Introduction &

Historical Review
What is • Destructive beliefs and attitudes held by a society that
are ascribed to groups considered different in some way

Stigma? • Psychological disorders remain the most stigmatized

condition in the 21st century

…as if it is a
permanent situation,
a character…

…dangerous, violent,
retarded,
unreliable…

…what if others
learn?
The effects of stigmatization
• Who is affected from stigmatization?
Patients, their families… how many
people?
• As harmful as the psychological
disorder itself
• Denial, not seeking for help
• Damaged self-esteem
• Social isolation, restriction of social
support
• Harmful impact on the treatment
process
• Stigmatization is the biggest
obstacle for mental health research
How does
stigmatizati
on develop?
How does
stigmatization
develop?
• Activation of mental illness schema
•  Cognitive: Stereotypes, prejudiced attitudes
•  Affective: Fear, disgust
•  Behavioral: Avoidance, keep distance, break
contact

• But where does the «mental illness schema»

come from?
•  Meanings attached to abnormal behavior
throughout history
How to prevent?
• People’s knowledge has • Reading: Focus on Discovery 1.1
increased, but stigma has not (p.4)
decreased • Community Strategies
• Social Media • Housing Options
• Websites and blogs serve • Education
as a medium to share • Personal Contact
personal stories, raise • Mental Health and Health Profession
awareness, and increase Strategies
social connectedness • Mental Health Evaluations
• Education and Training
• Public figures speaking about
• Individual and Family Strategies
their experiences with mental
• Education for Individuals and
illness may help to reduce Families
stigma • Support and Advocacy Groups
• Remember that experience
shapes learning
Defining
Psychologi
cal
Disorder
What do we mean by abnormal?
• Read each example and highlight the behaviors or characteristics that make it abnormal. Think about why it
could be considered abnormal.
1. A young woman reports that she has an acute fear of snakes. She cannot bear to watch any films or
television programs which include snakes. If she sees a picture of a snake, she becomes very anxious or
distressed. If she sees a toy snake in a toy shop, she wants to walk away. She certainly will not go
anywhere near a zoo.
2. A young man, who lives with his mother, believes that the world beyond his house is filled with radio
waves which will insert evil thoughts into his head. For this reason, he never leaves the house. He covers
his bedroom window with aluminium foil because he believes that this will protect him. He claims to hear
voices which tell him that he should give up the fight against the evil waves.
3. A 37 year-old woman has an extreme fear of germs and bacteria. She will only allow visitors into her
house if she is convinced that they are clean. She goes through elaborate rituals when performing
ordinary tasks. For example, when making a cup of tea, she will fill and empty the kettle fourteen times in
order to make sure that the water is clean.
 1) Personal Distress
Too subjective &
unreliable
• A person’s behavior causes significant
distress
• Examples of distress:
• Difficulty paying attention
• Emotional pain and suffering
•  Not all psychological disorders cause
distress
• E.g., Antisocial personality disorder
• An individual may violate the
law without guilt, remorse, or
anxiety
•  Not all behaviors that causes distress
are disordered
• E.g., Distress of hunger due to
religious fasting
 2) Disability and Dysfunction
• Disability
• Impairment in an important area
(e.g., work, relationships)
• Chronic substance abuse
resulting in job loss
• Rejection by peers due to social
anxiety
• Not all psychological disorders
involve disability
• Not all disabilities are considered to
be psychological disorders
• Dysfunction
• Developmental, psychological, and/or
biological systems are not working as
they should (impairment)
• These systems are interrelated
Global Assessment of Functioning
• 91-100 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her
many qualities. No symptoms.
• 81-90 Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally
satisfied with life, no more than everyday problems or concerns.
• 71-80 If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social,
occupational, or school functioning.
• 61-70 Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some
meaningful interpersonal relationships.
• 51-60 Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.
• 41-50 Serious symptoms OR any serious impairment in social, occupational, or school functioning.
• 31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment,
thinking, or mood.
• 21-30 Behaviour is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to
function in all areas.
• 11-20 Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication.
• 1-10 Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with
clear expectation of death.
• 0 Not enough information available to provide GAF.
 3) Violation of Social Norms
Ethical issues &
human rights abuse
• Social norms are widely held standards
• Beliefs and attitudes used to make
judgments about behaviors
• Behaviors that violate social norms may be
classified as disordered
• Repetitive rituals performed by
people with obsessive-compulsive
disorder
• Talking to nonexistent voices that
some people with schizophrenia
experience
• Too broad and too narrow of a definition
• Criminals violate social norms (too broad)
• Highly anxious people typically do not
violate social norms (too narrow)
• Social norms vary across cultures and ethnic
groups
4) Statistical
Infrequency
• Under this definition, a
person’s trait, thinking or
behaviour is classified as
abnormal if it is rare or
statistically unusual.
Defining Psychological Disorders: DSM-5

