2 - Historical & Contemporary Views of Abnormal Behaviour Flashcards
What was in the Edwin Smith papyrus?
- detailed description of treatment of wounds & other surgical operations
- 1st record of description of brain; clearly identified as centre of mental functioning
What provides clues to the earliest treatments of diseases and behaviour disorders?
Two Egyptian papyri - the Edwin Smith papyrus and the Ebers papyrus
What was in the Ebers papyrus?
- internal medicine
- circulatory system
- reliance on incantations & magic to explain/cure diseases w/ unknown causes
Name four peoples who believed abnormal behaviour was caused by possession.
Chinese, Greeks, Hebrews, & Egyptians
How were “possessed” people treated?
Depended on whether they were thought to be possessed by a good or bad/angry spirit/god
• good: reverence & awe; believed they had supernatural powers
• bad/angry: attempted exorcism (or other means of expelling the dark force)
What did exorcism usually entail?
Magic, prayer, incantation, noise-making, & use of horrible-tasting concoctions
Who is often referred to as the father of modern medicine?
Hippocrates - Greek physician (460-377bce)
What are five ways Hippocrates’ approach was progressive or revolutionary?
- believed mental disorders had natural causes & appropriate treatments
- emphasized importance of heredity & predisposition
- acknowledged importance of environment
- gave thorough descriptions of disorders based on clinical observation
- considered dreams to be important
What were the four humours and who was associated with them?
- blood (sanguis), phlegm, bile (choler), black bile (melancholer)
- described four temperaments: sanguine, phlegmatic, choleric, & melancholic - depending which fluid was thought to be dominant in the person
- initially associated w/ Hippocrates; later w/ Galen (Roman physician)
What was one way that Hippocrates’ approach was strange and flawed?
He believed hysteria (disease w/o physical cause?) was only sufferable by women and caused by a uterus wandering about the body pining for a child (Greeks saw the body as sacred and would not cut it open - had poor knowledge of physiology)
Name three people who contributed to our understanding of depression.
Philippe Pinel - improved classification schema & examined causes
Wilhelm Griesinger - sought biological determinants
Emil Kraepelin - created classification schema upon which modern system is founded & identified manic depression as a main category
What were some of Plato’s contributions to understanding mental illness?
- said mentally disturbed individuals were not responsible for their acts & should be treated differently - ie, not be punished the same way
- made provisions for mental cases to be cared for in community
- viewed psychological phenomena as responses of whole organism reflecting internal state & appetites
- emphasized importance of individual differences in abilities
- looked at sociocultural influences in shaping thinking & behaviour
- proposed treatment in which they would be engaged in conversations comparable to psychotherapy to promote health of their souls
- still felt there was some divine causation
What were Aristotle’s contributions to psychology?
- felt that “thinking” as directed would eliminate pain & help attain pleasure
- rejected idea that mental disorders could be caused by psychological factors such as frustration & conflict; generally followed Hippocrates’ theory of disturbances in the bile
How did physicians in Alexandria, Egypt treat mental patients?
Being a Greek city, physicians there continued from Hippocrates’ work; temples to Saturn were first-rate sanatoria
• pleasant surroundings considered to be of great therapeutic value
• constant activities like parties, dances, walks in the gardens, rowing the Nile, & concerts
• used dieting, massage, hydrotherapy, gymnastics, & education
• also practiced bleeding, purging, & used mechanical restraints
What did Asclepiades contribute?
- theory that disease was caused by flow of atoms through pores
- developed treatments like massage, special diets, bathing, exercise, listening to music, & rest/quiet
What did Galen contribute?
A Roman physician (130-200 AD)
• elaborated on Hippocratic tradition
• studied anatomy of nervous system (by dissecting animals)
• divided causes into physical & mental categories
What is contrariis contrarius?
“Opposite by opposite” - eg having patients drink chilled wine while in a warm bath
Discuss the early views of mental disorders in China.
- yin/yang - sought to treat by balancing these energies/forces
- Chung Ching (sometimes called the Hippocrates of China) implicated organ pathologies as primary causes & based his theory on clinical observations; also believed that stressful psychological conditions could cause organ pathology & used both drugs & appropriate activities to restore emotional balance
- regressed to supernatural causes (like in the West), eg possession
- “Dark Ages” in China were shorter & less severe (in terms of treatment)
What survived in Islamic countries in the Middle Ages?
Scientific aspects of Greek medicine; first mental hospital was established in Baghdad in 792 AD, followed by two others (in Damascus & Aleppo), where patients received humane treatment
Who was Avicenna?
- called the “prince of physicians”
- from Persia; lived 980-1037 AD
- wrote The Canon of Medicine (possibly most widely studied medical work ever written)
- humanely & creatively treated a delusional patient who thought he was a cow and wanted to be killed
What were the Middle Ages like in Europe?
