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1、abnormal PSYCHOLOGYFourth Canadian EditionPrepared by: Tracy Vaillancourt, Ph.D.Modifed by: Rjeanne Dupuis, M.A. Chapter 1Chapter 1Introduction: Definitional and Historical Considerations, and Canadas Mental Health System1Psychopathology Field concerned with the nature and development of abnormal Be
2、haviourThoughts or cognition Feelings or emotions2What is abnormal behaviour?Abnormality usually determined by the presence of several characteristics at one time such as: Statistical infrequencyViolation of normsPersonal distressDisability or dysfunctionUnexpectedness3Statistical Infrequency A beha
3、viour that occurs rarely or infrequentlyA 14-year old boy wetting his bed andMental retardation (IQ 130)4Violation 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
4、 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 anotherDiscussion point: A prostitute violates social norms but does this mean that she/he would necessarily meet diagnostic criteria f
5、or a mental disorder?5Personal 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 distress Psychopaths are often not distressed by their behaviour
6、although these behaviour clearly impact others in a negative way Hunger and childbirth cause distress, but is this abnormal?6Disability or DysfunctionA behaviour that causes impairment in some important area of life, e.g., work, personal relationships, recreational activitiesExamples of exceptions:
7、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 a
8、re married, lead conventional lives, and usually cross-dress in private. 7Unexpectedness A 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
9、laugh after being sexually assaulted.Other example: An anxiety disorder is diagnosed when the anxiety is unexpected and out of proportion to the situation.8The study and treatment of mental disorders in CanadaThere are approximately:3,600 practicing psychiatrists 13,000 psychologists and psychologic
10、al associates11,000 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 de
11、livered by general practitioners9Psychiatrist, psychologistwhats 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 i
12、n 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”10History of Psychopathology “Those who cannot remember the past are con
13、demned to repeat it.”George Santayana, The Life of Reason11Pre-scientific InquiryMental 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
14、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 demons12Early Demonology Demonology: The doctrine that an evil being, such as the devil, may dwell within a person a
15、nd 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 exorcismRanged from elaborate rites of prayer to flogging and starvation as a way of rendering the body u
16、ninhabitable to devils13TrepanningInvolved 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 demons Thought to be introduced into the Americas from Si
17、beria Practice was most common in Peru and Bolivia, 3 British-Columbia Aboriginal specimens found 14Hippocrates (ca. 460377 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
18、 had natural causes thus should be treated like other illnesses 15Somatogenesis vs. PsychogenesisHippocrates 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 thoug
19、ht and action Psychogenesis Mental disorders have their origin in psychological malfunctions 16Hippocrates Humoral PhysiologyHippocrates treatments were different from exorcistic tortures Tranquility, proper nutrition, abstinence from sexual activity were prescribed for melancholia Mental health dep
20、endent 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 dullness17The Dark Ages and DemonologyChurches gained in influence, papacy was declar
21、ed 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 orConcocting fantastic potions for them18Persecution of WitchesDuring the 13th and the following few
22、 centuries, major social unrest and recurrent famines and plaguesPeople turned to demonology to explain disasters Led 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 witches Sent 2 Dominican mon
23、ks to northern Germany as inquisitors who later issued the manual entitled the Malleus Maleficarum Used to guide witch huntersCame 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 murdered19Wit
24、chcraft and Mental IllnessWere so-called witches psychotic?Detailed examination of historical period indicates most were not mentally illDelusion-like confessions were obtained during torture20Other info. that witches not mentally illFrom 13th century on in England, hospitals took over churches resp
25、onsibility to tend to the ill Laws 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 England Trials conducted to protect the mentally illJudgment of insanity allowed Crown to becom
26、e guardian of estate Defendants orientation, memory, intellect, daily life, and habits were at issue in the trialStrange behaviour were explained as physical illness / injury 21Development of AsylumsUntil the end of the 15th century, very few mental hospitals in Europe but England and Scotland had 2
27、20 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 beggars Had no specific regimen for their inmates but workDespite the d
28、esire to help the mad, hospitals tailored for the confinement of the mentally ill also emerged22St. Mary of BethlehemFounded in 1243 in London, devoted solely to the confinement of the mentally illConditions were deplorable (bedlam) Eventually became one of Londons great (paid) tourist attractionsVi
