Week 1 Chapter 1 Intro & Historical Overview CF

Question 0

What are the four characteristics of a stigma?

Answer 0

1. A label as applied to a group of people that distinguishes them from others (e.g. Crazy)
2. The label is linked to deviant or undesirable attitudes by society (e.g. Crazy people are dangerous)
3. People with the label are seen as essentially different from those without the label, contributing to an “us” & “them” mentality (e.g., we are not like those crazy people)
4. People with the label are discriminated against unfairly (e.g. A clinic for crazy people can’t be built in our neighbourhood)

Question 1

Define Stigma

Answer 1

The destructive beliefs & attitudes held by a society that are ascribed to groups considered different in some manner, such as people with mental illness

Question 2

What is the Study of Psychopathology concerned with?

Answer 2

The Study of Psychopathology is concerned with the nature, development & treatment of mental disorders.

Question 3

What are the arenas that need to address the stigma of Mental Illness (As proposed by Stephen Hinshaw in 2007)?

Answer 3

*Policy & Legislation including Employment, Decriminalisation, Discriminatory Laws & Insurance laws
*Community Strategies, including Housing, Education and personal contact
*Mental Health & Health Profession Strategies including, Mental Health Evaluations, Education & Training,
Individual & Family Strategies, including: Education for individuals and families, and support & advocacy groups

Question 4

What are the characteristics essential to the concept of a Mental Disorder according to the DSM-IV-TR & DSM-V?

Answer 4

• A mental disorder occurs within the individual
• It Causes personal distress or disability
• It is not a culturally specific reaction to an event (e.g. death of a loved one)
• It is not primarily a result of social deviance or conflict within society

Question 5

What are the main points to consider in relation to the personal distress caused by the presence of a mental disorder?

Answer 5

• A person’s behaviour may be classified as disordered if it causes him or her great distress
• Personal distress characterises many forms of mental disorder
• Not all mental disorder causes distress
  e. g. anti-social personality disorder
• Not are behaviour that causes distress is disordered (e.g. hunger or the pain of childbirth)

Question 6

What are the main points to consider in relation to the sense of disability caused by the presence of a mental disorder?

Answer 6

• Disability is the impairment in some important area of life (e.g., work, or personal relationships)
• Disability can also characterise mental disorder e.g. being rejected by peers, or substance use disorders can be socially or occupationally disabling
• Like distress however, disability alone cannot be used to define mental disorder: as not all disabilities are related to mental disorder and not all mental disorders include disablement - e.g. bulimia nervosa doesn’t always involve disablement.

Question 7

Define Social Norms

Answer 7

Social norms are widely held standards, beliefs, & attitudes that people use consciously or intuitively to make judgements about where behaviours are situated on such scales as good-bad, right-wrong, justified-unjustified, and acceptable-unacceptable

Question 8

What are the main points to consider in relation to the violation of Social Norms caused by the presence of a mental disorder?

Answer 8

• Behaviour that violates Social Norms might be classified as Disordered
  e. g. repetitive rituals of OCD,
• Not all violations of Social Norms fits into psychopathology however.
  e. g. some criminal behaviour, extreme tattooing
• It is essential to remember that what is socially acceptable or in violation changes dependent on the cultural and ethnic context being considered.

Question 9

There are two main attempts to define ‘harmful dysfunction’ what is the definition put forward by Wakefield?

Answer 9

Wakefield’s definition has 2 parts: a value judgement (harmful) and an objective, scientific component - the dysfunction

• A judgement that a behaviour is harmful requires some standard, dependent on social norms.
• Dysfunctions are said to occur when an internal mechanism is unable to perform its natural function (the function it evolved to perform).

Question 10

There are two main attempts to define ‘harmful dysfunction’ what is the main criticism of the definition put forward by Wakefield?

Answer 10

The main difficulty with Wakefield’s theory is that the internal mechanisms involved in mental disorders are largely unknown; thus, we cannot say exactly what may not be functioning adequately.

• Wakefield countered this by referring to “plausible” rather than proven dysfunctions
• However, Wakefield’s definition still requires we are judging a behaviour as harmful & then stating it represents a mental disorder because we BELIEVE it is caused by a dysfunctional internal system
• Like all definitions of mental disorder, Wakefield’s has its limitations
• Page 7 - not - not much of a definition :-)

Question 11

There are two main attempts to define ‘harmful dysfunction’, in order to address the criticism of Wakefield’s definition, what is the definition put forward by the DSM?

