Defining abnormality and history of mental disorders

Question 1

give 5 criteria for defininig abnormality

Answer 1

•   Statistical infrequency
•   Violation of norms
•   Personal distress
•   Disability / dysfunction
•   Unexpected response

Question 2

what is statistical infrequency?

Answer 2

Based on statistical principals, normal distribution
•  Used to define mental retardation, for example
•  But what about ‘good’ outliers?
Genius
•  And what of ‘appropriate’ abnormal emotions?

Question 3

What is violation of norms?

Answer 3

Bereavement
•  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
Public exposure: are they mad?

Question 4

What about personal distress?

Answer 4

Intuitively a major criteria
•  But what of those who don’t? Paedophiles, psychopaths
•  And what if it is appropriate? Fear and anger in war, depression in bereavement

•  If people feel something is wrong, surely it is?
•  Expectations?
Example: body image.
I want to be 10 / 10 happy 100% of the time!!!

Question 5

Outline dynsfunction/disability as a criteria of mental health

Answer 5

Related to self care/functioning in daily life
•  Work or relationships based - can give an indication beyond self-report
•  But context still essential: –  When is it normal to withdraw from friends and family? –  When is it normal to miss work / college, or perform poorly? •  Alone, this criteria cannot imply mental disorder, but combined with others, it might.

Question 6

outline unexpected behaviour

Answer 6

Related with the response level to a situation
e.g. spider phobia
•  Related with matching the response to the situation
e.g. obsession with weight loss in thin people
Fear of Spiders: Mental disorder?
Fear in UK versus fear in Australia

Question 7

define diagnosis

Answer 7

Identification of a disease or condition by a scientific evaluation of physical signs, symptoms, history, laboratory test results, and procedures.

– Diagnosis: identification and labelling of disorder, based on signs, symptoms, case history, and laboratory findings

– Differential diagnosis- which of several ‘suspects’ is producing the symptoms?

Question 8

what does APA define as a mental disorder?

Answer 8

a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.

Question 9

Outline Szaz’s thoughts on Dianosis

Answer 9

Diagnosis is evil
– The State controls people through diagnosis – Income goes to the state for ‘health control’ – Behaviours are defined more and more as ‘diseases’ (smoking, drinking, gambling)
– Drugs dispensation is controlled by the state, and only available on diagnosis

Question 10

what does Szaz campain for?

Answer 10

•   The right to commit suicide
•   The right to take drugs
•   The right to live dangerously
•   The right to annoy others without punishment (treatment)
•   The right to be odd

Question 11

outline why diagnosistic criteria such as the DSM and ICD are considered “gold standard?”

Answer 11

•   Behaviour viewed IN CONTEXT
•   Extended distress and/or impaired functioning, in respect of expected performance
•   Supposedly take into account the political context: the relationship between the individual and society

Question 12

Outline what forms current views in abnormal psych?

Answer 12

Prevailing attitudes of past times + Advances in science –> Current views of abnormal behaviour

Question 13

Outline how mental health was viewed in ancient times?

Answer 13

Spirits and possession; only bad if the spirit is bad… n  Treated by religious figures
Early Demonology

An evil being, such as the devil, may dwell within a person and control his or her mind and body Exorcism

Delphi temples

Question 14

what was the view of the grrek and romans when it came to mental health?

Answer 14

Hippocrates and the greeks and romans

Father of the modern medicine Separated medicine from religion, magic and superstition

Brain –> Intellectual life, Emotion, Consciousness

–> Pathology –>

Deviant thinking Deviant behaviour

Question 15

what is somatogenesis

Answer 15

Somatogenic theory states that abnormality is caused by a biological disorder or illness

Question 16

what did hippocrates argue for mental health?

Answer 16

Mental Disorders –> Melancholia Phrenities Mania—> (treatment) –> Tranquillity Sobriety Food care Sexual abstinence

Humeral theory: black bile, blood, yellow bile and phlegm –> Preponderance –> Dullness, melancholia, Irritability, temperment

Treatment: Diet, exercise, change of cognitions and life style

Question 17

what time period was the middle ages and how did they explain mental health disorders?

Answer 17

500-1500
Churches gained influence
Supernatural explanations, including sin n 
Mass madness n 
A period of depression, hunger and plague n  Treatment: Exorcism n  Witch hunting

Question 18

Outline witch trials

Answer 18

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.
Example of a convenient witch: Joan of Arc

Question 19

Outline pre-humanism ideas of mental illness

Answer 19

Slow emerging idea of ‘sickness’  
Criticism of witch hunting  
Beginning of the confinement of mentally ill – the move from family control to state control --> asylym Hospitals  
Madness replaces ‘witchcraft’  
Attempt to gain control or break free socially seen as mental illness.  
Same obsession with sexual behaviour.  
 ‘Psychiatrists’ replaced inquisitors.  
‘Science’ replaced theology.  
But still about power.

Question 20

outline the priory of st mary

Answer 20

Priory of St. Mary of Bethlehem (1243)

London

Hospital for the confinement of the mentally ill

Entertainment: tickets of admission to bedlam were sold! Crude and painful treatments

Bedlam –>Descriptive term for a place or scene of wild uproar and confusio

Question 21

outline pre-18th centuray treatment of mental health

Answer 21

Private institutions
n  Pre 18th century very few confined. n  In Britain, a ‘trade in lunacy’ existed. n  Run by Doctors- or laymen. n  Some charging high fees. n  Secluded and secret- no safeguards
Allegations

Wives confined to allow husbands free play.

Used to punish disobedient daughters.

Very little documentation.

Question 22

Outline the study of samuael bradshaw and William Belcher

Answer 22

The story of Samuel Brackshaw
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.

