abnormal psych notes ch 1.doc

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 1: Definitional and Historical Considerations and Canada’s Mental Health System Bretts Childhood  His recent inability to maintain an erection when making love to his wife was the immediate reason for his seeking therapy  Brett didn’t have a happy childhood. His mother died suddenly when he was only 6 and for the next 10 yrs he lived either with his father or with a maternal aunt. His father drank heavily and the mans moods were extremely variable; he had even been hospitalized with a diagnosis of manic depressive psychosis  Brett often became depressed for no apparent reason and sometimes this was followed by periods of manic  He felt self conscious with ppl who he felt had authority over him and he was esp sensitive about his clothes which were old compared to his peers  He entered the police academy and he had hopes that his badge and uniform would give him the instant respect that he seemed incapable of earning on his own  He wondered if he was actually avoiding the responsibility of having a child  He attacked her both verbally and physically about her alleged infidelity and then got help  Psychopathology- the field concerned with the nature and development of abnormal beh thoughts and feelings  Challenge in studying abnormal psych is the need to remain objective  Abnormal psysh is most popular but it has one distinct disadvantage which is that all of us bring to your study preconceived notions of what the subject matter is WHAT IS ABNORMAL PSYCHOLOGY?  Challenge is how to define it  Abnormal beh- patterns of emotion, thought and action deemed pathological for one or more of the following reasons: infrequent occurrence, violation of norms, personal distress, disability or dysfunction and unexpectedness Statistical infrequency  One aspect of abnormal beh is that its infrequent  Normal curve or bell shaped curve- places majority of ppl in the middle as far as any particular characteristic is concerned; very few ppl fall at either extreme.  An assertion that a person is normal implies that he or she does not deviate much from the average in a particular trait or beh patterns  Statistical infrequency is used explicitly in diagnosing mental retardation  When an indiv IQ is below 70 his or her intellectual functioning is considered sufficiently below subnormal to be designated as mental retardation Violation of norms  Consider whether the beh violates norms or threatens or makes anxious those observing it  Violation of norms is too broad and too narrow  Cultural diversity can affect how ppl view social norms. What is the norm in one culture may be abnormal in another Personal distress  Personal suffering ; that is beh is abnormal if it creates distress and torment in the person experiencing it  But some disorders don’t involve distress Disability or dysfunction  Disability –impairment in some important area of life cuz of the abnormality can also be a part of abnormal beh  It applies to some but not all disorders.  Ex transvestism (Cross dressing for sexual pleasure) is diagnosed as a mental disorder if it distresses the person but isn’t necessarily a disability 1 Unexpectedness  Distress and disability are considered abnormal when they are unexpected responses to environmental stressors  There are approx 3,600 practising psychiatrist, 13000 psych and psych associate and 11000 nurses in the metal health area in Canada  2.15% respondents had consulted with a pscyh one or more times in the preceding 12 months. This is = to 515,000 ppl in the Canadian population aged 12 yrs and older  Psychological services are underused  Psych services are more available in urban areas than in rural THE MENTAL HEALTH PROFESSIONS  Clinician- a health professional authorized to provide services to ppl suffering from one or more pathologies  Clinical psychologist- an indiv who has earned a Ph.D degree in psychology or a Psy.D and whose training has included an internship in a mental hospital or clinic. Entails 4 to 7 yrs of graduate study  A psych may have a either a doctoral or a M.A degree  In some areas psych are for doctoral level and psych associates are for M.A  1995 Agreement on Internal Trade (AIT) was developed so credentials of psych would be recognized from one part of Canada’s would be recognized in other parts  mutual agreement was signed in June 2001. person has to have obtained 5 core competencies in order to become registered as a psych 1) interpersonal relationships 2) assessment and evaluation (including diagnosis) 3)intervention and consultation 4) research 5)ethics and standards  training for a Ph.D in clinical psych is similar to that in other psych specialities. It requires a heavy emphasis on lab work, research design, statistics and the empirically based study of human and animal beh. The Ph.D is a research degree and are require to research and write on it. Those in clinical psych learn two more things 1) learn technique of assessment and diagnosis of metal disorders----- Diagnosis- the determination that a patient’s set of symptoms or problems indicates a particular disorder  -2) they practise psychotherapy --a primarily verbal mans of helping troubled indiv change their thoughts, feelings and behaviours to reduce distress and to achieve greater life satisfaction  the new Psy.D degree (doctor of psych) is similar to Ph.D but there is less emphasis on research and more on clinical training. The Ph.D is more of a scientific