29、ewing the violent patients considered entertainmentDiscussion Point: What might be the effects of such inhuman treatment on the sequela of mental illness? 23Moral TreatmentPhilippe Pinel (17451826) considered primary figure in movement for humanitarian treatment of the mentally ill in asylums Believ
30、ed patients should be treated with dignityPut in charge of a large asylum in Paris known as La Bictre Removed the chains of the people imprisoned Began to treat patients as sick rather than as beastsLight and airy rooms replaced dungeonsWalks around the grounds were allowedResults?Some patients inca
31、rcerated for years were discharged24Dorothea DixMoral treatment was abandoned in the latter part of the 19th century but Dorothea Dixs (180277) efforts resurrected it Boston schoolteacher who taught a Sunday-school class at the local prison Shocked by deplorable conditions and interest spread to the
32、 conditions of patients in mental hospitals Campaigned vigorously and successfully to improve the lives of people with mental illness25Asylums in CanadaNetwork of asylums eventually established in Canada26Asylums in CanadaAlbertaInsane Asylum, Ponoka1911British ColumbiaPublic Hospital for the Insane
33、, 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, Halifa
34、x185727OntarioProvincial Lunatic Asylum, Toronto1850Kingston Asylum (Rockwood), Kingston1856London Asylum, London1859Orillia Asylum for Idiots, Orillia1861Hamilton Asylum, Hamilton1876Mimico Branch Asylum, Mimico1890Hospital for Insane, Brockville1894Cobourg Asylum1902Penetanguishene Asylum, Penetan
35、guishene1904Whitby Hospital, Whitby1914Prince Edward IslandThe Prince Edward Island Hospital for the Insane1877Asylums in Canada28Asylums in Canada QuebecQuebec Lunatic Asylum, Beauport1845Provincial Lunatic Asylum, St. Johns1861LHospice St. Jean de Dieu, Longue Point1856LHospice St. Julien, St. Fer
36、dinand dHalifax1873LHospice Ste. Anne, Baie-St. Paul1890Protestant Hospital for the Insane, Verdun1890St. Benedict Joseph Asylum, near city of Montreal1885SaskatchewanThe Saskatchewan Provincial Hospital, Battleford1914NewfoundlandAsylum for the Insane, St. Johns1855Northwest TerritoryTaken to asylu
37、ms of Alberta and Saskatchewan1914YukonTaken to New Westminster by Royal Northwest Mounted Police187729Beginning of Contemporary ThoughtIn 19th century, return to the somatogenic views first espoused by HippocratesEarly system of classification established30Emil Kraepelin (18561926)Created a classif
38、ication 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 men
39、tal 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, Kraepelins early classification s
40、cheme became the basis for the present diagnostic categories 31General Paresis and SyphilisMid-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 s
41、yphilisGeneral 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 illness32Louis PasteurGerm theor
42、y of disease, established by PasteurLaid 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 biologica
43、l cause, so could others Result: Somatogenesis gained credibility and became a dominant theory 33Psychogenesis 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 co
44、untries like France and Austria34Current 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 ne
45、gative stereotyping and stigmatization Unfortunate consequence is that many people with mental illness do not seek help 35Mental Health Care in CanadaCanada has a universal health care system since 1970Each province / territory is responsible for administrating health care Health-care re-organisatio
46、n 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 services See Canadian Perspectives 1.2 for more details36Historical Perspective of Mental Health Care in CanadaThe hea
47、lth care system in Canada has not always been stellar in its ethical treatment of patients under its care Examples are: Dr. Camerons 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 patients
48、In 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 details37The Romanow Report Building on Values: The Future of Health Care in Canada (2002) The Romanow Report made 47 recommendat
49、ionsRomanow 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 servicesDevelop a national drug agency Provide a emergency drug program to help those with s
50、evere 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 38The Kirby Report Out of the Shadows at Last: Transforming Mental Health, Mental Illness, and Addiction Servic
51、es in Canada (The Senate Committee on Social Affairs, Science and Technology, 2006) 2 Key recommendations were made: 1.The creation of the Canadian mental health commission A.Facilitate a national approach to mental health issues B.Promote reform of mental health policies and improvement of services
52、 C.Educate Canadians by increasing mental health literacy D.Reduce stima and discrimination of mentally ill individuals and families 2.The creation of the 10-year Mental Health Transition Fund 1.Provide affordable housing to the mentally ill2.Offer support to provinces / territories in order to incr
53、eas services in the community 39The Future of PsychologyThe Canadian Psychological Association (CPA) was critical of the Romanow Report as it (1) did not include psychologys vision and (2) embraced a physical medicine vision or somatogenic perspectiveCPA argued that:A plethora of research on the imp
54、roved 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 prim
55、ary health care and (2) the collaboration of care tams as the way of the future 40CopyrightCopyright 2011 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requ
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