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Chapter 1

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PSYC 3140
James Alcock

Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System The Dark ages and Demonology  The death of Galen (130-200 A.D), the second century Greek and the last major physician of the classical era, marked the beginning of the Dark Ages for Western European medicine and for the treatment and investigation of abnormal behavior.  Churches gained influence during this time and through their missionary and educational work, they replaced physicians as healers and authorities on mental disorder.  Monks cared and nursed the sick by:  Praying over them  Touched them with relics  Concocted fantastic potions for them to drink in the waning phase of the moon The Persecution of Witches  Hundreds of thousands of men, women, and children were accused, tortured and put to death if they were believed to be witches  In 1484, Pope Innocent v||| exhorted the clergy of Europe to extensively search for witches. He sent two Dominican monks to northern Germany as inquisitors  Two years later they issued a comprehensive and explicit manual, “Malleus Maleficarum” (“The Witches’ hammer”) Witchcraft and Mental Illness  In the middle ages the mentally ill were generally considered witches  Witches were believed to be psychotic because in their confessions they were accused of having intercourse with the devil – this has been interpreted by some writers as delusions and hallucinations  Detailed examination of this historical period indicated that many of the accused were not mentally ill  Careful analyses of the witch hunts reveal that many more sane than insane people were tried  The delusion like confessions were typically obtained during brutal torture; words were pit on the tongues of the tortured by their accusers and by the beliefs of the times  In England, where torture was not allowed, the confessions did not usually contain descriptions indicative of delusions or hallucinations  From the thirteenth century on, as the cities of Europe grew larger, hospitals began to come under secular jurisdiction. It was a place where “the mad were kept safe until they are restored of reason”  English laws during this period allowed both the dangerously insane and the incompetent to be confined in a hospital Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System  Those that were confined were not described as being possessed  In the beginning of the thirteenth century “lunacy” trails to determine a person’s sanity were held in England  The trials were conducted under the Crowns right to protect the mentally impaired  Judgment of insanity allowed the Crown to become guardian of the lunatics estate  The defendants orientation, memory, intellect, daily life, and habits were at the issue in the trial  Strange behavior was linked to emotional shock or physical illness  Only one case was referred to demonological possession indicating that the explanation of mental disturbances was not as dominant during the middle ages as was one thought Development of Asylums  In the twelfth century England and Scotland had 220 leprosy hospitals for a population of 1.5 million  As leprosy started to disappear from Europe attention seemed to have turned to the mad  Confinement of the mentally ill began in earnest in the fifteenth and sixteenth centuries  Leprosarium’s were converted to asylum  Asylums: refuges established in the confinement and care of the mentally ill  Many took in a mixed lot of disturbed people and beggars  Beggars were regarded as a great social problem as 1/3 or Paris population consisted of beggars Bethlehem and other early Asylums  The priory of St. Mary of Bethlehem was founded in 1243  In 1547 it was handed over to the City of London and then to a hospital devoted only the mentally ill  Bedlam: a contraction and popular name for the hospital Bethlehem, where conditions were deplorable  Became a descriptive term for a place or scene of wild uproar and confusion  It eventually became one of London’s great tourist attractions  The Lunatics Tower constructed in Vienna in 1784 was also a tourist attraction where patients were confined in the spaces between inner square rooms and the outer walls  Just because the mentally ill were put in hospitals did not mean that they were receiving better treatment. Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System  Medical treatments were crude and painful  Benjamin Rush (1754-1813): began practicing medicine in Philadelphia, in 1769, is considered the father of American psychiatry  He believed that mental disorder is caused an excess of blood in the brain  Therefore his treatments included drawing great quantities of blood  Believed that many “lunatics” could be cured by being frightened Moral Treatment  Philippe Pinal (1745-1826):considered a primary figure in the movement for humanitarian treatment of the mentally ill in asylums o In 1793, during the French Revolution, he was in charge of a large asylum in Paris named “La Bicetre”  He removed chains off the people imprisoned there, there was an adopted practice from Jean-Baptise Pussin o Began to treat patients as sick human beings rather than beasts because he believed that patients were normal people who should be treated with compassion, understanding, and dignity  He believed that if these people had severe personal and social problems then this can only be restored to them by comfort counsel and purposeful activity o The mentally sick became more calmer and much easier to handle  They were allowed to walk around the hospital grounds without disturbing or harming others  Some who had been imprisoned for a very long time