could be cured with treatment.

In order to develop proper treatments for his patients, Pinel applied the scientific methods of observation and analysis (Woods & Carlson, 1961). He kept records of many mentally ill patients and believed that by analyzing their symptoms, he would be able to find the common underlying causes of their illness. This led to Pinet describing different kinds of mental illnesses, such as mania and melancholy. Although not completely accurate, some of his descriptions mirror mental disorders found in the DSM today, demonstrating the effectiveness of his methodology. Pinet also determined two causes of mental illness, predispositional and occasional. Predispositional causes included genetics and an irregular life environment, while occasional causes included physiological disturbances, such as menopause and head injuries.

Pinel’s analytic observations lead to him developing psychological treatments for his patients, rather than physical ones, as was the norm for many years prior (Woods & Carlson, 1961). Pinel’s treatment method was rooted in kindness. He believed that building a good rapport with his patients and giving them hope for improvement would benefit their treatment. The first of his reforms was unchaining the patients, believing that they needed liberty in order to be better understood. However, sometimes Pinel was forced to be a bit more disciplinary and even coercive when patients experienced delusions that endangered themselves and others. Pinel ensured that all of his patients received the necessary environmental comforts, such as proper nutrition and living spaces. He denounced the use of heavy medications as a treatment, and believed that they could interfere with the recovery process. However, he occasionally used sedatives to calm his patients down so that they could be reasoned with.

Pinel summarized his methods and findings in [Medico-Philosophical Treatise on Mental Alienation] (1809) (Woods & Carlson, 1961). He argued that physicians should be the ones helping the mentally ill, not “jailers or priests” (Woods & Carlson, 1961, p.25). Overall, Pinel’s employment of humane treatments and the use of scientific methods to help treat mental illness set the foundations for the field of psychiatry, and make him one of the most important historical figures in psychiatry.

References

Cognitive Behavioural Therapy (CBT)

Aaron Beck (1921-2021)

Aaron Beck is considered is the founder of Cognitive Behavioural Therapy (CBT).

Beck was born in Providence, Rhode Island to an Eastern European Jewish family. Beck completed his graduate studies at Brown University in 1942, where he was an exemplary student. After completing his medical degree at Yale University, one of Beck’s residency rotations placed him at the Cushing Veterans Administration Hospital (Yavuz & Turkcapar, 2012). This psychiatry placement roused his interest in psychoanalysis. After some years of experience with psychoanalysis and neuropsychiatric, Beck began working as an assistant professor in the psychiatry department at the University of Pennsylvania in 1954 (Thase, 2022). Here, Beck began his research, which aimed to expand psychoanalytic treatment methods.

In his research, Beck discovered that the dreams of depressed and anxious individuals reflected their real-life perspectives (Thase, 2022). This led to Beck developing “Beck’s cognitive triad”*, which describes how depressed and anxious individuals have automatic cognitive processes that negatively alter their views of themselves, the world and their future. Beck believed that individuals may not always be aware of these “automatic thoughts” that influence their feelings and behaviours(Moskow et al., 2022). To treat these mental disorders, the negative thoughts must be corrected and replaced by healthy thinking patterns. In his behavioural exercises, Beck asked his patients to test the rationality of their automatic negative thinking, and later challenge this thinking (Rachman, 2015).

After witnessing the success of cognitive therapy, Beck combined the ideas of his cognitive psychology and behavioural psychology to form cognitive-behavioural therapy (CBT) (Moskow et al., 2022). Since its founding in the 1970s, CBT has been used as an effective method for treating psychological disorders. In modern CBT, individuals identify situations and emotions which trigger negative thoughts and behaviours and attempt to build positive coping methods for these triggers. Currently, the application of CBT has made great progress, and has been altered to treat various disorders.

Over his life, Beck published over 550 works and developed important clinical assessment scales** (Yavuz & Turkcapar, 2012). He has held several important positions in the field, including being the president of the Beck Institute for Cognitive Therapy and Research. His work and achievements have made him one of the most influential psychiatrists in the history of Western psychiatry.

References

Moskow, D. M., Barthel, A. L., Hayes, S. C., & Hofmann, S. G. (2022). A process-based approach to Cognitive Behavioral Therapy. In Comprehensive Clinical Psychology (pp. 16–33). Elsevier. https://doi.org/10.1016/B978-0-12-818697-8.00183-7

Yavuz, K. F. & Turkcapar, M. H. (2012) Aaron Temkin Beck (born July 18, 1921-) biography. Journal of Cognitive-Behavioral Psychotherapy and Research, 1 (2), 77-80.

Further Reading

*Beck, A. T. (Ed.). (1979). Cognitive therapy of depression. Guilford press.

**Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory (BDI-II) (Vol. 10, No. 3). London, UK: Pearson.

Dialectical Behavioural Therapy (DBT)

Marsha Linehan (1943~)

The Emmanuel Movement (**SC)

Written by: Freddy Bishay

The birth of the Emmanuel Movement occurred in 1906, in a church in Boston, Massachusetts. One day, Dr. Elwood Worcester, a clergyman of the Episcopal Protestant Emmanuel Church, announced that he would be willing to speak with any parishioners dealing with moral or psychological problems (Benjamin & Baker, 2004, as cited in Schultz & Schultz, 2015). Worcester noticed the turnout was much larger than expected and realized the need for therapeutic services for the general public.

Worcester was the student of German experimental psychologist Willhelm Wundt, who believed in the need for the application of psychology to real-world problems(Schultz & Schultz, 2015). Worcester, alongside other clergy members, began administering talk therapy to individuals seeking help. Worcester aimed to solve emotional problems that physicians could not solve and stated that his clinic was open to all sexes and races (McCarthy, 1984). The Emmanuel movement’s methods strayed from those of ordinary confession found in Orthodox or Catholic Christianity, likely due to the Protestant church not having a priest-led confession (Allen, 2017, Shenouda III, 1996). Orthodox and Catholic confession involves individuals confessing their sins to a priest or clergymen who acts as a proxy for God, and the priest typically does not offer any therapeutic remedies other than prayer and simple advice (Allen, 2017; Shenouda III, 1996). Contrastingly, the movement employed two-way communication, self-help, suggestive therapy and hypnosis (McCarthy, 1984; White, 2000).

The movement introduced methods commonly used today, such as using group therapy to help those with alcohol use disorder, mirroring modern Alcoholics Anonymous meetings (White, 2000). Recovered patients even acted as lay therapists, treating others suffering from alcoholism (McCarthy, 1984). While some techniques used by the movement’s therapists were empirically questionable, such as hypnosis, many progressive methods were used that involved holistically treating the individual and promoting better thought patterns (Cunningham, 1962). These techniques are comparable to those used in cognitive-behavioural therapy, in which cognitive distortions are addressed and changes in life structure and habits are made to ensure the maintenance of healthy thinking.

In September 1909, Sigmund Freud visited America and popularized psychoanalysis (McCarthy, 1984; Schultz & Schultz, 2015). American physicians quickly took on the philosophies of psychoanalysis and discouraged the use of religious language in their work (McCarthy, 1984). On the other hand, clergymen also refused to use language derived from psychoanalysis. This created a divide between the religious and scientific schools of thought, with clergymen and physicians arguing that the two forms of therapy could not coexist. Regardless of the divide between religion and psychoanalysis at the time, many argue that the American public more readily welcomed psychoanalysis because of the Emmanuel Movement (Caplan, 1998; Cunningham, 1962; Schultz & Shultz, 2015).

The Emmanuel movement made it possible for many distressed Americans to receive the help they need and opened the doors to normalizing seeking mental health therapy. Although psychoanalysis took over the mental health movement in Western culture in the past, today religious and scientific techniques are integrated, such as those found in socially just counselling (CRSJ) or religious cognitive-emotional therapy (McLeod, 2019; Rajaei, 2010).

References

Allen, R. (2017, September 29). Do protestants confess? Classroom. https://classroom.synonym.com/do-protestants-confess-12085342.html

Caplan, E. (1998). Popularizing American psychotherapy: The Emmanuel Movement, 1906–1910. History of Psychology, 1(4), 289–314. https://doi.org/10.1037/1093-4510.1.4.289

Cunningham, R. J. (1962). The Emmanuel Movement: A variety of American religious experience. American Quarterly, 14(1), 48–63. https://doi.org/10.2307/2710226

Hymer, S. (1995). Therapeutic and redemptive aspects of religious confession. Journal of Religion and Health, 34(1), 41–54. http://www.jstor.org/stable/27510875

McCarthy, K. (1984). Psychotherapy and religion: The Emmanuel Movement. Journal of religion and health, 23(2), 92–105. https://doi.org/10.1007/BF00996152

McLeod, J. (2019). An introduction to counselling and psychotherapy: Theory, research, and practice (6th ed.). Open University Press/McGraw-Hill Education.

Rajaei A. R. (2010). Religious cognitive-emotional therapy: a new form of psychotherapy. Iranian journal of psychiatry, 5(3), 81–87.

Schultz, D., & Schultz, S. E. (2015). A history of modern psychology (11th ed.). CENGAGE Learning Custom Publishing.

