Lecture 9

Question 1

What were early theories and treatments for mental illness?

Answer 1

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

Question 2

Who is Emil Kraeplin and what did he do?

Answer 2

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.

Question 3

What did Kraeplin identify?

Answer 3

Identified the pathological basis of Alzheimer’s disease, identified schizophrenia (named it dementia praecox) and manic depression.

Question 4

What is a symptom of untreated schizophrenia?

Answer 4

Waxy posture - can be moved and placed in different positions

Question 5

How did Kraepelin classify manic depression?

Answer 5

Moving, dancing, generally happy

Colourful and clashing clothes

Question 6

Who is Monitz?

Answer 6

Scientist who was awarded the Nobel prize for inventing the frontal lobotomy

Question 7

What did Monitz do?

Answer 7

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

Question 8

Where did the idea that mental health could be improved by psychosurgery originate from?

Answer 8

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’

Question 9

How did Monitz die?

Answer 9

He was shot by one of his patients

Question 10

How many people received frontal lobotomies in the US between 1949-1952?

Answer 10

50,000 people (about 10,000 were transorbital lobotomies and the rest were prefrontal)

Question 11

How many lobotomies did Walter Freeman perform during his life?

Answer 11

3,500, of which 2,500 were his ice-pick procedure

Question 12

When did the USSR ban FL?

Answer 12

1950 - contrary to principles of humanity. They continued to be performed in other places until 1980.

Question 13

Where did the Freudian idea come from?

Answer 13

He developed his ideas because he would not believe they had been abused, believed they were actually fantasies.

Question 14

When did drug treatments begin?

Answer 14

After WW2, following the awful aftermath of WW1

Question 15

Was there a drop in patients admitted to mental institutions after drug treatments?

Answer 15

Yes there were but only very slightly and they didn’t drop significantly until 65/66

Question 16

What is traditional psychiatry?

Answer 16

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

Question 17

What is the DSM?

Answer 17

It is the recipe book for psychiatry - on volume 5 which simply suggests that there is nothing definite about these definitions.

Question 18

What are the 5 stages of medical science?

Answer 18

Recognition of specific symptoms
Definition of symptoms 
Identification of tissue pathology 
Demonstration of tissue pathology 
Establishment of appropriate cure

Question 19

Why does psychiatry fail to follow these?

Answer 19

Because it progresses with the first 2 stages and then fails to progress with the others

Question 20

What percentage of general population is depressed at one time?

Answer 20

3-4%

Question 21

How many people will get depressed at least once in their life?

Answer 21

1 in 4

Question 22

What’s the incidence rate difference between men and women?

Answer 22

2-3 times greater in women

Question 23

What is depression a product of?

Answer 23

The interaction between genes and environment

Question 24

Why hasn’t it been selected out?

Answer 24

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.

Question 25

Is there clinical evidence to suggest depression is linked with seratonin levels?

Answer 25

No

Question 26

How old are drug treatments and do they generally work?

Answer 26

50 years old and no

Question 27

Is anyone still looking?

Answer 27

No

Question 28

In what percentage of people does the placebo effect work?

Answer 28

40% of people

Question 29

How long is the period of therapeutic lag?

Answer 29

3-4 weeks during which patients often feel worse rather than better

Question 30

What is the Corticotrphin releasing factor hypothesis?

Answer 30

It suggests that there is a relationship between high levels of stress hormones and depression

Question 31

What does the DSM suggest about fear?

Answer 31

That it is linked with evolution - we make ourselves bigger

Question 32

What is the EEA?

Answer 32

The Environment of evolutionary adaptedness

Question 33

What is mismatch theory?

Answer 33

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.

Question 34

What are frequently mismatched and to what?

Answer 34

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.

Question 35

What consequences will a mismatch between the EEA and the one in which we exist have?

Answer 35

Distortions of typical behaviour and mental disorders

Question 36

What are the proposed ways in which Western society frustrate the needs of the paleolithic person who persists within us?

Answer 36

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

Question 37

What are the evolutionary theories of depression?

Answer 37

1. Social competition hypothesis - acceptance of defeat
2. Social Navigation hypothesis - enhances capacities for the accurate analysis and solution of key social problems.
3. Defection Hypothesis (post-partum depression) - signal to ancestral mothers that their costs were exceeding their benefits
4. Individual differences hypothesis - continuous population distribution of affective reactivity with individuals vulnerable to depression are at the upper end of this distribution.
5. Pathogen host defence hypothesis - social withdrawal and other symptoms of depression help individuals avoid infection
6. Produced by a pathogen hypothesis

Question 38

What are the criticisms of the clinician’s approach to depression as an adaptation?

Answer 38

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

Question 39

What does Ethology involve?

Answer 39

Form, function, ontogeny (how does it change over a lifetime), phylogeny (how doe sit change across species)

Question 40

What is ethologic analysis?

Answer 40

A method by which behaviour can be quantified, analysed and eventually understood - can be applied to any species in any situation

Question 41

What are the symptoms of depression for the patient? (16)

Answer 41

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

Question 42

What are the signs of depression for the observer? (10)

Answer 42

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

Question 43

Depression is a cluster of what?

Answer 43

Of defensive behaviours

Question 44

What are the defensive behaviours?

Answer 44

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)

Question 45

Under what circumstances could these defensive behaviours be useful?

Answer 45

In situations where an individual’s survival depends on them remaining in a group that has become hostile to their presence.

Question 46

What is the key stimulus for initiating depression?

Answer 46

Damage to reproductive potential

Question 47

What causes the damage to the reproductive potential?

Answer 47

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

Question 48

What is the third ventricle hypothesis?

Answer 48

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.

Question 49

What does the third ventricle hypothesis propose?

Answer 49

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.