Chapter 1: Intro
-need to remain objective, dificult
-difficulty in how to define abnormal behavior
-normal curve places the majority of people in the middle as far as any particular characteristic is
concerned; very few ppl fall at either extreme.
-statistical infrequency is used explicitly in diagnosing mental retardation.
Violations of Norms
-norms in one culture can vary. diffrent norms for different cultures.
Disability or Dysfunction
-tranvestism: cross-dressing for sexual pleasure
-ex. an anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the
situation, as when a person who is well off worries constantly about his/her financial situation.
History of Psychopathology
-Hebrews-deviancy was attributed to possession of the person by bad spirits, after God in his wrath had
-exorcism can from the belief that abnormal behavior was caused by possession.
-trepanning-one popular theory was that it was a way of treating disorders attributed to demons within
-individual would return to normal by creating an opening through which evil spirits could
-Kidd suggested that trepanning were done to relieve pressure resulting from depressed
fractures caused by war clubs
-Hippocrates= the father of modern medicine, separated medicine from religion, magic, and superstition -regarded the brain as the organ of consciousness, of intellectual life and emotion; thus thought
that deviant thinking and behavior were indications of some kind of brain pathology.
-the SOMA= physical body
-the 3 categories hippocrates classified mental disorders into: MANIA, MELANCHOLIA,
-hippocrates humoral physiology did not withstand later scientific scutiny but his basic premise- that
human behavior is markedly affected by bodily structures or substances and that abnormal behavior is
produced by some kind of physical imbalance or even dmg.
The Dark Ages and Demonology
-Galen was the last major physician of the classical era
Persecution of Witches
-population turned to demonology to explain disasters, ppl in Europe became obsessed with the devil.
-witchcraft viewed as instigated by satan- seen as denial of God
-burning of wtiches were seen seen as method of dirving out the supposed demon.
Witchcraft and Mental Illness
-mentally ill were generally considered witches
-many of the accused were NOT mentally ill
-confessions were a result of brutal torture- words were put in mouths
-lunacy trails determined a person's sanity
Development of Asylums
-very few mental hospitals in europe until the end of the crusades in the 15th century.
-when leprosy was no longer a great social concern, focus turned to the mad.
Bethlehem and other early Asylums
-the Priory of St.Mary of Bethlehem was FOUNDED in 1243.
-handed to the city of London in 1547 to be a hospital devoted solely to the confinement of the mentally
-BENJAMIN RUSH- considered the father of American Psychiatry- believed that mental disorder was
caused by an excess of blood in the brain -further he beleived that any lunatics can be cured by being frightened
-PHILIPPE PINEL- considered a primary figure in the movement for humanitarian treatment of the
mental ill in asylums
-began to treat the patients as sick humans beings rather than as beasts-"remove chains"
-Pinel reserved more humanitarian treatment for the upper class, the lowers classes were still subjected
to terror and coercion as a means of control
-Williams Tuke inspired by Pinel's work
-sympathetic and attentive treatment- MORAL TREATMENT
-RESTORATION OF PATIENT'S SELF ESTEEM by letting them demonstrate SELF-
-drugs were the most common treatment
-moral treatment abandoned in the latter part of the 19th century
-Dorothea Dix, a crusader for improved conditions for people w/ mental illness, helped effect
Asylums in Canada
-a network of asylums was eventually established in Canada
-J.F Lehman wrote the first textbook published in Canada with a focus on the care and control of
mentally ill ppl. In contrast to the compassionate, humane views of reformers such as DIx and Stabb,
Lehman recommended discipline and harsh treatments.
-Many strategies in Canada during the 20th century were just as harsh and a few were much
more severe and had tragic consequences.
-52% discharge rate, 20% death rate while in the instituion. A large # of the deaths due to "general
paresis of the insane" and to a condition called "phthisis".
The Mental Hospital in Canada- 20th Century
-provincial mental hospitals became extremely overcrowded. Drugs became the central means of
-in the 1970s, concerns about the restrictive nature of confinement in a mental hospital led to the
deinstitutionalization of a large number of metal hospital patients -the goal in Canada was to shift care from psychiatric hospitals into the community
-a somewhat specialized mental hospital, sometimes called a PRISON or FORENSIC HOSPITAL, is reserved
for ppl who have been arrested and judged unable to stand trial and for those who have been acquitted
of a crime because they are "not criminally responsible on account of mental disorder"
-in canada there are 3 MAXIMUM-SECIRUITY FORENSIC HOSPITALS
-even in the best hospitals, patients usually precious LITTLE CONTACT with psychiatrists/ clinical
-institutionalized mindset is difficult to reverse once ppl have resided in mental hospitals for more than
-an ongoing cocern is the need to balance the rights of mentally ill individuals with the rights of the
community to be protected from them if they are a danger. CTOs- COMMUNITY TRREATMENT ORDERS
-noncompliance with CTOs results in being returned to psychiatric facility for assessment.
