PSYCHOPATHOLOGY-I

Oya MORTAN SEVI

Assistant Professor Dr.

Bahcesehir University
Psychology Department
Autumn Term, 2019-2020
• At different periods in history,
explanations for mental disorders have
been supernatural, biological, and
psychological.

• As we quickly travel through these

different periods,
ask yourself what level of
explanation was operating at different
times.
 Early Demonology

Before the age of scientific inquiry, all good and bad manifestations of power beyond
human control
—eclipses, earthquakes, storms, fire, diseases, the changing seasons—
were regarded as supernatural.
The doctrine that
an evil being or spirit can dwell within a person
and control his or her mind and body is called
demonology.

e.g. noisemaking, forcing the

afflicted to drink terrible-tasting
brews
Early Biological Explanations

•In the fifth century b.c., Hippocrates, the father of modern

medicine, separated medicine from religion and magic.

•He rejected that the gods sent mental disturbances as

punishment and said that such illnesses had natural causes
and hence should be treated like colds.

Hippocrates thought that disordered thinking and behavior

were indications of some kind of brain pathology.

!!!! He is often considered one of the earliest proponents of the

notion that something wrong with the brain disturbs
thought and action.
• Hippocrates classified mental disorders into three categories:
mania, melancholia, and brain fever.

• Hippocrates believed that normal brain functioning, and therefore mental health, depended on a
delicate balance among four humors,
(or fluids of the body),

1.blood (changeable/temperament),
2.black bile (melancholia),
3.yellow bile (anxiousness/irritability), and
4.phlegm (apathy).

An imbalance of these humors produced disorders.

 The Dark Ages and Demonology

 Galen was a Greek physician who followed Hippocrates’ ideas and is

regarded as the last great physician of the classical era.

 The death of Galen is accepted as the beginning of the so-called Dark

Ages in western European medicine and in the treatment and
investigation of mental disorders.

During this period, there was a return to a belief in supernatural causes of mental disorders.
 The persecution of witches

Witchcraft was seen as a heresy and a denial of

God.

In the dunking test, if the woman did not drown, she was
considered to be in league with the devil (and punished
accordingly)

.
Modern investigators initially believed that many of the people accused of being witches during the later
Middle Ages were mentally ill.

Their ideas actually were delusional beliefs or hallucinations.

Lunacy trials

•From the thirteenth century, the Church started to

care of people who were mentally ill.

•English laws during this period allowed people with

mental illness to be hospitalized. Notably, the people
who were hospitalized were not described as being
possessed.

•The word «lunacy» comes from a theory that odd

behavior is attributed to a misalignment of
the moon and stars.

•Even today, many people believe that a full moon is

linked to odd behavior; however, there is no scientific
evidence to support this belief.
Development of Asylums

•Until the fifteenth century, there were many

hospitals for people with leprosy.

But there were very few hospitals for

people with mental illness in Europe.

•Attention seems to have turned to people with

mental illness.

•Leprosariums were converted to asylums,

refuges for the confinement and care of people
with mental illness.
 Bethlehem and Other Early Asylums
The Priory of St. Mary of Bethlehem was
founded in 1243.

In 1403 it housed six men with mental illness.

In 1547, it became a hospital for people with

mental illness.

Then Bethlehem (bedlam) eventually became

one of London’s great tourist attractions, people
bought tickets to see them.

• Unfortunately the medical treatments in Behtlehem Similarly, in the Lunatics Tower (Vienna) patients
were often crude and painful. were confined in the spaces between inner
square rooms and the outer walls, where they
could be viewed by passersby.
• Benjamin Rush (1745–1813), is considered the
father of American psychiatry.

• But he believed that mental disorder was

caused by an excess of blood in the brain, so his
treatment was to draw great quantities of
blood from patients.

• He also believed that many people with

mental illness could be cured by being
frightened.
Pinel’s Reforms

•Philippe Pinel (1745–1826) has often been

considered a primary figure in the movement for
humanitarian treatment of people with
mental illness in asylums.