The story of William Belcher
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.

Question 23

Outline why it was so bad for women in the 17th centuary

Answer 23

17th century onward, almost twice as many women incarcerated.
The proportion of female carers declined.
The essence of madness- irrationality, is perceived as a feminine trait.
Puberty for women seen as a ‘danger’ zone for insanity.

Question 24

Outline women puberty in 18th centuary

Answer 24

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

Question 25

give some 18th centuary signs of insanity

Answer 25

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.

Question 26

give general “clusters” of insane women

Answer 26

n  The sexual woman.

The hysterical teenager.

The fasting girls.

The drunks.

The frigid spinster

The lesbian

Question 27

explain asylum work

Answer 27

Cleaning, sewing, ironing.
Considered an essential part of treatment (stopped complaints, reduced talking, focused aggression towards task)
6:30 to 5.00, 6 days a week.
Minimised machinery- hand labour desired.

Question 28

Outline the case of Bertha Mason

Answer 28

Bertha Mason,  Rochesters’ wife  
Violent and hideous   
predator on men.  
 Confined to the attic: ‘clothed hyena’; corpulent’ ‘demon’. 
 Explanations:  
 ‘tainted heredity’- mother mad drunk.  
Madness carried through female reproductive organs. 
  Worst attacks during mentrual period

Question 29

Outline 18th centuary “cures” for female insanity

Answer 29

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

Question 30

What was Dr Isaac Baker Browns surgery?

Answer 30

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…
1867, Brown expelled from Obstetrical Society

Not for his methods: but for coercing and tricking patients into surgery.

The issue: misuse of male authority: q  Male doctors ‘guardians of honour’ q  Women not in a position to dispute, must believe what they’re told. q  This must be upheld, hence Brown——out!

Question 31

What, during the 18th centuary was consdidered successful treatment?

Answer 31

Women who are ‘cured’ are: Silent Have decorum. Have taste. Service.  Have piety. Have gratitude.

Question 32

Outline the case of Orphilia

Answer 32

Connolly, Hanwell Asylum.

Ophelia

Weak and irrational

Loose hair and flowers, symbols of sexual promiscuity and sexuality.

Connections to song, metaphors, free association- creative, unstructured.

Connection to water- mystical, life giver and taker, and representation of female fluids, blood, milk, tears.

Question 33

Outline the humanism approach to treating mental disorders

Answer 33

Philippe Pinel (1745-1826) Primary figure in the movement for humanitarian treatment of the mentally ill in asylums

“Patients were shackled to the wall of their cells, by iron collars which held them flat against the wall and permitted little movement… they could not lie down at night, as a rule… Oftentimes there was hoop of iron around the waist of the patient and in addition… chains in both the hands and feet… these chains were sufficiently long so that the patient could feed himself out of a bowl, the food usually being bread soaked in a week soup. They were presumed to be animals… and not to care whether the food was good or bad…” (Selling, 1940)

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

The more humanitarian treatment he reserved to the upper classes, patients of the lower classes were still subjected to terror and coercion

Question 34

What was Tuke’s approach to treatment?

Answer 34

William Tuke (1732-1822)

Established the York Retreat (1976)

•  Quiet and religious environment
•  Patients discussed their difficulties with attendants

Question 35

What about Rush’s approach to treatment?

Answer 35

Benjamin Rush (1745-1813)

Founder of the American Psychiatry

•  mental illness as humoral imbalance
•  Humane treatment of the mentally ill
•  Believed in the rehabilitation of character

Question 36

Who was Emil Kraeplin?

Answer 36

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

Less favourable features:

•   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

Question 37

Who was DIx?

Answer 37

Dorothea Dix (1802-1887)

Mental Hygiene Movement

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

Question 38

What was General Paresis?

Answer 38

n  Siphilis (caused by micro organism) n  General Paresis – paralysis and insanity, then death. n  Discovery through: q  Accurate description of symptoms leading to diagnosis as mental disorder (1825) q  Inoculation of paretic patients with syphilitic matter- no infection (thus relationship)(1897) q  Blood test- bacteria.(1906)

Question 39

What was syphilis?

Answer 39

Syphilis was a huge killer…

In The POX (2003) Deborah Heyden names the following as sufferers:

Lincoln (Mary & Abraham)

Beethoven, Schumann and Schubert

Nietzsche, Wild, Joyce

Adolf Hitler

Question 40

Outline the advancements in mental health in the 20th Centuary

Answer 40

Biological discoveries
•  Development of a classification system for the mental disorders
•  Emergence of Psychological causation views
•  Experimental Psychological research
Understanding of psychological factors was progressing…
Sigmund Freud (1856-1939)
Inner dynamics of unconscious motives
Behaviourism
Learning plays an important role in human behaviour

Question 41

Outlijne some things that occured in the 20 centuary that limit the view we have advanced

Answer 41

Eugenics: q  1907 Indiana bill of sterilization q  1927 The Us supreme court rules bill constitutional, around 20,000 Americans sterilised. q  1929-1932 Scandinavian countries pass similar bill. q  1933 Nazi Germany kills 70,000 and sterilizes over 350,000 for mental disorders

Question 42

Outline some things in the 21st centuary that limit the view we have advanced

Answer 42

n  A 15-year-old boy was tortured and drowned by his sister and her boyfriend because they believed he was a witch.
Kristy Bamu, from Paris, was found dead in Newham, east London, on Christmas Day in 2010.

The boy had 101 injuries and died from being beaten with a metal bar and drowning. n  The jury heard that witchcraft or sorcery - called kindoki - is practised in Congolese Christian churches