-the asylums will no doubt all but disappear in the 21st century
The Beginning of Contemporary Thought
-emerging empirical approach to medical science that gathered knowledge by direct observation
-Thomas Sydenham was particularly successful in advocating an empirical approach to classification and
diagnosis, one that subsequently influenced those interested in mental disorders
An Early System of Classification
-Wilhelm Griesinger- insisted that any diagnosis of mental disorder specify a BIOLOGICAL CAUSE- a
return to the somatogenic views first espoused by Hippocrates.
-Emil Kraepelin furnished a classification system in order to establish the biological nature of mental
-Kraepelin proposed 2 major groups of severe mental diseases: DEMNTIA PRAECOX (early term for schiz)
and MANIC-DEPRESSIVE PSYCHOSIS (bipolar disorder)
-postulated a chemical imbalance as the cause of shiz and an irregularity in metabolism as the
explanation of manic-depressive psychosis.
General Paresis and Syphilis
Mesmer and Charcot -hysterical disorders were caused by a particular distribution of a universal magnetic fluid in the body.
Moreover, thought that one person could influence the fluid of another to bring about a change in the
-removal of hysterical disorder by touching rods that transmitted animal magnetism and
adjusted the distribution of the universal magnetic fluid, thereby removing the hysterical disorder.
-considered of a form of hypnosis
Breuer and the cathartic method
-young woman with a number of hysterical symptoms
Current Attitudes Toward People With Psychological Disorders
-consistent with other minority groups in Canada, people with psychological disorders often face
NEGATIVE STEREOTYPING and STIGMATIZATION
-jim carrey's character in "you, me and irene" suffers from schiz rather than DISSOCIATIVE IDENTITY
The Public Perception
-myths of violence and the mentally ill
-myths about never being able to be cured
-Clarence Hincks founded the CANADIAN MENTAL HEALTH ASSOCIATION
-objectives of the CNCMH: psychiatric examination and care of war recruits and returning
soldiers suffering from shell shock, post-war psychiatric screening of immigrants, adequate facilities for
diagnosis and treatment of mental disease, adequate care of the mentally deficient, prevention
-women were more willing to admit to receiving treatment than men
-the reduction of the stigma of schiz is the focus of the worldwide campaign by the World Psychiatric
Mental Health Literacy= the accurate knowledge that a person develops about mental illness and its
causes and treatment.
Canada's Mental Health Care System
-Canada>USA in terms of health care
Medicare -in Canada, taxes are employed for universal health care, including care for ppl with psychological
disorders- the Canadian MEDICARE system has been in effect since 1970.
Mental Health of Canadians: First View
What Factors are associated w/ Mental health in canada?
-mental health status
-mental health is relatively poor among young ppl but tends to improve w/ age
What is the Extent of Mental Health Problems in the People of Canada?
-20% of ppl in Ontario have one or more MENTAL DISORDERS
-2% of all Ontarians can be considered severely mentally il.
-did not find any major independent association between mental health and a respondent's province of
residence. HOWEVER, good mental health in both Newfoundland and Labrador and P.E.I- most happiest
and least distress
Treatment and Prevention
Deinstitutionalization and other challenges to service delivery
-mood disorders were the most common psychiatric disorders leading to hospital treatment followed by
schiz, substance abuse, dementia, anxiety, and personality disorders
Delivery of Psychotherapy
-evidence based treatment
-common phenomenon of "therapist drift" away from using eivdenced-based therapies that can occur in
the real world-typially a shift from "doing therapies" to "talking therapies".
Help-seeking and Perceived Need for Help
-some ppl from minority groups have difficulty asking for help for psychological problems
-COMORBID: the presences of 3 or more disorders simultaneously- increased liklihood for asking for
Community Psychology and Prevention
Cost of Mental Health Problems -personal misery, disruption of family life, lower quality of life, loss of productivity
-total mental health care spending in Canada is only 5% of the total health care spending.
The Romanow Report
-recommended that mental health be made a priority within the system. Broadening medicare to
include a limited number of home care services and some drug treatments.
The Senante Committee Final Report
-AKA the KIRBY REPORT
Chapter 2: Current Paradigms and the Role of Cultural Factors
The Role of Paradigms
-4 types of major paradigms: biological, cognitive-behavioural, psychoanalytic, humanistic-existential.