• 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., death of a loved one)
• It is not primarily a result of social deviance or
conflict with society
History of
Psychopathol
ogy
HOW YOU EXPLAIN A HOW YOU APPROACH TO IT
PROBLEM (ETIOLOGY) (TREATMENT)
 Antiquity
• China, India, Iran, Egypt, Babylon, Ancient Greek…
• Supernatural explanations
• Displeasure of the gods or possession by demons
• Treatment: Exorcism—Ritualistic casting out of evil
spirits
• The «name» of the evil spirits and the methods vary
according to culture
• «Abnormal» is viewed as «immoral»
• The concept of «balance»
• Early thoughts influenced the understanding of the
interaction between mind and body
• Prevention/Treatment: Keep the balance, reestablish
the balance
Early Biological Explanations
• Hippocrates (5th Century BC)
• Mental disturbances have natural causes (brain pathology)
•  Rather than supernatural causes
• Three categories of mental disorders:
• Mania, melancholia, & phrenitis (brain fever)
• Healthy brain functioning depended on balance of four humors:
• Blood, black bile, yellow bile, & phlegm
•  Humor theory is seen as the basis of neurotransmitter theory
• Treatment: Physicians restored natural balance (e.g., tranquility,
sobriety, care in choosing food)
Early Biological Explanations
• Roman Empire
• Galen
• Brain is the center of behaviors, emotions, and
consciousness
• Further developed Hipoccrates’ explanations
• Regarded as the last great physician of the classical
era, as the beginning of the so-called Dark Ages in
western European medicine and in the treatment
and investigation of psychological disorders
Middle Ages – Islamic World
• Psychological disorders are defined as «illness»
• Opening of the first mental hospitals (Bimaristan)
• Gevher Nesibe Darüşşifası (in Seljuk museum) – first in
Anatolia
• Treatment: Hydrotherapy, music therapy, bibliotherapy
• Most important figures:
• Ebu Bekir El-Razi  Opposing against demonology
• Ibn-i Sina 
• El-Kanun Fi’t Tıbb (Principles of Medicine) remained as
the main resource in Europe throughout almost 5
centuries
Dark Ages and
Lunacy Trials

• Return to the belief of supernatural causes

(institutionalization of demonology)
• Psychological disorders – under the control
of church / municipal authorities
• Lunacy trials were held to determine the
«sanity» of any kind of «abnormal»
behavior (i.e., orientation, memory, intellect,
Daily life, habits, etc.)
•  A very powerful social control in the
society
• The interventions were aimed to «moralize»
the suspects
15th – 17th
Centuries

