M1: Chapter 1 Flashcards
Define: Psychopathology
the field concerned with the nature and development of abnormal behaviour, thoughts, and feelings.
Why is the field of abnormal psychology under scrutiny?
As a result of the next edition of the DSM-5 (which is now released)
Who is Clara Huges?
olympic champion who speaks about mental health issues and her own struggles with depression.
What is the best definition of abnormal behaviour?
patterns of emotion, thought, and action deemed pathological for one or more of the following reasons:
- statistical infreqnecy
- violation of norms
- personal suffering
- disability of dysfunction
- unexpectedness
(none of these reasons alone can explain or define abnormal behaviour, typically need multiple of them).
What is statistical infrequency?
(one contributor to abnormal behaviour)
Abnormal behaviour is infrequent in the general population
Normal Curve = places most people in the middle, with very few people at either extreme. If a person is “normal”, they do not deviate much from average.
CHALLENGE: Statistical infrequency gives us little guidance in determining WHICH infrequent behaviours psychopathologists should study.
Therefore, infrequency is NOT a sufficient definition of abnormal behaviour.
Define: Violation of Norms
(one potential contributor to abnormal behaviour)
Whether the behaviour violates social norms or threatens/makes those observing it feel anxious.
Cultural diversity can affect how people view social norms.
Challenge: Violation of norms can be too broad or too narrow
Define: personal suffering
(one potential contributor to abnormal behaviour)
Behaviour is abnormal if it creates great distress in the person experiencing it
CHALLENGES:
- Not all disorders involve distress (ex. The psychopath)
- Not all forms of distress (ex. hunger, or childbirth) belong to the abnormal psychology field.
Define: disability of dysfunction
(one potential contributor to abnormal behaviour)
Impairment in some important areas of life DUE TO THE abnormality.
Ex. Phobia can produce distress and disability like a severe fear of flying preventing taking a job promotion.
Disability does not apply to all disorders, what is an example of this?
Transvestism (cross-dressing for sexual pleasure) is a mental disorder if it distresses the person, but it does not create a disability.
Define: Unexpectedness
(one potential contributor to abnormal behaviour)
Distress and disability are considered abnormal when they are unexpected responses to environmental stressors.
Ex. a person who has lots of money is constantly worrying about their financial situation.
How do you define clinicians?
various professionals authorized to provide psychological services.
What is a clinical psychologist?
usually requires Ph.D or Psy.D degree and whose training has included an internship in a mental hospital or clinic.
*depending on the jurisdiction, you can become a “psychological associate” with a master’s degree.
What agreement made the framework so credidentials of professional psychologists is recognized in all parts of Canada?
1995 Agreement on Internal Trade
A Mutual Recognition Agreement (signed 2001) requires a person to obtain what 5 core competencies in order to become a registered psychologist in Canada?
(1) interpersonal relationships
(2) assessment and evaluation (including diagnosis)
(3) intervention and consultation
(4) research
(5) ethics and standards.
Clinical psychologists learn techniques of ——- and ——– of mental disorders and learn how to practice psychotherapy
assessment and diagnosis
What is psychotherapy?
Verbally helping troubled individuals change their thoughts, feelings, and behaviour to reduce distress
Who is a psychiatrist?
A physician (MD) who has taken specialized postdoctoral training (a residency) in the diagnosis, treatment, and prevention of mental disorders
*main job responsibility is to provide psychoactive drugs (chemical compounds having a psychological effect to alter mood/thought process
Who is a psychoanalyst?
A therapist who has taken specialized post-doctoral training in psychoanalysis after earning an MD or a Ph.D. degree.
*very few in modern times → can take up to 10 years of graduate work.
Who are counselling psychologists?
A doctoral-level mental health professional with similar training to clinical psychologists (but with less focus on research and severe psychopathology).
What did the analyses of the national population health survey (1995) reveal?
- Approximately 2% of survey respondents had consulted with a psychologist one or more times in the preceding 12 months.
- Psychological services are more available in urban areas than in rural areas (leaving many underserved areas in Canada)
What is prescriptive authority?
the right to prescribe drugs
*current controversy if psyhologists should have the right to prescribe drugs or not
Prescriptive authority for psychologists has been granted in what 3 U.S. jurisdictions?
New Mexico, Louisiana, and the U.S. territory or Guam
What is demonology?
the doctrine that a person’s abnormal behaviour is caused by an autonomous EVIL SPIRIT
What did treatment for demonology often involve?