The Biological Paradigm
-was the dominant paradigm in Canada and elsewhere from the late 1800s until at least the middle of
the 20th century.
Contemporary Approaches to the Biological Paradigm
-3 areas of research within the biological paradigm: BEHAVIOUR GENETICS, MOLECULAR GENETICS,
-genes turn on/off throughout one's life so should not be seen as a fixed entity (genotype)
-various clinical syndromes are disorders of the phenotype, NOT OF THE GENOTYPE.
-about 10% of first degree relatives can have schiz if it is genetically in inherited, compared to 1% of
-CONCORDANCE higher is genetically identical MZ pairs than in DZ pairs
-when the MZ pair concordance is higher than the DZ pair concordance= characteristic is HERITABLE
-adoptee methods eliminates the effects of being raised by disordered parents. Molecular Genetics
Neuroscience and Biochemistry in the Nervous System
-NEUROSCIENCE is the study of the brain and the nervous system
-neuron stimulated at its cell body or through its dendrites----> leads to nerve impulse
-nerve impulses cause the synaptic vesicles to release molecules of their transmitter substances, and
these molecules flood the synpase and diffuse toward the receiving, or postsynaptic cell.
-NOREPINEPHRINE= a NT of the sympathetic nervous system.
-GABA-inhibits some nerve impulses and may be involved in anxiety disorders
-the onset of puberty in adolescents DECREASE SEROTONIN AND DOPAMINE ACTIVITY in certain cortical
-the deulsions and hallucinations of schiz may result from an overabundance of dopamine receptors (ie
problems with reuptake, oversensitivity)
Structure and Function of the Human Brain
-frontal lobe lies in front of CENTRAL SULCUS, parietal lies BEHIND it and ABOVE the LATERAL SULCUS,
temporal is BELOW the LATERAL SULCUS, occipital lies BEHIND the PARIETAL and TEMPORAL lobes.
-white matter makes up most of the INTERIOR of the brain
-BASAL GANGLIA-four masses of neuron cell bodies within each hemisphere, named collectively
-the MEDULLA also contains nuclei that maintain the regular LIFE RHYTHMS of the heartbeat, of the
rising and falling DIAPHRAGM, and of the constricting and dilating BLOOD VESSELS.
BIOLOGICAL APPROACHES TO TREATMENT
-prevention or treatment of mental disorders should be possible by altering bodily functioning.
-DISORDER: BIOLOGICAL DEFECT, TREATMENT: BIOLOGICAL INTERVENTION
-neuroimaging studies have become an increasingly important area of psychiatric research over the past
30 years and have advanced our understanding of the pathophysiology and treatment of disorders such
as ocd, schiz, bipolar, depression and dementia
Evaluating the Biological Paradigm -reductionism
-the cognitive-behavioural(learning) paradigm is regarded as a generally effective, evidence-based
-very influential today
-psychodynamic and humanistic-existential are less influential today than in the past.
-all of these roles emphasize the role of social factors, including socio-cultural considerations
and internal psychological processes.
THE CONGNITIVE-BEHAVIOURAL PARADIGM
-cognitive-behavioural therapy -CBT
THE BEHAVIOURAL PERSPECTIVE
The Rise of Behaviorism
-JOHN B. WATSON= key figure in the rise of behaviourism
-responded with a focus on behaviorism when there was a focus on INTROSPECTION
-john watson and rosalie rayner discovered that classical conditioning could instill pathological fear.
-striking steel bar when child reached for mouse (who previously did not fear the mouse)
-the abnormal tendency of people with shiz to make context-inappropriate associations may be an
example of classical conditioning gone awry as strong associations are made to seemingly neutral stimuli
-can produce abnormal behavior- ie aggression is often rewarded, as when one child hits another to get
a toy(getting the toy is a reinforcer)
-witnessing someone perform certain activties can increase/decrease diverse kinds of behavior
-children of parents with phobias or substance-abuse problems may aquire similar behaviour patterns,
in part through modelling.
-Bandura concluded that there are FOUR key processes in observational learning: ATTENTION,
RETENTION, REPRODUCTION, MOTIVATION
-Self Efficacy: an individual's perceived sense of being capable Behavioural Therapy
-is an attempt to change abnormal behaviour, thoughts, and feelings by applying in clinical context the
methods used and discoveries made by experimental psychologists in their study of both normal and
-cognitive therapy is often considered a FOURTH aspect of behavior therapy
Counter conditioning and Exposure
-behavioural approaches assume that behavior is the result of learning
-Wolpe hypothesized that counterconditioning underlies the efficacy of desensitization; a state or
response antagonistic to anxiety is substituted for anxiety as the person is exposed gradually to stronger
and stronger does of what he/she fears.
