History & The Present: Treating Mental Illness

1. 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

2. Trephining • Earliest human societies – Neolithic Period (7000BP) • Europe – 5000BC • Asia (Palestine) – 6000BC • High concentrations in Peru and Bolivia, but seen across the world independently

3. Kashmir, India • Female 26-30yrs • Roughly 2000BC

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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”

10. Witchcraft

13. Dorthea Dix & Philippe Pinel • 18th century • Fought for improvements in humane treatment of those with mental illnesses • All people should be treated with dignity

14. DRUGS! –1950s • Drugs = Deinstitutionalization • Unanticipated results = homeless population increases, some formerly in mental hospitals end up in jail

15. The Present

16. 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

17. 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)

18. Clinical Assessment • Interviews • Objective Questionnaires: • MMPI • Project Tests: • Rorschach, TAT, etc. • Behavioral monitoring • YOU can do this one… • Brain Measurement • EEG, PET scans

19. 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

20. 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

21. 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

22. 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

23. 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

25. 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

26. Effectiveness across types of problems

27. No One Theory is Perfect…