Psyc 2002- Lecture 1

Mental Health
- Mental health is defined as the state of well-being in which an individual
realizes their abilities, copes with normal stresses of life, works productively
and efficiently, and contributes to the society in which they live. (WHO 2001)
- Mental Health also refers to one’s ability to cope with life’s stress and how
stress is conceptualized.
Normality
- Normality can be defined as a state of mind, exhibited in behaviour that is
culturally accepted in accordance with social normal and that does not cause
a hinderance in a person’s adaptability to the environment.
- Normality provides feelings of safety, certainty and familiarity which endows
social order in maintaining what is considered as the “norm.”
Abnormality
- Abnormality on the other hand was defined in terms of the 4 D’s- Deviance,
distress, dysfunction and debilitating, which is something away from the
normal.
- Though abnormality has been defined by many theorists and professionals,
none are universally accepted or mutually exclusive. The definition of
abnormality is arbitrary and open to change and criticism.
- The social norms that are often used to determine what is normal versus
abnormal can shift over time, so settling on a standard definition isn't simple
or straightforward.
It can be viewed as: A statistical deviation, Maladaptive behavior, Norm or value
violation, Deviation from an ideal, Personal distress/discomfort, medical disorder
Elements of Abnormality
1. Suffering- If people suffer or experience psychological pain, it can be
considered as indicative of abnormality. Though, an elements of abnormality,
it is not sufficient nor a necessary condition for considering something as
abnormal.

2. Maladaptiveness- Maladaptive behaviors interferes with our well-being and

with our ability to enjoy our work and relationships. It is often an indicator of
abnormality It is important to note that not all disorders involves
maladaptive behaviours and matters in context. For instance, A contract killer
takes someone’s life in return for payment. Is this behavior maladaptive? Not
for him, because it is the way he makes his living. We consider his behaviour
abnormal, however, because it is maladaptive for and toward society.

3. Statistical Deviancy- The word abnormal indicates that it’s removed away
from being normal. Considering statistically rare behaviour to be abnormal
 does not provide us with a definition of abnormality. Geniuses are considered
as rare but we don’t refer to such as abnormal. On the other hand,
intellectual disability is referred to as abnormal. This indicates that while
defining abnormality, value judgements are made. If something is statistically
rare and undesirable such as an intellectual disability, it is more likely to be
considered as abnormal in comparison to something that is statistically rare
and desirable such as a genius.

4. Violations of the standards of society- All cultures and societies has norms
and values, whether it be understood or formalized as laws. When people fail
to follow the convention social norms and laws, this is considered as
abnormal. However, it is much dependent on the magnitidue of the violation
as well as the frequency in which the rule is violated. Additionally, it is also
dependent on how statically common the behaviour exhibited. For instance,
having a television can be seen as abnormal within the Amish community but
is a very common thing within society.

5. Social discomfort- When someone violates a social rule, those around them
would feel a level of discomfort.

6. Irrationality and unpredictability-

The DSM-5
 The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides all
the information necessary to diagnose mental disorders. It is the accepted
standard for defining various types of mental disorders. It was published in
2013 and was revised and republished to be named the DSM-5-TR in March
2022.
 Rather than thinking the DSM as a finished product, it should always be
regarded as a work in progress.
 The DSM creates a common language so that a specific diagnosis means the
same thing to one clinician as it does to another. It also helps to ensure
diagnostic accuracy, consistency and reliability

Within the DS-5, a mental disorder is

defined as a symptom. When certain
symptoms regularly occur together
( a cluster of symptoms is known as a
syndrome) and follow a particular
course that involves clinically
significant disturbance in behavior,
emotion regulation or cognitive
functions, clinicians agree that those
symptoms make up a particular
mental disorder.

