Abnormal Psychology – Definitional & Historical Considerations, and the Mental Health System

Identifying & Understanding Abnormal Behaviour

Abnormal behaviour can be deduced from statistical infrequency of behaviour(s)/characteristics, a violation of norms, experiences of personal distress, disability/dysfunction, and unexpectedness of behaviour.

Psychopathology is a field that works with the development and nature of abnormal behaviour, thoughts and feelings.

Statistical Infrequency

Statistical infrequency involves the normal curve (bell curve) that has the majority of “normal” behaviours in the middle and abnormal behaviours on the outer edges of the curve.  An example of this can be IQ tests.

Violation of Norms

Violation of norms is a somewhat socially relative or constructed principle, as it is based on actions that make others feel threatened or anxious.  This category can be either too broad or too narrow, as the participation of an individual in illegal actions does not fit within the scope of abnormal psychology.  What one might want to consider is the collective consciousness’s attitude towards the thoughts/feelings/beliefs portrayed in the violation of norms of an individual.  Looking at the social construction component of this logic, it is important to recognize that cultural diversity and context both have an impact on the perception of if norms are actively being violated.

Personal Suffering

Simply put, this is understanding how the thoughts/feelings/beliefs of an individual personally impact their wellbeing.  This could be looked at from a psychosocial-spiritual lens.

Disability &/or Dysfunction

This category examines impairments one may experience in their life due to some form of abnormality.  This section can be looked at from a biopsychosocial-spiritual lens as well, but with a focus on how biological components interact with the other domains of wellbeing.  It is important to note that disability can apply to some, but not all, disorders.

Unexpectedness

When distress or disability appear malaligned to the context and scope of environmental stressors, they become an abnormal response.  Unexpectedness essentially looks at the proportionality of thoughts/feelings/beliefs to the situations experienced by clients.

 

History of Psychopathology

Early Demonology

Before modern scientific inquiries into behaviour, mysticism had a significant influence on the understanding of abnormal behaviour.  Demonology, the belief that an evil being (such as the devil) had control over the mind & body of an individual was common in civilizations such as the early Chinese, Greeks, Egyptians, and Babylonians.  The common treatment in demonology was an exorcism – the removal of evil spirits through rituals or torture.  Another treatment was trepanning; the creation of an opening in a living skull with an instrument during the stone-age and with neolithic cave-dwellers.

Somatogenesis

Hippocrates separated medicine from religion, magic, and superstition.  He insisted that the root of illness came from natural causes, and should thus be treated similarly to other common illnesses.  This lead to abnormal behaviour being looked at as a brain pathology.  Somatogenesis – the view of something with the physical body causing disturbances of thoughts and actions began to gain ground.  This is contrasted with psychogenesis, which looks at disturbances as being psychological in its origins.  His ideas would not withstand scientific scrutiny later on.

Hippocrates had 3 mental disorder classifications:

1. Mania
2. Melancholia
3. Phrenitis

Hippocrates viewed mental health as being dependent on a balance between four humours (body fluids):

1. Blood – too much blood was associated with a changeable temperament.
2. Black bile – overabundance associated with melancholia.
3. Yellow bile – high levels associated with irritability and anxiousness.
4. Phlegm –  too much phlegm was associated with being sluggish or dull.

Dark Ages Demonology

Christian monasteries of the dark ages, the decay of Greek and Roman civilization replaced physicians with monks as primary healers.  This era was marked by monks praying over individuals and touching the individuals with relics or drinking concocted potions. The movement was more towards mythological explanations.

Persecution of witches began in this era, as demonology began to be used to explain plagues and other phenomena that could not be easily explained at the time.

Witchcraft & Mental Illness

Many of those accused of witchcraft in the middle ages would not be considered mentally ill today, and many confessions were gained through the use of torture.

As secularization of healthcare began to emerge,  under English law persons could be confined involuntarily (both the dangerously insane and incompetent).  By the thirteenth “lunacy” trials began to take place, and it became the state’s responsibility to protect the mentally impaired.  The individual’s orientation, memory, intellect, daily life, and habits were considerations in determining lunacy.

By the fifteenth & sixteenth centuries, confinement of the mentally ill began with asylums, which established care and confinement for the mentally ill.  There was no specific treatment at the time other than getting the individuals able to work.  Specialized hospitals for the confinement of the mentally ill also began to emerge.

