Abnormal2

• Stigma refers to the destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner, such as people with mental illness
• Characteristics of stigma


  • A label is applied to a group of people that distinguishes them from others (e.g., "crazy")
  • The label is linked to deviant or undesirable attributes by society (e.g., crazy people are dangerous)
  • People with the label are seen as essentially different from those without the label, contributing to an "us" versus "them" mentality (e.g., we are not like those crazy people)
  • People with the label are discriminated against unfairly (e.g., a clinic for crazy people can't be built in our neighborhood)
• In 1999, David Satcher, then Surgeon General of the United States, wrote that stigma is the "most formidable obstacle to future progress in the arena of mental illness and mental health" in his groundbreaking report on mental illness. Sadly, this remains true more than 10 years later
• People's knowledge has increased, but unfortunately stigma has not decreased
• Characteristics of mental disorder (as defined in DSM-IV-TR and proposed for DSM-5)

  • The disorder occurs within the individual
  • It causes personal distress or disability
  • It is not a culturally specific reaction to an event (e.g., death of a loved one)
  • It is not primarily a result of social deviance or conflict with society
• Personal distress


  A person's behavior may be classified as disordered if it causes him or her great distress
• Not all mental disorders cause distress. For example, an individual with the antisocial type of personality disorder may treat others coldheartedly and violate the law without experiencing any guilt, remorse, anxiety, or other type of distress
• Not all behavior that causes distress is disordered - for example, the distress of hunger due to religious fasting or the pain of childbirth
• Disability


  Impairment in some important area of life (e.g., work or personal relationships)
• Substance use disorders are defined in part by the social or occupational disability (e.g., serious arguments with one's spouse or poor work performance) created by substance abuse
• Being rejected by peers, as Felicia was, is also an example of this characteristic
• Phobias can produce both distress and disability - for example, if a severe fear of flying prevents someone living in California from taking a job in New York
• Disability alone cannot be used to define mental disorder, because some, but not all, disorders involve disability. For example, the disorder bulimia nervosa involves binge eating and compensatory purging (e.g., vomiting) in an attempt to control weight gain but does not necessarily involve disability
• Defining mental disorder based on violation of social norms is both too broad and too narrow
• Dysfunction


  Occurs when an internal mechanism is unable to perform its natural function - that is, the function that it evolved to perform
• The DSM definition of dysfunction refers to the fact that behavioral, psychological, and biological dysfunctions are all interrelated
• Many early philosophers, theologians, and physicians who studied the troubled mind believed that disturbed behavior reflected the displeasure of the gods or possession by demons
• Demonology


  The doctrine that an evil being or spirit can dwell within a person and control his or her mind and body
• Exorcism typically took the form of elaborate rites of prayer, noisemaking, forcing the afflicted to drink terrible-tasting brews, and on occasion more extreme measures, such as flogging and starvation, to render the body uninhabitable to devils
• Hippocrates rejected the prevailing Greek belief that the gods sent mental disturbances as punishment and insisted instead that such illnesses had natural causes and hence should be treated like other, more common maladies, such as colds and constipation
• Hippocrates regarded the brain as the organ of consciousness, intellectual life, and emotion; thus, he thought that disordered thinking and behavior were indications of some kind of brain pathology
• Hippocrates' classification of mental disorders

  • Mania
  • Melancholia
  • Phrenitis, or brain fever
• Humors


  Four fluids of the body - blood, black bile, yellow bile, and phlegm - whose balance determined normal brain functioning and mental health
• The Church gained in influence, and the papacy was declared independent of the state. Christian monasteries, through their missionary and educational work, replaced physicians as healers and as authorities on mental disorder
• In 1484, Pope Innocent VIII exhorted the clergy of Europe to leave no stone unturned in the search for witches. He sent two Dominican monks to northern Germany as inquisitors. Two years later they issued a comprehensive and explicit manual, Malleus Maleficarum ("the witches' hammer"), to guide the witch hunts
• The manual specified that a person's sudden loss of reason was a symptom of demonic possession and that burning was the usual method of driving out the supposed demon
• In the dunking test, if the woman did not drown, she was considered to be in league with the devil (and punished accordingly); this is the ultimate no-win situation
• Lunacy


  Odd behavior attributed to a misalignment of the moon and stars
• Until the fifteenth century, there were very few hospitals for people with mental illness in Europe. However, there were many hospitals for people with leprosy
• Leprosariums were converted to asylums, refuges for the confinement and care of people with mental illness
• The conditions in Bethlehem were deplorable. Over the years the word bedlam, the popular name for this hospital, came to mean a place or scene of wild uproar and confusion
• Benjamin Rush believed that mental disorder was caused by an excess of blood in the brain, for which his favoured treatment was to draw great quantities of blood from disordered individuals
• Benjamin Rush also believed that many people with mental illness could be cured by being frightened. Thus, one of his recommended procedures was for the physician to convince the patient that death was near!
• Historical research indicates that it was not Pinel who released the patients from their chains at La Bicêtre, but rather a former patient, Jean-Baptiste Pussin, who had become an orderly at the hospital
• Moral treatment


  Patients had close contact with attendants, who talked and read to them and encouraged them to engage in purposeful activity; residents led lives as close to normal as possible and in general took responsibility for themselves within the constraints of their disorders
• Moral treatment was largely abandoned in the latter part of the nineteenth century. Ironically, the efforts of Dorothea Dix, a crusader for improved conditions for people with mental illness who fought to have hospitals created for their care, helped effect this change
• In the 1860s and 1870s, Louis Pasteur established the germ theory of disease, which posited that disease is caused by infection of the body by minute organisms. This theory laid the groundwork for demonstrating the relation between syphilis and general paresis
• Francis Galton, often considered the originator of genetic research with twins, because of his study of twins in the late 1800s in England, attributed many behavioral characteristics to heredity
• Galton is also credited with creating the eugenics movement in 1883. Advocates of this movement sought to eliminate undesirable characteristics from the population by restricting the ability of certain people to have children (e.g., by enforced sterilization)
• In the early 1930s, the practice of inducing a coma with large dosages of insulin was introduced by Sakel, who claimed that up to three-quarters of the people with schizophrenia whom he treated showed significant improvement