• Psychopathology = the field concerned with the nature, development and treatment of psychological disorders
  • Challenge: remaining objective, avoiding preconceived notions, reduce stigma
  • Stigma = destructive beliefs and attitudes held by society that are ascribed to groups considered different in some manner (people with psychological disorders) o 1) Label is applied to a group of people that distinguishes them from others o 2) Label is linked to deviant/undesirable attributes by society (crazy people are dangerous) o 3) People w/label are seen as essentially different from those without the label, contributing to an “us” versus “them” mentality (we are not like those crazy people)
    • 4) People w/label are discriminated against unfairly (clinic for crazy people can’t be built in our neighborhood)
  • Nearly half of US citizens will experience some type of psychological disorder during some point of their lifetime

Defining Psychological Disorder

  • Definition of mental disorder is found in the 5th edition of the American diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) *May 2013  Psychological disorder:
    • Occurs within the individual
    • Involves clinically significant difficulties in thinking, feeling, or behaving
    • Usually involves personal distress of some sort, such as in social relationships or occupational functioning
    • Involves dysfunction in psychological, developmental, and/or neurobiological processes that support mental functioning
    • Is not a culturally specific reaction to an event (e.g. death of a loved one) o Is not primarily a result of social deviance or conflict with society
  • 4 key characteristics: personal distress, disability, violation of social norms, dysfunction
  • Personal Distress
    • A person’s behaviour may be classified as abnormal if it causes him/her great distress
    • Not all psychological disorders cause distress *e.g. antisocial/personality disorder
    • Not all behaviour that causes distress is disordered *e.g. hunger due to religious fasting
  • Disability
    • Disability = impairment in some important area of life
    • g. substance use disorders defined in part by social or occupational disability
  • Violation of Social Norms
    • Social norms = widely held standards that people use consciously or intuitively to make judgments about where behaviours are situated on such scales as good-bad, right-wrong, etc.
    • Social norms vary a great deal across cultures and ethnic groups
    • Make others uncomfortable or causes problems (e.g. antisocial behaviour of psychopath)
  • Dysfunction
    • Harmful dysfunction = failure of internal mechanisms in the mind to function properly o 1) Value judgment (harmful), 2) objective, scientific component (dysfunction)
    • Standard of comparison as to what is harmful depends on social norms and values
    • Dysfunction = occurs when an internal mechanism is unable to perform its natural function  Developmental, psychological, and biological dysfunctions are all interrelated

History of Psychopathology

Early Demonology

  • Before advances in scientific discovery, all good/bad manifestations of power beyond human control were regarded as supernatural
  • It was thought that disturbed behaviour reflected the displeasure of the gods or possession by demons
  • Demonology = the doctrine that an evil being or spirit can dwell within a person and control his/her mind and body
  • Exorcism = the ritualistic casting out of evil spirits o Rites of prayer, noisemaking, forcing the afflicted to drink terrible-tasting brews, flogging, starvation

Early Biological Explanations

  • Hippocrates (father of modern medicine) separated medicine from religion, magic and superstition
  • Insisted that illness had natural causes and should be treated like other more common maladies
  • Regarded the brain as the organ of consciousness, intellectual life, and emotion
  • Disordered thinking/behaviour indicate brain pathology
  • 3 categories of psychological disorders: mania, melancholia, and phrentis (brain fever)
  • Mental health depends on a balance among 4 humors (fluids of the body) o Blood, black bile, yellow bile, and phlegm *imbalance produces disorders
  • Predominance of phlegm = sluggish/dull, black bile = melancholia, yellow bile = irritability/anxiousness, blood = changeable temperament

