psy 312

introduction to
psychopathology

Levent Küey, M.D.

associate professor of psychiatry
 Ψυχή

Psyche
soul, spirit, (inner) self, ego, true being, inner
man/woman, persona, subconscious, mind,
intellect, anima

Ψυχοσύνθεση
Psychosynthesi

Mentality, frame of mind

 Ruh:
spirit, soul, psyche, ghost, essence, genius
Kimse:
one, person, soul, wallah, thing, cad
Can:
life, soul, darling, heart, spirit, beloved
Kişi:
person, individual, self, persona, soul, cad
Öz:
self, essence, extract, core, substance, soul
Gönül: heart, soul, feelings
Timsal: soul
 The tale of Cupid and Psyche

Psyche
(Greek: Ψυχή, "Soul" or "Breath of Life")
and

Cupid:
(Latin Cupido, "Desire") or
Amor ("Love", Greek Eros "Ερως")
 Psyche Revived by Cupid's Kiss
Antonio Canova, first version 1787-1793
Louvre, Paris; Hermitage Museum, Saint Petersburg
The tale of Eros (Cupid) and Psyche
 psy 312
introduction to
psychopathology

Levent Küey, M.D.

associate professor of psychiatry
• This course provides an introduction to
theoretical perspectives, descriptions,
epidemiology, diagnostic techniques, clinical
patterns, explanations and treatment
methods related to main psychopathological
states classified as Mental Disorders in DSM V.

psy 312 psychopathology

• The course emphasizes the continuum
between normal and abnormal mental states,
and maintains a humanistic approach toward
psychopathology.
• Attention will be paid to understanding the
experience of psychopathology, in its
physiological, psychological and socio-cultural
context.
• The course will be undertaken using
interactive techniques such as sociodrama
techniques as well theoretical presentations
and discussions.

psy 312 psychopathology

• The textbook for this course is by David H.
Barlow & V. Mark Durand. Abnormal
Psychology: An Integrative Approach
(Looseleaf Version), Cengage Learning
Publication; 7th. edition (January 1, 2014),

ISBN-10: 1285761340, ISBN-13: 978-

1285761343”.

psy 312 psychopathology

Main topics

•Introduction and historical issues;

•Normality and abnormality
•Diagnostic systems and techniques
•Anxiety Disorders
•Obsessive-Compulsive and Related Disorders
•Trauma- and Stressor-Related Disorders
•Depressive Disorders
•Bipolar and Related Disorders
•Schizophrenia Spectrum and Other Psychotic
Disorders

psy 312 psychopathology

• There is no mid-term exam, instead quizzes
and class work evaluations, undertaken
during the course hours will build up the
coursework grade.

• Attandence: 20 (10x2)
• Paper: 10
• Quiz: 20 (5x4)
• Final: 50
will give the final grade for this course.

psy 312 psychopathology

Introduction and historical issues
normality and abnormality in clinical
psychopathology

Diagnostic systems and techniques

interviews, observations and tests

Anxiety disorders
symptoms of anxiety, phobic disorders,
generalized anxiety disorders, panic disorder

Obsessive-Compulsive and Related Disorders

obsessive-compulsive disorder

Trauma- and Stressor-Related Disorders

post traumatic and acute stress disorders
psy 312 psychopathology
Depressive Disorders
major depressive disorder
dystimia

Bipolar and Related Disorders

bipolar disorder I and II
cyclothymic disorder

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia
symptoms and issues
explanations and treatments

psy 312 psychopathology

 • Philip IV of Spain (1605/1621 – 1665)

• Diego Velázquez's Las Meninas, 1656, El Prado

• From 17 August to 30 December 1957, Picasso

a series of 58 large-scale oils related to Las Meninas.

• Michel FOUCALT 's work, "Les mots et les choses"

(Words and Things), 1966
•Description
•Explanation
•Treatment

psy 312 psychopathology

 Golden steps in the assessment and
treatment of psychopathological states

•Description
•Explanation
•Treatment

psy 312 psychopathology

1. Introduction and historical issues

psy 312 psychopathology

1. what behaviors are abnormal?

2. how did our explanations for abnormal

behavior develop?

