The Philosophical Story I

Before undertaking a systematic analysis of the diverse traditions of study and treatment of mental disorders, we must probe their historical origins and evolution. Efforts to understand and resolve problems of the mind can be traced through many centuries in which solutions have taken unanticipated turns. They have become enmeshed in obscure beliefs and entangled alliances that unfolded without the care and watchful eye of scientific methods. We remain today, a relatively young science; however, many techniques and theories of our time have long histories that connect current thinking to preexisting beliefs and systems of thought. Many of these connections are intertwined in chance associations, primitive customs, and quasi-tribal quests. The path to the present is anything but a simple and straight line; it has come to its current state through values and customs of which we may be only partly aware. Many are the product of historical accidents and erroneous beliefs that occurred centuries ago when mysticism and charlatanism flourished.

The movements and traditions of today are not tight systems of thought in the strict sense of scientific theories; they certainly are neither closed nor completed constructions of ideas that have been worked out in their final detail. They are instead products of obscure lines of historical development, often subject to the confusions and misunderstandings of our remote past when disaffection with complexities typified life. Nevertheless, interest in ourselves, in our foibles as well as our achievements, has always been central to humans' curiosity. The origins of interest in the workings of the mind were connected in their earliest form to studies of astronomy and spiritual unknowns. Even before any record of human thought had been drafted in written form, people asked fundamental questions such as why we behave, think, act, and feel as we do. Although primitive in their ideas, ancient people were always open to the tragic sources in their lives. Earliest answers, however, were invariably associated with metaphysical spirits and magical spells. Only slowly did people formulate more sophisticated and scientific ideas.

It was not until the sixth century B.C. that humans attributed their actions, thoughts, and feelings to natural forces, that is, to sources within themselves. Philosophers and scientists began to speculate intelligently about a wide range of psychological processes, and many of their ideas turned out to be remarkably farsighted. Much of this early imaginative and empirical work was forgotten through the centuries, slowly stumbled on, and rediscovered time and again through careful or serendipitous efforts. In the seventeenth century, John Locke described a clinical procedure for overcoming unusual fears; the procedure he set forth is similar to the systematic desensitization method developed this past century by Joseph Wolpe. Similarly, Gustav Fech-ner, founder of psychophysics in the mid-nineteenth century, recognized that the human brain was divided into two parallel hemispheres that were linked by a thin band of connecting fibers, what we now term the corpus collosum. According to his speculations, if the brain was subdivided, it would create two independent realms of consciousness, a speculation confirmed and elaborated in the latter part of this past century by Roger Sperry, in what has been referred to as split-brain research.

The earliest conceptions of the mind and its disorders started with a sequence of three prescientific paradigms that may broadly be considered sacred: the animistic, the mythological, and the demonological. These prehistoric phases of history slowly came to an end with the emergence of philosophically sophisticated and medically logical approaches. Certain beliefs dominated every historical period ultimately winning out over previously existing conceptions while retaining elements of the old.

As the study of mental science progressed, different and frequently insular traditions evolved to answer questions posed by earlier philosophers, physicians, and psychologists. Separate disciplines with specialized training procedures developed. Today, divergent professional groups are involved in the study of the mind (e.g., the neuroscientifically oriented psychiatrist with a clear-eyed focus on biological and physiological processes; the psychoanalytic psychiatrist with an austere, yet sensitive attention to unconscious or in-trapsychic processes; the personological psychologist with the tools and techniques for appraising, measuring, and integrating the mind; and the academic psychologist with a penchant for empirically investigating the basic processes of behavior and cognition). Each has studied the complex questions generated by mental disorders with a different focus and emphasis. Yet the central issues remain the same. By tracing the history of each of these and other conceptual traditions, we can learn how different modes of thought today have their roots in chance events, cultural ideologies, and accidental discoveries, as well as in brilliant and creative innovations.

It seems likely that future developments in the field will reflect recent efforts to encompass and integrate biological, psychological, and sociocultural approaches. No longer will any single and restricted point of view be prominent; each approach will enrich all others as one component of a synergistic whole. Integrating the disparate parts of a clinical science—theory, nosology, diagnosis, and treatment—is the latest phase in the great chain of history that exhibits an evolution in mental science professions from ancient times to the new millennium. Intervening developments, whether successful or unsuccessful, were genuine efforts to answer humankind's ceaseless efforts to understand more fully who we are and why we behave the way in that we do. The complexity of human functioning makes the desire to know who we are an unending challenge. New concepts come to the fore each decade, and questions about established principles are constantly raised. Perhaps in this century, we will bridge the varied aspects of our poignant, yet scientific understanding of mental diagnosis and therapy, as well as bring the diverse traditions of the past together to form a single, overarching synthesis.

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