The Dark Ages and Demonology

  • Death of Galen said to be the start of the Dark Ages in western European medicine  Monks in the monasteries cared for and nursed the sick (prayed, touched w/relics, potions)  The Persecution of Witches:
    • 13th century, recurrent famines and plagues *demonological explanations for disasters o Witchcraft (instigated by Satan) viewed as heresy and a denial of God o Torture sometimes led to bizarre delusional sounding confessions o Pope Innocent VIII mandated witch hunts o Burning used as method of driving out the demon
    • Turns out more healthy individuals than mentally ill individuals were tried and/or prosecuted as witches  Lunacy Trials:
    • Municipal authorities took over some activities of the church, one being care of mentally ill o 1 purpose of the hospital: mad are kept safe until they are restored of reason
      • Not described as being possessed o Trials conducted under the Crown’s right to protect the people with psychological disorders
      • Trials were to determine a person’s mental health/sanity (13th century, England)
      • Judgment of insanity allowed the Crown to become guardian of the lunatic’s estate o Strange behaviour was attributed to physical illness/injury, or emotional shock

o “Lunacy” comes from Swiss physician, attributed odd behaviour to misalignment of the moon and stars

Development of Asylums

  • Very few hospitals for people with psychological disorders until the 15th century
  • Many hospitals for people with leprosy o As leprosy disappeared, these buildings were no longer used, converted to asylums  Asylums = establishments for the confinement and care of mentally ill  Bethlehem and Other Early Asylums:

o Priory of St. Mary and Bethlehem founded in 1243 *one of first mental institutions

1547 Henry VIII devoted the hospital to confinement of people with psychological disorders o Became a tourist attraction *bought tickets to enter o Origin of term bedlam (wild uproar or confusion)  o Similar to the Lunatics Tower in Vienna o Medical treatments were crude and painful

o Benjamin Rush (father of American psychiatry) – believed psyc disorders were caused by excess blood in the brain, would treat by drawing large quantities of blood from disordered individuals

 Believed he could cure people by frightening them *convince them death is near  Pinel’s Reforms:

o Figure for more humane treatment of people with psychological disorders in asylums o Pinel was thought to have removed the confining chains worn by patients at La Bicetre

 Was really a former patient (Jean-Baptiste Pussin), became an orderly o Pinel believed that if reason had left a patient because of severe social/personal problems, it might be restored through comforting counsel and purposeful activity  Moral Treatment:

  • Friend’s Asylum (1817 Pennsylvania), Hartford Retreat (1824 Connecticut)
  • Mental treatment = people had close contact with attendants, who talked and read to them and encouraged them to engage in purposeful activity
  • Residents lead lives as close to normal as possible o Engage in purposeful, calming activities (e.g. gardening) o Talked with attendants
  • In general, took responsibility for themselves
  • Dorthea Dix – crusader for improved conditions for people with psychological disorders
    • Campaigned to improve the lives of people with psychological disorders
    • Efforts lead to 32 public hospitals being built
    • Staff unable to provide individual attention, ran by physicians not interested in psychological well-being, only interested in biological aspects of illness The Evolution of Contemporary Thought

Biological Approaches

  • Biological Origins in General Paresis and Syphilis:
    • By mid 1800s, partially understood anatomy and workings of the nervous system o Not enough to know if structural brain abnormalities that cause psychological disorders were present
    • Many people with psyc disorders had a syndrome of steady deterioration of mental and physical abilities and progressive paralysis = general paresis
      • = Degenerative disorder with psyc symptoms (delusions of grandeur) & physical symptoms (progressive paralysis)
      • Established that some people with general paresis also had syphilis o Louis Pasteur – germ theory of disease = disease is caused by infection of the body by minute organisms
      • Demonstrated relation between syphilis and general paresis
      • Causal link established between infection, damage to certain areas of the brain, and a form of psychopathology (paresis)  Genetics:

o Galton – originator of genetic research with twins, attributed many behavioural characteristics to heredity