were eventually discharged o However he was not a complete paragon of enlightenment and egalitarianism  More humanitarian treatment was reserved for upper class and patients of lower class were still subjected to terror and coercion as a means of control  In 1796 the York Retreat, an asylum in England, was established on a country estate. This was done by Tuke o This provided the mentally ill with a quiet and religious atmosphere in which they could live, work, and rest  In 1817, founded in Pennsylvania, the Friends’ Asylum and the Hartford Retreat established in 1824 in Connectuit, were patterned after the York Retreat o This influenced other US hospitals to become like that too  Moral Treatment: patients had close contact with the attendants who talked and read to them and encouraged them to engage in purposeful activity o Residents led as normal lives as possible and in general took responsibility for themselves within the constraints of their disorder  Despite the emphasis on moral treatment in the early nineteenth century, drugs were also used frequently in mental hospitals Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System o Two findings were from a detailed case recording of the York Retreat from 1880 to 1884 o Drugs were the most common treatment and included alcohol, cannabis, opium, and chloral hydrate o The outcomes were not always favorable; fewer than one third of the patients were discharged as improved or recovered  Dorothea Dix (1802-1877): Boston school teacher that taught a Sunday school class at a local prison(In Toronto), was shocked at the conditions in which the intimates lived and the conditions suffered by the “insane” in the Quebec Lunatic Asylum o Her interest spread to people who had nowhere to go for treatment, the mentally ill, and patients in private mental hospitals o Campaigned vigorously to improve the lot of people with mental illnesses  Helped see that 32 state hospitals were built to take in the many patients whom the private ones could not accommodate o On Jan 21, 1850 she presented a compelling “memorial prayer” on behalf of the mentally ill to the Nova Scotia legislature and requested construction of a public mental hospital  Unfortunately state hospital members were not able to provide the individual attention that was needed for moral treatment o Hospitals were administered by physicians who were more interested in the biological aspect of illness and in the physical rather than the psychological well-being of mental patients o Money that was once used for salaries was now used for equipment and laboratories  There were attempts to apply moral treatment in certain areas of Canada however this was undermined by the political and economic decisions of those in power o Premier Arthur Sifton was more interested in focusing on larger institutions were patients were crowded into buildings with inadequate space rather than on moral treatment  Dr. Henry Hunt Stab: put a lot of effort to institute moral treatment at the Lunatic Asylum in St. Johns, Newfoundland o He presided at this site until his death in 1892 o His efforts were hindered by inadequate financial resources and more patients than the hospital could actually 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 o Recommended stringent discipline and harsh treatments, including flogging  Sussman 1998: argued that the development of services for the mentally ill in Canada and B.N.A was largely ad hoc, with little cross-fertilization of ideas from province to province Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System o From the 1840s-1880s when most formal asylums were first established, all of the jurisdictions could be characterized as having a need to develop separate facilities with better conditions for the mentally ill  Hotel-Dieu, established in Quebec city in 1714 by Duchess d’Aiguillon o Cared for indigents and crippled people in addition to “idiots” o Similar “hospitals” were built in other parts of Quebec using a system where the Ling of France paid religious order of the French Roman Catholic Church to care for the mentally ill  In 1763, following the Treaty of Paris the English assumed power over the area, and although this practice continued there was a difference in the funding, practice, and management between Quebec and the rest of Canada  Alberta was the last province to open up an asylum for the insane in Canada which meant that the mentally did not need to be transported from Alberta to Manitoba by the Royal North West Mounted Police (1911)  Typically asylum superintendents were British-trained physicians who modeled the asylums after British forms of structure, treatment, and administration o However they functioned differently and reflected very different norms of social governance  In upper Canada power remained with the asylum doctor  It was reported that both the Chief Asylum and the University Branch (a smaller asylum near the University of Toronto) were “dangerously overcrowded” o This overcrowding was responsible for a striking increase in the death list (mostly females), and for the impaired general health of the intimates  The average cost of caring for each patient to the province in 1864 was $152.88  The discharge rate in 1841 was believed to be 52%, almost 20% died while in the institution: a larger 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 system o The Homewood Retreat, a profit-orientated, independent, private asylum was established in 1883 at Guelph Ontario o Dr. Lett was the first medical superintendent of this place and he always encouraged his staff to employ the principles of moral therapy in order to provide symptomatic relief to his wealthy charges  History of development