Week 13 Flashcards
Who is William Stanley Milligan
Arrested for kidnapping, aggravated robbery, sexual assault (while on parole)
* Entered a plea of insanity – claiming “other personalities” had committed the crime
* 1st time defense was raised due to DID, and 1st to be acquitted
* DID is controversial
multiple personalities
go back to slide 3
medical model
historical conceptions
- During the Renaissance, the medical model emerged
- Mental illness as a physical disorder needing treatment
- People housed in asylums – but institutions were overcrowded and understaffed
- Treatments: bloodletting and snake pits
moral treatment
historical conceptions
- During the Renaissance, the medical model emerged
- Mental illness as a physical disorder needing treatment
- People housed in asylums – but institutions were overcrowded and understaffed
- Treatments: bloodletting and snake pits
slide 8
Deinstitutionalization
*Abysmal conditions in asylums & discovery of psychotropic meds
*No infrastructure (e.g., services) to support them in communities!
*Asylums à different institutions (hospitals, jails, prisons etc.)
slide 10
Taijin Kyofusho
Japanese form of soocial anxiety
- Fear of interpersonal relations– intense fear that one’s body parts of functions displease, embarrass or are offensive to others
- NA social anxiety more commonly generated by fear of public embarrassment
- Culture influences how people express interpersonal anxiety
- Collectivist culture – more concerned about impact on others
What is the DSM-5
- Official system for classifying individuals with mental disorders according to APA - 5 editions since 1952
- Contains diagnostic criteria and decision rules for each condition
- “think organic” (rule out physical causes of symptoms first)
- E.g., substance use or medical disorders can mimic psychological disorders
(e.g., hypothyroidism) - Biopsychosocial perspective
- E.g., hormonal abnormalities, irrational thoughts, interpersonal interactions – consider life stressors, medical conditions, level of functioning
slide 13
Biological perspectives
View psychological disorders as linked to biological phenomena: genetic factors, chemical imabalnces, brain abnormality
Supported by evidence that most psychological disorders have a genetic component
perspectives on mental illness
psychosocial perspective, Diatthesis-stress model
**Psychosocial perspective
*** Emphasizes importance of learning, stress, faulty and self-defeating thinking patterns, and environmental factors
* Views the cause of psych disorders as a combination of biological and psychosocial factors
**Diathesis-stress model:
*** DIATHESIS + STRESS = DEVELOPMENT OF DISORDER
* Diathesis = underlying predisposition (psychological or biological vulnerability)
Anxiety related disorders
Characterized by distressing, persistent anxiety or maldaptive behaviours tht reduce anxiety
MOSt anxieties are transient and can be adapative BUT can become excessive and innapropriate
GAD
Panic disorder
Specific phobias
OCD
PTSD
Generalized anxiety disorder
Continual feelings of worry, anxiety, physical tension and irritability about many areas
Can develop after major stressor of life change
More prevalent in females and caucasians
Panic disorder
+ panic attacks
Repeated unexpected panic attacks along with persistent concerns about future attacks and a change in personality in an attempt to avoid them.
Panic attacks are brief intense episodes of extreme fear characterized by sweating, diziness, lighteadeedness, racing heartbeat, and feelings of imoending death
Phobia + agoraphobia
Unrealistic fear of a specific situation, activity, or object.
Agoraphobia : Basic fear of being away from safe pêrson or place
OCD + obsessions and compulsions
Obsessions: persistent, unintentional and unwanted thoughts and urges that are highly intrusive, unpleasant, distressed.
* Common obsessions: concerns about germs, doubts, order and symmetry, aggressive or lustful
Compulsions: repetitive and ritualistic acts, carried out to minimize distress that obsessions trigger, or reduce likelihood of feared event
Disorders related to OCD
Hoarding disorder, excorciation disorder, trichotillomaniaa, body dysmorphic disorder
Bipolar disorder
Mood disorder characterized by alternating periods of mania (elevated mood) & depression
* More common in women
* Average age onset is 25 years
Causes:
* Genetic predisposition
* Linked to oxidative stress & accelerated aging
Omega-3 fatty acid may provide protection
Overrepresented in groups with artistic & creative talent
Major depressive disorder
- Lengthy periods of depressed mood, loss of pleasure in normal activities, disturbances in sleep & appetite, difficulty concentrating, hopelessness, possible suicidal ideation
- Must have either depressed mood OR anhedonia
Prevalence:
* Affects more women than men
* Decreases with age
MDD explanations, (cognitive + social)
Cognitive: negative thoughts about self, world and future
* Rumination related to negative outcome (women are more likely to ruminate!)
Social:
* Loneliness, perceived social isolation
Biological: 35% heritable
* Serotonin
* Disturbances in circadian rhythms – spend to much time in REM
Schizophrenia
+ positive and negative symptoms
Characterized by highly disordered thought processes; may be referred to as psychotic
Positive symptoms:
* Hallucinations
* Delusions
* Thought disorder
* Movement disorder (e.g., catatonia)
Negative symptoms (social withdrawal, behavioural deficits, loss or decrease of normal function) – e.g., flat affect
Causes of schizophrenia
Biological
Genetic vulnerability
Genetic marker includes occurence of dysfunction eye movement
Different brain activity
Abnormal brain development in adolesence
Abnormalities in dopamine activtiy
Environmental causes of schizophrenia
Extreme stress
SES
Minority status in a community
Prenatal environment
Cannabis use nearly doubles risk
Personality disorders
Rigid, maladaptive patterns that cause personal distress or inability to get along with others (e.g., borderline personality disorder, narcissistic, antisocial..)
