CHAPTER 1: ABNORMAL BEHAVIOR IN HISTORICAL CONTEXT

A psychological disorder

A BLANK is typically defined as a psychological dysfunction within an individual that is associated with distress or impairment in functioning, and a response that is not typically or culturally expected.

Psychological Dysfunction

This refers to a breakdown in cognitive, emotional, or behavioral functioning. It signifies a deviation from what is considered normal functioning in a given context.

Distress or Impairment

This can affect various aspects of life, including work, relationships, and social functioning. However, it is important to note that not all disorders involve BLANK; some individuals may not be aware of their dysfunction or its impact.

DSM 5, 2013

It provides a more comprehensive definition: behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment. The BLANK emphasizes the importance of considering cultural context when diagnosing disorders

Atypical or Culturally Unexpected Response

What is considered abnormal varies across cultures; behaviors acceptable in one culture may be deemed abnormal in another

prototypical approach

The DSM-5 utilizes a BLANK, meaning that disorders are defined by a set of characteristic features or symptoms. A patient may not exhibit all symptoms to meet the criteria for a specific disorder; instead, they need to display a sufficient number of prototypical features to be diagnosed. This approach acknowledges the variability in symptom presentation among individuals with the same disorder1

Distress

The criterion is satisfied if the individual is extremely upset.

PSYCHOLOGICAL DYSFUNCTION

A breakdown in cognitive, emotional, or behavioral functioning

Impairment

If you are so shy that you find it impossible to date or even interact with people and you make every attempt to avoid interactions even though you would like to have friends. is an example of??

Robert Sapolsky

He Worked closely with the Masai people in East Africa.

• A woman had been acting aggressively and had been hearing voices and killed a goat with her own hands.

• Only men killed goats and hearing voices in a wrong time.

Psychopathology

The scientific study of psychological disorders.

Counseling Psychologists

Tend to study and treat adjustment and vocational issues encountered by relatively healthy individuals.

Clinical Psychologists

Concentrate on more severe psychological disorders

Psy.D

Focus on clinical training and de-emphasize or eliminate research training.

Ph.D

Integrate clinical and research training.

Psychiatrists

First earn an M.D. degree in medical school and then specialize in psychiatry during residency training that lasts 3 to 4 years.

Psychiatric Social Workers

Earn a master’s degree in social work as they develop expertise in collecting information relevant to the social and family situation of the individual with a psychological disorder.

Psychiatric Nurses

Have advanced degrees (master’s or Ph.D.) and specialize in the care and treatment of patients with psychological disorders, usually in hospitals as part of a treatment team.

Marriage and Family Therapists and Mental Health Counselors

Spend 1 to 2 years earning a master’s degree and are employed to provide clinical services by hospitals or clinics, usually under the supervision of a doctoral-level clinician.

THE SCIENTIST-PRACTITIONER

1. Keep up with the latest scientific developments in their field and therefore use the most current diagnostic and treatment procedures.

2. Evaluate their own assessments or treatment procedures to see whether they work.

3. Scientist-practitioners might conduct research that produces new information about disorders or their treatment.

Presenting Problem

Patient “presents” with a specific problem or set of problems.

Presents

Traditional shorthand way of indicating why the person came to the clinic.

Prevalence

How many people in the population as a whole have the disorder.

Incidence

How many new cases occur during a given period.

Chronic Course

Tend to last a long time, sometimes a lifetime

Episodic Course

The individual is likely to recover within a few months only to suffer a recurrence of the disorder at a later time.

Time-Limited Course

The disorder will improve without treatment in a relatively short period with little or no risk of recurrence

Acute Onset

Begin suddenly

Insidious Onset

Develop gradually over an extended period.

Prognosis

The anticipated course of a disorder.

Developmental Psychology

Study of changes in behavior over time

Developmental Psychopathology

Study of changes in abnormal behavior.

Life-Span Developmental Psychopathology

Study of abnormal behavior across the entire age span

Etiology

The study of origins and has to do with why a disorder begins (what causes it) and includes biological, psychological, and social dimensions.

How were psychological disorders viewed in the late 14th century?

They were attributed to demonic possession or witchcraft. Individuals exhibiting symptoms were believed to be responsible for misfortunes in the community.

What were some common treatments for psychological disorders in the late 14th century?

Magic, sorcery, and exorcism (religious rituals to expel evil spirits).

Name two unusual treatments for psychological disorders in the late 14th century.

• Shaving a cross into the victim's hair

• securing the sufferer to a church wall to benefit from Mass.

Exorcism

Various religious rituals were performed in an effort to rid the victim of evil spirits

Medieval Understanding of Insanity

Insanity was seen as a natural result of mental/emotional stress, believed to be curable.

Medieval Insanity Treatments

Rest, sleep, healthy environment, baths, ointments, potions. Patients often moved between houses in villages for care.

