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Chapter 1

Chapter One - Abnormal Behaviour in Historical Context.docx

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David Moscovitch

[ ONE ] – ABNORMAL BEHAVIOUR IN HISTORICAL CONTEXT Psychological disorder = psychological dysf’n w/in indvdl associated w/ distress/impairment in f’n’g and response not typical/culturally expected WHAT IS A PSYCHOLOGICAL DISORDER? Psychological Dysfunction  … = breakdown in cog./emotional/beh. f’n’g i.e. date should be fun BUT if you are exp’g severe fear all evening and on all future dates, your emotions are not f’n’g properly  Hard to know when to draw line btwn normal & abnormal (TF) problems considered to exist on continuum/as a dimension rather than present/absent Personal Distress  Criterion satisfied if indvdl extremely upset  BUT by itself dN define abnormal beh’  Impairment criteria useful i.e. if being shy goes so far as to prevent you from going out w/ friends for a good time, your social f’n’g is impaired Atypical or Not Culturally Expected  Criterion sometimes inefficient since at times, smthng considered abnormal b/c it occurs infrequently and deviates from avg  Another view: beh’ abnormal if violating soc’ norms  useful in considering important cultural diffs in psychological disorders THE SCIENCE OF PSYCHOPATHOLOGY Psychopathology = scientific study of psychological disorders Clinical psychologists = conduct research into causes & trtmt of psychological disorders and to diagnose, assess & trt these disorders; usually concentrate on more severe psychological disorders Counselling psychologists = study & trt adjustment & vocational issues encountered by relatively healthy indvdls Psychiatrists = investigate nature and causes of psychological disorders, and offer trtmts; emphasize drugs/other biological trtmts, although most use psychosoc’ trtmts too Psychiatric social workers = collect info relevant to soc’ and family situation of indvdl w/ psychological disorder; treat disorders, often concentrating on family problems associated w/ them Psychiatric nurses = specialize in care & trtmt of patients w/ psychological disorders, usually in hospitals as part of a trtmt team Marriage and family therapists and mental health counsellors = provide clinical services in hospitals/clinics, usually under supervision of doctoral-level clinician The Scientist-Practitioner  Many mental health professionals take scientific approach to their clinical work and (TF) referred to as scientist-practitioners, f’n’g in at least 1 of 3 ways: 1 – may keep up w/ latest scientific dvlpmts in their field and (TF) use most current diagnostic and trtmt procedures 2 – evaluate own assessments/trtmts procedures to see if they work/not (acc’able to gov & insurance co.) 3 – conduct research (in clinic/hospital) tht produces new info abt disorders/trtmt  Focus: i) clinical description ii) causation (etiology) iii) trtmt and outcome Clinical Description  Presenting problem = patient presents w/ specific/set of problems; 1 step  One f’n: specify what makes disorder diff from normal beh’ or from other disorders  Statistical data relevant—prevalence i.e. how many ppl in pop’n have disorder?  Statistics on how many new cases occur during given period (such as a year)—prevalence of disorder  Sex ratio  Age of onset  Course = indvdl pattern of disorder  chronic—last long time (even lifetime) (i.e. schizophrenia)  episodic—recover w/in few mths only to have recurrence later (i.e. mood disorders)  time-limited—improve w/o trtmt in relatively short period  Acute onset = begin suddenly  Insidious onset = dvlp gradually over extended time  Prognosis = anticipated course of disorder Causation, Treatment, and Outcomes  Etiology = study of origins; why disorder begins (causes); includes bio, psych, and soc dimensions  Trtmt important i.e. drug/trtmt successful  may give hints abt nature of disorder and its causes THE PAST: HISTORICAL CONCEPTIONS OF ABNORMAL BEHAVIOUR  Purpose of models to explain why someone is ―acting like tht‖ The Supernatural Tradition  Deviant is bad in good vs. evil battle Demons and Witches  Belief in reality and pwr of demons & witches and magic & sorcery aar of schism of Catholic church  Trmts: - exorcism = various religious rituals performed to