Lecture 9 Flashcards
What were early theories and treatments for mental illness?
Flame into the man’s face so that the devils are driven out of him. (12th century)
Example of William (James) Norris - chained to his bed in Bedlam for 10 years - led to the Mad House Act of 1828, which aimed to regulate the treatment of the insane.
Removing the stone of madness - opened up the skull to remove the spirit of madness
Trepenation - drill a hole in the skull
The running away disease - specificaly linked with black or afro-carribbean race when they tried to run away from their masters - used the tranquilizing chair
Who is Emil Kraeplin and what did he do?
He led the way for psychiatric research in the nineteenth century. Educated and trained in Germany.
Studied mental disorders and eventually developed a system of classifying mental illness that took into account a condition’s onset, course and prognosis
He grouped conditions/illnesses together by patterns of symptoms - called it clinical rather than symptomatic view.
Classifying by pattern rather than symptoms led to a simpler and more uniform diagnostic system.
What did Kraeplin identify?
Identified the pathological basis of Alzheimer’s disease, identified schizophrenia (named it dementia praecox) and manic depression.
What is a symptom of untreated schizophrenia?
Waxy posture - can be moved and placed in different positions
How did Kraepelin classify manic depression?
Moving, dancing, generally happy
Colourful and clashing clothes
Who is Monitz?
Scientist who was awarded the Nobel prize for inventing the frontal lobotomy
What did Monitz do?
He drilled two holes in the patient’s skull and injected pure alcohol into the frontal lobes of the brain to destroy the tissue in an effort to alter the patient’s behaviour
Done with no scientific evidence
Where did the idea that mental health could be improved by psychosurgery originate from?
Swiss nuerologist Gottlieb Burckhardt who operated on 6 patients with schizophrenia and reported a 50% success rate, meaning they appeared to calm down.
‘Some patients seemed to improve, some became ‘vegetables’, some appeared unchanged and others died’
How did Monitz die?
He was shot by one of his patients
How many people received frontal lobotomies in the US between 1949-1952?
50,000 people (about 10,000 were transorbital lobotomies and the rest were prefrontal)
How many lobotomies did Walter Freeman perform during his life?
3,500, of which 2,500 were his ice-pick procedure
When did the USSR ban FL?
1950 - contrary to principles of humanity. They continued to be performed in other places until 1980.
Where did the Freudian idea come from?
He developed his ideas because he would not believe they had been abused, believed they were actually fantasies.
When did drug treatments begin?
After WW2, following the awful aftermath of WW1
Was there a drop in patients admitted to mental institutions after drug treatments?
Yes there were but only very slightly and they didn’t drop significantly until 65/66
What is traditional psychiatry?
They are medically trained and adhere to the medical or disease model of mental disorder
Examine, diagnose, treat
Based on assumption that psychiatric disorders have a known origin, a definable cause and a definite cure
ILLUSION
What is the DSM?
It is the recipe book for psychiatry - on volume 5 which simply suggests that there is nothing definite about these definitions.
What are the 5 stages of medical science?
Recognition of specific symptoms Definition of symptoms Identification of tissue pathology Demonstration of tissue pathology Establishment of appropriate cure
Why does psychiatry fail to follow these?
Because it progresses with the first 2 stages and then fails to progress with the others
What percentage of general population is depressed at one time?
3-4%
How many people will get depressed at least once in their life?
1 in 4
What’s the incidence rate difference between men and women?
2-3 times greater in women
What is depression a product of?
The interaction between genes and environment
Why hasn’t it been selected out?
Because it is mostly seen in adults - many of whom may already have had children by the time it becomes evident that they have this adaptation.
Is there clinical evidence to suggest depression is linked with seratonin levels?
No
How old are drug treatments and do they generally work?
50 years old and no
Is anyone still looking?
No
In what percentage of people does the placebo effect work?
40% of people
How long is the period of therapeutic lag?
3-4 weeks during which patients often feel worse rather than better
What is the Corticotrphin releasing factor hypothesis?
It suggests that there is a relationship between high levels of stress hormones and depression
What does the DSM suggest about fear?
That it is linked with evolution - we make ourselves bigger
What is the EEA?