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 A.J.Davis
Mental Disorders, or Diseases of the Brain and Nerves
New York, 1871
1. what behaviors are abnormal ?

distress, disability, and deviance

* the individual’s perspective
* the culture’s perspective

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distress, disability, and deviance

* the individual’s perspective

* the culture’s perspective

psy 312 psychopathology / 1-3

the individual’s perspective

* distress
* disability

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distress

emotions such as anxiety and depression

that upset an individual; a factor used to
define abnormal behavior from an
indiviual’s point of view

lack of happiness

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disability

disruptions in the ability to function

pesrsonally, or socially; a factor used to
define abnormal behavior from an
indivual’s point of view

lack of effectiveness

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deviance

* the culture’s perspective

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deviance

the degree to which an individual’s

behaviors differ from others’; a factor used
to define abnormal behavior from a
cultural point of view

in terms of societal norms

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what is abnormal?

both personal and cultural aspects of

behavior should be considered in
determining what is abnormal

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what is abnormal behavior?

abnormal behavior is behavior that is

personally distressful or personally
disabling or is culturally deviant that other
individuals judge the behavior to be
inappropriate or maladaptive

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The mad man as wild man
Bedford Book of Hours,
a 14th. Century French manuscript

the wild man is the mad man in nature,

placed there for denying God’s order on earth
behaviors are abnormal not people

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we don’t say
“depressive person”

we say
“a person with depressive disorder”

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2. how did our explanations for
abnormal behavior develop?

the “history of madness” is interesting,

but it has also important implications
because some of the mistakes of the past
are being repeated today

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early explanations and treatments for
abnormal behaviors were a function of the
prevailing philosophical beliefs of the time
rather than the state of the objective
knowledge

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prehistoric times: evil spirits

the cause of abnormal behavior: evil spirits

the mentally ill are tortured to drive spirits out

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exorcism

the process of curing mental illness by driving

out evil spirits or the Devil

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 The 10th. century ivory relief of Christ
healing the man of Gerasa possessed by the devil
greek and roman civilizations: physiology

the cause of mentally ill: physiological

problems (humors in the body)
the mentally ill are viewed as patients and
treated with diet and lifestyle changes

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Hippocrates (460-377 BC)
humoral theory of behavior-causes

imbalances in the level of four humors

excess of
black humor: depression
yellow humor: anxiety
phlegm: dull, sluggish
blood: mood swings

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black bile (µέλαινα χολή, melaina chole),
yellow bile (χολή, chole),
phlegm (φλέγμα, phlegma),
blood (αἷμα, haima),
Hippocrates (460-377 BC)
humoral theory of behavior-treatment

restoring the appropriate balance of humors

bleeding
altering diet
increasing exercise
reducing alcohol intake
general lifestyle changes

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 Hippocrates is said to have received his medical
training at an asclepieion on the isle of Kos. Prior
to becoming the personal physician to the
Roman Emperor Marcus Aurelius, Galen treated
and studied at the famed asclepieion at Pergamon
psy 312 psychopathology / 1-19
 the Asclepion of Pergamon
became famous under Galen (131-210 AD), a local
physician who pursued his medical studies in
Greece and Alexandria (Egypt) before settling here
as doctor to Pergamon's gladiators.
psy 312 psychopathology / 1-19
the dark ages: the devil
the cause of abnormal behavior: the devil
the mentally ill are persecuted or killed as
witches

psy 312 psychopathology / 1-20

Ulrich Molitor,
De lamiis et phitonicis mulieribus
the first published illustration
of flying witches
Strassburg: 1489
Christian Thomasius
Kurze Lehr-satze von dem
Laster der Zauberey
Flying witches on broom sticks
1712
the dark ages: (500-1500 AD)
religion became the dominant force in all
aspects of life
life was a struggle between the forces of
good and evil

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 Abraham Palingh
t’Aufgerukt Mom-Aansight der Tooverye
Demonic possession
Amsterdam:1725
Bosch
1480
the removal of the stone
of folly from the head of Lu
Sebastian Brant
1498 Latin translation
a ship of fools
 Darüşşifa ve Tıp Medresesi
Darüşşifa ve bitişiğindeki Tıp Medresesi, II. Beyazit
1484-1488 yılları arasında yaptırıliyor.

