Changing Minds (1) : the Self as

an object of change in history

Professor Gwen Adshead
Gwen.Adshead@southernhealth.nhs.uk
 Acknowledgements and Apologies
• Professors Joanna Woodall and Barbara Taylor;
and the work of Professor Andrew Scull
• Dr Morris Nitsun, therapist and artist.
• Apologia 1: to set out some historical
background to the process of changing minds
• Apologia 2: The second is a traditional apology
and plea for forgiveness for the inevitable
limitations of a 1 hour lecture!
 Changing minds
• What do we mean by change? A difference
across time
• What do we mean by Mind?
• How to relate to concepts like Self, Personality
and Identity
• Dan McAdams’s account of personality:
• Actor, Agent and Author: the story we tell of
ourselves
Early accounts of the Self and Mind
• Abrahamic or theological accounts: the Self,
the Heart, the Soul, the Will: all separate
aspects of the person
• Plato’s account of a Self in three parts
• Mental illness: first understood as a loss of
reason, caused by possession
• Hippocrates: an early disease model of mind –
body imbalance.
 Hippocratic corpus
• Hippocrates and other writers
• A disease model of mental illness, based in the brain.
• A homeostatic model: mind and body linked together
by humors
• Illnesses arise from disturbance of humoral
regulation: much like neurotransmitter theory now
• Hippocratic Corpus described mania, delirium,
melancholia, anxieties, phobias and puerperal
psychosis and paranoia.
 The Humoral Model
Mental illness thought due to disturbances of
humors – black bile, yellow bile, blood and phlegm
• Black bile: earth, cold and dry, associated with
melancholia.
• Yellow bile: fire, hot and dry, associated with
mania.
• Needed to rebalance the humors to cure people –
warm, cold, purging, bloodletting, diet, activity, rest
and exercise etc.
• Persisted until 17th century; international
acceptance and expansion.
 An early separation
• Knowing Yourself: which could be known by
introspection and self-reflection: the Narcissus
Myth sets out the dangers of not recognising
yourself. The subject of philosophy and
theology .
• Madness: loss of reason and behavioural
constraint. Treated by doctors. A perceived
link with violence and magic/witchcraft
persisted for centuries.
 Different types of intervention
• For Self-improvement there was religious belief
and living a life of faith: c.f. Religious Exercises,
Meditative practice, spiritual instruction.
• For mental illness: the treatments associated
with humoral regulation. Emphasis on organic
causes: cf Aristotle’s brain drawings. First
‘hospitals’ for mental illness associated with
religious foundations in 14C.
 Early modern ideas of Self
• The Self is plural: not only is there internal
conflict, there may be conflict between the
inner Self and the external Self that is seen by
others
• The rise of the Portrait: depiction of the Self as
virtuous, memorable and heroic
• But there is an aspect of Self that is secret, not
what it seems, hard to see clearly
 The Self, the Person, the Identity
• The Self that speaks and self reflects
• A Self on show
• The hidden Self: often in the form of desires that
cannot be spoken of
• The Person who has rights and duties
• Face and Appearance are distinct from Hearts and
Souls
• Identity: a social construct: the ‘picture’ of yourself
for the world
 Shakespeare and the modern Self
• The Self that speaks and self reflects: Richard III and
the 4th wall on the stage
• Lear as an exploration of changes of identity as a
prelude to madness
• Edgar/Poor Tom/Lear: Counterfeit and True
madness
• Othello: madness induced by thought
• ‘The mind diseased’: physicians, divines and self
healing
 18C
• Sydenham: Nerves, brain and mind
• Defects or deficits in brains lead to madness
• ‘Degenerate’ brains lead to otherness:
madness as ‘the Other’
• Romantic movements addressing Self
experience
• The rise of the Secular Self: portraits become
more realistic
St Mary of Bethlehem
 Madhouses and psychiatry
• Patients chained to the walls if violent.
• Filthy living conditions, residents physically abused
• Used for the violently psychotic, sometimes for morally
‘unusual’ people.