Extrocism
(the casting out of evil spirits by ritualistic chanting or torture - ex. prayer, noisemaking, startvation, beatings, drinking potions)
What is trepanning?
Making a surgical opening in a living skull
Performed based on the beleif that evil spirits would leave or escape the body through it
*introduced into the Americans from Siberia
*3 Aboriginal skulls with trepanning have been found in Canada
Who is Hippocrates?
Father of modern medicine
He separated medicine from religion and superstition
Thought that mental disturbances should be treated like other illnesses like colds.
What is somatogenesis?
Belief that mental disurbances come from BODILY origins, as distinguished from psychological origins.
(opposite of psychogenesis).
What is psychogenesis?
Belief that mental disturbances come from psychological origins, as distinguished from somatic (bodily) origins.
(opposite to somatogenesis)
Did Hippocrates thoughts/beliefs align more with somatogenesis or psychogenesis?
SOMATOGENESIS
(mental disturbances come from bodily origins and should be treated like any other illness)
Hippocrates classified mental disorders into what 3 categories?
- Mania
- Melancholia
- Phrenitis (or brain fever)
Hippocrates felt normal brain functioning was dependent on a equal balance of what 4 “humors” (fluids)?
Blood = changeable temperament
Black Bile = melancholia
Yellow Bile = irritability and anxiousness
Phlegm = sluggish/dull
*if you had an imbalance of one or more, you would experience the mental disturbances associated with the humor.
What event is suggested to mark the begining of the Dark Ages?
the death of Galen
(the last major Greek physican of the classical era)
In the dark ages, who was responsible for the treatment of mental disorders?
CHURCHES
Monks cared for the mentally disordered by praying over them, touching them with relics, and getting them to drink potions.
How was witchcraft viewed in the dark ages?
Witchcraft was seen as a denial of God → led to lots of blame on those seen as witches and were persecuted.
What is the Malleus Maleficarum? How did it develop?
Pope Innocent VIII declared the clergy of Europe to search for witches –> leading to the development of Malleus Maleficarum (“the witches hammer”) to guide witch hunts.
Manual claimed that a person’s “loss of reason” was a symptom of demonic possession → burning was the usual method for getting rid of this “demon”.
In the middle ages, the mentally ill were generally considered to be ———.
witches!
*however, many of the accused witches were not actually mentally ill - but thought to be witches as many of the confessions took place under brutal torture.
What is the dunking test?
Women dunked in water. If the women did not drown in the water, she was taught to be associated with the devil and then confirmed a witch
(no-win situation)
What are lunacy trials?
Took place in 13th century in England to determine a person’s sanity
*demonstrates that being possessed by evil spirits was not the only dominant view during the middle ages
Do some places in the world still practice withc hunting?
Yes
Ghana had 6 witch camps, but they closed in 2012.
In the 15th century, there were thousands of hospitals for ———–.
LEPERS (leprosy - infecious disease)
Once leprosy disapeared from Europe, there was more attention for the mentally ill
(loprosariums –> asylums)
Confinement of mentally ill happened in 15th and 16th centuries
What are asylums?
Refuges established in western Europe to confine and provide for the mentally ill.
What is the significance of the Priory of St. Mary of Bethlehem (bedlam)
An asylum in London for the mentally ill
Bethlehem became one of London’s greatest tourist attractions! (up until the 19th century)
Popularly known as Bedlam (a scene or place involving a wild uproar or confusion).
*similar to the Lunatic’s Tower in Vienna: patients are seen from street
Who is Benjamin Rush? What did he beleive?
Benjamin Rush (the father of American psychiatry) believed that mental disorder was caused by an excess of blood in the brain
→ drew great quantities of blood
→ scared patients (also felt “lunatics” could be cured by being frightened).
Who is Philippe Pinel?
a primary figure in the movement for humanitarian treatment for the mentally ill in asylums
Remove the chains of people imprisoned at the La Bicetre asylum in Paris (marked the beginning of more humanitarian treatment).
He introduced the concept of moral treatment!
Due to Pinel’s work, mental hospitals established in Europe and the US were ————.
small and privately supported - where patients were treated with more care
(however more respect was always given to upper class patients, lower class patients treated worse)
Define moral treatment? What did Pinel believe to be the main aspect of it?