- limited inquiry into abnormal behaviour
- treatment of mentally ill characterized by ritual/superstition
- largely devoid of scientific thinking or humane treatment for mentally ill
- mental illness prevalent especially near end when institutions, social structures, & beliefs were changing
When did mass madness reach its peak?
During the 13-1400s
• Black Death was ravaging Europe, disrupting social organization
• likely that the depression, fear, & wild mysticism engendered by the events of this period was correlated
Describe two modern cases of mass hysteria.
April 1983 - affected hundreds of West Bank Palestinian girls
1990 - men in Nigeria feared their genitals had vanished; accompanying fear of death; thought it occurred supernaturally for the magical benefit of others; occurred at a time when women were more successful during economic strain
Who mainly dealt with mental illness in Europe during the Middle Ages?
The clergy - used prayer, holy water, sanctified ointments, breath/spit of priests, touching of relics, visiting holy places, & mild forms of exorcism; were generally quite kind
What was thought to be the connection between mental illness and those accused of witchcraft in the Middle Ages? What is now thought to be the connection?
- used to think mentally ill were accused of witchcraft & killed
- now think that both mentally ill and “witches” were thought to be possessed; different types of possession
Give some examples of mass madness.
- tarantism
* lycanthropy
Who was Paracelsus?
- Swiss physician (1490-1541)
- critic of superstitious beliefs about possession
- rejected demonology
- believed in astral influences (especially the moon - hence lunatic)
Who was Johann Weyer?
- German physician (1515-1588)
- carefully studied imprisonment, torture, & burning of “witches” b/c it deeply disturbed him
- published “On the Deceits of the Demons”, a point-for-point rebuttal of the Malleus Maleficarum (witch-hunting handbook, published nearly 100 years prior)
- felt that all “witches” were really sick (in mind or body)
- one of first physicians to specialize in mental disorders
- viewed as the founder of modern psychopathology
- writings banned by church; scorned by peers
What did St Vincent de Paul say?
“Mental disease is no different than bodily disease and Christianity demands of the humane and powerful to protect, and the skillful to relieve the one as well as the other.”
What were asylums like initially?
- storehouses for insane; aim was to remove them from society (those who were troublesome & incapable of caring for themselves)
- deplorable conditions (eg Bedlam); patients/inmates treated more like beasts than human beings
- often charged a fee to let people view the patients
What was the first hospital in the US devoted exclusively to mental patients, and what were their methods?
The Public Hospital in Williamsburg, Virginia (1773)
• believed that patients had to choose rationality over insanity
• “treatments” involved intimidation and were aggressive; based on scientific views of the day, aiming to restore balance to the physical body and brain
- powerful drugs
- water treatments
- blistering
- bleeding
- electric shocks
- physical restraints
What was Philippe Pinel’s experiment?
To remove chains from patients and treat them with kindness
• proposed this when he took over La Bicêtre in France in 1792
• would likely have been beheaded if it failed
• proved a great success
• created impetus for reform in the rest of Europe & America
* Pussin (Pinel’s predecessor) said he had taken humanitarian steps in his time - replacing chains w/ straitjackets for some patients & forbidding staff from beating them
Who was William Tuke?
- English Quaker
* established York Retreat
Describe the York Retreat.
- established around same time as when Pinel took over La Bicêtre (1792)
- pleasant country house
- mental patients lived, worked, & rested in a kindly, religious atmosphere
- Quakers believed in treating all people w/ kindness & acceptance
- their belief that kind acceptance would help mentally ill people sparked growth of more humane psychiatric treatment in a time when mental patients were ignored/mistreated
- continues today
Discuss the reform of mental care in England following the work of Tuke and Pinel.
- word of Pinel’s success spread to England
- Tuke gained support of medical practitioners
- Samuel Hitch put trained nurses and trained supervisors in staff at Gloucester Asylum
- Thomas Wakley lobbied for reforms
- Lunacy Inquiry Act passed (1842) - required regular & effective inspection of asylums
- County Asylums Act passed (1845) - every county required to provide asylum to “paupers and lunatics”
- expanded policy to colonies after scandal in Jamaica
Who was Benjamin Rush?
- founder of American psychiatry
- signed Declaration of Independence
- wrote first systematic treatise on psychiatry in America
- first American to organize a course in psychiatry
- believed in astrological influences
- relied mainly on bloodletting & purgatives
- invented & used “tranquilizing chair”
Describe moral management and discuss its effectiveness.
