week 19 - psychopathology part 1 Flashcards
Identify what the criteria used to distinguish normality from abnormality are.
Depends on the context, it changes as a function of time and culture
In the past, uncommon behaviour or behaviour that deviated from the sociocultural norms and expectations of a specific culture and period has been used as a way to silence or control certain individuals or groups.
As a result, a less cultural relativist view of abnormal behaviour has focused instead on whether behaviour poses a threat to oneself or others or causes so much pain and suffering that it interferes with one’s work responsibilities or with one’s relationships with family and friends.
Understand the difference among the three main etiological theories of mental illness.
Supernatural - Supernatural theories attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin.
Somatogenic - Somatogenic theories identify disturbances in physical functioning resulting from either illness, genetic inheritance, or brain damage or imbalance.
Psychogenic - Psychogenic theories focus on traumatic or stressful experiences, maladaptive learned associations and cognitions, or distorted perceptions.
Etiological theories of mental illness determine the care and treatment mentally ill individuals receive. As we will see below, an individual believed to be possessed by the devil will be viewed and treated differently from an individual believed to be suffering from an excess of yellow bile. Their treatments will also differ, from exorcism to blood-letting. The theories, however, remain the same. They coexist as well as recycle over time.
Describe specific beliefs or events in history that exemplify each of these etiological theories (e.g., hysteria, humorism, witch hunts, asylums, moral treatments).
Trephination is an example of the earliest supernatural explanation for mental illness. Examination of prehistoric skulls and cave art from as early as 6500 BC has identified surgical drilling of holes in skulls to treat head injuries and epilepsy as well as to allow evil spirits trapped within the skull to be released (Restak, 2000).
Around 2700 BC, Chinese medicine’s concept of complementary positive and negative bodily forces (“yin and yang”) attributed mental (and physical) illness to an imbalance between these forces. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential
Mesopotamian and Egyptian papyri from 1900 BC describe women suffering from mental illness resulting from a wandering uterus (later named hysteria by the Greeks): The uterus could become dislodged and attached to parts of the body like the liver or chest cavity, preventing their proper functioning or producing varied and sometimes painful symptoms. As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong smelling substances to guide the uterus back to its proper location (pleasant odours to lure and unpleasant ones to dispel).
Throughout classical antiquity we see a return to supernatural theories of demonic possession or godly displeasure to account for abnormal behaviour that was beyond the person’s control. Temple attendance with religious healing ceremonies and incantations to the gods were employed to assist in the healing process. Hebrews saw madness as punishment from God, so treatment consisted of confessing sins and repenting. Physicians were also believed to be able to comfort and cure madness, however.
Greek physicians rejected supernatural explanations of mental disorders. It was around 400 BC that Hippocrates (460–370 BC) attempted to separate superstition and religion from medicine by systematising the belief that a deficiency in or especially an excess of one of the four essential bodily fluids (i.e., humours)—blood, yellow bile, black bile, and phlegm—was responsible for physical and mental illness.
Hippocrates classified mental illness into one of four categories—epilepsy, mania, melancholia, and brain fever—and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. Mentally ill individuals were cared for at home by family members and the state shared no responsibility for their care. Humorism remained a recurrent somatogenic theory up until the 19th century.
Between the 11th and 15th centuries, supernatural theories of mental disorders again dominated Europe, fueled by natural disasters like plagues and famines that lay people interpreted as brought about by the devil. Superstition, astrology, and alchemy took hold, and common treatments included prayer rites, relic touching, confessions, and atonement.
Modern treatments of mental illness are most associated with the establishment of hospitals and asylums beginning in the 16th century. Such institutions’ mission was to house and confine the mentally ill, the poor, the homeless, the unemployed, and the criminal
Explain the differences in treatment facilities for the mentally ill (e.g., mental hospitals, asylums, community mental health centres).
Modern treatments of mental illness are most associated with the establishment of hospitals and asylums beginning in the 16th century. Such institutions’ mission was to house and confine the mentally ill, the poor, the homeless, the unemployed, and the criminal. War and economic depression produced vast numbers of undesirables and these were separated from society and sent to these institutions.
Most inmates were institutionalised against their will, lived in filth and chained to walls, and were commonly exhibited to the public for a fee. Mental illness was nonetheless viewed somatogenically, so treatments were similar to those for physical illnesses: purges, bleedings, and emetics.
