Clinical psychology and philosophies of mental health.

Clinical Psychology and Philosophies of Mental Health.
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Abstract
The history of the philosophies of mental health can be traced back thousands of years ago. The rise of mental health cases over the years led to the development of the discipline of clinical psychology. From its early days, clinical psychology has, however, been in conflict with the field of psychiatry in relation to understanding mental disorders and their treatment. In this paper, I will address the conflict between this two disciplines by critically looking at the history of mental philosophies and clinical psychology. I have first briefly introduced what clinical psychology is and how it is closely related to psychiatry. In the remainder of the paper, I have delved into the historical events that led to the development of clinical psychology and the historical differences in explaining mental disorders and their treatment. In the last part, I have included what one scholar thinks should be done to harmonize the varying approaches towards mental health.
How do we explain health? Thanks to the many studies and innovations in medicine clinicians understand that sickness is caused by absolutely biological factors. However, when people fall sick, many tend to think it is because of factors such as stress. Others attribute sickness and mental disorders to a supernatural being based on their religious teachings. This shows that people have varying views and beliefs about illness and mental health.

Surprisingly, there are equally many varying academic, philosophical and theoretical models in clinical psychology for explaining mental disorders, which can be traced many centuries back.
First, according to Rohleder (2012), “Clinical psychology is a scientific and clinical profession that is concerned with the understanding, treatment, and prevention of psychological distress, the relieving of symptoms of distress and promotion of well-being.” For this reason, in many parts of the world, clinical psychology is controlled and supervised by the health profession. Professionals in clinical psychology work alongside other mental health care specialists such as nurses, social workers, psychiatrists and occupational therapists. The role of clinical psychologists in mental health care is to offer therapy services and help in diagnosis and assessment of mental disorders. In most cases, the treatment of mental disorders is based on a medical approach based on the understanding that mental disorders are a consequence of core physiological abnormalities, but there are also many other historical models and approaches that are used to assess and diagnose mental disorders. Additionally, clinical psychologists and other mental health care professionals use the available classifications of mental disorders to understand mental problems.
Before we delve into the history of clinical psychology with regards to the models and approaches used to assess and treat mental disorders, it is important to look at some of the occurrences in mainstream clinical psychology, medicine and psychiatry in the last few centuries. This is because such occurrences form the basis for understanding some of the approaches and models we are going to discuss. In this regard, according to Vander & Suls (2014), clinical psychology was brought into the limelight by Lightner Witmer, who was a psychologist working at the University of Pennsylvania in the early 1900s. His early research mainly focused on individual differences in perceptual and sensory abilities, but he was equally interested in applying psychological principles to tackle applied problems. For instance, he used his knowledge of psychology to examine children with behavioral problems and speech problems. Witmer was the first to use the word ‘clinical’ since his examinations involved meticulous observation of patients, something synonymous with medicine. While Witmer focused on the resemblance between clinical psychology and medicine most clinical psychologists during the time were interested in cognitive and personality assessment. This was particularly evident when two tests known as ‘Army Alpha’ and ‘Army Beta’ were created to assess recruits to fight in World War I.
Equally, in the early 1900s, there emerged a field that was interested in physical disorders and there psychological origins or treatment. Psychiatrists were applying Freud’s theories to some physical conditions resulting in the development of a discipline of psychosomatic medicine. Freud had initially studied disorders that appeared not to be linked with a physical cause like paralysis or hysterical blindness. Based on his findings Freud argued that unconscious emotional conflicts were being changed to a physical form. It is this school of thought that led to the formation of psychodynamic explanation for health conditions such as hypertension, asthma, and headache. Proponents of this school of taught further argued that emotional conflict made an individual vulnerable to a certain illness due to biological weaknesses related to the corresponding body system. Nevertheless, psychiatrists were unable to point out the said biological weaknesses even as they depended on Freud’s talking therapy to treat patients (Vander & Suls, 2014).