- emphasized moral & spiritual development & rehabilitation of “character” rather than physical/mental disorders
- treatment usually involved manual labour, spiritual discussion, & humane treatment
- highly effective - 59-71% discharge rate (compared to 45.7% “cure” rate at Bedlam)
- surprising considering lack of antipsychotic drugs & prevalence of syphilis (CNS disease; then incurable)
Why was moral management abandoned?
• ethnic prejudice (created tensions between staff & patients)
• leaders failed to train successors
• overextension of hospital facilities (thought only difference between large hospital & small hospital was size)
• rise of mental hygiene movement
• advances in biomedical science
* by 1950s, discharge rates were down to about 30%
Who discovered that electric shock could be therapeutic? Who began implementing it and to treat what?
- Benjamin Franklin discovered it
* Cerletti & Bini implemented it in 1938 to treat depression
Who was Dorothea Dix?
- New England teacher forced to retire b/c of tuberculosis
- taught in women’s prison - saw deplorable conditions of asylums
- campaigned for change for 40 years -contributed to development of mental hygiene movement
- established 32 mental hospitals
- helped reform several countries (including US, Canada, Scotland)
What criticisms have been aimed at Dix?
- claimed building hospitals & increasing # of people in them -> overcrowded facilities
- argued that separation from society impeded moral therapy & deferred search for more effective treatments
How did military medicine contribute to the advancement of mental health treatment?
- first mental health facility for war casualties opened by Confederate Army
- psychiatrists in Germany in late 1800s worked w/ military administration to detect mental health issues that could interfere with performance of duty
Who were “alienists”, and what was their role during the 19th century?
- medical doctors treating the “alienated”, or insane; effectively psychiatrists
- gained control of asylums in latter part of century (instead of laypersons)
- maintained that emotional problems were caused by depletion of bodily energies from excesses in living; believed this to be treatable
Why did psychiatrists do little to educate the public or reduce their fear about insanity in the early 20th century?
- had little information to impart
* sometimes employed procedures that were damaging to patients
Who was Clifford Beers?
- Yale graduate
- described his own mental collapse & the bad treatment he got in 3 typical institutions of the day (including being put in a straitjacket)
- recovered in home of a kind attendant
- campaigned to make people realize that this was no way to handle the sick
- gained attention of William James & Adolf Meyer (“dean of American psychiatry”)
What year marked the beginning of an important period of change?
1946
• Mary Jane Ward published “The Snake Pit” - also made into a movie, raised awareness & concern about treatment of mental patients
• NIMH established
Name two pieces of legislation that helped change the state of mental health care in the US.
- Hill-Burton Act - funded community mental health hospitals
- Community Health Services Act (1963) - helped create far-reaching set of programs to develop outpatient psychiatric clinics, inpatient facilities in general hospitals, and community consultation & rehabilitation programs
When did deinstitutionalization begin, where is it happening, what was the original intention, and what are some of the actual outcomes?
• began after 1950
• happening internationally (US, Hong Kong, Netherlands, Finland, England, Wales, Australia, Italy)
• originally considered more humane (and cost effective)
- prevent negative adaptations to hospital confinement
- prevent “escape” from demands of life & submission to sick role
- hope that meds would help adjustment & functioning in society
• many homeless people are mentally ill; outreach & community services have failed to bridge the gaps
[looks a lot like executives didn’t want to spend money on housing “crazy” people, giving them an excuse to not be part of society; they preferred them being homeless because that was better for their bottom line.]
Name four major themes that developed in the last two centuries that have influenced our views of abnormal behaviour.
- biological discoveries
- development of classification system
- emergence of psychological causation views
- experimental psychological research developments
What biological discovery led to the exploration of brain pathology as a causal factor in mental illness?
General paresis (ie brain syphilis) was gradually better understood & eventually treated
• discovered they didn’t react to injections from syphilitic patients
• developed blood test for syphilis
• malarial treatment
Who were Albrecht von Haller & Wilhelm Griesinger?
Advocates of researching brain pathology’s relation to mental illness
Name at least two other disorders that were found to have organic pathologies.
- cerebral arteriosclerosis
- senile mental disorders
- toxic mental disorders
- certain types of mental retardation
What were some of the medical missteps in the 20th century?
- surgeries removing body parts (eg teeth, tonsils, gonads - Henry Cotton)
- lobotomy (Egas Moniz -> Walter Freeman)
Who was Emil Kraepelin?
(1856-1926; German psychiatrist)
• created system of classification that led to DSM
• argued that brain pathology was an important factor in mental disorders
• believed that course of disorder could be accurately predicted
What are the “ancestral” roots of psychoanalysis?
Hypnosis - induced state of relaxation in which one is highly open to suggestion - especially in its relation to hysteria
Name two drugs that were employed to treat psychosis as of 1956 in a widespread fashion in the US.
