By the beginning of the 20th century, then, doctors controlled the mental illness field. Yet doctors were deeply divided between those who assumed mental ill- ness stemmed from psychological causes and those who assumed it had biological causes.
This split grew wider with the rise of Freudian psychiatry. According to Sigmund Freud, a Viennese doctor, to become a mentally healthy adult, one had to respond successfully to a series of developmental issues. Each issue occurred at a specific stage, with each stage linked to biological changes in the body and in- vested with sexual meanings. For example, Freud believed that during the phallic stage (ages three through six) boys naturally begin noticing genitalia, experiencing sexual attraction toward their mothers, and therefore viewing their fathers as rivals. To become healthy adults, he argued, boys had to conclude that girls lack penises because their fathers castrated them after some wrongdoing. To avoid the same fate, boys must abandon their attraction for their mothers and instead pursue their fathers’ love by adopting their fathers’ values. Through this process, Freud argued, boys develop a strong internal sense of morality—something that girls, lacking penises, can never do.
Freud based this theory on his interpretations of the lives and dreams of his upper-middle-class patients; no scientific data underpin this theory. Looking back at this theory from the present, it is hard to comprehend how anyone could have believed in such notions. Yet the theory remained popular for decades, undoubt- edly because it both reflected and supported popular ideas about men’s superior bodies, intellect, and moral virtues.
For those who accepted Freud’s theory, the only way to cure mental illness was to help patients resolve their developmental crises. To do so, Freud and his followers relied on psychoanalysis, a time-consuming and expensive form of psy- chotherapy geared to patients without major mental illnesses. In psychoanalysis, patients recounted their dreams and told a (usually silent) therapist whatever came to mind for the purpose of recovering hidden early memories and understanding their unconscious motivations.
Because psychoanalysis was so costly, few people could afford to use it. By the 1950s, most mental patients instead received new, far cheaper physical interventions such as electroconvulsive (shock) therapy or lobotomies. Neither therapy received scientific testing before becoming popular and both could cause brain damage. At any rate, therapy of any sort occupied only a minuscule proportion of patients’ time in mental hospitals. Instead, patients spent their days locked in crowded wards with little other than radios or televi- sions to ease their boredom.