However, it was until the onset of World War II that clinical psychology became a major discipline in mental health treatment. As a result of the war, the number of neuropsychiatric patients greatly outnumbered patients ailing from other health complications. Owing to the increased demand for caregivers, psychologists were called to help physicians and psychiatrists to address patient psychological problems. After the war, the US established the National Institute of Mental Health (NIMH) to enhance mental health and offer support to improve diagnostic and treatment approaches for mental disorders (Vander & Suls, 2014). This marked the breakthrough for the advancement in clinical psychology in the US and other parts of the world, but even then there seems to be no unanimously agreed upon approach for explaining and treating mental disorders.
In fact, throughout the history of clinical psychology, there has always been a conflict between psychiatry and clinical psychology despite the two being closely related. The tensions exist because the two disciplines are continually evolving with regards to the approaches used in understanding and treating mental disorders. One of the tensions or conflicting approaches is the religion versus natural science interpretation (Chung & Hyland, 2012). From as early as the 460 BC some physicians believed that illness and mental disorders were associated with gods and hence could be treated using superstition and charms. However, Hippocrates, a Greek physician rejected this view despite being born in a family of priest-physicians. Instead, he proposed an empirical approach of explaining illness besides his believe that physicians had a spiritually restoring ability. He offered the cures for bleeding and recommended better diets and lifestyles. Also, Hippocratic’s hypothesis that illness was triggered by a disparity of bodily humor was embraced in the west for many years. Herbs and other factors such as lifestyle, psychology, and diet played a key role in treatment during these early days. In some traditional Chinese communities diet, for instance, was recommended based on the type of person and the prevailing weather. What is more, the traditional medical system did not treat mental disorders as being different from physical illness. Importantly, the traditional medical approach rejected any superstitious explanation of sickness and mental disorders. Conversely, in regions associated with strong religious ties, sickness and mental illness were perceived to have a supernatural origin such as witches. This often led to the persecution of some members of the society in some European countries (Chung & Hyland, 2012). The two conflicting approaches resulted in the conflicting approaches to treatment between religion and natural science.
Secondly, the history of clinical psychology is also characterized by the Hippocratic versus modern medicine tensions. The Hippocratic medical approach lasted up to the 19th century. However, even as various treatment techniques stemming from Hippocratic system continued to be applied alternative approaches were being developed. Unlike the assumption that sickness was as a result of an imbalance in body humor, the new alternatives asserted that there was a particular and local cause for all forms of sicknesses. The new approach relied on the assumption that the body was a mechanical system. One of the greatest proponents of this school of taught was Rudolf Virchow who is known for his views that each illness was specific, contrary to Hippocratic approach. The alternative approaches laid the ground for modern western medicine that became popular in the 19th century. Consequently, the new approach was applied to mental illness because it was evidence-based. The new approach assumed that each mental disorder was caused by a different physiological abnormality and hence a uniquely different treatment for each disorder. It was also during the 19th century that the concept of moral treatment emerged whereby its proponents believed that a physician could impose moral authority on patients. They also believed that patients ought to be restricted in conditions of harmony and peace and that they ought to be subjected to discipline (Chung & Hyland, 2014).
The classification of mental disorders is also a historical approach used to understand and treat mental illnesses. Such classification can be traced back to the 19th century. By 1844 there were at least nine classifications of mental illness which were inclined to Hippocratic medical approach. This is because the classifications were not associated with any fundamental biological cause. Other forms of classifications based on biological factors have since been developed based on modern approaches. Depending on the type of classification, a patient will receive a corresponding treatment. The classifications and development of current medical approaches ushered in the modern era of viewing mental illness. A case in point was the development of psychoanalysis in the early 20th century. As earlier mentioned some of the events that triggered this development were the World War I and World War II. It also happened that during this period, the theory of behaviorism was being advanced by psychologists. This meant that behaviorism and psychoanalysis were competing approaches in relation to mental illness therapy. In this regard, the proponents of behaviorism were of the view that psychoanalysis had no benefits when compared to natural history. The behaviorist approach, unlike psychoanalysis, asserted that mental disorders could be explained through some conditioning (Chung & Hyland, 2014). It is worth noting that the early advocates of behaviorism such as Wundt and James argued that conscious mental life could be understood using physiological conditions. By the start of the 20th, many psychologists were, however, supporting the proposal that psychology should be used to understand and predict human behavior (Hatfield, 2012). This marked the beginning of behaviorism which was later used to develop some treatment techniques for mental disorders. The behavioral techniques sought to modify the user’s or patient’s behavior by incorporating special reinforcing conditions.
