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Masters of the MindReview - Masters of the Mind
Exploring the Story of Mental Illness from Ancient Times to the New Millennium
by Theodore Millon
Wiley, 2004
Review by James Sage, Ph.D.
Oct 3rd 2005 (Volume 9, Issue 40)

This book outlines seven "coexisting paradigms" that aim to understand the life of the mind. These paradigms reflect the insights of thinkers and scientists from ancient Greece up to the most recent psychological contributions of the 21st Century. In other words, this volume is a detailed and thorough survey of mental science over the ages. One of the central values of this excellent volume is its ability to locate contemporary mental health debates within this historical sequence.

Millon presents these seven paradigms in the form of stories or narratives that weave together psychological insights -- including how the mind works, the neurological basis of the mind, the nature of mental illness, and the role of evolutionary and social factors in our understanding of the mind. Millon identifies seven main paradigms, as follows: Philosophical Stories, Humanitarian Stories, Neuroscientific Stories, Psychoanalytic Stories, Pyschoscientific Stories, Sociocultural Stories, and Personologic Stories. Millon devotes two chapters to exploring each paradigm in depth and uses numerous examples of scholars and writers to illustrate his main ideas. In what follows, I provide a few brief remarks about each paradigm.

My overall assessment of the book is very positive. It reads much more like a narrative (as it is intended to read) than a reference manual. It is also a "who's who" of psychology (and so, it is very valuable). However, I suspect that it is the sort of book that would require serious study and digestion (not a casual flip-through or a quick-reference guide). To this extent, I think it would be an excellent book for introductory graduate students in psychology, given that it is a comprehensive survey of major psychological themes that will help to situate modern psychology within its historical context.

1. Philosophical Stories.

In this first paradigm, Millon presents the ideas that emerge in the Ancient world regarding the nature of mental illness, including Ancient Greece, China, and Egypt. For example, the Greeks take on an "animal spirits" model that has animistic, mythological, and demonological aspects; the Chinese describe mental illness as a certain kind of "wind in the mind"; and the Egyptians identified the heart as the center of mental activity (tied closely with aspects of astronomy/astrology). Millon's treatment is thorough and provocative, and provides the basis for additional study (with excellent references to other important scholarly works).

Millon then traces the transformation of the understanding of mental illness. For example, the Egyptians soon learn to associate mental illness with the brain; the Greeks began to recognize mental pathology as a disorder originating from within a person (rather than from unseen, mysterious outside forces). This change of orientation allowed for significant improvement regarding the various therapies that were aimed at restoring a person's mental health. I found it interesting to learn that the Greeks offered different therapies, depending on their assumptions about the nature of the mental illness. Those offering numerical/harmony explanations for illness offered different therapy solution than did those who thought of mental illness in terms of harmful "vapors" or "bile". But this theme is not just true of the Greeks: Millon takes great care in attempting to explain each epoch of thought within its historical context (rather than reading back into history through our modern understanding).

The emergence of Roman medicine also offered a new approach to understanding and treating mental illness. The Romans tended to see mental illness as an illness of the whole body (not just a particular organ, and certainly not of the brain). Hysteria, for example, was a mental disorder that was associated with a "wandering uterus" and melancholy was associated with various imbalances within the body as a whole. By organizing mental illnesses in terms of a "conflict of emotions", the Romans adopted a method of therapy based on kindness and generosity that were aimed at restoring the equilibrium of internal emotional states.

This period also saw the emergence of systematic studies of human physiology and anatomy (most notably in the works of Galen and Aurelius). While Galen was a champion of the "bile theory" of illness, Aurelius viewed mental illness in a mechanical way (as opposed to the "animal spirits" approach or the "hydraulic" approach). Both, however, presupposed something like a "harmony" approach to mental illness.

What is fascinating about Millon's work is his systematic presentation of historical advances in understanding both the underlying assumptions about the causes of mental illness and the treatments that correspond to such assumptions. In fact, many of the treatments discussed are rather humorous (hot baths, wearing warm woolen clothes, relaxing walks). At other times, unfortunately, the treatments discussed are brutal and distressing (such as blood letting and trepanation). In each case, Millon is fair-minded, and attempts to explain the connection between the proposed therapy and the underlying assumptions about the causes of mental illness.

