Mental Health and Psychoanalysis Quiz

Queen Street Site Redevelopment

• In 1998, the Queen Street site transitioned from a provincially-run psychiatric hospital to a public hospital.
• This transformation led to the creation of CAMH.
• CAMH resulted from a merger of the Addiction Research Foundation, the Clarke Institute, Queen Street Mental Health Centre, and the Donwood Institute.
• CAMH is affiliated with the University of Toronto (U of T).

1001 Queen Street Site Redevelopment

• The site at 1001 Queen Street was redeveloped into a project called "Urban Village".

CAMH Redevelopment (2010)

• A redevelopment of CAMH facilities took place in 2010.

Consumer Survivor Ex-Patient Movement

• Dr. Reaume, a York University professor, published a work in 2000 called "Remembrance of Patients Past: Patient Life at the Toronto Hospital for the Insane, 1870-1940."
• Dr. Reaume inspired David Reville, a psychiatric survivor and part-time TMU instructor known for "History of Madness."

Consumer Survivor Initiatives (CSI)

• CSIs are organizations run by and for people with a history of mental illness.
• In Ontario, the Ontario Peer Development Initiative (OPDI) began in 1991.
• Potential CSI programs include one-to-one peer support, self-help & peer support groups, community-economic development, education/training for public & mental health professionals, advocacy, opportunities for CSs to develop skills, resource development based on CS knowledge, and artistic & cultural activities.

Consumer/Survivor Initiatives (Study: Nelson, Ochocka, Janzen, & Trainor (2006))

• This longitudinal study (baseline, 9 months, 18 months) evaluated the effects of participation in CSI initiatives on wellbeing.
• Seven factors examined: social support, community integration, personal empowerment, subjective quality of life, symptom distress, utilization of hospitals, employment/education
• Data on participants and active participants (minimum number of hours of participation) at baseline, 9 months, and 18 months were tracked, to see the trends.

Paradigms in Science

• Paradigms are sets of basic assumptions, creating perspectives, for conceptualizing and evaluating scientific subject matter, gathering meaningful data, and determining how to approach the topic, shaping the field of study.
• Science is limited by the current state of knowledge and maintaining objectivity when examining thoughts, emotions, and behaviors.
• Paradigms are fundamental to science, both intrinsic to it and shaping rules.
• Biases inevitable in a scientific paradigm are introduced into the definition and collection of data and can affect the interpretation of facts and meaning.

Primary/Integrative Paradigms of Psychopathology

• Biological (diathesis-stress model)
• Psychoanalytic (schema therapy)
• Humanistic (dialectical behaviour therapy)
• Behavioural (learning) (Lazarus' multimodal therapy)
• Cognitive (cognitive behavioural therapy)

Biological Paradigm

• A continuation of the somatogenic hypothesis: mental disorders are caused by aberrant or defective biological processes.
• Often called the medical or disease model, this was the dominant paradigm in Canada and elsewhere from the late 1800s to the mid-20th century.

Behavioural Genetics

• Studies individual differences in behavior due to genetic makeup.
• Genotype: unobservable genetic constitution, fixed at birth.
• Phenotype: totality of observable behavioral traits, dynamic. influenced by both genotype and environment, like intelligence.
• Clinical syndromes are disorders of the phenotype, not the genotype.

Nature & Nurture (Twin Studies) (Video)

• Twin studies examining influence of genetic factors in psychopathology are presented in the video on nature and nurture.

Integrative Paradigm: The Diathesis-Stress Model (Video)

• Links biological, psychological, and environmental factors
• Shows diathesis, the constitutional predisposition toward a given illness, is influenced by genetic factors and may be triggered by stress. Stressors (internal/external factors) induce physical or emotional stress and coping mechanisms in individuals.
• Examples from biological and psychological realms (e.g., schizophrenia, genetic diathesis, depression, cognitive set for hopelessness, dissociative identity disorder).

Diathesis-Stress Model in Research Action

• Based on a sample of 300 American boys, researchers found three biologically-based personality types: resilient, overcontrolling, and under-controlled.
• A more recent longitudinal study on children from baseline (10-12 years old) to 18 years examined life experiences and adjustment using the diathesis-stress model.
• This study revealed that the underlying differences (in externalizing problems or substance use) related to the under-controlling personality type were explained by differences in levels and types of childhood maltreatment.

Biological Clinical Approaches to Treatment

• Prevention and/or treatment of mental disorders are possible via bodily functioning alterations (implication of biological paradigm).
• Most common biological therapies used today don't stem from precise knowledge of given disorders.