•Pinel is said to have begun to treat the patients as

sick human beings.
They became calm. Some patients were apparently
restored to health and eventually discharged from the
hospital.

•It is said that it was a former patient, Jean-Baptiste

who released the patients from their chains. Pinel
began to follow his practices.

•He reserved the more humanitarian treatment for

the upper classes; but patients of the lower classes
were still seen as a danger.
 Moral Treatment

•Mental hospitals were relatively small,

privately supported.
Then other hospitals were established to
provide humane (moral) treatment.

(Patients had close contact with

attendants, who talked and read to them
and encouraged them to engage in
purposeful activity)

•But the staff was unable to provide the

moral treatment.

•So the hospitals came to be administered

by physicians, most of whom were
interested in the biological aspects of
illness and in the physical, rather than the
psychological well-being of patients with
mental illness.
The Mental Hospital Today
 The Evolution of
Contemporary Thought
Biological Approaches
•Discovering Biological Origins in General Paresis and Syphilis

•For the first time, a causal link had been established between
infection, destruction of certain areas of the brain, and a form of
psychopathology (general paresis).

•If one type of psychopathology had a biological cause, so could

others.

•Biological approaches gained credibility, and searches for more general paresis: a syndrome characterized
biological causes were off and running. by a steady deterioration of both mental and
physical abilities, including symptoms such
as delusions of grandeur and progressive
paralysis.
(Biological Approaches-ongoing)

• Genetics
Francis Galton (1822–1911), the originator of genetic
research with twins, because of his study of twins
attributed many behavioral characteristics to heredity.

He used the terms nature and nurture to talk about

differences in genetics (nature) and environment
(nurture).

the idea that mental illness may run in families, and

beginning at that time would set the stage for later
theories about the causes of mental illness.
(Biological Approaches-ongoing)

Biological Treatments

•In the early 1930s, the practice of inducing a coma with

large dosages of insulin: presented serious risks to health,
including irreversible coma and death—was gradually
abandoned.

•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 cognitive capacities.
(Biological Approaches-ongoing)

• In the early twentieth century,

electroconvulsive therapy (ECT):

 by applying electric shocks to the sides of

the human head, the physician could
produce full epileptic seizures.

It was used for the treatment of

schizophrenia (and it is still used today for
people with severe depression)
Psychological Approaches

Beginning in the late eighteenth century, various psychological

points of view emerged that attributed mental disorders to
psychological malfunctions.

Mesmer believed that hysteria was caused by a particular

distribution of a universal magnetic fluid in the body. One person
could influence the fluid of another to change the other’s
behavior.

 He is generally considered one of the earlier practitioners of

modern-day hypnosis (mesmerism=hypnotism).

While the patient was sitting around a tube, he would touch afflicted parts of his patients’ bodies with the
aid of the rods which are believed to transmit animal magnetism and adjust the distribution of the universal
magnetic fluid.

According to him, this procedure was removing the hysterical disorder.

(Psychological Approaches-ongoing)

• Charcot was also interested in hysteria that he accepted as a nervous system problem. But his studies
show that it has a psychological aspect.
(his student example: «when the healthy woman was hypnotized, showed hysterical symptoms and then
the symptoms could be removed)
(Psychological Approaches-ongoing)
Breuer and the Cathartic Method
Catharsis: reliving an earlier emotional trauma and releasing emotional tension by expressing previously forgotten
thoughts about the event

•Breuer’s method became known as the cathartic method. (the case «Anna O.»)

But actually Anna O. was not only cured by catharsis, also used morphine. She was also hospitalized.

Breuer & Sigmund Freud , Studies in Hysteria (1895-partly based on the case of Anna O.)

Physiologist Neurologist
(1842-1925) (1856-1939)

• Breuer-Nietzche therapy sessions- When Nietzsche Wept (2007)

(Psychological Approaches-ongoing)

Freud and Psychoanalysis

•The central assumption of Freud’s psychoanalytic theory is that psychopathology results from
unconscious conflicts in the individual.

•Freud divided the mind (the psyche) into three principal parts: id, ego, superego.