This fairness is apparent when Millon discusses the history of mental illness during the early Christian period. During this time, mental illness was thought to be caused by demon possession. During the Middle Ages, magic, superstition, demonology, and exorcism replaced the naturalism of the Greeks and Romans. In this period (but before the Dark Ages), the mentally ill were treated kindly (usually in monasteries), but still it was thought that mental illness was associated with demonic or satanic influences (adding to the "mythology" of mental illness). The Dark Ages, however, brought considerable misery and torment to those who were mentally ill.

By the 1600s, various supernatural worldviews of the Churches were slowly being replaced by appeals to both reason and experience (i.e. the rise of Rationalism and Empiricism within modern science). This new way of thinking not only transformed natural science, but the human science of psychology as well. This historical trajectory of philosophical themes helps to make the development of modern psychology much more accessible and meaningful. Again, this represents and invaluable source for those studying psychology.

2. Humanitarian Stories.

The aim of this portion of Millon's narrative is to trace the historical development of the treatment of mental illness along humanitarian lines (from Ancient times, thru the Middle Ages, and into the 20th Century in the United States).

Again, Millon is careful to explain how the various treatments of (and attitudes toward) mental illness change depending on the presumed causes of mental illness. For example, during the times when mental illness was thought to be the work of demonic forces, treatments tended to focus on eliminating the demonic influence, in which case it is perfectly reasonable to expect religious experts to offer therapies. However, such therapies were diverse, and only some counted as "humanitarian".

For example, some treatments were simply "custodial" (keeping such people away from society by housing them in monasteries). This protected both society and the mentally ill person from harm. Other treatments included exorcisms and/or severe physical punishment (whipping, chained restraints, starvation, amputation, etc.). The goal of the physical abuse was to weaken the body possessed by the demon so that the demon would leave. Unfortunately, such treatments frequently resulted in death. (It is disturbing to note that such demonic schools of thought still exist in the U.S. today, and occasional news stories still report fatalities among the mentally ill at the hands of religious fundamentalists.)

Another trend was to house the mentally ill in asylums (not necessarily connected with religion). This custodial arrangement varied. Some asylums were simply repositories (in which no therapies were attempted; the mentally ill simply were "locked up"). Some asylums were open to public visitation (as a disturbing and not very humanitarian form of entertainment). And yet some asylums were the birthplace of careful, systematic studies and new therapies (resulting in some robust classification systems, diagnostic methods, and effective treatments).

Asylums also differed in their overall therapeutic goals. Millon suggests that in Europe, the goals of therapy were to rejuvenate the person and to provide the person with a fulfilled, meaningful life in which they take responsibility for their actions and their characters (a tradition largely associated with existentialism).

In the United States, humanitarian asylums (including the state hospital system that emerged in the 20th Century) took on the goal of reintegrating the mentally ill back into society (of providing social skills, job skills, and the ability to live on their own). Such goals, in other words, were less existential and more behavioral (i.e., therapeutic success was measured in terms of eliminating symptoms... a feature that still exists within modern American psychotherapy).

Throughout this narrative, Millon raises wonderful examples that provide the opportunity for discussion. I can easily imagine a graduate seminar in psychology organized around this book (in the context where class discussions can proceed in a variety of directions, from social work to public policy to the goal of therapy, etc.).

3. Neuroscientific Stories.

This "narrative" is largely concerned with the historical development of classification systems or "categorizing symptom clusters". To this extent, Millon presents the history of schemes of classification, leading up to the DSM (Diagnostic and Statistical Manual). A second aspect of this narrative has more to do with the history of identifying the brain as the source of mental illness. Let me say just a bit about each thread of discussion.

Regarding the notion of classification and categorization, Millon presents key historical developments leading to the modern psychological system of classification (the DSM). Some of the key themes that emerge include: the emergence of systematic diagnostic criteria, the recognition of mental illness as a "disease", various pioneering systems of classification (including those for mania, melancholy, autism, depression, etc.), and the attempt to consolidate various classification systems (as needed by a growing state hospital system, so that there can be a common language spoken among researchers and therapists).

The chapter on the brain (chapter 6) is fully of fascinating (and rather technical) achievements in the area of neuroscientific research. This narrative contributes to understanding the clinical/research tradition of modern psychology (as opposed, say, to the counseling/therapy side). However, Millon is careful to note the connection between research and therapies.

