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Chapter 1

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Konstantine Zakzanis

Chapter 1: Introduction: Definitional and Historical Considerations, and Canada's Mental Health System  Psychopathology: the field concerned with the nature and development of abnormal behaviour, thoughts, and feelings  To understand abnormal behaviour, we must get rid of preconceived notions that we have about the topic --> remain objective  Abnormality is hard to define --> no one definition --> usually determined by the presence of several characteristics at one time What Is Abnormal Behaviour?  Abnormal Behaviour: includes such characteristics as statistical infrequency, violation of norms, personal distress, disability or dysfunction, and unexpectedness o Statistical infrequency  Aspect of abnormal is that it is infrequent in the normal population  Normal Curve: (or bell shaped curve) places the majority of people in the middle as far as any particular characteristic is observed; very few people fall at each extreme  Assertion that a person is normal implies that they do not deviate much from the average in a particular trait/ behavioural pattern  Used explicitly in diagnosing mental retardation (ie IQ below 70)  Statistical component gives us little guidance in determining which infrequent behaviours psychopathologists should study o Violation of norms  Whether the behaviour violates social norms or threatens or makes anxious those observing it  Violation of norms explicitly makes abnormality a relative concept; various forms of unusual behaviour can be tolerated, depending on the prevailing cultural norms  Aspect is too broad and too narrow (ie highly anxious person does not violate social norms)  Cultural diversity can affect how people view social norms --> what is normal in one culture may be abnormal in another o Personal distress  Personal suffering; behaviour is abnormal if it creates great distress and torment in the person experiencing it  Ie people experiencing anxiety disorders and depression suffer greatly  Some disorders do not involve distress (ie psychopath may treat others cold-heartedly and may continually violate the law without experiencing any guilt, remorse, or anxiety whatsoever)  Not all forms of distress belong to the field (ie hunger, pain of childbirth) o Disability or dysfunction  Disability: impairment in some important area of life (ie work or personal relationships) because of an abnormality  Substance-use disorders are also defined in part by the social or occupational disability created by substance abuse and addiction (ie poor work performance, marital issues)  A phobia can produce both distress and disability  Disability applies to some but not all disorders o Unexpectedness  Distress and disability are considered abnormal when they are unexpected responses to environmental stressors  Ie anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the situation Mental Health Professions  Clinicians: the various professionals authorized to provide psychological services  Clinical Psychologist: requires a PhD, or Psy.D degree o According to Gauthier, a person must obtain 5 core competencies in order to become a registered psychologist: (1) interpersonal relationships; (2) assessment and evaluation (including diagnosis); (3) intervention and consultation; (4) research; (5) ethics and standards o Learn techniques of assessment and diagnosis of mental disorders o Learn how to practice psychotherapy, a primarily verbal means of helping troubled individuals change their thoughts, feelings, and behaviours to reduce distress and to achieve greater life satisfaction o Doctor of Psychology (Psy.D) curriculum is similar to that required of PhD students, but less emphasis on research and more on clinical training  Psy.D approach is based on a scientist-practitioner model, while the Psy.D approach is based on a scholar-practitioner model o Psychologists are the largest group of licensed and specialized mental health care providers --> primary researchers and providers of evidence-based psychological treatments  Psychiatrist: holds an MD degree and has had postgraduate training (residency) for practice in psychotherapy o Continue functioning as physicians- giving physical examinations, diagnosing medical problems, etc o Primary aspect of medical practice in which psychiatrists engage is prescribing psychoactive drugs (chemical compounds that can influence how people feel and think  Psychoanalyst: received specialized training at a psychoanalytic institute  Social Worker: obtains an M.S.W (master of social work) degree  Counselling Psychologists: similar to graduate training in clinical psychology but usually have less emphasis on research and the more sever forms of psychopathology  Psychiatric Nurse: specializes in the mental health field History of Psychopathology  Behaviour seemingly outside individual control as well as good and bad manifestations of power beyond the control of humankind were seen as supernatural  Early philosophers/theologians/physicians thought deviancy reflected the displeasure of the gods or possession by demons  Demonology: doctrine that an evil being, such as the devil, may dwell within a person and control their mind and body  Exorcism: treatment of possession by casting out of evil spirits by ritualistic chanting or torture; typically took 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: the making of a surgical opening in a living skill by some instrument; way of treating conditions such as epilepsy, headaches, and psychological disorders attributed to demons within the cranium --> in Stone Age --> introduced into the Americas from Siberia  In 5th century B.C, Hippocrates (the father of modern medicine) separated medicine from religion, magic, and superstition o Insisted that such illnesses as physical diseases and mental disturbances had natural causes and should thus be treated like others o Brain regarded as the organ of consciousness, of intellectual life, and emotion -- > therefore deviant thinking and behaviour was an indication of some kind of brain pathology o Somatogenesis: the notion that something wrong with the soma, or physical body, disturbs thought and action o Psychogenesis: the belief that a disturbance has psychological origins o Classified mental disorders into 3 categories: mania, melancholia, and phrenitis (or brain fever) o Began to treat in more natural ways such as prescribing tranquility, sobriety, care in choosing food and drink, etc as opposed to exorcistic tortures --> also began to examine and notice specific signs and symptoms of different disorders o Physiology was rather crude as he conceived of normal brain function, and therefore of mental health, as dependent on a delicate balance among 4 humours (fluids) of the body: blood (temperament), black bile (melancholia), yellow bile (irritability and anxiousness), and phlegm (sluggish and dull) --> imbalance thought to produce disorders o Hippocrates's basic premise- that human behaviour is markedly affected by bodily structures or substances and that abnormal behaviour is produced by some kind of physical imbalance or even damage- did foreshadow aspects of contemporary thought  Persecution of witches- in 13th century, populace was suffering from social unrest and recurrent famines and plagues, causing them to turn to demonology to explain the disasters o Witchcraft (instigated by Satan) was seen as a