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Chapter 1

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Waldemar Skrobacki

Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System • psychopathology is the field concerned with the nature and development of mental disorders What is Abnormal Behaviour? • abnormal behaviour are patterns of emotion, thought, and action deemed pathological for one or more of the following reasons: infrequent occurrence, violation of norms, person distress, disability or dysfunction, and unexpectedness Statistical Infrequency • normal curve is applied in psychology, the bell-shaped distribution of a measurable trait depicting most people in the middle and few at the extremes • statistical infrequency is used explicitly in diagnosing mental retardation when an individual’s IQ is below 70, his or her intellectual functioning is considered • sufficiently subnormal to be designated as mental retardation Violation of Norms • J. Brett Barkley’s verbal and and physical attacks on his wife illustrate this criterion the anti-social behaviour of the psychopath fits the definition of abnormal, as do the obsessive- • compulsive person’s complex rituals and the psychotic person’s conversation with imaginary voices • violation of norms explicitly makes abnormality a relative concept; various forms of unusual behaviour can be tolerated, depending on the prevailing cultural norms Personal Distress • personal suffering; that is, behaviour is abnormal if it creates great distress and torment in the person experiencing it • personal distress clearly fits many of the forms of abnormality considered in this book- people experiencing anxiety disorders and depression truly suffer greatly- but some disorders do not necessarily involve distress Disability or Dysfunction • disability- that is, impairment in some important area of life (e.g., work or personal relationships) because of an abnormality- can also be a component of abnormal behaviour • the disruption of J. Brett Barkley’s marital relationship fits this criterion • substance-use disorders are also defined in part by the social or occupational disability (e.g., poor work performance, serious arguments with one’s spouse) created by substance abuse and addiction • a phobia can also produce both distress and disability Unexpectedness • distress and disability are considered abnormal when they are unexpected responses to environmental stressors ➡ e.g. an anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the situation, as when a person who is well of worries constantly about his or her financial situation The Mental Health Professions • clinician is a health professional authorized to provide more services to people suffering from one or more pathologies • clinical psychologist is an individual who has earned a Ph.D. degree in psychology or a Psy.D. and whose training has included the internship in a mental hospital or clinic • assessment is finding out what is wrong with a person, what may have caused a problem or problems. and what steps may be taken to improve the person’s condition • diagnosis is the determination that a patient’s set of symptoms or problems indicates a particular disorder • psychotherapy is a primarily verbal means of thoughts, feelings, and behaviour to reduce distress and to achieve greater life satisfaction • psychiatrist is a physician (MD) who has taken specialized postdoctoral training, called a residency, in the diagnosis, treatment, and prevention of mental disorders • psychoactive drugs are chemical compounds having a psychological effect that alters mood or thought process. Valium is an example. • psychoanalyst is a therapist who has taken specialized postdoctoral training in psychoanalysis after earning an MD or a Ph.D. degree • social worker is a mental health professional who holds a master of social work (M.S.W.) degree • counselling psychologists is a doctoral-level mental health professional whose training is similar to that of a clinical psychologist, though usually with less emphasis on research and severe psychopathology • psychiatric nurse is a nurse who has obtained additional training in the mental health field History of Psychopathology many early philosophers, believed that deviancy reflected the displeasure of the gods or • possession by demons Early Demonology • demonology is the doctrine that a person’s abnormal behaviour is caused by an autonomous evil spirit • exorcism is the casting out of evil spirits by ritualistic chanting or torture • exorcism typically took the form of elaborate rites of prayer, noisemaking, forcing the afflicted to drink terrible-tasting brews, and on occasion more extreme measures, such as flogging and starvation, to render the body uninhabitable to devils • trepanning ➡ one popular theory is that it was a way of treating conditions such as epilepsy, headaches, and psychological disorders attributed to demons within the cranium ➡ it was presumed that the individual would return to a normal state by creating an opening through which evil spirits could escape Somatogenesis • Hippocrates rejected the prevailing Greek belief that the gods sent serious physical diseases and mental disturbances as punishment and insisted instead that such illnesses had natural causes and hence should be treated like other, more common maladies, such as colds and constipation • Hippocrates regarded the brain as the organ of consciousness, of intellectual life and emotion; thus, he thought that deviant thinking and behaviour were indications of some kind of brain pathology • somatogenesis is development from bodily origins, as distinguished from psychological origins • psychogenesis is development from psychological origins, as distinguished from somatic origins • Hippocrates classified mental disorders into three categories: mania, melancholia, and phrenitis (or brain fever) • for melancholia he prescribed tranquility, sobriety, care in choosing food and drinks and abstinence from sexual activity • he also left behind remarkably detailed records describing many of the