Presentation on theme: "abnormal PSYCHOLOGY Fourth Canadian Edition"— Presentation transcript:
1 abnormal PSYCHOLOGY Fourth Canadian Edition Chapter 1Introduction:Definitional and Historical Considerations, and Canada’s Mental Health SystemPrepared by: Tracy Vaillancourt, Ph.D.Modifed by: Réjeanne Dupuis, M.A.
2 PsychopathologyField concerned with the nature and development of abnormal…BehaviourThoughts or cognitionFeelings or emotionsSource: page 2
3 What is abnormal behaviour? Abnormality usually determined by the presence of several characteristics at one time such as:Statistical infrequencyViolation of normsPersonal distressDisability or dysfunctionUnexpectedness
4 Statistical Infrequency A behaviour that occurs rarely or infrequentlyA 14-year old boy wetting his bed andMental retardation (IQ < 70) occur infrequently, as do most mental disordersDiscussion point: Is statistical infrequency a good enough marker to determine if a behaviour is abnormal?Consider elite athletic abilityConsider the flip side of mental retardation--intellectual giftedness (IQ >130)
5 Violation of NormsA behaviour that defies or goes against social norms; it either threatens or makes anxious those observing itAnti-social behaviour of the psychopath violates social norms and is threatening to othersBut, “violation of norms” needs to be considered in reference to prevailing cultural normsWhat is the norm in one culture may be abnormal in anotherDiscussion point: A prostitute violates social norms but does this mean that she/he would necessarily meet diagnostic criteria for a mental disorder?
6 Personal DistressA behaviour that creates personal suffering, distress or torment in the personThis criterion fits many of the forms of abnormality such as depression but some disorders do not necessarily involve distressPsychopaths are often not distressed by their behaviour although these behaviour clearly impact others in a negative wayHunger and childbirth cause distress, but is this abnormal?
7 Disability or Dysfunction A behaviour that causes impairment in some important area of life, e.g., work, personal relationships, recreational activitiesExamples of exceptions:Being short if you want to be a professional basketball playerTransvestism is not necessarily a disability although it is currently diagnosed as a mental disorder if it distresses the personDiscussion point: Why would transvestism without distress not be considered a disability?Most transvestites are married, lead conventional lives, and usually cross-dress in private.
8 UnexpectednessA surprising or out-of-proportion response to environmental stressors can be considered abnormalFor example, we would expect a person to be sad if they lost a love one to cancer. We would not expect a person to laugh after being sexually assaulted.Other example: An anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the situation.
9 The study and treatment of mental disorders in Canada There are approximately:3,600 practicing psychiatrists13,000 psychologists and psychological associates11,000 nurses specialize in the mental health areaNon-medical practitioners usually work within hospital or agency settings on a salary or in private practicePublic health plan reimbursement of fees-for-service is limited to medical doctorsMost of the primary mental health care is delivered by general practitioners
10 Psychiatrist, psychologist— what’s the difference? Clinical psychologists typically have a Ph.D. or Psy.D. degree, which entails four to seven years of graduate studiesPsychiatrist hold an MD degree and have had postgraduate training, in which they receive supervision in the practice of diagnosing and psychotherapyBecause psychiatrists have an MD degree, they can prescribe psychoactive drugs, whereas psychologists can notFor more details: “FOCUS ON DISCOVERY 1.1: THE MENTAL HEALTH PROFESSIONS”
11 History of Psychopathology “Those who cannot remember the past are condemned to repeat it.”George Santayana, The Life of Reason
12 Pre-scientific Inquiry Mental disorders were believed to be caused by:Events beyond the control of humankind, such as eclipses, earthquakes, storms, fire, diseases were regarded as supernaturalBehaviour that seemed outside individual control was subject to similar interpretationThus, many early philosophers, theologians, and physicians believed that deviant behaviour reflected the displeasure of the gods or possession by demons
13 Early DemonologyDemonology: The doctrine that an evil being, such as the devil, may dwell within a person and control his or her mind and bodyFound in the records of the early Chinese, Egyptians, Babylonians, and GreeksGiven that abnormal behaviour was caused by possession, treatment often involved exorcismRanged from elaborate rites of prayer to flogging and starvation as a way of rendering the body uninhabitable to devils
14 TrepanningInvolved the making of a surgical opening in a living skull by some instrumentTreatment used by Stone Age or Neolithic cave dwellersUsed to treat epilepsy, headaches, and psychological disorders attributed to demonsThought to be introduced into the Americasfrom SiberiaPractice was most common in Peru and Bolivia,3 British-Columbia Aboriginal specimens found
15 Hippocrates (ca. 460–377 B.C)Separated medicine from religion, magic, and superstitionRejected belief that the gods sent physical diseases and mental disturbances as punishmentInsisted that illnesses had natural causes thus should be treated like other illnesses
