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Chapter 1

PSYB32 Chapter 1.doc

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Mark Schmuckler

Chapter 1: Definitional and Historical Considerations, and Canada's mental Health System - Story: Brett Barkley unable to sexually perform  mood swings (himself and dad), drinking problems, uncaring father - Psychopathology: the field concerned with the nature and development of abnormal behaviour, thoughts, and feelings. - Challenges faced in Abnormal Psychology: o the study of psychopathology offers few hard and fast answers (knowledge for this subject is far too small) o remaining objective (subject matters are personal + we have preconceived notions)  greatest intellectual and emotional challenge for deciding both HOW TO CONCEPTUALIZE the life of a person with psychological problem and HOW BEST TO TREAT him or her (free from subjective feelings) What is Abnormal Behaviour? - abnormality is usually determined by the presence of several characteristics at a time - Abnormal Behaviour (AB) includes such characteristics as: • Statistical Infrequency  AB is infrequent in the general population  person is normal = he/she does not deviate much from the average in a particular trait or behaviour pattern (normal curve)  only certain infrequent behaviours (hallucinations, depressions) are studied by psychopathologists • e.g. explicit use in diagnosing mental retardation • Violation of Norms  violates social norms or threatens or makes anxious those observing it  **various forms of unusual behaviour can be tolerated, depending on the prevailing cultural norms (cultural diversity)  ** depends on degree of violation of social norms (prostitutes and highly anxious person not TOO abnormal) • Personal Distress  AB if it creates great distress and torment in the person experiencing it (personal suffering) • Disability or Dysfunction  Impairment in some important area of life (e.g. work or personal relationships) because of an abnormality (disability applies to some, but not all)  e.g. substance abuse = social or occupational disability, phobias  **transvestism (cross-dressing for sexual pleasure) is a mental disorder if it distresses a person, BUT IT IS NOT NECESSARILY A DISABILITY  **no rules that tell us which disabilities belong and which do not (e.g. being short and not being able to make it to basketball team =/= a disability) • Unexpectedness  distress and disability are considered abnormal when they are unexpected responses to environmental stressors  e.g. anxiety disorder = anxiety is unexpected and out of proportion to the situation - characteristics together offer a useful framework for beginning to define abnormality (BUT only a partial definition because it does NOT EQUALLY APPLY TO EVERY DIAGNOSIS) - list of abnormalities constantly evolving The Mental Health Professions (Discovery 1.1)  more psychological services in urban than in rural (underutilized services) - Clinicians: various professional authorized to provide psychological services - Clinical Psychologist: Ph.D (scientist-practitioner model) or Psy.D. (scholar-practitioner model) Degree (4-7 years graduate studies) • lab work, research design, statistics, studied human and animal behaviour o Registered Psychologist required core competencies =  interpersonal relationships  assessment and evaluation (including diagnosis)  intervention and consultation  research; and  ethics and standards o Assessment & Diagnosis of mental disorders o Psychotherapy: primarily verbal means of helping troubled individuals changed their thoughts, feelings, and behaviour to reduce distress and to achieve greater life satisfaction - Psychiatrist: MD degree + post graduate training (residency) o can be functioning as physicians (physical examinations, diagnosing medical problems etc) o prescribing psychoactive drugs: chemical compounds that can influence how people feel and think - Psychoanalyst: has special training in a psychoanalytic institute (10 years) o clinical training + psychoanalysis training - Social worker: obtains a M.S.W (Master in Social Work) - Counselling psychologists: similar to graduate training in clinical psychology but less emphassis on research - Psychiatric Nurse: specializes in the mental health field History of Psychopathology - behaviour outside of individual control = supernatural interpretations - deviancy = displeasure of the gods or possession by demons (believed by philosophers, theologians, physicians) Early Demonology - Demonology: evil being/the devil that may dwell within a person and control his or her mind and body - Treatment = exorcism: casting out of evil spirits by ritualistic chanting or torture (starvation, flogging, concoctions) - Trepanning: surgical opening in a living skill by some instrument (stone age + Neolithic cave dwellers) o Cures headaches, epilepsy, psychological disorders o Release demons in the cranium