Chapter 1: Introduction: Definitional and Historical Considerations
and Canada’s Mental Health System
Psychopathy – the field concerned with the nature and development of abnormal
behaviour, thoughts, and feelings.
What is Abnormal Behaviour?
Abnormal Behaviour –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.
1. Statistical Infrequency
Abnormal behaviour is INFREQUENT in the general population
Normal Curve – the bell-shaped distribution of a measurable trait depicting most
people in the middle and few at extremes.
Normal = does not deviate much from the average of a trait/behaviour
Eg. Diagnoses mental retardation diagnoses through low IQ below 70
BUT only certain infrequent behaviours are studied (NOT great athletic ability)
infrequency doesn’t help determine which behaviours to study
2. Violation of Norms
Violates Social Norms – threatens or makes anxious those observing it
Eg. anti-social behaviour of psychopath, complex rituals of OCD,
conversations with imaginary voices of psychotic person.
Violation of norms abnormality is RELATIVE; various forms of unusual
behaviour can be tolerated depending on the cultural norm/diversity
Violation of norms is too broad and too narrow
Doesn’t include criminals and prostitutes but focuses on the anxious
person who doesn’t violate social norms
3. Personal Distress
Personal Suffering – behaviour is abnormal if it creates great distress and torment
in the person experiencing it
Eg. anxiety disorders and depression
BUT some don’t involve distress; psychopath is cold-hearted and violate laws
without guilt, remorse, or anxiety.
Not all distress (childbirth) is studied
4. Disability or Dysfunction
Disability – impairment in some important area of life (Eg. work or personal
relationships) because of an abnormality
Eg. substance-abuse disorders = social or occupational disability, phobia
= distress and disability.
Disability applies to SOME disorders. Eg. Transvestism is diagnosed as a mental disorder if it distresses the
person (NOT a disability) most are married, lead normal lives, cross-
Disabilities determined by circumstances NO rule to determine which disabilities
Eg. being short ≠ professional basketball player NOT disability
Distress and disability are abnormal when they are UNEXPECTED responses to
Eg. anxiety disorder = anxiety is unexpected and out of proportion to the
situation BUT hunger is an expected reaction to not eating
All Factors = Abnormality BUT it’s definition is constantly changing and not certain
Focus on Discovery 1.1: The Mental Health Professions
Clinicians – A health professional authorized to provide services to people suffering
from one or more pathologies.
Clinical Psychologist – An individual 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
1995 Agreement on Internal Trade Mutual Recognition Agreement
2001 to recognize the credentials of psychologists from one part of
Canada in others
Gauthier: 5 core competencies to become a registered psychologist
1. Interpersonal relationships
2. Assessment and evaluation (including diagnosis)
3. Intervention and consultation
5. Ethics and standards
Clinical psychology Ph.D. is the scientist-practitioner model with lab work,
research design, statistics, and empirically based study of human and animal
behaviour + Assessment – finding out what is wrong with a person, what may have
caused a problem or problems and what step may be taken to improve the person’s
condition - and Diagnosis – the determination that a patient’s set of symptoms or
problems indicates a particular disorder - of mental disorders + how to practice
Psychotherapy – a primarily verbal means of helping troubled individuals change
their thoughts, feelings, and behaviour to reduce distress and to achieve greater life
Clinical graduate programs Psy.D. is the scholar-practitioner model with clinical
Psychiatrist – A physician (M.D.) who has specialized post-doctoral training
(residency), in the diagnosis, treatment and prevention of mental disorders. Psychoactive Drugs – Chemical compounds having a psychological effect
that alters mood or thought process. Eg. Valium
Psychoanalyst – A therapist who has taken specialized postdoctoral training in
psychoanalysis after earning an MD or a Ph.D. degree.
Social Worker – A mental health professional who holds a master of social work
Counseling Psychologist – A doctoral-level mental health professional whose
training is similar to that of a clinical psychologist, with usually less emphasis on
research and severe psychopathology.
Psychiatric Nurse – has training in the mental health field.
2.15% of Canadians used psychologists in the last year it’s service is underused
and focused on urban areas.
The debate as to administering drugs, is still debated due to psychiatrist’s training
and whether efficiency is worth the cost.