One of the key features of the research tradition is the recognition of the bio-chemical changes that occur in the brain (and how such changes correspond to changes in personality and temperament). But this insight gave way to three distinct approaches: the first understood psychic pathology in terms of various natural (bio-chemical) variations that exist among people. To this extent, mental illness was both organic and natural, and could be remedied by correcting this variation, or the variation was thought to be something that simply could not be corrected... which gave rise to such policies as forced sterilization.

A second approach maintained that mental disorders stem from foreign or aberrant factors that disrupts natural functioning. This is largely the known as the "disease model" and therapies aimed to correct imbalances (returning the person back to the "natural" state of balance).

Still a third research approach viewed mental illness in terms of "psychogenic origins" in which psychological states were the source of mental illness. In this approach, it was thought that various afflictions (such as depression that results when a loved one dies) were brought about by psychological states (not organic diseases). The sadness or depression experienced in such cases are treated not by introducing new bio-chemicals, but through "talk therapy", also known as cognitive-behavioral therapy. (It's important to note, however, that such psychological states could have real impact on brain chemistry, and so the combination of talk therapy and psychopharmaceuticals is thought to be completely appropriate.

It is during this era of brain research (which is still happening today), researchers are making incredible advances in understanding the organic basis of mental illness. These advances give rise to a number of therapeutic techniques. Millon does an excellent job classifying these types of therapies (again, reaching back in history for some), and I would like to briefly present two main types: somatic therapies and chemical-based therapies.

Somatic therapies include: cranial chipping (trepanation), release of "foul" humors or "toxic" bile (in the form of bloodletting), electrical therapies (including electrical baths, electric eels across the forehead), and surgical procedures (lobotomies, etc.).

Chemical-based therapies included the development of morphine and other alkaloids, bromides and Phenobarbital, insulin and adrenaline (all of which were subject to systematic clinical trials). It is also curious to note that Millon places the emphasis on the importance of chemical therapies within the modern context of psychopharmacology and the development of new drugs by for-profit corporations. This "commercialization" of psychological therapies gave rise to new drugs (such as valium, tricyclics, and SSRIs such as Prozac and Zoloft), as well as sophisticated marketing techniques and aggressive promotion of new drugs.

Millon suggests that the influence of these psychopharmaceuticals within psychology is significant: classification and diagnostic systems have been influenced by drugs and drug companies, as well as insurance companies.

4. Psychoanalytic Stories.

The two chapters that make up the "Psychoanalytic Story" are outstanding, not because Freud is correct, but because Millon is able to generate a fair and systematic presentation of his views. Chapter 7 begins by surveying Freud's predecessors, including the history of thinking about the unconscious (including early theorists who postulated "animal magnetism" as well as those who experimented with hypnosis). The tradition of insight, research, and therapy that Freud is credited with starting (psychoanalysis), is a presented as a rich and diverse field. The field includes both research applications, as well as therapeutic goals and orientations (as well as the division between treating/removing symptoms vs. treating the underlying causes of psychoses).

According to Millon, the psychoanalytic theorist is generally committed to the disease model of mental illness: that symptoms of mental illness reflect the existence of basic unconscious psychological pathology, and that such symptoms also represent compensatory (or defensive) adaptations. Thus, the psychoanalyst identifies a systematic response system as a model to explain and understand psychopathology that incorporates such ideas as early life insecurities, childhood trauma, sexual frustration, as well as other conflicts and anxieties, each of which might form the basis of a long-term psychological response (or adaptation).

Millon traces two important influences in Freud's thinking. The first was Freud's familiarity with neuroanatomy; the second influence was Darwin's theory of evolution. Both of these insights/influences shaped Freud's thinking by grounding psychological conditions in the human body which is the product of evolution (especially the idea (now outdated) that each human being harbored unobservable mechanisms from "earlier stages" of evolution). These sorts of insights, of course, influenced Freud's emphasis on the unconscious as a key explanatory component for mental illness (and the basis of his therapeutic techniques).

Millon next identifies (and nicely explains) four key "themes" that have emerged as the core of psychoanalysis: (1) the structure and processes of the unconscious (i.e., the hidden intrapsychic world), (2) the key role of early childhood experiences in shaping personality development, (3) the distinctive methodology Freud created for the psychological treatment of mental disorders; and (4) the recognition that the patient's character is central to understanding psychic symptomatology. Millon proceeds to explain each of these key themes in detail. And once again, Millon is able to weave a coherent narrative that connects Freud's insights into the causes/origins of mental illness with his suggestions for treatment (again, Freud's aims were to identify and correct the underlying causes of mental disorders, not simply to remove symptoms).

