Historical Perspectives

When did the development of medications for mental health symptoms begin?

In the 1940s.

What was chlorpromazine initially developed as?

Anti-psychotic (manage psychotic disorders such as schizophrenia)

What type of antidepressant is imipramine? What was Imipramine originally synthesized as?

A tricyclic antidepressant. (TCA)

It’s an antihistamine (blocks the effects of histamine - chemical in the body involved in allergic reactions). 

Who is known as the 'father of modern psychopharmacology'?

Heinz Lehmann.

What significant role did Heinz Lehmann play in mental health treatment?

He introduced chlorpromazine (for schizophrenia) and imipramine (for depression) into mainstream treatment in North America.

What psychological condition did Jean-Martin Charcot study?

Hysteria (diagnostic label no longer used).

A neurological disorder, potentially hereditary, characterized by unexplain symptoms, fainting. He believe hysteria was a brain dysfunction.

What technique did Charcot use to help patients recall memories?

Hypnosis.

Who treated 'Anna O' and contributed to Freud's theories?

Joseph Breuer.

What concept did Josef Breuer's work highlight?

The subconscious

He encouraged disclosure and used hypnosis to retrieve memories. The patient improved during a hypnotic state (Catharsis), leading to a reduction in symptoms.

What method did Sigmund Freud develop for psychotherapy?

Psychoanalysis - Theory of the structure of the mind and the role of the unconscious process.

Freud method involved clients lying on a couch, not seeing the therapist, to promote free association and prevent interaction from interfering with the flow of thought.

Dream analysis = the therapist interprets the patient’s thoughts and feelings from free association and the content of the dreams.

The Psychoanalytic couch

What is Freud’s concept of the structure of the mind.

The mind has three major parts: 

• Superego: the conscience (moral principles)

• Ego (mediator): reality of principle - we act realistically

• Id: Pleasure principle

What are the defence mechanisms?  (6)

• Denial: Refuses to acknowledge some aspect of objective reality or subjective experience.

• Projection: Falsely attributes own unacceptable feelings, impulses or thoughts to another individual or object.

• Rationalization: Creates logical-sounding explanations or excuses to justify something that might otherwise cause guilt, shame or anxiety.

• Reaction formation: Replaces an unacceptable impulse, feeling, or thought with its opposite, always exaggerating. 

• Repression: Blocks disturbing wishes, thoughts or experiences from conscious awareness. 

• Sublimation redirects unacceptable impulses, urges or emotions into more socially acceptable and constructive outlets. 

Who introduced behaviorism to psychology?

John B. Watson.

What did Watson argue psychology should focus on?

Objectively measurable behavior

He believed that all behaviour could be explain by the principes of operant and classical conditioning. ( Little Albert)

Who is the mother of behaviour therapy?

Mary Cover Jones

Influenced by Watson, what was Mary Cover Jones known for pioneering?

Counter-conditioning (e.g. like fear is gradually replaced with a more desirable response through conditioning).

What therapy did Aaron T. Beck develop?

Cognitive Behavioural Therapy (CBT).

He argued that interpretations of events, not simply events, largely determine emotional responses. (People’s thoughts play a big role)

Came from religious institutions, which provided asylum — sense of refuge to the mentally ill.

Meaning of the word “asylms”

What did the New Order of Our Lady of Bethlehem (Bedlam) represent?

One of the first mental institutions in England.

Originating from this institution, referring to a state of uproar and confusion. 

Meaning of the word “bedlam”

Who is credited with removing chains from mental patients in the early 1800s, viewing them as “sick” individuals rather than “beasts or criminals”?

Philippe Pinel, but originally Jean-Baptiste Pussin.

What did Dorothea Dix advocate for?

• Humane treatment of mental patients and the establishment of 32 new mental hospitals.

• Promoted the Mental hygiene movement (the purpose of treating patients as individuals with mental illness who need help to recover)

What is Moral Management? (Benjamin Rush)

Method of treatment focusing on patients’ social, individual, and occupational needs as well as their moral and spiritual development.

What is the first mental institution in Quebec, Canada? What were the problems?

Beauport Asylum

• Faced challenges (private ownership, weak state involvement, limited role for physicians)

Founded in 1881 by Alfred Perry and a group of Protestant clergy.

Previously named “Protestant Hospital for the Insane” 

The most progressive mental health institution in Quebec. 

Douglas Hospital 

What was a common early treatment method in mental institutions before effective medication?

Cold water dousing, spinning chairs (Cox’s chair), restraints (straightjackets) and physical punishment (burning).

What can be found in Alexander Morrison’s work , Physiology of Mental Diseases?

He suggested facial features could indicate mental health conditions. 

Treatments: bloodletting, purgatives (laxative), leeches (worms), blisters and douches.

What did Erving Goffman's book 'Asylums' expose?

The bad conditions in mental institutions.

What was the outcome of the deinstitutionalization movement?

A decrease in mental institution populations and an increase in homelessness and incarcerations.

What is the current focus of modern mental institutions?