1850’lerden sonra darüşşifa, sadece ruh hastalarının

tecrit edildiği bakımsız bir kurum haline geldi.

1878 Osmanli-Rus savaşında Edirne işgale

uğradığında hastalar İstanbul’a gönderildi.

1896 yılında şifahane onarım gördü ve bir süre daha

ruh hastalarının tecrit edilmesinde kullanıldı.
1916’ya kadar hizmet vermeyi sürdürdü.
Darüşşifa ve Tıp Medresesi (Edirne)
Darüşşifa ve Tıp Medresesi
 The Compendium of Materia Medica is a
pharmaceutical text written by Li Shizhen (1518–
1593 AD) during the Ming Dynasty of China.
This edition was published in 1593
 Traditional Chinese medicine is a broad range of
medicine practices sharing common concepts
which have been developed in China and are based
on a tradition of more than 2,000 years, including
various forms of herbal medicine, acupuncture,
massage, exercise, and dietary therapy
the age of enlightment:
the guiding philosophy incorporated both
religion and science

religion: concern about the welfare of others

science: interest in finding natural rather than
supernatural explanations

psy 312 psychopathology / 1-22

asylums

asylum: a place of refuge or protection

included beggars and the physically ill also

a philosophical shift:
mentally ill rather than being seen as
problem people who needed to be persecuted or
punished, were now viewed as
people with problems who needed help

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hospitals

separate hospitals for the mentally ill

Hospital of St. Mary of Bethlehem
London, 1547

no care
nothing was done for them other than to confine
them under horrible conditions

bedlam: a scene of uproar and confusion

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Bedlam
Bernard Lens- John Sturt
in the
A tale of a tub
by Jonathan Swift
1710
hospitals

patients in these institutions were considered a

source of amusement, and tickets were sold to
watch them !!!

while confining patients in such hospitals

seemed to be an improvement
over actively torturing and executing them,
it was along way from truly humanitarian
treatment

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Richard Dad, 1850
 Petr Dutsmna
1781
political cartoon satirizing the war between England and Holland
moral treatment

late in the 16th. century:

mental illness might be the result of emotional
stress and strain … this idea had 2 results:
1. more humane treatment of the patient
“remove the chains”
Philippe Pinel (1745-1826) France
William Tuke (1732-1822) England
Benjamin Rush (1745-1813) USA
Dorothea Dix (1802-1887) USA

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Philippe Pinel (1745-1826) Bicêtre, Paris France,
1794
Philippe Pinel (1745-1826) Sal Petriere, France,
1795
moral treatment

late in the 16th. century:

mental illness might be the result of emotional
stress and strain … this idea had 2 results:
2. after removing the chains, how to treat?

moral treatments:
one of the first psychological treatments to be
used for mental patients; it involved providing
better living conditions for patients and treating
them as normal individuals
psy 312 psychopathology / 1-27
People with mental disabilities suffer severe abuses in
spiritual healing centers in Ghana, Togo, Benin. 2012
http://internationalreporting.org/out-of-the-
shadows/stories/praying-for-a-cure/
 Katharine Drake
Lunatic’s Ball
the event at the Somerset County Asylum, 1848
 Aristoteles: On dreams
the melancholic cured by music
13th. century manuscript
physiological treatment

bleeding patients (mental illness was due to

excessive blood in the brain)
also used for physical disorders (G. Washington)

spinning patients around until they passed out

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Benjamin Rush
Tranquillizer
Philadelphia Medical Museum
1811
Restraints used in conjunction
with a circulating swing
Guislain
1826
at the end of the age of enlightment

moral treatment had come and gone, individuals

who behaved abnormally were hospitalized in
relatively humane conditions, and the treatments
were usually physiological in nature

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the modern era: psychology and physiology

psychological physiological
suggestibility chemical imbalance
unconscious conflicts in the brain
learning structural problems
incorrect beliefs in the brain

