Transcript Early History of Treating Mental Illness

History & The Present:
Treating Mental Illness
http://www3.niu.edu/acad/psych/Millis/History/2002/mainsheet.htm
http://www.webrenovators.com/psych/TheMysteryOfMentalIllness.ht
m
Lobotomy:
http://www.youtube.com/watch?v=_0aNILW6I
Lk
Trephining
• Earliest human societies – Neolithic Period
(7000BP)
• Europe – 5000BC
• Asia (Palestine) – 6000BC
• High concentrations in Peru and Bolivia,
but seen across the world independently
• Kashmir, India
• Female 26-30yrs
• Roughly 2000BC
W
H
Y
?
• “Release of evil spirits” = conjectural
• Biological reasons = headaches, fractures,
infections, insanity, convulsions
• Other reasons = acquire rondelles, or the
circular shaped bones from skull used for
charms and other jewelry
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Overall…
Astonishingly widespread
across time and space
Done in presence and
absence of head trauma
Living and the dead
Men, women, children
Only a small percentage of
discovered human skulls
are trephined
In some, trephining was
incomplete, as if abandoned
mid-procedure
Still done today! – parts of
Africa, South America, and
Melanesia
Hippocrates – Father of Medicine
• 460-377BC
• All disorders
(mental/physical) are
caused by natural forces
• All things made from earth
(black bile), water
(phlegm), air (yellow bile),
and fire (blood)
– When out of balance = ill
• Discovered “hysteria”
• Brain was responsible for
emotions and perceptions
Galen
(129-200AD)
st
• 1 anatomist
• Believed diseases were
contained within organs
• Physician of the gladiators!
• Relied on experimental,
observational results &
logic/reason
• Developed method for measuring
fevers – monitoring pulse
• Discovered function of nerves
• Mapped out the spinal cord and
various levels of paralysis
Europe – Middle Ages
1300-1600
• Almost NO advances in
understanding of mental illness
• Back to bodily fluids, demons &
spirits
• Likely forced to see a priest and
given an exorcism—beatings,
starvings, forced eating of
substances (blood, sheep dung)
– To agitate the spirit and force it
to leave
• Ostracized
• Executed
• Christian churches built
monasteries and poorhouses
for the poor; allowed in the
mentally ill
• Eventually became known as
“asylums”
• Most famous is St. Mary of
Bethlehem in London
(1247)…
– Called the habitants “lunatics”
– Housing known as a “bedlam”
Witchcraft
Dorthea Dix & Philippe Pinel
• 18th century
• Fought for improvements
in humane treatment of
those with mental illnesses
• All people should be
treated with dignity
DRUGS! –1950s
• Drugs = Deinstitutionalization
• Unanticipated results = homeless
population increases, some formerly in
mental hospitals end up in jail
The Present
David Rosenhan
• 1970s
• 12 normal people faked
auditory hallucinations
– “empty, hollow, thud”
• Upon entrance, said
they no longer heard
the voices
• Avg 7 minutes of
contact a day with staff
– NOT therapeutic
Paul and Lentz
• Social-Learning Theory
• Staff interacts more with patients, in
respectful ways, NOT using standard
therapy
• Reduce use of antipsychotics
• Therapy’s goal was to teach social skills
• 5 year study
• 97% were later discharged (46% of
control)
Clinical Assessment
• Interviews
• Objective Questionnaires:
– MMPI
• Project Tests:
– Rorschach, TAT, etc.
• Behavioral monitoring
– YOU can do this one…
• Brain Measurement
– EEG, PET scans
Psychodynamic Therapies
• Distress stems from
“unconscious mental
conflicts” so we must
uncover these to
induce recovery
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Free association
Dream analysis
Slips of the tongue
Transference
– Projection of feelings
onto the therapist
• Insight
• Resistance:
– unconscious
avoidance of painful
areas
Humanistic
• Carl Rogers clientcentered therapy
– Active listening /
echoing
– Genuineness,
acceptance, empathy
• Gestalt Therapy –
Fritz Perls
– Integrate all actions,
feelings, & thoughts
into a harmonious
whole
• Existential Therapy
– Subjective meanings
Behavior Therapy
• Counter Conditioning
– Associate bad stimulus
• Systematic
w/ good reinforcement
Desensitization (C.C.)
– Afraid of Dentists? Why
• Token Economies
do you think they hand
(O.C)
out candy when you’re
• Modeling: Bandura
done!!??
• Implosive Therapy /
• Aversive Therapy (aka
Flooding
Reconditioning)
– Elevator lady
– Replace good response
to harmful stimulus with a
bad response
– Antabuse
Cognitive Therapy
• Albert Ellis’s Rational • Aaron Beck’s StressEmotive Therapy (RET) Innoculation
– Same, but train client to
– Challenge
think, analyze own thoughts
irrational/illogical
thought processes
• Beck’s Cognitive Triad
– Client: “Life is perfect.”
– Ppl’s belief about:
Therapist: “no, it’s not.”
• Self
– ABC
• World
• A = activating event
• B = irrational belief
• C = emotional
consequence
• Future
– Ppl w/depression have
irrational neg beliefs in
these 3 areas
Group & Family
• GROUP:
• Comforting to Know
that others have
similar problems
• Develops listening
skills
• Empathy, not
sympathy
• Ex: AA, Fight Club
• FAMILY:
• Problems are
INTERPERSONAL
• “No man is an island.”
• Develops listening skills
• Relationship Triangles
– Enmeshment
– Distance/diffusion
Biological Treatments
(Besides Drugs)
• Shock Therapy – ECT
• Lobotomy
– Prefrontal: Sever connection btwn frontal lobe
and thalmus/hypothalamus
– Transorbital: knife inserted abovve eyeball to
cut random brain fibers
– A.E. Moniz 1930 Nobel Prize for discovery of
this procedure
– 10,000+ done…NOT BENEFICIAL AT ALL
• Cingulotomy
Effectiveness across
types of problems
CognitiveBehavioral
1.08
Psychodyna
mic
0.93
Cognitiv Humanisti Behavior
e
c
al
0.78
.65
0.59
No One Theory is Perfect…
Problem
First Choice Therapy
Anxiety/Fear
Cognitive/Behavioral,
Cognitive
Social Behavior
Cognitive/Behavioral
Addiction
Psychodynamic
Work/School
Achievement
Psychodynamic
Self-Esteem
Humanistic