Nicholas Oresme's Contribution

Who contributed the 14th-century advisor to the King of France. Suggested melancholy (depression), not demons, was the root of some unusual behaviors.

Primary Treatment for Possession

Exorcism: A ritualistic practice aimed at expelling evil spirits from a person believed to be possessed. Various religious traditions have their own methods, often involving prayer, incantations, and religious symbols

Secondary Treatments (if Exorcism Failed)

If exorcism proved ineffective, additional methods were employed, often involving harsh and dangerous practices. These included:

• Confinement and Physical Abuse: Individuals were sometimes imprisoned, beaten, or subjected to other forms of torture to make their bodies undesirable to the spirits3.

• Exposure to Dangers: Practices like suspending individuals over pits of venomous snakes or submerging them in freezing water were believed to frighten the spirits away. These methods were extremely risky and often resulted in serious injury or death

Important Note on Historical Context

These treatments reflect past beliefs and understandings of mental illness. They are not medically sound and would be considered unethical and harmful by modern standards. Many conditions once attributed to possession are now understood to be mental or physical illnesses requiring appropriate medical care.

Mass Hysteria

Characterized by widespread outbreaks of unusual and seemingly inexplicable behavior affecting large groups of people simultaneously.

Saint Vitus's Dance/Tarantism

A historical example of mass hysteria in Europe. Large groups of people would spontaneously run into the streets, engaging in frenzied dancing, shouting, and other erratic behaviors, resembling a wild party. These events were often attributed to supernatural causes or demonic possession in the past, but modern interpretations suggest underlying psychological or social factors.

Emotion Contagion

The experience of an emotion seems to spread to those around us.

Mob Psychology

A shared response. If one person identifies a “cause” of the problem, others will probably assume that their own reactions have the same source.

Paracelsus (1493-1541)

Swiss physician who believed celestial bodies significantly impacted human psychology.

Paracelsus's Theory of Lunar Influence

Paracelsus proposed that the moon's gravitational pull affected bodily fluids, directly causing mental disorders. This theory is now considered outdated but historically significant.

Origin of "Lunatic"

The word "lunatic" derives from "luna," the Latin word for moon, reflecting Paracelsus's theory linking lunar cycles to mental instability. The term highlights the historical association between the moon and mental illness.

Hippocrates (460-377 BC)

Considered the "Father of Modern Western Medicine," Hippocrates believed psychological disorders could stem from brain pathology, head trauma, or heredity. He viewed the brain as the center of intellect and emotion.

The Hippocratic Corpus

A collection of writings (450-350 BC) advocating for treating psychological disorders as medical illnesses.

Hippocrates and Hysteria

Hippocrates coined the term "hysteria," adopting an Egyptian concept. He initially believed it was restricted to women due to the "wandering uterus" theory, where the uterus's movement caused various physical symptoms. Treatment involved marriage or vaginal fumigation.

Wandering Uterus Theory

An ancient, inaccurate belief that hysteria in women was caused by a displaced uterus seeking conception. This theory highlights past misunderstandings of female anatomy and physiology.

Hippocrates's Legacy

Hippocrates's emphasis on biological factors in mental illness laid the groundwork for modern approaches to understanding and treating psychological disorders. His work, while containing inaccuracies, was a crucial step in the development of medical thought.

Galen (AD 129-198)

Prominent Roman physician who expanded upon Hippocrates's work.

The Four Humors

Galen's humoral theory proposed that imbalances in four bodily fluids—blood, phlegm, yellow bile, and black bile—caused illness. These humors were associated with different temperaments and organs.

Blood (Humor)

Originated in the heart; associated with a sanguine temperament (cheerful, optimistic). Excess could cause insomnia or delirium.

Black Bile (Humor)

Originated in the spleen; associated with a melancholic temperament (depressive).

Yellow Bile (Humor)

Originated in the liver; associated with a choleric temperament (hot-tempered).

Phlegm (Humor)

Originated in the brain; associated with a phlegmatic temperament (apathetic, sluggish, or calm).

Galenic Treatments (Humoral Imbalance)

Environmental regulation (temperature, moisture), bloodletting, and inducing vomiting to restore humoral balance.

Chinese Theories of Mental Illness

Unexplained mental disorders were attributed to blockages or imbalances of air or "wind" within the bo

Yin and Yang (Wind)

Cold, dark wind was associated with illness, while warm, life-sustaining wind was considered healthy.

Treatment of Wind Imbalance

Restoring the proper flow of wind through techniques like acupuncture.

Bleeding or Bloodletting

a carefully measured amount of blood was removed from the body.

Induce Vomiting

Robert Burton recommended eating tobacco and a half-boiled cabbage

Syphilis

Sexually transmitted infection (STI) caused by Treponema pallidum.

Advanced Syphilis

Can invade the brain, causing neurosyphilis. Symptoms include delusions of persecution or grandeur, and bizarre behaviors.

