abnormal PSYCHOLOGY

Fourth Canadian Edition

Prepared by: Tracy Vaillancourt, Ph.D.

Modifed by: Réjeanne Dupuis, M.A.

Chapter 1Chapter 1Introduction:

Definitional and Historical Considerations, and Canada’s Mental Health System

Psychopathology

• Field concerned with the nature and development of abnormal… – Behaviour– Thoughts or cognition – Feelings or emotions

2

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

3

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)

4

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?

5

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?

6

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.

7

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.

8

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

9

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”

10

History of Psychopathology

“Those who cannot remember the past are condemned to repeat it.”

George Santayana, The Life of Reason

11

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

12

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

13

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

14

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

15

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

16

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

17

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

18

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

19

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

20

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

21

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

22

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?

23

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

24

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

25

Asylums in Canada

• Network of asylums eventually established in Canada

26

Asylums in CanadaAlberta 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

27

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

Asylums in Canada

28

Asylums in CanadaQuebec 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 1890

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 1914

Yukon Taken to New Westminster by Royal Northwest Mounted Police

1877

29

Beginning of Contemporary Thought

• In 19th century, return to the somatogenic views first espoused by Hippocrates

• Early system of classification established

30

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

31

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

32

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

33

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

34

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

35

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

36

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

37

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

38

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: 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

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 ill

2. Offer support to provinces / territories in order to increas services in the community

39

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

40

Copyright

Copyright © 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. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.