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Chapter 1

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University of Toronto St. George

Chapter One • Clifford Beers: suffered from paranoia, fear and depression; suffered in terrible hospital conditions in early twentieth century; inspired to start mental hygiene movement; wrote a book that changed how physicians and the public viewed mental patients and hospitals; all psychological disorders are medical diseases • Worked with Clarence Hincks to “humanize” mental health problems – both suffered from severe depression • Formed Canadian National Committee for Mental Health Hygiene (later Canadian Mental Health Association) • Abnormal psychology: study of people who suffer mental, emotional and often physical pain as a result of some form of psychological or mental disorder; often referred to as psychopathology • Context influences whether a behaviour is viewed as abnormal • Some argue that behaviours become defined as abnormal if they violate a culture’s gender roles, which are expectations for an individual’s behaviour based on their gender • Cultural relativism: no universal standards or rules for labelling a behaviour as abnormal; can only be abnormal relative to cultural norms; different definitions across different cultures o Ex: bereavement practices across the globe • Opponents: dangers arise when societal norms are allowed to dictate normality and abnormality; justification for control (Jews, slaves) o Drapetomania: “sickness” attributed to slaves who desired to leave their master; justification for capture How can we define abnormality? • Unusualness: behaviours that are unusual or rare are abnormal while behaviours tat are typical are normal; ties to relativist criterion o Who decides how rare an action is in order to call it abnormal? How can we have an objective cut-off? o What do we do in cases where rare behaviours are positive for society? Ex: child prodigies, eccentrics (rare but harmless hobbies/activities) • Discomfort: behaviours should be considered abnormal only if the individual suffers discomfort and wishes to be rid of the behaviours; doesn’t consider societal norms; ex: changing views on homosexuality o What about people who are not aware of problems their behaviours create for themselves or others? Ex: people who have lost touch with reality o What about people who enjoy behaviour that is discomforting to others? Ex: psychopaths or sadists • Mental illness: behaviour that results from disease; clear, identifiable physical process that differs from “health” and leads to specific behaviours or symptoms o No biological tests for abnormalities yet, possibly as due to number of biological AND psychosocial factors, not just abnormal genes o Diagnosis just as a label for a set of symptoms NOT an identifiable physical process found in all people who exhibit these symptoms • Maladaptiveness: behaviours cause people to suffer distress and prevent them from functioning in daily life; dysfunction, distress and deviance; supported by most clinicians in the field • How much pain should a person suffer? How much should the behaviours interfere with daily functioning? What is adequate functioning? • Culture and gender influence expression, admittance, likelihood and treatments for maladaptive behaviours Historical perspectives on abnormality • Theories of causes of abnormal behaviours through history o Biological: breakdown of body systems; must restore body to good health o Supernatural: divine intervention, curses, demonic possession and personal sin; prescribed exorcisms, atonement and religious rituals o Psychological: traumas (stress or bereavement); prescribed rest, relaxation, herbal medicines, change of environment Ancient theories • Prehistoric people believed demons and ghosts were cause of abnormal behaviour so the treatment was exorcism (sometimes extreme measures like starvation) • Trephination: drilling of holes in skulls to allow spirits to depart; done in Stone Age; tool used called a trephine; typically used on people who were hallucinating; might also have been used to remove blood clots • Other standards: unusualness, discomfort of person experiencing behaviour, mental illness and maladaptiveness • Yin and yang: positive (yang) and negative (yin) forces in body which had to complement each other; imbalance resulted in insanity; excited insanity result of too much positive force • Human emotions also believed to have been controlled by internal organs; encouraged to live harmoniously • Some religious theories of abnormality (Taoism, Buddhism) • Egypt and Mesopotamia: believed disorders in women caused by a “wandering uterus” which would interfere with other organs (Greeks would call this hysteria) • Belief in both physiological interventions and incantations to gods • Greeks and Romans believed madness was an affliction from the gods; madness could also be the source of prophetic and literary gifts • But physician Hippocrates believed imbalances in humours to be root of abnormal behaviour; classified mania, brain fever, epilepsy, etc • Treatments to restore balance: bleeding patients, emotional control, change of scenery • State claimed no responsibility for the insane but could take away rights from people declared mad Medieval views • Severe emotional shock and physical illness/injury as roots  witchcraft and supernatural forces • Breakdown of feudalism and political rebellions threatened stability of church, who chose to interpret threats in terms of heresy and Satanism • Witches may have been experiencing delusions (false beliefs) or hallucinations (unreal perceptual experiences); likely cause was ill health and poor nutrition • Accusations of witchcraft used as social punishment/control • Eventually Teresa of Avila attributed mass hysteria as effect of infirmities/sickness, not witchcraft • Use of cultural beliefs to explain own feelings and behaviour • Psychic epidemics: phenomenon in which large numbers of people begin to engage in unusual behaviours that appear to have a psychological origin; dance frenzies and manias • Tarantism: acute pain followed by wild