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Chapter 1

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 1 PSYB32 Chapter 1 Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System  Psychopathology: The field concerned with the nature and development of mental disorders o Concerned with the nature of abnormal behavior, thoughts, feelings o Know less about this field and the people being studied do not always offer fast answers  Another challenge faced is the need to be objective  Concepts and labels used in psychopathology must be free of subjective feelings of appropriateness ordinarily attached to certain human phenomena What is Abnormal Behavior?  No single characteristic is adequate to define abnormal behavior  Abnormality is determined by the presence of many characteristics at a time  Abnormal behavior: 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 Statistical Infrequency  Infrequency of a certain behavior in the general population is a characteristic of abnormal behavior o Ex. Alternating episodes of depression and mania (case study – page 2)  The normal curve: As applied in psychology, the bell-shaped distribution of a measurable trait depicting most people in the middle and few at the extreme o People are not considered normal if they fall on the extremes  Statistical infrequency is used in diagnosing mental retardation o Other criteria are used but statistical infrequency is primary o If IQ is below 70 – intellectual functioning is subnormal  The part where statistical infrequency doesn’t mean negative abnormal behavior o E.g. having great athletic ability is on the extreme of the curve but is not bad  Therefore only certain behaviors (hallucinations, deep depression) fall into the domain considered in this book Violation of Norms  Another characteristic is if the behavior violates social norms or threatens or makes anxious those observing it o E.g. physical and verbal attacks on wife in case study  Anti-social behavior, obsessive-compulsive, conversation with imaginary voices - behaviors that fit definition of psychopath/abnormal behavior  Various forms of unusual behavior can be tolerated depending on the prevailing cultural norms  But social norms are to broad o Ex. Criminals and prostitutes or anxious people: violate social norms but are not psychologically abnormal  Cultural diversity also needs to be considered since different cultures have diff. norms Personal Distress  Personal suffering: behavior is abnormal if it creates great distress and torment in the person experiencing it  Personal distress fits many of the forms of abnormality (e.g. anxiety and depression)  Some disorders do not necessarily involve distress (psychopaths can continually break the lawwithout remorse)  Not all forms of distress belongto this field (childbirth pain or hunger) Disability or Dysfunction  Impairment in some important area of life (e.g. work or personal relationship) because of an abnormality o Can also be a component of abnormal beahviorr o E.g. disruption of J.Brett’s marital relationship fits criteria  Substance-use disorders are also defined in part by the social or occupational disability (e.g. poor work performance) created by substance abuse or addiction Chapter 1 PSYB32  Phobia can produce distress/disability (e.g. sever fear of flying prevents people going on business trips)  Not all disorders are dysfunctional o Transversion (cross-dressing for sexual pleasure) is a mental disorder if it distresses the person but is not a disability o Most transvestities are married and cross-dress in private  Not all dysfunctionalities are part of a disorder (e.g. being short and not being able to be a model) Unexpectedness  Distress and disability are considered abnormal when they are unexpected responses to environmental stressors  E.g. Anxiety disorder is diagnosed as anxiety if it unexpected and out of proportion (someone who is well off constantly worries about money)  E.g. Hunger is expected though so it is not abnormal ________________________________________________________________________________________________________________________________ Focus on Discovery 1.1 The Mental Health Professional  Clinicians: various professionals authorized to provide psychological service  Clinical psychologist: An individual who has received a Ph.D. degree in psychology or a Psy.D. and who training has included an internship in a mental hospital or clinic o Requires a Ph.D. or Psy.D. degree which entails 4-7 years of graduate study o In Canada, psychologist may have a doctoral- or a master’s – level degree.  There is now recognition for psychologists in different provinces and territories of Canada to accept their qualifications from their home province o Agreement on Internal Trade o Mutual Recognition Agreement: requires a person to obtain five core competencies to become a registered psychologist 1. Interpersonal relationships 2. Assessment and evaluation (incl. diagnosis) 3. Intervention and consultation 4. Research 5. Ethics and standards  Training for Ph.D. in clinical psychology requires a heavy emphasis on lab work, research desing, stats, and empirically based study of human and animal behavior  Clinical psychologists have two extra requirements o Assessment and diagnosis o Psychotherapy  Assessment: Finding out what is wrong with the person, what may have caused a problem or problems, and what steps may be taken to improve the person’s condition  Diagnosis: The determination that patient’s set of symptoms or problems indicates a particular disorder  Psychotherapy: a primarily verbal means of helping troubled individuals change their thoughts feelings and behavior to reduce distress and to achieve greater life satisfaction  Psy.D is like a Ph.D. but with a lower emphasis on research and more emphasis on clinical training  Psychiatrist: a physician (MD) who has taken specialized postdoctoral training, called a residency, in the diagnosis, treatment and prevention of mental disorders o Function as physicians giving physical examinations and diagnosing medical problems  Psychoactive drugs: chemical compounds that can influence how people feel and think  Psychoanalyst: received specialized training at a psychoanalytic institute o Several years of clinical training as well as an in-depth psychoanalysis of the trainee o 10 years  Social worker: obtains an M.S.W. (master of social work) degree  Counseling psychologists: somewhat similar to graduate training in clinical psychology but less emphasis on research and more sever forms of psychopathology  Psychiatric nurse: specializes in the mental health field _________________________________________________________________________________________________________________________________ Chapter 1 PSYB32 History of Psychopathology  Before the age of scientific inquiry, all good and bad manifestations of power beyond the control of humankind (eclipses, earthquakes, storms, fire, serious and disabling diseases, passing of the seasons) were regarded as supernatural o Same was for behavior that was seemingly outside individual control  Early philosophers, theologians, and physicians who studied the troubled min believed that deviancy reflected the displeasure of the gods of possession by demons Early Demonology  Demonology: The doctrine that a person’s abnormal behavior is caused by an autonomous evil spirit  Hebrews – deviancy was attributed to possession of the person by bad spirits o Christ healed a man by driving out the devil  Exorcisms: casting out the evil spirits by ritualistic chanting or torture o Elaborate rites of prayer noisemaking, forcing the afflicted to drink terrible-tasting brews, flogging, starvation  Trepanning: done to skulls; making a surgical opening in a living skull by some instrument o In the Stone Age to cure epilepsy, headaches and psychological disorders o Thought to let the demons out of the head Somatogenesis  5 century – Hippocrates did not believe that gods sent serious physical diseases and mental disturbances as punishment o He thought that these illnesses had natural causes and should be treated like other physical maladies  Hippocrates saw the brain as the organ of consciousness, intellectual life and emotion (therefore was part of deviant thinking and behavior)  Somatogenesis: development from bodily origins, as distinguished from psychological origins  Psychogenesis: development from psychological origins, as distinguished from somatic origins  Hippocrates classified mental disorders into three categories 1. Mania 2. Melancholia 3. Phrenitis (brain fever)  Melancholia – prescribed tranquility, sobriety, care in choosing food and drink and abstinence from sex  Hippocrates thought normal brain functioning and consequently mental health was dependent on the balance among four humors/fluids of the body: blood, black bile, yellow bile, and phlegm o An imbalance produced disorders The Dark Ages and Demonology  After the death of the 2 century Greek Galen; who was known as the last major physician of the classical era  The church started taking over and replaced physicians as healers and as authorities on mental disorder  Monks cared for mentally disordered by praying over the and touched them with relics or gave them concocted potions for them to drink in the waning phase of the moon  Families of deranged took them to shrines The Persecution of Witches  During 13 century and follow centuries, populace that was already suffering from social unrest and recurrent famines and plaguesagain turned to demonology to explain these disasters  Witchcraft was seen as a heresy and a denial of god  People who were mentally disturbed were deemed as witches and were tortured  1484 Pope Innocent VIII sent a search out for all witches  Malleus Maleficarum – “the witch’s hammer” o Guide to witch hunts o Legal and theological document that became a textbook for Catholics and Protestants on witchcraft  Those accused of witchcraft were to be tortured if they didn’t confess o Imprisoned for life if confessed o Executed if they didn’t confess  Burning was the usually method of driving out the supposed demon Chapter 1 PSYB32 Witchcraft and Mental Illness  Middle Ages – mentally ill were generally considered witches  In confessions of the accused – they report having intercourse with the devil and meeting with cults o Today they are interpreted as hallucinations  These confessions were also found to be taken during torture and words were usually put in their mouths  When government started taking over hospital care from church in Europe during the 13 century, the mentally ill and insane were kept in the hospital until they were sane  Demonacy was not as prominent in middle ages and physical illness and injury or emotional shock were seen as links to strange behavior Development of Asylums th  15 century – not a lot of hospitals for mentally ill but lots of hospital for lepers  After crusades were waged, leprosy started to disappear leaving many empty hospitals  They started to keep mentally ill in these old leper hospitals  Asylums: Refuges established in western Europe in the fifteenth century to confine and provide for the mentally ill; the forerunners of the mental hospital o Took in a lot of beggars since they were considered a great social problem at the time Bethlehem and Other Early Asylums  Priory of St.Mary of Bethlehem was handed over the City of London in 1547 and was devoted to be a hospital devoted solely to the confinement of the mentally ill o Horrible conditions  Bedlam: a scene or place involving a wild uproar or confusion. The term is derived from the sense at Bethlehem Hospital in London, where unrestrained groups of mentally ill people interacted with each other  Bethlehem became a great tourist attraction by the 18 century o People viewed violent patients and their antics  Medical treatments were often crude and painful  Benjamin Rush believed mental disorder was caused by an excess of blood in the brain so he drew great quantities of blood o Also believed lunatics could be cured by being frightened  A New England doctor would put patients in a coffin with holes in it, lower the coffin in water until no more bubbles rose to the surface o If the person was not dead they would rub him back to consciousness Moral Treatment  Philippe Pinel treated patients in a humanitarian way  He unchained patients at the La Bicetre asylum in Paris  He treated patients as human beings rather than as beasts  Changed the dingy rooms to light- filled airy rooms  William Tuke was shocked by the conditions of Asylums in England and founded the York Retreat  Provided mentally ill people with a quiet and religious atmosphere in which to live, work and rest  Patients discussed their difficulties with attendants, worked in the garden and took walks on the countryside  US asylums were influenced by this moral approach  Moral treatment: A therapeutic regiment, introduced by Pinel during the French Revolution, whereby mental patients were released from their restraints and were treated with compassion and dignity rather than with contempt and denigration o Helped patients restore their sense of self-esteem  Drugs were also used in mental hospitals frequently (most common treatment) o Alcohol, cannabis, opium, chloral hydrate o Outcomes were not favorable th  19 century – moral treatment was abandoned  Dorothea Dix fought to change the crude treatments of mentalpatient
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