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Summary Exam 1 Clinical Psychology UvA Year 1
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Summary of Clinical Psychology Exam 1 as part of the course Clinical Psychology and Neuropsychology
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W1.1CHAPTER 1 (KRING & JOHNSON) – INTRODUCTION AND HISTORICAL
OVERVIEW
STIGMATISATION
Stigma: The destructive beliefs and attitudes held by a society that are ascribed to groups
considered different in some manner, such as people with psychological disorders – Can lead
to discrimination
↓
Characteristics of stigma:
1. A label is applied to a group of people that distinguishes them from others (E.g.:
‘crazy’)
2. The label is linked to deviant or undesirable attributes by society (E.g. ‘crazy people
are dangerous’)
3. 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’)
4. People with the label are discriminated against unfairly (E.g. ‘a clinic for crazy people
cannot be built in our neighbourhood’)
The treatment of people with psychological disorders throughout recorded history has not
generally been good, and this has contributed to their stigmatisation
Reducing stigma:
- Programs – Clear evidence about programs and their effectiveness in reducing stigma
is generally lacking
- Lobbying legislatures and community leaders about the importance of adequate
housing
- Educating people about psychological disorders – The mere acquisition of knowledge
does not ensure the end of stigma – People’s knowledge has increased over time, but
stigma has not decreased – Knowing more is linked to a greater desire for more social
distance from people with psychological disorders
- Personal contact where status is relatively equal – Informal settings can help bridge
the gap between people with and without psychological disorders
- Using rating scale assessments to prevent psychological disorders among children and
adolescents by identifying problems before they become more serious
- Trainings for mental health professionals in stigma issues
- Psychoeducation for individuals and family
- Advocacy groups
- Familiarity with people with a mental illness – There is some evidence that greater
familiarity is associated with more stigma due to family burden and job burnout (for
mental health professionals)
- Celebrities or public figures with psychological disorders
,DEFINING PSYCHOLOGICAL DISORDERS
The DSM-5 includes several characteristics essential to the concept of psychological disorder:
- The disorder occurs within the individual
- It involves clinically significant difficulties in thinking, feeling or behaving
- It usually involves personal distress of some sort
- It involves dysfunction in psychological, developmental, and/or neurobiological
processes that support mental functioning
- It is not a culturally specific reaction to an event (E.g.: the death of a loved one)
- It is not primarily a result of social deviance or conflict with society
Three key characteristics of psychological disorders – No single characteristic can fully
define the concept
1. Personal distress – A person’s behaviour may be classified as disordered if it causes
him or her great distress
2. Disability (= impairment in some important area of life) and dysfunction (= something
that has gone wrong and is not working as it should) – Interrelated as the brain impacts
behaviour, and behaviour impacts the brain
3. Violation of social norms – Behaviour that violates social norms might be classified as
disordered – Varies greatly across cultures
EARLY HISTORY OF PSYCHOPATHOLOGY
Psychopathology: The field concerned with the nature, development, and treatment of
psychological disorders
Supernatural explanations → Before the age of scientific inquiry, all good and bad
manifestations of power beyond human control were regarded as supernatural – The belief
that odd behaviour was caused by possession led to treating it by exorcism (= the ritualistic
casting out of evil spirits)
Early biological explanations → Hippocrates: Father of modern medicine – Separated
medicine from religion, magic and superstition by rejecting the belief that the gods sent
mental disturbances as punishment – Insisted that psychological illnesses had natural causes
and hence should be treated like other maladies
- Regarded the brain as the organ of consciousness, intellect and emotion – Thought that
disordered thinking and behaviour were indications of some brain pathology
- Classified psychological disorders into three categories: mania, melancholia, and
phrenitis or brain fever
- Humourism: The idea that healthy brain functioning, and therefore mental health,
depended on a delicate balance among four humours (namely: blood, black bile,
yellow bile and phlegm) – An imbalance of these humours produced disorders
The Dark Ages → The death of Galen resulted in a return to a belief in supernatural causes of
psychological disorders – Christian monasteries replaced physicians as healers and authorities
on psychological disorders
- From the 13th century on: Municipal authorities tended to supplement or take over
some of the activities of the Church → Lunacy trials: Trials conducted under the
, Crown’s right to protect people with psychological disorders, where a judgment of
