XII.  Therapy

 

            A.  A Brief History of 'Insanity'
        

                         1.  Caveat:  "Insanity" As A Legal Term

                  2.  The Supernatural Model: Trephining & Exorcism

        
                  3.  Hippocrates:  Early Medical Model

                  4.  1792:  Phillipe Pinel & Humane Asylums

                  5.  Kraeplin; Wasserman:  The Medical Model

                  6.  The Psychological Model: Response to Stress

                                    a.  Psychodynamic Approach

 

                                                i.  Maintaining Integrity of the Personality

 

                                                ii.  Defense Mechanisms (repression, denial, reaction formation, projection)

                
                                                iii.  Fixations:  Regressions to Earlier Conflicts 

 

                                    b.  Learning Approach

 

                                                i.  Symptom = 'Disease'

 

                                                ii.  Short-Term Reinforcements

 

                                                iii.  Depression & Learned Helplessness

 

                                                iv.  Acquired Fears & Anxiety

 

 

                        7.  Other Models                    

 

                                    a.  Biological Model

 

                                    b.  Cognitive Model

 

                                    c.  Sociocultural Model (Norms)  

 

 

       B.  Normalcy & The Abnormal

 

                        1.  Absence of a Clear Definition

                2.  Relative Nature of Behavior

                3.  Rule-Of-Thumb Characteristics

 

                                    a.  Personal Factors

 

                                    b.  Social Factors

                             c.  Statistical Issues

 

 

                        4.  On Diagnosis & Its Difficulty

                                    a.  DSM-IV (and some controversies)

 

                                    b.  Rosenham (1973)

 

 

       C.  Some Categories of Abnormal Behavior

 

                        1.  Affective Disorders

                2.  Anxiety Disorders

                3.  Dissociative Disorders

                4.  Somatoform Disorders

                5.  Psychosexual Disorders

                6.  Personality Disorders

                7.  Psychoses

 

   

       D.  Somatic/Biomedical Therapies

                        1.  Psychosurgery

                                  a.  1940s: Frontal Lobotomies

                            b.  Side Effects

                            c.  Moratorium with Antipsychotics

                            d.  Deep Lesioning

                            e.  Irreversibility

                        2.  ECT

                                  a.  Indication

                            b.  Treatment Duration (6 or so Sessions)

                            c.  Controversies

                            d.  Alternative (rTMS)

                        3.  Psychiatric Drugs (Pharmacotherapy)

                                  a.  Minor Tranquilizers

                            b.  Antidepressants

                            c.  Antipsychotics (Major Tranquilizers)

                            d.  Side Effects (e.g., 15% tardive dyskinesia)

 

       E.  Insight Therapies

                        1.  Psychoanalysis

                                  a.  Free Association

                            b.  Dream Interpretation

                            c.  Resistance & Transference & Catharsis

                            d.  Eysenck & Spontaneous Remission

                            e.  Brief Psychodynamic Therapy

 

                                                i.  Time Limited

 

                                                ii.  Direct rather than Indirect

                
                                                iii.  Provocative  

 

                        2.  Rogers: Client-Centered Therapy

                                  a.  Unconditional Positive Regard

                            b.  Empathy

                            c.  Authenticity

                            d.  Non-Directive (Reflective)

                        3.  Existential Therapy (e.g., Frankl's Logotherapy)

                                  a.  Search for Meaning

                            b.  Death, Freedom, Connection

                            c.  Confrontational:  Examine/Take Responsibility

                        4.  Perls: Getsalt Therapy

                                  a.  Fragmented Perception/Awareness

                            b.  Gaps in Experiencing/Awareness

                            c.  Focus on Present Experiences

                            d.  Highly Directive: Role Playing, etc.

                            e.  "Is" not "Ought;"  Chose vs. Obligations

                        5.  Ellis: Rational Emotive Therapy

                                  a.  Event, Belief System, Emotion

                            b.  Recognize Irrationality; Change Behavior

                            c.  Confrontational & Directive

                            d.  Rational Emotive Behavior Therapy