The biomedical model for explaining illness also became dominant during the 19th and 20th century and remains applicable to date. The model asserts that illness and mental disorders are conditions of the body caused by biological factors. It further asserts that social and psychological factors have an insignificant impact on explaining and treating sickness and mental disorders. The model, therefore, views the body and mind as two different units. It also means all illnesses including mental disorders can be associated with abnormalities in the physiological system triggered by biological factors such as infections, biochemical imbalances, injuries and much more. In the absence of a biological disease, the body is considered healthy. Therefore, to treat illness, the disease-causing pathogen has to be removed. While the biomedical model has been credited with the development of drugs, vaccines, and advancement of surgical procedures, it has also been met with considerable criticism for ignoring social and psychological factors (Rohleder, 2012).
Critics say that the biomedical model is discriminatory since it gives only biological explanations for sickness. It ignores other factors such as psychological and social that are involved in health. Also, its view that the body and mind are different entities ignores the psychological aspect of the body. Others argue that the mechanist approach of the model towards illness assumes every health condition can be fixed biologically which may not always true. The biomedical model of mental disorder also emphasizes on mitigating the symptoms instead of cure plus the fact that it has developed some cures without explaining the cause. It is also apparent that the model ignores environmental and social factors such as a person’s behavior, personality, and lifestyle that can impact a person’s mental health. The criticism was especially precipitated by the fact that some diseases declined in the 20th century partly owing to enhanced hygiene, enhanced nutrition and decrease in poverty levels. Some scholars, however, argue that the continued application of the biomedical model in psychiatry is due to the medical training of psychiatrists. The psychiatrists receive medical training based on the medical model. This means that they never view mental complications as diseases but as disorders treatable just like any illness through medical means (Rohleder, 2012).
Due to the criticism advanced against the biomedical model coupled with other challenges in explaining mental disorders one scholar is now proposing a new approach. In an article entitled “Toward a Philosophical Structure for Psychiatry,” Kendler outlines how we can best harmonize the conflicting approaches with regards to understanding and treating mental disorders. To this end, the scholar suggests eight propositions that can be used to interlink the varying methodological approaches. The first proposition reads, “Psychiatry is irrevocably grounded in mental, first-person experiences” (Kendler, 2005). Based on this proposition he argues that many symptoms of mental disorders can only be evaluated by asking patients how they feel. He further notes that despite the improvements in molecular biology and neurosciences, this should not be a reason to ignore the patient’s mental suffering. The second proposition is to drop the philosophy of dualism in relation to mental health. He feels that the Cartesian dualism is false and, therefore, should be abandoned. In this regard, he advocates for the rejection of the assumption that the mind and brain are separate entities. Instead, he argues that the two should be viewed as one.
The third proposition says that the epiphenomenalism philosophy is also false. The epiphenomenalism philosophy asserts that impulses, thoughts, and feelings occur within and individuals are subject experiences but have no impact. Kendler (2005) thinks this assumption is wrong hence should be abandoned. The fourth proposition suggests that we should accept the bidirectional causality. The bidirectional causality says that variations in the brain can result in variations in mental functioning and vice versa. The remaining four propositions only emphasize on the first four propositions. In conclusion, Kendler hopes that the discipline will reach a level of maturity that will allow for the integration of scientific improvements. However, he warns that for this to happen we have to abandon some of the old philosophies as discussed above. Additionally, we have to remain objective and dedicated to gaining deeper insights into mental health.
References
Chung, M. C., & Hyland, M. E. (2012). History and philosophy of psychology. West Sussex, UK: Wiley.
Hatfield, G. (2002). Psychology, philosophy, and cognitive science: Reflections on the history and philosophy of experimental psychology. Mind & Language, 17(3), 207-232.
Kendler, K. S. (2005). Toward a philosophical structure for psychiatry. American Journal of Psychiatry, 162(3), 433-440.
Rohleder, P. (2012). Critical issues in clinical and health psychology. Sage.
Vander Weg, M., & Suls, J. (2014). A history of clinical psychology in medical settings. In Handbook of clinical psychology in medical settings (pp. 19-38). Springer New York.