Shenouda III, H.H. P. (1996). Comparative theology (M. Bassilli & A. Bassilli, Trans.). Coptic Orthodox Publishers Association. (Original work published 1988)

White, W. L. (2000). The history of recovered people as wounded healers. Alcoholism Treatment Quarterly, 18(1), 1–23. https://doi.org/10.1300/J020v18n01_01

Art Therapy (**SC)

Written by: Elias Elaneh

Art has been an important form of human self-expression throughout history, and its interface with practices of healing is hardly a new discovery. However, the formal recognition of art’s role in the diagnosis and treatment of mental illness can only be traced back to the mid-20th century, which saw the birth of art therapy (Vick, 2012).

Inspired by Freud’s work, two major figures have been recognized in North America for their significant contributions to the development of art therapy: Margaret Naumburg and Edith Kramer (Vick, 2012). While based on the same conviction that both art and mental illness constitute a “placing of an inner experience . . . into the outside world” (Kris, 1952, as cited in Vick, 2012), Naumburg and Kramer’s approaches to art therapy diverge in important ways, that have shaped the trajectory of the field (Tobin, 2015). Naumburg’s “dynamically oriented art therapy” was heavily influenced by Freud’s psychoanalysis, and more particularly the processes of verbalization and transference, in which the patient communicates their feelings to the therapist (Vick, 2012). Naumburg saw artistic expression as a concrete and uncensored symbolic communication of inner conflict that enhanced the patient’s power to express themselves and to actively interpret their transference reactions (Tobin, 2015). Unlike Naumburg, Kramer denied the usefulness of Freudian techniques, and instead built on Freud’s theory of sublimation, or psychological defence mechanisms. In her “art as therapy” approach, Kramer viewed producing art as an intrinsically therapeutic practice that strengthened patients’ ability to cope with conflict (Tobin, 2015).

While their approaches differed, these pioneers have inspired generations of art therapists to come, some noteworthy ones being Elinor Ulman, who founded The American Journal of Art Therapy, and Hanna Kwiatkowska, who developed and popularized family art therapy (Vick, 2012). Since its inception in the mid-1900s, the field has seen rapid growth, currently holding the title of most eclectic psychotherapy, with its broad range of applications in both psychiatric and educational settings (Vick, 2012). That said, much like an unfinished painting, the profession remains a work in progress.

References

Additional Reading

Music Therapy (**SC)

Written by: Mark Pillai

While music therapy is rarely visualized as belonging in a clinical health care setting, the history of music and medicine is quite ancient.

In preliterate culture, music was used for both communication and healing purposes. Prehistoric religious systems upheld music as a supernatural force, that affected physical and mental well-being (Thaut, 2015). Early civilizations also used music as medicine. Ancient Egyptian priest-physicians used music as a medicine for the soul through magic healing rituals and chant therapies (Thaut, 2015). Ancient Greeks also found healing importance in music. The ancient Greek philosopher Aristotle believed that music can help relieve repressed emotions, and physician Asclepiades of Bythnia encouraged his patients to listen to music to treat mental disorders (Yapijakis, 2009 as cited in Thaut, 2015). 17th-century German scholar, Athanasius Kircher, introduced that when therapeutic music is played, it releases vibrations into the air, simultaneously vibrating the body and healing the soul (Thaut, 2015). Furthermore, music was empirically understood as a metaphysical element innately connected to the universe, as described by the principle of musica universalis. With the advent of 19th-century empiricism, the institution of medicine shifted its focus of inquiry onto an evidence-based study of the human body. Underlying this new medical model was an institutional apathy towards the seemingly subjective, healing effects of music.

Today, we still perceive the effects of this outlook via the institutional powerhouse of the biomedical and pharmaceutical industries. Following World War II, musicians frequented American military hospitals and were found to have a profound positive effect on morale (History of Music Therapy | American Music Therapy Association (AMTA), n.d.)These findings led to the first music therapy laboratory being established at the University of Michigan. In Canada, the Canadian Association for Music Therapy was established in 1974, after which the first graduate program was established at Concordia University. Ever since, music therapy has become a more accepted form of mental health therapy, offered in hospitals and clinics around the world.

References

History of Music Therapy | American Music Therapy Association (AMTA). (n.d.). History of Music Therapy | American Music Therapy Association (AMTA); www.musictherapy.org. Retrieved from https://www.musictherapy.org/about/history/

Thaut, M. H. (2015). Music as therapy in early history. Progress in brain research, 217, 143-158.

Cultural Psychiatry

Lev Vygotsky (1896-1934)

Richard Shweder (1945~)

The Mental Institution

This section is currently under construction.

Abuses of Psychiatry

This section is currently under construction.

Project MKUltra

This section is currently under construction.