Answer 11

The DSM definition of dysfunction refers to the fact that behavioural, psychological, and biological dysfunctions are all interrelated and effect each other.

Question 12

What, in a nutshell, where the stages of the historical treatment of Psychopathology?

Answer 12

• Early Demonology
• Hippocrates
• The Dark Ages, return to Demonology including witch trials and lunacy trials
• Development of Asylums - Bethlehem,
• Pinel’s reforms
• Development of Moral Treatment

Question 13

What were the main beliefs involved in Early Demonology?

Answer 13

• Many Early philosophers, theologians, and physicians who studied the troubled mind believed that disturbed behaviour reflected the displeasure of the gods or possession by demons
• Demonology is the belief that an evil spirit can dwell within a person and control his or her body
• Exorcism was used to treat the odd behaviour, achieved by the ritualistic casting out of evil spirits

Question 14

What was Hippocrates (5th century BC) belief system and how did it change the treatment of mental disorders?

Answer 14

• Hippocrates separated medicine from religion, magic, and superstition
• Hippocrates insisted that mental disturbances have natural causes and should be treated like other illnesses
• Hippocrates believed the brain as the organ of intellect & consciousness so thought that disordered thinking & behaviour was an indication of brain pathology
• Hippocrates classified mental disorders as: Mania, Melancholia, & Phrentis/brain fever
• Hippocrates work foreshadowed many aspects of contemporary thought

Question 15

The Dark Ages & a return to Demonology were thought to coincide with the death of Galen (AD 130-200), regarded as the last great physician of the classical era. What were the main treatments for mental disorders in the Dark Ages?

Answer 15

• Churches gained influence again, monks cared for those with mental disorders, by praying over them and touching them with relics, gaining them potions to drink in the waning phase of the moon.
• During this period there was a return to the belief in the supernatural
• Demonology was used to explain a number of plagues and natural disasters. Witchcraft was seen as instigated by Satan, thus as heresy, witchcraft trials were held in vast number with more healthy than ill people tried
• Lunacy trials were also held: a judgement of insanity allowed the Crown to become guardian of the ‘lunatic’s’ estate. “Holy Trinity Hospital” in Salisbury, England kept the “mad safe”

Question 16

As Leprosy disappeared from Europe in the 15th Century, Leprosariums were converted into Asylums, refugees for the confinement and care of people with mental illness. St. Mary’s of Bethlehem, known as ‘Bedlam’ was one of the most well-known.
What were the conditions like?

Answer 16

• The conditions were deplorable. ‘Bedlam’ came to mean a place or scene of wild uproar & confusion.
• Viewing patients was a more popular tourist attraction than visiting the Tower of London or Westminster Abbey
• Medical treatments were crude & painful: Benjamin Rush believed in bleeding people or scaring them by telling them they would die as treatments

Question 17

Philippe Pinel (1745-1826) was credited for major reform.  Jean-Baptiste Pussin (a former patient) actually began the changes in the treatment of people housed in asylums.
What were the main changes Pussin and Pinel brought about?

Answer 17

• The chains of the imprisoned people in La Bicetre were removed
• Patients were treated as human beings rather than animals
• as a result people were treated with compassion, dignity, and respect
• Dungeons were replaced by light and airy rooms
• Patients were allowed to walk around the grounds
• Many eventually recovered and were released
• However, some of the lower class patients continued to be treated poorly: straitjackets replaced chains; and they were treated with terror and coercion

Question 18

What are the main characteristics of Moral Treatment with regards to the treatment of mental illness?

Answer 18

• Private hospitals were set up to provide humane treatment for people with mental disorder in the 1800’s in the USA
• Patients had close contact with attendants, were engaged in purposeful activity, patients lives resembled ‘regular life’ as far as possible, and were encouraged to take self-responsibility wherever possible

Question 19

What was the main problem with the development of public hospitals set up by Dorothea Dix (1802-1887) which attempted to emulate the Moral Treatment approach to the treatment of mental illness?

Answer 19

*Despite campaigning vigorously to improve the lives of people with mental disorders, insufficient funding, staffing and a focus on the biological causes of mental illness led to these institutions being unable to care for people using the Moral Treatment approach and focus was instead on patients physical rather than psychological health

Question 20

What was so interesting about the Bethlehem Physician (1810), William Black’s, hypothesis of the causes of the patients maladies?

