Week 19: Psychopathology I Flashcards
Learning Objectives:
Identify what the criteria used to distinguish normality from abnormality are.
Understand the difference among the three main etiological theories of mental illness.
Describe specific beliefs or events in history that exemplify each of these etiological theories (e.g., hysteria, humorism, witch hunts, asylums, moral treatments).
Explain the differences in treatment facilities for the mentally ill (e.g., mental hospitals, asylums, community mental health centers).
Describe the features of the “moral treatment” approach used by Chiarughi, Pinel, and Tuke.
Describe the reform efforts of Dix and Beers and the outcomes of their work.
Describe Kräpelin’s classification of mental illness and the current DSM system.
cultural relativist view & Mental illness
The idea is that cultural norms and values of a society can only be understood on their own terms or in their own context.
sociocultural norms and expectations of a specific culture and period has been used as a way to silence or control certain individuals or groups.
View of abnormal behavior has focused instead on whether behavior poses a threat to oneself or others or causes so much pain and suffering that it interferes with one’s work responsibilities or with one’s relationships with family and friends.
Etiology
The causal description of all of the factors that contribute to the development of a disorder or illness.
three general theories of the etiology of mental illness:
- supernatural
- somatogenic
- psychogenic
Each form determines the care and treatment mentally ill individuals receive.
Supernatural theory of etiology
Developing from origins beyond the visible observable universe.
*possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin.
Somatogenic theory of etiology
Developing from physical/bodily origins.
*disturbances in physical functioning resulting from either illness, genetic inheritance, or brain damage or imbalance.
Psychogenic theory of etiology
Developing from psychological origins.
*traumatic or stressful experiences, maladaptive learned associations and cognitions, or distorted perceptions.
Maladaptive - Developing from psychological origins
Trephination
The drilling of a hole in the skull, presumably as a way of treating psychological disorders.
6500 BC - identified surgical drilling of holes in skulls to treat head injuries and epilepsy as well as to allow evil spirits trapped within the skull to be released
2700 BC - Around 2700 BC, Chinese medicine’s concept of complementary positive and negative bodily forces (“yin and yang”) attributed mental (and physical) illness to an imbalance between these forces. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential
Hysteria
Term used by the ancient Greeks and Egyptians to describe a disorder believed to be caused by a woman’s uterus wandering throughout the body and interfering with other organs (today referred to as conversion disorder, in which psychological problems are expressed in physical form).
Mesopotamian and Egyptian papyri from 1900 BC describe women suffering from mental illness resulting from a wandering uterus
*The uterus could become dislodged and attached to parts of the body like the liver or chest cavity, preventing their proper functioning or producing varied and sometimes painful symptoms. As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong smelling substances to guide the uterus back to its proper location (pleasant odors to lure and unpleasant ones to dispel).
400 BC that Hippocrates (460–370 BC)
Attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency in or especially an excess of one of the four essential bodily fluids
*blood, yellow bile, black bile, and phlegm—was responsible for physical and mental illness
*did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior.
Hippocrates four categories of mental illness
- epilepsy
- mania
- melancholia
- brain fever
Humorism
A belief held by ancient Greek and Roman physicians (and until the 19th century) that an excess or deficiency in any of the four bodily fluids, or humors—blood, black bile, yellow bile, and phlegm—directly affected their health and temperament.
animistic soul
The belief that everyone and everything had a “soul” and that mental illness was due to animistic causes, for example, evil spirits controlling an individual and his/her behavior.
Greek physician Galen (AD 130–201)
rejected…
agreed…
the notion of a uterus having an animistic soul, he agreed with the notion that an imbalance of the four bodily fluids could cause mental illness.
Hippocratic oath
Many of Hippocrates’ medical theories are no longer practiced today. However, he pioneered medicine as an empirical practice and came up with the “Hippocratic oath,” which all doctors must swear to before joining the profession (i.e., the promise to never intentionally harm a patient)
asylums
A place of refuge or safety established to confine and care for the mentally ill; forerunners of the mental hospital or psychiatric facility.
*Such institutions’ mission was to house and confine the mentally ill, the poor, the homeless, the unemployed, and the criminal.
