1. abnormal PSYCHOLOGY Fourth Canadian Edition
Chapter 1
Introduction:
Definitional and Historical Considerations, and Canada’s Mental Health System
Prepared by: Tracy Vaillancourt, Ph.D.
Modifed by: Réjeanne Dupuis, M.A.

2. Psychopathology
Field concerned with the nature and development of abnormal…
Behaviour
Thoughts or cognition
Feelings or emotions
Source: page 2

3. 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

4. Statistical Infrequency
A behaviour that occurs rarely or infrequently
A 14-year old boy wetting his bed and
Mental retardation (IQ < 70) occur 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)

5. Violation of Norms
A behaviour that defies or goes against social norms; it either threatens or makes anxious those observing it
Anti-social behaviour of the psychopath violates social norms and is threatening to others
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?

6. Personal Distress
A behaviour that creates personal suffering, distress or torment in the person
This criterion fits many of the forms of abnormality such as depression but some disorders do not necessarily involve distress
Psychopaths are often not distressed by their behaviour although these behaviour clearly impact others in a negative way
Hunger 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 activities
Examples of exceptions:
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.

8. Unexpectedness
A surprising or out-of-proportion response to environmental stressors can be considered abnormal
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.

9. The study and treatment of mental disorders in Canada
There are approximately:
3,600 practicing 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

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 studies
Psychiatrist hold an MD degree and have had postgraduate training, in which they receive supervision in the practice of diagnosing and psychotherapy
Because psychiatrists have an MD degree, they can prescribe psychoactive drugs, whereas psychologists can not
For 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 supernatural
Behaviour that seemed outside individual control was subject to similar interpretation
Thus, many early philosophers, theologians, and physicians believed that deviant behaviour reflected the displeasure of the gods or possession by demons

13. 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

14. Trepanning
Involved the making of a surgical opening in a living skull by some instrument
Treatment 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

15. 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

16. Somatogenesis vs. Psychogenesis
Hippocrates is one of the earliest proponents of somatogenesis
Somatogenesis (genesis = origin)
Mental disorders are caused by aberrant functioning in the soma (i.e., physical body) and this disturbs thought and action
Psychogenesis
Mental disorders have their origin in psychological malfunctions

17. Hippocrates’ Humoral Physiology
Hippocrates’ treatments were different from exorcistic tortures
Tranquility, proper nutrition, abstinence from sexual activity were 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

18. The Dark Ages and Demonology
Churches gained in influence, papacy was 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

19. Persecution of Witches
During the 13th 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
1484 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

20. Witchcraft and Mental Illness
Were so-called witches psychotic?
Detailed examination of historical period indicates most were not mentally ill
Delusion-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 ill
Laws allowed dangerously insane and incompetent to be confined to hospital
 and people confined were not described as being possessed
Early 13th 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
Strange 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 hospitals
Leprosy gradually disappeared from Europe and attention turned to the mentally ill
Confinement began in earnest in the 15th-16th centuries
Leprosariums were converted to asylums
Asylums took disturbed people and beggars
Had no specific regimen for their inmates but work
Despite the desire to help ‘the mad,’ hospitals tailored for the confinement of the mentally ill also emerged

23. St. Mary of Bethlehem
Founded in 1243 in London, 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?

24. 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 Bicêtre
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 were discharged

25. Dorothea Dix
Moral treatment was abandoned in the latter part of the 19th 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

26. Asylums in Canada
Network of asylums eventually established in Canada

27. Asylums in Canada Alberta Insane Asylum, Ponoka 1911 British Columbia
Public Hospital for the Insane, New Westminster
1878
British Columbia Mental Hospital, Coquitlam
1913
Manitoba
Selkirk Asylum, Selkirk
1886
Home for Incurables, Portage-la-Prairie
1890
Brandon Asylum, Brandon
1891
New Brunswick
Provincial Hospital, Saint John
1835
Provincial Lunatic Asylum
1848
Nova Scotia
Nova Scotia Hospital for Insane, Halifax
1857

28. Asylums in Canada Ontario Provincial Lunatic Asylum, Toronto 1850
Kingston Asylum (Rockwood), Kingston
1856
London Asylum, London
1859
Orillia Asylum for Idiots, Orillia
1861
Hamilton Asylum, Hamilton
1876
Mimico Branch Asylum, Mimico
1890
Hospital for Insane, Brockville
1894
Cobourg Asylum
1902
Penetanguishene Asylum, Penetanguishene
1904
Whitby Hospital, Whitby
1914
Prince Edward Island
The Prince Edward Island Hospital for the Insane
1877

29. Asylums in Canada Quebec Quebec Lunatic Asylum, Beauport 1845
Provincial Lunatic Asylum, St. John’s
1861
L’Hospice St. Jean de Dieu, Longue Point
1856
L’Hospice St. Julien, St. Ferdinand d’Halifax
1873
L’Hospice Ste. Anne, Baie-St. Paul
1890
Protestant Hospital for the Insane, Verdun
St. Benedict Joseph Asylum, near city of Montreal
1885
Saskatchewan
The Saskatchewan Provincial Hospital, Battleford
1914
Newfoundland
Asylum for the Insane, St. John’s
1855
Northwest Territory
Taken to asylums of Alberta and Saskatchewan
Yukon
Taken to New Westminster by Royal Northwest Mounted Police
1877

30. Beginning of Contemporary Thought
In 19th century, return to the somatogenic views first espoused by Hippocrates
Early system of classification established

31. 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 is 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

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 perspective
Far more was then discovered about the 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 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 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

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

35. 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
Class 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 1970
Each province / territory is responsible for administrating health care
Health-care re-organisation and funding cuts have led to the closing of long-term psychiatric mental hospitals and beds on psychiatric hospital wards
Community services are expected to take over some of these services
See 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 care
Examples are:
Dr. Cameron’s brainwashing treatment in Montreal in the 1950s and 60s
Psychosurgery (e.g., lobotomy) performed out of scientific curiosity, i.e., to see how it would change patients
In either case, consent was not obtained from patients or families
Lobotomies were banned in all psychiatric hospitals in early 1980s
See Canadian Perspectives 1.3 for more details

38. The Romanow Report
Building on Values: The Future of Health Care in Canada (2002)
The Romanow Report made 47 recommendations
Romanow called mental health care “the orphan child of medicare” and recommended to make it a priority
Some of the recommendations were:
Include some homecare services for case management and intervention services
Develop a national drug agency
Provide 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 Report
Out 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 commission
Facilitate a national approach to mental health issues
Promote reform of mental health policies and improvement of services
Educate Canadians by increasing mental health literacy
Reduce stima and discrimination of mentally ill individuals and families
The creation of the 10-year Mental Health Transition Fund
Provide affordable housing to the mentally ill
Offer 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 perspective
CPA argued that:
A plethora of research on the improved effectiveness of pharmacotherapy when combined with psychological treatment
Savings could range as high as 80% of currently dominant treatments, including medication
The 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

41. Copyright
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