Stabilizing patients with medication and psychosocial interventions.

According to Huang Ti (2674 BC), what are the symptoms of excited insanity?

Sadness, eating and sleeping less then feeling smart and noble, talking and scolding day and night, behaving, seeing and hearing strange things, believing that he can see the devil or gods.

He’s describing either bipolar or schizophrenia condition.

How did ancient Mesopotamians explain the cause of mental illness?

They believed it was caused by evil spirits or demons.

The first known treatment for mental illness.

Involved scraping a hole into the skull to evict the spirit from the mind. No anesthetic, no antibiotics and the mortality rate was likely high.

If the treatment doesn’t work after one try, the demon must have moved to a different place, so you keep going.

Trepanation 

Witch Hunts 

Practices made to hunt and burn “witches” who were likely suffering from mental health problems. Mostly women were tortured into admitting they were witches and then burned. 

First physician to deny the use of witchcraft as an explanation for strange behaviour. He argued that it was the result of mental illness.

Johaan Weyer

What did the Middle Ages emphasize as the main cause of mental illness? (after the concept of witchcraft).

God’s punishment or demonic possessions.

What treatment was commonly used for mental illness in the Middle Ages? Describe.

Exorcisms

Involved specific prayers, rituals and the use of sacred objects (holy water, cross). 

Painless intervention. 

If it failed, more torturous means would be used to make the body uninhabitable by evil spirits. 

In what cases could the use of exorcisms be useful?

1- Something inside of you that needs to leave.

2- Imbalance (to create a rebalance).

3- When you’re incomplete and something is missing inside of you.

Who is Paracelsus?

A physician who rejected the notions of possession by the devil. He suggested that the movements of the moon and stars had a profound effect on people’s psychological functioning. His theory inspired the word lunatic (luna = moon).

Who is Franz Anton Mesmer?

Father of hypnotism

He believed that good physical and psychological health came from aligned magnetic forces (or fluids) and bad health from forces being out of alignment (fluids being blocked or out of balance)

Animal magnetism could work in correcting misaligned forces. 

Who is Hippocrates?

Father of modern medicine

• Argued that the causes of mental disorders are natural, not supernatural. 

• Suggested that psychological disorders could be treated like any other disease. 

• Our body contains four “humors”: black bile, yellow bile, phlegm and blood. Out of balance with these humors, disease took over. 

• Believe that psychological disorders might be caused by brain pathology or head trauma and could be influenced by genetics.

According to Hippocrates, what caused feelings of sadness and depression?

An excess of black bile.

What effect did Hippocrates believe an excess of yellow bile had on a person?

It made them angry and impulsive.

How did Hippocrates classify mental disorders?

Into three categories: mania, melancholia, and phrenitis (brain fever).

Who is Aritstotle 

Student of Plato 

• Viewed diseases as disturbances and imbalances in the bodily elements, referring to corrupt and/or misplaced humours, vapours and mixtures.

• Mania was caused by excessive heat in the body, which disturbed the soul and its functions, affecting thought and perception. 

Supported Aristotle's humoral theory.

Introduced bloodletting as a medical treatment to evacuate bad things to reestablish the balance of the bodily humours.

Galen 

Blood letting

A measured amount of blood was removed from the body, either by severing a blood vessel or with leeches.

He associated mental health issues with a specific part of the brain.

Suggested that the brain was divided into 27 separate “organs”. Each organ corresponded to a discrete human faculty (personality).

Franz Joseph Gall

Tampering iron entered through his mouth, exiting through the top of his head. 

The injury led to personality changes: impatience, irritability, profanity, inability to follow through on plans.

Phineas Gage

Advanced Syphillis

Believing that everyone is plotting against you or that you are God.

Who helped establish the link between syphilis (a biological condition) and paresis (a mental disorder) in 1897?

Richard von Krafft-Ebing.

Julius von Wagner-Jauregg

Successfully treated syphilis-related paresis with malaria fever in 1917?

Performed the first lobotomy on Alice Hood Hammatt, who suffered anxiety, insomnia and depression.

Inserting an ice pick-like instrument through the eye socket to sever brain connections between the frontal lobes and the rest of the brain.

Walter Freeman

When was ECT first introduced and to who ?

In 1939, a patient was suffering from schizophrenia.

What was the outcome after the first patient received 10 treatments of ECT?

A marked reduction in symptoms.

What is the primary modern use of ECT today?

The management of treatment-resistant depression.

What is a psychological disorder?

1- Psychological dysfunction 

2- Associated with distress or impairment in functioning 

3- And a response that is atypical (not frequent) or culturally expected.

4- Experience a lack of control

The scientific study of psychological disorders has trained professionals, including clinical/counselling psychologists and psychiatrists.

Psychopathology

Scientist-practitioners

• They keep up with the latest findings.

• Use scientific data to evaluate their own work

• Conduct research within their clinics or hospitals

What are the three basic categories that research about psychological disorders falls into?

Description, Causation, Treatments and Outcomes.