History of Psychopathology
Earlier, when the earth seemed supernatural, the mind and it’s behaviour’s seemed
Demonology – the doctrine that a person’s abnormal behaviour is caused by an
autonomous evil spirits
Hebrews deviancy = possession of bad spirits after God in his wrath
had withdrawn protection
o Exorcism – the casting out of evil spirits by ritualistic chanting or
Treplanning – the making of a surgical opening in a living skull by some instrument
Stone age, Aboriginals in Canada brought from Siberia, common in Peru
and Bolivia to treat conditions such as epilepsy, headaches, and “demonic
Somatogenesis – the notion that something wrong with the soma or
physical body disturbs thought and action
o (opposite)Psychogenesis – belief that disturbance has
o more medical treatment rather than religious help
3 categories of mental disorders: mania, melancholia and phrenitis (brain
Melancholia prescribed: tranquility, sobriety, care in choosing food and
drinks and abstinence from sexual activity had cures for epilepsy,
alcoholic delusion, stroke and paranoia He believed that mental health depended on a balance of 4 humors/fluids
of the body: blood, black bile, yellow bile, phlegm.
Too much black bile = melancholia, too much yellow bile = irritability and
anxiousness, too much blood = changeable temperance.
The Dark Ages and Demonology
Began with Galen, Greek physician who died in the 3nd century Christian
monasteries, through their missionary and educational work, replaced physicians as
healers and as authorities on mental disorder.
The Persecution of Witches
13 century Europe there were a lost of famines and plagues demonology
explanation witch hunt instigated by Pope Innocent VIII 1484 Malleus
Maleficarum “guide to witch hunting”: tortured if they didn’t confess, those
convicted and penitent were imprisoned for life, those convicted and unrepentant
were executed by fire as an exorcism.
Witchcraft and Mental Illness
Witchcraft bizarre confessions were primarily due to mental illness and torture. In
England (torture banned) there weren’t demonic confessions and hospitals kept the
mad safe till they have reason. Early 13 century “Lunacy trials” occurred for
strange behaviour linked to physical illness or injury or emotional shock Crown
to gain citizen’s estate.
Development of Asylums
Many Leprosariums - institution were people with leprosy were isolated, which
was believed during the time to be caused due to committing a sin, or being sexually
promiscuous - were converted to Asylums - refuges established in western Europe
in the 15 century to confine and provide for the mentally ill; the forerunners of the
mental hospital – after the Crusades. Asylums contained many beggars and mentally
ill used to work, but were later just confined.
Bethlehem and Other Early Asylums
Bethlehem was a hospital built for the confinement of the mentally ill. The
conditions were deplorable. Over the years the word Bedlam - a contraction and
popular name for the London hospital became a descriptive term for a place or
scene of wild uproar and confusion where unrestrained groups of mentally ill
people interacted with each other. It became a destination place for viewing the
violent patients and their antics as many found it entertaining.
Benjamin Rush - (the father of American psychiatry) believed that an excess of
blood in the brain caused mental disorders. Consequently, his favored treatment
was to draw great quantities of blood or scaring them.
Moral Treatment Philippe Pinel - A primary figure in the movement for humanitarian treatment of
the mentally ill in asylums BUT his humanitarian treatment was reserved for the
Moral treatment – therapeutic regimen during the French Revolution,
where mental patients were released from their restraints and were
treated with compassion and dignity rather than contempt and
o = sense of self-esteem by allowing self-restraints
Drugs were being used in early 19 century
First drugs: alcohol, cannabis, opium, chloral hydrate outcome
Dorothea Dix – advocated for development of state hospitals for patients who
couldn’t stay in private hospitals BUT less moral treatment more focus on
biological than mentality
Dr. Henry Hunt Stabb – efforts to institute moral treatment and non-restraint at
the Lunatic Asylum in St. John’s NFL BUT failed due to financial troubles and
Asylums in Canada
J.F. Lehman – wrote first textbook in Canada that focused on the care and control of
mentally ill people using stringent discipline and harsh treatments (flogging).
Sussman – services of mentally ill in Canada varied in each province.
1840s-1880s formal asylums established from a country wide need to
develop separate facilities with better conditions for the mentally ill.