  • Coined the terms nature and nurture (genetics vs. environment)
  • Mental illness can be inherited (internal trait)
  • Also created the eugenics movement, sought to eliminate undesirable characteristics from the population by restricting the ability of certain people to have children (= enforced sterilization)  Biological Treatments:
  • Experimentation with radical interventions began on those with psychological disorders o Insulin induced coma (Sakel) to treat schizophrenia **serious risks of treatment
  • Electroconvulsive therapy = applying electric shocks to the sides of the human head, used to produce epileptic seizures (used as a technique on patients with schizophrenia & severe depression)
  • Prefrontal lobotomy = a surgical procedure that destroys the tracts connecting the frontal lobes to other areas of the brain (Moniz) *used especially for violent behaviour

 Recipients became dull and listless, suffered serious losses in cognitive capacities

Psychological Approaches

  • Search for biological causes dominated until well into the 20th century  Mesmer and Charcot:

o Mesmer was a physician with an interest in astronomy who theorized that there was a natural energetic transference that occurred between all animate & inanimate objects that he called ANIMAL MAGNETISM, sometimes later referred to as MESMERISM

 Treated patients w/hysteria using animal magnetism (early practitioner of hypnosis) o Many people were observed to be subject to hysteria in 18th century western Europe o Hysteria = physical incapacities, such as blindness or paralysis, for which no physical cause could be found

o Mesmer believed hysteria was caused by a distribution of a universal magnetic fluid in the body

  • One person could influence the fluid of another to bring about change in the other’s behaviour
  • Conducted meeting involving mystery and mysticism, trying to transmit animal magnetism and adjust universal magnetic fluid in individuals to remove the hysterical disorder (first using rods, then just by looking)
  • Viewed hysteria of having strictly biological causes
  • Early practitioner of modern-day hypnosis o Charcot believed hysteria was a problem of the nervous system, also persuaded by psychological explanations  Breuer and the Cathartic Method:
  • Anna O had a number of hysteria symptoms: partial paralysis, impairment of sight and hearing, and difficulty speaking, sometimes went into a dream-like state
  • Breuer hypnotized her and she spoke freely about upsetting events from her past o Felt much better upon being awakened after hypnotic session
  • Cathartic method = reliving an earlier emotional trauma and releasing emotional tension by expressing previously forgotten thoughts about the event
  • Published “Studies in Hysteria” with Sigmund Freud  Freud and Psychoanalysis:
  • Much of human behaviour is determined by forces that are inaccessible to awareness o Psychoanalytic theory = psychopathology results from unconscious conflicts in the individual  Structure of the Mind (Freud):

Psyche = the mind, divided into 3 principle parts: id, ego and superego o Id = present at birth, repository of all energy needed to run the psyche, includes basic urges

*aka limbic system

  • Libido = biological source of the id’s energy (unconscious)
  • Id seeks immediate gratification = pleasure principle (tension is produced if not satisfied)
  • Ego = begins to develop from the id during the second 6 months of life, conscious, deals with reality

 Operates on the reality principle = mediates between the demands of reality and the id’s demands for immediate gratification

  • Superego = a person’s conscience, develops throughout childhood, arising from the ego
    • Incorporate parental values as their own
    • Ego and Superego aka frontal lobe  Defense Mechanisms:
  • Discomforts experienced by the ego as it attempts to resolve conflicts and satisfy demands of the id and superego can be reduced in several ways
  • Defense mechanism = a strategy used by the ego to protect itself from anxiety (repression, denial, projection, regression, rationalization)  Psychoanalytic Therapy:
  • Goal of the therapist is to understand the person’s early-childhood experiences, the nature of key relationships, and the patterns in current relationships
  • Therapist listens for core emotional and relationship themes that surface again and again o Free association = a person reclines on a couch, facing away from the analyst, and is encouraged to give free rein to his or her thoughts, verbalizing whatever comes to mind, without censoring anything
  • Transference = the person’s responses to his/her analyst that seem to reflect attitudes and ways of behaving toward important people in the person’s past
    • Analyst could gain insight into childhood origins of a person’s repressed conflicts o Interpretation = the analyst points out to the patient the meanings of certain of a person’s behaviour
    • Defense mechanisms are a principle focus  Jung and Analytical Psychology:
  • Collective unconscious = part of the unconscious that s common to all human beings and that consists primarily of archetypes = basic categories that all human beings use in conceptualizing about the world
  • Each of us has masculine and feminine traits that are blended o People’s spiritual and religious urges are as basic as the id urges o Extraversion vs. introversion  Adler and Individual Psychology:
  • Individual psychology = regarded people as inextricably tied to their society, fulfillment is found in doing things for the social good
  • Stressed the importance of working toward goals o Focus on helping people change their illogical and mistaken ideas and expectations o Feeling and behaving better depend on thinking more rationally (lead to CBT)  Continuing Influences of Freud and His Followers:
  • – Freud conducted no formal research on causes/treatments of psychological disorders o – Based on anecdotal evidence, not grounded in objectivity