Somatogenesis - Somatogenesis: the notion that something wrong with the soma (physical body) disturbs thought and action o Hippoccrates (separate medicine from religion, magic, and superstition) natural > supernatural  Mental disorders • Mania • Melancholia  tranquility, sobriety, care in choosing food and drink, abstinence • Phrenitis (brain fever)  Physiology  normal brain functioning = balance between: Blood, Black bile, Yellow bile and phlegm - Psychogenesis: the belief that a disturbance has psychological origins The Dark Ages of Demonology - Christian monasteries, through missionary and educational work, replaced physicians as healers and as authorities on mental disorder - Monks cared for the mentally disordered in the countryside where they became more disturbed th - The Persecution of Witches -13 century and after o Witchcraft = instigated by Satan and a denial of God o Heaped enormous blame on those regarded as witches  persecution o Malleus Maleficarum = The witches’ hammer (witch hunting manual)  Person’s lost of reason = symptom of demonic possession - Witchcraft and Mental Illness o Middle Ages  mentally ill = witches  E.g. hallucinations and delusions from psychotics  **many more sane than insane people were tried  “confessions” came after harsh tortures  Dangerously insane and the incompetent were confined in the hospital “until they are restored of reason”  “lunacy” trials to determine sanity of a person based on orientation, memory, intellect, daily life, and habits to see if there are any strange behaviours  **demonic possession was not a prominent explanation of mental disturbance in Middle Ages Development of Asylums -15 thcentury - Leprosariums converted to Asylums: refuges established for the confinement and care of the mentally ill - Bethlehem and Other Early Asylums - The Priory of St. Mary of Bethlehem = asylum for the mentally ill AKA Bedlam (scene of wild uproar/confusion) o Conditions were deplorable o Tourist attraction in the 18 and 19 century = to Westminster Abby and the Tower of London o Inclusion of abnormal behaviour in hospitals and medicine =/= more humane/effective treatment o Benjamin Rush: Father of American Psychiatry  Believed mental disorders were caused by an excess of blood in the brain • Favoured treatments to draw great quantities of blood  Lunatics can be cured by being frightened (e.g. drowning) - Moral Treatment o Philippe Pinel: Primary figure in the movement for humanitarian treatment of the mentally ill in asylums  treated patients as sick human beings rather than beasts  approached patients with compassion and care  **humanitarian treatment reserved only for the upper classes o Friends’ Asylum + York Retreat = influenced by the sympathetic and attentive treatment (privatized) o Moral Treatment: patients had close contact with the attendants who talked and read to them and encouraged them to engage in purposeful activity  residents led as normal lives as possible  Restores a patient’s sense of self-esteem o Drugs as treatment: alcohol, cannabis, opium, and chloral hydrate (outcomes not favourable >1/3) o Dorothy Dix: indirectly helped abandoned moral treatment by implementing hospitals to care for the patients while applying moral treatment…BUT workers were more interested in biological aspects rather than psychological (money went to lab equipment_ Asylums in Canada - network of asylums “process began with humane intentions as part of a progressive and reformist movement to overcome the neglect and suffering in the community, jails, penitentiaries, almshouses, poorhouses, and hospitals” - asylums = very beginning of state provisions for mentally ill people in a vast and sparsely populated country - Contracting-out system: The king paid religious orders of the French Roman Catholic Church to care for the mentally ill (French) - Institution-building period (prior to the first world war) – with British superintendents - $153.88 to care for a patient 20% of inmates died while in the institution (overcrowding) “phthisis” “general paresis of the insane” - Alberta = last place to open an insane asylum - Private Lunatic Asylums Act: accommodates the wealthy in alternatives to the public asylums - ** with the advent of the asylums, provisions for the mentally ill were separate from other provisions (criminals etc) - ** the process was segregated from the wider community (institution vs. community) The Mental Hospital In Canada: The Twentieth Century and Into The New Millennium - Deinstitutionalization of patients: shift care from psychiatric hospitals into the community o Discharged people lived in poverty o Reduced overcrowding in institutions o Chronic patients kept protected with little individual psychosocial treatment sedentary o Provincial Psychiatric Hospitals: old, grim, and somewhat removed from major metropolitan centres  Better than USA o Forensic Hospital: people who have been arrested and judged