Psychopathology: Historical Overview

Transcription

1 Psychopathology: Historical Overview

2 What is the meaning of diagnosing?

3 Psychopathology Study of the nature, development, and treatment of psychological disorders Challenges to the study of psychopathology: Maintain objectivity Avoid preconceived notions Reduce stigma

4 Four Characteristics of Stigma

5 Defining Mental Disorder Personal Distress The condition causes the individual distress Emotional pain and suffering Helplessness and hopelessness of depression Disability Impairment in work, relationships etc. Chronic substance abuse results in job loss Violation of Social Norms Makes others uncomfortable or causes problems Antisocial behavior of the psychopath Dysfunction Wakefield's Harmful Dysfunction: failure of internal mechanisms in the mind to function properly Behavioral, psychological, and/or biological systems are impaired

6 Social norm violation?

7 Defining Mental Disorder, DSM-5 The disorder occurs within the individual. It involves clinically significant difficulties in thinking, feeling, or behaving. It involves dysfunction in processes that support mental functioning. 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 with society.

8 Definition of Mental Disorder

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10 History of Psychopathology Early Demonology Possession by evil beings or spirits Exorcism Early Biological Explanations Hippocrates (5 th century BC) Mental disturbances have natural (not supernatural) causes (problems with the brain) Three categories of mental disorders: mania, melancholia, & phrenitis (brain fever) Normal brain functioning depended on balance of four humors: blood, black bile, yellow bile, & phlegm

11 Before Dark Ages

12 History of Psychopathology: Dark Ages Dark Ages (2 nd century AD) Monks cared and prayed for mentally ill Witches (13 th century AD) Torture sometimes led to bizarre delusional sounding confessions, e.g., concourse with demons. Initially, historians concluded many of the accused were mentally ill. Further research found little support for this conclusion.

13 Witches

14 History of Psychopathology: Lunacy Trials Lunacy Trials Trials held to determine sanity Began in 13 th century England Municipal authorities assumed responsibility for care of mentally ill Lunacy attributes insanity to misalignment of moon ( luna ) and stars

15 History of Psychopathology: Asylums Asylums (15 th century AD) Establishments for the confinement and care of mentally ill Priory of St. Mary of Bethlehem (founded in 1243) One of the first mental institutions The wealthy paid to gape at the insane Origin of the term bedlam (wild uproar or confusion) Treatment non-existent or harmful at asylums Benjamin Rush recommended drawing copious amounts of blood, to relieve brain pressure

16 Bethlehem (Bedlam)

17 History of Psychopathology: Pinel s Reforms and Moral Treatment Philippe Pinel ( ) Pioneered humanitarian treatment at LaBicetre Moral Treatment Small, privately funded, humanitarian mental hospitals Friends Asylum (1817) Patients engaged in purposeful, calming activities (e.g., gardening) Talked with attendants

18 History of Psychopathology: Dorothea Dix Dorothea Dix ( ) Crusader for prisoners and mentally ill Urged improvement of institutions Worked to establish 32 new, public hospitals Unfortunately, small staffs at these new public hospitals could not provide necessary individual attention Hospitals administered by physicians, who were more interested in biological rather than psychological aspects of mental illness

19 The Evolution of Contemporary Thought

20 Biological Approaches General paresis and Syphilis Degenerative disorder with psychological symptoms (delusions of grandeur) and physical symptoms (progressive paralysis) By mid-1800 s, it was known that general paresis and syphilis occurred together in some patients In 1905, biological cause of syphilis found Since general paresis had biological cause, other mental illness might also Biological causes of psychopathology gained credibility

21 Genetics Galton s ( ) work lead to notion that mental illness can be inherited Nature (genetics) and nurture (environment) Eugenics Promotion of enforced sterilization to eliminate undesirable characteristics from the population Many state laws required mentally ill to be sterilized Galton

