History & The Present: Treating Mental Illness m Lobotomy: Lk Lk

Trephining Earliest human societies – Neolithic Period (7000BP) Europe – 5000BC Asia (Palestine) – 6000BC High concentrations in Peru and Bolivia, but seen across the world independently

Kashmir, India Female 26-30yrs Roughly 2000BC

WHY?WHY? “Release of evil spirits” = conjectural Biological reasons = headaches, fractures, infections, insanity, convulsions Other reasons = acquire rondelles, or the circular shaped bones from skull used for charms and other jewelry

Overall… Astonishingly widespread across time and space Done in presence and absence of head trauma Living and the dead Men, women, children Only a small percentage of discovered human skulls are trephined In some, trephining was incomplete, as if abandoned mid-procedure Still done today! – parts of Africa, South America, and Melanesia

Hippocrates – Father of Medicine BC All disorders (mental/physical) are caused by natural forces All things made from earth (black bile), water (phlegm), air (yellow bile), and fire (blood) –When out of balance = ill Discovered “hysteria” Brain was responsible for emotions and perceptions

Galen ( AD) 1 st anatomist Believed diseases were contained within organs Physician of the gladiators! Relied on experimental, observational results & logic/reason Developed method for measuring fevers – monitoring pulse Discovered function of nerves Mapped out the spinal cord and various levels of paralysis

Europe – Middle Ages Almost NO advances in understanding of mental illness Back to bodily fluids, demons & spirits Likely forced to see a priest and given an exorcism—beatings, starvings, forced eating of substances (blood, sheep dung) –To agitate the spirit and force it to leave Ostracized Executed

Christian churches built monasteries and poorhouses for the poor; allowed in the mentally ill Eventually became known as “asylums” Most famous is St. Mary of Bethlehem in London (1247)… –Called the habitants “lunatics” –Housing known as a “bedlam”

Witchcraft

Dorthea Dix & Philippe Pinel 18 th century Fought for improvements in humane treatment of those with mental illnesses All people should be treated with dignity

DRUGS! –1950s Drugs = Deinstitutionalization Unanticipated results = homeless population increases, some formerly in mental hospitals end up in jail

The Present

David Rosenhan 1970s 12 normal people faked auditory hallucinations –“empty, hollow, thud” Upon entrance, said they no longer heard the voices Avg 7 minutes of contact a day with staff –NOT therapeutic

Paul and Lentz Social-Learning Theory Staff interacts more with patients, in respectful ways, NOT using standard therapy Reduce use of antipsychotics Therapy’s goal was to teach social skills 5 year study 97% were later discharged (46% of control)

Clinical Assessment Interviews Objective Questionnaires: –MMPI Project Tests: –Rorschach, TAT, etc. Behavioral monitoring –YOU can do this one… Brain Measurement –EEG, PET scans

Psychodynamic Therapies Distress stems from “unconscious mental conflicts” so we must uncover these to induce recovery Free association Dream analysis Slips of the tongue Transference –Projection of feelings onto the therapist Insight Resistance: –unconscious avoidance of painful areas

Humanistic Carl Rogers client- centered therapy –Active listening / echoing –Genuineness, acceptance, empathy Gestalt Therapy – Fritz Perls –Integrate all actions, feelings, & thoughts into a harmonious whole Existential Therapy –Subjective meanings

Behavior Therapy Systematic Desensitization (C.C.) Token Economies (O.C) Modeling: Bandura Implosive Therapy / Flooding –Elevator lady Counter Conditioning –Associate bad stimulus w/ good reinforcement –Afraid of Dentists? Why do you think they hand out candy when you’re done!!?? Aversive Therapy (aka Reconditioning) –Replace good response to harmful stimulus with a bad response –Antabuse

Cognitive Therapy Albert Ellis’s Rational Emotive Therapy (RET) –Challenge irrational/illogical thought processes –Client: “Life is perfect.” Therapist: “no, it’s not.” –ABC A = activating event B = irrational belief C = emotional consequence Aaron Beck’s Stress- Innoculation –Same, but train client to think, analyze own thoughts Beck’s Cognitive Triad –Ppl’s belief about: Self World Future –Ppl w/depression have irrational neg beliefs in these 3 areas

Group & Family GROUP: Comforting to Know that others have similar problems Develops listening skills Empathy, not sympathy Ex: AA, Fight Club FAMILY: Problems are INTERPERSONAL “No man is an island.” Develops listening skills Relationship Triangles –Enmeshment –Distance/diffusion

Biological Treatments (Besides Drugs) Shock Therapy – ECT Lobotomy –Prefrontal: Sever connection btwn frontal lobe and thalmus/hypothalamus –Transorbital: knife inserted abovve eyeball to cut random brain fibers –A.E. Moniz 1930 Nobel Prize for discovery of this procedure –10,000+ done…NOT BENEFICIAL AT ALL Cingulotomy

Effectiveness across types of problems Cognitive- Behavioral Psychodyna mic Cognitiv e Humanisti c Behavior al

No One Theory is Perfect… ProblemFirst Choice Therapy Anxiety/FearCognitive/Behavioral, Cognitive Social BehaviorCognitive/Behavioral AddictionPsychodynamic Work/School Achievement Psychodynamic Self-EsteemHumanistic