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Blurting: Bodies and Minds (W6) - Coggle Diagram
Blurting: Bodies and Minds (W6)
Historical views of insanity
No distinction between doctors of the mind and doctors of the body in early understanding of insanity.
The insane were often not institutionalised but were dealt with by their community. In some cases they were sent to 'mad houses' but these focused on restraining and controlling insantiy rather than treating it.
Ideas of there being different humours in the body which interacted with eachother, and an imbalance of these four humours was what led to insanity.
Insanity as a female pathology
From the onset hysteria was understood as a female pathology. Traditionally was understood as having been a result of the upward movement of the womb which interrupted other bodily systems and resulted in physical and mental symptoms.
Later on women were believed to be predisposed to hysteria because they had weaker brains and irritable nerves.
In the 19thc the idea of women having weaker brains and irritable nerves was coupled with growing concerns on female overindulgence and sexual promiscuity. Women were said to be indulging too much sexually and this was leading to them becoming hysteric.
Freud
Freud didn't believe in the theory of degeneracy which Charot supported. He originally did agree with Charcot on a lot of things but opon his visit to the Salpatriere he developed distinctly Freudian ground (Makari).
Freud treated a patient named Anna O. She was one of the most important case studies he encountered and was responsible for much of this thinking on hysteria. She was a wealthy woman of a high education and upper class status. When not experiencing bouts of hysteria, Freud described her to be a woman of exceptional intelligence. He said that to ascribe her hysteria to poor heredity and describe her as degenerate would "distort the meaning of the word" out of all proportions.
Anna O experienced an odd set of symptoms such as a paralysed arm, inability to see straight, etc. Freud hypnotised her and worked to ask her questions to uncover root problems. This led him to develop his theory that hysteric people were suffering from repressed memories which led to physical symptoms. He called these 'reminisces', and said that hysteric people must recover these memories in order to heal. When he hypnotised her and she uncovered these memories, she would often not show any symptoms for a temporary period.
Whilst Charcot focused on this idea of physical trauma and an external conflict, Freud turned to the idea of an inner conflict leading to hysteria.
Freud was more of a 'bedside medicine' practicioner.
Charcot
Charcot treated women at a public hospital in Paris where there was a huge scale of patients- often poor women who had been institutionalised for many years.
Charcot denied theories that hysteria was gendered and studied male hysteria in his career.
He believed in degeneration theory and said that poor lineage left people predisposed to hysteria. His belief was that physical trauma could lead to insanity (train track victims etc), but only in cases where the patient had already been exposed to insanity because of their inherently inferior heredity.
He believed in the idea of a patterned lesion which corresponded to a symptom.
HOSPITAL MEDICINE.
One of his key failures was that he didn't consider the specificty of the accident to the hysteria.
19th century
The newly rising 'hospital medicine' meant that there was a focus on classification and arranging patients according to symptoms. This meant that 'mad houses' became asylums, where the insane were classified and treated according to their symptomology.
Patients were studied in life and autopised in death. Doctors attemped to find characteristic lesions on the brain post-mortem but failed to do so, which was at odds with their belief that insanity was caused by medical lesions in the brain. Nevertheless, common medicine continued to push this view rather than studying alternative ideas. Standardised patients accroding to their symptoms rather than questioning their specific circumstances.
Failures to find lesions led to the development of 'degeneration' theory- the belief that insanity was a result of accumulated poor heredity over many generations which resulted in a range of things- alchoholism, criminality, hysteria.
Makari
Makari explores the difference in the patients that Charcot and Freud treated. She emphasises the large patient to doctor ratio at Charcot's hospital in Paris and he was treating poorer, often less educated women. Makari argues that for Charcot, the patients he treated further served to legitimise his beliefs in heredity.
Makari says that Freud was treating patients who were often well educated, were paying for his services, and were well respected in society. This meant he was less likely to believe in theories of degeneracy.