16 Somatogenesis vs. Psychogenesis Hippocrates is one of the earliest proponents of somatogenesisSomatogenesis (genesis = origin)Mental disorders are caused by aberrant functioning in the soma (i.e., physical body) and this disturbs thought and actionPsychogenesisMental disorders have their origin in psychological malfunctions
17 Hippocrates’ Humoral Physiology Hippocrates’ treatments were different from exorcistic torturesTranquility, proper nutrition, abstinence from sexual activity were prescribed for melancholiaMental health dependent on a delicate balance among four humours, or fluids, of the bodyImbalances and results blood = changeable temperament black bile = melancholia yellow bile = irritability and anxiousness phlegm = sluggish and dullness
18 The Dark Ages and Demonology Churches gained in influence, papacy was declared independent of the stateChristian monasteries replaced physicians as healers and as authorities on mental disorderThe monks cared for and nursed the sickBy praying and touching them with relics orConcocting fantastic potions for them
19 Persecution of Witches During the 13th and the following few centuries, major social unrest and recurrent famines and plaguesPeople turned to demonology to explain disastersLed to an obsession with the devil – ‘witches’ blamed and persecuted1484 Pope Innocent VIII exhorted European clergy to leave no stone unturned in the search for witchesSent 2 Dominican monks to northern Germany as inquisitors who later issued the manual entitled the Malleus MaleficarumUsed to guide witch huntersCame to be seen by Catholics and Protestants as a textbook on witchcraftOver the next several centuries, hundreds of thousands of people accused, tortured, and murdered
20 Witchcraft and Mental Illness Were so-called witches psychotic?Detailed examination of historical period indicates most were not mentally illDelusion-like confessions were obtained during torture
21 Other info. that ‘witches’ not mentally ill From 13th century on in England, hospitals took over churches’ responsibility to tend to the illLaws allowed dangerously insane and incompetent to be confined to hospital and people confined were not described as being possessedEarly 13th century “lunacy” trials held in EnglandTrials conducted to protect the mentally illJudgment of insanity allowed Crown to become guardian of estateDefendant’s orientation, memory, intellect, daily life, and habits were at issue in the trialStrange behaviour were explained as physical illness / injury
22 Development of Asylums Until the end of the 15th century, very few mental hospitals in Europe but England and Scotland had 220 leprosy hospitalsLeprosy gradually disappeared from Europe and attention turned to the mentally illConfinement began in earnest in the 15th-16th centuriesLeprosariums were converted to asylumsAsylums took disturbed people and beggarsHad no specific regimen for their inmates but workDespite the desire to help ‘the mad,’ hospitals tailored for the confinement of the mentally ill also emerged
23 St. Mary of BethlehemFounded in 1243 in London, devoted solely to the confinement of the mentally illConditions were deplorable (bedlam)Eventually became one of London’s great (paid) tourist attractionsViewing the violent patients considered entertainmentDiscussion Point: What might be the effects of such inhuman treatment on the sequela of mental illness?
24 Moral TreatmentPhilippe Pinel (1745–1826) considered primary figure in movement for humanitarian treatment of the mentally ill in asylumsBelieved patients should be treated with dignityPut in charge of a large asylum in Paris known as La BicêtreRemoved the chains of the people imprisonedBegan to treat patients as sick rather than as beastsLight and airy rooms replaced dungeonsWalks around the grounds were allowedResults?Some patients incarcerated for years were discharged
25 Dorothea DixMoral treatment was abandoned in the latter part of the 19th century but Dorothea Dix’s (1802–77) efforts resurrected itBoston schoolteacher who taught a Sunday-school class at the local prisonShocked by deplorable conditions and interest spread to the conditions of patients in mental hospitalsCampaigned vigorously and successfully to improve the lives of people with mental illness
26 Asylums in CanadaNetwork of asylums eventually established in Canada
27 Asylums in Canada Alberta Insane Asylum, Ponoka 1911 British Columbia Public Hospital for the Insane, New Westminster1878British Columbia Mental Hospital, Coquitlam1913ManitobaSelkirk Asylum, Selkirk1886Home for Incurables, Portage-la-Prairie1890Brandon Asylum, Brandon1891New BrunswickProvincial Hospital, Saint John1835Provincial Lunatic Asylum1848Nova ScotiaNova Scotia Hospital for Insane, Halifax1857
28 Asylums in Canada Ontario Provincial Lunatic Asylum, Toronto 1850 Kingston Asylum (Rockwood), Kingston1856London Asylum, London1859Orillia Asylum for Idiots, Orillia1861Hamilton Asylum, Hamilton1876Mimico Branch Asylum, Mimico1890Hospital for Insane, Brockville1894Cobourg Asylum1902Penetanguishene Asylum, Penetanguishene1904Whitby Hospital, Whitby1914Prince Edward IslandThe Prince Edward Island Hospital for the Insane1877
29 Asylums in Canada Quebec Quebec Lunatic Asylum, Beauport 1845 Provincial Lunatic Asylum, St. John’s1861L’Hospice St. Jean de Dieu, Longue Point1856L’Hospice St. Julien, St. Ferdinand d’Halifax1873L’Hospice Ste. Anne, Baie-St. Paul1890Protestant Hospital for the Insane, VerdunSt. Benedict Joseph Asylum, near city of Montreal1885SaskatchewanThe Saskatchewan Provincial Hospital, Battleford1914NewfoundlandAsylum for the Insane, St. John’s1855Northwest TerritoryTaken to asylums of Alberta and SaskatchewanYukonTaken to New Westminster by Royal Northwest Mounted Police1877
