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Psychological disorders and therapeutic intervention > Historical perspectives > Flashcards

Historical perspectives Flashcards

1
Q

Trepanation.

A

Making a hole in the skull through scraping, grooving, and cutting.

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2
Q

Medieval trepanation - purpose.

A

> Allow demons to escape from the skull.
To treat depressed skull fracture by removing damaged pieces of the skull.
Try and bring the unconscious back to life.

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3
Q

Modern trepanation - purpose.

A

> Explore brain pathology.
Relieve intracerebral pressure after brain injury.
Clean up diseased or damaged brain tissue.

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4
Q

Christian perspectives on madness.

A

> Punishment from God.
King Saul punished for not following God’s orders.
King Nebuchadnezzar II said to have dissatisfied God with his power and pride.
Ordinary mad - left to roam their communities, some imprisoned, and others lauded as prophets.

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5
Q

Muslim perspectives on madness.

A

> Used to describe someone who acts in a way contrary to Quranic teachings.
If a madman commits a murder they are to be tied up but not to be retaliated against.
If a woman were mistakenly married to a madman then she would be allowed a divorce.
Caused by possession of evil spirits.

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6
Q

Hindu perspectives on madness.

A

> Many depictions of madness within ancient Indian texts.
Many Gods described as acting in mad ways.
Some Hindu saints were considered to be affected by divine madness.
Disorders where fear is a key element are associated with an increase in wind.
Anger: elevation of bile.
Lethargy: reduction in phlegm.

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7
Q

Buddhist perspectives on madness.

A

> Unhealthy emotions cause physical and mental ill-health.
Parallels between Buddhist teachings and contemporary methods of behavioural modification.
Minduflness - derives from Buddhist teaching.

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8
Q

Socrates’ thoughts on madness.

A

> ‘Madness (is) superior to a sane mind for the one is only of human, but the other is of divine origin’.
Four different types of divine madness.

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9
Q

Socrates’ types of divine madness.

A

> Having the gift of prophecy.
Purging away an ancient curse.
The inspiration behind poetry.
Love.

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10
Q

Plato’s thoughts on madness.

A

> Epithumetikon - represents base instincts and desires.

>Madness results when this becomes too powerful.

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11
Q

Hippocrates’ thoughts on madness.

A

> Madness is created when the brain becomes unhealthy.
Body contains four fluids called humours: black bile, yellow bile, blood, and phlegm.
Madness may result but type of madness depends on which humour is affected.

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12
Q

Hippocrates: Black bile properties.

A

Cold and dry

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13
Q

Hippocrates: Black bile personality characteristics.

A

Melancholic-introspective, sentimental, and apathetic.

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14
Q

Hippocrates: Black bile mental health effects.

A

Melancholia, despondency, sleeplessness, loss of appetite, restlessness, and inability to speak.

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15
Q

Hippocrates: Black bile treatment.

A

Hellebore to purge the intestines, bloodletting, keeping the patient warm, giving hot baths, feeding non-dry foods.

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16
Q

Hippocrates: Yellow bile properties.

A

Hot and dry

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17
Q

Hippocrates: Yellow bile personality characteristics.

A

Choleric - hot-tempered and belligerent.

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18
Q

Hippocrates: Yellow bile mental health effects.

A

Vociferous, malignant, and will not be quiet but are always doing something improper’ Similar to mania

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19
Q

Hippocrates: Yellow bile treatment.

A

Bleeding and purging, treatment to counteract the negative effects of hotness and dryness, cold baths, cold and dry foods.

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20
Q

Hippocrates: Blood properties.

A

Hot and wet

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21
Q

Hippocrates: Blood personality characteristics.

A

Sanguine - optimistic, cheerful, and generous.

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22
Q

Hippocrates: Blood mental health effects.

A

Not clearly associated with mental health disorders. If personality characteristics missing, attempts made to increase levels of the humour.

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23
Q

Hippocrates: Blood treatment.

A

Levels can be increased by ingesting food with hot and moist qualities, hot baths.

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24
Q

Hippocrates: Phlegm properties.

A

Cold and wet.

25
Q

Hippocrates: Phlegm personality characteristics.

A

Phlegmatic - showing little emotion.

26
Q

Hippocrates: Phlegm mental health effects.

A

Excess - caused a mild form of madness, devoid of emotion.

27
Q

Hippocrates: Phlegm treatment.

A

Warm environment and dry foods.

28
Q

The Graeco-Roman era.

A

> Therapies were varied

>Hippocrates - let illness take natural course.

29
Q

The Graeco-Roman era - Epicurus (342 - 270 BC).

A

> Focussed on needs of patient.
Talking therapy with mild argument and suggestion.
Harsh remarks if that failed.

30
Q

The Graeco-Roman era - Asclepiades (1st century).

A

> Also patient centered.

>Soothing music or relaxing baths.

31
Q

The Graeco-Roman era - Celsus (2nd century).

A

> Soft music or forced vomiting for melancholy.
Phlebotomy.
Enemas.
If it is the mind that deceives the madman, he is best treated by certain tortures.

32
Q

The medieval period - Supernatural resurgence.

A

> Came with the collapse of the Roman empire in the 5th century.
God’s punishment for sin.
Test of faith.
Warning to repent sins.

33
Q

The medieval period - Servants to the Devil.

A

> Mid-medieval change in perspective: those with mental illness were willing servants to the devil.
Witch-hunts resulted: hundreds of thousands of deaths.
Considered witches who had made a deal with the Devil and needed to be dealt with.
After centuries people began to question this association.

34
Q

The medieval period - Johann Weyer

A

> Argued many accused of witchcraft were mentally sick.

>’The Deception of Demons’ 1563 - Starting point for resurgence of interest in natural cases of madness.

