Chapter One: Definitions and Historical Considerations, and Canada’s
Mental Health System
• Psychopathology: the field concerned with the nature and development of abnormal behaviour, thoughts, and feelings.
• The concepts and labels we use in the scientific study of abnormal behaviour must be free of the subjective feelings of
appropriateness ordinarily attached to certain human phenomena
• The field of abnormal psychology is continually evolving
WHAT IS ABNORMAL BEHAVIOUR?
• No single definition is enough. So, abnormality Is usually determined by the presence of several characteristics at a
time such as: statistical inference, violation of norms, personal distress, disability or
dysfunction, and unexpectedness
• The normal curve (a bellshaped curve) places the majority of people in the middle as far as a particular characteristic is
concerned; very few people fall at either extreme (becoming classified as infrequent). An assertion that a person is
normal implies that he/she doesn’t deviate much from the average in a particular trait/behaviour pattern
• Used openly in diagnosing mental retardation.
o When IQ is below 70, individual is considered sufficiently subnormal to be designated as mental retardation.
• Only infrequent abilities like hallucinations and deep depression are considered abnormal rather than the infrequency if
having great athletic abilities
• Statistical component gives little guidance in determining which infrequent behaviours psychopathologists should study.
VIOLATION OF NORMS
• Another characteristic to consider is whether or not behaviour violates social norms or threatens or makes anxious
those observing it.
o Example; beating your wife is socially unacceptable
o The antisocial personality of a psychopath is another example
• Violation of norms is too broad of a definition by itself because there are criminals and prostitutes that violate norms but
are not studied in abnormal psychology
• Violation of norms makes abnormality a relative concept; various forms of unusual behaviour can be tolerated,
depending on the existing cultural norms
o But what is the norm in one culture may not be the norm in another; cultural diversity can affect how people
view social norms.
• Behaviour is abnormal if it creates great distress and torment in the person experiencing it; personal suffering.
• Some disorders do not necessarily involve distress; psychopaths treat others coldheartedly and may continually violate
the law without experiencing any guilt, remorse or anxiety
• Not all distress is abnormal though; Ex. Hunger, the pain of childbirth
DISABILITY OR DYSFUNCTION
• Disability is defined as impairment in some important area of life (work, personal relationships) because of an
o I.e. substance abuse problems that lead to issues at work, or ruin romantic relationships such as a marriage
o I.e. a phobia of flying might prevent someone from taking a job promotion over seas
• Although transvestism is diagnosed as a mental disorder if it distresses the person, it is not a disability. It does not prevent a person from getting married, going to work and they usually crossdress (for sexual pleasure) in private.
• Distress and disability are considered abnormal when they are unexpected response to environmental stressors.
o I.e. a person who is well off worries constantly about his or her financial situation
o Hunger, however is an expected response to not eating and would exclude as a state of distress that is
relevant to abnormal behaviour
FOCUS ON DISCOVERY 1.1: The Mental Health Professions
• To become a clinical psychologist typically requires a Ph.D. or Psy.D. degree, which entails 4 to 7 years of graduate
o In some places, the title of psychologist is only used for those at the doctoral level, whereas master’slevel
registrants are referred to as “psychological associates”
They learn techniques of assessment and diagnosis of mental disorders and they learn how to
o A psychiatrist holds an MD degree and has postgraduate training, called a residency, in which he/she has
received supervision in the practice of diagnosis and psychotherapy.
They are able to prescribe psychoactive drugs which are chemical compounds that can influence
how people feel and think
o A psychoanalyst has received specialized training at a psychoanalytic institute. Includes several years of
clinical training as well as the indepth psychoanalysis of the trainee. Graduates require an MD and a
o A social worker obtains an M.S.W. (masters of social work) degree.
HISTORY OF PSYCHOPATHOLOGY
• Before the age of scientific inquiry, all good and bad manifestations were accredited to doings of the supernatural.