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the modern era: psychology and physiology

psychological
suggestion and hypnotism:
Franz Anton Mesmer (1734-1815)
the symptoms were the result of imbalances in
the “magnetic fluids” in the body
treatment: magnetic fluid and iron rods

the effect of the treatment was due to

suggestion

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Mesmer believed that abnormal behavior was
due to a physical factor, his work led others to
the conclusion that a psychological factor
(suggestion) played an important role in many
disorders

psy 312 psychopathology / 1-32

the modern era: psychology and physiology

Jean-Martin Charcot (1825-1893)

hsyterical disorders

a french physician who thought that illnesses

were due to a weak nervous system and treated
them with hypnosis

psy 312 psychopathology / 1-33

Jean-Martin Charcot (1825 – 1893) - 1886
 André Brouillet
Salpétriére’de bir klinik ders, 1887
Arq. Neuro-Psiquiatr. vol.71 no.5, 2013

Where is Gilles? Or, the little mistake in a copy of

Brouillet's painting: "A clinical lesson at the Salpêtrière"

Francisco M. B. Germiniani, Adriana Moro, Renato

P. Munhoz, Hélio A. G. Teive
Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de
Clínicas, Federal University of Paraná (UFPR), Curitiba PR, Brazil
ABSTRACT
Professor Jean-Martin Charcot is considered the most important professor of Neurology and also the head of the Salpêtrière School of Neurology. In a famous
picture painted by André Brouillet and presented at the Salon of 1887, under the title "A clinical lesson at the Salpêtrière", Professor Charcot presents a case of
hysteria to a large audience of physicians and renowned intellectuals. Copies of this guided picture are also available for sale at the shop of the Museum of the
School of Medicine of Paris and are frequently used in lectures by neurologists worldwide. However, in these reproductions, Gilles de la Tourette's and Charles
Féré's positions are inverted. This historical note sheds some light on this little mistake in some of the reproductions of Brouillet's famous painting, so that
further confusion can be avoided.
Key words: Salpêtrière; Charcot; Brouillet; Gilles de la Tourette; Féré
 André Brouillet
Charcot at the Salpétriére, 1887
 André Brouillet
Charcot at the Salpétriére, 1887
Charcot‘nun öğretmeni Guillame Duchenne tarafından yapılan
elektroterapötik alet
Jean-Martin Charcot (1825 – 1893) - 1886
the modern era: psychology and physiology

Sigmund Freud (1856-1939)

Psychoanalysis

Psychosexual stages (oral-anal-latent-genital)

Conflicts between id-ego-superego
Ego defense mechanisms

psy 312 psychopathology / 1-34

Each individual hysterical symptom immediately and
permanently disappeared when we had succeeded in
bringing clearly to light the memory of the event by
which it was provoked and in arousing its accompanying
affect, and when the patient had described that event in
the greatest possible detail and put the affect into
words. Recollection without affect almost invariably
produces no result.

"The hysterical attack corresponds to a memory from a

patient's life."

Sigmund Freud, 1895

“Blanche” Marie Whittman (1859-1913)
the modern era: psychology and physiology

Ivan Pavlov (1849-1936)

Edward L. Thorndike (1874-1949)
John B. Watson (1878-1958)
conditioning (learning)
behavior therapy

Aaron Beck (1921-…..)

incorrect beliefs
cognitive therapy

psy 312 psychopathology / 1-34

the modern era: psychology and physiology

physiological processes

psy 312 psychopathology / 1-34

Emil Kraepelin (1856 – 1926)
Karl Theodor Jaspers (1883 – 1969)
“Farklı ruhsal durumların ayırt edilebilmesi,
hastanın kendi durumunu nasıl hissettiğine dair
klinisyen tarafından yapılan empati ile
bu duruma dair yine klinisyen tarafından yapılan
gözlem arasındaki ilişki bağlamında (mümkündür)”

Karl Jaspers, “General Psychopathology” (1913), (trans. J. Hoenig, M.W. Hamilton)

Johns Hopkins Paperback Edition, 1997
Karl Theodor Jaspers (1883 – 1969)
top 10 causes of mental illness
10. Poor Nutrition
9. Exposure to Toxins
8. Brain Chemistry
7. Personal Problems/Negative Experiences
6. Psychological Trauma
5. Substance Abuse
4. Infections
3. Brain Injury/Defects
2. Prenatal Damage
1. Genetics