During the Renaissance the idea began to arise that people acting strangely were mentally ill. A Dutch physician, Johann Weyer, suggested that other treatments than exorcism was needed. However, the church was much too powerful, and his books were burned and banned and the church continued to proclaim the theory of possession. Eventually, a change was seen and mental institutions were opened. In 1547, the first mental institution in England was founded in the monastery of St. Mary of Bethlehem (Bedlam) and there were also institutions on the continent. Bedlam was open to people as a show until well into the 1800s, and it was known as an awful and dreadful place.
The French revolution in the late 1700s brought about a marked change in the methods of dealing with mentally ill people. The French doctor, Pinel, was shocked to see the conditions under which the inmates of asylums were expected to live and, in the spirit of revolution, called for their unchaining. He made a new kind of institution and achieved good results with his new approach called moral treatment, and the idea was that people should be treated with dignity. The mentally ill behaved much more quiet under his care, and this led to a change in attitude. He saw the sick as normal people who had lost their ability to reason normally because of the environmental stress. He also introduced occupational therapy and light work. He achieved a high rate of success (70%). Pinel’s represents the first of the environmental stress explanations for disturbed behaviour. His treatments were much more effective than the punitive ones following the possession theory, and his ideas spread through western Europe, where for example, William Tuke, a Quaker, persuaded others from his religious group to fund the building of a mental hospital, the York Retreat founded in 1796. Ironically, the success or moral treatment also contributed to its downfall in the latter stages of the nineteenth century, as it became apparent that mental illness was much more common than had previously been thought. As more people were recognised to be suffering from mental illness, major building programmes were instigated both in Europe and the United States, leading to the rapid growth in the number of state-run asylums for the mentally ill. In Victorian England, several hundreds hospitals were built to accommodate many thousands of patients, but the standards of care that prevailed in York could not be extended to these new hospitals and moral treatment fell out of favour.
By the end of the 19th century, there was a renewed interest in science and in the principle of somatogenesis, which had first been described by Hippocrates 2000 years earlier. The discipline of psychiatry began to emerge and the work of Kraepelin and Bleuler came to prominence. They were convinced that mental illnesses had physical origins (the somatogenic approach, somatogenesis). At that time, melancholia and mania, first described by Hippocrates were identified as mental disorders, and this list was expanded to include paranoia and schizophrenia among many others. While Kraepelin and Bleuler were convinced about the physiological origin of dysfunctional behaviour, others believed that there were psychological (psychogenic, psychogenesis) explanations of mental disorders. The discussion between somatogenesis and psychogenesis began to receive attention again. In the late nineteenth hundred, there was an explosion of interest in the role of psychological mechanisms in illness. The prominent French neurologist Charcot demonstrated that symptoms characteristic of nerve damage could arise for psychological reasons and could be influenced by hypnotic suggestion. His colleague Breuer began using hypnosis as a treatment and he found that his clients were better relieved from their symptoms if he talked to them about it using hypnosis. His technique was called catharsis, and was for a time used by Freud, who saw it as a powerful way to explore the unconscious mind.
One strength of psychopathology in the 20th century came from the increased interest in science within medicine and the belief in empirical evidence gathered through scientific research. This was extended to the discipline of psychiatry. The discovery of the consequences of syphilis to mental health in the beginning of the 20th century, encouraged the assumption within psychiatry that all mentally problems had a physical origin (somatogenesis) and could be treated with somatic therapies (drugs, physical treatments). In the early years, it was mostly a question of trying things and see what happened. The mentally ill had no civil rights, and experimental treatment was accepted.
Reliance on empirical evidence led to giving up some of the somatic therapies that had been developed in the 20th century, such as insulin shock therapy and brain operations (lobotomy, leucotomy). However, electro-convulsive therapy is still used because research has shown good results although the procedures are considered controversial. Not all scientific discoveries have favoured somatogenic approaches. For example, the value of biofeedback training to help control anxiety and the adoption of cognitive therapy in the treatment of depression, both tend to support psychogenic arguments.
In the 20th century, the pendulum has continued to swing between somatogenic and psychogenic explanations of disorders. Since psychiatrists are trained doctors, there has been a tendency to adopt the somatogenic explanation, also called ‘the medical model’. Psychologists, on the other hand, tend to adopt psychogenic explanations.