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HISTORY
The roots of clinical psychology extend back to before the field of psychology was ever named, back to developments in philosophy, medicine, and several of the sciences. From the beginning of recorded history, human beings have tried to explain behaviour that is bizarre or apparently irrational. Early explanations of disordered behaviour involved possession by demons or spirits. Treatments for such supernaturally induced maladies involved various forms of exorcism, including trephining, the boring of holes in the skull to provide evil spirits with an exit. In early monotheistic cultures, God was seen as a possible source of behaviour problems. In the Old Testament, for example, we are told that “the Lord shall smite thee with madness, and blindness, and astonishment of heart” (Deuteronomy 28:28). Where supernatural approaches to behaviour disorders were prevalent, philosophy and religion were dominant in explaining and dealing with them.
Before psychology was founded as a field:
2500–500 B.C: Babylonians
First, as clinical psychology is a discipline involved in studying and treating mental disorder, it is worth noting that awareness of mental illness, as distinct from physical illness, can be dated as far back as in 2100 B.C. to the ancient Babylonians. Typically, mental illness was viewed from a religious perspective and treatments such as prayer, wearing of amulets, or religious rituals were used and thus, supernatural, magic, herbs, and reason was the approach to mental and physical illness.
500- 300 B.C: GREEKS
HIPPOCRATES: Supernatural explanations of behaviour disorders were still highly influential when, the Greek physician Hippocrates suggested that these aberrations stem from natural rather than supernatural causes. Among the early Greek scholars in the period of 500–300 B.C., Hippocrates (often called the father of medicine) emphasized what is now known as a biopsychosocial approach to understanding both physical and psychological disorders. Hippocrates’ “bodily fluid” theory argues that imbalances in the levels of blood, black bile, yellow bile, and phlegm are responsible for emotional disturbance. PLATO and ARISTOTLE: The philosophers Plato and Aristotle are both credited with promoting some of Hippocrates’ ideas, even though they did so in different ways. Plato emphasized the role of societal forces and psychological needs in the development and alleviation of mental disorders, whereas Aristotle emphasized the biological determinants of mental disorders.
130–200 A.D.
GALEN: Like his Greek colleagues, Galen (Greek physician) also used the humoral theory of balance between the four bodily fluids discussed previously as a foundation for treatments. These fluids were black bile, yellow bile, phlegm, and blood.
500–1450 A.D: THE MIDDLE AGE
In the Middle Ages, the medical model was swept away as the church became the primary social and legal institution in Europe. Demonological explanations of behaviour disorders regained prominence, and religious personnel again took over responsibility for dealing with cases of deviance. Ever resourceful, many physicians soon became priests and began “treating” the insane by exorcizing the spirits presumed to possess them. Therefore, healing and treatment became, once more, a spiritual rather than a medical issue. However, some, such as Saint Thomas Aquinas (1225–1274), felt that there was both theological truth and scientific truth, thus using scientific thinking to help explain health and illness.
1500–1700: THE RENAISSANCE
With the Renaissance, the pendulum gradually swung back to naturalistic explanations of mental illness. At first, the treatment of deviant individuals took the form of confinement in newly established hospitals and asylums, such as London’s St. Mary of Bethlehem, organized in 1547 and referred to by locals as “bedlam.” Renaissance witnessed numerous scientific discoveries suggesting that biological factors influence health and illness. During this period, René Descartes (1596–1650), a French philosopher, argued that the mind and body were separate. This dualism of mind and body became the basis for Western medicine.
THE NINETEENTH CENTURY:
During the period of the Enlightenment in Europe and North America that began in the latter half of the 1700s, a new world view emerged in which problems could be analyzed, understood, and solved and the methods of science could be applied to all natural phenomena, including the human experience. The impact of this philosophical movement on the treatment of the mentally ill was astounding. Reformer Philippe Pinel, the director of a major asylum in Paris in the late 1700s, ordered that the chains be removed from all mental patients and that patients be treated humanely. Around the same time in England, William Tuke advocated for the development of hospitals based on modern ideas of appropriate care and established a country retreat in which patients lived and worked.