heresy and a denial of God o The times conspired to heap enormous blame on those regarded as witches, and these unfortunate were persecuted with great zeal --> 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 --> burning was the usual method of driving out the supposed demon  Witchcraft and mental illness- later in the Middle Ages, the mentally ill were generally considered witches o Delusion-like confessions were typically obtained during brutal torture; words were put on the tongues of the tortured by their accusers and by the beliefs of the times o Municipal authorities, gaining power, tended to supplement or take over some of the activities of the church, one of these being the care of the ill  English laws during this period (13th century onwards) allowed both the dangerously insane and the incompetent to be confined in a hospital --> those confined were not described as being possessed  "Lunacy": trials to determine a person's sanity; held in England  Development of Asylums o Confinement of the mentally ill began in earnest in the 15th and 16th centuries o Asylums: refuges established for the confinement and care of the mentally ill; previously leprosariums for those with leprosy o Most asylums took in a mixed lot of disturbed people and beggars o No specific regimen for their inmates other than to get them to work --> during same period, hospitals geared more specifically for the confinement of the mentally ill also emerged o Bedlam: a contraction and popular name for the hospital The Priory of St. Mary of Bethlehem --> became a descriptive term for a place or scene of wild uproar and confusion  Located in London  Conditions of hospital were deplorable o Philippe Pinel (1745-1826) is considered a primary figure in the movement for humanitarian treatment of the mentally ill in asylums --> began to treat patients as sick human beings rather than as beasts  Reserved more humanitarian treatment for the upper classes while patients of the lower classes were still subjected to terror and coercion as a means of control o Moral treatment: sympathetic and attentive treatment provided by Pinel and Tuke o Drugs were the most common treatment and included alcohol, cannabis, opium, and chloral hydrate (knockout drops)  Outcomes were not very favourable as fewer than one third of the patients were discharged as improved or recovered o Moral treatment abandoned in the latter part of the 19th century o Hospitals came to be administered by physicians who were interested in the biological aspects of illness and in the physical, rather than the psychological, well-being of mental patients o Dorothea Dix 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 --> was honoured for her contributions  Asylums in Canada o History in development of the network is a history of the institutionalization of people with serious psychological disorders o The process "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, and hospitals o Strategies employed in Canada during the twentieth century were harsh and few were much more severe and had tragic consequences o Asylums began to get "dangerously overcrowded" and lamented the fact that this overcrowding was responsible for a striking increase in the death list (composed mostly of females) and for the impaired general health of the inmates  Majority of the patients remining in the asylums by the end of the year were "the noisy, the unruly, and the violent" o Currently hear much about the possibility that Canada is developing a two-tier medical system in which the wealthy will have more opportunity for, and quick access to, superior health care o In 1853 the legislature passed the Private Lunatic Asylums Act to accommodate the wealthy in alternatives to the public asylums o The history of the development of institutions for the mentally disordered in Canada can be characterized in terms of 2 distinctive trends:  with the advent of the asylums, provisions for the mentally ill were separate from provisions for the physically ill, indigents, and criminals  the process was segregated from the wider community- "the institution and the community were two separate and distinct solitudes" 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, including compliance with treatment o Provincial Psychiatric Hospital: a facility where chronic patients are treated. Such hospitals provide protection, but treatment is often custodial and may involve little psychosocial treatment  The Begininning of Contemporary Thought o In the west, the death of Galen and the decline of Greco-Roman civilization temporarily ended inquiries into the nature of both physical and mental illness - -> not until late Middle Ages did any new facts begin to appear, discovered thanks to an emerging empirical approach to medical science that gathered knowledge by direct observation o An early system of classification --> Griesinger insisted that any diagnosis of mental disorder specify a biological cause- a clear return to the somatogenic views first espoused by Hippocrates  Kraepelin discerned among mental disorders a tendency for a certain group of symptoms, called a syndrome, to appear together regularly enough to be regarded as having an under-lying physical cause, much as a particular medical disease and its syndrome may be attributed to biological dysfunction --> he regarded each mental illness as distinct from all others, having its own genesis, symptoms, course, and outcome  Kraepelin proposed 2 major groups of sever mental diseases: dementia praecox, an early term for schitzophrenia; and manic- depressive psychosis o General paresis and syphilis --> degenerative changes in the brain cells associated with senile and presenile psychoses and some structural pasthologies that accompany mental retardation were identified  most striking medical success was the discovery of the full nature and origin of syphilis, a venereal disease that had been recognized for several centuries  General paresis: 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: view that disease is caused by infection of the body by minute orgnisms --> developed by Louis Pasteur in the 1860s and 1870s --> lay the groundwork for demonstrating the realtion between syphilis and general paresis o Psychogenesis --> search for somatogenic causes dominated the field of abnormal psychology until well into the 20th century, no doubt partly because of the stunning discoveries made about general paresis  various psychogenic points of view, which attributed mental disorders to psychological malfunctions, were fashionable in France and Austria  Mesmer believed that hysterical disorders were caused by a 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 --> introduced basic hypnosis  Study of 'hypnosis' gradually became respectable through Charcot --> studied hysterical states, including anesthesia (loss of sensation), paralysis, blindness, deafness, convulsive attacks, and gaps in memory -- > interested in the non-physiological interpretations of these very puzzling phenomena  Breuer hypnotized women experiencing hysterical symptoms, cleared them while hypnotized, and felt better when awoken --> found that relief and cure of symptoms seemed to last longer if, under hypnosis, they were able to recall the precipitating event for the symptom and if their original emotion was expressed  Cathartic Method: a therapeutic procedue introduced by Neuer and developed further by Freud i
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