A therapeutic regimen, introduced by Pinel in the French Revolution where mental patients were released from restraints and treated with compassion and dignity
Pinel believed a main aspect of moral treatment is restoring a patient’s sense of self-esteem.
When was moral treatment abandoned?
At the end of the 19th century
*Dorthea Dix ironically helped lead the abandonment of the treatment
Who is Dorthea Dix
a crusader for improved conditions for people with mental illness → campaigned for better treatment and the importance of patients obtaining help early.
(ironically led to the abandonment of moral treatment).
Development of Asylums in Canada had what 2 overall trends?
(1) With the creation of asylums, provisions for the mentally ill were separate from provisions for the physically ill, indigents, and criminals.
(2) The process of asylum creation was very separate and was not exposed to the wider community - “the institution and the community were two separate and distinct solitudes”
What did Dorthea Dix do with the development of Canadian asylums?
She visited Canada and discovered the awful conditions for the mentally ill incarcerated in the Toronto Jail and Quebec Lunatic Asylum.
Performed a “memorial prayer” to the Nova Scotia legislature and requested construction of a public mental hospital.
What were the conditions like of asylums in Canada?
Very overcrowded, no individual treatment available, and drugs were central means of treatment.
Asylum superintendents were typically British-trained physicians or with asylum doctors.
Private Lunatic Asylums Act passed to accommodate the wealthy in alternatives to the public asylums in private asylums.
What is the Private Lunatic Asylums Act?
Passed to accommodate the wealthy in alternatives to the public asylums.
As a result, moral treatment was offered in a private asylum for the wealthy in Guelph, Ontario.
What is the deinstitutionalization process?
Shifting care from mental hospitals to the community
(has been going on for more than 40 years in Canada)
What is transinstitutionalization?
The tendency to reduce the number of people in psychiatric hospitals by transferring them to other institutions
Often happens by increasing the number of people with mental health problems in general hospitals!
There are specialized mental hospitals reserved for people who had been arrested and judged unable to stand trial –> what are these called?
Maximum-security forensic hospitals
(although not prison, their lives are controlled with tight security)
There are three in Canada (Ontario, Quebec, and BC)
What are provincial psychiatric hospitals?
A facility (present today) where chronic patients are treated.
They provide protection, but treatment is often CUSTODIAL and may involve little psychosocial treatment.
What is a community treatment order?
a legal tool that specifies the terms of treatment that must be adhered to in order for a mentally ill person to be released and live in the community.
Recent court decisions emphasize the intent of protecting the mentally ill person.
Who is Emil Kraeplin?
He published a textbook of psychiatry with a classification system in order to establish the biological nature of mental illness.
Kraepelin regarded each mental illness as distinct from all others → own symptoms, course, and outcome.
Kraepelin proposed what 2 major groups of severe mental diseases?
(1) dementia praecox (an early term for schizophrenia)
- He thought chemical imbalance was the cause of schizophrenia
(2) manic-depressive psychosis (now called bipolar disorder).
- He thought irregularity is metabolism as an explanation for this.
This classification became the basis of the present diagnostic categories.
Define syndrome
a group or pattern of symptoms that tend to occur together in a particular disease.
(first identifed by Kraeplin)
What is general paresis?
Mental illness characterized by paralysis and “insanity” that typically led to death within five years → (now known to be caused by syphilis of the brain - infection of brain and spinal cord).
What is germ theory of disease?
The general view in medicine that disease is caused by infection of the body by minute organisms and viruses.
Laid groundwork for demonstrating the relationship between syphilis and general paresis.
Huge medical success was the discovery of the full nature and origin of syphilis. Why?
Because a causal link had been established between infection, destruction of certain areas of the brain, and a form of psychopathology → meaning if one type of psychopathology had a biological cause, so could others → somatogenesis gained credibility. (bodily functions can explain mental problems).
Who is Mesmer?
Believed hysterical disorders were caused by a particular distribution of a universal magnetic fluid in the body → thought one could influence the fluid of another to change their behaviors.
Thought of hysterical disorders as strictly physical, but considered one of the earlier practitioners of modern-day hypnosis. (“mesmerize”)
Mesmer’s procedure for transmitting animal magnetism was generally considered a form of hypnosis.
Who was Jean Charcot?
an important figure in reviving interest in psychogenesis → interested in non-physiological interpretations of hysteria and other symptoms.
What is the Cathartic method?
Therapeutic procedure introduced by Breuer (and developed further by Freud) in the late 19th century where a patient recalls and relives an earlier emotional catastrophe and re-experiences the tension and unhappiness through HYPNOSIS
The goal being to relieve emotional suffering.