- reserpine - derived from Rauwolfia (used as herbal folk remedy in India for centuries)
- chlorpromazine - first used as malaria treatment, then anaesthetic
Who was Franz Anton Mesmer?
(1734-1815; Austrian physician)
• developed ideas of Paracelsus (influence of planets on human body)
• believed there was a universal magnetic fluid in all people responsible for health/illness, & that it was influenced by planets & magnetic forces in other people
• developed technique (mesmerism) which utilized many techniques later associated w/ hypnosis
• discredited by colleagues who found that results were due to patients’ belief that they were receiving effective treatment [placebo effect]
Who started the Nancy School and on what bases?
Liébault & Bernheim
• phenomena observed in hysteria (eg paralysis of a limb, inability to hear, anaesthetic areas) could be reproduced in normal subjects through hypnosis
• same symptoms could also be removed through hypnosis
Who opposed the Nancy School? What was his view?
Jean Charcot; believed degenerative brain changes caused hysteria (eventually proven wrong - then promoted study of psychological factors in mental disorders)
What major step was taken because of the Nancy School-Charcot debate, and what question remained unanswered?
- became clear that mental disorders could have psychological bases, physiological bases, or both
- how do psychologically based mental disorders actually develop?
What was Freud’s role in answering the question of how psychologically based mental disorders develop?
• studied with Charcot; later became acquainted w/ work of Liébault & Bernheim
• worked w/ Breuer, who had incorporated innovative methods of hypnosis into his work w/ patients
- directed patients to speak freely of their problems while hypnotized
- usually resulted in considerable emotional display & catharsis
- generally unaware of any connection between problems & hysterical symptoms - led to notion of unconscious mind
• eventually dispensed w/ hypnosis entirely, replacing it w/ free association & dream analysis
Discuss the early psychology laboratories.
- began with Wilhelm Wundt in 1879 (established first experimental psychology laboratory in Germany)
- Cattell brought Wundt’s methods to the U.S.
- Witmer (father of clinical psychology) combined research w/ application & established first psychological clinic in U.S.
- William Healy established Institute of Juvenile Research & was one of first to acknowledge environmental/sociocultural factors in mental illness
What did Watson contribute to the understanding of human behaviour?
That there are sociocultural influences which shape both normal and abnormal behaviour
What are the problems with examining historical times?
• tenacity of misinformation • open to reinterpretation • can't rely on direct observation (must rely on documents) - out of context - lack of understanding of motives or purposes of documents - bias of writers • varied meanings of terms • bias of interpreters
What were asylums historically?
Institutions meant solely for care of mentally ill
What is the behavioural perspective?
Theoretical viewpoint organized around theme that learning is central in determining human behaviour
What is behaviourism?
School of psychology that restricted itself primarily to study of overt behaviour
What is catharsis?
Discharge of emotional tension associated w/ something (eg talking about past traumas)
What is classical conditioning?
NS paired w/ US repeatedly, eliciting UR, until NS becomes CS (eliciting CR, which resembles UR)
What is deinstitutionalization?
Movement to close mental hospitals & treat people with severe mental disorder in the community
What is dream analysis?
Method involving recording, describing, & interpreting patient’s dreams
What is exorcism?
Religiously inspired treatment procedure designed to drive out evil spirits or forces from a possessed person
What is free association?
Method for probing the unconscious by having patients talk freely about themselves, their feelings, & their motives
What is insanity?
Legal term for mental disorder, implying lack of responsibility for one’s actions & inability to manage one’s affairs
What is lycanthropy?
Delusion of being a wolf
What is mass madness?
Widespread occurrence of group behaviour disorders that were apparently cases of hysteria
What was the mental hygiene movement?
Advocated method of treatment focused almost exclusively on the physical well-being of hospitalized mental patients
What is mesmerism?
Theory of “animal magnetism”
(hypnosis) formulated by Anton Mesmer
What was moral management?
Wide-ranging method of treatment focusing on patient’s social, individual, & occupational needs
What was the Nancy School?
Group of physicians in 19th-century Europe who saw hysteria as a form of self-hypnosis
What is operant (instrumental) conditioning?
Form of learning in which reinforced responses are more likely to occur again in similar situations
What is psychoanalysis?
Methods Freud used to study and treat patients
What is the psychoanalytic perspective?
Theory of psychopathology that emphasizes inner dynamics of unconscious motives
What was Saint Vitus’s dance?
Dancing mania & mass madness that spread from Italy to Germany (& rest of Europe) during Middle Ages
What was tarantism?
Dancing mania that occurred in Italy in 13th century
What is the unconscious?
Major portion of the mind consisting of hidden mass of instincts, impulses, & memories; not easily available to conscious awareness but plays important role in behaviour