22 Early Biological Treatments Insulin-coma therapy Sakel (1930 s) Electroconvulsive Therapy (ECT) Cerletti and Bini (1938) Induce epileptic seizures with electric shock Prefrontal lobotomy Moniz (1935) Often used to control violent behaviors; led to listlessness, apathy, and loss of cognitive abilities

23 Psychological Approaches Mesmer ( ) Treated patients with hysteria using animal magnetism Early practitioner of hypnosis Charcot ( ) His support legitimizes hypnosis as treatment for hysteria Breuer ( ) Used hypnosis to facilitate catharsis in Anna O. Cathartic Method Release of emotional tension triggered by reliving and talking about event

24 Psychological Approaches Breuer and Freud ( ) jointly publish, Studies in Hysteria in 1895, which serves as the basis for Freud s theory. Freudian or Psychoanalytic theory Human behavior determined by unconscious forces. Psychopathology results from conflicts among these unconscious forces.

25 Hysteria - Anna O.

26 Psychological Approaches Id Unconscious Pleasure principle Immediate gratification Libido Energy of ID Ego Primarily conscious Reality principle Attempt to satisfy ID s demands within reality s constraints Superego The conscience Develops as we incorporate parental and society values

27 Psychological Approaches Id, Ego, Superego continually in conflict Conflict generates anxiety Ego generates strategies to protect itself from anxiety Defense mechanisms Psychological maneuvers used to manage stress & anxiety

28 Psychological Approaches

29 Psychological Approaches Goals of Psychoanalytic Therapy or Psychoanalysis Understand early-childhood experiences, particularly key (parental) relationships Understand patterns in current relationships Psychoanalytic Techniques Free Association Analysis of Transference Interpretation

30 Psychological Approaches

31 Psychological Approaches Neo-Freudians Jung ( ) Analytical psychology Collective unconscious Archetypes Catalogued personality characteristics Extraversion vs. Introversion Adler ( ) Individual psychology Fulfillment derived from working for the social good

32 Rise of Behaviorism John Watson ( ) Behaviorism Focus on observable behavior Emphasis on learning rather than thinking or innate tendencies Three types of learning: Classical Conditioning Operant Conditioning Modeling

33 Classical Conditioning Discovered by Pavlov ( ) Unconditioned Stimulus (UCS) Meat powder (automatically elicits salivation) Unconditioned Response (UR) Salivation (automatic response to meat powder) Neutral Stimulus (NS) Initial ringing of bell (does not automatically elicit salivation) Conditioned Stimulus (CS) After pairing the NS and the UCS, the NS becomes a CS (bell now automatically elicits salivation) Conditioned Response (CR) Salivation (automatic response to bell) Extinction CS (bell) not followed by UCS (meat powder) causes gradual disappearance of CR (salivation)

34 The process of classical conditioning

35 Operant Conditioning E. Thorndike ( ) Learning through consequences Law of Effect Behavior that is followed by satisfying consequences will be repeated; behavior that is followed by unpleasant consequences will be discouraged B.F. Skinner ( ) Principle of Reinforcement Positive reinforcement Behaviors followed by pleasant stimuli are strengthened Negative reinforcement Behaviors that terminate a negative stimulus are strengthened

36 Modeling Learning by watching and imitating others behaviors Can occur without reinforcement Bandura & Menlove (1968) Modeling reduced children s fear of dogs

37 Behavior Therapy Behavior Therapy or Behavior Modification Systematic Desensitization (Wolpe) Used to treat phobias and anxiety Combines deep muscle relaxation and gradual exposure to the feared condition or object Starts with minimal anxiety producing condition and gradually progresses to most feared Intermittent Reinforcement Rewarding a behavior only occasionally more effective than continuous schedules of reinforcement

38 Importance of Cognitions Limitations of Behavior Therapy How we think or appraise a situation influences our feelings and behaviors Cognitive Therapy Emphasize how people think about themselves and their experiences can be a major determinant of psychopathology Focus on understanding maladaptive thoughts Change cognitions to change feelings and behaviors Ellis ( ) REBT (Rational-Emotive Behavior Therapy)

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