practitioner model and the Psy.D is more of a scholar practitioner model  psychiatrist- a physician (M.D) who has taken specialized post doctoral training called a residency in the diagnosis, treatment, and prevention of mental disorders  Psychoactive drugs – chemical compounds having a psychological effect that alters mood or thought process. Ex: valium  Psychoanalyst- a therapist who has taken specialized postdoctoral training in psychoanalysis after earning an M.D or a Ph.D degree. Can take up to 10 yrs of graduate work  Social worker- a mental health professional who holds a master of social work (M.S.W) degree  Counselling psychologist- a doctoral level mental health professional whose training is similar to that of a clinical psychologist though usually with less emphasis on research and serious psychopathology  Psychiatric nurse- a nurse who has obtained additional training in the mental health field HISTORY OF PSYCHOPATHOLOGY Early demonology  Demonology- the doctrine that an evil being such as the devil may dwell within a person and control his or her mind and body. Ex found in records of early Chinese, Egyptians, Babylon’s and Greeks  Since they thought ab beh was caused by possession its treatment involved  exorcism -- the casting out of evil spirits by ritualistic chanting or torture. Elaborate rites of prayer, noisemaking, forcing the afflicted to drink terrible tasting brews, and flogging/starvation  Trepanning (of skulls) - the act of making a surgical opening in a living skull by stone age or Neolithic cave dwellers was quite widespread. This act was sometimes performed cuz of the belied that it would allow evil spirits to leave the body  Thought evil sprits would escape through the opening. Introduced into Americas from Siberia. The practise was most common in Peru and Bolivia three aboriginal specimens have been found in Canada in B.C  The openings were located in the same area in all three, the upper central occipital 2 SOMATOGENESIS  Hippocrates – father of modern medicine separated medicine from religion, magic and superstition. He rejected the Greek belief that the gods sent serious physical diseased an mental disturbances as punishment and insisted instead that such illnesses had natural causes  H. regarded the brain as the organ of consciousness, of intellectual life and emotion; thus he thought that deviant thinking and beh were indications of some kind of brain pathology. H is often considered one of the very earliest proponents of somatogenesis – the notion that something wrong with the soma or physical body, disturbs thought and action.  Psychogenesis- in contrast is the belief that a disturbance has psych origins  H. classified mental disorders into 3 categories: mania, melancholia and phrenitis (or brain fever)  The ab beh became more imp for physicians than priests  For melancholia he prescribed tranquility, sobriety, care in choosing food and drink and abstinence from sexual activity  H. believed in natural rather than supernatural causes  Mental health was dependent on balance of four humours or fluids of the body: blood, black bile, yellow bile and phlegm. An imbalance produced disorders  Sluggish and dull the body contained a preponderance of phlegm. Black bile was the explanation for melancholia, too much yellow bile explained irritability and anxiousness and too much blood changeable temperament  H humoural physiology didn’t withstand but his basic statement that an beh is produced by some kind of psychical imbalance or even dance was good  H held a somatogenic view of ab beh considering psychopathology a disease of the brain The dark ages and demonology nd  Death of Galen the 2 cen Greek who is regarded as last major physician of the classical era marked the beginning of the dark ages for western European medicine and for the treatment and investigation of ab beg  Christian montesaries replaced physicians on mental disorder. Monks cared for the sick The persecution of witches  Ppl in Europe became obsessed with the devil. Witchcraft instigated by Satan was seen as a heresy and a denial of god  Manual Malleus Maleficarum (the witches hammer) to guide the witch hunts  Those accused of witchcraft were to be tortured if they did not confess; those convicted and penitent were to be imprisoned for life and those convicted and unrepentant were to be hand over to the law for execution. The manual specified that a persons sudden loss of reason was a symptom of demonic possession and that burning was the usual method of driving out the supposed demon Witchcraft and Mental Illness  For some time they thought it was the mentally ill of the middle ages who were witches  Sometimes the accused reported having sex with the devil and these were interpreted as delusions and hallucinations and indicated that some of the so called witches were psychotic  Many of the accused however were not mentally ill. Many more sane than insane people were tried. The delusion like confessions were obtained during brutal torture. In England where torture was not allowed the confessions had no hallusicinations  From the 13 cen hospitals began to come under secular jurisdiction. Municipal authorities gaining in power tended to supplemtht or take over some of the activities of the church on e of these being taking care of the ill  mid 14 century specified the purposes of the hospital among them that the “mad are kept safe until they are restored of reason”. English laws during this time allowed both the