unable to stand trial and have been acquitted of crime because of their mental disorder o Community treatment orders (CTO): a legal tool issued by a medical practitioner that establishes the conditions under which the mentally ill person may live in the community, including compliance with treatment The Beginning of Contemporary Thought - Thomas Sydenham: successful in advocating an empirical approach to classifications and diagnosis  influenced those interested in mental disorders - An Early System of Classification o Griesinger: any diagnosis of mental disorder specify a biological cause (return to somatogenic views) o Syndrome: a certain group of symptoms found regularly enough among mental disorders to imply biological dysfunctions o Kraepelin: each mental illness was distinct from all others, having its own genesis, symptoms, course and outcome  Dementia praecox (chemical imbalance) = schizophrenia  Manic-depressive psychosis (irregularity in metabolism) = bipolar disorder - General Paresis and Syphilis o Mid-1800’s understood some of the workings of the nervous system & mental disorders o Empirical Approach to discovering nature and origin of syphilis:  General Paresis: steady deterioration of both physical and mental abilities • Impairments: delusions of grandeur and progressive paralysis • People who have general paresis usually had Syphilis  Germ theory of disease: disease is caused by infection of the body by minute organisms  Inoculation of syphilis  established causal link between infection, destruction of certain areas of brain, an a form of psychopathology  **SOMAGENESIS gained CREDIBILITY - Psychogenesis o Psychological malfunctions attributed to mental disorders (fashionable in France and Austria (18+19 C) o Hysterical patients can have: paralysis, blindness, deafness, convulsive attacks, gaps in memory etc. o Mesmer and Charcot  Mesmer: earlier practitioners of modern-day hypnosis “mesmerize” cured hysterical patients  Charcot: puzzled by the idea that people can act hysterically through hypnosis o Breuer and the Cathartic Method  Breuer’s Catharsis Method: hypnosis sessions that help patients relieve earlier emotional catastrophe and release the emotional tension caused by suppressed thoughts Current Attitudes Toward People With Psychological Disorders - many Canadians suspicious of people with psychological disorders (reinforced by incidents of threat, violence, etc by the seriously mentally ill people - Stereotyping and Stigmatization o CAMH (Centre for Addiction and Mental Health of Toronto): social stigma surrounding depression is the primary reason why only 1/3 of the estimated 3 million people in Canada who suffer from depression seek help o 50% of Canadians who suffer from mood, anxiety, or substance dependence disorders in the previous year felt embarrassed about their problems and reported facing discrimination o People with both psychiatric and physical disability face more perceived stigma and discrimination than psychiatric disability alone o Dissociative identity disorder (multiple personality disorder) - The public perception o People with psychological disorders are unstable and dangerous  Incidence of violence was higher for people with severe mental illness, however, the effect was significant only for those with co-occurring substance abuse or dependence  Majority of mentally ill people never perpetrate violent acts  more likely to be victims! o People with psychological disorders can never be “cured” and can never contribute meaningfully to society again  Hincks: had psychological problems that were not “cured” but founder and director of CMHA (Canadian Mental Health Association)  Manic depression (bipolar disorder) • Mental Hygiene Movement (CNCMH): o Psychiatric examination and care of war recruits and returning soldiers suffering from “shell shock” o Post-war psychiatric screening of immigrants o Adequate facilities for diagnosis and treatment of mental disease o Adequate care of the mentally deficient o Prevention • Organized the International Committee for Mental Hygiene (WHO) •  helped pass the Sexual Sterilization Act allowing the sterilization of “mental defectives”  they have genetic components that reflect hereditary weakness o 42% tell bosses and 50% tell their friends that they are receiving help for depression  Women more likely to admit receiving treatment than men o 46% (~50%) of Canadians believe “we call some things mental illness because it gives some people an excuse for poor behaviour and personal failings” o ~50% indicated they would avoid socializing (42%) with or marrying (55%) someone who is mentally ill o 27% are even afraid to be around some one with a serious mental illness o ~50% would decline to tell friends or co-workers about a family member suffering from mental illness (72% would share a cancer diagnosis) o Most wouldn’t hire doctors
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