Week 1 Chapter 1 Intro & Historical Overview CF Flashcards Preview

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Define Stigma

The destructive beliefs & attitudes held by a society that are ascribed to groups considered different in some manner, such as people with mental illness

1

What are the four characteristics of a stigma?

1. A label as applied to a group of people that distinguishes them from others (e.g. Crazy)
2. The label is linked to deviant or undesirable attitudes by society (e.g. Crazy people are dangerous)
3. People with the label are seen as essentially different from those without the label, contributing to an "us" & "them" mentality (e.g., we are not like those crazy people)
4. People with the label are discriminated against unfairly (e.g. A clinic for crazy people can't be built in our neighbourhood)

2

What is the Study of Psychopathology concerned with?

The Study of Psychopathology is concerned with the nature, development & treatment of mental disorders.

3

What are the arenas that need to address the stigma of Mental Illness (As proposed by Stephen Hinshaw in 2007)?

*Policy & Legislation including Employment, Decriminalisation, Discriminatory Laws & Insurance laws
*Community Strategies, including Housing, Education and personal contact
*Mental Health & Health Profession Strategies including, Mental Health Evaluations, Education & Training,
Individual & Family Strategies, including: Education for individuals and families, and support & advocacy groups

4

What are the characteristics essential to the concept of a Mental Disorder according to the DSM-IV-TR & DSM-V?

*A mental disorder occurs within the individual
*It Causes personal distress or disability
*It is not a culturally specific reaction to an event (e.g. death of a loved one)
*It is not primarily a result of social deviance or conflict within society

5

What are the main points to consider in relation to the personal distress caused by the presence of a mental disorder?

*A person's behaviour may be classified as disordered if it causes him or her great distress
*Personal distress characterises many forms of mental disorder
*Not all mental disorder causes distress
e.g. anti-social personality disorder
*Not are behaviour that causes distress is disordered (e.g. hunger or the pain of childbirth)

6

What are the main points to consider in relation to the sense of disability caused by the presence of a mental disorder?

*Disability is the impairment in some important area of life (e.g., work, or personal relationships)
*Disability can also characterise mental disorder e.g. being rejected by peers, or substance use disorders can be socially or occupationally disabling
*Like distress however, disability alone cannot be used to define mental disorder: as not all disabilities are related to mental disorder and not all mental disorders include disablement - e.g. bulimia nervosa doesn't always involve disablement.

7

Define Social Norms

Social norms are widely held standards, beliefs, & attitudes that people use consciously or intuitively to make judgements about where behaviours are situated on such scales as good-bad, right-wrong, justified-unjustified, and acceptable-unacceptable

8

What are the main points to consider in relation to the violation of Social Norms caused by the presence of a mental disorder?

*Behaviour that violates Social Norms might be classified as Disordered
e.g. repetitive rituals of OCD,
*Not all violations of Social Norms fits into psychopathology however.
e.g. some criminal behaviour, extreme tattooing
*It is essential to remember that what is socially acceptable or in violation changes dependent on the cultural and ethnic context being considered.

9

There are two main attempts to define 'harmful dysfunction' what is the definition put forward by Wakefield?

Wakefield's definition has 2 parts: a value judgement (harmful) and an objective, scientific component - the dysfunction
*A judgement that a behaviour is harmful requires some standard, dependent on social norms.
*Dysfunctions are said to occur when an internal mechanism is unable to perform its natural function (the function it evolved to perform).

10

There are two main attempts to define 'harmful dysfunction' what is the main criticism of the definition put forward by Wakefield?

The main difficulty with Wakefield's theory is that the internal mechanisms involved in mental disorders are largely unknown; thus, we cannot say exactly what may not be functioning adequately.
*Wakefield countered this by referring to "plausible" rather than proven dysfunctions
*However, Wakefield's definition still requires we are judging a behaviour as harmful & then stating it represents a mental disorder because we BELIEVE it is caused by a dysfunctional internal system
*Like all definitions of mental disorder, Wakefield's has its limitations
*Page 7 - not - not much of a definition :-)

11

There are two main attempts to define 'harmful dysfunction', in order to address the criticism of Wakefield's definition, what is the definition put forward by the DSM?

