Contrariis Contrarius

Patrician College of Arts and Science Department of Psychology

Psychopathology - I

Subject Code : SAT5A

Odd Semester

Presented By Dr.Ilakkiya

https://www.patriciancollege.ac.in/ What is Psychologically Abnormal?

• The Four D’s – Deviance – Distress – Dysfunction – Danger Four D’s in More Detail I.

• Deviance – Deviance from or violation of a society’s ideas about proper function. • Norms- a society’s explicit and implicit rules for proper conduct. • Culture- a society’s shared rules that govern the behavior of its members, common history, values, beliefs, habits, skills, technology, and arts. – Includes a valuational aspect which varies from culture to culture. Four D’s in More Detail II. • Distress – Pain or discomfort • Dysfunctional or Maladaptive Behavior – It interferes with daily functioning. • Danger – Behavior that becomes dangerous to self or others.

• Note: Abnormal behavior is to some degree arbitrary and culturally determined • Medical Model vs. Bio-psychosocial Model DSM DEFINITION: MENTAL DISORDER

• [A mental disorder] is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (a painful symptom) or disability (impairment in one or more areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual as described above. • Syndrome- a group of clinical observations or symptoms that tend to co- occur. Mental Disorder’s Qualifying Terms

• Comorbidity-existence of two or more disorders • Acute- describes a disorder of sudden onset, usually with intense symptoms • Chronic- describes a long-standing or frequently recurring disorder, often of progressing seriousness • Mild/Moderate/Severe- describes a disorder of a low order of severity, intermediate order of severity, and a high degree of seriousness. • Episodic Disorder- describes a disorder that tends to abate and to recur • Recurrent- describes a disorder pattern that tends to come and go. The Extent of Abnormal Behavior

• Epidemiology- study of the distribution of diseases, disorders, or health-related behaviors in a given population. • Prevalence- the proportion of active cases of a disorder that can be identified in a population at a given point in, or during a given period, of time. • Incidence- occurrence (onset) rate of a given disorder in a given population. • Lifetime Prevalence- the proportion of living persons in a population who have ever had a disorder up to the time of the epidemiological assessment. Historical Views of Abnormal Behavior

• Demonology, Gods, and Magic – Cause- possession of evil spirits – Tx- exorcism • Early Greek and Roman Thought – Hippocrates (460-370 B.C) • Cause – Mental Disorders have natural causes – Brain Central Organ of Intellectual Activity – Heredity – Four Bodily Humors (blood, black bile, yellow bile, and phlegm) • Tx – Tranquil lifestyle, abstinence from excesses, bleeding, exercise – Pleasant surroundings, massage, hydrotherapy, education, – Bleeding, purging, mechanical restraints Historical Views of Abnormal Behavior II

• Early Greek and Roman Thought (cont) – Galen (130-200 A.D.) • Anatomy of Nervous System • Causes – Physical and Mental Categories – Head injuries, alcoholic excess, shock, fear, menstruation – Disappointment of love • Tx – Contrariis contrarius (opposite by opposite) • Middle Ages (500-1500) – Return to Demonology & Superstition and away from Physical Causes • Mass Madness (lycanthropy and tarantism) Historical Views of Abnormal Behavior III

• Middle Ages (1500-1700s) – Establishment of Asylums and Shrines • Means of removing mentally ill from society – Horrid condition of filth and deprivation including: darkness, starvation, restraints, cold baths, tortures. • Beginning of the Modern Era – Biological Link between Brain and Mental Disorder • General Paresis & Syphilis • Classification System (Kraeplin) & Medical Model Historical Views of Abnormal Behavior IV

– Establishing the Psychological Basis • Mesmerism • Nancy School • Psychoanalysis (Freud) – Hypnosis and Catharsis – Unconscious and Free Association – Establishing An Experimental Research • Laboratories • Behavioral Perspective – Classical Conditioning – Operant Conditioning Historical Views of Abnormal Behavior • Demonology, Gods, and Magic • Chinese, Egyptians, Hebrews, and Greeks often attributed such behavior to a demon or god who had taken possession • Whether the “possession” was assumed to involve good spirits or evil spirits usually depended on the affected individual’s symptoms. Hippocrates’ Early Medical Concepts

• The Greek temples of healing ushered in the Golden Age of Greece under the Athenian leader Pericles (461–429 b.c.). • This period saw considerable progress in the understanding and treatment of mental disorders Greek physician Hippocrates

