Chapter 2 (Lecture)

Question 1

Whig history

Answer 1

a historical narrative that frames the past as a sequence of events leading up to the present through increasing enlightenment and progression. This term is often used to criticise narratives and writings

Question 2

What is madness? (1700s)

Answer 2

• elastic connect that helped explain a range of unusual bizarre, or irrational human behaviour
• explained through: demonic possession, misfortune in love, head injuries, bodily humours
• current definitions draw on contemporary concepts related to mental illness and disorders

Question 3

Madness before the 18th Century

Answer 3

treated madness in similar ways:
- trepanning
- religious ceremonies
- beatings

Hospitals to house those deemed mad in Europe detained or confined individuals, and it was not until later that care and treatment of patients became a priority as asylums emerged and medicine became responsible for managing mental illness

Question 4

Social History

Answer 4

subfield within history that seeks to understand historical social groups and structures, often with a particular focus on traditionally marginalised groups

• considers not only key achievements, but also the daily lives of ordinary people and how they may have experienced cultural or scientific change (urbanisation, industrial revolution)

Question 5

How did they treat madness in the 18th century?

Answer 5

• Bedlam was the first asylum for the mentally ill in England
• in the late 18th century “madness” evolved to be known as mental illness
• mental illness became medicalised through a long process related to other societal changes however non-medical treatments continued to be still be used

Question 6

medicalisation

Answer 6

the process where a condition becomes understood as something should be treated by physicians

Example: antisocial disorders (some people are just shy!)

Question 7

Factors contributing to the medicalisation of mental illness

Answer 7

• challenges to the authority and power of the Church in Europe
• the scientific revolution - idea that science could solve (all) problems
• the enlightenment - skepticism about religion and rejection of supernatural forces and causes
• increased urbanisation - may have led to increased visibility of people who appeared to behave unusually and were labelled “mad”

Question 8

The long process of medicalisation

Answer 8

Pre-1700s: madness, natural and supernatural causes, porto-medical explanations

Late 1700s: medicalisation and asylums

1800s: psychological explanations and growing influence of psychiatry, physical treatments (shock treatment and psychosurgery), and psychotherapy

Question 9

Large shifts (18th century compared to today)

Answer 9

• madness to mental illness
• madhouses to asylums to deinstitutionalisation
• diverse causes of madness, to medicalisation of mental illness and biological treatments, as well as psychological therapy (psychoanalysis)

Question 10

The transformation into mental illness and rise of the asylum

Answer 10

Late 18th century as transition point - emergence of “mental illness”
- medical definition and medical treatment becoming dominant
- mental illness: a problem for medicine and medical professionals

19th century - emergence of large state-run mental hospitals in Europe and colonies
- Diverse patients and diagnoses: mania, melancholy, “insanity”
- Physician led and operated - specialised medical knowledge of mental illness

Question 11

The development of asylums

Answer 11

• 1800s large institutions devoted to the care of people with mental illness
• it became a business and an industry
• overseen by physicians who specialised in mental illness
• asylums were a key component of the mental illness care through the 1960s and still exist today (but only for those who need intense care)

Question 12

How does urbanisation factor into the emergence of mental illness and asylums? How were problems related to mental illness viewed differently in cities?

Answer 12

• increased public attention to mental illness
• more visible in larger populations and cities
• people were deemed “dangerous” to society leading to state apprehension and detainment
• asylums as a response to an emerging social problem
• included charitable, private, state/public facilities
• new laws and new institutions (psychiatric hospitals)

Question 13

Humoral Theory

Answer 13

Hippocrates humoral theory of illness proposed that the body consisted of 4 humours: black bile (melancholic), yellow bile (choleric temperament), blood (sanguine), and phlegm (phlegmatic).

Therefore, if someone was too sad they had too much black bile, and if someone was manic they either had too much blood or yellow bile.

Question 14

critiques of the asylum era

Answer 14

• “moral treatment” is often pointed to as the foundation of the asylum movement in the treatment of mental illness
• moral treatment was a philosophy that emphasised humane benevolence in treatment rather than restraint and punishment and attempted to restore mental health
• enlightenment focus on rationality and optimism: belief that science could solve every problem

Question 15

what is moral treatment?

Answer 15

• goal: ending dehumanising treatment in madhouse - to build asylums providing active treatment
• calm environment for people to learn new skills, work, engage in recreational activities
• barriers to achieving this stemmed from overcrowding, understaffing, insufficient funding

Question 16

Social control in asylums

Answer 16

• people viewed asylums as a way to hide problematic people so it wasn’t really a curing thing more of a place of confinement
• once established they were filled as unwanted behaviours and reimagined and relabelled as ‘mental illness’

Question 17

Debates on the causes of mental illnesses: nature (genetics) vs nurture (environment, experience)

Answer 17

• eugenics: heredity/genetics as cause, sought to eliminate the genetic material thought to cause mental illness through forced sterilisation and life-long institutionalisation
• organic lesions causing mental illness could be identified through autopsies and surgical techniques
• organicists: causes of mental illness were perhaps elusive, but physical body-focused treatments could provide temporary relief (bleeding, purging)

Question 18

How did the psychiatrist Emil Kraeplin view mental illness?

