16 September, 2013
Health Age 2G03 Lecture 1-2
- 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
- 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”
- Canadian version
- Beers foundation spurred Clarence Hincks, MD to found The Canadian National Committee for Mental
- 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..
- 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.
- 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.
- 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
- 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).
- if a behavior causes significant difficulties in meeting the demands of daily living the behavior is seen as
- Based in the 3”D’s”
- 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
- 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
- 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
- Their mode of inquiry set the stage for all subsequent inquiry even though the theories have been
Hippocrates and Temperaments
- 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
- But what did they really mean?
- 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.
- 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/
- 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.
- 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
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
- Statically Average
- Mediocre 30 September, 2013
Lecture 4: From Bedlam to Freud
- 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
- 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
- To be mentally ill could me
- Suffering from psychosis
- Dementia due to venereal disease
- Hydrophobia (symptom of rabies)
- Unruly behavior coupled with poverty
- 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
- 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
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