of institutions for the mentally disordered in Canada can be characterized in terms of two distinctive trends: o 1. With the advent of the asylums, provisions for the mentally ill were separate from the provisions for the physically ill, indigents, and criminals o 2. The process was segregated from the wider community – “The institution and the community were two separate and distinct solitudes” Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System The Mental Hospital in Canada: the Twentieth Century and Into the New Millennium  Human motives stimulated the institutional building period in Canada, however the results of the twentieth century were not very positive o Mental hospitals became overcrowded o Individual treatment was unavailable with the exception of some radical treatments and psychoactive drugs that were available  Drugs became central means of treatment  Deinstitutionalization occurred because of concerns about the restrictive nature of confinement in a mental hospital o Canada wanted to shift the care from psychiatric hospitals into the community o Bed capacity in mental hospitals went from 50,000 to 15,000 between 1960 and 1976  At the same time general hospital psychiatric units increased from fewer than 1,000 to almost 6,000 o There were many budget cuts. Community mental health programs allocated only about 3% of provincial mental health budgets o This had been tempered by the fact that many discharged people led lives of poverty in the community with a significant number included among the homeless and the prison population  Patients are kept in a protected environment, but receive little individual psychosocial treatment  Provincial psychiatric hospitals: A faculty where chronic patients are treated. Such hospitals provide protection, but treatment is often custodial and may involve little psychosocial treatment o Remain old, grim, and somewhat removed from major metropolitan centers o These are far superior to the majority of “state” mental hospitals in the US  A prison or a forensic hospital is sometimes the name given to specialized mental hospitals that are reserved for those people who go to jail but cannot go on trials because they “are not criminally responsible on account of mental disorder” o Treatment for them is supposed to occur during this time o There are three in Canada: In Ontario, Quebec, and British Columbia  Gordon Paul and his co-workers confirmed that o For 80-90% of patients waking hours they had no contact with staff o Clinical staff spent less than a one quarter of their working time in contact with patients o Except the severely disturbed patients, there was an opportunity for patients to have access to facilities such as swimming pool, and gymnasium o Some patients has a few sessions alone with a professional therapist and most were required to attend group therapy Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System o Traditional hospital treatment oriented on giving drugs rather than offering psychotherapy  One problem with that the patients in the mental hospitals had was that someone of them had become accustomed to living there and the care they received o It was as frightening for them to leave as it would have been for someone who has never lived there to live there  In Canada there is a current emphasis on reducing the number of beds in psychiatric hospitals o It is suggested that there could be as few as 7 beds per 100, 000 people  The role of provincial psychiatric hospitals is that o “they will provide specialized treatment and rehabilitation services for individuals whose needs for care are too complex to be managed in the community” (Goering et al. 2000)  Canadian Institute for Health Information (CIHI): o Canadians who left hospitals with a mental illness diagnosis in 2003-04 had stayed over 6.6 million days  The majority (57.8%) were spent in psychiatric hospitals where the length of stay for most patients (72.8%) was between one month and one year o Nowadays the average stay is more than 100 days o Usually the most severe cases receive hospitalization  Schizophrenia, psychotic, and mood disorders made up over half of the 192,562 departures from both psychiatric and general hospitals in 2003-04  On march 31, 2009 Ontario officially closed its institutions for the mentally disabled o At one point in the early 1960s there were over 7000 people in 16 institutions, many of them children  In 2008 the Psychiatric Patient Advocate Office celebrated 25 years of progress in mental health advocacy and rights protection  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  The Centre for Addiction and Mental Health (CAMH) in Toronto has embarked on a 12 year project to integrate the mentally ill into society that is intended to serve as a model for Canada and the rest of the world The Beginning of Contemporary Thought  Galen believed that the human physiology was like one of an apes but Vesalius believed he was wrong o After more than a thousand years with the autopsy study of humans it was finally proven wrong Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System o Further progress came from the efforts of the English physician Thomas Sydenham, who was partially 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: German physician who was impressed by Sydenham’s approach o Insisted that any diagnosis of mental disorder specify a biological cause (like the somatic views espoused by Hippocrates  Emil Kraepelin (1856-1926): Griesingers well known follower o He wrote a textbook that was first published in 1883, that furnished a classification system in order to establish the biological nature of mental illnesses o Syndrome: a group or pattern of symptoms