rid victim of evil spirits - shaving pattern of cross in victim’s hair and securing them to wall near front of church so they might benefit from hearing mass  14 -15 c.: cont’d even into New World (i.e. 1692 Salem witch trials) Stress and Melancholy  Enlightened view: insanity was natural phenomenon, caused by mental/emotional stress and curable  Mental depression and anxiety recognized as illnesses  Trtmts: - rest, sleep, and healthy & happy env’ - baths, ointments, various potions Treatments for Possession  Person largely responsible for own disorder, which might well be punishment for evil deeds  If exorcism failed, make body uninhabitable for spirit by confinement, beatings, and forms of torture The Moon and the Stars  Paracelsus rejected notion of possession by devil  mvmts of moon and stars has profound effect on human beh’ / psychological f’n’g  No serious evidence has ever confirmed connection The Biological Tradition Hippocrates and Galen  H: - dN limit causes to general area of ―disease‖ b/c believed they might also be caused by brain pathology or head trauma and could be influenced by heredity (genetics) - considered brain to be seat of wisdom, consciousness, intelligence and emotion (TF) disorders involving these f’ns logically located in brain - recognized importance of psychological and interpersonal contributions  H & G: humoral theory = normal brain f’n’g related to bodily fluids (humors): blood, black/yellow bile, phlegm; 1 ex. of associating psychological disorders w/ chemical imbalance  4 humors related to Greeks’ conception of 4 basic qualities: heat, dryness, moisture, and cold  excesses of 1/more humors trt’d by regulating env’ to i↑/d↓ qualities  Bleeding/bloodletting = carefully measured amnt of blood removed from body, often w/ leeches  Vomiting induced The Nineteenth Century  Syphilis: - believing everyone plotting against you (delusion of persecution) OR yu are god (delusion of grandeur) - become paralyzed and die w/in 5 yrs of onset - ultimately, clinical investigations discovered penicillin is cure, but malaria cure convinced many for first time that ―madness‖ and associated beh’al and cog’ symp’s could be traced directly to curable infection  John P. Grey: - insanity always has phys causes (TF) mentally ill patient should be treated as phys’ly ill - emphasis: rest, diet, proper room temp & ventilation - under his leadership, hospital conditions greatly improved The Development of Biological Treatments  1930s: phys’ interventions of electric shock and brain surgery often used  Insulin shock therapy = high dosage of insulin until patient convulses and temp’ comatose (SOME recover mental health, but dangerous as others resulted in prolonged coma or death)  1920s (Joseph von Meduna): treated depression patient with 6 small shocks directly t/ brain  recovered  modern use: electroconvulsive therapy (ECT)  1950s: drug discoveries & i↑’d usage - opium (sedative) - neuroleptics (major tranquilizers; hallucinatory and delusional thought processes diminished and ctrl’d agitation and aggressiveness) - benzodiazepines (minor tranquilizers; reduce anxiety) *drawbacks and side effects and limited effectiveness discovered  d↓’d prescription The Psychological Tradition Moral Therapy  … = treat institutionalized patients as normally as possible in setting tht encouraged and reinforced normal soc’ interaction  *moral meant ―emotional/psychological‖ rather than code of conduct  Indvdl attention emphasized +ve consequences for appropriate interactions and beh’  staff made pt of modelling this beh’  Principles of moral therapy date back to Plato and beyond, but as a sys, originated w/ Philippe Pinel (worked w/ previous patient at hospital to reform hospital into humane socially facilitative atmosphere to produce ―miraculous‖ resultth  Before: asylums appeared 16 c. Europe w/ intent of providing places of refuge for confinement and care of ppl w/ mental illnesses  however early asylums more like prisons (housed beggars and provided little trtmt for patients) Asylum Reform and the Decline of Moral Therapy  Reason 1: moral therapy works best w/ indvdl’ized attention (< 200 patients per institution) but hospitals held great deal more (> 1000)  Reason 2: mental hygiene mov
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