Answer 20

That about half were presumed to have biological causes (e.g. fever, hereditary, venereal) and half were thought to have a psychological basis (e.g. grief, love, jealousy). Only about 10% of the illnesses were attributed to spiritual causes

Question 21

What led to biological causes for psychopathology gaining credibility in 1905?

Answer 21

The specific micro-organism that causes syphilis was discovered, establishing a causal link between infection, destruction of certain areas of the brain, & a form of psychopathology (general paresis).
Prior to this discovery the anatomy & workings of the nervous system were only partially understood & not enough was known to conclude that structural brain abnormalities caused various mental disorders.

Question 22

The Eugenics movement played a huge role in the stigmatisation of mental disorder. What was the implication of state laws passed in the USA in the late 1800’s & early 1900’s?

Answer 22

The laws prevented people with mental illness from marrying & forced them to be sterilised in order to prevent them from passing on their illness. It wasn’t until the middle of the 20th century that these abhorrent practices were halted.

Question 23

What were the three main biologically based radical experiments that were practised in early 20th century mental hospitals?

Answer 23

• Insulin-induced coma to treat people with schizophrenia (Sakel, 1938)
• ECT to treat schizophrenia & major depression (Ugo Cerletti & Lucino Bini, 1938)
• Pre-frontal lobotomy (Moniz, 1936)

Question 24

What were the main psychological approaches to treating mental illness that developed from the late 18th century approach, which attributed mental disorders to psychological malfunctions?

Answer 24

• Mesmer & Charot developed hypnosis
• Breuer developed the cathartic method (on Anna O, which didn’t actually work it seems)
• Freud developed Psychoanalytic theory after working with Breuer in the treatment of Anna O

Question 25

Freud developed psychoanalysis, an influential treatment for mental illness. Provide a brief summary of Freud’s view of the ‘structure of the mind’

Answer 25

The mind or psyche consists of 3 principle areas:

• id = unconscious & holds energy for all basic needs - the energy is called libido (sex, food, elimination, affection). The id seeks immediate gratification
• ego = largely conscious & mediates between the demands of reality & the id’s needs for gratification
• superego = a person’s conscience.

Question 26

Freud conceived of eight defence mechanisms used by the ego to protect itself from anxiety. What are the defence mechanisms?

Answer 26

• Repression
• Denial
• Projection
• Displacement
• Reaction Formation
• Regression
• Rationalisation
• Sublimination

Question 27

What are the goals of a therapist practising Freud’s psychoanalytic theory?

Answer 27

The goal of the therapist is to understand the persons early childhood experiences, the nature of key relationships, and the patterns in current relationships in order to identify recurrent themes/patterns.
The therapist may use free association, interpretation and the analysis of transference to achieve this goal (where transference is the patients response to the analyst that seems to reflect attitudes & ways of behaving toward important people in the patient’s past, rather than reflecting actual aspects of the analyst-patient relationship

Question 28

Freud also conceived of the personality developing through a series of psycho-sexual stages, as at each stage, a different part of the body is the most sensitive to sexual excitation & therefore, the most capable of satisfying the id.
Name the stages in Freud’s model

Answer 28

• The Oral Stage (birth-18 months)
  pleasure: feeding, sucking, biting - lips, mouth, gums, tongue
• The Anal Stage (18 months - 3 years)
  pleasure: passing & retaining faeces
• The Phallic Stage (3 years - 5/6 years)
  pleasure: genital stimulation

*Latency period (6-12 years) The id is not major motivator during this period

*The Genital stage (Puberty)
heterosexual interests predominate

Question 29

Who are the main Neo-Freudian analysts?

Answer 29

Carl Jung & Alfred Adler

Question 30

What was Jung’s Analytic theory?

Answer 30

Jung hypothesised that in addition to the personal unconscious there is also a collective unconscious, common to all human beings, which consists primarily of archetypes or basic categories that all human beings use in conceptualising the world

Question 31

What were the main points of Adler’s individual psychology theory?

Answer 31

Alder’s theory regarded people as inextricably linked to their society because fulfilment comes from doing things for the social good. Alder’s therapy concentrated on helping individuals change their illogical & mistaken ideas & expectations; he believed that feeling & behaving better depends on thinking more rationally = this approach gave rise to Cognitive Behavioural Therapy (CBT)

Question 32

What are Freud’s 3 main lasting influences in the field of mental health treatment?

