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Mental Health Lecture Notes .pdf

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McMaster University
Lovaye Kajiura

16 September, 2013 Health Age 2G03 Lecture 1-2 Pertinent Questions: - What is “mental health”? - What is a “mental illness”? - How has the concept of a mental illness changed over time? - What is the current status of mental illness as a concept? - What are the societal implications of mental health/illness? - What treatments for mental illness work? What is Mental Health? - blue denotes depression - picture of a painting by Vincent Van Goh [older looking man in blue, sitting with his face covered] Origins of “Mental Health” Here are some terms used to describe mental health/patients - morally insane, rogue, deranged, lunatic, mad, unfortunates, insane, bedlamers/bedlamites (specific to Britain) , Abraham-men, inpatient, committed, patient, client, consumer, stake-holder - terms that marginalized people - today we are more sensitive to this Mental Hygiene - A mind That Found Itself :Clifford Beers - Clifford Beers was very important in mental health studies because he really advanced the cause - its like he’s been there, come back to tell us about it. - prof recommends to read about him in the textbook - in the mid 19th century, the term “mental hygiene” was coined - Mental hygiene was a kind of early health promotion scheme seen as the art of fortifying the mind against harsh experiences and keeping it from falling into derangement - Clifford Beers was an early patient/activist who found what became “Mental Health America” Clarence Hinks - Canadian version - Beers foundation spurred Clarence Hincks, MD to found The Canadian National Committee for Mental Hygiene - Now called The Canadian Medical Health Association - Also, the Hinks- Dellcrest Treatment Centre was named after him (The C.M. Hinks Institute merged with Dellcrest Treatment Centre) Mental Health is... - “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can wok productively and fruitfully, and is able to make a contribution to his or her community” - World Health Organization - analyzing the definition ... if your in a situation where you don’t realize your own abilities.. what’s normal? , work productively - what if you had a bad day.. Psychopathology - disease of the mind - typically, mental illness is constructed as an aberrant or disordered process. - termed psychopathology: literally means”disease of the mind” - based on a medical model of human distress, or aberrant or extreme experiences that are either transient, or persistent - Human distress has been medicalized and is see as disease/disorder that is treatable by medical means. Abnormality - the concept of psychopathology is predicted on the concept of “ abnormal behavior” - Abnormal constitutes behavior that is counter productive to meeting the demands of daily living - Psychopathology is classified by the DSM-IV - The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Unusual or Rare Behavior - behavior that is significantly beyond what is accepted as the normal range - where does eccentricity stop and abnormality begin? - What about immense talents such as genius or remarkable talent? - Based on a rigid sense of conformity to society demands. What constitutes abnormality? - deviation from established cultural norms for behavior - deviation from traditional conceptions of gender roles - deviation from established norms for experience (eg. hallucinations, talking to imaginary people) - behaviors which seriously impair the ability to meet the basic demands of daily living. Cultural Relativism - This lead us into the issue of cultural relativism - What is acceptable behavior in one culture may not be in another - For ex., until recently there was little concept of Alzheimer’s in India - Dementia as a physical process exists in India, it was recognized as a spiritual process - However, serious issues can occur when one cultural paradigm meets another. - Difficulty translating across conceptions of “disorder” and causes thereof. Discomfort - In this view, if a behavior causes discomfort to a person, and the person wants the behavior to stop, we can consider that this behavior constitutes a mental illness - Pro: this is a compassionate viewpoint that marked a moved forward in how we consider and treat homosexuality, for example - However, it if predicted on awareness: If you are not aware of how your behavior is hurting others, well, it, could still be a problem - Can be take to the ridiculous “if it feels good do it/if it makes you happy it can’t be that bad” conclusion Mental Disease - there is a clear physical cause of aberrant behavior - the physical cause leads to specific behaviors - this is a disorder /disease model - it places any form of aberrant or non-conformist behavior with the medical model. Criticisms of the disease model - There are studies that show genetic heritability of major mental illnesses to a degree. - However, there is no “blood test” for any mental illness, unless the mental illness is a symptom of an underlying medical condition - The categories of mental illness are what philosophers call an “artifactual kind” (made by humans) as opposed to a “natural kind” (made by nature). Maladaptive Approach - if a behavior causes significant difficulties in meeting