Behaviour seemingly outside individual control was subject to similar interpretation. Many early philosophers,
theologians, and physicians who studied the troubled mind believed that deviancy reflected the displeasure of the gods
or possession by demons.
• Demonology: the doctrine that an evil being, such as the devil, my dwell within a person and control his or her mind and
body • Following from the belief that abnormal behaviour was caused by possession, it treatment often involved exorcism, the
casting out of evil spirits by ritualistic chanting or torture.
o Usually took the form of elaborate rites of prayer, noisemaking, forcing the afflicted to drink terribletasting
concoctions, and in extreme cases flogging and starvation tactics were used in order to render the body
uninhabitable to devils.
• Trepanning of skulls (making surgical opening in a living skull by some instrument). It was presumed that the individual
would return to a normal state by creating an opening through which evil spirits could escape.
o Also were done to relieve pressure resulting form depressed fractures caused by war clubs
• Hippocrates (the father of modern medicine) separated medicine from religion, magic, and superstition. He 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 needed to be treated like colds and constipation.
Hippocrates is often considered one of the very earliest proponents of somatogenesisthe notion that something wrong
with the soma, or psychical body, disturbs thought and action.
• Psychogenesis, in contrast, is the belief that a disturbance has psychological origins.
• Hippocrates classified mental disorders into three categories: mania, melancholia, and phrenitis (brain fever).
o For melancholia he suggested tranquillity, sobriety, and care in choosing food and drink, and abstinence from
• Hippocrates thought of mental health as dependent on a delicate balance among four humours, or fluids, of the body,
namely: blood, black bile, yellow bile, and phlegm – an imbalance produced disorder
o Lots of phlegm: sluggish and dull person
o Black bile: melancholia, depression
o Too much yellow bile: irritability and anxiousness
o Too much blood: changeable temperament
• Hippocrates‘s humoral physiology did not hold up to later scientific scrutiny.
THE DARK AGES AND DEMONOLOGY
• The Dark Ages began in 200 A.D. in Western European medicine and for the treatment & investigation of abnormal
behaviour. Churches began to gain influences and Christian monasteries, through their missionary and educational
work, replaced physicians as healers and as authorities on mental disorder. Many of the mentally ill roamed the
countryside, becoming more and more disturbed.
THE PERSECUTION OF WITCHES
• The thirteenth century saw greater suffering: recurrent famines and plagues, social unrest.
o People again turned to demonology to explain the disasters. o The times conspired to heap enormous blame on those regarded as witches, and these unfortunates were
persecuted with great zeal.
• Those accused of witchcraft were to be tortured if they did not confess; those convicted and repentant were to be
imprisoned for life and those convicted and unrepentant were handed over to the law for execution (procedures set out
in the ‘Malleus Maleficarum’ aka witches hammer, a guide to witch hunts)
• Over the next several centuries, hundreds of thousands of men, women, and even children were accused, tortured, and
put to death
WITCHCRAFT AND MENTAL ILLNESS
• The prevailing idea for some time in the later Middle Ages was that the mentally ill were witches. The so call ‘delusion
like confessions’ that many prisoners spoke about were usually obtained during brutal torture.
• However, in England, were torture was not allowed, the confessions did not usually contain descriptions indicative of
delusions or hallucinations
• As European cities grew, in the 13 century, municipal governments took over some duties of the church one of which
was caring for the ill.
DEVELOPMENT OF ASYLUMS
• After the principal Crusades had been fought, leprosy gradually disappeared from Europe, and interest was turned to
the mentally ill once again.
• Confinement of the mentally ill began in earnest in the 15 and 16 centuries. Leprosariums were converted into
asylums, refuges established for the confinement and care of the mentally ill. Many asylums took in a mixed lot of
disturbed people and beggars (great social problem).