insanity allowed the Crown to become guardian of the person’s estate (lunacy is
derived from luna, meaning ‘moon’ in Latin, and is based on the ideas of Paracelsus
that odd behaviour could be attributed to a misalignment of the moon and stars)
The development of asylums (= refuges for the housing and care of people with psychological
disorders):
- Old leprosy hospitals were converted to mental hospitals
- The Priory of St. Mary of Bethlehem: One of the first hospitals devoted solely to the
housing of people with psychological disorders – Viewing the people housed in
Bethlehem was considered entertainment, and the medical treatments were often crude
and painful
- Rush: Considered to be the father of American psychiatry
- Believed that psychological disorders were caused by an excess of blood in the
brain, for which his favoured treatment was to draw great quantities of blood
from people with psychological disorders
- Believed that many people with psychological disorders could be cured by
being frightened
- Pinel: Often considered a primary figure in the movement for more humane treatment
of people with psychological disorders
- Came to believe that people in his care were first and foremost human beings,
and thus that people with psychological disorders should be approached with
compassion, understanding and dignity
↓ However
Humanitarian treatment was reserved for the upper classes
- Asylums were set up in the US to provide humane treatment (known as moral
treatment) – People 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 19th century partly due
to efforts of Dix, who campaigned vigorously to improve the lives of people with
psychological disorders, after which mental hospitals became overcrowded and
understaffed
HISTORY OF CONTEMPORARY VIEWS ON THE CAUSES OF DISORDERS
Biological approaches → The anatomy and workings of the nervous system were partially
understood by the mid-1800s, but not enough was known to conclude whether or not the
structural brain abnormalities presumed to cause various psychological disorders were present
- The clarification of the nature and origin of syphilis:
- Late 1700s: It had been known that a number of people with psychological
disorders manifested a syndrome characterised by deterioration of mental and
physical abilities and progressive paralysis (named general paresis)
- Mid 1800s: It was discovered that some people with general paresis also had
syphilis
, - 1860s and 1870s: Pasteur established the germ theory of disease, which
posited that disease is caused by infection of the body by tiny organisms
- 1905: The specific microorganism that causes syphilis was discovered – The
causal link had been established between infection, damage to certain areas of
the brain and general paresis
- Genetics:
- Galton: Often considered the originator of genetic research – Attributed many
behavioural characteristics to heredity – Credited with the coining of the terms
nature (= differences in genetics) and nurture (= differences in environment)
↓
Early 20th century: Investigators became intrigued by the idea that
psychological disorders might run in families – Eugenics: A movement that
attempted to alter human gene pools by excluding people and groups judged to
be inferior or promoting those judged to be superior
- Biological treatments – Experimentation with radical interventions in the early 20th
century:
- Early 20th century: Electroconvulsive therapy (ECT) was originated by
Cerletti and Bin
- Early 1930s: Sakel introduced the practice of inducing a coma with large
dosages of insulin
- 1935: Moniz introduced the prefrontal lobotomy (= a surgical procedure that
destroys the tracts connecting the frontal lobes to other areas of the brain) –
After surgery, many people became dull and listless and suffered serious losses
in their emotional experience and cognitive capacities
Psychological approaches → Beginning in the late 18th century, various psychological points
of view emerged that attributed psychological disorders to psychological malfunctions
- Mesmer: Believed that hysteria was caused by a distribution of a universal magnetic
fluid in the body, and thought that one person could influence the fluid of another to
bring about a change in the other’s behaviour – Generally considered one of the earlier
practitioners of hypnosis
- Charcot: Believed that hysteria was a problem with the nervous system and had a
biological cause, but was also persuaded by psychological explanations – His support
of hypnosis as a worthy treatment for hysteria helped to legitimise this form of
treatment among medical professionals of the time
- Breuer: Developed the cathartic method (= a method for the treatment of hysteria
where the aim was to enable a hypnotised patient to recollect a traumatic event, to
have them express emotional trauma and to release emotional tension)
- Freud:
- Postulated that much of human behaviour is determined by forces that are
inaccessible to awareness (= unconscious)
- Divided the mind into three principal parts:
1. Id: Present at birth – The source of all the energy needed to run the
mind, including the basic urges for food, water, elimination, warmth,
affection and sex – Below the level of awareness – Seeks immediate
gratification of its urges – Pleasure principle
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