Who is Dr. Ewen Cameron
Held a nine-year series of experiences on patients in an attempt to discover breakthrough treatments or a “cure” for mental illness.
He had a theory of “beneficial brainwashing” that had tragic consequences - aim to wipe away troubled pasts of patients and it sadly worked.
Used massive doses of hallucinogenic drugs, shock treatments, psychic driving (subliminal messages - “you killed your mother”)
CIA funded experiments bc they thought it could be used during the cold war.
What is schizophrenia?
A group of psychotic disorders characterized by major disturbances in thought, emotion, and behaviour:
- Disordered thinking in which ideas are not logically related; faulty perception and attention; bizarre disturbances in motor activity; flat or inappropriate emotions; and reduced tolerance for stress in interpersonal relations.
- The patient withdraws from people and reality, often into a fantasy life of delusions and hallucinations.
Differenciate between stereotyping and stigmatization
Stereotyping = a fixed belief of a negative generalization about a group of people - general public has negative beliefs about mentally ill people (engaging in stereotyping).
Stigmatization = A reduction in the status of a group of people, like mentally ill people, due to perceived deficiencies.
What is dissociative identity disorder (DID)?
a rare dissociative disorder in which 2+ fairly distinct and separate personalities are present within the same individual (each with own memories, relationships, and behaviour patterns) with only one of them dominant at any given time.
*Formerly called “multiple personality disorder”
What is the Canadian Mental Health Association (CMHA)
A national organization that provides information about mental illness and acts as an advocate for mentally ill people.
—-% of Canadians think mental illnesses are an excuse for poor behaviour/failures, avoid socializing or marrying someone who is mentally ill, and decline to tell friends about a family member suffering from mental illness.
50%
Findings from a 2008 National Iposos Reid Online Survey.
Contact with people who have psychological problems is a factor that mitigates against ——-
STIGMA
Who is Health Stuart?
Anti-Stigma Research Chair for Bell Mental Health.
Involved in preventive interventions to reduce stigma in high school students with video-based learning to show the challenges of schizophrenia
(students did have improved knowledge and less social distancing from people with mental illness and reductions in SELF STIGMA).
What is self-stigma?
the tendency for distressed people to internalize negative views of the self for not being well-adjusted (aka. people high in self-stigma are seeing themselves according to negative stereotypes).
What is mental health literacy? What is mental health literacy like in Canada?
The knowledge that a person develops about mental illness, including its causes and treatment.
Mental Health Literacy in Canada:
- Most Canadians see mental health as a medical problem
- Many Canadians are cautious about the use of psychiatric medications
- Canadians prefer a holistic treatment approach (but are mostly unaware of the range of treatment options)
- 90% think anyone can suffer from a mental disorder
- Better understanding of depression (rather than anxiety or schizophrenia)
What provides the best available information regarding the extent of mental health in Canada?
Canadian Community Health Survey - Mental Health (CCHS-MH)
Findings from survey:
- About 1 out of every 10 Canadians reported symptoms consistent with one of the disorders during the previous 12 months.
- 1 in 3 Canadians met criteria for a disorder at some point in their lifetimes.
- About 1 in 5 Canadians met lifetime criteria for a substance use disorder.
- About 1 in 7 Canadians met lifetime criteria for a major depressive episode or a bipolar disorder.
According to the CCHS-MH, what is the difference between males and females?
Females, relative to males, had higher rates of mood disorders and generalized anxiety disorder.
Males had higher rates of substance abuse.
What are the regional/provincial differences for mental health?
Not significant associations with mental health and province of residence.
But good mental health for those in Newfoundland and Labrador and PEI
(most happiness and the least distress)
Quebec has highest levels of self-esteem but lowest levels of happiness and most distress.
The costs of mental health problems to society include…
(1) personal misery
(2) disruption of family life
(3) lower quality of life
(4) loss of productivity.
The costs of mental health problems are also expressed in terms of the disease burden for people.
What are the 5 disorders with the highest amount of burden?
Depression
Bipolar disorder
Alcohol use disorders
Social phobia,
Schizophrenia.
What is the Romanow Report? What did it include?
Roy Ramanow reccomended that mental health should be made a priority within the Medicare system.