that tend to occur together in a particular disease  Has an underlying physical cause o Believed that mental illnesses had their own genesis, symptoms, course, and outcome  Even though cures had not been worked out, at least the course of the disease could be protected o Proposed two major groups of severe mental diseases  1. Dementia praecox, an early term for schizophrenia  Chemical imbalance  2. Maniac-depressive psychosis, (now called bipolar disorder)  Irregularity in metabolism General Paresis and Syphilis  Work of the nervous system was understood somewhat by the mid-1800s  Degenerative changes in the brain cells associated with senile and presenile psychoses and some structural pathologies that accompany mental retardation were identified  Syphilis: a venereal disease that had been recognized for several centuries  General paresis: mental illness characterized paralysis and “insanity” that typically led to death within 5 years. Now known to be caused by syphilis of the brain o Established in 1857  Germ theory of disease: the general view in medicine that disease is caused by infection of the body by minute organisms and viruses o Established by Lois Pasteur in the 1860s and 1870s o Laid the ground work for demonstrating the relation between syphilis and general paresis o In 1905 the specific micro-organism that causes syphilis was discovered Psychogenesis Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System  Search for somatogenic causes dominated the field of abnormal psychology until well into the twentieth century  From the late eighteenth to the nineteenth century some investigators believed that mental illnesses had an entirely different origin Mesmer and Charcot  Franz Anton Mesmer: an Australian physician believed that hysterical disorders were caused by a particular distribution of universal magnetic fluid in the body o Believed that one person could influence the fluid of another to bring about a change in the others behavior o Conducted an experiment where patients sat around a covered tub that had bottles in it that contained various chemicals. Iron rods were sticking out of the bottles and through the covers. Mesmer would touch the afflicted part of the patient’s body with the rod. Rods were believed to transmit animal magnetism and adjust the distribution of the universal magnetic field. Also this theory is questionable today, it believed to have cured many people o “mesmerize” is an older term for “hypnotize”  Jean Martin Charcot: Parisian neurologist o Studied hysterical states, anesthesia (loss of sensation), paralysis, blindness, deafness, convulsive attacks, and gaps in memory o His students hypnotized a woman and he believed that she was suffering from hysteria  When his students woke the patient up and she was normal, he became very interested in this phenomenon Breuer and the Cathartic Method  Josef Breuer (1842-1925) o Established the Cathartic method: 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 o Published Studies in Hysteria – considered a milestone in abnormal psychology The Lesson of History: a view from the Twenty-First Century  Dr. Ewen Cameron: Montreal psychiatrist was the head of the Allan Menorial Institute at McGill University in the 1950s and early 1960s o In 1955 he initiated a nine-year series of experiments on unsuspecting psychiatric patients to find a “cure” Chapter 1: Introduction: Definitional and Historical Considerations, and Canada’s Mental Health System  These patients nor their family members gave any consent to the treatments that were beyond acceptable in the era  His quest led to a bizarre theory of “beneficial brainwashing” and was used on some patients that only had a mild problem when they first came to the institute  It was discovered many years later that these experiments were funded by the U.S Central Intelligence Agency and the deferral government of Canada  It was believed that these brainwashing strategies were used on “enemies: during the Cold war o He administered massive doses of hallucinogenic drugs such as LSD, repeated courses of electroconvulsive therapy (ETC) or shock treatment, often three times a day, while patients were kept in a drug-induced coma, for three months  While these patients were in drug-induced states he would use psychic driving by saying subliminal messages such as “you killed your mother”  These experiments were conducted to wipe away the troubled past of the patients o The role of the CIA was not discovered until 1997. In 1988 the US government settled out of the court for $750,000 with a group of 9 former patients who sued them  In 1992 each patient was paid $100,000 and did not receive an apology  Lobotomy or psychosurgery were used on patients in the past o In this surgical procedure the tracts connecting the frontal lobes to lower centers of the brain are destroyed o This was introduced by Egas Moniz in 1935 after he heard about this being used on two cats  He received a Nobel prize for using this procedure in the treatment of schizophrenia o This procedure was misused in Canada as it was ineffective and harmful and so it was banned  Initially there were high success rates but then people believed that psychiatrics abused their authority  The first operation was in 1944 and the last three were in Ontario in 1981 Current Attitudes toward People with Psychological Disorders  Schizophrenia: a group of psychotic disorders characterized by major disturbances in thought, emotion, and behavior; 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 relationships. The person withdraws from people and reality, often in a fantasy life of delusions and hallucinations. Chapter 1
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