Antisocial personality disorder (ADP)
- Characterized by lying, stealing, manipulation & sometimes violence
- Lack of guilt, shame, and empathy
- Exploit, manipulate, violate the rights of others
- 3% of men and less than 1% of women –about 10 – 15% will become psychopaths (NOT a diagnosis!)
Psychopathy
- Guiltless, manipulative, callous, and self-centered
- Most psychopaths aren’t violent
- They know their irresponsible actions are morally wrong, they just don’t care
Uncommon psychiatric syndromes
Capgras syndrome, Ekbom syndrone, Munchausen syndrome
Capgras’s syndrome: belief that a person close to them has been replaced by an exact double
Ekbom’s syndrome: delusions of infestation
Munchausen syndrome: persistent fabrication of medical symptoms – leads to illness, endangerment, unnecessary invasive/hazardous treatment
Who is Sean Clifton
Paranoid schizophrenic & OCD
- Voices told him to seek out the prettiest girl in the mall and stab her
- Stabbed 22-year-old Julie Bouvier
in 1999 - Deemed NCR, sent to psychiatric facility at Brockville
cjs & mental illness
CJS is not a place for people who are mentally ill
- Correctional system as Canada’s largest MH service provider
- Mental illness is 2-3 times more common in prisons than in the general population
- Potentially fruitful opportunity to connect people with services
- Different ways that PMI end up justice-involved
- Pre-existing, developed, exacerbated
For a person being charged with a crime to be tried fairly, they should..
+ theyre unfit when…
- Have an understanding of charges and proceedings
- Be able to help in preparing their defence
A defendant is unfit to stand trial if s/he is unable to:
1. Understand nature or object of proceedings
2. Understand possible consequences of proceedings
3. Communicate with counsel (limited cognitive capacity
standard)
What does criminal guilt require
Actus reus- the guilty action
Mens rea- the guilty mind
No person is criminally responsible for an act committed or an omission made while:
NCRMD – Current Test
(a) suffering from a mental disorder at the time of the offence that
(b) rendered that person incapable of appreciating the nature and quality of an act or omission OR
(c) knowing that it was wrong
Myths and realities of NCMRD
- Frequent Use:
* Myth: public believes it is regularly used; estimates that it is raised in 33-43% of all cases
* Reality: used in only 1% of felony cases, and fails 75% of the time - Crafty Cons:
* Myth: NCR is a loophole that lets the guilty go free
* Reality: Most NCR defendants spend their sentence in jail or a hospital; only 2-10% of cases involve a “successful” NCR plea - Extremely Dangerous
Myth: mentally ill people are extremely dangerous and likely to reoffend
Reality: Most NCR cases are non-violent; there is either no difference or lower rates of recidivism - Quick Release
Myth: all those found NCRMD get out early and quickly
Reality: Those found NCR are committed to mental institutions longer than they would be in jail if found guilty; Extremely rare to get an absolute discharge
What are things that contributed to the criminalization of mental illness
- Historically, deinstitutionalization
- Behave in disruptive or disorderly ways due to symptoms
IN the system:
* Issues accessing quality legal representation (poverty, homelessness)
* Lack of services in prison/jail
* Prison is bad for your mental health!
slide 46
Incarceration and mental health
- 1 in 10 males and 3 in 10 females enter federal custody with preexisting MH issues
- 41% of ON prisoners will have at least one current, severe symptom indicative of a mental problem
- Jails not equipped to provide care (less than 2-year sentence OR remand)
- Lack of services in federal facilities
- inappropriate use & overuse of segregation
Solitary confinement
Explain disciplinary and administrative
Disciplinary: punishment for inmates who have
violated institutional rules or committed offenses in
custody
* Maximum of 30 consecutive days and can be extended
Administrative: Inmate’s presence poses a safety risk
(e.g., inmate, security, staff members) or is at own risk
(e.g., pedophiles)
* No limit! Returned at earliest appropriate time…
Sprott & Doob
3 in 10 inmates in SIU didn’t have all or sometimes any of the four hours out of their cells, for 2 weeks at a time
- 1 in 10 kept in excessive isolation for 16 days or longer, aka torture (UN)
- 10 were kept in SIU for 10 months, most (n=7) missed their full four hours AND 2 hours of contact in 76% or more of their days
Effects of solitary confinement
Profound psychological impact
* Hallucinations
* Cognitive disabilities
* Insomnia
* Self-harm
* Paranoia
* Suicidal tendencies & more
Neurological effects– causes changes in brain structures, shrinks neurons, etc.
Kalief Browder
Arrested at 16 after accused of stealing a backpack
* Held on remand for three years at Rikers Island (couldn’t afford bail)
* More than half of sentence spent in solitary
* Never fully recovered from trauma & abuse
