Psychopathology in Historical Context Lecture 1 PDF

Psychopathology in Historical Context Dr. Frances Jin| PSYC7319 1 9/4/24 Course outline ▪ Teaching team ▪ Format ▪ Lecture ▪ Tutorial/Discussion ▪ Assessment ▪ Group presentation ▪ Public education article ▪ Quiz ▪ Respect your fellow classmates...

Psychopathology in Historical Context Dr. Frances Jin| PSYC7319 1 9/4/24 Course outline ▪ Teaching team ▪ Format ▪ Lecture ▪ Tutorial/Discussion ▪ Assessment ▪ Group presentation ▪ Public education article ▪ Quiz ▪ Respect your fellow classmates 9/4/24 2 Do you have a disorder if… ▪ You are statistically in the minority? ▪ You are behaving in an irrational or odd or atypical way? ▪ You are suffering? ▪ You are making other people uncomfortable? ▪ Violating social rules? 9/4/24 3  At the core: What is abnormal behavior? So, what is normal? ▪ Is it “normal” to be sad? Anxious? ▪ Does an individual know if they are normal? ▪ Who decides what is normal vs abnormal? 9/4/24 4 Distress, Impairment, and Cultural Context ▪ Dysfunctional distress occurs when a person is much more distressed than others would be ▪ Distress is normal in some situations ▪ Impairment must be pervasive and/or significant ▪ Again, illustrates the point that most psychological disorders are simply extreme expressions of otherwise normal emotions, behaviors, and cognitive processes. ▪ Culture: Consider “normalcy” relative to behavior of others in same cultural context 9/4/24 5 What Do We Mean by Abnormal Behavior or Mental Disorder? ▪ Generally accepted definition: Cognition, emotion regulation, or behavior dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning. 9/4/24 6 Society & Psychopathology ▪ Homosexuality ▪ Disorder until 1970s ▪ Premenstrual dysphoric disorder (PMDD) ▪ Is now a mental disorder 9/4/24 7 8 The science of psychopathology 9/4/24 The Science of Psychopathology ▪ Psychopathology is the scientific study of psychological dysfunction ▪ Mental health professionals (e.g., in North America) Ph.D.: Clinical and counseling psychologist (trained in research and delivering treatment) Psy.D.: Clinical and counseling “Doctor of Psychology” (trained in delivering treatment) M.D.: Psychiatrist Psychiatric nurses Licensed clinical social worker (trained in delivering treatment) 9/4/24 9 Scientist Practitioner 9/4/24 10 Our work covers 11 9/4/24 Clinical Description ▪ Begin with the presenting problem ▪ Symptoms (e.g., chronic worry, panic attacks) ▪ Description aims to distinguish clinically significant dysfunction from common human experience ▪ May also describe other factors: Prevalence and incidence of disorders Onset of disorders: acute vs. insidious onset Course of disorders: episodic, time-limited, or chronic course Prognosis: good vs. guarded 9/4/24 12 Causation, Treatment and Outcome ▪ Etiology What contributes to the development of psychopathology? ▪ Treatment development How can we help alleviate psychological suffering? Includes pharmacological, psychosocial, and combined treatments 9/4/24 13  Three historical 14 models of psychopathology 9/4/24 The supernatural model ▪ Deviant Behavior as a Battle of “Good” vs. Evil ▪ Deviant behavior was believed to be caused by demonic possession, witchcraft, sorcery. ▪ Treatments included exorcism, hung over snake pits, torture, beatings, and crude surgeries ▪ Exorcism: religious rituals to remove the spirit ▪ The moon and the stars Paracelsus: Swiss physician suggested that mental health problems are affected by pull of moon and stars ▪ Led to term “lunatic” ▪ Today? 9/4/24 15 The Supernatural Tradition ▪ Competing view that coexisted with supernatural tradition: “insanity” is caused by emotional stress, not supernatural forces Curable Treatments: Rest, sleep, healthy environment (e.g., community support), baths, potions 9/4/24 16 The Biological Tradition ▪ Hippocrates (460-377 BC) ▪ Greek Physician Father of modern Western medicine Mental disorders understood as physical disease Hysteria “the wandering uterus” – psychological symptoms were a result of the uterus moving around in the body Linked abnormality with brain chemical imbalances Remarkable insights foreshadowed modern views 9/4/24 17 Hippocratic-Galenic Tradition ▪ Galen (129-198 AD) extended Hippocrates’ work ▪ Roman Physician ▪ Humoral theory of disorders: ▪ Related to having too much or too little of four key bodily fluids (humors) Blood, phlegm, black bile, yellow bile E.g.,: Depression caused by too much black bile. Melancholia (“black bile”) is still used to day