 

1) Childhood experiences help shape adult personality (don’t focus on his psychosexual stages as much)

  • 2) There are unconscious influences on behaviour *people can be unaware of the cause of their behaviour
  • 3) The causes and purposes of human behaviour are not always obvious  The Rise of Behaviourism:
  • Dissatisfaction in Freud’s theories bright to a head by John Watson
  • Behaviourism = focuses on observable behaviour rather than on consciousness or mental functioning
  • Focus shifted from thinking to learning o 1) Classical Conditioning:
    • Ivan Pavlov
    • Unconditioned stimulus = automatically elicits a response without prior learning
    • Unconditioned response = response elicited by UCS
    • Conditioned stimulus = previously neutral stimulus that elicits a conditioned response after multiple pairings with UCS
    • Conditioned response = response elicited by CS
    • Extinction = CR gradually disappears if the CS is no longer followed by the UCS
    • John Watson and Little Albert o 2) Operant Conditioning:
    • Thorndike studied the effects of consequences on behaviour
    • Law of effect = behaviour that is followed by consequences satisfying to the organism will be repeated, and behaviour followed by unpleasant consequences will be discouraged
    • Skinner – operant conditioning “Principle of reinforcement”
    • Positive reinforcement = strengthening of a tendency to respond by virtue of the presentation of a pleasant event called a positive reinforcer
    • Negative reinforcement = strengthens a response but does so with the removal of an aversive event
    • Operant conditioning principles may contribute to persistence of aggressive behaviour of conduct disorder o 3) Modeling:
    • We learn by watching and imitating others (even without reinforcement)
    • Witnessing someone perform certain activities can increase/decrease diverse kinds of behaviours (Bandura & Menlove)  Behaviour Therapy:
  • Emerged in 1950s – applied procedures base don classical and operant conditioning to alter clinical problems = behaviour modification
  • Systematic desensitization = includes deep muscle relaxation and gradual exposure to a list of feared situations, starting with those that arouse minimal anxiety and progressing to these that are the most frightening (used to treat anxiety & phobias)
  • A state opposite to anxiety is substituted for anxiety as the person is exposed gradually to stronger and stronger doses of what he/she fears
  • Modeling also included in behaviour therapy
  • Operant techniques using rewards have been particularly successful with treating childhood problems

Intermittent reinforcement (only rewarding some instances of target behaviour) makes new behaviour more enduring  The Importance of Cognition:

  • Humans don’t just behave, we think and feel too
  • The way in which people think about situations can influence behaviour in dramatic ways  Cognitive Therapy:
  • Based on the idea that people not only behave, they also think and feel
  • Emphasize how people construe themselves and the world is a major determinant of psychological disorders
  • Therapist begins by helping clients become more aware of their maladaptive thoughts o Change cognition to change feelings and behaviour
  • Roots in Beck’s cognitive therapy and Ellis’s Rational Emotive Behavioural Therapy o REBT = sustained emotional reactions are caused by internal sentences that people repeat to themselves; these self-statements reflect sometimes unspoken assumptions – irrational beliefs – about what is necessary to lead a meaningful life