Abstract
Depression is a mental illness which is “characterized by at least one major depressive episode” where the person experiences symptoms for at least two weeks. This form of mental illness has been around for many centuries and there have been several treatment therapies developed to help alleviate the patient’s symptoms.
During the early nineteen hundreds and late nineteen hundreds therapists and doctors utilized two forms of therapy: biomedical and psychotherapy. Biomedical therapies were commonly used during the early 1900’s and included lobotomies as well as electroconvulsive therapy. In the mid-1900’s treatment methods changed and doctors started using Client Based Therapy and Rational Behavioral Therapy.
Depression Treatments During The 1900’s
The Diagnostic and Statistical Manual of Mental Disorders or DSM is a book that is published by the American Psychiatric Association. The manual describes over 260 psychological disorders with the specific symptoms and diagnostic criteria for each.
The DSM is helpful tool utilized by many therapists to help diagnose their patients with possible psychological disorders. Several items that are included in these books includes: the name of the disorder, diagnose code, descriptions of common symptoms, and the guidelines for diagnosing a patient. (Hockenbury page 533) One type of psychological disorder that is included in the manual is Major Depressive Disorder/Episode.
The DSM describes a Major Depressive Disorder as the “presence or absence of a mood episode. “Within the disorder the patient will experience Major Depressive Episodes which are diagnosed when a person experiences a depressive mood for at least two weeks. Several symptoms that occur during these episodes include changes in appetite, weight, sleep patterns, and decreased energy. Patients may also experience feelings of worthlessness, guilt, and thoughts of death or suicide.
Major Depressive Disorder is a serious illness which can affect patients emotionally, behaviorally, cognitively, and physically. For many patients the only way to help alleviate their suffering is to seek professional help from therapists and psychiatrists. Even before the inception of the DSM doctors have been treating depression through various forms of treatments. Biomedical and Psychotherapy were two common forms of treatment during the 1900’s with each having differing success rates as well patient risks.
Biomedical Treatment Therapy
Biomedical therapy is “based on the assumption that the symptoms of many psychological disorders involve biological factors, such as abnormal brain chemistry.” (Hockenbury page 580) This type of treatment involves changing the biological functions of a patient by using surgery, electroshock, or medication. Electroshock and lobotomies were common methods used to treat various psychological disorders including major depressive disorder.
Electroconvulsive Therapy
Electroconvulsive therapy or ECT is defined as a “form of biomedical therapy which uses electrical shocks to treat severe depression.” These electric shocks would cause seizures which doctors believed might relieve or stop a patients symptoms. The modern form of ECT has been around since that late 1930’s and its original creators were psychiatrist Ungo Cerletti and neuropathologist Lucino Bini.
This type of therapy is done by placing several electrodes on the patient’s head, right over the temporal lobes of the brain. An electric current is then delivered for one second causing the patient to have a seizure and become unconscious. This is repeated six to twenty times depending on the patients’ condition and the doctors’ recommendation. The patient typically wakes up around an hour later.
Patient’s often experience several short term and minor side effects which disappear over a period of time. However, ECT also has been known to cause many serious and permeant side effects such as physical damage, permanent brain damage, and retrograde amnesia.
Despite these negative side effects ,however, electroconvulsive is still used as a form of treatment today. There are ,however, far more regulations which are in place to help protect the patient. Several of these regulations include the use of muscle relaxants, general anesthesia, and the adherence to a professional code of ethics. ECT is also now used as a last resort and only for certain psychological disorders such as major depression.
Just like anything else there is still allot of controversy regarding the use of electroconvulsive therapy as a form of treatment. Many people belief that the short-term problems are slight in comparison to the possible long term issues. On the other side of this ,however, many believe permanent cognitive problems are too risky. Then there are others who believe that this form of therapy works for some patients and needs to be performed more often despite side effects. (Sparknotes 101 Psychology pg. 362)
Lobotomies
Lobotomies are a type of psychosurgery that was used to help treat certain psychological disorders. This procedure was invented by the Portuguese neurologist by the name of António Egas Moniz. Moniz was also joined by an American neuropathologist named Walter Freeman who traveled around convincing doctors to carry out the procedure on their patients.
The procedure was first performed on November 12, 1935 in Lisbon, Portugal and a year later it was brought to the United States. The purpose of this treatment was used to help cure those with schizophrenia, uncontrollable aggressive disorder, and also severe forms of depression.
The article “Violence, mental illness, and the brain – A brief history of psychosurgery: Part 1” was published by Miguel Faria and it provides use with an in depth historical look at this procedure. The article states that the surgery was performed by “using a modified icepick instrument to traverse the roof of the orbit and enter the base of the skull. . . The orbitoclast was then inserted to a depth of 7 cm at the base of the frontal lobes and swept 15[degrees] laterally.” (Faria) The doctors would then severe the nerves which are connected to the frontal lobes of the brain and the thalamus or hypothalamus. (Strickland page 298)
Once the procedure was completed the patient would end up having a disabled or destroyed portion of their brain. This was suppose to help with curing their psychiatric conditions, but instead caused a host of short-term and long-term side effects. Some examples of these include: apathy, permanent brain damage, and retrograde amnesia.