•The id -is present at birth and is the repository of all of the energy needed to run the psyche,
including the basic urges for food, water, elimination, warmth, affection, and sex.
-the source of the id’s energy as biological, and called it libido.
-it is unconscious, below the level of awareness.
-is operating on the pleasure principle. When the id is not satisfied, tension is produced
(e.g. a hunger baby)
• The ego -begins to develop from the id during the second 6 months of life.
-is primarily conscious.
-operates on the reality principle (mediator between the demands of reality and
the id’s demands for immediate gratification).

• The superego -is seen as a person’s conscience.

-it develops throughout childhood.
-as children discover that many of their are not acceptable to their parents,
they begin to incorporate parental values as their own in order to receive the pleasure of
parental approval and avoid the pain of disapproval.
Defense Mechanisms is a strategy used by the ego to protect itself from anxiety.
• Repression: Keeping unacceptable impulses or wishes
from conscious awareness
• Denial: Not accepting a painful reality into conscious
awareness
• Projection: Attributing to someone else one’s own
unacceptable thoughts or feelings
• Displacement: Redirecting emotional responses from
their real target to someone else
• Reaction formation: Converting an unacceptable
feeling into its opposite
• Regression: Retreating to the behavioral patterns of an
earlier stage of development
• Rationalization: Offering acceptable reasons for an
unacceptable action or attitude
• Sublimation: Converting unacceptable aggressive or
sexual impulses into socially valued behaviors
Psychoanalysis/Psychoanalytic Therapy

Free association The patient tries to say whatever

comes to mind without censoring anything.

Interpretation The analyst points out to the patient

the meaning of certain of the patient’s behaviors.

Analysis of transference The patient responds to the

analyst in ways that the patient has previously
responded to other important figures in his or her life,
and the analyst helps the patient understand and
interpret these responses.
• Stages of Psychosexual Development
During each stage, a different part of the body is the most sensitive to sexual excitation and, therefore,
the most capable of satisfying the id.
1 . The oral stage (birth-18 months): the demands are feeding, sucking and biting. The body receives
gratification through the lips, mouth, gums, and tongue.
2. The anal stage (18 months-3 years): a child receives pleasure mainly via the anus, by passing and
retaining feces.
3. The phallic stage (3-5/6): maximum gratification of the id is obtained through genital stimulation.
4. The latency period (6-12): the id impulses do not play a major role in motivating behavior.
5. Genital stage (adult stage): heterosexual interests predominate.

During each stage, the developing person must resolve the conflicts between what the id wants and
what the environment will provide.

A person who experiences either excessive or deficient amounts of gratification at a particular stage
develops a fixation and is likely to regress to that stage when stressed.
Neo-Freudian Psychodynamic Perspectives

Jung and Analytical Psychology:

Psychiatrist
•There is a collective unconscious (1875-1961)

the part of the unconscious that is common to all human beings and that consists «archetypes»
=basic categories that all human beings use in conceptualizing about the world.

•Each of us has masculine and feminine traits that are blended and that people’s spiritual and
religious urges are as basic as their id urges.

•He catalogued some personality charactheristics:

extraversion (an orientation toward the external world)
vs.
introversion (an orientation toward the inner, subjective world).
Adler and Individual Psychology

Alfred Adler
Medical doctor
(1870-1937)

•Like Jung, he stressed the importance of working toward goals.

•He focuses on helping individual patients change their illogical and mistaken ideas and expectations.

•He believed that feeling and behaving better depend on thinking more rationally, an approach that
anticipated contemporary developments in cognitive behavior therapy.
• Although some psychodynamic theories have been heavily criticized that they are not grounded in
objectivity and therefore are not scientific, the work of Freud and his followers continues to have
an impact on the field of psychopathology holding 3 assumptions:

1.Childhood experiences help shape adult personality.