35
Q

Renaissance.

A

> Rediscovery of the scientific writings of the Greeks and Romans: returned to the humoral theory of mental illness.
Mentally ill were now often left to their own devices and looked after by family or local community.
Only the most disturbed and dangerous were excluded from the community.

36
Q

Asylums - Hamberg.

A

> 1376
Probably the first dedicated place for mad people to be contained.
Detainees forced to live in the tower of the city wall.

37
Q

Asylums - Bedlam.

A

> 1403

>First hospital to admit lunatics.

38
Q

Asylums - Paris.

A

> Hospital general
1556
Mad people contained as well as criminals, prostitutes, the unemployed, and the poor.

39
Q

Asylums - Reasoning.

A

> Mainly for economic reasons.
The mad would not be able to trouble communities.
Some could be used as cheap labour.

40
Q

Asylums - Conditions.

A

> The scenes inside were chaotic.
‘thousands of lunatics are locked up in prison without…even the slightest remedy’ ‘the half-mad…with the completely deranged.’

41
Q

The medicalisation of mental illness - physicians.

A

> Confinement meant the medical profession began to play a role.
1774 - a physicians certificate became necessary for confinement in a mad house.
Physicians considered the primary source of knowledge in identification and treatment.

42
Q

The medicalisation of mental illness - Phillipe Pinel.

A

> 1745-1826
Speculating genetic, psychological, and social factors that contributed to madness.
Very influential ideas - had the effect of securing madness within the medical domain.

43
Q

The medicalisation of mental illness - Government persuasion.

A

> Govenments were persuaded physicians had the necessary understanding and skills to identify and treat mental illness.

44
Q

The medicalisation of mental illness - 19th century.

A

> Early 19th century - madhouses legally became the domain of those in the medical profession.
Madness was officially medicalised despite being experimental in nature.

45
Q

The medicalisation of mental illness - General paresis of the insane.

A

> Caused lesions on the skin, memory loss, confusion, motor deficits, and eventually dementia.
Also delusions of grandeur.
Syphillis bacteria found to cause this in the 1900s.
Idea of a biological basis to mental illness further enforced.
Around this time a new approach to understanding and treating MI was being conceived.

46
Q

Psychoanalysis - Jean-Martin Charcot.

A

> 1825-1893
Neurologist who came across patients with neurological problems and symptoms that didn’t fit in with knowledge about the organisation of the NS.
Called this hysteria.
Used hypnosis to understand symptoms.
Hysteria occurred due to a traumatic event.
Symptoms result from patients ideas of the physical effects that the event would cause.

47
Q

Psychoanalysis - Freud.

A

> Influenced by Charcot’s work.
Set up a practice in Vienna to treat patients with hysteria.
Developed own theory of mind and mental disorders.
Unconscious desires seek fulfilment but are in conflict with socio-cultural forces - cause of hysteria.

48
Q

Psychoanalysis - Freud’s hysteria treatment.

A

> Help the individual gain realisation of their unconscious desires.
Then the conflict and the expression of the conflict would dissipate.
This is the basis of psychoanalysis.

49
Q

Shock therapy - Insulin shock therapy.

A

> 1929, Berlin, a psychiatrist accidentally caused convulsions due to an overdose of insulin.
The mental health of the patient greatly improved when they regained consciousness.
Sakel tried this on many disorders (Schizophrenia was particularly responsive).
Became very popular despite dangers. Basis for ECT.

50
Q

Shock therapy - Electroconvulsive therapy.

A

> Cerletti and Bini, 1938.
Beneficial for schizophrenia and depression.
Eventually superseded insulin shock therapy.
Used today in treatment-resistant depression.
Remains a controversial technique.
Reasons for its efficacy are still unknown.

51
Q

Lobotomy - Origins.

A

> Pioneered in the 1930s by a Portuguese neurologist, Egas Moniz.
Thought that reverberating circuits, or abnormal cellular connections, in the frontal parts of the brain caused depression or obsession.
Damaging this could halt the thoughts.

52
Q

Lobotomy - Initial procedure.

A

> Holes would be drilled in the patients head, alcohol was then injected to destroy brain tissue.
Then Moniz utilized a technique of making incisions into the cortex with a special cutting device.

53
Q

Lobotomy - Initial refinements.

A

> Walter Freeman refined the treatment, reaching the frontal lobe through the tear ducts.
A sharp instrument is forced through the thin layer of skin above the eye socket.
Pick wiggled to damage the frontal lobe.
Considered to be so safe it didn’t need to be done in an operating theatre.
Freeman argued it would one day be as common as dental work.

54
Q

Lobotomy - Decline in use.

A

> Discovered in the 1960s that medication could treat mental disorders.
Safety concerns due to potentially disastrous effects.

55
Q

Lobotomy - Modern use.

A

> Contemporary analogue of the procedure ‘Neurosurgery for Mental Disorder’ (NMD) still carried out in specialist centres. Reserved for resistant cases of OCD and affective disorders.
Between 2012-2013 only 4 procedures carried out in the UK.
Focus is to disrupt connections between emotional centres of the brain and the cortex.

56
Q

Medication - Henri Laborit.

A

> Experimented with antihistamines with sedative effects in an attempt to reduce shock during surgery.
Chlorpromazine in high doses seemed to calm patients.

57
Q

Medication - Pierre Deniker.

A

> Heard about the sedative effects of chlorpromazine and tried it on some of his most disturbed patients.
Dramatic improvements in thought and behaviour were observed. Enabled most patients to function adequately.

58
Q

Medication - Chlorpromazine effects.

A

> Had a massive effect on psychiatric care in Europe and America.
Described as a miracle drug.
Medications for other conditions soon followed.

Psychological disorders and therapeutic intervention (4 decks)

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