Due to the many severe long term side effects many of those in the medical world showed resistance towards the treatment. However, “many psychiatrists and nonsurgical practitioners seized on the procedure as a new last resort for patients who lacked any effective alternate treatments.” (Faria) This view did change later on however when patients started to develop complications and even died.
In proof that this form of treatment was ineffective Freeman himself published his own findings. In the article ‘Violence, Mental Illness, And The Brain’ the following quote states that Freeman “published his long-term follow up of 707 schizophrenics, 4-30 years after lobotomy. He reported that despite improvement in the majority, 73% were still hospitalized or at home in a “state of idle dependency.” (Faria)
Psychotherapy
Psychotherapy is defined as “the treatment of emotional, behavioral, and interpersonal problems through the use of psychological techniques designed to encourage understanding of problems and modify troubling feels, behaviors, or relationships.” (Hockenbury page 581) This form of therapy was developed in the early 1900’s by Sigmund Freud who believed that emotional suffering is the result of unresolved conflict.
Freud approached the treatment of psychological ailments by working with conflicts that exist in the patients unconscious. The goal of treatment was to help free the patient from their repressed memories in order to alleviate their mental pain. Clients also seek this form of therapy in order to receive help with: psychological issues, life challenges, and relationship concerns. Finally, clients may also want to gain self-knowledge or to obtain personal fulfillment. (Hockenbury page 580)
There are several forms of psychotherapy treatment which a client can use in order to obtain their goals. Two forms of psychotherapy treatment that they can use are rational emotive therapy and client based therapy.
Rational –Emotive Therapy
Rational emotive therapy or RET is defined as “a cognitive based psychotherapy that attempts to replace or modify a clients irrational, inappropriate, or problematic thought processes,outlooks,and self concept.” (Piotrowski page 938)
RET was created by Albert Ellis in the 1950’s and the goal of the therapy was to treat depression. This form of therapy “hinges on the idea that people’s feelings are influenced not by negative events but by their catastrophic thoughts and beliefs about these events.” (Sparknotes 101 Psychology page 352) It is based on the irrational assumption that you must be or do something specific.
Rational emotive therapy methods can be explained through the ABC model. This model states that when an “Activating event (A) occurs, it is the person’s Beliefs (B) about the event that cause emotional Consequences (C). So, the event can trigger your belief which then causes the consequences.” (Hockenbury page 593)
Clients seek this form of treatment because they have self-defeating thoughts which are causing them trouble in everyday life. Several examples of self-defeating thoughts can include: “I must be successful” and “I should have tried harder”. Self-defeating thoughts can cause patients to develop depression. During the course of treatment a client attempts to reveal inflexible and absolutist thoughts, feelings and actions. Albert Ellis believed that by doing so clients can start to think of and choose pathways that are healthier, how to internalize and habituate new, and more beneficial beliefs.
Those seeking help for their self-defeating thoughts through RET can visit a licensed therapist trained in the treatment. However, despite the large amount of licensed therapist some may find it difficult to obtain appointments in their area and others may find it difficult affording the sessions.
Client based therapy
A form of humanistic therapy, client based therapies aim is to help people accept who they are and also to free themselves from unnecessary limitations. The creator of this type of therapy was Carl Rogers who developed it during the 1940’ and the 1950’s. Rogers set his therapy apart from other forms of therapies by using the term “client” instead of “patient” to describe those who sought help.
The aim of this therapy is to help clients increase their self acceptance as well as their personal growth by providing a supportive emotional environment. The client learns to “adopt a more realistic self-concept by accepting who they are and thus becoming less reliant on the acceptance of others.” (Sparknotes 101 Psychology page 355) The goal of this therapy is to develop a client’s self-awareness and self acceptance.
During the therapy sessions the role of the therapist is that of a facilitator and he/she helps the client find their own answers to their problems. It is the client who identifies the problem and then decides how they want to go forward with the therapy.
Client based therapy is still used today in order to help patients with depression as well as other psychological problems. Effectiveness of this form of treatment varies between patients and can work well for some while others may need to combine this form of treatment with other biomedical treatments in order to see results.
Mental illness is a global problem which has been around for centuries and affects those of all walks of life. Though therapies from the earlier 19th century caused harm to patients and had limited success there was a silver lining. It was through the repeated attention to the issue of mental illness and finding a cure that we now have far better treatments. It may take several more years before a true cure is found but through emerging therapies we are getting closer.