2.There are unconscious influences on behavior.
3.The causes and purposes of human behavior are not always obvious.
The Rise of Behaviorism

•Because of the efforts of Watson, the dominant focus of

psychology switched from thinking to learning.
John B. Watson
• Behaviorism focuses on observable behavior rather than on Psychologist
consciousness or mental functioning. (1878-1958)

•Here are three types of learning: classical conditioning,

operant conditioning, and modeling.
1. Classical Conditioning

Pavlov discovered classical conditioning quite by

accident. (Pavlov’s dog)
Ivan Petroviç Pavlov
Physiologist, psychologist,
a. Initial situation: bell (CS)  no salivation medical doctor
(1849-1936)
meat powder (UCS)  salivation (UCR)

b. Training trial: bell (CS) / meat powder (UCS)

c. Conditioning established: bell (CS)  salivation (CR)

The process of classical conditioning:

(a) Before learning, the meat powder (UCS) elicits
salivation (UCR), but the bell (CS) does not.
(b) A training or learning trial consists of presentations
of the CS, followed closely by the UCS.
(c) Classical conditioning has been accomplished when
the previously neutral bell elicits salivation (CR).
If repeated soundings of the bell are not
followed by meat powder?

The answer is that fewer and fewer CRs

(salivations) are elicited, and the CR
gradually disappears. This is termed
extinction.
John Watson and Rosalie Rayner’s experiment:
Classical conditioning can even instill pathological
fear.

•a white rat & an 11-month-old boy, Little Albert.

•The fear initially associated with the loud noise had come to be
elicited by the previously neutral stimulus, the white rat(now the
CS).

•This study suggests a possible relationship between classical

conditioning and the development of certain disorders, in this
instance a phobia.
https://youtu.be/9hBfnXACsOI
2. Operant Conditioning
•Thorndike studied the effects of consequences on behavior.
He formulated what was to become an extremely important principle, the
law of effect:
behavior that is followed by consequences satisfying to the
organism will be repeated, and behavior that is followed by
noxious or unpleasant consequences will be discouraged.

Edward Thorndike
•Skinner introduced the concept of operant conditioning, because it Psychologist
applies to behavior that operates on the environment. (1874-1949)
•Renaming Thorndike’s “law of effect” the “principle of reinforcement,”
Skinner distinguished two types of reinforcement:
-Positive reinforcement refers to the strengthening of a tendency to
respond by virtue of the presentation of a pleasant event, called a positive
reinforcer.
-Negative reinforcement also strengthens a response, but it does so
via the removal of an aversive event, such as the cessation of electric
shock.
3. Modeling
•We all learn by watching and imitating others, a process
called modeling.
Children of parents with phobias or substance abuse
problems may acquire similar behavior patterns, in part
through observation.

•Witnessing someone perform certain activities can

increase or decrease diverse kinds of behavior, such as
sharing, aggression, and fear.

•Modeling was also included in behavior therapy.

For example, people reduced their fear of snakes by viewing
both live and filmed encounters in which other people
gradually approached and successfully handled snakes.
Behavior Therapy (behavior modification)
•Its procedures based on classical and operant conditioning to alter
clinical problems.

•Behavior therapy was an attempt to change behavior, thoughts,

and feelings by applying in a clinical context the methods used and
the discoveries made by experimental psychologists.

•One important behavior therapy technique that is still used to

treat phobias and anxiety today is called systematic desensitization
(by Wolpe).
It has two components: (1)deep muscle relaxation and (2) gradual
exposure to a list of feared situations, starting with those that
arouse minimal anxiety and progressing to those that are the most
frightening.

•Wolpe hypothesized that a state or response opposite to anxiety is

substituted for anxiety as the person is exposed gradually to
stronger and stronger doses of what he or she fears.
Cognitive Therapy

Cognitive therapy is based on the idea that people

not only behave, they also think and feel.

The first aim is to make a patient aware of

their maladaptive thoughts.

By changing cognition, therapists hope

that people can change their feelings,
behaviors, and symptoms.
 Aaron Beck’s cognitive therapy

Psychiatrist
(1921- )

The roots of cognitive therapy included Aaron Beck’s cognitive therapy

 Albert Ellis’s rational-emotive behavior therapy (REBT)

Albert Ellis
Psychologist
(1913-2007)

Ellis focused on the role of irrational beliefs as causes of psychopathology