The Environment of evolutionary adaptedness
What is mismatch theory?
The idea that organisms possess many traits (including behavioural patterns) that have been preserved because of their adaptive function in a specific environment. This environment may have been very unlike that in which the species now finds itself.
What are frequently mismatched and to what?
Ancient adaptive traits are mismatched to the current environment and organisms find themselves doing the best they can to deal with contemporary situations using the traits they do possess.
What consequences will a mismatch between the EEA and the one in which we exist have?
Distortions of typical behaviour and mental disorders
What are the proposed ways in which Western society frustrate the needs of the paleolithic person who persists within us?
Disruption of community-based kinship bands
Disruption of nuclear families
Loss of female support networks
Lack of provision for secure and intimate care of children
Frequent occurrence of negative life events
What are the evolutionary theories of depression?
- Social competition hypothesis - acceptance of defeat
- Social Navigation hypothesis - enhances capacities for the accurate analysis and solution of key social problems.
- Defection Hypothesis (post-partum depression) - signal to ancestral mothers that their costs were exceeding their benefits
- Individual differences hypothesis - continuous population distribution of affective reactivity with individuals vulnerable to depression are at the upper end of this distribution.
- Pathogen host defence hypothesis - social withdrawal and other symptoms of depression help individuals avoid infection
- Produced by a pathogen hypothesis
What are the criticisms of the clinician’s approach to depression as an adaptation?
Emphasis on emotional responses
View that human evolution is an historical rather than current process
View that present environment is a corrupted version of an earlier ‘paradise’
Assumption that depression is a pathology
Apparent misunderstanding that the key element of evolution is reproduction, not survival as an end in itself
Failure to provide hypotheses that generate risky predictions that van be tested by experiment
What does Ethology involve?
Form, function, ontogeny (how does it change over a lifetime), phylogeny (how doe sit change across species)
What is ethologic analysis?
A method by which behaviour can be quantified, analysed and eventually understood - can be applied to any species in any situation
What are the symptoms of depression for the patient? (16)
Sleep disturbance Change in appetite Change in psychomotor activity Diurnal variation in mood Loss of interest (reduced attention span) Fatigue Loss of libido Constipation Amenorrhea Aching discomfort Hypochondriacal Depersonalisation Morbid thoughts about past, present and future Possibly suicidal Poverty of thought Misery
What are the signs of depression for the observer? (10)
Neglected dress and grooming Turned down corners of mouth Vertical furrowing of centre of brow Reduced rate of blinking Reduced non-verbal communication Hunched posture Downward direction of gaze Poverty of speech Weight gain or loss Poor memory
Depression is a cluster of what?
Of defensive behaviours
What are the defensive behaviours?
Hunched body posture (defensive) Avoidance of eye contact (reduction of attack provoking stimuli) Diminished appetite for food and sex (and so reduced motivation to compete for these) Withdrawal to the edge of social groups (avoidance of situations where conflict is likely) Sleep disturbance (peaks of activity when others are asleep)
Under what circumstances could these defensive behaviours be useful?
In situations where an individual’s survival depends on them remaining in a group that has become hostile to their presence.
What is the key stimulus for initiating depression?
Damage to reproductive potential
What causes the damage to the reproductive potential?
Loss of social status
Loss of child/spouse
Loss of parent/grandparent/other close relative/job
Precocial pregnancy/reduced ability to attract a mate
Other factors
What is the third ventricle hypothesis?
It is when the third ventricle is implicated because the behaviours associated with depression can be related to structures that contact this ventricle.
The hypothalamus lies at one end of the ventricle and this accounts for the effects on appetites for food and sex whilst the pineal lies at the other and has influence over circadian rhythms and sleep/wake cycles.
Other behavioural symptoms can be accounted for by effects of the amygdala and the hippocampus whose major pathways (stria terminalis and fornix) pass through the ventricle. The theory proposes that the symptoms of depression are produced by a release of a tissue damaging cytokine into the ventricular space.
What does the third ventricle hypothesis propose?
That depression is an evolutionary adaptation that developed in response to the social emergency of an individual’s survival depending upon them remaining in a group that had become hostile to their presence.
