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Abnormal Psychology PSY404

LESSON 3

PSYCHOPATHOLOGY IN HISTORICAL CONTEXT

Throughout history, many societies have held quite different views of the problems that we consider to be

mental disorders. The search for explanations of the causes of abnormal behavior dates to ancient times, as

do conflicting opinions about the etiology of mental disorders. Ancient records attribute abnormal behavior

to the disfavor of the gods or the mischief of demons.

Models for Studying Psychopathology

1. Supernatural Model

2. Biological Model

3. The Psychological Model

What purpose do these Models serve?

These Models try to explain the cause of individual Abnormal Behavior. Each model represents its own

individual interpretation of psychopathology and recommends its individual treatment procedures. So all the

models try to answer the question that

Following are the Models of Studying Psychopathology

1. The Supernatural Model

This Model attributes Abnormal Behavioral to magic, evil spirits, demons, moon and the stars. This model

includes

a- Witchcraft and Demonology

b -Moon and Stars

c- Mass Hysteria

a- Witchcraft and Demonology

The individuals suffering from mental disorders are possessed and controlled by magic, evil spirits and

demons etc.

The Treatments included punishments like chaining them or keeping them in cages or horrible ritual of

boring a hole in the skull.

These victims after going through an unfair trial were condemned as witches or demons were burned alive

or hanged. Witchcraft trials reached their peak in the sixteenth and seventeenth century. In 1692, in a small

town of Salem, Massachusetts a group of 19 women and men were hanged as witches.

b- Moon and stars

The Latin word for moon is Luna, this inspired people to use the word lunatic for abnormal people, but

now this word , is not used any more. According to this notion the movements of the full moon and the

stars have an effect on behavior of people. This view is reflected by followers of astrology who think that

their behavior as well as major events in their lives can be predicted by the position of the planets.

c- Mass Hysteria

It is a phenomenon in which the experience of an emotion seems to spread to those in the surroundings

around. If an individual is frightened and sad this feeling and experience spreads to near by people and

soon this feeling further escalates, develops into a panic and the whole community is affected. For example

the 8th October 2005 Earthquake experience affected the whole Pakistani nation and the whole nation was

traumatized.

The Supernatural model is still popular and used in undeveloped cultures where poverty is high and literacy

rate is low and mental health professionals are not permitted to play their role. People still look towards

magic and rituals performed by peers and fakirs for the solutions of mental disorders.

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Abnormal Psychology PSY404

2-Biological model

This model attributes mental disorders to disease and biochemical imbalances in the body.

Greek Contribution

· Hippocrates (450-377 B.C.)

· Galen (129-198A.D.)

Nineteenth Century

· J.P. Grey -1854

· E. Kraeplin -1913

Twentieth Century

· Insulin shock therapy

· Electroconvulsive therapy

The Greek contribution

The Greek physician Hippocrates ridiculed demonological accounts of illness and insanity. Instead,

Hippocrates hypothesized that abnormal behavior, like other forms of disease, had natural causes. Health

depended on maintaining a natural balance within the body, specifically a balance of four body fluids (which

were also known as the four humors): blood, phlegm, black bile, and yellow bile.

Hippocrates argued that various types of disorder or psychopathology, resulted from either an excess or a

deficiency of one of these four fluids.

The Hippocratic perspective dominated medical thought in Western countries until the middle of the

nineteenth century.

People trained in the Hippocratic tradition viewed "disease" as a unitary concept.

In other words, physicians did not distinguish between mental disorders and other types of illness. All

problems were considered to be the result of an imbalance of body fluids, and treatment procedures were

designed in an attempt to restore the ideal balance.

Four fluid theory

Galen a Roman physician adopted Hippocratic theory and advocated that the four fluids relate to the Greek

environmental concepts such as heat (blood) ,dryness (black bile), moisture ( yellow bile) and cold (

phlegm).

Each fluid was related to one quality. Excess of one or more fluids were treated by regulating the

environment to increase or decrease heat, dryness, moisture and cold depending on the deficiency of the

fluid.

Example

King Charles the sixth, when he got sick he was treated according to the following concept of Galen. He

was moved to less stressful countryside environment to restore the balance of his body fluids .Rest, good

diet and exercise were recommended.

Techniques of Treatment

1-Bloodletting, a technique where a measured amount of blood was removed by leeches to minimize

aggressive tendencies. Induced vomiting was used to reduce Depression .The diagnosed person was forced

to eat tobacco and half boiled cabbage for vomiting.

2-Syphilis

A sexually transmitted disease caused by a bacterial micro-organism entering the brain.

The person having syphilis developed behavior patterns and cognitions of a psychotic disorder i.e.

Schizophrenia and paralysis. The symptoms of Schizophrenia include

Hallucination (apperception), delusion (false belief) of grandeur, persecution and reference and bizarre

behaviors as well.

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Abnormal Psychology PSY404

Nineteenth Century

J.P.Grey theorized that mental disorder (insanity) was always due to physical causes and emphasis should

be on rest and diet, proper room temperature and ventilation.

He even invented the rotary fan and used it State Hospital in New York.

Emil Kraepelin

Contributed in the area of diagnosis and classification of Psychological Disorders

Each psychological disorder has a different age of onset and time course to follow, along with a different

cluster of presenting symptoms. His descriptions of Schizophrenia are still useful. Schizophrenia is a

psychotic disorder. It has 11 subtypes where reality contact is severed (lost), delusions (false beliefs) and

hallucinations (apperception).