1785 Italian physician Vincenzo Chiarughi
removed the chains of patients at his St. Boniface hospital in Florence, Italy, and encouraged good hygiene and recreational and occupational training.
French physician Philippe Pinel (1745–1826) and former patient Jean-Baptise Pussin
traitement morale
“moral treatment”
A therapeutic regimen of improved nutrition, living conditions, and rewards for productive behavior that has been attributed to Philippe Pinel during the French Revolution, when he released mentally ill patients from their restraints and treated them with compassion and dignity rather than with contempt and denigration.
*also unshackled patients, moving them to well-aired, well-lit rooms, and encouraging purposeful activity and freedom to move about the grounds
York Retreat
patients were guests, not prisoners, and where the standard of care depended on dignity and courtesy as well as the therapeutic and moral value of physical work
Benjamin Rush
father of America psychiatry
Promotion of matogenic theory of mental illness led to treatments such as blood-letting, gyrators, and tranquilizer chairs.
Dorothea Dix
worked to change the negative perceptions of people with mental illness and helped create institutions where they could receive compassionate care.
*advocated for the establishment of state hospitals.
Franz Anton Mesmer (1734–1815)
influenced by contemporary discoveries in electricity, attributed hysterical symptoms to imbalances in a universal magnetic fluid found in individuals, rather than to a wandering uterus
Mesmerism
Derived from Franz Anton Mesmer in the late 18th century, an early version of hypnotism in which Mesmer claimed that hysterical symptoms could be treated through animal magnetism emanating from Mesmer’s body and permeating the universe (and later through magnets); later explained in terms of high suggestibility in individuals.
cathardic method
A therapeutic procedure introduced by Breuer and developed further by Freud in the late 19th century whereby a patient gains insight and emotional relief from recalling and reliving traumatic events.
Psychoanalysis
was the dominant psychogenic treatment for mental illness during the first half of the 20th century, providing the launching pad for the more than 400 different schools of psychotherapy found today
biopsychosocial model
A model in which the interaction of biological, psychological, and sociocultural factors is seen as influencing the development of the individual.
Emil Kräpelin on mental illness
published a comprehensive system of psychological disorders that centered around a pattern of symptoms (i.e., syndrome) suggestive of an underlying physiological cause.
syndrome
Involving a particular group of signs and symptoms.
homosexuality as a disorder
Up until the 1970’s, homosexuality was included in the DSM as a psychological disorder. Thankfully, society and clinical understanding changed to recognize it didn’t belong.
Diagnostic and Statistical Manual (DSM).
American Psychiatric Association’s 1952 first publication
1980 DSM-III version that began a multiaxial classification system that took into account the entire individual rather than just the specific problem behavior.
Axes I and II contain the clinical diagnoses, including intellectual disability and personality disorders.
Axes III and IV list any relevant medical conditions or psychosocial or environmental stressors, respectively.
Axis V provides a global assessment of the individual’s level of functioning.
*The most recent version — the DSM-5– has combined the first three axes and removed the last two. These revisions reflect an attempt to help clinicians streamline diagnosis and work better with other diagnostic systems such as health diagnoses outlined by the World Health Organization.
*the number of diagnosable disorders has tripled since it was first published in 1952, so that almost half of Americans will have a diagnosable disorder in their lifetime, contributing to the continued concern of labeling and stigmatizing mentally ill individuals.
DSM vs ICD
(the International Classification of Diseases, 11th revision)
There are some differences between the DSM 5 and ICD-11. For example, Gender Incongruence, that is, a discordance between experienced gender and the assigned sex, is not listed as a mental disorder in the ICD-11, but a condition related to sexual health. In the DSM 5, this phenomenon is termed “gender dysphoria” and considered a mental disorder.
Individuals have often theorized on the cause, or ______, of mental illness.
etiology
What is the name of the ancient Greco-Roman belief that mental illness was caused by an imbalance in the four bodily fluids?
humorism
The Greek physician Galen was one of the first people to believe that mental illness could have a ______ cause such as stress, in addition to other bodily causes.
psychogenic
What book allows psychiatrists and psychologists to standardize their diagnoses of mental illness?
DSD
Diagnostic and Statistical Manual of Mental Disorders
The idea that the cultural norms and values of a society can only be understood in their own context is known as what?
cultural relativism
