Lecture 4

Question 1

We discussed the shift that took place form a religious to a scientific explanation of madness, and the subsequent redefinition of madness as mental illness. This shift was precipitated by all of the following, except…

A) The scientific revolution
B) The “Enlightenment”
C) Urbanization
D) Deinstitutionalization

Answer 1

D!

Question 2

According to the eugenics movement, mental illness was a hereditary disorder that could be efficiently addressed through ________.

A) Institutionalization and sterilization
B) Abortion and birth control
C) Abortion and deinstitutionalization
D) Birth control and sterilization

Answer 2

A!

Question 3

What is the eugenic movement

Answer 3

• reduce prevalence of mental illness by forced sterilization and life-long institutionalization

Question 4

What did the people who did not believe in hereditary transfer believe in?

Answer 4

• believed that organic lesions caused mental illness nad were acquired during one’s life

Question 5

What did proponents believe in?

Answer 5

• believed that these could be identified through autopsies and surgical techniques
• a biologic/organic view of mental illness

Question 6

What did Emil Kraeplin (psychiatrist) say about mental illness?

Answer 6

• that mental illness was a broad term including series of discrete diseases (each had its own cause, symptoms, and natural course - similar to the view in the DSM)

Question 7

Who was Sigmund Freud?

Answer 7

important theorist trained as a neurologist

Question 8

What did Freud argue

Answer 8

• argued that mental illness was psychological in nature emphasizing the importance of personal experiences and the unconscious mind (psychoanalysis)

Question 9

What did Freud’s treatment techniques focus on? give examples of some treatments

Answer 9

focused on helping patients access and understand their unconscious thoughts and urges

• dream analysis, free association, hypnosis

Question 10

Review (can’t think of questions so read carefully and memorize)

Answer 10

• Freud’s work included more “mild” forms of anxiety and obsessions (e.g., anxieties and obsessions among people who would not typically be admitted to asylums)
• His treatment techniques began to move treatment for mental illness from the hospital to private offices (the psychiatrist’s “couch”)
• Freud popularized the notion that our childhood experiences influence our mental health in adulthood, especially interpersonal relationships
• Although psychoanalysis as practiced by Freud is less common now, his ideas have been foundational in modern treatments for mental illness (modern talking therapies or psychotherapy)

Question 11

What is WHR Rivers

Answer 11

• a medical doctor and anthropologist at Craiglockhart Hospital in Scotland
• treated many wounded and former WWI soldiers

Question 12

What were some of the symptoms of trauma

Answer 12

• memory disturbances, temporary blindness, and paralysis without evident physical cause

Question 13

What were the treatments for trauma?

Answer 13

• based on Freud’s idea
• included psychotherapies designed to draw the traumatic experiences out of the unconscious so that the soldiers could process the memories

Question 14

What are the 2 things that psychoanalysis informed

Answer 14

• understanding and treatment of Trauma
• attachment theory

Question 15

Explain the attachment theory

Answer 15

• 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

Question 16

What are 3 critiques of psychoanalytic theory in early 20th century

Answer 16

• lack of research/scientific rigour in the development of theory
• heavy emphasis on childhood sexuality was problematic for some
• Freud’s normative ideas about fender were critiqued by some

Question 17

The Cognitive Behavioural Therapy draws on the behavioural theories of who?

Answer 17

• Skinner and Pavlov
• recondition responses to stimulie
• also draws on cognitive therapy techniques of Beck and Ellis
• supports patients in rationally examining their “automatic thoughts” and how they relate to their emotions and behaviours

Question 18

Why is CBT widely use in healthcare settings?

Answer 18

• time limited (can be short term)
• cost effective
• amenable to evaluation of outcomes
• aligned with goals of evidence-based treatment

Question 19

Why were physical treatments like shock therapies and psychosurgery made?

Answer 19

• clinicians thought it might be possible to cure mental illness with direct physical interventions actin on the biology of the brain

Question 20

Give other physical treatment examples

Answer 20

• Electroconvulsive Therapy (ECT)
• insulin shock
• medically induced convulsions or comas
• prefrontal lobotomies (severing prefrontal cortex)

Question 21

What did prefrontal lobotomies often result into?

Answer 21

• 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 22

explain the recognition of the rights and perspectives of patients

Answer 22

• because of the recognition of errors in the past, attitudes about rights have changed dramatically
• voices of patients have been largely absent from accounts of treatment of mental illness (due to focus on practitioners, lack of sources)
• movements work to destigmatise mental illness and improving access to treatment

Question 23

What does deinstitutionalization mean?

Answer 23

• the process whereby many large, state-run hospitals, were closed in favour of individuals accessing treatment in the community

Question 24

What led to deinstitutionalization?

Answer 24

• very poor conditions of asylums
• many physicians also saw forced hospitalization as being potentially or inherently harmful

Question 25

What did the introduction of psychopharmaceuticals in 1950s lead to?

Answer 25

• led to many to be optimistic that many patients could be treated successfully in the community
• also resulted in decreased use of insulin and metrazol shock therapies and psychosurgery

Question 26

review deinstitutionalization

Answer 26

• From the 1960s-1990s the size and number of psychiatric institutions greatly declined, as populations were moved to community settings
• Often, there were not sufficient community-based services developed to meet the needs of patients leaving institutions

Question 27

How did the Scientific Revolution and the Enlightenment challenge and change the religious view of mental illness?

Answer 27

• see evidence instead of believing it just on what our religion said
• relying on scientific method
• demonic possession - result of sin, punishment

Question 28

Among the top 20 causes of global burden of disease, which of the following mental disorder ranked second?

A) Obsessive-compulsive disorder (OCD)
B) Post-traumatic stress disorder (PTSD)
C) Bipolar disorder
D) Major depression

Answer 28

D

Question 29

What are the 5 types of mental illness that appeared in the top 20 causes of global burden of disease (GBD) in 2013

Answer 29

2nd - major depression
7th - anxiety disorders
11th - schizophrenia
16th - dysthymia (persistent depressive disorder-mild depression but more long-term)
17th - bipolar disorder