People are social creatures who learn how to behave appropriately in families and communities. What is considered appropriate, however, depends on a host of factors, including historical period, culture, geography, and religion. Thus, what is valued and respected changes over time, as do sociocul-tural perceptions of aberrant or deviant behavior. How deviancy is treated depends a great deal on the extent of the deviancy—is the person dangerous, a threat to self or to the community, in flagrant opposition to community norms, or is the person just a little odd? How the community responds also depends on its beliefs as to what causes aberrant behavior. Supernatural beliefs in demons, spirits, and magic were common in preliterate societies. In the medieval Western world, Christians believed that the devil was in possession of deranged souls. Hence, the mentally ill were subjected to cruel treatments justified by the idea of routing out demons or the devil. For centuries, the prevailing explanation for madness was demoniacal possession. Prior to the nineteenth century, families and communities cared for the mad. If they were unmanageable or violent, the mad were incarcerated in houses of correction or dungeons, where they were manacled or put into straitjackets. If a physician ever attended someone who was deemed mad by the community, it was to purge or bleed the patient to redress a supposed humoral imbalance.
Most medical explanations prior to the advent of scientific medicine were expressed in terms of the four humors: black bile, yellow bile, blood, and phlegm. Imbalances usually were treated with laxatives, purgatives, astringents, emetics, and bleeding. Understanding moved from the holistic and humoral to the anatomical, chemical, and physiological. Also, views of humans and their rights changed enormously as a consequence of the eighteenth century American and French Revolutions.
During the nineteenth and twentieth centuries, madhouses were first replaced by more progressive lunatic asylums and then by mental hospitals and community mental health centers. In parallel fashion, custodians and superintendents of madhouses became mad-doctors or alienists in the nineteenth century and psychiatrists, psychologists, and counselors of various kinds in the twentieth century. Similarly, the language changed: Madness was variously called lunacy, insanity, derangement, or alienation. The term currently used is mental disorder. These changes reflect the rejection of supernatural and humoral explanations of madness in favor of a disease model with varying emphases on organic or psychic causes.
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