BETHLEHEM AND OTHER EARLY ASYLUMS
• St. Mary Bethlehem: asylum founded in 1243 run by the city of London. It was devoted solely to the confinement of the
mentally ill. It was described as bedlam (a place or scene of wild uproar and confusion).
o Tickets were sold for people to view the violent patients and their antics because they were considered
• Benjamin Rush: founder of American psychiatry, favoured treatment that drew great quantities of blood. He also
believed that many lunatics could be cured by being frightened
• Philippe Pinel: primary figure in the movement for humanitarian treatment of the mentally ill in asylums. He was in
charge of the asylum La Bicetre in Paris where he treated patients like sick human beings rather than as beasts.
Patients who were once out of control became calm enough to walk about the hospital grounds in peace. Some were
even discharged after many years in the asylum.
• He believed these patients were normal people who deserved to be treated with compassion and understanding and
treated with dignity.
• Unfortunately, the more humanitarian treatment was reserved for the upper classes; the lower classes were still
subjected to terror and coercion as a means of control
• William Tuke: was shcked by the conditions at the York Asylum in England and in 1796, the York Retreat was
established which provided the mentally ill with quiet and religion atmosphere in which to live, work and rest. Patients
discussed their difficulties with attendants, worked in the garden and took walks through the countryside
• US hospitals were influenced by the sympathetic and attentive treatment provided by Pinel and Tuke – moral treatment.
• Pinel believed that a central aspect of moral treatment was restoring a patient’s sense of selfesteem by letting her or
him demonstrate selfrestraint
• Despite moral treatment, drugs were also used frequently in mental hospital, which included the use of alcohol,
cannabis, opium, and chloral hydrate. Also the outcomes of drug use were not very favourable; fewer than 1/3 of
patients were discharged as improved/recovered
• Moral treatment was abandoned in the latter part of the 19 century due to the hard work of Dorothea Dix
• Dorothea Dix: personally helped see that 32 state hospitals were built to take in the many patients whom the private
ones could not accommodate. The hospitals came to be administrated by physicians who were interested in the
biological aspects of illness and in the physical rather than psychological wellbeing of the mentally ill
• For limited time, there were attempts to apply moral treatment in certain regions of Canada, but these were undermined
by the political and economic decisions of those in power ASYLUMS IN CANADA
• The network of asylums in Canada began with humane intentions as part of a progressive and reformist movement,
which attempted to overcome neglect and suffering in the community, jails, penitentiaries, almshouses, poorhouses
• Most of the formal asylums in Canada were formed between 1840s and 1880s
o The development of services forthhe mentally ill were unplanned
• HotelDieu: was the earliest asylum in the 19 century. It cared for indigents and crippled people in addition to idiots.
• Following the 1763 Treaty of Paris, the English assumed power over the area and although the contractingout practice
and the influence of the Catholic Church continued, the British influence on care practices, daily asylums
managements, and funding moderated the differences between Quebec and the rest of Canada
o The Tukes (pioneers from Great Britain) influenced the design and construction of asylums
• Alberta was the last to open an asylum for the insane
• In 1864, the average cost to care for each patient was $152.88;the superintendent calculated that since 1841, 52% of
patients were discharged; 20% die in the institution, mostly die to general paresis of the insane and phthisis
• In 1853, the legislature pass the Private Lunatic Asylums Act to accommodate the wealthy in alternatives to the public
asylums; the established the Homewood Retreat (a profitorientated, independent, private asylum)
• Dr Lett: first medical superintendent was believed in humane care of patients and he encouraged his staff to employ the
principles of moral therapy
• In Canada, the institution and the community were two separate and distinct solitudes
Canadian perspectives 1.1: DOROTHEA DIX AND THE DEVELOPMENT OF THE ASYLUMS IN
CANADA: LIGHT INTO THE DARKNESS
• On Jan 21, 1850, Dix presented a compelling memorial prayer on behalf of the mentally ill to the Nova Scotia legislature
and requested construction of a public mental hospital
• She discussed the neglect and suffering of patients that she witnessed in the Toronto jail and Quebec Lunatic Asylum
