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LOOKING BACK Historical Notes During the Middle Ages, there was, on average, one church for every 200 people (Asimov, 1997).<< Most of the patients in asylums, from all classes and circumstances, were women (Gold, 1998; Showalter, 1985).<< Doctors who treated people with mental disorders in the eighteenth century were called “mad-doctors.”<< Before the American Revolution, only 10 percent of the 3,500 doctors in the country had any formal training. Fewer than 5 percent had medical degrees (Whitaker, 2002).<< was to rid the person’s body of the devil that possessed it. Exorcisms were revived, and clergymen, who generally were in charge of treatment during this period, would plead, chant, or pray to the devil or evil spirit. If these techniques did not work, they had others to try, some indistinguishable from torture (see Box 1–3). Abnormal Psychology: Past and Present 11 B O X 1–3 priests have sought exorcisms, determining in each case whether exorcism is appropriate. In 1999 the church issued a revised Catholic rite of exorcism for the first time since 1614, establishing rules to be followed in making such decisions and in the exorcisms themselves. For example, a church exorcism can take place only after the church-approved exorcist consults with physicians to rule out mental or physical disorders. Also, church exorcisms must be approved by a bishop. As a result of such rules and procedures, only a small number of potential cases actually result in church-approved exorcisms (Fountain, 2000). Even a small number of exorcisms, however, is excessive in the eyes of many mental health professionals. They argue that one can never totally rule out mental and physical causes in cases of abnormal functioning and that exorcisms—even those that are carefully selected and conducted—divert attention from more accurate explanations of abnormal behavior and more appropriate interventions. Given its long history and deep roots, this debate is not likely to be settled in the near future. seemed to grow more extreme, at times dangerous. The media reported cases of death by exorcism; a New York mother accidentally smothered her teenage daughter during one such procedure and a Rhode Island man jammed steel crosses down his mother-in-law’s throat (Fountain, 2000). In addition, a growing number of priests began to perform spiritual cleansing ceremonies not sanctioned by the Roman Catholic Church. By the year 2000, hundreds of exorcists, from evangelical ministers and charismatics to unsanctioned priests, were performing a wide variety of exorcisms in the United States (Cuneo, 2000). In order to regulate this growing field, both within and outside the church, and to ensure more acceptable procedures, the Roman Catholic Church in the United States has become more actively involved in exorcisms during the past decade. The number of full-time exorcists formally appointed by the church increased from 1 in 1990 to 10 in 2000 (Fountain, 2000). Over the past several years, these officials have investigated and evaluated hundreds of cases in which individuals or their relatives or Exorcism has a long history as a “treatment” for persons who behave abnormally. During biblical times, shamans, or priests, would often perform exorcisms on such people— reciting prayers or offering bitter-tasting drinks in order to coax evil spirits to leave the bodies of the troubled individuals. Similarly, during the Middle Ages, clergymen would plead with or insult the devil who was thought to be residing in those people who behaved abnormally, recite prayers, administer holy water or bitter solutions, or even starve or stretch the bodies of the individuals in question. But all that is a thing of the distant past, right? Well, not completely, it turns out. By the 1970s exorcism had all but disappeared from Western culture (Cuneo, 2000). Then in 1973, the enormously popular book and movie The Exorcist spurred an onslaught of books and movies on demonic possession, and public interest in this kind of intervention increased dramatically. Since then, numerous evangelical ministers and charismatics have declared themselves exorcists and performed exorcisms on people with behavioral disturbances. In most such instances, the person’s problems have failed to respond to a conventional intervention such as psychotherapy or drug therapy. Typically, the exorcist blesses the person who is thought to be possessed, recites passages from the Bible, and commands the evil spirits to leave the body (Fountain, 2000). Often a support group is present to pray for the person while he or she cries out and perhaps even thrashes on the floor, regurgitates, or flails out (Cuneo, 2000). During the 1990s, the techniques used by some contemporary exorcists Exorcism Lives Exorcism at the movies In the remarkably popular horror movie The Exorcist, an exorcist offers prayers and administers holy water to try to force the devil to leave the body of a troubled teenage girl. Photofest It was not until the Middle Ages drew to a close that demonology and its methods began to lose favor (Magherini & Biotti, 1998). Towns throughout Europe grew into cities, and municipal authorities gained more power and took over nonreligious activities. Among their other responsibilities, they began to run hospitals and direct the care of people suffering from mental disorders. Medical views of abnormality gained favor once again. When lunacy trials were held in late thirteenth-century England to determine the sanity of certain persons, it was not unusual for natural causes, such as a “blow to the head” or “fear of one’s father,” to be held responsible for