History & The Present: Treating Mental Illness

http://www3.niu.edu/acad/psych/Millis/History/2002/mainsheet.htm http://www.webrenovators.com/psych/TheMysteryOfMentalIllness.htm

Lobotomy: http://www.youtube.com/watch?v=_0aNILW6ILk

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

WHY?

• “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

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)• 1st 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 Ages1300-1600

• 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

• 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 client-centered 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

• Systematic Desensitization (C.C.)

• Token Economies (O.C)

• Modeling: Bandura• Implosive Therapy /

Flooding– Elevator lady

• Counter Conditioning– Associate bad stimulus

w/ good reinforcement– Afraid of Dentists? Why

do you think they hand out candy when you’re done!!??

• Aversive Therapy (aka Reconditioning)– Replace good response

to harmful stimulus with a bad response

– Antabuse

Cognitive Therapy

• Albert Ellis’s Rational Emotive Therapy (RET)– Challenge

irrational/illogical thought processes

– Client: “Life is perfect.” Therapist: “no, it’s not.”

– ABC• A = activating event• B = irrational belief• C = emotional

consequence

• Aaron Beck’s Stress-Innoculation– Same, but train client to

think, analyze own thoughts

• Beck’s Cognitive Triad– Ppl’s belief about:

• Self• World• 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

Cognitive-Behavioral

Psychodynamic

Cognitive

Humanistic

Behavioral

1.08 0.93 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