o She discussed moral treatment and the consequence of failure to obtain help at an early point
o She appealed to the members to consider what it was like to be mentally ill in Canada
Canadian perspectives 1.2: THE MENTAL HOSPITAL IN CANADA: THE 20 CENTURY AND INTO TH
THE NEW MILLENNIUM
• Provincial mental hospitals in the 20 century were overcrowded and individual treatment was unavailable with the
exception of lobotomy and psychoactive drugs (became the central means of treatment)
• In the1970s, the goal in Canada was to shift care form psychiatric hospitals into the community
o Less beds were needed from 160 1976
o There were budget cuts in 1980s and 1990s, continuing the trend of deinstitutionalization
• However, many of the patients that were deinstitutionalized were living life in poverty
• Medicare is regulated and in part financed by the federal government. Unlike the US, which pays for services mainly for
the elderly and disabled, Canada Medicare pays basic medical and hospital costs for all Canadians
• In Canada, chronic patients are kept in protected environments, but receive little individual psychosocial treatment
• Some of our psychiatric hospitals remain old but are still superior to those in the US
• Forensic hospital: mental hospital where people who have been arrested and judged unable to stand trial and for those
who have be acquitted of a crime because they are not criminally responsible on account of mental disorder
o Their lives are controlled by tight security
o They are given treatment
o In Canada, there are 3 forensic hospitals
• In most mental hospitals, patients don’t see staff for 8090% of the time. However, if they are not disturbed, they do
have activities they can do (swimming, gym, group therapy)
o Staff rely of drug rather than practicing psychotherapy the institution setting is used to provide supportive
care, to try to ensure that patients are taking their medication
o Some patients become so accustomed to the closed in lifestyle that they become frightened by the thought of
leaving • The role of provincial psychiatric hospitals in he new millennium will be to provide specialized treatment and
rehabilitation services for individuals whose needs for care are too complex to be managed in the community
o Stays in dedicated hospitals are shorted but still average more than 100 days
o There is an ongoing concern that the need to balance the rights of mentally ill individuals with the right of the
community to be protected form them if they are a danger
o Community treatment orders (CTOs): a legal tool issued by a medical practitioner that establishes the
conditions under which a mentally ill person may live in the community
• It is certain that how asylums were 150 years ago will disappear by the 21 century
THE BEGINNING OF CONTEMPORARY THOUGHT
• One development that fostered progress was the discovery the Flemish anatomist and physician Vesalius that Galen
presentation of human anatomy was incorrect
o Galen presumed that human physiology mirrored that of the apes he studied
o Took more than thousands of autopsies to prove he was wrong
• Thomas Sydenham: English physician who was successful in advocating an empirical approach to classification and
diagnosis, one that subsequently influenced those interested in mental disorders
AN EARLY SYSTEM OF CLASSIFICATION
• Wilhelm Griesinger: impressed by Sydenham’s approach, he insisted that any diagnosis of mental disorder specify a
biological cause – a clear return to the somatogenic views first espoused by Hippocrates
• His follower Emil Krapelin furnished a classification system in order to establish the biological nature of mental illness
• He separated mental disorders based on their syndromes – a group/ pattern of symptoms that occur together in a
particular disease. He regarded each mental illness as distinct form each other, having its own genesis, symptoms and
• He proposed 2 major groups of severe mental diseases:
o 1) Dementia praecox (an early term of schizophrenia), caused by a chemical imbalance
o 2) Maniacdepressive psychosis (bipolar disorder), caused by an irregularity in metabolism
GENERAL PARESIS AND SYPHILIS
• There was not enough knowledge about the brain in the 1800s to reveal all the expected abnormalities in structure that
might underlie various mental disorders. However, it was identified that degenerative changes in the brain cells was
associated with senile and presenile psychoses and some structural pathologies accompanied mental retardation
• The most striking medical success was the discovery and the full nature and origin of syphilis – a venereal disease
o Since 1978, a number of mental patients suffered multiple impairments (delusions of grandeur and
progressive paralysis). These patients never recovered
o In 1825, the