These disturbances are though to

reflect a dysfunction in biological,
psychological or developmental
processes that are necessary for
mental functioning, which then
 .
The DSM-5-TR Criteria and Updates.
 The DSM-5-TR is divided into 20 Disorder Chapters organized in sequence
with the developmental lifespan.
 DSM-5-TR are sequenced in recognition of the advances in our understanding
of the underlying vulnerabilities and symptom characteristics of disorders.
 The chapters are also grouped by broad categories that—in some cases—
indicate the common features within larger disorder groups.
 The new framework is intended to encourage research within and across
diagnostic groupings with the hope of advancing our understanding of the
relationships between disorders. The revised version includes a new
diagnosis (prolonged grief disorder).
 Clarifying modifications to the criteria set for more than 70 disorders,
addition of International Classification of Diseases, Tenth Revision, Clinical
Modification (ICD-10-CM) symptom codes for suicidal behavior and
nonsuicidal self-injury, and updates to descriptive text for most disorders
based on extensive review of the literature.
 DSM-5-TR includes a comprehensive review of the impact of racism and
discrimination on the diagnosis and manifestations of mental disorders.
 Language throughout the DSM-5-TR was updated to promote inclusivity for
People of Color and marginalized groups
Why classify Mental Disorders?
 Classification systems provide nomenclature (a naming system) and enable
us to structure information in a more helpful manner.
 Organizing the information within a classification system also allows for the
study of different disorders that are classified and therefore learn more about
what causes them and how they might be treated, classifying the disorders
and not the people.
 Additionally, the classification of mental disorders has social and political
implications. Defining the domain of what is considered to be pathological
 establishes the range of problems that the mental health professions can
address. Subsequently, it delineates which types of psychological difficulties
warrant insurance reimbursements and the extent of it.
Disadvantages of Classification.
 Within a classification system, it gives way for stigmas to be created
surrounding psychiatric diagnosis. Despite the large amount of information
that is available about mental health issues, the level of mental health
literacy is often very poor.
 Related to stigma, there is an issue of stereotyping. Due to what we have
heard about certain behaviors that accompany mental disorders, automatic
and incorrect deductions can be made to infer that these behaviors will also
be present in person who has a psychiatric diagnosis.
 Additionally, classifying disorders can perpetuate stigmas by labeling. A
person self-concept may be directly affected by a diagnosis of a mental
illness. Once a group of symptoms is given a name and identified by a means
of diagnosis, this diagnosis label can be hard to shake due to personal and
societal implications.
Cultural influence of disorders.
 Within a given culture, there are many beliefs and behaviors that are shared
and widely accepted. For instance, in Christian cultures, the consider the
number 13 to be unlucky but in the Japanese culture, they have no worry
about the number 13 but rather of the number 4.
 Prejudice towards the mentally ill seems to be found worldwide. Some types
of psychopathologies appear to be highly culture specific. They are found
only in certain areas of the world and seem to be linked to cultural concerns.
 In the case of taijin kypfusho, an anxiety disorder is prevalent in Japan. It
involves the fear that one’s body or body parts may offend, embarrass or
make others feel uncomfortable. People with this disorder may be afraid of
blushing, upsetting others by their gaze, facal expression or body odor.
 Subsequently, another culturally rooted expression of distress is ataque de
nervios. This is a clinical syndrome amongst Latin individuals which does not
seem to correspond to any specific diagnosis within the DSM. It involves
crying, trembling, uncontrollable screaming and a general feeling of loss of
control due to stressful life events such as divorce or bereavement.
Terms and Definitions
 Principal Diagnosis – the disorder that is considered to be the primary reason
the individualseeks professional help
 Differential diagnosis – the process of systematically ruling out alternative
diagnoses
 Comorbidity - the situation that occurs when multiple diagnostic conditions
occur simultaneously within the same individual.
 Acute- describes a disorder of suddent onset, usually with intense symptoms.
  Chronic- describes a long-standing or frequently reccuring disorder often of
progressing seriousness.
 Milld/Moderate/Severe- describes a disorder of a low order of severity,
intermediate order of severity and a high degree of seriousness.
 Episodic Disorder- describes a disorder that tends to abate and to recur.
 Recuurent- describes a disorder pattern that tends to come and go.

Historical Viewpoints
Demonology, Gods and Magic
 References to abnormal behavior in early writings show that the Chinese,
Egyptians, Hebrews and Greeks often attributed such behavior to a demon or
god possession of a person. Whether the possession was assumed to be good
or evil spirits usually depended on the affected person’s symptoms.
 The primary type of treatment for demonic possession was exorcisms. This
included various techniques for casting an evil spirit out of an afflicted
person. It involved magic, prayer, incantation, noise making and the use of
horrible-tasting concoction made from sheep’s dung and wine
 Another form of treatment was trephining which included allowing the evil
spirit to escape from the head. This practice involved the chipping of a hole in
the skull of the afflicted person who behaved strangely to allow the evil spirit
to escape.
Hippocrates (460-377 B.C)
 Hippocrates (460–377 B.C.), often called the father of modern medicine,
taught that illnesses had natural causes. He saw abnormal behavior as a
disease arising from internal physical problems and denied the notion that
deities and demons intervened in the development of illnesses.
 Specifically, he believed that the brain was the central organ of intellectual
activity and mental disorders were due to some form of brain pathology.
Hippocrates emphasized the importance of heredity and predisposition and
pointed out that injuries to the head could cause sensory and motor
disorders. He classified mental disorders into three general categories:
mania, melancholia and phrenitis(brain fever).
  In his view, an imbalance of four fluids, or humors, that flowed through the
body: yellow bile, black bile, blood (sanguis) , and phlegm, can result in
physical or mental diseases. An excess of yellow bile, for example, caused
mania; an excess of black bile was the source of melancholia.
Plato (429-347 B.C)
 Plato studied mentally disturbed individuals who have committed criminal
acts. He believed that such persons were not responsible for their acts and
should not receive punishment for their behavior in the same way as normal
persons.
 He also made provision for mental cases to be cared for in the community.
His ideas regarding treatment included a provision for “hospital” care for
individuals who development beliefs that ran counter to those of the broader
social order.
 Plato viewed psychological phenomena as responses of the whole organism,
reflecting its internal state and natural appetites. He also shared the belief
that mental disorders were in part divinely caused.

