abnormal PSYCHOLOGY Third Canadian Edition Prepared by: Tracy Vaillancourt, Ph.D. Chapter 1 Introduction: Definitional and Historical Considerations

Psychopathology Field concerned with the nature and development of abnormal: –behaviour –thoughts –feelings

What is abnormal behaviour? Abnormality usually determined by the presence of several characteristics at one time such as: –statistical infrequency –violation of norms –personal distress –disability or dysfunction –unexpectedness

Statistical Infrequency Abnormal behaviour occurs infrequently. –For example, mental retardation (IQ < 70) occurs infrequently as do most mental disorders. Discussion point: Is statistical infrequency a good enough marker to determine if a behaviour is abnormal? consider elite athletic ability consider the flip side of mental retardation— intellectual giftedness (IQ >130)

Violation of Norms Abnormal behaviour violates social norms or threatens or makes anxious those observing. –anti-social behaviour of the psychopath violates social norms and makes those observing it anxious –but, “violation of norms” needs to be considered in reference to prevailing cultural norms What is the norm in one culture may be abnormal in another. Discussion point: A prostitute violates social norms but does this mean that she/he would necessarily meet diagnostic criteria for a mental disorder?

Personal Distress Abnormal behaviour creates great distress and torment in the person (personal suffering). –This criterion fits many of the forms of abnormality such as depression but some disorders do not necessarily involve distress. psychopaths are often not affected by their behaviour although their behaviour clearly impacts others in a negative way hunger and childbirth cause distress, but is this abnormal?

Disability or Dysfunction Abnormal behaviour is related to impairment in some important area of life such as work or personal relationships –Exceptions exist such as: being short if you want to be a professional basketball player transvestism is not necessarily a disability although it is currently diagnosed as a mental disorder if it distresses the person. Discussion point: Why would transvestism without distress not be considered a disability? –Most transvestites are married, lead conventional lives, and usually cross-dress in private.

Unexpectedness Unexpected responses to environmental stressors can be considered abnormal behaviour. –For 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.

The study and treatment of mental disorders in Canada There are approximately: –3,600 practising psychiatrists, –13,000 psychologists and psychological associates –11,000 nurses specialize in the mental health area. Non-medical practitioners usually work within hospital or agency settings on a salary or in private practice. Public health plan reimbursement of fees-for-service is limited to medical doctors. Most of the primary mental health care is delivered by general practitioners.

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. Psychiatrist hold an MD degree and have had postgraduate training (residency), in which they receive supervision in the practice of diagnosis and psychotherapy. Because psychiatrists have an MD degree they can prescribe psychoactive drugs whereas psychologists can not. –See for more details “FOCUS ON DISCOVERY 1.1: THE MENTAL HEALTH PROFESSIONS”

History of Psychopathology “Those who cannot remember the past are condemned to repeat it.” George Santayana, The Life of Reason

Pre-scientific Inquiry Events beyond the control of humankind such as eclipses, earthquakes, storms, fire, diseases were regarded as supernatural. Behaviour that seemed outside individual control was subject to similar interpretation. Thus, many early philosophers, theologians, and physicians believed that deviancy reflected the displeasure of the gods or possession by demons.

Early Demonology Demonology: The doctrine that an evil being, such as the devil, may dwell within a person and control his or her mind and body. –Found in the records of the early Chinese, Egyptians, Babylonians, and Greeks. Given that abnormal behaviour was caused by possession, treatment often involved exorcism –Ranged from elaborate rites of prayer to flogging and starvation as a way of rendering the body uninhabitable to devils.

Trepanning Involved the making of a surgical opening in a living skull by some instrument. –widespread practice used by Stone Age or neolithic cave dwellers Used to treat epilepsy, headaches, and psychological disorders attributed to demons. Thought to be introduced into the Americas from Siberia. –practice was most common in Peru and Bolivia, –3 British Columbia Aboriginal specimens found

Hippocrates (ca. 460–377 B.C) Separated medicine from religion, magic, and superstition. Rejected belief that the gods sent physical diseases and mental disturbances as punishment Insisted that illnesses had natural causes thus should be treated like other illnesses Regarded the brain as the organ of consciousness –Thus abnormal thinking and behaviour were indications of brain pathology.

Somatogenesis vs. Psychogenesis Hippocrates one of the earliest proponents of somatogenesis. –Somatogenesis something wrong with the soma (physical body) and this disturbs thought and action. –Psychogenesis disturbance has psychological origins.

Hippocrates’ humoral physiology Hippocrates’ treatments were different from exorcistic tortures. –tranquility was prescribed for melancholia, Mental health dependent on a delicate balance among four humours, or fluids of the body Imbalances and results –  blood = changeable temperament –  black bile = melancholia –  yellow bile = irritability and anxiousness –  phlegm = sluggish and dullness

The Dark Ages and Demonology Churches gained in influence, papacy declared independent of the state. Christian monasteries replaced physicians as healers and as authorities on mental disorder. The monks cared for and nursed the sick –by praying and touching them with relics –or concocting fantastic potions for them

Persecution of Witches During the 13 th and the following few centuries, major social unrest and recurrent famines and plagues People turned to demonology to explain disasters. Led to an obsession with the devil– ‘witches’ blamed and persecuted Pope Innocent VIII exhorted European clergy to leave no stone unturned in the search for witches. –Sent 2 Dominican monks to northern Germany as inquisitors who later issued the manual entitled the Malleus Maleficarum Used to guide witch hunters Came to be seen by Catholics and Protestants as a textbook on witchcraft. Over the next several centuries, hundreds of thousands of people accused, tortured, and murdered.