Answer 32

1. Childhood experiences help shape our personality
2. There are unconscious influences on behaviour
3. The causes & purposes of human behaviour are not always obvious

Question 33

The Dominant focus of psychology switched from thinking to learning as a result of disillusion with psychoanalytic theory and John B Watson revolutionised psychology with his views on behaviourism.
What is behaviourism?

Answer 33

Behaviourism focuses on observable behaviour rather than on consciousness, or mental functioning.

Question 34

What are the 3 main behavioural theories & who are the main proponents of them?

Answer 34

The 3 main behavioural approaches are:

• Classical Conditioning (Pavlov’s Dog & Watson & Little Albert)
• Operant Conditioning (Thorndike & Skinner)
• Modelling (Bandura)

Question 35

What did Pavlov bring to Behaviourism?

Answer 35

Pavlov discussed classical conditioning

Pavlov observed with his dog study that food is the UCS (Unconditioned Stimulus) elicits salivation, which in turn is the UCR (Unconditioned Response). By ringing a bell prior to the dog seeing the food led to the bell becoming the CS (Conditioned Stimulus). When the dog salivates by the sound of the bell alone, this becomes the CS (Conditioned Response)
NB: Extinction happens to the CR when the CS is no longer followed by the UCS

Question 36

What did John B Watson teach us about the power of Classical Conditioning with 11 month old Little Albert?

Answer 36

That Classical Conditioning can lead to Pathological Fear (Little Albert became terrified of a cuddly toy as a result of J.B. Watson’s experiment)
This study suggested a possible relationship between classical conditioning and the development of certain disorders.

Question 37

What was Thorndike’s “Law of Effect” in reference to Operant Conditioning?

Answer 37

Thorndike’s law of effect states that behaviour which is followed by consequences satisfying the organism will be repeated, & that behaviour that is followed by noxious or unpleasant consequences will be discouraged.

Question 38

How did Skinner rename Thorndike’s “Law of Effect” and how did it shape Operant Conditioning?

Answer 38

• B. F. Skinner renamed it the “Principle of Reinforcement” & distinguished 2 types of reinforcement:
• Positive Reinforcement: strengthening a tenancy to respond by presenting a pleasant ‘positive reinforcer’ &
• Negative Reinforcement: strengthens a response by removing an adverse consequence

Question 39

How might the principles of Operant Conditioning contribute to the persistence of aggressive behaviour?

Answer 39

• Aggression is often rewarded e.g. when a child hits another to get the toy they want.
• Parents giving in when a child becomes angry

Question 40

What is Modelling and who were the key proponents of the principles of Modelling in the 1960’s?

Answer 40

• Modelling is learning by watching the behaviours of others
• Learning in the absence of a reinforcer
• Bandura & Menlove (1968) used a modelling treatment to reduce fear of dogs in children

Question 41

When Behaviour Therapy emerged in the 1950’s, how did it apply procedures based on Classical & Operant conditioning?

Answer 41

*Behaviour Therapy was an attempt to change behaviour, thoughts & feelings by applying the methods used and the discoveries made by experimental psychologists in a clinical context

Question 42

Behaviour Therapy treated phobias with systematic desensitisation. What are the two components used?

Answer 42

1. Deep Muscle relaxation

2. Gradual exposure to a list of feared stimulus

Question 43

What other principles were used in Behaviour Therapy?

Answer 43

• Modelling
• Operant techniques (e.g. systematic reward)
• Intermittent reinforcement was found to be more effective than continual reinforcement once a desirable behaviour pattern had been established

Question 44

What principles are Cognitive Therapy based on?

Answer 44

• The idea that people not only behave, they think and feel.
• All cognitive approaches emphasise that how people construe themselves & the world is a major determinant of psychological disorders

Question 45

What is the therapist’s main aim in cognitive therapy?

Answer 45

*To help clients become aware of their maladaptive thoughts. By Changing cognition, therapists hope people can change their feelings, behaviours, and symptoms.

Question 46

Where are the roots of Cognitive Therapy?

Answer 46

• Aaron Beck’s cognitive therapy &

* Albert Ellis’s Rational-Emotive Behaviour Therapy (REBT)

Question 47

What are the main points of REBT (Rational-Emotive Behaviour Therapy)?

Answer 47

• To eliminate self-defeating beliefs
• To Challenge irrational beliefs arising from negative self-statements
• To Challenge the ‘musts’ and ‘shoulds’ that people impose on themselves