Chapter 1-Past & Present Flashcards
Generally, what is abnormal?
“Ab” = away from - the norm (social/statistical)
The 3 D’s (+1)
- Deviance: most obvious, behavior deviates from norm
- Discomfort: least observable, psychological OR physiological discomfort for individual
- Dysfunctional: more observable, behavior does not allow them to live up to expectations & interferes with daily activities
* 4. Dangerous: although they are most often VICTIMS, usually no more dangerous than others
Multicultural perspective
All behavior originates from & takes place within a cultural context
Culture
Ethnic, racial diversity,
& gender, disabilities, sexual orientations, etc.
Internal representation of culture
Values, attitudes, world views
Ex: “lokahi” - one with others/environment around you
External representation of culture
Customs, habits, traditions (actions)
“Lokahi” - feel welfare of others, help others, take care of land, don’t take more than you need
Collectivism
Identity part of culture/family/community, maintain health/well-being of group
Individualism
Value placed on personal achievement, independence, self
Cultural universality
Traditional view
Behaviors/disorders assumed to be the same cross-culturally
–>that which deviates from the majority is abnormal
Cultural relativity
Each behavior is to be evaluated relative to ones own culture/values
–> only behaviors that deviate from that culture are abnormal
Cultural universality vs relativity
Reality likely in between
Some universalities, but also deviations based on cultural context
Adaptation
Balance between what you do and what the environment requires of you
Maladaptation
Imbalance between what you do and what is expected of you
Maladaptive vs Deviant
All maladaptive behavior is deviant, but not all deviant behavior is maladaptive
Maladaptive vs Deviant
Andreasan study on creativity
Creative writers: 80% history of mood disorders
“Normal” controls: 30% history of mood disorders
*no difference in psychotic disorders
Maladaptive vs Deviant
Kyaga study
Creative individuals have higher prevalence of mood disorders compared to less creative
Stigma associated with abnormal (maladaptive) behavior
A set of negative & often unfair beliefs that a society/group have about something
Prejudice
Negative ATTITUDES based on group membership
-covert/internal prejudice: not explicitly stated, after diagnosis–> prejudice against self
Discrimination
Negative BEHAVIORS towards members of these groups
NMHA public survey about views on mental illness
Items most often chosen:
- Bring on own illness
- Due to sinful behavior
- Due to lack of will power/self-discipline
*belief of PERSONAL RESPONSIBILITY leads to stigma against mental illness
Systematic review: Angermeyer about stigma
Unpredictability & perceived dangerousness leads to stigma
Effects of stigma
- reluctant to seek help
- hinders treatment
- lack of social support
- view self more negatively
- often shunned by coworkers/family/friends
Prehistoric societies views/treatment
Focus: “evil spirits”
Abnormal–>presence of these spirits
Treatment: Trephination-carving/drilling holes in skull to “let out” spirits
Greeks/romans views/treatments
Still some focus on spiritual
&
Hippocrates: personality based on body fluids
FOCUS: physical/internal causes
Hippocrates personality theory:
Choleric
(Yellow Bile)
Impatient, cynical, irritable, touchy, aggressive
Abnormal = some symptoms of Mania, Antisocial personality, reactive temperament
Hippocrates personality theory:
Melancholic
(Black bile)
Moody, anxious, sad, pessimistic, serious, thoughtful
Abnormal = depression, anxiety disorders, neuroticism
Hippocrates personality theory:
Sanguine
(blood)
Sociable, outgoing, playful, hopeful, carefree
Abnormal = some mania, some personality disorders
Hippocrates personality theory:
Phlegmatic
(Mucous)
Passive, slow to warm up, controlled, reliable, even-tempered, organized
Abnormal = OCD, some personality disorders, rigidity, some eating disorders
Middle Ages views/treatment
Focus: Devil was cause of abnormal/dysfunctional behavior
Treatment: forms of punishment to get rid of evil spirits (whipping/beating)
End of Middle Ages–> medical explanations re-emerged
Renaissance views/treatment
Biological causes revisited
Johann Weyer: first physician to specialize in mental illness
-patients seen as ill, not evil
-Asylums: gentle and humane treatment, but didn’t have enough resources
Johann Weyer
first physician to specialize in mental illness
-patients seen as ill, not evil
(Renaissance)
Bedlam
Bethlehem hospital in London during Renaissance
-chaotic and tourist attraction
19th century views/treatment
Reform & Moral Treatment
-more humane conditions, unchained, peaceful, restful
Eventual decline in moral treatment due to overcrowding and limited resources
Philip Pinel
19th century
-provided more humane conditions, unchained patients, peaceful accommodations
William Tuke
19th century England (Quaker)
York Retreat: Restful Setting, like the real world
Benjamin Rush
19th century in US
Considered more humane treatment
-Restraining Chair: Meant to comfort/treat patient, and restrain disturbed patients
Decline of moral treatment
End of 1800s
Overcrowding, limited resources
Care was custodial “warehousing”
Somatogenic perspective
(Early 20th century)
Abnormal behavior has physical causes
Ex: syphilis & general paresis: forms of paralysis & delusional thinking
Treatment: many biological treatments (usually unsuccessful) like lobotomies, hydrotherapy, early ECT, etc
Emil Kraeplin
Argued physical factors responsible for behavioral disturbances
Psychogenic perspective
(Early 20th century)
Abnormal behavior can result in physical symptoms/problems
Treatments: hypnosis for hysterical disorders, psychoanalysis
*more care away from in-patient, to out-patient settings
Biopsychosocial
Varying interaction of biological, psychological, and social factors that can influence disease
1950s
Drug Revolution
Deinstitutionalization-many released from in patient settings
–>swinging door phenomenon
Modern treatment options
- Outpatient psychotherapy
- varying orientations
- financial issues - Community mental health centers
- helped many but–>resources being lost
Positive psychology
Focuses on what is right
-resilience, optimism, happiness
Positive traits: hard work, wisdom
Positive abilities: social skills, altruism, tolerance
Teach coping skills, encourage meaningful activities/relationships
Prevention programs
In communities, schools, etc.
- life skills trainings programs
- correct social conditions that underlie psychological problems (poverty, violence)
Mental Health Parity
Equal care for mental health
Utilization review committees
NOT effective at predicting actual patient needs
Multicultural perspective on treatment
Increase in and recognition of diversity
Minorities:
1. Seek treatment less
2 drop out of treatment sooner
3. Don’t improve as well in treatment
More effective:
- Sensitivity to cultural issues
- Incorporating cultural values in treatment
Cultural Awareness
Awareness of one’s OWN culture
Cultural Sensitivity
To be sensitive & respect (& appreciate) cultural differences
Cultural Competence
Ability to work competently with people within their own cultural values
Severe disturbance treatment
- psychotropic meds
- deinstitutionalization
- outpatient care-community mental health approach (many do not make lasting recoveries)
Less severe disturbances treatment
- outpatient care
- previously all private psychotherapy (expensive)
- community mental health centers, crisis intervention, social service agencies
- more centers devoted exclusively to one kind of problem (suicide, substance abuse, eating disorders, etc)
Managed Care Program
Insurance companies determine key issues-which therapists they may choose, cost, number of sessions
- shortens therapy
- favors non lasting results
- hard for severe disorders
- lower reimbursements than physical disorders
ACA
Mental health essential health benefit, must be provided by all insurers
-also must provide preventative mental health services at no cost