The French in Quebec city began the asylums in Canada and cared for indigents,
crippled and idiots contracting system where the King of France paid religious
orders of the French Roman Catholic Church to care for the mentally ill. BUT after
Britain invaded, their influence of care practices, asylum management and funding.
overcrowding and noisy, unruly, violent patients discharge rate of 52%
& 20% deaths
wealthy privilege Private Lunatic Asylums Act to accommodate
wealthy people Homewood Retreat Asylum where Dr. Lett used moral
therapy (good treatment for the poor too, not just rich)
The history of the development of institutions for the mentally disordered in Canada
can be characterized in terms of two distinctive trends:
1. With the advent of the asylums, provisions for the mentally ill were
separate from provisions for the physically ill, indigents, and criminals.
2. The process was segregated from the wider community- “The institution
and the community were two separate and distinct solitudes.
Community treatment order (CTOs): a legal tool issued by a medical practitioner
that establishes the conditions under which a mentally ill person may live in the
Canadian Perspectives 1.2: The Mental Hospital in Canada: the 20 Century
and into the New Millennium Provincial Psychiatric Hospitals – A facility where chronic patients are treated.
Such hospitals provide protection, but treatment is often custodial and may involve
little psychosocial treatment.
Community Treatment Orders – Written orders that serve as a form of community
commitment designed to ensure treatment compliance.
The Beginnings of Contemporary Thought
Vesalius – proved that Galen’s presentation of human anatomy was incorrect.
Thomas Sydenham – successful in advocating an empirical approach to
classification & diagnosis
An Early System of Classification
Wilhelm Griesinger - insisted that any diagnosis of mental disorder specify a
Emil Kraepelin - discerned among mental disorders a Syndrome – a group or
pattern of symptoms that tend to occur together in a particular disease. He regarded
each mental illness as distinct from all others, having its own genesis, symptoms,
courses, and outcomes. Even though cures had not been worked out, at least the
course of the disease could be predicted.
2 major groups of severe mental diseases:
1. dementia praecox, an early term of schizophrenia caused by
2. manic-depressive psychosis (bipolar disorder) caused by
irregularity in metabolism
General Paresis and Syphilis
Discovery of the full nature and origins of syphilis, a venereal disease that had been
recognized for several centuries.
Symptoms: General Paresis – mental illness characterized by
deterioration of physical and mental abilities and several impairments
(delusions of grandeus, progressive paralysis) that lead to death in 5
o Common in men and sailors
Louis Pasteur - Germ Theory of disease - the view that disease, is caused by
infection of the body by minute microscopic organisms and viruses connected
syphilis to GP
Richard von Krafft-Ebing – inoculated paretic patients with matter from syphilitic
1905: The specific microorganism for syphilis was discovered link between
infection, destruction of brain, and a form of psychopathology.
Search for Somatogenesis throughout 20 century BUT 19 & 18 century mental
illnesses had different origins. Mesmer and Charcot
Many people were subject to hysterical states; they suffered from physical
incapacities, such as blindness or paralysis, for which no physical cause could be
Mesmer – hysteria wascaused by disturbances of a universal magnetic fluid in the
body; one person could influence the fluid of another to bring about a change in the
other’s behaviour. He used rods to touch afflicted parts of the patient’s bodies to
transmit animal magnetism and adjust the distribution of the universal magnetic
fluid. He was considered one of the earlier practitioners of modern-day hypnosis
“mesmerize” = “hypnotize”.
Charcot - studied hysterical states, including anesthesia (loss of sensation)
paralysis, blindness; deafness, convulsive attacks, and gaps on memory. One of his
students showed him that he hypnotized a woman to display certain actual
hysterical patient, thus Charcot became interested in non-physiological
interpretations of these very puzzling phenomena.
Breuer and The Cathartic Method
Catharsis - The experience of reliving an earlier emotional catastrophe and
releasing the emotional tension caused by suppressed thoughts about the event,
Cathartic Method – a therapeutithprocedure introduced by Breuer and developed
further by Freud in the late 19 century whereby a patient recalls and relives an
earlier emotional catastrophe and re-experiences the tension and unhappiness, the
goal being to relieve emotional suffering.
Current Attitudes Toward People With Psychological Disorders
Suspicions that are reinforced with threats, violence, frightening behaviour, those
who refuse to take medicat