Answer 18

mental illness was broad term including series of discrete diseases- each had its own symptoms, and natural course (quite consistent with current psychology view in the DSM)

Question 19

Unconscious view of mental illness

Answer 19

problems were psychological rooted in the mind and personal experience

• didn’t reject organic explanations but prioritised treatment by a psychiatrist to bring patients back to rational thinking and have them see the unsound nature of their ideas when ill
• Psyche is central to mental illness - the belief that experience is the cause of mental problems is an old idea
• treatments like dream analysis, free association, hypnosis - and talk based therapy too

Question 20

Sigmund Freud

Answer 20

• trained as a neurologist
• important theorist, arguing that mental illness was psychological in nature emphasising the importance of the subconscious mind
• his treatment techniques focussed on helping patients access and understand their subconscious thoughts and urges

Question 21

Contributions from Freud

Answer 21

• came to include more “mild” forms like anxiety and obsessions
• his treatment techniques began to move treatment for mental illness from the hospital to private offices (the psychiatrists couch)
• popularised the notion that our childhood experiences influence our mental health in adulthood, especially interpersonal relationships
• modern talking therapies are influenced by psychoanalysis

Question 22

critiques of psychoanalytic theory (freud)

Answer 22

• lack of research/scientific rigour in the development of theory
• heavy emphasis on childhood sexuality was problematic for some
• Freud’s normative ideas about gender were considered dated by some, but it may have led to more examination of gender relations

Question 23

War trauma

Answer 23

• soldiers got shell shock and war neurosis due to their combat trauma
• symptoms (memory disturbances, temporary blindness, paralysis with no evident physical cause) and syndrome seen as unconscious defence mechanism (repressed emotions and memories)

Question 24

Treatment for war trauma

Answer 24

WHR Rivers: a medical doctor and anthropologist at hospital in Scotland

• treated many wounded soldiers, and treatments partially based on Freuds ideas, included psychotherapies designed to draw the traumatic experiences out of the unconscious so they could process their memories
• modern conceptualisation of PTSD is related to these early ideas
• represents another example of a “new” and emerging disorder

Question 25

Attachment theory

Answer 25

• In the 1940s attention turned to further focus on child development, the mother-child relationship, and how these may impact adult mental health
• “good mothering” was seen as the foundation for emotional health and healthy relationships - influencing later interpersonal relationships
• attachment theory remains an important aspect of child psychology research and practice

Question 26

Cognitive Behavioural Therapy (CBT)

Answer 26

• CBT involves efforts to change thinking patterns b using problem solving, recognise distortions in thinking, gaining better understanding of situations, learning to develop confidence in owns abilities.
• draws on the behavioural theories of Skinner and Pavlov (reconditioning responses to stimuli)
• widely used b/c it can be short term, cost effective, amenable to evaluation of outcomes, aligned with goals of evidence-based treatments, effective!

Question 27

Shock therapies and psychosurgery

Answer 27

• 1930s-1950s movement towards discovering physical cures for mental illness by direct physical interventions acting on the biology of the brain
• electroconvulsive therapy (ECT) has been highly controversial
• Other shock therapies were insulin shock and medically induced convulsions or comas
• prefrontal lobotomies (severing prefrontal cortex) were used for some mental and behavioural disorders - but these often resulted in personality changes, lost capacity and harms (brain damage, death in some cases)

Question 28

Rights and perspectives of patients (post world war 2)

Answer 28

• attitudes about rights of patients have changed dramatically b/c of recognition of the errors of the past (and treatments now deemed unethical)
• the voices of patients have been largely absent from accounts of treatments of mental illness (due to focus on practitioners, lack of historical sources)

Question 29

Social movements and the patients voice: deinstitutionalisation

Answer 29

• advocated for greater patient autonomy and self-determination, they drew attention to the very poor conditions of asylums
• physicians saw forced hospitalisation as inherently harmful
• introduction of medications has helped a lot
• 1960s-1990s psychiatric institutions greatly declined, as populations were moved to community settings

Question 30

what is etiology?

Answer 30

cause (or set of causes) of a disease or condition

Question 31

what is organicists?

Answer 31

belief that mental illness has an organic cause or component

Question 32

what is psychodynamic perspective?

Answer 32

focus on unconscious psychological processes

Question 33

what is psychodynamic theory?

Answer 33

focus on psychological roots of emotional suffering through self-reflection and self-examination - the relationship between therapist and patient provides a window into problematic relationship patterns. goal is to alleviate the symptoms and help people lead healthier lives

Question 34

what is moral treatment philosophy?

Answer 34

often pointed to as the foundation of the asylum movement in the treatment of mental illness:: emphasised humane benevolence in treatment rather than restraint and punishment and attempted to restore mental health

goal: ending dehumanising treatment by building asylums providing active treatment

Question 35

what is social control perspective?

Answer 35

critical view of the asylum era interpreted as a social project to remove “problematic people” from society

• theorist (Foucault and Scull) saw psychiatrists as agents of control, rather than providers of care, whose role was to enact discipline on unruly bodies