Madness Historical Concepts

Type of psychology: Psychopathology
Fields of study: General constructs and issues; models of abnormality
Throughout history, humans have tried to explain the abnormal behavior of people
with mental disorders. From the ancient concept of demoniacal possession to modern
biopsychosocial models, beliefs regarding the cause of mental disorders have influenced
the way communities treat those variously labeled mad, insane, or mentally ill.

Key concepts
• asylum
• biopsychosocial model of mental disorders
• deinstitutionalization
• demoniacal possession
• humoral imbalance
• lobotomy
• madness
• moral treatment
• phenothiazines

People are social creatures who learn how to behave appropriately in families
and communities. What is considered appropriate, however, depends
on a host of factors, including historical period, culture, geography, and religion.
Thus, what is valued and respected changes over time, as do sociocultural
perceptions of aberrant or deviant behavior. How deviancy is treated
depends a great deal on the extent of the deviancy—is the person dangerous,
a threat to self or to the community, in flagrant opposition to community
norms, or is the person just a little odd? How the community responds
also depends on its beliefs as to what causes aberrant behavior. Supernatural
beliefs in demons, spirits, and magic were common in preliterate societies.
In the medievalWestern world, Christians believed that the devil was in possession
of deranged souls. Hence, the mentally ill were subjected to cruel
treatments justified by the idea of routing out demons or the devil. For centuries,
the prevailing explanation for madness was demoniacal possession.
Prior to the nineteenth century, families and communities cared for the
mad. If they were unmanageable or violent, the mad were incarcerated in
houses of correction or dungeons, where they were manacled or put into
straitjackets. If a physician ever attended someone who was deemed mad by
the community, it was to purge or bleed the patient to redress a supposed
humoral imbalance.

Most medical explanations prior to the advent of scientific medicine were
expressed in terms of the four humors: black bile, yellow bile, blood, and phlegm. Imbalances usually were treated with laxatives, purgatives, astringents,
emetics, and bleeding. Understanding moved from the holistic and
humoral to the anatomical, chemical, and physiological. Also, views of humans
and their rights changed enormously as a consequence of the eighteenth
century American and French Revolutions.

During the nineteenth and twentieth centuries, madhouses were first replaced
by more progressive lunatic asylums and then by mental hospitals
and community mental health centers. In parallel fashion, custodians and
superintendents of madhouses became mad-doctors or alienists in the nineteenth
century and psychiatrists, psychologists, and counselors of various
kinds in the twentieth century. Similarly, the language changed: Madness
was variously called lunacy, insanity, derangement, or alienation. The term
currently used is mental disorder. These changes reflect the rejection of supernatural
and humoral explanations of madness in favor of a disease
model with varying emphases on organic or psychic causes. 508