The DSM definition of dysfunction refers to the fact that behavioural, psychological, and biological dysfunctions are all interrelated and effect each other.

12

What, in a nutshell, where the stages of the historical treatment of Psychopathology?

*Early Demonology
*Hippocrates
*The Dark Ages, return to Demonology including witch trials and lunacy trials
*Development of Asylums - Bethlehem,
*Pinel's reforms
*Development of Moral Treatment

13

What were the main beliefs involved in Early Demonology?

*Many Early philosophers, theologians, and physicians who studied the troubled mind believed that disturbed behaviour reflected the displeasure of the gods or possession by demons
*Demonology is the belief that an evil spirit can dwell within a person and control his or her body
*Exorcism was used to treat the odd behaviour, achieved by the ritualistic casting out of evil spirits

14

What was Hippocrates (5th century BC) belief system and how did it change the treatment of mental disorders?

*Hippocrates separated medicine from religion, magic, and superstition
*Hippocrates insisted that mental disturbances have natural causes and should be treated like other illnesses
*Hippocrates believed the brain as the organ of intellect & consciousness so thought that disordered thinking & behaviour was an indication of brain pathology
*Hippocrates classified mental disorders as: Mania, Melancholia, & Phrentis/brain fever
*Hippocrates work foreshadowed many aspects of contemporary thought

15

The Dark Ages & a return to Demonology were thought to coincide with the death of Galen (AD 130-200), regarded as the last great physician of the classical era. What were the main treatments for mental disorders in the Dark Ages?

*Churches gained influence again, monks cared for those with mental disorders, by praying over them and touching them with relics, gaining them potions to drink in the waning phase of the moon.
*During this period there was a return to the belief in the supernatural
*Demonology was used to explain a number of plagues and natural disasters. Witchcraft was seen as instigated by Satan, thus as heresy, witchcraft trials were held in vast number with more healthy than ill people tried
*Lunacy trials were also held: a judgement of insanity allowed the Crown to become guardian of the 'lunatic's' estate. "Holy Trinity Hospital" in Salisbury, England kept the "mad safe"

16

As Leprosy disappeared from Europe in the 15th Century, Leprosariums were converted into Asylums, refugees for the confinement and care of people with mental illness. St. Mary's of Bethlehem, known as 'Bedlam' was one of the most well-known.
What were the conditions like?

*The conditions were deplorable. 'Bedlam' came to mean a place or scene of wild uproar & confusion.
*Viewing patients was a more popular tourist attraction than visiting the Tower of London or Westminster Abbey
*Medical treatments were crude & painful: Benjamin Rush believed in bleeding people or scaring them by telling them they would die as treatments

17

Philippe Pinel (1745-1826) was credited for major reform. Jean-Baptiste Pussin (a former patient) actually began the changes in the treatment of people housed in asylums.
What were the main changes Pussin and Pinel brought about?

*The chains of the imprisoned people in La Bicetre were removed
*Patients were treated as human beings rather than animals
*as a result people were treated with compassion, dignity, and respect
*Dungeons were replaced by light and airy rooms
*Patients were allowed to walk around the grounds
*Many eventually recovered and were released
*However, some of the lower class patients continued to be treated poorly: straitjackets replaced chains; and they were treated with terror and coercion

18

What are the main characteristics of Moral Treatment with regards to the treatment of mental illness?

*Private hospitals were set up to provide humane treatment for people with mental disorder in the 1800's in the USA
*Patients had close contact with attendants, were engaged in purposeful activity, patients lives resembled 'regular life' as far as possible, and were encouraged to take self-responsibility wherever possible

19

What was the main problem with the development of public hospitals set up by Dorothea Dix (1802-1887) which attempted to emulate the Moral Treatment approach to the treatment of mental illness?