I must admit, this may be the most level-headed, and persuasive, presentation of Freud's work that I've ever read. Of course, Millon also offers a survey of those who criticize Freud. All in all, this balanced, fair treatment of the issues is a testament to the quality of Millon's work.

Besides tracing the history of the objections to Freud's psychoanalytic approach, in chapter 8, Millon goes on to present key outgrowths of psychoanalysis, including a discussion of:

(a) new approaches to psychoanalysis (which maintains Freud's basic insights, but incorporates various updates that have emerged in both research and therapy),

(b) a tradition of "neosocial" analysis (which prefers sociocultural factors over Freud's biological orientation in explaining and treating mental illness),

(c) a tradition that emphasizes an "ego-analytic" focus (including the work of Anna Freud),

(d) a variety of positions known as "object relations" theory (which departs from Freud's emphasis on sexuality, and emphasizes social relationship and object relations), and

(e) a tradition (started by Millon himself) of "development models" (which aim to connect development and personality with psychopathology).

Again, Millon provides a comprehensive and (from what I can tell) balanced treatment of these various traditions. Of special value were the concluding "Comments and Reflections" at the end of each chapter: Millon provides careful insights that only someone with his experience and knowledge could convey. These chapters were truly a pleasure to read.

5. Pyschoscientific Stories.

The chapters making up the "psychoscientific" narrative deal primarily with the emergence and transformation of behaviorism. Behaviorism ushered into psychology a kind of rigorous scientific methodology that was lacking with psychoanalysis. The aim of psychology, according to behaviorism, is to identify the basic laws that underlie both simply and complex psychological functioning. This is an important insight: the behaviorists saw mentality as existing on a continuum (from simple to complex) but also believed that the same basic principles are responsible for all such mental phenomenon. The goal was to precisely anchor all mental concepts and psychological events in terms of measurable empirical properties. As such, behaviorists adopt a methodology of studying simplified mental phenomenon, and then extrapolating the results to more complex cases. (Of course, this sort of assumption has its limitations, and Millon is careful to point this out.)

These chapters trace the history of the development of key elements of behaviorism, including: conditioned stimulus and reflexes (S-R), excitation, learning, operant conditioning, as well as research on perception and thresholds.

Millon also traces the developments by behaviorists in the field of therapy, including: desensitization, a rejection of "emotional venting" or "talk therapies (common to Freud and others), emphasis on cognitive-behavioral therapies, and issues regarding "war neurosis" (post-traumatic stress, etc.).

Millon then traces the historical emergence of cognitive approaches from their behaviorist origins. This "cognitive" turn in psychology had a number of key themes, including:

        the inclusion of introspection and discussion of thought patterns,

        research (and therapies) regarding cognitive dissonance,

        the development of "gestalt" models of perception,

        research cognitive development as well as personality development and moral development (such as with Piaget and Kohler, respectively),

        the analysis of linguistics (where Millon includes a nice discussion of Chomsky's contributions (especially as a critic of behaviorism), as well as Chomsky' positive contributions to psychology as well as linguistics), and finally,

        the emergence of "computational" models of cognition (based on the computer metaphor of "information processing").

Again, Millon provides a succinct and hard-hitting commentary at the end of each of these chapters.

6. Sociocultural Stories.

Of the two chapters making up this narrative, the first (Chapter 11) deals primarily with theoretical advances made from social and anthropological perspectives. The basic idea behind the sociocultural orientation is this: as a departure from other approaches to mental illness (that focus solely on the individual), focus is on the wider social setting that impinges on people. To this extent, pioneering theorists emphasize the importance of society and culture as shaping forces in the development of individuals (including individuals who display symptoms of mental illness). Because sociocultural factors form the context within which individuals learn about the world, develop values, and refine behavioral strategies, theorists are able to incorporate study of "society as patient" including the study of the changing social environments, such as the cumulative impact of rapid industrialization, immigration, urbanization, and the growth of technology.