30 Beginning of Contemporary Thought In 19th century, return to the somatogenic views first espoused by HippocratesEarly system of classification established
31 Emil Kraepelin (1856–1926)Created a classification system to establish the biological nature of mental illnessesNoticed clustering of symptoms (syndrome) which were presumed to have an underlying physical cause,In fact, mental illness is seen as distinct, with own genesis, symptoms, course, and outcomeProposed two major groups of severe mental diseases:Dementia praecox (early term for schizophrenia)Thought chemical imbalance as the cause of schizophreniaManic-depressive psychosis (now called bipolar disorder)Thought an irregularity in metabolism as the cause of manic-depressive psychosisImportantly, Kraepelin’s early classification scheme became the basis for the present diagnostic categories
32 General Paresis and Syphilis Mid-1800s progress was being made in terms of understanding senile and presenile psychoses and mental retardation from a more biological perspectiveFar more was then discovered about the nature and origin of syphilisGeneral paresis characterized by steady physical and mental deterioration, delusions of grandeur and progressive paralysis from which there was no recoveryDiscovery provides a good example of the increasing use of empirical approaches used to understand mental illness
33 Louis Pasteur Germ theory of disease, established by Pasteur Laid the groundwork for demonstrating the relation between syphilis and general paresisAlso helped establish a causal link between infection, destruction of brain areas, and a form of psychopathologyLight bulb moment: If one type of psychopathology had a biological cause, so could othersResult: Somatogenesis gained credibility and became a dominant theory
34 Psychogenesis Re-visited Somatogenic causes dominated field of abnormal psychology until 20th Century due in large part to discoveries about general paresisbut, psychogenesis was still “in fashion” in countries like France and Austria
35 Current AttitudesMuch progress has been made in terms of understanding the nature, origin, developmental course and treatment of psychological disordersStill, many Canadians are still suspicious of people with mental health issuesThese concerns are reinforced with negative stereotyping and stigmatizationUnfortunate consequence is that many people with mental illness do not seek helpClass discussion point: Have students help you debunk the myths concerning mental illness (see pages 20-21).
36 Mental Health Care in Canada Canada has a universal health care system since 1970Each province / territory is responsible for administrating health careHealth-care re-organisation and funding cuts have led to the closing of long-term psychiatric mental hospitals and beds on psychiatric hospital wardsCommunity services are expected to take over some of these servicesSee Canadian Perspectives 1.2 for more details
37 Historical Perspective of Mental Health Care in Canada The health care system in Canada has not always been stellar in its ethical treatment of patients under its careExamples are:Dr. Cameron’s brainwashing treatment in Montreal in the 1950s and 60sPsychosurgery (e.g., lobotomy) performed out of scientific curiosity, i.e., to see how it would change patientsIn either case, consent was not obtained from patients or familiesLobotomies were banned in all psychiatric hospitals in early 1980sSee Canadian Perspectives 1.3 for more details
38 The Romanow ReportBuilding on Values: The Future of Health Care in Canada (2002)The Romanow Report made 47 recommendationsRomanow called mental health care “the orphan child of medicare” and recommended to make it a prioritySome of the recommendations were:Include some homecare services for case management and intervention servicesDevelop a national drug agencyProvide a emergency drug program to help those with severe mental illnesses (e.g., schizophrenia and bipolar disorder)Establish a program to support informal caregivers (e.g., friends, families) who assist the mentally ill in critical times
39 The Kirby ReportOut of the Shadows at Last: Transforming Mental Health, Mental Illness, and Addiction Services in Canada (The Senate Committee on Social Affairs, Science and Technology, 2006)2 Key recommendations were made:The creation of the Canadian mental health commissionFacilitate a national approach to mental health issuesPromote reform of mental health policies and improvement of servicesEducate Canadians by increasing mental health literacyReduce stima and discrimination of mentally ill individuals and familiesThe creation of the 10-year Mental Health Transition FundProvide affordable housing to the mentally illOffer support to provinces / territories in order to increas services in the community
40 The Future of Psychology The Canadian Psychological Association (CPA) was critical of the Romanow Report as it (1) did not include psychology’s vision and (2) embraced a ‘physical medicine vision’ or somatogenic perspectiveCPA argued that:A plethora of research on the improved effectiveness of pharmacotherapy when combined with psychological treatmentSavings could range as high as 80% of currently dominant treatments, including medicationThe World Health Organization (WHO) and other organizations advocate for (1) the integration of mental health services into primary health care and (2) the collaboration of care tams as the way of the future