an individual’s unusual behavior (Neugebauer, 1979, 1978). During these same years, many people with psychological disturbances received treatment in medical hospitals. The Trinity Hospital in England, for example, was established to treat “madness,” among other kinds of illness, and to keep the mad “safe until they are restored to reason” (Allderidge, 1979, p. 322). The Renaissance and the Rise of Asylums During the early part of the Renaissance, a period of flourishing cultural and scientific activity (about 1400–1700), demonological views of abnormality continued to decline. The German physician Johann Weyer (1515–1588), the first physician to specialize in mental illness, believed that the mind was as susceptible to sickness as the body. He is now considered the founder of the modern study of psychopathology. The care of people with mental disorders continued to improve in this atmosphere. In England such individuals might be kept at home while their families were aided financially by the local parish. Across Europe religious shrines were devoted to the humane and loving treatment of people with mental disorders. The best known of these shrines was actually established centuries earlier at Gheel in Belgium, but beginning in the fifteenth century, people came to it from all over the world for psychic healing. Local residents welcomed these pilgrims into their homes, and many stayed on to form the world’s first “colony” of mental patients. Gheel was the forerunner of today’s community mental health programs, and it continues to demonstrate that people with psychological disorders can respond to loving care and respectful treatment (Morton, 2002; Aring, 1975, 1974). Today patients are still welcome to live in foster homes in this town, interacting with other residents, until they recover. Unfortunately, these improvements in care began to fade by the mid–sixteenth century. By then municipal authorities had discovered that private homes and community residences could house only a small percentage of those with severe mental disorders and that medical hospitals were too few and too small. Increasingly, they converted hospitals and monasteries into asylums, institutions whose primary purpose was to care for people with mental illness. These institutions were founded with every intention of providing good care. Once the asylums started to overflow, however, they became virtual prisons where patients were held in filthy conditions and treated with unspeakable cruelty. The first asylum had been founded in Muslim Spain in the early fifteenth century, but the idea did not gain full momentum until the 1500s. In 1547, Bethlehem Hospital was given to the city of London by Henry VIII for the sole purpose of confining the mentally ill. In this asylum patients bound in chains cried out for all to hear. During certain phases of 12 chapter 1 Bewitched or bewildered? A great fear of witchcraft swept Europe even during the “enlightened” Renaissance. Tens of thousands of people, mostly women, were thought to have made a pact with the devil. Some appear to have had mental disorders, which caused them to act strangely (Zilboorg & Henry, 1941). This individual is being “dunked” repeatedly until she confesses to witchery. Bedlam In this eighteenth-century work from The Rake’s Progress,William Hogarth depicted London’s Bethlehem Hospital, or Bedlam, as a chaotic asylum where people of fashion came to marvel at the strange behavior of the inmates. The Granger Collection Corbis-Bettmann the moon in particular, they might be chained and whipped in order to prevent violence (Asimov, 1997). The hospital even became a popular tourist attraction; people were eager to pay to look at the howling and gibbering inmates. The hospital’s name, pronounced “Bedlam” by the local people, has come to mean a chaotic uproar. Similarly, in the Lunatics’ Tower in Vienna, patients were herded into narrow hallways by the outer walls so that tourists outside could look up and see them. In La Bicêtre in Paris, patients were shackled to the walls of cold, dark, dirty cells with iron collars and given spoiled food that could be sold nowhere else (Selling, 1940). Such asylums remained a popular form of “care” until the late 1700s. The Nineteenth Century: Reform and Moral Treatment As 1800 approached, the treatment of people with mental disorders began to improve once again. Historians usually point to La Bicêtre, an asylum in Paris for male patients, as the first site of asylum reform. In 1793, during the French Revolution, Philippe Pinel (1745–1826) was named the chief physician there. He argued that the patients were sick people whose illnesses should be treated with sympathy and kindness rather than chains and beatings. He unchained them and allowed them to move freely about the hospital grounds, replaced the dark dungeons with sunny, well-ventilated rooms, and offered support and advice. Pinel’s approach proved remarkably successful. Patients who had been shut away for decades were now enjoying fresh air and sunlight and being treated with dignity. Many improved greatly over a short period of time and were released. Pinel later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière. Jean Esquirol (1772–1840), Pinel’s student and successor, went on to help establish 10 new mental hospitals that operated on the same principles. Meanwhile an English Quaker named William Tuke (1732–1819) was bringing similar reforms to northern England. In 1796 he founded the York Retreat, a rural estate where about 30 mental patients lived as guests in quiet country houses and were treated with a combination of rest, talk, prayer, and manual work (Borthwick et al., 2001).