Supernatural Tradition: Part 1
- Causes included demonic possession, witchcraft, sorcery (e.g. 14th + 15th century Europe, Salem witch trials US).
- BUT also some belief in ‘stress’
Supernatural Tradition: Part 2
- Mass hysteria (St. Vitus’ dance or Tarantism – 14C-17C) i.e. many people simultaneously acting strangely! (“dancing”) Insect bites? Emotion contagion?
- Treatments included exorcism, torture, beatings & crude surgeries.
Supernatural Tradition: Part 3
Other worldly causes:
•Movement of the moon and stars affect psychological functioning
•Paracelsus (Swiss German physician, botanist, astrologer) and lunacy = lunatic; “It must have been a full moon”
Biological Tradition: Part 1
•Hippocrates (460-377BC): Abnormal Behaviour
as a Physical Disease (disease, brain pathology, genetics!)
•Galen (129-198AD) extends Hippocrates Work
•Humoral theory of mental illness: imbalance of 4 bodily fluids – blood (heart), black bile (spleen), yellow bile (liver), phlegm (brain)
•Treatments remained crude e.g. environmental regulation, bloodletting
Biological Tradition: Part 2
- Ancient Greece
- Hysteria (medical problem with no apparent physical cause e.g. paralysis)
- “The Wandering Uterus”*
- Galenic-Hippocratic Tradition
- Linked abnormality with brain chemical imbalances
- Foreshadowed modern view
Biological Tradition: Part 3
- General Paresis and Syphilis – 19th C
- STD with psychosis-like symptoms e.g. delusions (especially persecutory and grandeur), hallucinations
- Pasteur: a bacterial micro-organism entering the brain; STD
- Led to penicillin as a successful treatment
- Bolstered the view that mental illness = physical illness
- Provided a biological basis for madness
Consequences of Biological Tradition
The 1930’s:
• Biological treatments were standard practice
• Insulin shock therapy, ECT (shock therapy – causes
convulsions), brain surgery
The 1950’s:
• Medications increasingly available
• Neuroleptics (i.e.reserpine) & major tranquilisers e.g.
Valium
• Medication still often the first point of call in NZ
Psychological Tradition: Part 1
- Already identified by Plato, Aristotle – Ancient Greece
- The Rise of Moral Therapy 18C
- Not “moral” in the usual sense of the word, but psychological or emotional
- Key tenet: Treating patients ‘normally’, encouraging social interaction, focus on relationships, individual attention, education
Psychological Tradition: Part 2
•Philippe Pinel (1745- 1822) & Jean-Baptiste Pussin
(1746-1826) in Paris, France
•William Tuke (1732-1822) – Followed Pinel’s lead in
England
•Benjamin Rush (1745-1813) – Led reforms in the USA
•Dorothea Dix (1802-1887) in US – Led mental hygiene
movement; but unfortunate consequences – increase
in number of patients, inadequate staffing…so more
into custodial care
•And then shift in19C – cause is brain pathology and
incurable?
Psychological Theories: Freud (1856-1939)
Psychoanalysis: unconscious mind, id/ego/superego, defence mechanisms, psychosexual stages of development
•Key tenet: Adult personality and problems reflect childhood experiences/ trauma
•Treatment: Talk therapy, free association,
dream analysis, transference and countertransference
Psychological Theories: Erikson (1902-1994)
Psychosocial stages of development
•Key tenet: Each stage has particular issues that need to be resolved
•E.g. 0– 18mths: trust vs mistrust; 3-5yrs: initiative vs guilt
•Particular life tasks or challenges not successfully resolved
Psychological Theories: Rogers (1902-1987)
Humanistic psychology:
•Key tenet: People are basically good and strive towards self-actualisation; problems arise when blocked growth occurs
- Treatment: Talk therapy –warmth, empathy, unconditional positive regard
- Minimal therapist directives
Psychological Theories: Part 1
•Behavioural psychology (early 20C)
•Key tenet: All behaviour may be learned
Conditioning & Cognitive Processes
•Respondent & operant learning (Pavlov, Thorndike, Skinner)
•Learned helplessness
•Modelling, observational and social learning (Bandura)
Psychological Theories: Part 2
Cognitive theories
Tenet: Focus on how we make senseof what happens to us
Treatment
•Wolpe – Systematic desensitisation
•Lazarus – Multi-modal behaviour therapy
•Beck – Cognitive therapy, Ellis – REBT
•CBT
•ACT
•Behaviour Therapy
•Tends to be time-limited, direct, here-and-now focused
•Behaviour therapies have widespread empirical support
Concept of Multiple Causations: Part 1
One-dimensional models:
• Explain behavior in terms of a single cause: reductionist
• Could mean a paradigm, school, or conceptual approach
• Problem - other information is often ignored! Reductionist
Concept of Multiple Causations: Part 2
Multi-dimensional models:
• Interdisciplinary, eclectic & integrative
• “System” of influences that cause & maintain suffering
• Predisposing (underlying; set the stage) and
Precipitating (immediate trigger or precipitant) causes (+
Perpetuating factors)*
• Uses information from several sources
• Abnormal behaviour as multiply determined; various theoretical perspectives may explain different components
• Principle of equifinality (a disorder may have a number of
causes)
The Diathesis-Stress Model
•Genetic contribution – psychological disorders?
•But many genes may act together, and may be
influenced by the environment
•Eric Kandel and Gene-Environment Interactions
•The Diathesis-Stress Model (stress vulnerability
model)
•Individuals inherit certain vulnerabilities/tendencies
(diathesis) that make them more susceptible to a
disorder when the right type of stressor comes along
Interaction of Genes and Environment: Part 1
Reciprocal Gene-Environment Model
•Individual’s genetic vulnerability towards a disorder may make it more likely that they will experience the stressor(e.g. because inherit particular personality traits) that in turn, triggersthe genetic vulnerability and thus the disorder
•Possible examples: depression; divorce (particular traits + environment)
e.g. rumination; impulsivity, short-tempered
Interaction of Genes and Environment: Part 2
Environmental influences may override genetic influences
e.g. immediate effects of environment, such as early stressful experiences (or opposite), impact cells that can turn certain genes on or off (e.g. kids with parents with schizophrenia adopted into functional families with high quality parenting)
NB: concept of critical time periods.
Neuroscience Contributions: Part 1
The role of the nervous system in disease and
behaviour
• Role of neurotransmitters (biochemicals
released from one neuron and transmitting
impulse to another neuron) e.g. serotonin,
dopamine (look at relative excess or deficiency)
and neuroendocrine activity (e.g. thyroid).
Neuroscience Contributions: Part 2
• Can change brain structure and function (e.g.
studies have shown that therapy/trauma/stress
can lead to changes in brain functioning)
• Core concept: mind body connection e.g. PTSD;
psychosocial dwarfism
Socio-Cultural Theorists
- E.g. anorexia among young, white women in industrialised nations
- E.g. insect phobia (W); alcoholism (M); depression (W); anxiety
- Thus ask: To what extent do cultural expectations or gender roles affect the expression of MH issues? i.e. may not be the cause, but influences the form and content of a disorder
Assessment: Interviews : Part 1
- Process of gathering info by talking to them!
- Clinical interview – either structured or unstructured
- Structured e.g. DSM interview or MSE
- Unstructured
- Usually begins open-ended
Assessment: Interviews : Part 2
History of the problem • Safety concerns • Medical/psychiatric history • Current medication • Previous support • Treatment history - effective? • Interpersonal & social functioning; cultural factors • Educational & occupational history • Stressors • Resilience