Early Asylums

Deplorable asylums such as bedlam emerged as chaotic and confusing places to send those with mental illness.  Showings of those in the asylum to the public became more common, and the viewing of the antics of the facilities became a tourist attraction and form of entertainment for the general population.  Similar to a prison, patients were confined to small square rooms that passersby could see.

Moral Treatment

Part of a humanitarian approach to the asylums, Philippe Pinel, began by removing the chains of individuals held in asylums and began to treat the patients as sick individuals.  This lead to the patients becoming calmer and easier to handle.  Dungeons were replaced by light and airy rooms.

Pinel also began to treat patients like any other person – focusing on compassion, understanding, and dignity.  Part of the treatment plan became comforting counsel and purposeful activity.  These humanitarian approaches were often more available to the upper classes.

Key components of moral treatment are close contact with service providers, who were engaged with the individuals and provided encouragement for the individual’s pursuit of meaningful activity.  Those in treatment were to live as normal of a life as possible and took as much responsibility for themselves as possible, within the constraints of their disorder.

Despite the pragmatic approach, drugs were often used as a form of treatment (alcohol, cannabis, opium, and chloral hydrate).  Also, fewer than one-third of patients would be discharged for improvement or recovery.  As hospitals began to become involved in the treatment of mental illness, without training in moral treatment, interest grew in the biological components of illnesses rather than psychological or client wellbeing.

Canadian Asylums

With time (1700-1800s), psychiatric asylums emerged throughout Canada.  While the intentions of the asylums came from the progressive and reformist movements, neglect and suffering were common.  In Québec, a contracting-out system from the King of France was paid to religious orders to care for the mentally ill.  Many other asylums in Canada were built prior to the first world war.  Many asylum superintendents were British-trained physicians.

Focuses of British-trained were:

1. Structure
2. Treatment
3. Administration

Many of the asylums were overcrowded, which led to a subsequent increase in deaths and poorer health outcomes.  Almost 20% of those in institutions would die, while 52% would eventually be discharged.

Today’s concern of a two-tiered system reflects changes in the 1853 legislation “Private Lunatic Asylums Act” which provided more opportunity, quicker access, and superior quality of care for the wealthy.

In essence, Canada’s system historically had separate provisions for the physically and mentally ill and a separation between the institution and the greater community.

Transinstitutionalism was the shift of hospitals beginning to provide psychiatric care in specialized units within the hospital.  The remaining provincial psychiatric hospitals provide specialized treatment and rehabilitation services in instances where needs or care are too great to be managed by the community.

Early Classification Systems

Syndromes became a means to classify a certain cluster of symptoms that appeared to have a common underlying physical cause.  This was influenced by the disease model.  The two early major groups were dementia praecox (schizophrenia), and manic-depressive psychosis (bipolar disorder).

Advances in biological knowledge enhanced the ability to become more accurate in attributing degenerative brain diseases with symptoms.  One of the first breakthroughs in this realm was understanding the full nature and origin of syphilis.  Prior to the degenerative knowledge of syphilis, the symptoms had been designated as a disease known as general paresis.  The germ theory of disease, that minute organisms led to the symptoms, was a breakthrough in linking syphilis and general paresis

Mesmer

Mesmer believed that hysterical disorders were attributed to a distribution of universal magnetic fluid in the body.  It was believed that one person could influence the fluid of another to bring about change in another’s behaviour.  Mesmer used techniques that may be considered precursors to hypnosis.

Cathartic Method

Breuer found that under hypnosis exploration of past events with the client led to more open conversation about the adverse experiences and upon wakening the client would feel better.  Relief and cure of symptoms seemed to last longer if the individual was able to recall precipitating events for the symptom and was allowed to express the original emotion.  The reliving of the earlier adverse experience and releasing the emotions became know as catharsis.

Current Attitudes towards People with Psychological Disorders

Many individuals experience stereotyping and stigma.  Additionally, drawing from concepts such as intersectionality, those with a physical and psychiatric disability encounter a compounding impact of both disabilities with regards to stereotypes, discrimination, and stigma.

Public Perception

Counter to misconceptions of mental illness with danger, the vast majority of mentally ill individuals never perpetrate violent acts.  They are more likely to be victims.  Current negative attitudes and discrimination leave approximately half of the population, avoiding involvement with someone who has a mental illness.

Self-stigma is a tendency for one to internalize their mental health and thus view themselves in more negative terms due to experiencing a psychological problem.  Protective factors against self-stigma include a secure attachment to significant others.

We have a role to play in advocacy against stigma and discrimination by challenging prejudice, promoting positive human-interest stories that show compassion and empathy, and encouraging help-seeking and self-esteem for those with a mental illness.

