abnormal PSYCHOLOGY Third Canadian Edition

1、abnormal PSYCHOLOGYFourth Canadian EditionPrepared by: Tracy Vaillancourt, Ph.D.Modifed by: Rjeanne Dupuis, M.A. Chapter 1Introduction: Definitional and Historical Considerations, and Canadas Mental Health System1Psychopathology Field concerned with the nature and development of abnormal BehaviourTh

2、oughts 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 behaviour tha

3、t 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 threaten

4、ing 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 for a ment

5、al 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 although

6、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: Being sho

7、rt 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 are marrie

8、d, 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 laugh aft

9、er 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 psychological associ

10、ates11,000 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 b

11、y 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 in the pra

12、ctice 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 condemned to

13、 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 was subje

14、ct 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 and contro

15、l 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 uninhabita

16、ble 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 Siberia Pra

17、ctice 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 had natu

18、ral 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 thought and ac

19、tion 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 dependent on

20、 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 declared indepe

21、ndent 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 centurie

22、s, 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 monks to nor

23、thern 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 murdered19Witchcraft a

24、nd 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 responsibilit

25、y 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 become guardia

26、n 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 220 lepros

27、y 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 desire to

28、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 attractionsViewing the

29、 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 Believed patien

30、ts 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 incarcerated

31、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 conditio

32、ns 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, New Wes

33、tminster1878British Columbia Mental Hospital, Coquitlam1913ManitobaSelkirk Asylum, Selkirk1886Home for Incurables, Portage-la-Prairie1890Brandon Asylum, Brandon1891New BrunswickProvincial Hospital, Saint John1835Provincial Lunatic Asylum1848Nova ScotiaNova Scotia Hospital for Insane, Halifax185727On

34、tarioProvincial Lunatic Asylum, Toronto1850Kingston Asylum (Rockwood), Kingston1856London Asylum, London1859Orillia Asylum for Idiots, Orillia1861Hamilton Asylum, Hamilton1876Mimico Branch Asylum, Mimico1890Hospital for Insane, Brockville1894Cobourg Asylum1902Penetanguishene Asylum, Penetanguishene1

35、904Whitby Hospital, Whitby1914Prince Edward IslandThe Prince Edward Island Hospital for the Insane1877Asylums in Canada28Asylums in CanadaQuebecQuebec Lunatic Asylum, Beauport1845Provincial Lunatic Asylum, St. Johns1861LHospice St. Jean de Dieu, Longue Point1856LHospice St. Julien, St. Ferdinand dHa

36、lifax1873LHospice 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 asylums of Albe

37、rta 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 classification sy

38、stem 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 mental diseas

39、es: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 scheme beca

40、me 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 syphilisGen

41、eral 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 theory of disea

42、se, 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 biological cause, s

43、o 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 countries li

44、ke 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 negative ste

45、reotyping 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-organisation and fund

46、ing 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 health care s

47、ystem 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 In either

48、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 recommendationsRomano

49、w 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 severe ment

50、al 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 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 natio