In the "unfolding of key ideas" Millon presents a wide and interesting survey of the contributions of various sociologists and anthropologists, as well as early public health professionals (i.e., social workers). The "who's who" list includes early philosophers (Plato and Aristotle, both of whom emphasize the individual-society relationship as formative for individual mental health), modern philosophers (such as Hegel), as well as the early "positivist" sociologist Comte. The contributions of Marx, Spencer, Durkheim, and Weber are also weaved into the presentation in with systematic clarity.

Millon also traces the contributions of early anthropologists including Boas, Kroeber, Sapir, Malinowski, Benedict, Levi-Straus, Mead, and Whorf. All in all, Millon's treatment allows the reader to comprehend the unique contributions to the history of mental illness offered by sociologists and anthropologists, especially their emphasis on sociocultural context as an important (and dynamic) component.

The second chapter (Chapter 12) traces the development of refined research methodologies that incorporate the insights offered by those in the previous chapter. In particular, Millon traces the development of both research methods (just how to systematically study sociocultural factors when they are all too often non-quantitative, and non-repeatable), and how such research methods inform the emergence of new therapies (in particular, group therapies, relational therapies, family therapies, etc.).

Sprinkled within this narrative of the development of refined sociocultural research and social therapies, Millon also marks the development of social work (along with its corresponding methodologies of field work), social psychology (as a new official discipline of study and source of new therapies), as well as several "anti-psychiatry" movements.

7. Personologic Stories.

The chapters representing the Personologic approach outline the details and commitments of the most recent trends in understanding the mind. Personology refers to a comprehensive, integrated assessment of personality. Personology provides a variety of complex assessment, diagnostic, and treatment schemas. The fundamental insight of such an approach is to recognize that a person is the organic center of a number of complex variables (behavioral, social, functional, emotional, etc.), in which the whole is greater than the sum of its parts (to repeat a platitude). In order to understand and treat mental illness, in other words, an adequate theoretical orientation must reflect these dynamic qualities of whole persons. This is what personologic theories attempt to provide.

While the personologic integration is an important new approach to mental illness, Millon points out that such an approach is fundamental to the development of a comprehensive mental science in the twenty-first century. The personologic approach is not just another "story" like the other outlined in the book, nor is it merely a call for "eclecticism" within psychology. Rather, the personologic approach is essential because it has the explicit goals to develop: (a) universal scientific principles, (b) subject-oriented theories (in general), (c) classification schemas of personality styles and pathological syndromes, and (d) personality and clinical assessment instruments, (e) integrated therapeutic techniques.

One of the key ideas (provided by Darwin's theory of evolution) is the origin of the notion that personality traits are expressions of adaptive function (as an organic response to an environmental stimulus). This places the focus of studying the mind on the processes that give rise to mentality (rather than focusing on the mental contents themselves). This perspective opens the door for understanding a number of interrelated dimensions of mental life, such as temperament, intelligence, personality traits, and maladaptive personality traits. (Millon includes in his discussion the development of various personality/intelligence systems, including some that postulate three kinds of intelligence (analytic, creative, practical), to personality inventories that specify anywhere from 16 Personality Factors all the way up to 4,504 "real traits"!)

The personologic approach also includes techniques for scientific measurement: psychometric statistics, projective techniques (such as word-association and Rorshach ink-blot), self-reporting techniques, and apperception tests. (Millon's treatment of the origin of such instruments is quite fascinating, including a brief discussion of astrology, phrenology, and physiognomics.)

Finally, Millon discusses the various developments (and achievements) of therapeutic techniques based on the basic commitments of personology (with the emphasis on integration and unification around each unique person). These integrated, synergistic therapies draw on components borrowed from pre-existing therapies, such as: psychoanalysis, bio-social conditioning, psychopharmacological remedies, and cognitive-behavioral therapies.

Millon takes special efforts to explain the details and importance of personologic theories, most likely because this is where his own professional interests are located. In fact, among the list of individuals that he presents, he includes himself (complete with a brief biography, list of significant contributions to the field, as well as commentary on his own contributions). I found this both charming and endearing (after all, his assessment of his own contributions is not inflated, nor is it down-played). What I take from this chapter (and the book as a whole) is Millon's incredibly even-handed treatment of each topic and theory discussed.



2005 James Sage


James Sage is Assistant Professor of Philosophy at the University of Wisconsin-Stevens Point. In addition to teaching courses in epistemology, philosophy of science, and philosophy of technology, he also has interests in philosophical psychology and the history of science.


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