• denied that deities and demons intervened in the development of illnesses and instead insisted that mental disorders, like other diseases, had natural causes and appropriate treatments • brain was the central organ of intellectual activity and that mental disorders were due to brain pathology. • emphasized the importance of heredity and predisposition and pointed out that injuries to the head could cause sensory and motor disorders. • Hippocrates classified all mental disorders into three general categories— mania, melancholia, and phrenitis (brain fever). • Four essential fluids of the body—blood (sanguis), phlegm, bile (choler), and black bile (melancholer). The fluids combined in different proportions within different individuals, and a person’s temperament was determined by which of the humors was dominant. Early Philosophical Conceptions of Consciousness • Plato (429–347 b.c.) studied mentally disturbed individuals who had committed criminal acts and how to deal with them. He wrote that such persons were, in some “obvious” sense, not responsible for their acts and should not receive punishment in the same way as normal persons. • Aristotle (384–322b.c.), who was a pupil of Plato, wrote extensively on mental disorders. Among his most lasting contributions to psychology are his descriptions of consciousness. Later Greek and Roman Thought

• Alexandria, Egypt • Medical practices developed to a higher level, and the temples dedicated to Saturn were first- rate sanatoria. • Pleasant surroundings were considered of great therapeutic value for mental patients, who were provided with constant activities including parties, dances, walks in the temple gardens, rowing along the Nile, and musical concerts. • the principle of contrariis contrarius (“opposite by opposite”)—for example, having their patients drink chilled wine while they were in a warm tub. Early Views of Mental Disorders in China

• China was one of he earliest developed civilizations in which medicine. • Chinese medicine was based on a belief in natural rather than supernatural causes for illnesses. • The concept of yin and yang, the human body, like the cosmos, is divided into positive and negative forces • both complement and contradict each other. • Chung Ching, who has been called the Hippocrates of China. • views of physical and mental disorders on clinical observations, and he implicated organ pathologies as primary causes. Views of Abnormality During the Middle Ages • The first mental hospital was established in Baghdad in a.d. 792; • Followed by others in Damascus and Aleppo • Avicenna from Persia (c. 980–1037),called the “prince of physicians • Author of The Canon of Medicine. • Avicenna frequently referred to hysteria, epilepsy, manic reactions, and melancholia. MASS MADNESS

• The widespread occurrence of group behavior disorders that were apparently cases of hysteria. • Whole groups of people were affected simultaneously. Dancing manias (epidemics of raving, jumping, dancing, and convulsions) were reported as early as the tenth century. TARANTISM

• A disorder that included an uncontrollable impulse to dance that was often attributed to the bite of the southern European tarantula or wolf spider. • later spread to Germany and the rest of Europe, known as Saint Vitus’s dance. Toward Humanitarian Approaches • Middle Ages and the early Renaissance, scientific questioning reemerged. The Resurgence of Scientific Questioning in Europe • Paracelsus (1490–1541), a Swiss physician, was an early critic of superstitious beliefs. • formulated the idea of psychic causes for mental illness, and advocated treatment by “bodily magnetism,” later called hypnosis. The Resurgence of Scientific Questioning in Europe

• Johann Weyer (1515–1588), a German physician. • disturbed by the imprisonment, torture, and burning of people accused of witchcraft that he made a careful study. • too far ahead of his time. • Banned by the Church. • St. Vincent de Paul (1576–1660), at the risk of his life, declared, “Mental disease is no different than bodily disease and Christianity demands of the humane and powerful to protect, and the skillful to relieve the one as well as the other”. The Establishment of Early Asylums • Sixteenth century -special institutions called asylums. • Sanctuaries or places of refuge meant solely for the care of the mentally ill • way of removing from society troublesome individuals who could not care for themselves. • madhouses,” were not pleasant places or “hospitals” The Establishment of Early Asylums • The first asylum established in Europe was in Spain in 1409. • In 1547 the monastery of St. Mary of Bethlem in London initially founded as a monastery was officially made into an asylum by Henry VIII. • Known as Bedlam -widely known for its deplorable conditions and practices. • The more violent patients were exhibited to the public for one penny a look. • harmless inmates were forced to seek charity on the streets of London. • Mexico (1566), France (1641) and Moscow (1764) • The notorious Lunatics’ Tower in Vienna was constructed in 1784. Humanitarian Reform

• PINEL’S EXPERIMENT 1792 • Pinel -in charge of La Bicêtre in Paris. • Revolutionary Commune to remove the chains from some of the inmates- treated with kindness and consideration. • Chains were removed • sunny rooms were provided • exercise on the hospital grounds • Jean-Baptiste Pussin • 1784 removed -chains from patients • more humane straitjackets instead • issued orders forbidding the staff from beating patients TUKE’S WORK IN ENGLAND

• William Tuke (1732–1822) established the York Retreat. • Quakers believed in treating all people, even the insane, with kindness and acceptance. • Humane mental health treatment for over 200 years. • gained the support of English medical practitioners such as Thomas Wakley and Samuel Hitch. RUSH AND MORAL MANAGEMENT IN AMERICA • Benjamin Rush (1745–1813), the founder of American psychiatry. • humane treatment of the mentally ill • systematic treatise on psychiatry in America, Medical Inquiries and Observations upon Diseases of the Mind. • first American to organize a course in psychiatry. • medical • theory was tainted with astrology, and his principal remedies were bloodletting and purgatives. • “the tranquilizing chair,” MORAL MANAGEMENT

