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Chapter 1

PSYB32 Chapter 1 Notes.docx

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Michelle Hilscher

PSYB32 Chapter 1 CHAPTER 1: INTRODUCTION: DEFINITIONAL AND HISTORIAL CONSIDERATIONS, AND CANADA’S MENTAL HEALTH SYSTEM -Psychopathology: the field concerned with the nature and development of abnormal behaviours, thoughts, feelings What is Abnormal Behaviour -Abnormal Behaviour: includes characteristics like statistical infrequency, violation of norms, personal distress, disability or dysfunction, and unexpectedness. Statistical Infrequency -Statistical infrequency used explicitly in diagnosing mental retardation -The normal curve (bell curve), an assertion that a person is normal implies they do not deviate much from average Violation of Norms -Characteristic to consider is whether the behaviour violates social norms and makes those observing it anxious Personal Distress -behaviour is abnormal if it creates great distress and torment in the person experiencing it Disability or Dysfunction -impairment in an important area of life because of an abnormality can also be a component of abnormal behaviour Unexpectedness -Distress and disability are considered abnormal when they are unexpected responses to environmental stressors -According to National Population Health Survey, 2.15% of respondents (515,000) had consulted with a psychologist one or more times in the preceding year The Mental Health Profession -Clinicians: the various professionals authorized to provide psychological services -To be clinical psychologist typically needs Ph.D or Psy.D. degree which entails 4-7 years of graduate study -In Canada regulation of psychology profession is within jurisdiction of provinces, and depending on regulatory statutes a psychologist may either have a doctoral or masters degree -In some jurisdictions “psychologist” is reserved for doctoral level, whereas masters level are referred to as “psychological associate” -5 core competencies to becomes registered psychologist -Interersonal relationships, assessment and evaluation, intervention and consultation, research, ethics and standards -The Ph.D. is basically a research degree, candidates are required to right a dissertation -Candidates for clinical psychology learn two additional areas: techniques of assessment and diagnosis of mental disorders, and how to practice psychotherapy (primarily verbal means of helping troubled individual change their thoughts) -For Psy.D. curriculum is similar to Ph.D. but with more focus on clinical training and less on research -Psychiatrist holds MD degree and had a post graduate training called residency, in which they receive supervision in practice of diagnosis and psychotherapy -By virtue of medical degree, can also continue functioning as physicians PSYB32 Chapter 1 -Primary aspect of medical practice in which psychiatrists engage is prescribing psychoactive drugs (Drugs that influence how people feel and think) -Psychoanalyst receives training at a psychoanalytic institute, involves years of clinical training and an in-depth psychoanalysis of the trainee -Social worker obtains M.S.W. degree, programs for counselling psychologists are similar to graduate training in clinical psychology but less emphasis on research and more severe forms of psychopathology -Psychiatric nurse specializes in mental health field. History of Psychopathology Early Demonology -Demonology: the doctrine that an evil being may dwell within a person and control his or her mind and body, it’s treatment often involved exorcism -Trepanning of skulls (making of surgical opening in living skull) by stone age or cave dwellers was widespread Somatogenesis th -In 5 Century B.C. Hippocrates (regarded as father of modern medicine) separated medicine from religion, magic and superstition -Hippocrates an early proponent of somatogenesis: notion that something wrong with the soma, or physical body disturbs thought and action -Psychogenesis: is the belief that a disturbance has psychological origins -Hippocrates sorted mental disorders into 3 categories: mania, melancholia, and phrentis (brain fever) -For melancholia he prescribed tranquillity, sobriety, care in choosing food and drink, and abstinence from sex -Hippocrates perceived normal brain functioning as dependent on a delicate balance of 4 humours: blood, black bile, yellow bile, and phlegm The Dark Ages and Demonology -Historians marked death of Galen (who was regarded as last major physician of classical era) marked beginning of Dark ages for western European medicine -People returned to demonology, and the Pope had executed witch hunts. A person’s loss of reason was a symptom of demonic possession and that burning was the usual method of driving out the demon -Many of the accused were not mentally ill, more sane than insane people were tried -When church relieved of duty to care for ill, hospital started. Holy Trinity Hospital in Salisbury England specified purposes such as “mad are kept safe until they are restored of reason” Development of Asylum -Until end of Crusades in 15 century, there were very few mental hospitals in Europe -Priory of St. Mary of Bethlehem founded in 1243, in 1547 Henry VIII handed it over to London to be a hospital for mentally ill Bedlam: a contraction and popular name for above hospital, has become a term for a place of wild uproar and confusion -Benjamin Rush (father of American Psychiatry) believed mental disorder was caused by excess blood in the brain, so he would draw great amounts of it out. He also believed lunatics could be cured by being frightened -Phillipe Pinel considered primary figure in the movement for humanitarian treatment of mentally ill PSYB32 Chapter 1 -Pinel, following Pussin who did it before, removed the chains of people in LaBicetre asylum, and it calmed all the patients down th -Moral treatment was abandoned in latter part of 19 century. -Ironically the efforts of Dorothea Dix, a crusader for improved conditions of mentally ill, helped effect this change Asylums in Canada -1840 – Lehman wrote the first textbook published in Canada with a focus on the care and control of mentally ill -In contrast to compassionate humane views of Dix and Stabb, Lehman recommended stringent discipline and harsh treatments -Development of services for mentally ill was very ad hoc -Earliest predecessor to 19 century asylums was Hotel Dieu in Quebec in 1714 established by Duchess d’Aiguillon -Dr. Lett, the first medical superintendent encouraged his staff to employ principles of moral therapy -Development of institutions can be characterized in two trends: With the advent of the asylums, provisions for the mentally ill were separate from provisions for the physically ill, indigents and criminals - The process was segregated from the wider community Mental Hospital in Canada: the 20 Century -Despite humane motives, results were not very positive, especially from patient’s perspective -Provincial mental hospitals overcrowded, individual treatment unavailable, drugs became main form of treatment -In 1970, restrictive nature of mental hospitals led to deinstitutionalization of a large number of patients -In Canada there are three maximum security forensic hospital (for those who plead criminally insane), in Ontario, Quebec, and BC -Even in the best hospitals there was little contact with psychiatrists, most patients had no contact for 80-90% of waking hours -One problem is people sometimes get so accustomed to the institutional life, that leaving becomes frightening -In Canada, current emphasis is on psychiatric hospital bed reduction and closure -Commission set target of 35 beds per 100,000 for mental health services -Community Treatment Orders: a legal tool issued by a medical practitioner that establishes conditions under which a mentally ill person may live in the community, including compliance with treatment -Failing to follow the CTO, results in being returned to the psychiatric facility for assessment Beginning of Contemporary Thought -After death of Galen and decline of Greco-Roman civilization temporarily ended inquiries into nature of both physical and mental illness -Not until late Middle Ages did any new facts begin to appear -One development that fostered progress was discovery by Flemish anatomist and physician Vesalius that Galen’s presentation of human anatomy was incorrect. (He thought our anatomy mirror apes, took more than a thousand years for autopsy studies of humans to begin to prove he was wrong) -Further progress from Syndenham, he was successful in advocating an empirical approach to classification and diagnosis , which subsequently influenced those interested in mental disorders An Early System of Classification PSYB32 Chapter 1 -Griesinger, impressed by Sydenham’s approach, insisted an diagnosis of mental disorder specify a biological cause -Kraepelin, follower to Griesinger, wrote textbook, and discerned among mental dis
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