WORLD WAR -I: When the United States entered World War I in 1917, the need arose to screen and classify the hordes of military recruits being pressed into service. The application of psychological theories to the practices of the U.S. military started a gradual emphasis in clinical psychology, temporarily away from the study and treatment of children and on to adults. Psychologists' reputation as assessment experts grew during World War I with the development of two intelligence tests, Army Alpha and Army Beta (testing verbal and nonverbal skills, respectively), which could be used to screen large groups of military recruits. Due in large part to the success of these tests, the need for measures of personality, interests, specific abilities, emotions, and traits further led to the development of many new tests during the 1920s and 1930s. Some of the more familiar instruments of this period include Jung’s Word Association Test (1919), the Rorschach Inkblot Test (1921), the Goodenough Draw-A-Man Test (1926), the Thematic Apperception Test (TAT) (1935), the Bender– Gestalt Test (1938), and the Wechsler-Bellevue Intelligence Scale (1939).
WORLD WAR – II : When World War II broke out, the military once again
called upon clinical psychologists. As soldiers began to return from combat, psychologists started to notice symptoms of psychological trauma labelled "shell shock" (eventually to be termed posttraumatic stress disorder) that were best treated as soon as possible. Because physicians (including psychiatrists) were over-extended in treating bodily injuries, psychologists were called to help treat this condition. In the 1940s, education and training in clinical psychology became more widespread and more standardized. And in 1949, the historic Boulder conference took place, at which training directors from around the country agreed that both practice and research were essential facets of PhD clinical psychology training
BEYOND WW-II AND THE PRESENT:
After World War II, clinical psychology grew rapidly, branching out into the major theoretical approaches that came to define the field: psychodynamic, humanistic, behavioral, cognitive, systems, and biological. Each of these approaches is best thought of as a broad school of thought rather than a single theory. In order to train clinical psychologists, the Veterans Administration (VA) funded PhD training programs at various universities. Because the clinical practice piece was missing from these programs, the first to offer a practice-based PhD was the University of Illinois in 1968. This program provided a structure for other universities to follow, which led to the development of the Doctor of Clinical Psychology (PsyD) degree, first recognized in 1973.
Clinical psychology, firmly rooted and organized as a professional discipline by the mid-20th century, was poised for strong growth. Between the mid-1940s and the mid- 1950s, a series of actions by APA and its members defined clinical psychology with a clarity that it had not known before. A landmark in the acknowledgement of the discipline was in 1952, when a handbook for classifying and diagnosing mental disorders, the DSM−I, was published by the American Psychiatric Association (APA) In the 1980s, clinical psychologists enjoyed increased respect from the medical establishment as they gained hospital admitting privileges and Medicare payment privileges. Larger numbers of graduate training institutions continued to train larger numbers of new clinical psychologists, and the number of American Psychological Association members who were clinicians approached 50%. The growth of the profession continued through the 1990s and 2000s, as did the trend toward diversity in gender and ethnicity of those joining it. By now, mental hospitals and psychiatric facilities, long the training ground for psychiatrists, had begun to open their doors to clinical psychologists, if only in small numbers. Clinical psychologists now had training internships and job opportunities. Some universities and a few psychoanalytic institutes had created training programs for them. Clinical psychologists, thus, continue to be experts in assessment and psychotherapy while expanding their focus to address issues of gerontology, sports, and the criminal justice system to name a few. Given the history of clinical psychology, perhaps the only certainty for the future is that exciting changes are in store for the profession and for those who practise it. That being said, trends starting in the past decade or two can give us some idea of the ways in which clinical psychology will develop and grow. Accordingly, it is almost certain that clinical psychology will be influenced by, among other factors, increasing need to: provide psychological services for an array of health problems, not just mental health problems; develop services that respond to the health care needs of an aging population; ensure that psychological assessments, prevention programs, and treatments are both evidence-based and appropriate for the diverse range of people who receive these services; and enhance the impact of concurrent use of psychological and pharmacological interventions.