the demands of daily living the behavior is seen as maladaptive - Based in the 3”D’s” - Dysfunction - Distress - Deviance - Sometimes a 4th D is added: dangerousness. World Health Organization - these is no health without mental health - “Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can wok productively and fruitfully, and is able to make a contribution to his or her community” The Scope of Mental Illness in Canada Mental Health in Ontario - Ontario now spends about $3 billion a year on mental health programs plus another $2.3 billion in related law -enforcement services - in addition to the $2 billion a year the private sector spends on disability claims an employee assistance programs for workers with mental health and addiction table 23 September, 2013 Lecture 3 - Removing the Stone of Madness Painting: - Drilling a man through his head to let out the “Evil Spirit” - this is what they would do if you had a mental illness Early Approaches to Mental Health - What we will cover tonight: - Classical approach to mental health and treatment - Medieval approaches - Renaissance and Enlightenment approaches - The epistemology of “normal” Very Early Conceptions - Stone Age (Neolithic) peoples attempted psychosurgery - We know that the egyptians had a basic conception of mental health - So did the Ancient Indians cultures - The Ancient greeks had a more developed conception - actually tried to name things, some of these names are still here with us today - We will focus on the Greek/Hellenistic conception and developments up through the Middle Ages. Stone Aged psychosurgery -(image) : head drilled open, blood, group of people holding person being treated down with hands Neolithic Headache Cure... - Evidence suggests that holes found in ancient skulls were the result of “ psychosurgery” - This was termed “trepanning” - The hole in the skull was thought to let out the “evil spirits that were causing the person to act abnormally. - Many people survived as is evidence by skulls with healed over holes... Greek approaches to mental health - Greek philosophy became concerned with fundament questions of personhood. - There was the beginning of a “scientific approach” or a reasoned approach to thinking about human nature - Their mode of inquiry set the stage for all subsequent inquiry even though the theories have been discredited... Hippocrates and Temperaments The Humors - We now see that there is a move from “evil spirits” to some effort of understanding - Hippocrates hypothesized that there were four major humors: - Black bile (“Melancholic”) - Yellow bile (“Choleric”) - Phlegm (“Phlegmatic”) - Blood (“Sanguine”) - in balance = healthy Humours & Mental Illness - This theory was only displaced by the 1850’s - The term melancholic endures to this day - The imbalance was called dyskrasia (nope - “crazy” comes from another words “krasa” which means “to break”) - But what did they really mean? Humorous types - Sanguine: Extroverted and “bloody minded”, people persons, but can be sensitive and caring. Like social situation and bore easily - Choleric: Ambitious task oriented person; tend to be leaders - Melancholic (introverts today) Thoughtful, ponderous people, less oriented, creative. Neurotic Stoics: Hellenistic mental health pioneers - One legacy that greek philosophy left to our treatment of mental health is Stoic Philosophy - Stoics believed that it was not what happened to one that mattered, but what one thought of events. - “Nothing is good nor evil but thinking makes it so...” - stoicism was seen as anti emotion but it really is about harmony Tenets of Stoicism: - Founded in Athens by Zeno of Critium - Concerned with freedom and determination in human affairs and human nature - Encouraged reflective practice - Emphasized actions over thoughts - It was a mode of life designed to keep one at equilibrium with oneself and others. Famous stoics - Epictetus - Marcus Aurelius - Seneca (the younger) - “Get rid of the judgement, get rid of the ‘I am hurt’, you are rid of the hurt itself” (viii.40) - Marcus Aurelius Modern threads of stoicism - Freud was very influential - Where id was, ego shall be - Greek philosophy in general and recently, Stoic philosophy, and to a lesser degree, Epicurean philosophy has had an effect on the development of modern psychotherapy - Freud would have had a”classical” education which would have included reading the major Greek philosophers in Greek. Freud, for starters - Characterized people into types - Freud would have agree that “the unexamined life not worth living” - He also characterized people into type, and his neurotic” bears resemblance to the “melancholic yore” - He also believed that things below are awareness had a profound impact on our behavior and thus the character that we projected. - He was obsessed with antiquities and classical art. Aaron T Beck, Albert Ellis and Cognitive Therapy - Beck and Ellis can both be described as Stoics: They reject the idea of the unconscious and favor rational thinking as a basis of mental health - In Cognitive Behavioral Therapy, the emphasis is placed on discovering one’s ‘automatic thoughts’ that precede a change in emotional state - The goal is to develop awareness of these thoughts and awareness of change in emotion and hot to deal with them. - Like stoicism the goal is not “happiness” by eradicating thee