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abnormalpsych - ch1.docx

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Suzanne Sicchia

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CHAPTER 1 – ABNORMAL PSYCHOLOGY  Brett is a 35 year old police officer, seeking a therapist because he is unable to produce an erection  Rough childhood, mother passed and father was an alchy; lived in rundown houses and also lived with aunt  Father was diagnosed with manic-depressive-psychosis  Began experiencing moodswings in uni, and experienced self consciousness  He began drinking like his father to control his problems Psychopathology – the field concerned with the nature and development of abnormal behavior, thoughts and feelings  a big challenge in the study of abnormal psychology is the need to remain objective; the subject matter is personal so sometimes it can be hard to do so. WHAT IS ABNORMAL BEHAVIOUR? Abnormal behavior- includes such characteristics as statistical infrequency, violation of norms, personal distress, disability or dysfunction and unexpectedness.  Statistical infrequency – falls apart; people above average are statistically infrequent but nor abnormal  Violation of norms – falls apart; norms are subjective  Personal distress – falls apart; some people take pleasure in abnormal behavior  Disability or dysfunction – falls apart; disabilities are subjective as well (applies to some but not all )  Unexpectedness of disability, dysfunction or distress The Mental Health Professions: In Canada specific curriculum requirements vary from jurisdiction for psychology professions, so in 1995 the AIT established that there must be 5 core competencies in order to become a registered psychologist: 1. Interpersonal relationships 2. Assessment and evaluation 3. Intervention and consultation 4. Research 5. Ethics and standards Clinicians – the various professionals authorized to provide psychological services Clinical Psychologist- an individual who has earned a Ph.D. degree in psychology or a Psy.D. and whose training has included an internship in a mental hospital or clinic.  Ph.D. is basically a research degree in which students perform research and write a dissertation on a specialized topic  Candidates in clinical psychology Ph.D. learn skills in two additional areas that distinguishes them form other Ph.D. students 1. Assesment & Diagnosis of mental disorders; Assessment: 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: the determination that a patients’ set of symptoms or problems indicates a particular disorder. 2. Psychotherapy – a primarily verbal means of helping troubled individuals change their thoughts, feelings, and behavior to reduce distress and to achieve greater life satisfaction. Psychiatrist – a physician (MD) who has taken specialized training called a residency, in the diagnosis, treatment, and prevention of mental disorders. They can also prescribe meds Psychoanalyst- a therapist who has taken specialized postdoctoral training in psychoanalysis after earning an MD or Ph.D. degree Social Worker – obtains an MSW Counseling Psychologists – a doctoral level mental helth professional whose training is similar to that of a clinical psychologist, though usually with less emphasis on research and severe psychopathology Psychiatric Nurse – a nurse who has received additional training in the mental health field - other clinical graduate programs are more focused on practice - like the Psy.D. Degree, the curriculum is similar to that of Ph.D. students with less emphasis on research and more on clinical training - Ph.D. approach is based on a scientist- practitioner model, while the Psy.D. approach is based on the scholar- practitioner model - According to CPA psychologists are Canada’s largest group of licensed mental health care providers & they are the main contributors to research - 2.15% of the Canadian population has seen a psychologist in the past year - psychological and psychiatric services are more accessible in urban areas than in rural ones HISTORY OF PSYCHOPATHOLOGY Early Demonology: Demonology – the doctrine that an evil being, such as the devil, may dwell within a person and control his or her mind and body - examples of demonological thinking are found in early Chinese, Egyptian, Babylonians and Greeks - The Hebrews attributed deviancy to possession of the person by bad spirits after god has removed protection - Thus abnormal behavior usually involved excorcism - Exorcism: the casting out of evil spirits by ritualistic chanting or torture. Usually involved elaborate rites of prayer, noise making, forcing them to drinking horrible brews, and on occasion more extreme measures like flogging or starvation - Trepanning: the act of making a surgical opening in a living skull, This act was sometimes performed because of psychological disorders attributed to demons within the cranium. Popular in the stoneage or Neolithic cave dwellers – also presumed to be used for epilepsy and headaches - Introduced to Americas from Siberia - most popular in Peru and Bolivia; however, three aboriginal specimen have been found along the coast of BC – all with the openings located in the same area (the upper central occipital) - despite their culture’s focus on spirits, they argue it was done to relieve pressure resulting from depressed fractures in the skull caused by war clubs Somatogenesis - 5 century BC Hippocrates separated medicine from religion and superstition - insisted that mental disturbances had natural causes, not supernatural and thus should be treated like common maladies - he is often considered one of the very early proponents of somatogenesis: development from bodily origins, distinguished from psychological origins (contrast to psychogenesis) - psychogenesis: development from psychological origins - Classified mental disorders into three categories: mania, melancholia and phrenitis (brain fever) - For melancholia he prescribed tranquility, sobriety, care in choosing food and drink, and abstinence