Twentieth Century

Insulin shock therapy

In 1927 Manfred Sakel, a Viennese physician ,began using higher and higher dosages of Insulin, the patients

had convulsions and went into a state of coma but surprisingly these patients recovered so physicians

started to use it frequently. The method was abandoned because it was dangerous, caused coma and even

death.

Joseph Meduna, in 1920 observed that Schizophrenia was rarely found in epileptics (which later did not

prove to be true) and his followers concluded that induced brain seizures might cure Schizophrenia.

Electroconvulsive Therapy (ECT) was used extensively and frequently by doctors but was a controversial

method some doctors even used it to penalize the difficult unmanageable patients. It is effective with

suicidal patients.

Moral Therapy

It advocated humane and responsible care of the institutionalized patients and encouraged and reinforced

social interaction with them. Mental Hygiene Movement started with the concept of Moral Therapy

Pioneers in the Mental Reforms

P.Pinel (1745-1826)

William Tuke (1732-1822)

Benjamin Rush (1745-1813)

Dorothea Dix (1802- 1887)

All these individuals were the pioneers in the Mental Hygiene Movement which led to Asylum Reforms in

Europe and America.

In nutshell we can say

· The Biological Model had a scientific approach.

· Focus on medical procedures of treatment, drugs and medicines.

· Insulin Shock Therapy and Electroconvulsive Therapy are physically dangerous as well as harmful.

It is ethically wrong to use these methods with humans.

· Plato and Aristotle both emphasized on the importance of social environment and early learning on

later psychopathology. They wrote about the importance of dreams fantasies and cognitions in

studying behavior.

· Moral Therapy the term moral means emotional or psychological rather than a code of conduct.

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Abnormal Psychology PSY404

The Creation of the Asylum

In Europe during the Middle Ages, "lunatics" and "idiots," as the mentally ill and mentally retarded were

commonly called, aroused little interest and were given marginal care. Disturbed behavior was considered to

be the responsibility of the family rather than the community or the state. In the 1600s and 1700s, "insane

asylums" were established.

Early asylums were little more than human warehouses, but as the nineteenth century began, the moral

treatment movement led to improved conditions in at least some mental hospitals. Founded on a basic

respect for human dignity and the belief that humanistic care would help to relieve mental illness, moral

treatment reform efforts were instituted by leading mental health professionals of the day.

Contribution by Dorthea Dix

In the middle of the 1800s, Dorthea Dix argued that treating the mentally ill in hospitals was to be more

humane and more economical than caring for them haphazardly in their communities. She urged that

special facilities be provided to house mental patients.

The creation of large institutions for the treatment of mental patients led to the development of a new

profession--Psychiatry.

By the middle of the 1800s, superintendents of asylums for the insane were almost always physicians who

were experienced in taking care of people with severe mental disorders.

The Association of Medical Superintendents of American Institutions for the Insane (AMSAII), which later

became the American Psychiatric Association (APA), in 1844.

Worcester Lunatic Hospital: A Model Institution

In 1833, the state of Massachusetts opened a publicly supported asylum for lunatics, a term used at that

time to describe people with mental disorders, in Worcester.

Samuel Woodward, the asylum's first superintendent, also became the first president of the AMSAII.

Woodward claimed that mental disorders could be cured just like other types of diseases.

Treatment at the Worcester Lunatic Hospital included a blend of physical and moral procedures.

3. Psychological Model consists of following

a. Psychoanalysis

b. Humanistic

c. Behavioristic

Psychoanalysis

Psychoanalysis was pioneered by Sigmund Freud (1856-1939). He learned the art of Hypnosis from France.

He experimented with somewhat different procedures of Hypnosis. He used Hypnosis in a innovative way.

He encouraged his patients to talk freely about their problems, conflicts and fears .He discovered the

unconscious mind and its influence in psychopathology by using the techniques of Free Association, Dream

Analysis and Freudian Slips.

Structure of the mind: According to Freud the mind consists of

Mind--------------ego

Superego

Id which operates on pleasure principle, it is childish and immature. Libido provides energy to Id, Ego

and Superego. Ego operates on Reality Principle and it is the master control .It works on logic and reason

The Superego it operates on the moral principle and it is the conscience of the Psyche. The Ego mediates

and resolves conflict between Id and Superego.

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Abnormal Psychology PSY404

Defense Mechanism or Coping Styles

The Ego battles with Id and Superego to resolve conflicts, at times the resulting anxiety is so overwhelming

that the Ego has to adopt unconscious protective processes called Ego Defense Mechanisms or Coping

Styles. They have following characteristics in common

1. Operate at unconscious level.

2. Distort reality.

3. Protect the Ego.

4. All normal and abnormal individuals both use it in their daily life.

Some important ego defense mechanisms are following

1-Denial, 2- Displacement, 3- Projection, 4- Reaction formation,5- Repression,

6-Rationalization, 7- Sublimation

Psychosexual Theory of Development

Freud proposed a theory of development. This is known as the psychosexual theory of development. The

main emphasis in this theory is on the physical and psychological development.

1- Oral stage -birth to 18 months

2- Anal stage-18 months to 3 years

Psychosexual theory of ------------

3- Phallic stage -3 to 6 years

development

4- Latency stage

5-Genital stage-6 to 12 years

The stages of development represent patterns of gratifying our basic the needs, those needs which are not

gratified appear as fixations or psychopathologies at later adulthood. Oral stage fixations include nail biting,

chewing pencils. Freud is the first personality theorist to discuss the developmental perspective in the study

of abnormal behavior.

Psychoanalytic Therapy

It focuses on unconscious processes, conflicts and past experiences.

The techniques include

· Free Association

· Dream Analysis

· Freudian Slips

· Transference

· Analysis of humor