• A wide-ranging method of treatment that focused on a patient’s social, individual, and occupational needs. • emphasized the patients’ moral and spiritual development and the rehabilitation of their “character”. • high degree of effectiveness • Without antipsychotic drugs. • ethnic prejudice against the rising immigrant population in hospitals. • the failure of the movement’s leaders to train their own replacements MENTAL HYGIENE MOVEMENT • exclusively on the physical well-being of hospitalized mental patients. • Comfort levels improved under the mental hygienists, the patients received no help for their mental problems. • Advances in biomedical science BENJAMIN FRANKLIN’S EARLY DISCOVERY OF THE POTENTIAL CURATIVE EFFECTS OF ELECTRIC SHOCK

• using electricity to treat melancholia (depression) grew out of his observations that a severe shock he had experienced altered memories. • Ingen housz, reported a similar incident in which he observed alterations in his thinking following a shock he had received. • twentieth century that Cerletti and Bini (1938), at the University of Rome, initiated electric shock as a treatment for depression. DIX AND THE MENTAL HYGIENE MOVEMENT • Dorothea Dix (1802– 1887) champion of poor and “forgotten” people in prisons and mental institutions. • an important driving force in humane treatment for psychiatric patients. • schoolteacher as a young adult b-forced into early retirement-recurring attacks of tuberculosis. • 1841 she began to teach in a women’s prison. • The deplorable conditions in jails, almshouses, and asylums.

• “Memorial” submitted to the U.S. Congress in 1848 • “Idiots and insane in the United States, destitute of appropriate care and protection . . . bound with galling chains, bowed beneath fetters and heavy iron bails attached to drag-chains, lacerated with ropes, scourged with rods and terrified beneath storms of execration and cruel blows; now subject to jibes and scorn and torturing tricks; now abandoned to the mos outrageous violations. • Zealous campaign between 1841 and 1881 aroused people and. legislatures to do something about the inhuman treatment accorded the mentally ill. • Millions of dollars were raised to build suitable hospitals, and 20 states responded directly to her appeals. • Opening of two large institutions in Canada and completely reformed the asylum system in Scotland and several other countries. • establishing 32 mental hospitals. Criticisms • establishing hospitals for the mentally ill and increasing the number of people in them spawned overcrowded facilities and custodial care. • Interfered with the treatment of the day (moral therapy) and deferred the search for more appropriate and effective treatments for mental disorders THE MILITARY AND THE MENTALLY ILL • first mental health facility for treating mentally disordered war casualties was opened by the Confederate Army in the American Civil War. • extensive and influential program of military psychiatry evolved in Germany during the late 1800s. • Emil Kraepelin and Richard von Krafft-Ebbing, worked with the military administration, conducting research and training doctors to detect mental health problems that could interfere with performance of duty. • Alcohol was common cause The Emergence of Contemporary Views of Abnormal Behavior • Mental hygiene movement was gaining ground. • Nineteenth and twentieth centuries and generated powerful influences on our contemporary perspectives in abnormal behavior. (1) biological discoveries, (2) the development of a classification system for mental disorders, (3) the emergence of psychological causation views, (4)experimental psychological research developments. Biological Discoveries: Establishing the Link Between the Brain and Mental Disorder • Advances in the study of biological and anatomical factors as underlying both physical and mental disorders. • The discovery of the organic factors underlying general paresis—syphilis of the brain. BRAIN PATHOLOGY AS A CAUSAL FACTOR • Henry Cotton-problems such as schizophrenia could be cured by removing the infections. • To remove all of a person’s teeth or body parts such as tonsils, parts of the colon, testicles, or ovaries in order to reduce the infection. • Egas Moniz to treat severe mental disorders using surgical procedures called lobotomies. • Freeman -using an ice pick to sever the neural connections in the brain after entering through the patient’s eye sockets

The Development of a Classification System • Emil Kraepelin (1856–1926) • Compendium der Psychiatrie • emphasized the importance of brain pathology in mental disorders. Development of the Psychological Basis of Mental Disorder Mesmerism • Franz Anton Mesmer • Planets affected a universal magnetic fluid in the body. • Mesmer concluded that all people possessed magnetic forces that could be used to influence the distribution of the magnetic fluid in other people, thus effecting cures. Nancy School

• Ambrose August Liébeault (1823–1904), a French physician who practiced in the town of Nancy, used hypnosis successfully in his practice. • The phenomena observed in hysteria—such as paralysis of an arm, inability to hear, and anesthetic areas - stuck with a pin without feeling pain-normal subjects by means of hypnosis • The same symptoms also could be removed by means of hypnosis. Psychoanalysis

–Hypnosis and Catharsis –Unconscious and Free Association Establishing An Experimental Research • Laboratories • Behavioral Perspective – Classical Conditioning – Operant Conditioning Historical Views of Abnormal Behavior II

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