dangerously insane and the incompetent to be confined in a hospital. The ppl who were confined were not described as being possessed th  beginning in the 13 century “lunacy” trials to determine a persons sanity were held in England. A judgement of insanity allowed the crown to become guardian of the lunatics estate Development of Asylums  until the end of the crusades in the 15 cen there were very few mental hospitals in Europe  confinement of the ill began in the 15 and 16 cen 3  leprosarium’s were converted to asylums –refuges established for the confinement and care of the mentally ill. Bethlehem and other early asylums  the Priory of St. Mary of Bethlehem was founded in 1243. hospital devoted to mentally ill  bedlam- a scene or place involving a wild uproar or confusion. The term is derived from the scenes at Bethlehem hospital in London, where unrestrained groups of mentally ill people interacted with each other  viewing violent patients was considered entertainment and tix to bedlam were sold  medical treatments were painful and crude.  Rush who practised medicine is considered father of American psychiatry. He believed that mental disorders were caused by an excess of blood in the brain. He drew great quantities of it. He thought many lunatics could be cured by being scared Moral Treatment  Pinel is a primary figure in the movement for humanitarianism treatment of the mentally ill in asylums.. was in charge of large asylum in Paris La Bicetre. He removed the chains of ppl. He treated them as sick ppl rather than as beats. They became calmer.  He thought they were normal ppl who should be approached with compassion and understanding and treated with dignity  The more humanitarianism treatment he reserves for the upper classes; patients of the lower classes were still subjected to terror and coercion as a means of control  Tuke proposed to the Society of Friends that it found its own institution. In 1796 the York retreat was established on a country estate. Mentally ill were able to talk to attendants  Moral treatment- a therapeutic regimen, introduced by Pinel during the French Revolution whereby mental patients were released from their restraints and were treated with compassion and dignity rather than with contempt and denigration. Patients had close contact with attendants who talked and read to them and encouraged them to engage in activity; residents led as normal lives as possible and in general took responsible for themselves  Drugs were used a lot. Most common treatment and included alcohol, cannabis, opium and choral hydrate (knockout drops). Second the outcomes were not favourable, thwer than one third were discharged as improved or recovered  Moral treatment was abandoned in the later part of the 19 cen.  Dorthea Dix crusader for improved conditions for people with mental illness helped effect this change.  Dix campaigned a lot to improve the lot of people with mental illness; she personally saw that 32 state hospitals were built in to take many patients whom the private ones could not accommodate. got no indiv attention which is a hallmark of moral treatment  Dr. Henry Stabb made efforts to institute moral treatments and non restraint at the lunatic asylum in st johns Newfoundland. But his efforts were hindered by inadequate financial resources. ASYLUMS IN CANADA  J.F Lehman wrote the 1 textbook published in Canada with a focus on care and control of mentally ill ppl. He recommended stringent discipline and harsh treatments. His views failed  Pioneers from great Britain who influenced to design and construction of asylums  Alberta was the last province to open an asylum  Almost 20% of the inmates died while in the institution, a large # due to general paresis of the insane and to a condition called phthisis  Two tie system medical system where rich get quality care  The history of development o institution for the mentally disordered in Canada can be characterized in terms of two trends: 1) with the advent of asylums, provisions for the mentally ill were separate from provisions for the physically ill, indigents and criminals and 2) the process was segregate from the wider community –the institution and the community were two separate and distinct solitudes THE BEGINNING OF CONTEMPORARY THOUGHT  One development that fostered the progress was the discovery by Vesalius that Galen’s presentation of human anatomy was incorrect. Further process cam from Sydenham An early system of classification 4  Griesinger who insisted that any diagnosis of mental disorder specify a bio cause  Kraepelin furnished a classification system in order to establish the bio nature of mental illness  K. discerned among mental disorders a tendency for a certain group of symptoms called a syndrome to appear together regularly enough to be regarded as having an underlying physical cause. He regarded each mental illness as distinct from all others  K proposed two major groups of severe mental diseases: dementia praecox an early term for schitzo and manic depressive psychosis - now called bipolar disorder. He said it was a chemical imbalance for schitzo and an irregularity in metabolism as the explanation of manic depressive psychosis General paresis and syphilis  Most striking med success was discovery of nature and origin of syphilis. In 1905 the specific micro organism that causes syphilis was discovered. A causal link had been established between infection, destru
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