(1) Defining abnormality and history of mental disorders Flashcards
What is abnormality?
- Statistical infrequency
- Violation of norms
- Personal distress
- Disability / dysfunction
- Unexpected response
What is it meant by Violation of norms?
- Behaviour not tolerated by society, e.g. flashing, or eating people
- Values are cultural, contextual. Streaking, mooning, stripping
- Many behaviours do not offend society, but are considered abnormal, e.g. depression
What criteria can diagnose a mental disorder?
- No single criteria is sufficient to diagnose mental disorder.
- But a combination of several criteria may be more reliable
- In all cases, context and culture must be taken into account.
What is a -Diagnosis?
identification and labelling of disorder, based on signs, symptoms, case history, and laboratory findings
What did Thomas Szasz think about diagnosing mental issues?
- The state controls people through diagnosis
- Income goes to the state for ‘health control’
- Behaviours are defined more as ‘diseases’
- Drugs dispensa3on is controlled by the state, and only available on diagnosis
What did Thomas Szasz believe individuals had the right to do?
- Right to commit suicide
- Take dugs
- Live dangerously
- Annoy others without punishment (treatment)
- To be odd
What were psychological disorders believed to be due to in the ancient times?
- Symptoms of psychological disorders
- Spirits and possession: only bad if the spirit is bad…
- Treated by religious figures
What did the greeks and romans believe about mental disorders?
Hippocrates: Separated medicine from religion, magic and superstition, father of modern medicine
-Brain: consciousness, intellectual life, emotion (brain is responsible)
What did Middle Ages 500-1500 say about mental health?
- Churches gained influence
- Supernatural explanations, including sin
- Mass madness (could be response to situation)
- A period of depression, hunger and plague
- Treatment: Exorcism
- Witch hunting
- Change of religion
What happened with Witch Hunting ?
- Supress powerful females
- Records not kept, but estimates range between 100,000 to millions killed
- 6:1 female to males
- Scapegoats for all ill: illness, death, war, failure of crops
- Easy prey
- Restored sense of control to society
- Closely linked with sex: torture and confession, image as sexual agent, sex with Satan
- Targeted powerful female healers.
- E.g. Joan of Arc
What happened in the Pre-Humanism period?
- Slow emerging idea of ‘sickness’
- Criticism of witch hunting
- Beginning of the confinement of the mentally ill
- The move from family control to state control (asylum hospitals)
What happened to witchcraft in the pre-humanism period?
- Attempt to gain control or break free socially seen as mental illness
- Same obsession with sexual behaviour
- Psychiatrists replaced inquisitors
- ‘Science’ replaced theology
- Still about power
What were private institutions like?
- Pre 18th century very few confined
- In Britain, a ‘trade in lunacy’ existed
- Run by Doctors- or laymen
- Some charging high fees
- Secluded and secret- no safeguards.
- Poorly regulated
Why were people put into institutions?
- Wives confined to allow husbands free play
- Used to punish disobedient daughters
- Very little documentation
- Mainly women
What was Samuel Brackshaw’s story?
- A merchant who had a series of ‘brushes with the law’ (1770)
- Carried off to a private asylum
- 9 months in prison conditions, with no heating, no treatment
- Released by his brother, wrote two pamphlets
- However, admits that while confined, heard voices.
- Became unwell from situation
What was William Belcher’s story?
- Locked up between 1778-1795
- Judged insane by a jury that had not seen him
- Kept in filth, force fed, estates seizes
- Released by a Bethlem doctor
- Claimed sane when confined, but driven to madness- the purpose of the asylum.
What was Puberty for women like in the 18th century?
- Restrictive roles: Excluded from medicine, education, politics, law, economics, writing and all science
- No control over finance
- Little control over marriage: sex slavery?
- Restrictive clothing
- Terror over bodily functions
- Curtailment of exercise and hobbies
- Rebellion perceived as mental disorder.
- Not made aware of bodily changes
What were Signs of insanity?
- Mischievous and excited
- Attempt to take on ‘boy’ roles
- Flaunting sexuality
- ‘Moral perversion’- craving stimulants
- Impolite
- Adulterous, pregnant outside marriage, raped
- Postpartum depression, suicide and infanticide
What are the General clusters of ‘insane’ women?
- The sexual woman
- The hysterical teenager
- The fasting girls
- The drunks.
- The frigid spinster
- The lesbian
What was Work in asylums like?
- Cleaning, sewing, ironing. Had to be manual labour
- Considered an essential part of treatment (stopped complaints, reduced talking, focused aggression towards task)
- 6:30 to 5.00, 6 days a week
- Minimised machinary- hand labour desired
What were Cures for female insanity?
- Incarceration, chaining
- Deviation from Lady like behaviour resulted in solitary confinement, sedation, cold baths, seclusion in padded cells
- Prevention: girls kept in the nursery, drank milk, avoided meat- delaying menstruation.
- Controlling sexual urges:
- Injecting ice water into the rectum
- Leeching pubic area
- Clitordectomy
Dr Isaac Baker Brown’s Surgery 1859-1866
- Get them while they’re young (as young as 10)
- Five cases of insanity defined by wish for divorce.
- Signs of insanity: restless, excited, or loss of appetite, but most strongly, wish to escape, to work, especially as nurses
- Very successful: almost complete submission post-surgery
Women who are ‘cured’ are:
- Silent
- Have decorum
- Have taste
- Service
- Have piety
- Have gratitude.
What was treatment like in the 18th century?
- Treat because you’re unwell
- Removed the chains of people imprisoned
- Light and airy rooms replaced dungeons
- BEGUN TO TREAT THE INMATES AS SICK HUMAN BEINGS RATHER THAN AS BEASTS
Who was Emil Kraepelin (1856-1926)?
- creator of the first system of psychiatric classification
- Regarded psychiatry as part of the state’s responsibilities
- Physical factors (such as) fatigue= mental disfunction
Moral treatment approach
- Drugs were the most common treatment, including alcohol, cannabis, opium, choral hydrate, …
- Less than 1/3 of the patients were discharged as improved or recovered
What was the Mental hygiene movement?
-Dorothea Dix (1802-1887)
-Method of treatment that focused almost exclusively on the physical well-being of hospitalised mental patients
Administered by physicians
-Focused on the biological and physical aspects of illness
What was General Paresis?
- Siphilis (caused by microorganism)
- General Paresis – paralysis and insanity, then death
- Discovery through:
- Accurate description of symptoms leading to diagnosis as mental disorder (1825)
- Inoculation of paretic patients with syphilitic matter- no infection (thus relationship)(1897)
- Blood test- bacteria. (1906)
What is mental disorders like in the 20th century?
- Biological discoveries
- Development of a classification system for the mental disorders
- Emergence of Psychological causation views
- Experimental Psychological research
- Freud and behaviourism