• Some «relatively» progressive steps

• Trepanation: First example of psychosurgery
• Asylums (15th century)
• Establishments for the confinement and care of people with psychological
disorders
• Priory of St. Mary of Bethlehem (founded in 1243)
• One of the first mental institutions
• Late 17th century
• The wealthy paid to gape at the patients
• Origin of the term bedlam (wild uproar or confusion)
• Physical and psychological isolation of mentally ill from the society.
• Mentally ill became the object of fear and disgust
18th – 19th Centuries
• Increase in the criticizing voices, winds of reform
• Psychiatry is defined as an independent scientific discipline
• Transition periods  unequal across social classes
•  Upper class could achieve psychiatric treatment of some sort, while
lower class were subject to demonology
•  Later, upper class could enjoy reform practices earlier than lower
class
• Another major problem: Increase in the population
• For a long time, psychiatry was unable to effectively treat most of the
patients
• Hundreds of people were admitted in asylums
• With economic burdens, employing sufficient number of qualified staff
became impossible
•  Inhumane treatment
Reform in Mental Health
• Philippe Pinel (1745–1826)
• Pioneered humane treatment in asylums (Paris Bicetre ve Salpetriere
hospital)
• People should be approached with compassion and dignity
• Took government support
• Humanitarian treatment reserved for upper class
• William Battie, William Tuke in England
• Vincenzo Chiarugi in Italy, Johann Christian Reil in Germany
• Moral Treatment
• Small, privately funded, humanitarian mental hospitals
• Friends’ Asylum (Pennsylvania, 1817)
• Patients engaged in purposeful activities (e.g., gardening)
• They talked with attendants and led lives as close to normal as
possible
Benjamin Rush
• Father of American
psychiatry
recommended
• Drawing copious
amounts of blood to
relieve brain
pressure
• Fear as a cure (e.g.,
convince patient that
death is near)
• Tranquilizing chair
Dorothea Lynde Dix
(1802-1887)
• Her efforts were particularly important for triggering a social
movement and fighting for the rights of «lower class» as well
• Teacher in Boston
• In 1841 she visits a prison as a teacher and witness the terrible
conditions of the inmates
• She reports what she saw to the prison administration, but they
answer as «the inmates are incapable of distingushing their
conditions» and that «they infact deserve this»
• She sues the prison administration and wins the case
• She initiates an action in order to improve the conditions of all
mental health asylums and prisons in Massachusetts
• Takes the support of the government and spreads the action
nationwide
Early 20th Century
• Increasing interest in brain research
• Broca & Wernicke’s studies
• Alois Alzheimer’s studies
• Martin Charcot – father of modern neurology
• Emile Kraepelin
• Very important figure for modern psychiatry and
psychopharmacology
• Student of Wilhelm Wundt
• Strongly opposed to psychoanalysis
• Studied extensively on the classification of
psychological disorders
Biological Treatments
in Early 20th Century

• Frequent psychopharmacological approach: Barbiturate treatment

(a central nervous system depressant with high addictive potential)
• Electro-Convulsive Treatment (ECT)
• Psycho-surgery
•  Lobotomy was widespread until 1960-70s
•  Patients somewhat benefited from lobotomy, but problematic
personality changes were observed
•  No other option (especially for schizophrenia and bipolar patients)
•  Pharmacological revolution in the 1950s
Major Achievements

• The discovery of neurotransmitters  precipitated

psychopharmacological revolution
• Genetics research
• Sir Francis Galton (1822–1911)
• Originator of genetic research with twins
• Work led to the notion that mental illness can be inherited
• Nature (genetics) and nurture (environment)
• Eugenics
• Promotion of enforced sterilization to eliminate
undesirable characteristics from the population
• Many state laws required people with psychological
disorders to be sterilized
Psychoanalytic Approach
• Franz Anton Mesmer (1734-1815)
• Hysteria caused by a disruption of a universal magnetic fluid in the body
• Used magnetic attraction to influence the fluid and induce behavioral change
• Trans-like experience
• Early practitioner of hypnosis
• Jean Martin Charcot (1825-1893)
• His support legitimized hypnosis as treatment for hysteria
• Josef Breuer (1842-1925)
• Used hypnosis to facilitate catharsis
• Cathartic method
• Sigmund Freud
• Disappointed by the ineffectiveness of biological treatments
• Used hypnosis at first, but left it later
• Psychopathology results from unconscious conflicts
• Catharsis, free association
Meanwhile…
• Experimental psychology, the study of sensation,
perception, and behavior

