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Lecture

CHapter 1

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Department
Psychology
Course
PSYC 3140
Professor
Krista Phillips
Semester
Fall

Description
Abnormal Behaviour Chapter 1 Chapter 1: Abnormal Behaviour in Historical Context What is a Psychological Disorder? psychological disorder: a psychological dysfunction within an individual that is associated with distress/impairment and a response that is not typical or culturally expected. 3 criteria: - psychological dysfunction - distress/impairment - atypical response/ not culturally expected phobia: a psychological disorder characterized by marked + persistent dear of an object / situation psychological dysfunction: breakdown in cognitive, emotional, or behavioural functioning - exist on a continuum/dimension rather than categories personal distress: individual is extremely upset atypical/not culturally expected: occurs infrequently/deviates from the average // violating social norms example: Saplonsky's study on Masai tribe in East Africa - women acting aggressively, hearing voices "not at the right time" -"harmful dysfunction" / beyond individuals control official definition: behaviour al, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment. - some scholars have argued that the health professions will never be able to satisfactorily define disease or disorder prototype: typical profile - patient may have only some features/symptoms of the disorder (a min. number) and still meet criteria for the disorder because the symptoms are close to the prototype - the best thing to do: consider how the apparent disease or disorder matches a "typical" profile of a disorder (depression/skitzo) when st or all symptoms that experts age are part of the disorder are present Thomas Szasz + George Albee (1960s) - highly critical of medical diagnoses being used in the case of psychological disorders - "mental illness = myth" the practice of labelling mental illnesses should be abolished - argued that a fundamental diff. exists between the use of diagnoses for physical diseases (objective critera: blood tets) and their use in mental illnesses (subjective judgements) The Science of Psychopathology psychopathology: the scientific study of psychological disorders. - includes specially trained professionals: clinical + counselling psychologists, psychiatrists, psychiatric social workers, psychiatric nurses, marriage + fam. therapists, mental health counsellors Clinical Psychologists: Ph.D after a course of graduate level study (5 yrs) // Psy.D (more emphasis on clinical practice - less on research training) (not in Canada - in development in Quebec) - conduct research into causes + treatment of psychological disorders - diagnose, assess, treat the disorders Abnormal Behaviour Chapter 1 Canada: - regulation of the psychology profession is under the jurisdiction of the provinces/territories - depending on jurisdiction: psychologist can have doctoral or masters Ontario: only those who are licensed or registered with their provincial board or college are permitted to call themselves "psychologists" (psychotherapist + therapist are not regulated) psychologists with experimental or social training: concentrate on investigating the basic determinants of behaviour but do not assess or treat psychological disorders counselling psychologists (Ph.D, Psy.D, Ed.D): tend to study+ treat adjustment + vocational issus encountered by healthy individuals Psychiatrists (M.D. + specialize in psychiatry during 3-4 year residency training program) - investigate nature + causes of psychological disorder, often from biological point of view, make diagnoses, offer treatments - many emphasize drugs/other biological treatments + use psychosocial treatments Psychiatric Social Workers (Masters in Social Work) - develop expertise in collecting information relevant to the social and fam situation of the individual with a psychological disorder - treat disorders: concentrating on fam. problems associated with them Psychiatric Nurses (Masters/Ph.D) - specialize in care + treatment of patients with psychological disorders - usually in hospitals as part of treatment team Marriage + Family Therapists / Mental Health Counsellors - Masters (1-2 year) - provide clinical services in hospitals/clinic (under supervision of a doctoral-level clinician) 1. The Scientist-Practitioner most important recent development in psych: adoption of scientific methods to learn more about the nature of psychological disorders, their causes, and their treatment scientist-practitioners: mental health professionals that take a scientific approach to their clinical work 1. may keep up with the latest scientific developments in their field + use most current diagnostic + treatment procedures 2. evaluate their own assessments/treatment procedures to see whether they work (accountable to patients, government agencies, insurance companies that pay for treatments) 3. conduct research (in clinics/hospitals) that produces new info about disorders/treatment 2. Clinical Description presenting problem: (presents) indication of why the person came to the clinic clinical description: represents the unique combination of behaviours, thoughts, feelings that make up a specific disorder - what makes the disorder different from normal behaviour or from other disorders? clinical: 1. the types of problems or disorders you would find in a clinic/hospital 2. the activities connected with assessment + treatment 2. a) What' s Included in the Clinical Description? Abnormal Behaviour Chapter 1 prevalence: the number of people in the population (as a whole) that have the disorder incidence: how many new cases occur during a given period (ie: year) sex ratio: percentage of males and females that have the disorder age of onset course: individual pattern the disorder follow chronic course (skitzo): tend to last a long time, sometimes a lifetime episodic course (mood disorders): reoccurring throughout lifespan time-limited course: will improve without treatment in a relatively short period acute onset: begin suddenly insidious onset: develop gradually over an extended time prognosis: the anticipated course of a disorder "the prognosis is good" "the prognosis is guarded" persons age 3. Causation, Treatment, Outcomes Etiology: the study of origins - why a disorder begins (what causes it) - includes biological, psychological, social dimensions - effect doesn't necessarily imply cause ex: asprin may relieve headaches, but that doesn't mean headache was caused by lack of asprin - treatment may provide hints to nature of disorder - multidimensional perspective: current treatment does not focus on one theoretical approach: integrates most current + effective drugs or psychosocial treatments The Past: Historical Conceptions of Abnormal Behaviour 1. The Supernatural Tradition a) Demons + Witches (last quarter of the 14th century - through 15th - 1692 Salem Witch Trials) - religious + lay authorities - catholic church split - Roman Church fought French Church - individuals possessed by evil spirits were responsible for any misfortunate experienced by the townspeople, which inspired action again the possessed treatments: - exorcism: various religious rituals were performed to rid the victim of evil spirits - shaving pattern of cross in victims hair + securing them on a wall near the front of a church b) Stress + Melancholy (roughly same time period as above) view: insanity = natural phenomenon cause by mental / emotional stress, + its curable mental depression + anxiety = illnesses - although church identified symptoms like despair + lethargy with the sin of acedia/sloth common treatments: rest, sleep, healthy + happy envr. Abnormal Behaviour Chapter 1 other treatments: baths, ointments, potions - people with mental illnesses were moved from house to house in medieval villages Nicholas Oresme: depression = source of bizarre behaviour rather than demons * during 14th + 15th centuries some assumed that demonic influences were the reasons behind abnormal behaviour, while other the opposite * (p.10 - The Mad King) c) Treatments for Possession - in Middle Ages: if exorcism failed = individuals were subjected to confinement, beatings, tortured - some therapist decided that hanging people over a pit full of poisonous snakes might scare the evil spirits out of their bodies (this sometimes worked) - snake pits were therefore, built in many institutions - many other treatments based on the shock-method were developed (ie: dunkings in ice cold water) d) The Moon + the Stars (Paracelsus) - rejected notions of possession by the devil, suggested movements of stars and moons had profound effects on people's psychological functioning luna - lunatic - no serious evidence found to confirm this, however lots of horoscopes follow this belief e) Comments - supernatural tradition still exists (some cultures outside North America + small religious sects in N.A) now: Roman Catholic Church requires that all health care resources be used before spiritual solutions such as exorcism can be considered\ 2. The Biological Tradition a) Hyppocrates + Galen Hippocrates: father of modern medicine (Hippocratic Corpus) 450 BCE-350 BCE - suggested psychological disorders could be treated like any other disease - believed they might also be caused by brain pathology or head trauma and could be influenced by genetics - considered the brain to be sear of wisdom, consciousness, intelligence, emotion (therefore, disorders involving these functions would be located in the brain) - coined "hysteria": concept he learned from the Egyptians who had identified what we now call Somatoform disorders Somatoform Disorders: physical symptoms appear to be the result of an organic pathology for which no organic cause can be found (ie: paralysis, some kinds of blindness) - occurred primarily in women (egyptians assumed they were restricted to women) assumed cause: wandering uterus in body in search on conception prescribed cure: marriage / fugmintation of vagina to lure the uterus back to its regular location - recognized the importance of psychological + interpersonal contributions to psychopathology (ie: sometimes negative effects of family stress) -- on some occasions removed patients from families Galen: adopted ideas of Hippocrates + developed them further = powerful + influential school of thought within the biological tradition that extended into the 19th century humoral theory (of disorders) - first example of associating psychological disorders with chemical imbalance Abnormal Behaviour Chapter 1 - assumed that normal brain functioning was related to 4 bodily fluids (humors) - blood (heart) - black bile (spleen) (too much = depression/melancholia) - yellow bile (liver) -phlegm (brain) - disease = too much or too little of humors - 4 humors: Greeks 4 basic qualities (heat, dryness, moisture, cold) - applied to personality: sanguine (red/blood) - ruddy, cheerful/optimistic, insomnia, delirium melancholic: depressive phlegmatic: apathy/sluggishness/calm under stress chloeric: hot tempered - excess of humours: treated by regulating environment (increase/decrease in heat, dryness, etc) development of 2 new additional treatments: 1. bleeding/bloodletting: carefully measure amount of blood was removed from the body, often with leeches 2. induced vomiting: eating tobacco + half boiled cabbage b) The 19th Century - discovery of nature + cause of syphilis - support from American psychiatrist John P. Grey Syphilis - believing that everyone is plotting against you (delusion of persecution) - believing that you are God (delusion of grandeur) - bizarre behaviours - different from psychosis - (1825) general paresis: b/c had consistent symptoms (presentation) and a consistent course that resulted in death) - link between syphilis + general paresis onl discovered later on - Pasteur: germ theory of disease: identified specific bacterial micro-organism that cause syphilis - Pasteur: stated that all symptoms of a disease were caused by a germ (bacterium) that invaded the body - cure for general paresis: malaria, because high fever burned out the syphilis bacteria // penicilin - malaria cure lead many to believe that "madness" could be traced directly to a curable infection + that comparable causes + cures might be discovered for all psychological disorders John P. Grey - superintendent at a hospital in NY - editor of American Journal of Insanity -- Psychiatry - American Psychiatric Association - believed that insanity laways has physical causes; mentally ill patients should be treated as physically ill - emphasis on rest, diet, proper room temperate and ventilation - invtented rotary fan in order to ventilate his large hospital - under his leadership conditions in hospitals improved + became more humane + livable - became too large and impersonal, individuals didnt recieve required attention deinstitutionalization: patients released into communities (100 yrs later) - large increase in # of patients with chronic disabilities left homeless on the streets c) The Development of Biological Treatments Abnormal Behaviour Chapter 1 1930s electric shock + brain surgery - insulin (originally given to stimulate appetite, also seemed to calm patients down) (1927) Manfred Sakel: began using higher and higher dosages until patients convulsed + became temporarily comatose = recovery n mental health = attributed to convulsion (INSULIN SHOCK THERAPY) - abandoned b/c too dangerous - other methods of shock had to be found (1920s) Joseph von Meduna :observed skitzo rarely found in epileptics (not actually true) - concluded that inducing brain seizures would help skitzo d) Consequences of the Biological Tradition (19th century) John P. Grey + co. - eliminated interest in treating patients with mental illnesses because they thought mental disorders were due to some as yet undiscovered brain pathology and therefore incurable - in place of treatment, focus was on diagnosis, legal questions concerning the responsibility of patients + their actions during periods of insanity + study of brain pathology Emil Kraeplin (1856-1926) - dominant figure during this period - father of modern psychiatry - advocated major ideas of biological traditions - believed that disorders were due to brain pathology - contributed to diagnosis + classification of disorders - among the first to distinguish among various psych. disorders; seeing that each may have a diff. age of onset + course, with somewhat diff. clusters of presenting symptoms + prob. diff. cause - many of skitzo descriptions are still useful today overview of 19th century: - scientific bio approach to psych - search for biological causes - treatment based on humane principles - many drawbacks: active intervention + treatment were mostly eliminated The Psychological Tradition Plato: (and later Aristotle) causes for maladaptive heaviour = social + cultural influences in a person's life and the learning that took place in that envr. (precursor to modern psychosocial approached) - wrote about the importance of dreams, fantasies and cognitions - advanced humane and responsible care for people with psychological disturbances psychosocial approaches: focus on psychological, as well as social and cultural factors. 1. Moral Therapy (1st half of 18th century) moral: emotional/psychological, rather than a code of conduct basics: treating institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction - emphasis on positive consequences for appropriate interactions + behaviour (staff modelled this behaviour) - lectures on various interesting subjects were provided - restraint + seclusion = elimintated (official origin: Philippe Pinel) Pinel and former patient Pussin who worked at hospital: socially faciliative atmosphere William Turke: founder of North American Psychiatry - introduced Moral Therapy to the New World Abnormal Behaviour Chapter 1 early asylums (16th century): more like prisons than hospitals - mainly housed beggars + variety of people w. mental illnesses - horrible conditions - few treatment regimens - changed with rise of moral therapy 2. Asylum Reform + the Decline of Moral Therapy after mid-19th century - humane treatment declined because: - moral therapy worked best when # of patients was max 200 ppl - patient load increased to 1000-2000 + reasons: immigration + Dorothea Dix Dorothea Dix - mental hygiene movement - campaigned for reform in the treatment of insane in Canada) - involved in the constriction of the St. John Newfoundland asylum - appealed to Nova Scotia legislature (Where she described the conditions in asylums) - worked to make sure everyone who needed care received it (including the homeless) - consequence = increase in number of hospital patients Clarence Hicks - followed Dix's example - important reformer - toured mental institutions throughout Manitoba - documented continued appalling conditions in institutions - found that often those that worked in mental institutions has no special psychiatric training - women in closer, people locked in coffins, mentally defective children rolled in long strips of cotton at night - placed on shelves to sleep - advocated that mental illness is treatable // at the time: belief that mental illness was incurable psychological analysis: Freud's theory of the structure of the mind + the role of the unconscious processes in determining behaviour behaviourism: (Watson, Pavlov, Skinner): focuses on how learning + adaptation affect the development of psychopathology 3. Psychoanalytic Theory Anton Mesmer - suggested to his patients that their problem was due to an undetectable fluid found in all living organisms called "animal magnetism" that could become blocked - had his patients sit in a dark room around a large vat of chemicals with rods extending fr
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