Germ Theory of Disease

(Pasteur) Revolutionized understanding of infectious diseases, leading to identification of T. pallidum as the cause of syphilis.

General Paresis

Severe, late-stage neurosyphilis; consistent progression to paralysis and death (within ~5 years).

Malaria and General Paresis Treatment

Accidental discovery: Malarial fever sometimes improved general paresis symptoms, leading to deliberate malarial inoculation (a risky treatment).

John P. Grey

Prominent American psychiatrist who championed the physical basis of mental illness.

Grey's Treatment Approach

Treat mentally ill patients like physically ill patients; emphasized rest, diet, proper environment, and ventilation.

Grey's Contributions

Improved hospital conditions, making mental institutions more humane and livable. Invented the rotary fan to improve ventilation.

Insulin Shock Therapy (IST)

A now-discredited treatment involving repeated insulin injections to induce comas. Initially used to stimulate appetite in psychotic patients but later, higher doses were used to induce convulsions and comas, with recovery attributed to the seizures.

Manfred Sakel

Viennese physician who pioneered IST in 1927, increasing insulin dosages until patients convulsed and became comatose.

Early Observations of Electroconvulsive Therapy (ECT)

Benjamin Franklin (1750s) noted mild electric shocks caused convulsions and amnesia. A Dutch physician observed elation after self-administering a shock, suggesting potential for depression treatment.

Joseph von Meduna

Hungarian psychiatrist (1920s) observed the rarity of schizophrenia in epileptics, leading to the hypothesis that induced seizures might treat schizophrenia. This led to the development of ECT.

Rauwolfia Serpentine/Reserpine & Neuroleptics

Early antipsychotic medications (major tranquilizers) that reduced hallucinations, delusions, agitation, and aggression in some patients.

Benzodiazepines

Minor tranquilizers used to reduce anxiety.

Bromides

Sedative drugs used in the late 19th and early 20th centuries to treat anxiety and other psychological disorders.

Emil Kraepelin (1856-1926)

Made significant contributions to psychiatric diagnosis and classification. Distinguished between various psychological disorders based on age of onset, symptom clusters, time course, and potential causes. His work laid the groundwork for modern diagnostic systems.

Plato's View of Maladaptive Behavior

He believed social and cultural influences, along with learned experiences, caused maladaptive behavior. Treatment involved re-education through rational discussion to strengthen reason.

Aristotle's Influence

He emphasized the impact of social environment and early learning on the development of psychopathology.

Ancient Greek Asclepiad Temples

6th century BC temples provided humane care for the chronically ill, including those with psychological disorders. Treatments included massage and soothing music.

Philippe Pinel & Jean-Baptiste Pussin

They spearheaded humane reforms at French asylums. Him, prior to his arrival, initiated the removal of restraints and introduced positive interventions. he continued and expanded these reforms at Bicêtre and Salpêtrière hospitals

Benjamin Rush

Considered the founder of U.S. psychiatry, he introduced moral therapy to Pennsylvania Hospital.

Moral Therapy

A treatment approach emphasizing humane care, positive interactions, and the patient's social and emotional well-being. It involved removing restraints, providing a supportive environment, and engaging patients in meaningful activities. It contrasted sharply with earlier, harsh treatments.

Moral Therapy's Limitations

Most effective in small institutions (≤200 patients) where individualized attention was feasible. Scalability issues hindered its widespread application.

Dorothea Dix

Led the Mental Hygiene Movement, advocating for increased access to mental healthcare for all, including the homeless.

The Mental Hygiene Movement's Impact

While expanding access to care, it also led to overcrowding in asylums, diminishing the effectiveness of moral therapy due to inadequate staffing and resources.

The Ironic Consequence of Asylum Expansion (What happened when asylums got too big?)

Not enough staff to help patients, so care became more about keeping them safe than treating them.

Franz Anton Mesmer

Proposed "animal magnetism" as a cause of illness; used large vats of chemicals and rods to treat patients, employing suggestion and touch.

Jean-Martin Charcot

Head of Salpêtrière Hospital; legitimized the use of hypnosis in treating hysteria.

Josef Breuer & Sigmund Freud

Used hypnosis to explore patients' problems, leading to the discovery of the unconscious mind. Emphasized catharsis and insight.

Anna O. (Bertha Pappenheim)

A key case study illustrating the power of the unconscious mind and the development of hysterical symptoms. Showed the connection between psychological trauma and physical symptoms.

ID (Pleasure Principle)

• Source of strong sexual and aggressive feelings.

• Goal: Maximize pleasure, eliminate tension/conflicts.

• Primary Process: Emotional, irrational thinking filled with fantasies, preoccupied with sex, aggression, selfishness, and envy.

• Libido: Energy/drive within the id.

• Thanatos: The death instinct.

Ego (Reality Principle)

• Executive or manager of the mind.

• Mediates conflict between the id and superego.

• Secondary Process: Logical and rational thinking.