Witchcraft and Mental Illness Were so-called witches psychotic? –Detailed examination of historical period indicates most not mentally ill. –Delusion-like confessions obtained during torture

Other info. that ‘witches’ not mentally ill 13 th century on, hospitals took over churches’ responsibility to tend to the ill. laws allowed dangerously insane and incompetent to be confined to hospital.  and people confined were not described as being possessed Early 13 th century “lunacy” trials held in England. –Trials conducted to protect the mentally ill –Judgment of insanity allowed Crown to become guardian of estate Defendant’s orientation, memory, intellect, daily life, and habits were at issue in the trial.

Development of Asylums Until to end of t 15 th century very few mental hospitals in Europe but England and Scotland had 220 leprosy hospitals – leprosy gradually disappeared from Europe and attention turned to the mentally ill Confinement began in earnest in the 15 th -16 th centuries Leprosariums were converted to asylums –asylums took disturbed people and beggars –had no specific regimen for their inmates other work –still during the same period, hospitals tailored for the confinement of the mentally ill also emerged

St. Mary of Bethlehem Founded in 1243 and devoted solely to the confinement of the mentally ill. –Conditions were deplorable (bedlam) –Eventually became one of London’s great (paid) tourist attractions viewing the violent patients considered entertainment Discussion Point: What might be the effects of such inhuman treatment on the sequela of mental illness?

Moral Treatment Philippe Pinel (1745–1826) considered primary figure in movement for humanitarian treatment of the mentally ill in asylums. Believed patients should be treated with dignity –put in charge of a large asylum in Paris known as La Bicetre –removed the chains of the people imprisoned –began to treat patients as sick rather than as beasts –light and airy rooms replaced dungeons –walks around the grounds were allowed Results? –Some patients incarcerated for years discharged

Dorothea Dix Moral treatment was abandoned in the latter part of the nineteenth century but Dorothea Dix’s (1802–77) efforts resurrected it –Boston schoolteacher who taught a Sunday-school class at the local prison –shocked by deplorable conditions and interest spread to the conditions of patients in mental hospitals –campaigned vigorously and successfully to improve the lives of people with mental illness

Asylums in Canada network of asylums eventually established in Canada

Asylums in Canada AlbertaInsane Asylum, Ponoka1911 British ColumbiaPublic Hospital for the Insane, New Westminster1878 British Columbia Mental Hospital, Coquitlam1913 ManitobaSelkirk Asylum, Selkirk1886 Home for Incurables, Portage-la-Prairie1890 Brandon Asylum, Brandon1891 New BrunswickProvincial Hospital, Saint John1835 Provincial Lunatic Asylum1848 Nova ScotiaNova Scotia Hospital for Insane, Halifax1857

OntarioProvincial Lunatic Asylum, Toronto1850 Kingston Asylum (Rockwood), Kingston1856 London Asylum, London1859 Orillia Asylum for Idiots, Orillia1861 Hamilton Asylum, Hamilton1876 Mimico Branch Asylum, Mimico1890 Hospital for Insane, Brockville1894 Cobourg Asylum1902 Penetanguishene Asylum, Penetanguishene1904 Whitby Hospital, Whitby1914 Prince Edward Island The Prince Edward Island Hospital for the Insane1877 Asylums in Canada

QuebecQuebec Lunatic Asylum, Beauport1845 Provincial Lunatic Asylum, St. John’s1861 L’Hospice St. Jean de Dieu, Longue Point1856 L’Hospice St. Julien, St. Ferdinand d’Halifax1873 L’Hospice Ste. Anne, Baie-St. Paul1890 Protestant Hospital for the Insane, Verdun1890 St. Benedict Joseph Asylum, near city of Montreal1885 SaskatchewanThe Saskatchewan Provincial Hospital, Battleford1914 NewfoundlandAsylum for the Insane, St. John’s1855 Northwest Territory Taken to asylums of Alberta and Saskatchewan1914 YukonTaken to New Westminster by Royal Northwest Mounted Police 1877

Beginning of Contemporary Thought Return to the somatogenic views first espoused by Hippocrates Early system of classification established

Emil Kraepelin (1856–1926) created a classification system to establish the biological nature of mental illnesses. noticed clustering of symptoms (syndrome) which were presumed to have an underlying physical cause, –In fact, mental illness seen as distinct with own genesis, symptoms, course, and outcome. proposed two major groups of severe mental diseases: –dementia praecox (early term for schizophrenia) thought chemical imbalance as the cause of schizophrenia –manic-depressive psychosis (now called bipolar disorder). thought an irregularity in metabolism as the cause of manic- depressive psychosis

Importantly, Kraepelin’s early classification scheme became the basis for the present diagnostic categories

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 perspective far more was however discovered about nature and origin of syphilis –general paresis characterized by steady physical and mental deterioration, delusions of grandeur and progressive paralysis from which there was no recovery discovery provides a a good example of the increasing use of empirical approaches used to understand mental illness

Louis Pasteur Germ theory of disease is theorized by Pasteur –laid the groundwork for demonstrating the relation between syphilis and general paresis –Also helped establish a causal link between infection, destruction of brain areas, and a form of psychopathology. –Light bulb moment: If one type of psychopathology had a biological cause, so could others. –Result: Somatogenesis gained credibility and became a dominant theory

Psychogenesis Re-visited somatogenic causes dominated field of abnormal psychology until 20 th Century due in large part to discoveries about general paresis but, psychogenesis still “in fashion” in countries like France and Austria.

Current Attitudes Much progress has been made in terms of understanding the nature, origin, developmental course and treatment of psychological disorders Still, many Canadians are still suspicious of people with mental health issues –These concerns are reinforced with negative stereotyping and stigmatization Unfortunate consequence is that many people with mental illness do not seek help

Mental Health Care in Canada See Canadian Perspectives 1.2 for more details.

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