symptoms now recognized in epilepsy, alcoholic delusion, stroke, and paranoia The Dark Ages and Demonology • historians have often suggested that the death of Galen (130-200A.D.), the second-century Greek who is regarded last major physician of the classical era, marked the beginning of the Dark Ages for Western Europe medicine and for the treatment and investigation of abnormal behaviour The Persecution of Witches • witchcraft, viewed as instigated by Satan, was seen a heresy and a denial of God • two Dominican monks issued a comprehensive and explicit manual, Malleus Maleficarum (“the witches’hammer”), to guide the witch hunts • those accused of witchcraft were to be tortured if they did not confess; those convicted and penitent were to be imprisoned for life; and those convicted and unrepentant were to be handed over to the law for execution • the manual specified that a person’s loss of reason was a symptom of demonic possession and that burning was the usual method of driving out the supposed demon Witchcraft and Mental Illness the prevailing for some time in the later MiddleAges was that the mentally ill were generally • considered witches • in their confessions the accused sometimes reporting having had intercourse with the devil and having flow to sabbats, the secret meetings of their cults • other information, moreover, indicates that witchcraft was not the primary interpretation of mental illness ➡ English laws during this period allowed both the dangerously insane and the incompetent to be confined in a hospital ➡ notably, the people who were confined were not described as being possessed • “lunacy” trials were to protect the mentally impaired, and a judgment of insanity allowed the Crown to become guardian of the lunatic’s estate ➡ the defendant’s orientation, memory, intellect, daily life, and habits were at issue in the trial ➡ strange behaviour was typically linked to physical illness or injury or to some emotional shock • only one case referred to demonological possession, which indicates that this explanation of mental disturbance was not as dominant during the MiddleAges as was once thought Development of Asylums • Leprosariums were converted to asylums • asylums are refuges established in western Europe in the fifteenth century to confine and provide for the mentally ill; the forerunners of the mental hospitals many of the asylums took in a mixed lot of disturbed people and beggars • Bethlehem and Other Early Asylums • bedlam is a scene or place involving a wild uproar or confusion. The term is derived from the scenes at Bethlehem Hospital in London, where unrestrained groups of mentally ill people interacted with each other • Benjamin Rush (1745-1813), who began practising medicine in Philadelphia in 1769, is considered the father of American psychiatry ➡ he believed that mental disorder was caused by an excess of blood in the brain ➡ he believed that many “lunatics” could be cured by being frightened Moral Treatment • Philippe Pinel is considered a primary figure in the movement for humanitarian treatment of the mentally ill in asylums • Pinel was put in charge of a large asylum in Paris known as La Bicetre ➡ he removed the chains of the people imprisoned there, although he subsequently adopted the practice ➡ Pinel also began to treat the patients as sick human brings rather than as beasts • Pinel also believed that the patients in his care were essentially normal people who should be approached with compassion and understanding and treated with dignity as individual human beings ➡ he surmised that if their reason had left them because of severe personal and social problems, it might be restored to them through comforting counsel and purposeful activity ➡ the more humanitarian treatment he reserved for the upper classes; patients of the lower classes were still subjected to terror and coercion as a means of control • a prominent merchant and Quaker, William Tuke, shocked by the conditions at YorkAsylum in England, proposed to the Society of Friends that it found its own institution ➡ in 1796 the York Retreat was established on a country estate, providing 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 through the countryside • moral treatment is therapeutic regimen, 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 residents led as normal lives as possible and in general took responsibility for themselves ➡ within the constraints of their disorders • according to Charland, Pinel believed that a central aspect of moral treatment was restoring a patient’s sense of self-esteem by letting her or him demonstrate self-restraint • drugs were also used frequently in mental hospitals first, drugs were the most common treatment and included alcohol, cannabis, opium, and ➡ chloral hydrate (knockout drops) ➡ second, the outcomes were not very favourable; fewer than one third of the patients were discharged as improved or recovered • Dorothea Dix was a Boston school teacher, whom taught a Sunday-school class at the local prison and was shocked at the deplorable conditions in which the inmates lived ➡ campaigned vigorously to improve the lot of people with mental illness; she personally helped see that 32 state hospitals were built to take in the many patients whom the private ones could not accommodate Asylums in Canada • J. F. Lehman (1840) wrote the first textbook published in Canada with a focus on the care and control of mentally ill people • Sussman (1998) argued that the development of services for mentally ill in Canada and British North America was largely ad hoc, with little cross-fertilization of ideas from province to province the earliest precursor to the nineteenth-century asylums was the Hotel-Dieu, established in • Quebec City in 1714 by the Duchess d’Aiguillon, niece of Cardinal Richeliew, the effective ruler of New France ➡ the facility cared for indigents and crippled people in addition to “idiots” • Alberta was the last province to open an asylum for the insane typically, asylum superintendents were British-trained physicians who modelled the asylums • after