Where is Clinical
• Fechner, Wundt…
• The rise of behaviorism

Psychology? • Studying only «observable» behavior

• Late 19th century  popular interest in psychological
disorders
• William James – Boston School of Psychotherapy
• Lightner Witmer – First psychology clinic in America
• 1907  «The Psychological Clinic» journal and
identification of Clinical Psychology as a new scientific
discipline
•  Application of psychological principles
(experimental) to psychological disorders
• *Clinical psychology focused on assessment rather
than treatment for years.
• Became more popular with the increasing community
demands after 2 world wars
Revolution in
Psychopharmacology
• In 1951, a surgeon, Henri Laborit, accidentally discovers
that chlorpromazine, which he used for anaesthesia,
sedates the patients
• Chlorpromazine (e.g, largactil, thorazine) becomes the
first option for the treatment of psychotic symptoms
like delusion, hallucination, and agitation
• Lithium, tricyclic antidepressants, benzodiazepine were
also discovered in 1950s
• After these successes, psychopharmacological research
accelerated and in time safer procedures were
developed that led to fewer side effects
Deinstitutionalizatio
n of Patients

• But why is this called as a «revolution»?

•  Transition to the outpatient treatment period
(deinstitutionalization of the patients)
•  Which brought another problem: Inpatients’
adaptation to the society
• Homelessness, patients’ trying to return to the
hospitals…
Anti-Psychiatry
Movement
• Criticisms of mental health institutions’ conditions, efficacy of the
treatments, human rights violations, definition of abnormal behavior
• Examples:
• «Mental health institutions are like prisons, being locked up is a
human rights violation» (Franco Basaglia, Erving M. Goffman)
• Thomas Szasz criticized ECT
• Michel Foucault: «Psychiatry is an institution of control. It is
easier to keep society in check when unwanted
behavioral traits can be considered pathology»
Anti-Psychiatry
Movement
• David Rosenhan, an American psychologist, was concerned
about the validity of the diagnostic categories
• At that time, there were several categories in DSM, based on
psychoanalytic terminology (which were ambiguous)
• Rosenhan’s classical study (1973):
• 1st Study: 7-52 days of hospital stay, continuing treatment,
discharged with the note «in remission»
• 2nd Study: Real patients were not admitted to the hospitals
• Robert Spitzer (renown psychiatrist) criticized Rosenhan’s
studies methodologically, but in general accepted that
classification systems had to be updated.
Anti-Psychiatry Movement

• Anti-psychiatry movement led to improvements in psychiatry

hospitals’ conditions, open discussions of human rigths and
ethical practice in mental health, and revision of diagnostic
systems
• Today we have various mental health services
• Psychiatrist, psychiatric nurse, clinical psychologist,
counsellor, social worker
• Day care centers, rehabilitation clinics, community mental
health centers, etc.
• Increased number of outpatient clinics
• Combination of various treatment methods
(pharmacotherapy, psychotherapy, art therapy,
psychoeducation, group therapy, etc.)
Have we learned
from history?
• We have made several advancements and
still have much to learn!
• Do “reality” TV shows depicting
psychological disorders educate or
perpetuate stigma?
• People with psychological disorders are
more likely to be housed in jails than in a
hospital due to gaps in available services
• Many are unable to work and thus have
very little income, limiting housing
resources
• Medications have unpleasant side effects
Skipped parts
• Freuds Structures of the Mind • Behavior Therapy
• Defense Mechanisms • Importance of Cognition &
• Psychoanalytic Therapy Cognitive Therapy
• Major Techniques of Psychoanalysis • Mental Health Professions
• Freud’s Followers

• Behaviorism
• Classical Conditioning
• Operant Conditioning
• Modeling