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Biomedical Sciences
BIOM 3040
Richard Sanders

Chapter 1 Introduction: Definitional and Historical Considerations and Canada’s Mental Health System May 6, 2008 Brett’s Childhood Had difficulty in maintaining an erection when making love to his wife • Had difficulty maintain an erection when making love to his wife • He had a difficult childhood, his mother passed away when he was 6 and his father was a heavy drinker, diagnoses with manic depressive psychosis and could only afford to live in rundown neighbourhoods, thus he lived with his aunt for many weeks • He managed to get to university with a loan, but then experienced bouts of sadness followed by manic elation (like his father) • He was extremely nervous and self conscious • He became a police, but his mood swings still bothered him • In his thirties him and his wife wanted a family, but he was unable to achieve an erection • He also became suspicious of his wife, for she was becoming more beautiful than ever • One day she came home late, he was already drunk, he accused her of infidelity, she taunted him of his inability to make love, and he left and now is seeking professional help • Psychopathology: the field concerned with nature and development of abnormal behaviour, thoughts, and feelings • Another challenge of abnormal psychology is the need to remain objective What is Abnormal Behaviour? • There is no single one definition that is adequate • The best definition of abnormal behaviour includes such characteristics of; statistical frequency, violation of norms, personal distress, disability or dysfunction, and unexpectedness • The following 5 characteristics provide a framework for defining abnormality Statistical Infrequency • One aspect of abnormal behaviour is that its infrequent • The normal curve, or bell shaped curve, places the majority o people in the middle in any characteristic (very few people are at either end or extremes) • When someone is considered “normal” it is that he or she doesn’t deviate much from the average • This statistical infrequency is used explicitly in diagnosing mental retardation o When an individual’s IQ is below 70 they are considered subnormal and considered mentally retarded • But not all behaviours that are infrequent are abnormal (ex. great athletic ability) Violation of Norms • Whether the behaviour violates social norms or threatens or makes anxious those observing it helps categorize it as abnormal • There are exceptions to this also; criminals and prostitutes break social norms but are not considered abnormal or need to e studied within the domain of abnormal psychology • Cultural diversity can affect how people view social norms o What is normal in one culture may be abnormal in another Personal Distress • It can be considered abnormal if it creates personal suffering, great distress, and torments the person • Again there are exceptions though o Psychopath (treat others coldheartedly and may continuously violate the law without experiencing any guilt, remorse, or anxiety whatsoever) o Also, not all forms of distress (hunger, or pain of childbirth) belong in this field Disability or dysfunction • Another component of abnormality is disability or dysfunction • Disability: impairment in some important area of life because of an abnormality o Ex. Work or personal relationships • Ex. Brett’s marital relationship • Substance abuse also fits, as well as phobia (that can produce distress and disability) • Disability applies to some but all disorders o Transvestism: cross dressing for sexual pleasure Unexpectedness • Distress and disability are considered abnormal when they are unexpected responses to environmental stressors • Ex. Hunger is an expected response to not eating • Brett was experiencing some life stress, but many people do so without developing psychological problems The Mental Health Professions • Clinical psychologist o Requires Ph.D. or Psy.D. degree (4-7 years of graduate study) • In Canada, depending upon regulatory statues, a psychologist may have either a doctoral- or a master’s-level degree • In some jurisdictions “psychologist” is reserved for doctoral-level registrants where as master’s level registrants are referred to as psychological associates • there is no consensus among the provinces on the minimal academic requirements, the required length of supervised practise, and the timing of such practise • later there was an agreement on internal trade (AIT), that said in order to become registered as a psychologist, 5 competency areas must be o interpersonal relationships o assessment and evaluation o intervention and consultation o research o ethics and standards • training requires heavy laboratory work, research design, statistics, and the empirically based study of human and animal behaviour • A psychiatrist holds an M.D. degree and has had postgraduate training (called residency) o They give physical examinations, diagnosing medical problems o Prescribe psychoactive drugs, chemical compounds that can influence how people think • A psychoanalyst has received specialized training at a psychoanalytic institute o Involves several years of clinical training as well as the in-depth psychoanalysis of the trainee o Sigmund Freud • Social worker obtains an M.S.W (masters of social work) degree • Counselling psychologists are similar to clinical psychologists but they have less emphasis on research and the more severe forms of psychopathology • A psychiatric nurse specializes in working in the mental health field History of Psychopathology • Before the age of scientific inquiry, all good and bad manifestations of power being the control of human kind (eclipses, earthquakes etc) were seen as supernatural • Unexplainable behaviour was also outside the individual’s control and seem like that as well • Many physicians, philosophers, theologians, believed the deviancy reflected the displeasures of the gods or possessions by demons 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 • Its treatment often involved exorcism: the casting out of evil spirits by ritualistic chanting or torture (elaborate rites of prayer, noisemaking, drinking brews, starvation etc) • Trepanning: of skulls, making of surgical opening in a living skull by some instrument o A way of treating or relieving conditions such as epilepsy, headaches, and psychological disorders attributed to the demons within the cranium o It believed that the evil spirits could escape through this opening Somatogenesis • Hippocrates