Treated by changing environmental conditions (e.g., reducing heat) or bloodletting/vomiting Similar ideas exist in China and throughout Asia 9/4/24 18  Temperament Discussed by ancient Greeks (e.g., Galen)—forerunner of ‘traits’. warm Irritable; Cheerful; excitable Choleric Sanguine yellow active blood bile dry wet black phlegm bile Phlegmatic Melancholic Apathetic; Sad; sluggish brooding 9/4/24 19 cool The biological model- 19th century ▪ Syphilis and the Biological Link With Madness ▪ Syphilis can cause psychotic sxs (delusions) ▪ The cause – A bacterial microorganism ▪ Bolstered the view that mental illness = physical illness and should be treated as such ▪ John P. Grey and the reformers Psychiatrist who believed mental illness had physical roots Championed biological tradition in the U.S. Led to reforms of hospitals to give psychiatric patients better care 9/4/24 20 The Development of Biological Treatments ▪ Insulin shock therapy ▪ Electroconvulsive therapy (ECT) ▪ Medication became increasingly available starting in the mid-20th century Neuroleptics (major tranquilizers) now called antipsychotics Minor tranquilizers prescribed for anxiety and related disorders 9/4/24 21 Consequences of the Biological Tradition ▪ Overall, mental illness understood to have physical roots ▪ Increased hospitalization ▪ Mental illness sometimes seen as “untreatable” condition ▪ Improved diagnosis and classification ▪ Increased role of science in psychopathology 9/4/24 22 The Psychological tradition ▪ Root of psychosocial treatment can date back to Plato and Aristotle ▪ Plato thought maladaptive behaviors are caused by social and cultural influences and learning from the environment ▪ Discussed cognitions, emotions, as well as dreams and fantasies ▪ Advocated for humane and responsible care for individuals with psychological disturbances 9/4/24 23 The psychological tradition ▪ Moral therapy: ▪ Rise of “moral” (emotional) therapy: Treated institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction ▪ Pinel & Pussin – 18th century France ▪ Reform of asylums (formerly like prisons) ▪ Other countries, e.g., Benjamin Rush in the U.S. ▪ Dorothea Dix ▪ Mental Hygiene movement: focused on providing care to everyone who needed it, causing a large influx in patients ▪ Unfortunately, only temporary ▪ Crowding of mental hospitals eliminated individual attention ▪ Mental illness as brain pathology, people assumed it was incurable 9/4/24 24 Psychological Tradition: Psychoanalytic Theory Sigmund Freud’s theory encompassed: Structure of the Mind Defense mechanisms Stages of psychosexual development Treatment 9/4/24 25 Psychoanalytic theory 9/4/24 26 Psychoanalytic Theory ▪ Defense mechanisms: Ego’s attempt to manage anxiety resulting from id/superego conflict Displacement: transfer a feeling about or a response to an object that causes discomfort onto another, usually less threatening, object or person Sublimation: direct maladaptive feelings or impulses into socially acceptable behavior Rationalization: conceals the true motivation through elaborate reassuring or self-serving but incorrect explanations Projection: falsely attributes own unacceptable feelings, impulses, or thoughts to another individual or object ▪ Psychosexual stages of development Essentially a developmental perspective Oral, anal, phallic, latency, and genital stages Theory: conflicts arise at each stage and must be resolved All non-psychotic disorders come from unresolved unconscious conflicts, the anxiety result from them and the ego defense mechanisms – called neuroses. 9/4/24 27 Later Developments in Psychoanalytic Thought ▪ Carl Jung: ▪ Rejected the focus on sexual drives ▪ Emphasized spiritual and religious drives ▪ Introduced collective unconscious ▪ Alfred Adler: ▪ focused on feelings of inferiority and the striving for superiority ▪ Both believed the basic quality of human nature is positive. 