Biological Treatments

• Most commonly used psychoactive drugs: Valium (anxiety disorders), Prozac (depression), Clozaril (schizophrenia), Ritalin (ADHD).
• Other biological treatments include deep brain stimulation and electroconvulsive therapy.

Psychoanalytic Paradigm

• Suggested that psychopathology originates from unconscious conflicts within the individual.
• Formed by Sigmund Freud (1856-1939)
• Explores the structure of the mind into conscious and unconscious.

Psychoanalysis: Structure of the Mind

• Presents the Id, Ego, and Superego.
• Id operates on the pleasure principle (immediate gratification). Has a basic biological component.
• Ego operates on the reality principle, mediating between the id and the superego. Has a psychological component.
• Superego operates on the perfection principle (conscience), enforcing social expectations. Has a social component.

Psychoanalytic Paradigm: Defense Mechanisms

• Neurotic anxiety (unconnected to real threat) requires defense mechanisms.
• Defense mechanisms are unconscious strategies ego uses to lessen anxiety, discharging Id energy but avoiding true motivation.

Psychosexual Stages (and Fixations)

• Explains how unresolved issues during developmental stages can manifest in adult problems.
• Oral stage fixation leads to trust issues, low self-esteem.
• Anal stage fixation leads inability to express anger, autonomy issues.
• Phallic stage fixation leads to difficulty accepting sexuality.

Psychoanalytic Therapy

• An insight therapy aiming to resolve childhood conflicts using techniques like free association, resistance, interpretation, dream analysis, and transference.

Psychoanalytic Concepts: Transference & Countertransference

• Transference: Patient responses are influenced by prior relationships, reflected in the analyst-patient interaction.
• Countertransference: Feelings analyst unconsciously directs to the patient due to personal vulnerabilities.

Evaluating Psychoanalytic Paradigm

• Contributions: acknowledging the impact of childhood experiences on adult personality and the role of unconscious influences, and the use of defense mechanisms.
• Criticisms: concepts based on limited samples, not objective and theoretical.

Integrated Therapy Model: Schema Therapy

• Combines cognitive, behavioral, psychoanalytic (object relations, attachment), and Gestalt therapeutic approaches.
• Addresses core emotional needs (e.g., mistrust, abandonment, incompetence/dependence)
• Aims to resolve early maladaptive schemas and establish coping mechanisms.

Behaviour/Learning Paradigm

• Views psychopathology as learned responses akin to other behaviors.
• Origins focused on observable behavior, not subjective experience.
• Central assumption: environmental factors and prior learning affect behavior.
• Key types of learning theories within this paradigm:
  • Classical conditioning (Pavlov, Watson)
  • Operant conditioning (Skinner)
  • Modeling (Bandura)

Learning Paradigm: Classical Conditioning

• Pavlov (1849-1936) with dogs; an unconditional response is changed by learning association with a conditioned stimulus.
• Unconditioned stimulus (UCS) → Unconditioned response (UCR)
• Conditioned stimulus (CS) → Conditioned response (CR)

Classical Conditioning: The Case of "Little Albert"

• Watson & Rayner (1924) study
• Demonstrating learned emotional responses (via classical conditioning).

Learning Paradigm: Operant Conditioning

• Skinner (1904-1990) researched conditioning using rats & other animals.
• Demonstrates how behavior can be altered via rewards (reinforcement) and punishments (reducing the likelihood of behavior).

Operant Conditioning: Reinforcement & Punishment

• Positive reinforcement increases the likelihood of a behavior (e.g., praise, reward).
• Negative reinforcement increases the likelihood of a behaviour (e.g. taking aspirin for pain).
• Positive punishment decreases the likelihood of a behaviour (e.g., punishment, shock).
• Negative punishment decreases the likelihood of behaviour (e.g., time-out, deprivation).

Behaviour Therapy

• Systematic use of learning principles to improve individuals' behaviours to better their functioning.
• Examples: positive reinforcement, systematic desensitization, token economics, shaping, and social skills training.

Behaviour Therapy: Functional Assessment (ABC Model)

• Analyzing antecedents, behaviours, and consequences to understand and change behaviours.

Integrative Therapy: Lazarus’ Multimodal Model

• Uses a comprehensive model (BASIC ID) to create treatment plans.
• Addressing behaviour, affect, sensations, imagery, cognitions, interpersonal relationships, drugs/biology (as needed)