from sexual activity - He left behind detailed records describing many symptoms now recognized in epilepsy, alcoholic delusions, stroke and paranoia - Thought mental health was dependent on four fluids of the body: blood, black bile, yellow bile and phlegm and an imbalance produced disorders - Too much phlegm = sluggish and dull - Too much black bile = melancholia - Too much yellow bile = irritability and anxiousness - Too much blood = changeable temperament Dark Ages and Demonology - Historians have often suggested that the death of Galen, the last major physician in the classical era, marked the beginning of the dark ages of medicine for western Europe - Over several centuries Greek and Roman civilizations ended and churches took over and the papacy (authority of pope) was considered separate of the state - Christian monasteries replaced physicians as healers and authorities on mental disorders - A few monasteries had records of traditional Greek medical manuscripts Persecution of Witches: - 13 century population was already suffering from social unrest, recurrent famines and plagues and then once again turned to demonology to explain these disasters - people in Europe became obsessed with the devil - 1484 Pope innocent VIII insisted to leave no stone unturned in the search for witches - Sent out two Dominican Monks to northern Germany as inquisitors, two years later they published a comprehensive manual, Malleus Maleficarum (“the witches’ hammer”) to guide witch hunts – regarded by Catholics and protestants as a textbook on witchcraft - Those accused of witch craft were to be tortured if they did not confess; those who pleaded guilty were to be imprisoned for life and those who were convicted but did not plead guilty were to be executed by the law - The manual specified that a person’s loss of reason was a symptom of demonic possession and that burning was the usual method of action to drive the demon out of the body Witchcraft and Mental Illness: - Prevailing interpretation was that the mentally ill were generally witches - In their confessions the accused sometimes reported strange occurrences (sex with devil) which have been interpreted by writers as delusions/hallucinations indicating that some of the accused were psychotic - However, careful examination of the period reveals that more sane than insane people were tried - The delusion like confessions were usually obtained during torture, indeed in England where torture was illegal, confessions usually did not involve delusions or hallucinations - Other info indicates witchcraft was not the primary interpretation of mental illness - From the 13 century on Europe grew in size and municipal authorities began to takeover some of the responsibilities of the church, including care for the ill - English law “mad are kept safe until they are restored of reason” protected the mentally ill - Beginning in the 13 century they began to hold lunacy trials, judgment of mental illness give the crown rights to protect the mentally impaired - In all the cases examined, only 1 was attributed to demons - Thus the majority of evidence proves that this explanation of mental disturbances was not as dominant in the middle ages as once thought Development of Asylums: - Until the end of the crusades in the 15 century there were few hospitals for mentally ill in Europe, although there were 220 leprosy hospitals for a population of 1.5 million - After the war leprosy disappeared and the attention turned towards the mentally ill - Confinement of the mentally ill began in the 15 and 16 th century, when leprosariums were converted to asylums: refuges established for the confinments and care of the mentally ill - Many asylums took in a mix of disturbed people and beggars; beggars were a huge social problem at the time, in Paris out of the 100, 000 population 30, 000 were beggars - The asylums had no specific regimen for the ill besides work, however at the same time hospitals geared more towards the mentally ill also emerged Bethlehem and other Early Asylums: - In 1547 St. Mary of Bethlehem (hospital) was handed over to the city of London by Henry VIII, thereafter to be a hospital devoted solely to mental illness - Conditions were terrible - Over the years the term bedlam ( a contraction and popular name for the hospital) became a descriptive term for a place of wild uproar and confusion. - Bethlehem became one of London’s great tourist attractions - Even in the 18 century people were still entertained by patients and their antics and tickets of admission to bedlam were sold - Lunatics tower constructed in Vienna in 1784, patients were confined in small square rooms with an open window for people to view - The inclusion of abnormal behavior in the same domain as medicine didn’t necessarily mean moral treatment - Benjamin Rush, considered the father of American Psychiatry believed that mental disorder was caused by excess blood in the brain and thus as treatment he would draw great quantities of blood - Also believed that lunatics could be cured by being frightened - A new England doctor of the 19 century implemented this treatment; patients would be placed in a coffin full of water while the lid, with holes, would close down on them and once the bubbles ceased would lift – and if he had not already passed, he would then be revived” Moral Treatment - Philippe Pinel is considered a primary figure in the movement for moral treatment of the mentally ill - During the French revolution he was put in charge of a large asylum in Paris known as La Bicetre ( has been asserted that he lifted the chains off patients, although he later adopted similar practices), a former patient, Jean Baptiste Pussin is thought to have removed the chains - Pinel treated patients as sick rather than beasts, this resulted in them behaving more calm and dramatically improved the behavior of some who had been unmanageable - Believed that the mentally ill were essentially normal people who needed to be treated with compassion - He was