*Despite campaigning vigorously to improve the lives of people with mental disorders, insufficient funding, staffing and a focus on the biological causes of mental illness led to these institutions being unable to care for people using the Moral Treatment approach and focus was instead on patients physical rather than psychological health

20

What was so interesting about the Bethlehem Physician (1810), William Black's, hypothesis of the causes of the patients maladies?

That about half were presumed to have biological causes (e.g. fever, hereditary, venereal) and half were thought to have a psychological basis (e.g. grief, love, jealousy). Only about 10% of the illnesses were attributed to spiritual causes

21

What led to biological causes for psychopathology gaining credibility in 1905?

The specific micro-organism that causes syphilis was discovered, establishing a causal link between infection, destruction of certain areas of the brain, & a form of psychopathology (general paresis).
Prior to this discovery the anatomy & workings of the nervous system were only partially understood & not enough was known to conclude that structural brain abnormalities caused various mental disorders.

22

The Eugenics movement played a huge role in the stigmatisation of mental disorder. What was the implication of state laws passed in the USA in the late 1800's & early 1900's?

The laws prevented people with mental illness from marrying & forced them to be sterilised in order to prevent them from passing on their illness. It wasn't until the middle of the 20th century that these abhorrent practices were halted.

23

What were the three main biologically based radical experiments that were practised in early 20th century mental hospitals?

*Insulin-induced coma to treat people with schizophrenia (Sakel, 1938)
*ECT to treat schizophrenia & major depression (Ugo Cerletti & Lucino Bini, 1938)
*Pre-frontal lobotomy (Moniz, 1936)

24

What were the main psychological approaches to treating mental illness that developed from the late 18th century approach, which attributed mental disorders to psychological malfunctions?

*Mesmer & Charot developed hypnosis
*Breuer developed the cathartic method (on Anna O, which didn't actually work it seems)
*Freud developed Psychoanalytic theory after working with Breuer in the treatment of Anna O

25

Freud developed psychoanalysis, an influential treatment for mental illness. Provide a brief summary of Freud's view of the 'structure of the mind'

The mind or psyche consists of 3 principle areas:
*id = unconscious & holds energy for all basic needs - the energy is called libido (sex, food, elimination, affection). The id seeks immediate gratification
*ego = largely conscious & mediates between the demands of reality & the id's needs for gratification
*superego = a person's conscience.

26

Freud conceived of eight defence mechanisms used by the ego to protect itself from anxiety. What are the defence mechanisms?

*Repression
*Denial
*Projection
*Displacement
*Reaction Formation
*Regression
*Rationalisation
*Sublimination

27

What are the goals of a therapist practising Freud's psychoanalytic theory?

The goal of the therapist is to understand the persons early childhood experiences, the nature of key relationships, and the patterns in current relationships in order to identify recurrent themes/patterns.
The therapist may use free association, interpretation and the analysis of transference to achieve this goal (where transference is the patients response to the analyst that seems to reflect attitudes & ways of behaving toward important people in the patient's past, rather than reflecting actual aspects of the analyst-patient relationship

28

Freud also conceived of the personality developing through a series of psycho-sexual stages, as at each stage, a different part of the body is the most sensitive to sexual excitation & therefore, the most capable of satisfying the id.
Name the stages in Freud's model

*The Oral Stage (birth-18 months)
pleasure: feeding, sucking, biting - lips, mouth, gums, tongue

*The Anal Stage (18 months - 3 years)
pleasure: passing & retaining faeces

*The Phallic Stage (3 years - 5/6 years)
pleasure: genital stimulation

*Latency period (6-12 years) The id is not major motivator during this period

*The Genital stage (Puberty)
heterosexual interests predominate

29

Who are the main Neo-Freudian analysts?

Carl Jung & Alfred Adler