9/4/24 28 Psychoanalytic Psychotherapy ▪ Designed to reveal the nature of unconscious mental processes and conflicts through catharsis and insight ▪ Catharsis: release of emotional materials ▪ Insight: linking the current emotions to previous events ▪ Techniques include free association, dream analysis, and analysis of transference ▪ Free association: say whatever comes into mind ▪ Transference: patients relate to the therapists as they did to important figures, e.g., parents ▪ Very time consuming and costly ▪ Little evidence of effectiveness 9/4/24 29 Psychodynamic Psychotherapy ▪ Derived from psychoanalytic approach Focus on affect and the expression of emotions Exploration of attempts to avoid topics or engage in activities that hinder the progress of therapy Identification of patterns in actions, thoughts, feelings, experiences, and relationships Emphasis on past experiences Focus on interpersonal experiences Emphasis on the therapeutic relationship Exploration of wishes, dreams, or fantasies 9/4/24 30 Psychological Tradition: Humanist Models of Therapy ▪ Major Themes: ▪ Human beings are basically good (reaction to Freud’s theory, in which people are always in conflict, tending towards neuroses) ▪ Humans strive toward self-actualization 9/4/24 31  Humanistic Theory ▪ Abraham Maslow Hierarchy of needs, beginning with our most basic physical needs and ranging upward to needs for self-actualization, love, and self-esteem 9/4/24 32 Wikipedia Humanist Models of Therapy: Carl Rogers ▪ Rogers is the most influential Humanist ▪ Developed person centered therapy – in which the therapist creates an environment in which the client can grow and develop ▪ Unconditional positive regard – the therapist is completely accepting of the client’s feelings and actions (within reason). 9/4/24 33 Humanistic Therapy But some aspects are now universally recognized Therapist conveys empathy and unconditional acceptance Importance of client-therapist relationship Therapeutic alliance 9/4/24 34 Psychological Tradition: Cognitive- Behavioral Model ▪ Combines Behavioral model and Cognitive model ▪ Behavioral model: ▪ Classical conditioning ▪ Operational conditioning ▪ Cognitive model: ▪ Cognitive processes, thinking pattern, schema, belief 9/4/24 35  The Behavioral Model Ivan Petrovich Pavlov (1849-1936) Classical conditioning is a ubiquitous form of learning Conditioning involves pairing a neutral stimulus (CS; bell) and unconditioned stimuli (UCS; food) Dogs salivate to bell after pairing (conditioned response; CR) 9/4/24 36  Applications of Classical Conditioning “Little Albert” experiment UCS UCR Loud Noise Fear CS CR John Watson White Rat Fear Behaviorism 9/4/24 37 Major Conditioning Processes Acquisition - Initial learning of the response Extinction - Decrease in CR without CS Spontaneous Recovery - reappearance of the CR Generalization - tendency to respond to a similar CS (e.g., a different bell sound) 9/4/24 38  Operant Conditioning Operant Conditioning - associating your behavior with the consequences (e.g., teaching a child to say “Please”) B.F. Skinenr Influenced by Watson and Thordike’s law of effect 9/4/24 39  Behavioral Therapy Learning Traditions (studies of operant conditioning) influenced the development of behavior therapy ▪ Behavior therapy tends to be time-limited and direct ▪ E.g., Joseph Wolpe, a pioneering psychiatrist from South Africa, developed Systematic Desensitization. ▪ Strong evidence supporting the efficacy of behavior therapies ▪ Learning principles are used to eliminate unwanted behaviors Mary Cover Jones (1896–1987) was one of the first psychologists to use behavioral techniques to free a patient from phobia. 9/4/24 40  Classical Conditioning Pairing the CS with a new response Systematic Aversive Desensitization Conditioning 9/4/24 41 Contingency Management: Using Operant Conditioning Behaviors are influenced by their consequences Rewards used to modify behavior varies (e.g., attention, praise or food) Token Economy Rewards = tokens to be redeemed for desirable items like candy, toys, TV, trip to the movies, etc. 9/4/24 42 Token economy: Star Charts 9/4/24 43  Cognitive Therapy ▪ Assumptions ▪ Event → Thought → Emotion ▪ You can’t just change the way you feel ▪ You can’t control (always) events ▪ But you can control what you think ▪ Goal ▪ Restructure thinking ▪ Change false/unhelpful beliefs ▪ Challenge negative thinking Aaron Beck 9/4/24 44 Evolution to Cognitive Behavioral Therapy (CBT) Models Cognitive elements are now commonly integrated in behavioral treatments ▪ Reaction against reductive “behavioral” explanations ▪ Good evidence for effectiveness of CBT treatments 9/4/24 45 46 Discussion The myths of mental disorder 9/4/24 8 Myths ▪ People with mental disorders are different ▪ Reality: from us ▪ You either have a mental health problem or you don’t ▪ People with mental disorders are dangerous ▪ It’s all biological ▪ People with mental disorders are weak in character ▪ People with mental disorders come from bad homes ▪ Kids with mental health problems are just going through a phase ▪ You never recover from a mental disorder 9/4/24 47