dancing and odd behaviour • Frenzies and epidemics often found in religious services for the economically and socially deprived – Methodist movements, mystical Russian sects • Social psychology and influence of others on self-perceptions The spread of asylums during the Renaissance • 11 or 12 century: general hospitals include special rooms or facilities for abnormal behaviour; far from humane treatment; ex: Bedlam in London (patients had to beg for money and live in filth) • Laws regarding confinement of mentally ill concerned with protection of public and individual’s relatives • Act for Regulating Madhouses: England; 1774; wanted to clean up deplorable conditions in hospitals and madhouses and protect people from being unjustly jailed for insanity; licensing and inspection and approval from medical professional before admitting a patient – only applied to paying patients in private madhouses • Public Hospital in Virginia first hospital exclusively for mentally ill with treatments like electric shock, starvation and restraints Moral treatment in the 18 century • New psychological view that people became mad because they were separated from nature and succumbed to the stresses imposed by the rapid social changes of the period – advocated rest and relaxation • Moral treatment: mild system of treatment designed to restore patients’ self-restraint by treating them with respect and dignity and encouraging them to exercise self-control; Quaker William Turke founder • Dorothea Dix a crusader for moral treatment of the insane in the US; efforts led to the passage of laws and appropriations to fund the clean-up of mental hospitals and the training of professionals; established institutions • Philippe Pinel rejected supernatural theories and treated patients with dignity and tranquility (social activities, sunny rooms, good food) • Movement grew too fast and capacity of asylums declined; not enough time to dedicate to individual patients; lots of patients had problems unrelated to loss of tranquility and these failures stood out • Asylums in Cathda were overcrowded, pestilent, segregated and underdeveloped until well into 20 century, until effective biological treatments were developed • Patients warehoused if they could not afford private care and isolated from cities, which contributed to slow progress in application of medical advances The emergence of modern perspectives • Basic knowledge of anatomy, physiology, neurology and chemistry increases in late 19 th century which contributes to awareness of biological causes of insanity • Wilhelm Griesinger: brain pathology explains psychological disorders; wrote The Pathology and Therapy of Psychic Disorders • Emile Kraepelin: supported brain pathology argument; developed scheme of classifying symptoms into discrete disorders • General paresis: disease that leads to paralysis, insanity and eventually death; syphilis cause as proved by Richard Kraft-Ebing  biological factors can cause abnormal behaviour • Mesmerism: Franz Anton Mesmer believed that magnetic fluid in the body had to be distributed in particular patterns to maintain health; magnetic forces of others and planet alignment influenced distribution; put people in trances • Hypnosis: trancelike state induced in patients; became suggestible and suggestion that ailments could disappear seemed enough to make them disappear • Bernheim and Leibault argued that self-hypnosis caused hysteria • Sigmund Freud: mental life of an individual is hidden from consciousness; worked with Josef Breuer o Catharsis: great upwelling and release of emotion occurring when patients discuss problems under hypnosis • Psychoanalysis: study of the unconscious; Freud’s work basis • Behaviourism: study of the impact of reinforcements and punishments on behaviour • Classical conditioning: dog conditioned to salivate at stimuli besides food if food is paired with this stimuli; Ivan Pavlov and his work with stimuli and responses • Operant conditioning: behaviours followed by positive consequences are more likely to be repeated than behaviours with negative consequences; B.F. Skinner and E.L. Thorndike • Cognitions: study of thought processes that influence behaviour and emotion and mediate relationship between stimulus and response; Albert Bandura • Self-efficacy beliefs: people’s beliefs about their ability to execute the behaviours necessary to control important events; crucial to determining their well-being • Rational-emotive therapy: developed by Albert Ellis; therapy based on theory that people plagued by irrational negative assumptions about themselves and the world are prone to psychological disorders; therapists challenge patients belief systems; similar to that of Aaron Beck Modern mental healthcare • Drugs that can reduce symptoms of schizophrenia called phenothiazines allow people to be released from hospitals and asylums • Anti-psychotic medication (ex: chlorpromazine) changes psychiatric care  facilitates treatment of severely affected patients and leads to recognized importance of psychobiological factors in development of mental illness • Patients’ rights movement: advocated for mental patients to be integrated into the community with support of community-based treatment facilities • Deinstitutionalization occurs across Canada and deployment of resources to community; ex: Adult Community Mental Health Program • But resources never adequate: not enough halfway houses or community centres • Revolving door syndrome: patients still receiving shorter admissions to psychiatric hospitals/units; multiple short admissions  deinstitutionalization led to fragmented, disorganized and inefficient mental health system • Approx. 30% of homeless adults have a major mental disorder; 10-15% of prison population; 32% of Canadians with mental health disorder seek active treatment • Tommy Douglas’ universal insurance plan hat covers all hospital based diagnostic and treatment services and physician fees for services provided outside of hospitals applied all over Canada in 1972 • Primary care physicians not specialized experts in diagnosis/treatment
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