History of Treatment. Care as a social issue -- the history of treatment What to do with the severely disturbed? –middle Ages to 17th century madness.

History of Treatment

Care as a social issue -- the history of treatment

• What to do with the severely disturbed?– middle Ages to 17th century

• madness = in league with devil• torture, hanging, burning, sent to sea

– 18th century• mentally disordered people = degenerates • keep them away from society

The 19th century & attempts at reform

• Philippe Pinel (1745-1826)– reform in Paris

mental hospital– some patients got

better enough to leave hospital

The 19th century & attempts at reform

– reform of U.S. system– moral-treatment movement– kindly care– led to large, state-supported

public asylums• overcrowding, loss of

public attention

Dorothea Dix (1802-1887)

The 20th century

• Early Treatment Methods were crude and at time cruel. See Segment 36 of Worth Media Archive DVD (5 min)

• Deinstitutionalization (mid-1950s)– get people out of asylums and back into community– effective antipsychotic medication– general mood of optimism in country

• 1961: establishment of community mental health centers

We Still Have a Ways to Go

• Not all countries have come far in their treatment of mental disorders.

• View NBC Report on Serbian Mental Hospital (4 min) and the accompanying report when the revisited the hospital (3 min).

Hospitals from a patient's perspective

• Rosenhan (1973): "On being sane in insane places”– sane people got into mental hospitals as patients– found very low interaction with staff– dehumanizing nature of interactions– normal behaviors interpreted pathologically

• There are successful inpatient & outpatient treatment programs

Places of treatment

• public or private mental hospitals

• general hospitals

• nursing homes for older patients with mental health needs

• halfway houses/group homes

• community mental health centers

• private offices

Providers of treatment

• Psychiatrists– medical degree (M.D.)– special training/residency in psychiatry– mainly hospitals & private practice– can prescribe drugs

• Clinical psychologists– doctoral degree (Ph.D.) in psychology– training in research & practice– universities, private practice, community mental health

Providers of treatment

• Counseling psychologists– doctoral degree in psychology

– sometimes more emphasis on practice than research

– problems of living, rather than diagnosable conditions

• Counselors– master's degree in psychology

– schools & institutions

– school-or job-related problems

Providers of treatment

• Psychiatric social workers– master's degree in social work– public agencies, home visits

• Psychiatric nurses– bachelor's or master's in nursing– hospital settings

• Self-help groups– Alcoholics Anonymous– LaLeche League– Overeaters Anonymous

Recipients of treatment

• Most people who meet criteria for DSM diagnoses do not seek treatment• Variability due to sex, education, race & income level

– women seek more treatment than men– college educated seek more treatment than high school educated– whites seek more treatment than nonwhites– higher income seek more treatment than lower income

Income level and seeking treatment

At least 1 disorder

Visit to specialist, has disorder

Visit to specialist, no disorder

Clinical Assessment• Assessment

– process of gathering information to develop treatment plan for client

• Assessment Interview– very common assessment technique

– range from unstructured to highly structured

• Objective questionnaires– self-report to get information on feelings, thoughts,

behaviors of clients

– examples: Beck Depression Inventory, Child Behavior Checklist

The MMPI

• A psychometric personality test

• Used in clinical assessment

• 567 statements about the self

• Client answers true or false to items

• 10 clinical scales, 15 content scales, several validity scales

Projective Tests

• Most commonly used by psychodynamic therapists

• Designed to provide clues about unconscious mind

• Developed from free association technique– client asked to just say what comes into mind,

without censoring

Projective Tests

• The Rorschach – client looks at ink blots and discusses what

each looks like to them– therapist interprets these explanations

• Thematic Apperception Test (Roberts Apperception Test for Children)– client tells story based on picture they see– therapist interprets the stories

Behavioral Monitoring

• Used to help with treatment & assessment– Counting actual instances of target behaviors– Hospital staff, therapist, patient– Self-monitoring done by patient

Assessment of the physical brain• Electroencephalogram (EEG)

– pattern of electrical activity in brain– used to scan for brain damage

• Computerized axial tomography (CAT scan)– multiple x-rays of brain– can look for anatomical abnormalities

• Magnetic resonance imaging (MRI)– pictures of brain sections

• Positron emission tomography (PET scan)– images that reflect the pattern of blood flow and

rate of oxygen use

Biological Treatments

• Attempts to solve the disorder by altering bodily processes

• History– drilling holes in head

– blood letting