believed that the reasons for these disorders were not the demons but a medical aspect of treatment should be used • Hippocrates regarded the brain as the organ of consciousness, intellectual life and emotion • He though that deviant thinking and behaviour were some indications of brain pathology • Somatogenesis: the notion that something wrong with the soma, or physical body, disturbs thought and action • Psychogenesis: the belief that a disturbance has psychological origins • He classified mental disorders into 3 categories: o Mania o Melancholia  Treatment: tranquility, sobriety, care in choosing food and drink, and no sex o Phrenitis or brain fever • He also believed the body was on delicate balance among 4 humours: blood (temperament), black bile (melancholia), yellow bile (irritability and anxiousness) and phlegm (sluggish and dull). And that an imbalance produced the disorders. These did not withstand later scientific scrutiny • Hippocrates naturalistic approach was generally accepted The Dark Ages and Demonology • Over several centuries of decay, Christian monasteries, through their missionary and educational work, replaced physicians and healers and as authorities on mental disorders • During the 13 thcentury, a populace was already suffering from social unrest and recurrent famines and plagues (again turned to demonology for the explanation to this) • People in Europe became obsessed with the devil and witchcraft was viewed as instigated by Satan. At one time all the blame was to the witches and they were persecuted • 1484, the Malleus Maleficarum (the witches hammer) was a guide to witch hunts • Those accused of witch craft were to be tortured if they did not confess; those convicted and penitent were to be imprisoned for life • Then it was believed that it was the mentally ill who were considered witches and they were tortured th • From the 13 , Europe grew larger and hospitals were built by municipal authorities o “the mad were kept safe until they are restored for reason” o Lunacy trials were also held to determine a person’s sanity Developmentthf Asylths • 15 and 16 century hospitals were converted to asylums, rogues established for the confinement and care of the mentally ill • Bethlehem was an asylum for the mentally ill; later it came to be a great tourist attraction, by the th late 19 century, people were viewing their violent patients as entertainment and tickets were even sold • Other Asylums o Lunatic’s tower (Vienna, 1784) • Medical treatment were often crude and painful • Benjamin Rush believed that mental disorders were caused by excess blood in the brain, so he drew quantities of blood from their brains or frightening them • Philippe Pinel was considered a primary figure in the movement for humanitarian treatment of the mentally ill asylum o He helped them and freed them from their restrains o But again, he was not completely egalitarian because most of the compassionate treatment he gave was to the upper class; the lower class were still subjected to terror • Drugs were also being used in the early 19 century o First drugs were alcohol, cannabis, opium and chloral hydrate o The outcomes were not favourable • Later private hospitals were built for better treating the patients Asylums in Canada • In the 19 century, Dorothea Dix lobbied for improvement of the treatment of the mentally ill people th • Many strategies employed in Canada during the 20 century were just as harsh and a few were much more severe and had tragic consequences • Through 1840s to 1880s, the most formal asylums were first established • Asylums were the beginning of state provisions for mentally ill people in a vast and sparsely populated country • The British influence on the care practises, daily asylum management, and funding moderated the differences between Quebec and the rest of Canada • The majority of patients remaining in Chief asylum at the end of the year were “the noisy, the unruly and violent” ones • The discharge rate from the asylums were 52% • Almost 20% of inmates died while in the institution, a large number due to “general paresis of the insane” and to a condition called “phthisis” • Later a private asylum, Homewood, was built and used treatment from practitioners dedicated to working closely with a small number of patients • History of development of institutions for mentally disordered in Canada can be characterized in terms of 2 distinctive trends o With the advent of the asylums, provisions for the mentally ill were separate from provisions for the physically ill, indigent and criminals o The process was segregated from the wider community (the institution were two separate and discontinuous solitudes) Canadian Perspective 1.1: Dorothea Dix and the Development of the Asylums in Canada Light into the Darkness? • She visited Canada in 1843 – 1844 to improve conditions for the mentally ill • In 1850 she stated that throughout the province, she found cases incurable through long neglect, doomed to life-long burden to themselves through suffering, and life-long charge upon friends of public for care and maintenance • She also suggested moral treatment approaches and the consequences of failure to do so at early points The Beginning of Contemporary Thought • Thomas Sydenham was successful in advocating an empirical approach to classification and diagnosis An Early System of Classification • Kraepelin made a classification system in order to establish the biological nature of mental illnesses o He said that a certain group of symptoms (called syndrome), if appear regularly enough is to be regarded as having an underlying physical cause and may be attributed to a biological dysfunction o He regarded each mental illness as distinct from others, having its own genesis, symptoms, course, and outcome o he proposed 2 major groups of severe mental disorders (dementia praecox & manic- depressive psychosis) o he postulated a chemical imbalance as the cause of schizophrenia and an irregularity in metabolism for manic-depressive psychosis o His schema for classifying these and others became the basis for present diagnostic categories An Illustrative Case: General Paresis and Syphilis • The most striking medical success was the discovery of the full nature and origin of syphilis, a venereal disease that had been recognized for several centuries • Symptoms of deterioration of both physical and mental abilities and several impairments (delusions of grandeur, and progressive paralysis
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