• Developed as private businesses
• 18C expansion: a move away from religious contexts
• Organic medical models of mental illness develop in 19C:
‘degeneracy’
• “Psychiatry’ first used as a term in German in 19C
• Expansion continued until late 20C then abruptly reversed
 Moral therapy
• An attempt at a personal and compassionate
approach to people living with madness
• People who lacked reason were not all violent
and non-human
• Madness was compatible with creativity,
human emotions and thought
• An affliction model
• No psychological account
 The English Malady
• People of quality suffered with their ‘nerves’
• A problem from madness and mad houses
• Dealt with in a medical manner by
neurologists who prescribed ‘treatments’
• Women prescribed ‘rest’: too much
stimulation or action was bad
• The beginning of something psychological
 The split continues
• Neuroses dealt with by neurologists; a
disorders of the intelligent, sensitive, quality.
Diet, exercise, travel and rest ( not work).
Entirely secular.
• Psychosis dealt with by psychiatrists by
admission to madhouses and ‘therapeutic
regimes’: routine, work and high moral
standards. Also secular
• Self improvement by moral growth: religion
and philosophy are distinct
 Top 10 weird treatments
• Dr Rushes spinning chair – to relieve brain
congestion
• Warm baths for mania, cold baths for
depression.
• Near drowning
• Malaria for syphillis
• Tooth extraction
• Hysterectomies
 William James
• An account of the Self as an agency that
directs attention to that which has personal
meaning
• Three aspects: body, social and spiritual
• The spiritual self is the Core: the ‘sick soul’
• There is a public ‘I’ and a private ‘me’
• Both of these could be disturbed
 Phenomenology
• Descriptive studies of mental phenomena.
• Classification and categorisations
• Psychiatrists become psychologists also:
describing and treating psychological
phenomena which are deemed to be
‘abnormal’
• Psychological abnormality which is distinct
from lack of reason
 20C: the effect of war
• A challenge to the degeneracy model of mental
distress
• Strong, health males became psychologically
damaged by exposure to battle stress: US Civil War,
WW1 and WW2
• If psychological experience could produce
disturbance of mind: then a psychology of mind
was needed
• Tension between organic and psychological models
of ‘illness’ or abnormality
 20C ways of changing your mind
• 1900 The beginnings of psychoanalysis: the mind
that is not conscious
• 1954 Drug treatments: the ablation of mental
distress, disturbing thougths, anxiety and sadness
• 1950s: Brain surgeries: the rise ( and fall) of
lobotomy
• 1960s Development of cognitive therapies, and
challenge to psychoanalysis: the therapy wars
begin
• External change? Or internal change?
 The Social Self
• The effect of anthropological studies on
psychology
• Social relationships have an effect on self-
presentation
• Social environments affect mental ill health:
‘survivor syndrome’ in Holocaust survivors
• Criticism of traditional models of medicine
that excluded the subjective experience: the
rise of the post-modern
 The study of personality and
personality change
• A tension between fixed and changeable
aspects to the personality
• Genetic explanations versus social explanations
• Dan McAdams’ model of the personality: the
(re)actor, the agent and the author
• No longer a picture of your Self but a story of
your self: You narrate your own identity in the
social realm
 The Self as an object of treatment
• Rise of psychological treatments where patient’s
subjectivity is dominant
• Challenge to medical hegemony and psychiatric
control over labelling of experience and detention
• Influences political movements to save money in
mental health care, and promote normalisation
• 1960 rise of psychological therapies and the concept
of self-improvement by psychological exploration
• 20C version of classical ideas: the Self becomes a
Person who is located in a relational context as well
as being an Individual ‘I’
• Therapy for relationships
Changes in amygdala function with
mindfulness practice
 And now…
• A tension between mental distress as arising from
persons as individual bundles of brain circuits and
neuro-transmitters
• And the self-experience in social contexts: carers ,
partners and family are crucial
• Self exploration and introspection is encouraged
• Meditative practices encouraged and studied
• Still a split between psychology and psychiatry
• Still uncertainty about the relationship between Self,
Person, identity , Heart and Will
References