thoughts, or negative emotions, but teaches a method of peaceful co-existence The Middle Ages - The middle ages repealed some of the insights and humanitarianism of the early philosophers - “Dark Ages” - There was a tendency to see any abnormal behavior as being the result of forces such as demons and/ or witchcraft - There was not much of a scientific means of inquiry into mental health. Joan of Arc Image Care of the mentally ill - people were allowed to coexist - “that ones touched by god “ (for kids with down syndrome) - certain behaviors not tolerated - ROGUE - a homeless, who’s aggressive, running foul of law - However, the mentally ill in some quarters were allowed to peacefully coexist with others in the village and were tolerated - Specific forms were tolerated - The ROGUE was a vagrant (who may or may not have been mentally ill) - Rogues were persecuted heavily and subject to burning at the stake for a third time offense. Renaissance - orphanages came into being - By the renaissance the mentally ill were gathered together and housed in “asylums” - Special facilities were constructed for people exhibiting abnormal behavior - the famous “bedlam” hospital began as a priory in the early 1500s... The Concept of Normal - By the early-mid 1800s the concept of “normal” or “the norm” began to replace the Englishtenment concept of “Human Nature” - There was an increasing use of the dichotomy of normal/abnormal - This change the way we viewed mental illness - It led to modern diagnostic schemes. Philosophy of Kinds - Natural vs Human kinds - We often think that diagnostic categories are “Real” things but they are artifact - Is it possible that the diagnostic categories come before the symptoms, or the expression of “ angst” or stress into specific symptoms? - In certain cultures you don’t use certain words, Early uses of “Normal” - “Normal” as a word only came into being in the mid-late 1800s - It became a dichotomy: To be “normal” you also needed a counterpart “abnormal” - This was defined by a disease or a disordered process - Therefore, diseases need to be grouped in order for us to understand what was “normal” or abnormal. “Normal” and Early Diagnosis - So-we end up with the normal “curve” - Educational testing had a great deal to do with the promulgation of the idea of “normal” - As a result, we ended up with a dichotomy (you have the disorder, or you don’t) - BUT we also ended up with the bell curve, the idea that you could have some of the symptoms or a MILD case Bell Curve (on the right) Implications for mental health research - Autism is the best example currently - It used to be a categorical diagnosis - Now it is a continuous diagnosis - It is hotly debated: - So we have the “normal” as - Typical - Statically Average - Mediocre 30 September, 2013 Lecture 4: From Bedlam to Freud Tonights lecture: - We will examine the rise of asylums for the mentally ill - We will examine “Bedlams” as the prototypical “mad asylum” - The reformation of asylums - The rise of psychoanalysis - Decline of psychoanalysis - Rise of behavior - Rise of biological investigation - Evidence based medicine - the advent of the DSM system of classification Asylums: - roman architecture - inmates always wearing white? Birth of Asylum: - Mental illness (“madness”) was a very general term in the Middle Ages (and encompassed a lot of terms) - To be mentally ill could me - Epileptic - Suffering from psychosis - Dementia due to venereal disease - Hydrophobia (symptom of rabies) - Unruly behavior coupled with poverty Bedlam - Royal Bethlehem Hospital was founded in 1247 in London,England - Mentally ill people were sent there by about the 1370s by Richard II - The accommodations were primitive and filthy by any standard - The institution was corrupt. - By the 1600s “bedlam” became a synonym with pandemonium (craziness usually involving a group of people - By the 1700s, Bedlam also housed political prisoners, because incarceration in Bedlam kept them out of public and prevented execution (which might raise the popularity of their treasonous views) - Bedlam survived the Great Plague and the Great Fir of London - It was moved to Moorsgate (another part of London) in 1676 into a grand new building. - However, Bedlam became a freak show for the wealthy, who came to be entertained by naked, filthy inmates. What was it like for a patient? - One could be chained to the wall indefinitely (one patient died after his intestines burst, after years of being chained to the wall) - Patients were often hosed down - they often were stripped of clothing - There were no real provision for heating cells - Patients sleep on straw - Pestilence was rampant - Hygiene was non-existent The concept of the asylum - The concept of asylum was developed in France in the 1600s - Louis XIV locked up anyone he considered a threat(“the great confinement”) - The development of the asylum meant: - There was a sense that the mentally ill would benefit from removal from society - That the mentally ill could be studied - If studied, they could be cured. On the other hand - Asylums represented the birth of psychiatric medicine - One prominent early psychiatrist or “alienist” was named William Battie (He’s gone “battie”) - Asylums were also: - A means of social control - Prisons disguised as hospit
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