1. Terms and History
Chapter 1

2. Terms Presenting problem
Clinical description- behaviors, thoughts, feelings
Prevalence: How many people in the population as a whole have the disorder
Incidence: How many new cases occur during a given period (such as a year)
Sex ratio: what % males and females
Age of onset
Course- of a disorder (e.g., episodic)

3. Terms Acute onset Insidious onset
Prognosis: anticipated course of a disorder
Developmental: e.g., physical symptoms
Etiology: origins- why a disorder begins (bio, psycho, social)
Cause and effect; random assignment, cross-sectional data

4. Early views Demons and witches- exorcism
Stress and melancholy (depression)- seen as natural and curable- illness
Church: despair and lethargy were seen as the sin of sloth
Rest, sleep, healthy environment, baths, ointments, potions
Moved from house to house as neighbors took turns caring for them (beneficial)
Mass hysteria- today: emotion contagion (e.g., mob psychology; suggestibility; if there is a cause than I should feel this way; e.g., test anxiety)

5. Hippocrates and Galen
Hippocrates: father of modern western medicine; psychological disorders can be treated like any other disease
Hippocrates and Galen: Humors: 4 bodily fluids: blood (heart), black bile (spleen), yellow bile (liver), and phlegm (brain)
Disease happens when humors are not in balance (e.g., depression melancholier, black bile)
Psychological disorders as chemical imbalance
Greek word for uterus is hysteron; idea of hysteria (somatic symptom disorders; paralysis/blindness with no physical cause, primarily in women); thought empty uterus was wandering

6. 19th Century
Syphilis: bacterial microorganism entering the brain: behavioral and cognitive symptoms (like psychosis- paranoia and delusions)
Subgroup of patients who deteriorate and die within 5 years
Another group that remains stable
Louis Pasteur’s germ theory of disease (1870)- identification of microorganisms
Malaria- “burned out” the bacteria until penicillin cures; curable infection
John P Grey: causes of insanity were always physical
Rest, diet, proper room temp and ventilation
Conditions in hospitals became more humane
Became so large that individual attention was not possible
De-hospitalization in the 50s with no infrastructure

7. Treatments
Biological treatments- electric shock (electro-convulsive therapy), brain surgery, drugs (psychotic disorders)
Drug therapy- initial enthusiasm followed by disappointment: side effects, modest effects
IF disease- do we focus on treatment? Curable? (vs classification and dx)
Moral therapy: treat patients as normal as possible (asylums became more therapeutic)
Asylum reform: Dorthea Dix; improve care, get care to everyone who needed it
Increases in patients; reduction in moral therapy; brain pathology and thus incurable

8. Treatments cont Psychoanalytic theory and psychoanalysis Humanism
Behaviorism

9. Psychoanalytic Theory
Freud teamed up with Breuer- hypnotized patients talked about problems, conflicts, fears; felt better when they emerged had trouble remembering details (beyond awareness of patients)
Unconscious mind
Release of emotional material- catharsis
Insight- understanding current emotions and earlier events
Id (drives), Ego (reality), Superego (moral principles)
Defense Mechanisms (denial, displacement, projection, rationalization, reaction formation, repression, sublimation)
Unconscious protective process to keep emotions associated with conflicts in check so that the ego can continue to function

10. Psychosexual Stages of Development
Oral, anal, phallic, latency, and genital
If we do not receive appropriate gratification during a specific stage or if a specific stage left a strong impression (fixation) than the individuals personality will reflect that stage throughout adult life

11. Later developments in Psychoanalytic thought
Anna Freud- ego psychology
Slowly develop adaptation capacities, skills in reality testing, and defenses
Abnormal behavior is when the ego is deficient in regulating functions controlling impulses or using appropriate defenses
Object relations: how children incorporate images, memories, values of a person they are emotionally attached to
See the world through the eyes of the person you incorporated into your self
Carl Jung- focus on collective unconscious- wisdom stored deep in individual memories and passed down from generation to generation; spiritual and religious drives are just as important as sex drives
Alfred Adler- Inferiority and striving for superiority; inferiority complex; drive toward self-actualization (realizing full potential)

12. Psychoanalytic Psychotherapy
Free association: say whatever comes to mind; intended to reveal emotionally charged material that has been repressed
Dream analysis
Relationship between psychoanalyst and patient is important
Transference: patients come to relate to the therapist as much as they did to parents
Countertransference: therapists project some of their own personal issues and feelings onto the patient (trained to deal with this)
Therapy 4/5 times a week for 2-5 years
Reduction of symptoms not important- only expressions of underlying conflict that must be resolved or others will just pop up- symptom substitution
Analyze these conflicts, resolve them, restructure the personality to put the ego back in charge

13. Psychodynamic Psychotherapy
Conflicts and unconscious processes are still emphasized, efforts to identify trauma and defense mechanisms
Focus on expression of emotions
Exploration of patients attempts to avoid topics or hinder progress
Identification of patterns in thoughts, feelings, actions, relationships
Emphasis on past experiences
Focus on interpersonal experiences
Emphasis on therapeutic relationship
Exploration of wishes, dreams, fantasies
Briefer and less emphasis on personality reconstruction; focus on relieving suffering associated with psychological disorders

14. Problems Unscientific
Relies on reports of patients from many years prior
How interpreted differs by analyst
No measurement of phenomena
No way to prove or disprove hypotheses (foundation of scientific approach)

15. Behaviorism
Pavlov- classical conditioning: UR, US, CR, CS, extinction (vs habituation- still there)
Watson- little albert
Wolpe- systematic desensitization
Skinner- operant conditioning- Positive Reinforcement, PP, NR, NP
shaping