Report expanded on the 5 principles of the Canada Health Act:
- Stated that the principle of accountability (Canada’s health care system be held responsible for the quality of care provided) must be added to the act
- Proposed changes to medicare (expand medicare coverage beyong just hospitals, include number of home care services and drug treatments).
*recomendations were not added at the time.
What is the principle of accountability?
Canada’s health care system and provinces be held responsible for the quality of the care provided.
*a reccomendation from the Romandow Report for this pinciple to be added to the Canada Health Act.
What is the Senate Committee Final Report (“Kirby Report”)? What were the 2 key recomendations?
Senate Committee on Social Affairs released its final report related to mental health/illness and addiction in Canada
2 KEY recomendations (of the 118):
- Mental Health Commission of Canada → committee would develop a national action plan for mental health issues.
- Mental Health Transition Fund → to fund the development of a community-based system of mental health service delivery.
What is evidence-based treatment?
Treatments and interventions that have been shown to be effective according to controlled experimental research.
Today, psychotherapists are being asked to restrict themselves to using the ————–.
Most effective and efficient treatments.
Provincial governments concerned with cost-effectiveness of classical analysis/other forms of long-term psychotherapy –> so are limiting/attempting to limit longer forms of psychotherapy.
——– for mental health services is one of the most prominent problems within mental health services
WAIT TIMES
*Wait times of over one year for treatment for eating disorders have been discussed widely in the media.
*Long wait times are thought to play a role in children and adolescents presenting at hospital emergency rooms with mental health problems.
Do the majority of people who need help seek it out?
NO
There is a large mismatch between people’s needs and the care recived.
The strongest predictor of help-seeking is a psychiatric diagnosis
(but other strong predictors are marital disruption and poverty).
There is a need for interventions to encourage service use in what age group?
Emerging adults (15 - 24)
———– is the second leading cause of death for young Canadians
Completed suicide
*hald of young adults with suicidality do not access any mental health services
*among all ages, males are 3-4x more likely to commit suicide
*in younger ages, males and females are equally likely.
Predictors of university students not seeked help included:
- low perceived urgency
- negative attitude about the usefulness of help.
What is Deinsitutionalization?
The increasing tendency for treatment to take place in the community (such as an outpatient basis), rather than having patients reside in a public institution (such as a provincial mental hospital).
Well-intended attempt to reintegrate the mentally ill with the rest of Canadian society - but does always not work the way it is intended
What does the preferred mental health service model look like?
Emphasizes intensive local community support and services → and with general-hospital psychiatric units and regional care centres.
What are two huge national problems with mentally ill people and deinstitutionalization?
1) Homelessness & mental illness
- deinstituionalization AND the period (in 1990) where govs decreased welfare benefits are thought to contribute to the high number of mentally ill homeless people.
2) Jailing of mentally ill people
- Using incaerceration to adress mental health problems among prisoners
- Mental health needs of women in person are particularly chronic.
Howard Sapers, the correctional investigator of Canada, identified urgent mental health needs in his report, including…
- Create intermediate health care units.
- Increase capacity at regional treatment centres.
- Recruit and retain more mental health professionals.
- Expand the range of alternative mental health service delivery partnerships with the provinces and territories.
What is community psychology?
Emphasizes prevention and the seeking out of potential difficulties rather than waiting for troubled individuals to initiate consultation.
The location for professional activities tends to be in the person’s natural surroundings rather than in the therapist’s office.
Community psychologists SEEK out the problems or prevent them. (large focus on prevention)
What is prevention?
Efforts to reduce the incidence of new cases of psychological disorder (large part of community psychology!)
3 types of prevention:
(1) Primary prevention - reduce the incidence of new cases of disorder by altering stressful living conditions and genetic counselling.
(2) Secondary prevention - detect disorders early, so that they don’t develop into chronic disabilities
(3) Tertiary prevention - reduce the long-term consequences of having a disorder (fairly equivalent to therapy).
Community psychology programs focus on attempting to reduce —— factors and to develop —— factors
“risk”
“protective”
What are the 6 strategic directions in Canada’s Mental Health Strategy?
(1) Promote mental health across the lifespan in homes, schools, and workplaces, and prevent mental illness and suicide.
(2) Foster recovery and well-being for people living with mental health problems.
(3) Provide access to services, treatments, and supports, when and where people need them.
(4) Reduce disparities in risk factors and access to mental health services
(5) Work with First Nation, Inuit, and Metis citizens.
(6) Mobilize leadership and foster collaboration at all levels.
