These notes include:
• All the learning units and relevant learning objectives (LU1-LU13)
• DSM-5 diagnostic criteria (where necessary)
They combine notes from the lecture slides, articles and the textbook.
These notes include:
• All the learning units and relevant learning objectives (LU1-LU13)
• DSM-5 diagnostic criteria (where necessary)
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, LEARNING UNIT ONE – AN INTRODUCTION TO PSYCHOPATHPOLOGY
THEME ONE: HISTORY OF MENTAL ILLNESS
LO1: DISCUSS THE HISTORY OF MENTAL ILLNESS, PSYCHOPATHOLOGY IN SOUTH
AFRICA, GLOBAL AND CRITICAL PERSPECTIVES
A brief history of psychopathology
• Mental disorders have been, and sometimes still are, ascribed to supernatural causes.
o Seen as punishment for sins committed or as a form of demonic possession.
o Perspective has been repeatedly challenged.
• In the 1500s – institutionalization of the mentally ill in Europe was on the increase.
o These institutions (asylums) were more like prisons than hospitals and became
known for their inhuman treatment of mental patients.
o Treatment – restraining patients for long period of time, placing them in dark cells,
and subjecting them to torture-like treatments.
• Late 1700s – humanitarian reforms emerged.
o Phillipe Pinel put forward the idea that kindness and consideration towards mental
patients (moral therapy) was necessary for their recovery.
▪ Argued that their chains should be removed, and be placed in sunny rooms,
be permitted to do exercise, and partake in other constructive activities.
▪ Many patients reported to have recovered after being treated in a humane
fashion – gradually, trained nurses and other professionals were introduced to
help in the treatment of patients with mental disorders.
• Towards the end of the 1800s in Europe, there were many significant factors that
emphasized biological risk factors for mental disorders.
o One key factor – observation that syphilis (sexually transmitted disease caused by
bacteria infiltrating the brain) produces the same symptoms as a mental disorder:
▪ Delusions of persecution or grandeur;
▪ Bizarre behaviours.
o This encouraged the search for biological causes that might be associated with
mental illness and formed the foundation of modern-day psychiatry.
o John P. Grey – maintained that mental disorders are always caused by physical
factors; therefore, these patients should be treated as if they are physically ill.
o Emil Kraepelin observed that certain symptoms occurred with specific types of
mental disease.
▪ Based on this observation, he developed a classification system for a number
of disorders, most notably dementia praecox (schizophrenia).
▪ Revolutionary – served as precursor to the Diagnostic and Statistical Manual
of Mental Disorders.
o The scientific era has also been characterised by the development of many different
psychological theories and treatments like community psychology, cognitive-
behavioural theories, and psychoanalysis:
▪ Freud – psychoanalysis - which attempted to explain almost all areas of
human psyche. One aspect of his theory also attempted to explain how
mental disorders develop. At the basis of this explanation is Freud’s
understanding of the structure of personality (id, ego, and superego), as well
as defense mechanisms.
• 1900s:
o Frantz Fanon – was critical of colonial psychiatry and focused on enabling patients to
use ‘authentic speech by re-establishing an environment that allows each subject to
tale up again the traces of real or physical events’.
▪ Established a psychiatric hospital in Tunis – patients were free to come and
go – “care for madness requires returning of freedom to the mad”.
, ▪ Community psychology has continued to emphasize the importance of
providing services where people live, and of a focus on recovery.
o Pavlov and Watson - Behaviourism – claimed that psychopathology had its genesis
in psychological conflict caused by instinctual drives.
▪ B. F. Skinner (operant conditioning) and Joseph Wolpe (systematic
desensitization) built on Watson’s theory. They believed that psychopathology
could be better understood by the observation of how abnormal behaviour is
learned and reinforced by the external environment.
• Past 50 years – existential psychotherapy, logotherapy, gestalt psychotherapy, and
cognitive-behavioural therapy.
• Over the years there has been a great deal of conflict about which treatments are more
effective, and this has often led to some treatments being favoured over others.
o Choice often depends on the therapist’s chosen theoretical orientation, rather than
on the evidence base.
o There is increasing effort aimed at determining the common factors across different
psychotherapies that determine treatment outcome, and at expanding and
consolidating the evidence base.
• The introduction of psychotropic (mood-altering) drugs in the 1950s has also been headed
as an important landmark in the history of mental disorder.
o Drugs such as lithium, chloropromazine, and impramine were hailed as miracle
drugs because, for the first time, symptoms associated with mania, psychosis, and
depression could be controlled through the use of medication.
▪ This made it possible for many patients to be discharged from, or altogether
avoid admission to, psychiatric institutions.
▪ Many patients were able to maintain normal productive lives under continuing
medication.
o In this way, psychopharmacological treatment was able to prove cost-effective way of
managing patients without having to resort to lengthy stays in psychiatric hospitals.
▪ Ongoing debate about the possible over-medicalization of behavioural
conditions.
▪ However, particularly in low- and middle-income countries, where the majority
of the world’s population lives, the evidence shows that there is under-
diagnosis and under-treatment of medical disorders.
Psychopathology in South Africa
• Psychology was first established as a formal academic discipline in South Africa during the
1920s, which was a time of class ordering, labour problems, and racial oppression.
o It suited those in power to adopt the dominant social scientific discourse of the time,
which was one of racial differences and racial inferiority, an idea reinforced by the
fact that the psychometric tests being used in South Africa were designed mainly for
the white population.
▪ These culturally biased tests were used to endorse racial oppression, ill-
treatment, substandard education, misdiagnosis, exclusion from various
services and opportunities, and neglect.
• E.g. a study conducted by Freeman found that black patients were
more likely to be diagnosed with a psychotic disorder such as
schizophrenia, whereas white patients were more likely to be
diagnosed with a mood disorder.
• Colonial psychiatry saw itself as drawing on European principles of humanness; for
example, early psychiatric hospitals in SA aimed to provide patients with a caring
environment.
o However, they were racially segregated, and amenities for black patients were
significantly inferior.
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