Mental Health Literacy

Mental health literacy can be thought of as building capacity in individuals have accurate information on mental illness by way of causes and treatments.

Education, experience, access to training, and the young tend to have more informed and positive attitudes regarding mental health.

Statistics in Canada

1 in 3 meet the criteria for depression at some point in their life

1 in 5 meet the criteria for substance abuse disorder

1 in 7 meet the criteria for major depressive disorder or bipolar disorder

Males have higher rates of substance abuse over females

Females have higher rates of generalized anxiety and mood disorders over males

1 in 3 had an unmet need for treatment, in whole or in part.

Costs of Mental Health

Unrecognized costs to society include:

1. Personal misery
2. Disruption of family life
3. Lower quality of life
4. Loss of productivity

Other costs include disease burden – the impacts on life expectancy and quality of life.

The most burdensome disorders wee depression, bipolar, alcohol use, social phobia, and schizophrenia.

Transformations in the Mental Health System

The Mental Health Commission of Canada paved the way for a national action plan.  The Mental Health Transition Fund allowed the government to create a time-limited investment in community-based delivery of mental health services.

Despite these investments, Canadians tend to wait too long for treatments

Delivery of Services – Issues and Challenges

The CPA remains dedicated on efforts to reach a consensus on evidence-based practice, and expand research on this front.  This coincides with provincial governments wanting to ensure cost-effectiveness of services, with a limit on classical analysis and long-term psychotherapy.  CBT remains an effective intervention for many mental health concerns, but wait times remain inconsistent throughout the country for access to services.  Approximately 75% of those with a disorder did not seek help in the past year, while 27% who sought help did not qualify for a diagnosis.  Strong predictors of help-seeking included a psychiatric diagnosis, marital disruption, poverty and comorbidity (existence of 3 or more simultaneous disorders).

There is a particular need for interventions to encourage service use in young men, young persons living with their parents or unrelated others, and young people diagnosed with an anxiety substance-use disorder.  Many youths between 15-24 years of age rely largely on the internet for information on mental health.  Concerns with this rise for the lack of accountability that publishers of content can have, suggesting a need for an e-health literacy available for younger demographics.  Alarmingly only 1 in 4 with a substance use disorder and 1 in 2 with a mental disorder used professional services.

When it comes to the gender divide males are 3-4 times more likely to die from suicide than females.  Younger cohorts of both genders show a 2 to 1 ratio of male to female deaths by suicide.  Risk of suicide appears to be associated with a lower SES, possibly due to disparities in accessing the system and its resources.

Deinstitutionalization and Service Access

Canada has undergone institutionalization, leading to an extensive reduction in psychiatric beds and unit closures.  While reintegration was well-intended and aimed to prevent involuntary hospitalization, it has not been a perfect solution.  While the preferred mental health service model is one that combines intensive local community supports and services, combined with general-hospital psychiatric units and regional treatment centres, homelessness of the mentally ill and use of jails for keeping the mentally ill off the streets shows service gaps within the systems.  Societal service gaps also can contribute to mental illness by individuals developing mental illness when they fall through the cracks of other services.

Predictors of homelessness include:

1. Higher levels of depression
2. Lower levels of self-esteem
3. Delinquency
4. Substance use
5. Substandard neighbourhood housing

*Decreases in welfare benefits and underfunding of social housing have been argued as contributing factors to the current state of affairs.

Community Psychology and Prevention

Community psychology is a proactive, and preventative approach to addressing mental health concerns by seeking out potential or existent problems in communities.  The focus in community psychology is the promotion of psychological, social, and physical wellbeing of individuals.

Canada’s mental health strategy has 6 directions:

• Promoting mental health across the lifespan and preventing mental illness and suicide wherever possible
• Fostering recovery and well-being for people  of all ages living with barriers to mental wellbeing while promoting their rights
• Providing access to the right combination of services, treatment, and supports where service users are.
• Decrease the disparities in ability to access mental health services, while strengthening responses to diverse and northern communities.
• Collaborate with FNMI person(s) to address distinct mental health needs, acknowledging indigenous ways of knowing, historical injustices, and using culturally relevant practices.
• Enhance collaboration, improve knowledge, and mobilize leadership.

*Note: Volunteerism is a protective factor in maintaining positive mental health, especially when one is motivated to help.

Resources:

Canadian Mental Health Strategy: http://strategy.mentalhealthcomission.ca