not a complete advocate of equality; he reserved the more humanitarian treatment for the upper class, while the lower class were still subject to terror - William Tuke, a prominent merchant witnessed the condition of the York Asylum in England and insisted they changed - In 1796 the York retreat was established on a countryside, with a quiet and religious atmosphere - In the US the Friends Asylum was established in 1817 in Pennsylvania and the Hartford was established in 1824 in Connecticut, both patterned after the York Retreat - Moral Treatment: a therapeutic regimen introduced by Pinel, whereby patients were treated with compassion and dignity rather than with contempt; Pinel believed a central part of the moral treatment was restore the patients’ sense of self-esteem by letting her or him demonstrate self restraint - Drugs were still used in treatments in the early 19 th century - 2 fidnings emerged forma detailed review of records from the York Retreat; 1 drugs were the most common treatment and included alcohol, cannabis, opium and nd chloral hydrate (knockout drops), 2 the outcome wasn’t too great and only 1/3 of patients were discharged - in the latter parts of the 19 century moral treatment was abandoned - Dorothea Dix , helped contribute to this change, ironically she was a fighter for the better treatment of patients - she personally helped see that 32 state hospitals were built to take in the patients whom couldn’t get private care - unfortunately state hospital staff members could not provide the same individual attention as the private hospitals - the hospitals came to be administered by physicians who’s interest was in the biological aspect of the disease rather than the well-being of the mentally ill - there were attempts to apply the moral treatment in Canada, but were undermined by the political and economic decisions of those in power - Dr. Henry Hunt Stabb made heroic efforts to apply moral treatment and non-restraint at the St. John’s Newfoundland Lunatic Asylum; he stayed there till his death - His efforts were hindered by limited financial resources and more patients than the hospital could accommodate Asylums In Canada: - Dorothea Dix described shameful examples of the asylums in her 1850 memorial - Around the same time J.F. Lehman, wrote the first textbook in Canada regarding the care and control of the mentally ill - His book included harsh treatments and stringent discipline - Sussman argued that the care for the mentally ill was ad hoc, and they needed to further and improve the treatments - The earliest precursor to the 19 century asylums was the Hotel-dieu established by Duchess d’Aiguillon in Quebec city 1714 - The facility cared for indigents (poor), crippled and “idiots” - Similar hospitals were built throughout Quebec where the Roman Catholic church was in charge of caring for the mentally ill - Following the 1763 treaty of Paris the English assumed power over the area, and although contracting out practices and influence of the Catholic church continued “ - the British influence on care practices, daily asylum management, and funding weakened the differences between Quebec and the rest of Canada” - the reform movement was led primarily by pioneers form Great Britain (the Tukes) who influenced the design and construction of asylums - Alberta was the last province to build an asylum - Typically the asylum superintendent were British trained physicians who modeled the asylums after British structure - Bartlet in a comparative analysis between Ontario and London, concluded that they functioned very differently - In upper Canada the power rested with the asylum doctor - In the 1864 Annual report of Asylums the inspectors gave a glowing report on behalf of the superintendent of the Provincial Lunatic Asylum in Toronto, but the superintendent reported hat both the Chief asylum and the university branch were “”dangerously overcrowded” and that this overcrowding was responsible for the striking increase in the death list - Most of the remaining patients at the end f the year were “the noisy, the unruly and the violent” - Most women were sent to the university branch - Average cost of each patient was $15288 - Since the facility opened in 1841 the discharge rate is calculated to be 52% - Almost 20% of inmates died while in care, a large number due to general paresis of the insane and to a condition called “phthisis” - 1853 the legislature passed the private lunatic asylums acts to accommodate the wealthy In private asylums - as a result the Homewood Retreat was established in Guelph in 1883. Dr. Lett was the first medical superintendent in believed in the humane care of patients - the history and development of institutions for the mentally disordered in Canada can be characterized by two things: 1. with the introduction of asylums, provisions for the mentally ill were separate form the provisions of the physically ill, poor and criminals 2. the process and institution was separated from the community - Dorothea Dix also helped Henry Hunt Stabb in the establishment of the St. John’s Newfoundland asylum The Mental Hospital In Canada: - Despite humane motives that established the hospitals, the results were not very positive – hospitals were overcrowded and individual treatment was unavailable except for extreme procedures (lobotomy: a surgical operation where an incision is made to the prefrontal lobe of the brain) and drugs - Drugs became the main form of treatment after the introduction of antipsychotic phenothiazines in the 1950s - 1970s concerns about the restrictive nature of hospitals led to an increase in deinstitutionalization of patients - goal was to shift from psychiatric hospitals to the community - 1960-1976 beds dropped from 50, 000 to 15, 000 but psychiatric units in general hospitals increased from 1, 000 to 6, 000 - negative side of deinstitutionalization is many discharged people lead lives of poverty - although the provincial an terr
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