Aristotle (384-322 B.C)

 Aristotle, a student of Plato, made significant contributions to early
psychological thought, particularly in his descriptions of consciousness and
mental disorders. He believed that rational thinking, when properly directed,
could alleviate pain and lead to pleasure.
 Although he considered whether mental disorders could arise from
psychological factors such as frustration and conflict, he ultimately rejected
this idea, a perspective that was widely accepted in his time.
 Instead, Aristotle subscribed to the Hippocratic theory, which attributed
mental disturbances to imbalances in bodily fluids, particularly bile. He
believed that an excess of hot bile could lead to heightened passionate
desires, excessive verbal expression, and even suicidal impulses, reinforcing
the idea that emotions and behaviors were influenced primarily by
physiological conditions rather than psychological experiences.
 Despite modern psychology recognizing the complex interplay of biological,
psychological, and social factors in mental health, Aristotle’s work laid a
foundational framework for ongoing discussions on the origins and treatment
of mental disorders.
Galen (A.D. 130-200)
 Galen a highly influential Greek physician, expanded upon the Hippocratic
tradition and made significant contributions to the understanding of mental
disorders, primarily through his anatomical research and scientific
classification of psychological conditions.
  While he did not introduce new treatments, his work on the nervous system,
based on animal dissections, reinforced the idea that the brain, rather than
the heart, controlled thought and emotion.
 He approached mental illness systematically, categorizing its causes into
physical and mental factors. Among the physical causes, he identified head
injuries, excessive alcohol consumption, adolescence, and menstrual changes
as contributors to mental disturbances, acknowledging the biological basis of
mental health.
 His emphasis on both physiological and psychological influences marked an
early shift toward a more holistic view of mental health, laying the foundation
for the modern biopsychosocial model.

The Middle Ages (500-1500 A.D)