Asylums = mental health jails
Mental hospitals = mental health rehab
Community health centre = group environment, also good
Describe the features of the “moral treatment” approach used by Chiarughi, Pinel, and Tuke.
A therapeutic regimen of improved nutrition, living conditions, and rewards for productive behaviour that has been attributed to Philippe Pinel during the French Revolution, when he released mentally ill patients from their restraints and treated them with compassion and dignity rather than with contempt and denigration.
Is a a form of psychotherapy from the 19th century based on the belief that a person with a mental disorder could be helped by being treated with compassion, kindness, and dignity in a clean, comfortable environment that provided freedom of movement, opportunities for occupational and social activity, and reassuring talks
Describe the reform efforts of Dix and Beers and the outcomes of their work.
When retired school teacher Dorothea Dix discovered the negligence that resulted from such conditions, she advocated for the establishment of state hospitals.
Between 1840 and 1880, she helped establish over 30 mental institutions in the United States and Canada. By the late 19th century, moral treatment had given way to the mental hygiene movement, founded by former patient
Clifford Beers with the publication of his 1908 memoir A Mind That Found Itself. Riding on Pasteur’s breakthrough germ theory of the 1860s and 1870s and especially on the early 20th century discoveries of vaccines for cholera, syphilis, and typhus, the mental hygiene movement reverted to a somatogenic theory of mental illness.
Describe Kräpelin’s classification of mental illness and the current DSM system.
A standardised diagnostic classification system with agreed-upon definitions of psychological disorders creates a shared language among mental-health providers and aids in clinical research.
published a comprehensive system of psychological disorders that centred around a pattern of symptoms (i.e., syndrome) suggestive of an underlying physiological cause. Other clinicians also suggested popular classification systems but the need for a single, shared system paved the way for the American Psychiatric Association’s 1952 publication of the first Diagnostic and Statistical Manual (DSM)
It has gone under many revisions
While the DSM has provided a necessary shared language for clinicians, aided in clinical research, and allowed clinicians to be reimbursed by insurance companies for their services, it is not without criticism. The DSM is based on clinical and research findings from Western culture, primarily the United States. It is also a medicalized categorical classification system that assumes disordered behaviour does not differ in degree but in kind, as opposed to a dimensional classification system that would plot disordered behaviour along a continuum.
DSM-III version that began a multiaxial classification system that took into account the entire individual rather than just the specific problem behaviour. Axes I and II contain the clinical diagnoses, including intellectual disability and personality disorders. Axes III and IV list any relevant medical conditions or psychosocial or environmental stressors, respectively. Axis V provides a global assessment of the individual’s level of functioning. The most recent version — the DSM-5– has combined the first three axes and removed the last two.
animism
The belief that everyone and everything had a “soul” and that mental illness was due to animistic causes, for example, evil spirits controlling an individual and their behaviour.
asylum
A place of refuge or safety established to confine and care for the mentally ill forerunners of the mental hospital or psychiatric facility.
biopsychosocial model
A model in which the interaction of biological, psychological, and sociocultural factors is seen as influencing the development of the individual.
Cathartic method
A therapeutic procedure introduced by Breuer and developed further by Freud in the late 19th century
a patient gains insight and emotional relief from recalling and reliving traumatic events.
cultural relativism
Cultural relativism - The idea that cultural norms and values of a society can only be understood on their own terms or in their own context.
etiology
The causal description of all of the factors that contribute to the development of a disorder or illness.
humorism
Humorism (or humoralism) - A belief held by ancient Greek and Roman physicians (and until the 19th century) that an excess or deficiency in any of the four bodily fluids, or humours—blood, black bile, yellow bile, and phlegm—directly affected their health and temperament.
hysteria
Term used by the ancient Greeks and Egyptians to describe a disorder believed to be caused by a woman’s uterus wandering throughout the body and interfering with other organs (today referred to as conversion disorder, in which psychological problems are expressed in physical form).
maladaptive
Term refers to behaviours that cause people who have them physical or emotional harm, prevent them from functioning in daily life, and/or indicate that they have lost touch with reality and/or cannot control their thoughts and behaviour (also called dysfunctional).
mesmerism
Derived from Franz Anton Mesmer in the late 18th century, an early version of hypnotism in which Mesmer claimed that hysterical symptoms could be treated through animal magnetism emanating from Mesmer’s body and permeating the universe (and later through magnets); later explained in terms of high suggestibility in individuals.
psychogenesis
Developing from psychological origins.
