Defining abnormality and history of mental disorders Flashcards
give 5 criteria for defininig abnormality
- Statistical infrequency
- Violation of norms
- Personal distress
- Disability / dysfunction
- Unexpected response
what is statistical infrequency?
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?
What is violation of norms?
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?
What about personal distress?
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!!!
Outline dynsfunction/disability as a criteria of mental health
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.
outline unexpected behaviour
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
define diagnosis
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?
what does APA define as a mental disorder?
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.
Outline Szaz’s thoughts on Dianosis
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
what does Szaz campain for?
- 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
outline why diagnosistic criteria such as the DSM and ICD are considered “gold standard?”
- 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
Outline what forms current views in abnormal psych?
Prevailing attitudes of past times + Advances in science –> Current views of abnormal behaviour
Outline how mental health was viewed in ancient times?
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
what was the view of the grrek and romans when it came to mental health?
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
what is somatogenesis
Somatogenic theory states that abnormality is caused by a biological disorder or illness
what did hippocrates argue for mental health?
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
what time period was the middle ages and how did they explain mental health disorders?
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
Outline witch trials
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
Outline pre-humanism ideas of mental illness
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.
outline the priory of st mary
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
outline pre-18th centuray treatment of mental health
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.
Outline the study of samuael bradshaw and William Belcher
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.
Outline why it was so bad for women in the 17th centuary
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.
Outline women puberty in 18th centuary
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
give some 18th centuary 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.
give general “clusters” of insane women
n The sexual woman.
The hysterical teenager.
The fasting girls.
The drunks.
The frigid spinster
The lesbian
explain asylum work
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.
Outline the case of Bertha Mason
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
Outline 18th centuary “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
What was Dr Isaac Baker Browns surgery?
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!
What, during the 18th centuary was consdidered successful treatment?
Women who are ‘cured’ are: Silent Have decorum. Have taste. Service. Have piety. Have gratitude.
Outline the case of Orphilia
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.
Outline the humanism approach to treating mental disorders
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
What was Tuke’s approach to treatment?
William Tuke (1732-1822)
Established the York Retreat (1976)
- Quiet and religious environment
- Patients discussed their difficulties with attendants
What about Rush’s approach to treatment?
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
Who was Emil Kraeplin?
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
Who was DIx?
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
What was General Paresis?
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)
What was syphilis?
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
Outline the advancements in mental health in the 20th Centuary
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
Outlijne some things that occured in the 20 centuary that limit the view we have advanced
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
Outline some things in the 21st centuary that limit the view we have advanced
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