British forms of structure, treatment, and adminstration, although Bartlett (2000), in a comparative analysis of structures in Ontario and England, concluded that they functioned differently and reflected very different norms of social governance • while in the institute of Chief Asylum, almost 20% of the inmates died, a large number due to “general paresis of the insane” and to a condition called “phthisis” • in 1853 the legislature passed the Private Lunatic Asylums Act to accommodate the wealthy in alternatives to the public asylums • the history of the development of institutions for the mentally disorder 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” The Beginning of Contemporary Thought An Early System of Classification • German physican Wilhelm Griesinger, insisted that any diagnosis of mental disorder specify a biological cause- a clear return to the somatogenic views first espoused by Hippocrates a textbook of psychiatry, written by Griesinger’s well-known follower Emil Kraepelin, • furnished a classification system in order to establish the biological nature of mental illnesses • Kraepelin discerned among mental disorders a tendency for a certain group of symptoms, called a syndrome ➡ syndrome is 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, course, and outcome • Kraepelin proposed two major groups of severe mental diseases: dementia praecox, an early term for schizophrenia, and manic-depressive psychosis (now called bipolar disorder) he postulated a chemical imbalance as the cause of schizophrenia and an irregularity in ➡ metabolism as the explanation of manic-depressive psychosis General Paresis and Syphilis • degenerative changes in the brain cells associated with senile and presenile psychoses and some structural pathologies that accompany mental retardation were identified • general paresis is a mental illness characterized by paralysis and “insanity” that typically led to death within 5 years. Now known to be caused by syphilis of the brain. • germ theory of disease is the general view in medicine that disease is caused by infection of the body by minute organisms and viruses Psychogenesis Mesmer and Charcot • FranzAnton Mesmer, anAustrian physician, believed that hysterical disorders were caused by particular distribution of a universal magnetic fluid in the body • he felt that one person could influence the fluid of another to bring about a change in the other’s behaviour • Mesmer conducted meetings; he would enter a room, take various rods from the tub, and touch afflicted parts of his patients’bodies ➡ the rods were believed to transmit animal magnetism and adjust the distribution of the universal magnetic fluid, thereby removing the hysterical disorder Breuer and the cathartic method • Joseph Breuer found that the relief and cure of symptoms seemed to last longer if, under hypnosis, they were able to recall the precipitation event for the symptom and if their original emotion was expressed • cathartic method is a therapeutic procedure introduced by Breuer and developed further by Freud in the late nineteenth century whereby a patient recalls and relives an earlier emotional catastrophe and re-experiences the tension and unhappiness, the goal being to relive emotional suffering Current Attitudes Toward People With Psychological Disorders • Canadian’s concerns have ben reinforced by incidents involving threats, violence, and other examples of frightening behaviour on part of seriously mentally ill people, many of whom had refused to take or were no longer taking their prescribed medications schizophrenia is a group of psychotic disorders characterized by major disturbances in • thought, emotion, and behaviour; disordered thinking in which ideas are not logically related; faulty perception and attention; bizarre disturbances in motor activity; flat or inappropriate emotions; and reduced tolerance for stress in interpersonal relations. The person withdraws from people and reality, often into a fantasy life of delusions and hallucinations. • stereotyping is a fixed belief that typically involves a negative generalization about a group or class of people. Members of the general public often endorse a number of negative beliefs about mentally ill people, and thus engage in stereotyping. • stigmatization is a reduction in the status of a group of people, such as mentally ill people, due to perceived deficiencies • a recent Canadian study found that people with both a psychiatric and a physical disability faced more perceived stigma and discrimination than those with a psychiatric disability alone • dissociative identity disorder (DID) is a rare dissociative disorder in which two or more fairly distinct and separate personalities are present within the same individual, each with his or her own memories, relationships, and behaviour patterns, with only one of them dominant at any given time, Formerly called “multiple personality disorder.” The Public Reception • it is a common belief that people with psychological disorders are unstable and dangerous • a recent major American epidemiological study found that the 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 another insidious myth is the belief that people with psychological disorders can never be • “cured” and can never contribute meaningfully to society again ➡ such belief is a major misconception • Clarence Hincks suffered from serious, chronic psychological problems but was able to devote his life to helping the mentally ill and to trying to change the public’s attitudes towards them Hincks was a founder and long-term medical director of the Canadian Mental Health • Association (CMHA) • Canadian Mental Health Association is a national organization that provides information about mental illness and acts as an advocate for mentally ill people • Dr. David Goldbloom, vice-chairmen of the Mental Health Commission of Canada, summarized the message from this survey about Canadians’attitudes toward mental illness: “They’re not going to talk about it. They’re no
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