by Theodore Millon
Review by James Sage, Ph.D. on Oct 3rd 2005
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
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
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,
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
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
research (and therapies) regarding cognitive
the development of "gestalt" models of
research cognitive development as well as personality
development and moral development (such as with Piaget and Kohler,
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
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
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
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
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
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
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
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.