-exposure therapy is a form of cognitive intervention that specifically changes the expectancy of harm
Operant Conditioning as an Intervention
-socially withdrawn child could be reinforced for playing with others
-time out is an operant procedure wherin the consequence for misbheaviour is removal to an
environment with no positive reinforcers
THE COGNITIVE PERSPECTIVE
-COGNITION: the term that groups together the mental processes of of percieving, recognizing,
conceiving, judging, and reasoning
The basics of cognitive theory
-we are bombarded by far more stimuli than we can possibly respond to
-new information may fit the scehma. but if it does not, the learner reorganizes the scehma to
fit the information or construes the information in such a way as to fit the schema.
Beck's Cognitive Therapy
-based on the idea that a depressed mood is caused by distortions in the way people perceive life
experiences -therapists points out overlooked favourable happenings, alter their negative schemas and dysfunctional
beliefs and attitudes
-replaces negative thoughts with more adaptive thoughts
Rational-Emotive Behaviour Therapy
-emotional reactions are caused by internal sentences that people repeat to themselves, and these self-
statements reflect somes unspoken assumptions- IRRATIONAL BELIEFS
-if the person makes an error, it becomes a catastrophe bc it violates the deeply held conviction that he
or she must be perfect.
-once a client verbalizes a different belief or self-statement during a therapy session, it must be made
part of everyday thinking
COGNITIVE BEHAVIOUR THERAPY
-classical behavioural therapies emphasize the direct manipulation of overt behavior and occasionally of
covert behavior, with thoughts and feelings being construed as internal behaviors (mediational learning)
-cognitive behaviour therapists pay attention to private events- thoughts, perception, judgements, self-
statements and even unconscious assumptioons
-manipulated these processes in their attempts to understand and modify over and covert
COGNITIVE RESTRUCTURING: general terms for changing a pattern of thought that is presumed to be
causing a disturbed emotion or behavior.
Meichenbaum's cognitive-behavior modification
-Self instructional training: helps the client prepare to make specific coping statements when confronted
with difficult situations.
-Stress-inoculation training: multi-component coping-skills approach that incorporates systematic
aquisition of coping skills through learning to cope with small but manageable amounts of stress.
THE COGNITIVE-BEHAVIOUR INTEGRATED APPROACH
-the concepts on which the cognitive component of the cognitive-behavioural paradigms is based on
abstract and not always well defined
THE PSYCHOANALYTIC PARADIGM Classical Psychoanalytic Theory
Structure of the Mind
-Freud divided the mind into THREE principle parts: ID, EGO, SUPEREGO
-accounts for all the energy needed to run the psyche. Only later as the infant develops, is this
energy (LIBIDO) COVERTED INTO PSYCHIC ENERGY, all of it UNCONSCIOUS, below the level of
awareness. Acts towards the PLEASURE PRINCIPLE. When the id is not satisfied, tension is produced and
the id wants to elimante this tension. Primary process thinking generates IMAGES of what is DESIRED-
-develops from the ID during the second six months of life. Ego realizes that acting on the
pleasure principle is not the most effective way of maintaining life. Thus operates on REALITY PRINCIPLE
-Freud believes that the superego developed from the ego as much as the ego developed from
-the ID's instincts as well as many of the superego's activities are not known to the sonscious mind.
While the ego is primarily conscious and is involved in thinking and planning, it , too has imporantant
unconscious aspects (defense mechanisms).
-moral anxiety punishes bc individual not meeting expectations and thereby satisfying the principle that
drives the superego- PERFECTION PRINCIPLE.
DEFENCE MECHANISMS: COPING WITH ANXIETY
-OBJECTIVE ANXIETY,rooted in reality, can often handled by removing or avoiding the danger in the
external world or by dealing with it n a rational way.
-NEUROTIC ANXIETY, dealt with by DEFENCE MECHANISM
-repression is the MOST IMPORTANT defence mech
-defense mechanisms allow the ego to discharge some id energy while not facing frankly the true nature
of the motivation. More readily observed, provides reason for consulting a therapist
-FOR THE MOST PART, DEFENCE MECHANISMS ARE MALADAPTIVE
WHAT IS PSYCHOTHERAPY? -particular kinds of verbal/nonverbal exchanges in a trusting relationship can achieve goals, such as
reducing anxiety and eliminating self-defeating or dangerous behaviour
-insight thereapies/action(behavioural) therapies
-assume that behaviour, emotions, and thoughts become disordered bc ppl do not understand
what motivates them, especiailly when their needs and rives conflct
-attempts to remove the earlier repression and help the client face the childhood conflict, gain insight
into it, and resolve it in the li