in 1952 when a French naval surgeon was attempting to find medications to give before an operation to reduce stress (Freudenreich, Goff, & Henderson, 2016). What he discovered was that an antihistamine substance, called chlorpromazine, left individuals feeling indifferent about their operation. Noticing its calming effect, he suggested that this might be useful in the treatment of mental disorders. In particular, it was discovered that chlorpromazine (trade name, Thorazine) helped to reduce the symptoms of schizophrenia and became initially an important antipsychotic medication. This, in turn, led to the reduction in the number of patients in mental hospitals as noted in the LENS on page 25. Some of the early antipsychotic medications had problematic side effects. Newer drugs used today have fewer side effects.
Other treatment approaches seek to influence the individual’s brain by changing the underlying electrical activity. Some of these treatments are seen as noninvasive (Camprodon, Kaur, Rauch, & Dougherty, 2016). That is, there is no requirement that electrodes or other devices be placed inside the brain itself. The oldest of these techniques is electroconvulsive therapy (ECT) in which electrical activity is used to disrupt normal brain activity and produces convulsions (Welch, 2016). ECT has changed over the years with a reduction in motor convulsions and a reduction in the number of brain areas affected. It is seen as an effective treatment for those with severe depression that does not respond to other types of medication or psychotherapy. An alternative to ECT, referred to as transcranial magnetic stimulation (TMS), disrupts brain activity using magnetic stimulation to treat mental disorders, including depression.
More invasive treatments require that electrodes be placed in the brain that change the existing brain networks. The technique has been referred to as deep brain stimulation (DBS) and has been used for the treatment of motor disorders such as Parkinson’s disease, as well as obsessive compulsive disorder (OCD) and depression. Stimulating electrodes are placed deep in the brain, and these are connected to a pulse generator that is placed under the person’s skin, typically below the neck. Today’s devices allow health care professionals to adjust the stimulation from wireless devices outside the skin.
The most invasive procedures are surgeries in which different areas of the brain are removed or their connections disrupted. Severe epilepsy, in which a person has numerous seizures and cannot work or function normally, has been treated in this manner. Today, surgical procedures of the brain are limited to very small areas. In fact, gamma rays rather than a knife are used to make the small cuts. Such small cuts in the brain are used with individuals who show no improvement in epilepsy, depression, or anxiety using standard treatments.
Not all of the biological treatments have been successful. In the first half of the 1900s, as a treatment for mental illness, the frontal areas of the brain were disconnected from the rest of the brain. This procedure, called a frontal lobotomy, was used until the 1950s and then discontinued. It left the person with limited emotional and cognitive abilities. Even during its time, there were serious debates as to its ethics and effectiveness.
As you will see throughout this book, biological approaches play an important role in the treatment of mental disorders. Determining effective treatment is not an either/or question of psychological and biological approaches but an attempt to combine treatments that work together in an effective way. For example, research from 2015 shows that psychotherapy along with lower levels of psychotropic medication are very effective for treating schizophrenia (Insel, 2015; Kane et al., 2016). As you will also learn, psychotherapy and biological approaches work through different brain mechanisms and at different levels of the brain. Throughout the chapters of this book, particular biological approaches will be described in terms of each disorder.
In the next section, I will examine psychological factors involved in developing, maintaining, and treating mental disorders. What a person learns in interacting with other people as well as his or her environment is crucial. In addition, what individuals tell themselves or how they experience significant others in their lives is an important aspect of this perspective.
Psychological Treatment Perspectives in the Twentieth Century
In this section, I want to discuss three approaches to the psychological treatment of mental disorders. These are the psychodynamic approach, the existential-humanistic approach, and the cognitive behavioral approach. These approaches were developed somewhat independently and often in opposition to one another. For that reason, I will initially discuss each independently. I will introduce you to a historical understanding of the approach including its broad principles and then present one specific treatment that has been tested in a scientific manner.
Different versions of dynamic psychotherapy have been shown to be effective for a number of disorders, especially the personality disorders.
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Before the middle of the twentieth century, very little formal research had been performed to see how effective psychological interventions were. This was also true of traditional medical procedures. Beginning in the 1950s and 1960s, a movement started to determine the effectiveness of both medical and psychological treatments in a scientific manner. In medicine, this came to be known as evidence-based medicine. In psychology, the terms empirically based treatments and empirically based principles refer to treatments and their aspects for which there is scientific evidence of effectiveness.
As researchers and clinicians began to focus more on approaches and principles for which there was scientific evidence that they were effective, there began a movement to develop effective treatments for particular disorders. There has been more willingness to integrate techniques from the three different approaches as well as from other perspectives. For example, in the chapter on personality disorders, you will see that one of the most researched treatments—dialectical behavior therapy (DBT)—is based on techniques from each of the three approaches described in this chapter. This effective treatment uses aspects of cognitive-behavioral techniques, dynamic techniques, and humanistic-existential techniques.
psychodynamic perspective: approach to psychological therapy that emphasizes how behaviors and experience may be influenced by internal processes that are outside of awareness, often due to internal conflicts
Psychodynamic Perspectives on Treatment
The psychodynamic perspective is based on the idea that psychological problems are manifestations of inner mental conflicts and that conscious awareness of those conflicts is a key to recovery. Historically, Sigmund Freud laid the foundation for this perspective.
By the beginning of the twentieth century, there was an understanding that psychological processes were an important source of information concerning mental illness. Sigmund Freud had worked with Charcot in Paris and observed individuals with hysteria. In this disorder, the experience, such as not feeling pain in a limb or difficulty hearing, did not match the underlying physiology. Witnessing this type of disordered behavior led Freud to seek psychological explanations for the cause and treatment of mental disorders.
Sigmund Freud
Library of Congress
Sigmund Freud
Sigmund Freud was initially trained as a zoologist before he completed medical school. The nature of the neuron was just being discovered, and Freud based his early theories on the neuroscience of his day. Freud was an enthusiastic reader of Darwin and credited his interest in science to