 During the middle ages, the more scientific aspects of greek medicine survive
in the islamic and middle east. The first mental hospital was established in
Baghdad ans was soon followed by others in Damascus and Aleppo. In this
hospitals, mentall disturbed individuals received humane treatment. In
europe at this time, scientific inquiry into abnormal behaviours was limited.
 During the Middle Ages in Europe, scientific understanding of abnormal
behavior was limited, and treatment for individuals with psychological
disorders was often rooted in religious beliefs, superstition, or attempts to
interpret their conditions rather than medical inquiry.
 Mental disorders were prevalent during this period, and the dominant
explanations for their causes were heavily influenced by supernatural beliefs,
with individuals often attributing mental illness to demonic possession,
witchcraft, or divine punishment. The tremendous revival of strong influence
of religious doctrine meant that sin was frequently linked to abnormal
behavior, though it was not always explicitly regarded as a direct cause of
mental illness. Human being became the battle ground of ancient spirits and
demons of possessions of spirits.
Last half of Middle Ages
 During the last half of the Middle Ages in Europe, a peculiar trend emerged in
efforts to understand abnormal behavior. This involved mass madness. This
 was the occurrence of group behavior disorders that we apparently case of
hysteria. Whole groups of people were affected simultaneously. This includes
dancing manias, involving epidemics of raving, jumping and dancing.
 One such episode which occurred in Italy was known as tarantism. This was a
disorder that included an uncontrollable impulse to dance that was often
attributed to the bite of a tarantula or wolf spider.
 Similarly, areas were also afflicted with outbreaks of lycanthropy. This was a
condition in which people believed that they were possessed by a wolf and
imitated their behavior.
 Mass madness, also known as mass hysteria, was a recurring phenomenon
that persisted into the seventeenth century but reached its peak during the
fourteenth and fifteenth centuries marked by extreme social turmoil,
widespread famine, epidemic diseases, and severe oppression.
 One of the most devastating events of this period was the Black Death, a
catastrophic plague that wiped out an estimated 50% of Europe’s population,
leading to immense psychological distress and societal breakdown. The
immense fear, grief, and instability caused by such large-scale suffering
contributed to the rise of mass hysteria, where groups of people exhibited
irrational, frenzied behaviors fueled by collective fear and superstition.
 Many of these episodes were linked to deep-seated anxiety, depression, and
religious extremism, as people struggled to find explanations for the disasters
occurring around them. As a result, hysteria and panic spread rapidly within
communities, manifesting in behaviors such as wild mystical visions,
uncontrollable fear, and erratic physical movements.
Towards Humanitarian Approaches
During the latter part of the Middle Ages and the early renaissance, scientific
questioning reemerged and a movement emphasizing the importance of specifically
human interest and concerns began a movement that can be loosely referred to as
humanism.
During the resurgence of scientific inquiry in Europe, Paracelsus (1490–1541) and
Johann Weyer (1515–1588) played crucial roles in challenging superstitious beliefs
surrounding mental illness. Paracelsus, a Swiss physician, was an early critic of the
widespread notion that psychological disturbances were caused by demonic
possession, rejecting demonology in favor of more rational explanations.
Similarly, Johann Weyer, a German physician, was deeply troubled by the brutal
imprisonment, torture, and execution of individuals accused of witchcraft, many of
whom likely suffered from mental disorders. He extensively wrote against the belief
in witchcraft and demonology, advocating for a more humane and scientific
approach to understanding mental illness.
Clergy members, including Saint Vincent de Paul (1576–1660), also began to
question the harsh practices of the time, emphasizing Christianity’s moral
responsibility to protect the vulnerable and urging the powerful to adopt more
compassionate attitudes.
Despite these evolving perspectives, the establishment of early asylums during the
16th to 18th centuries was initially focused more on social control than treatment.
These institutions were created primarily to isolate individuals deemed troublesome
or incapable of caring for themselves, rather than to provide proper medical care.
Many of these asylums resembled prisons or storage facilities, characterized by
overcrowded and filthy conditions, where patients were often subjected to cruel and
inhumane treatment.
Although the shift towards scientific reasoning marked the beginning of a more
humanitarian approach to mental health, the reality of early asylums revealed the
continued struggle between moral responsibility and societal attitudes toward
mental illness.

Humanitarian Reform
France- Phillipe Pinel (1745-1826)
Shortly after the first phase of the french revolution, pinel was placed in charge of
La Bicetre, a hospital in Paris. In this capacity, he received the grudging perission of
the revolutionary commune to remove the chains from some of the inmates as an
experiment to test his views that mental patients should be treated with kidness
and consideration, as sick people and not vicous beasts or criminals.
The chains were removed, sunny rooms were provided and patients were permiited
to excerice on the hospital grounds. Kindess was also extended to these poor
beings, some of whom were chained in dungeons for 30 or more years. The results
of thes were miraculous and the previous condition of noise and filth were replaced
by order and peace.
England- William Tuke (1732-1822)
Around the same time that Pinel was reforming La Bicetre, an English Quaker name
William Tuke established the York Retreat, a pleasant country house where menta
patients lived, worked and rested in a kindly, religious atmosphere. The Quakers
believed in treating all people, even the mentally ill, with kindness and acceptance.
Their view wouldl help mentall ill people to recover and spark the growth of more
human psychiatric treatment during a period where mental patients were ignored
and mistreated.
America- Benjamin Rush (1745-1813)
In the united states, the humanitarian revolution was reflected in the work of
Benjamin Rush, the founder of the American Pschiatry. While he was associated
with the Pennsylvania Hospital in 1973, he used moral manageent on pinel’s
methods and encouraged the more human treatment of the mentall ill and wrote
the first systematic treatise on psychiatry in America.
Dorethea Dix (1802-1887)
Dorothea Dix played a crucial role in advocating for more humane treatment of
individuals with mental illness. Dix founded the mental hygiene movement in the
United States, which focused on the physical well-being of patients with mental
illness in hospitals
She conducted extensive investigations across the United States, documenting the
neglect, abuse, and lack of proper medical treatment for the mentally ill. Her efforts
led to the establishment of 32 mental hospitals that focused on providing proper
medical care, structured treatment, and rehabilitation rather than punishment or
isolation.
Dix’s approach emphasized the belief that mental illness was a medical condition
rather than a moral failing or supernatural affliction. By advocating for state-funded
institutions with trained professionals, she helped shift public perception toward a
more compassionate and scientific approach to mental health care. Her work not
only influenced mental health reforms in the U.S. but also had a global impact,
inspiring similar changes in Europe and Canada. Through her efforts, Dix laid the
foundation for modern psychiatric care.