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 Introduction:

Definitional and Historical Considerations, and

Canada's Mental Health System LEARNING
OBJECTIVES
1. Understand what constitutes abnormal behaviour.
2. Compare the history of psychopathology across
centuries. 3. Describe current attitudes toward people
with psychological disorders, including how stigma
and self-stigma are potential barriers to help-seeking.
4. Describe mental health problems and
theirtreatment in Canada. s. Describe the issues and
challenges in the delivery of psychotherapy. Every day
of our lives we try to understand other people. Acquir
ing insight into what we consider normal, expected
behaviour is difficult. It is even more difficult to
understand human behav iour that is beyond the
normal range. This book deals with abnormality as it
applies to psy chological disorders, including their
description, causes, and treatment. As you will see,
we know with certainty much less about our field than
we would like. As we approach the study of
psychopathology-the field concerned with the nature
and development of abnormal behaviour, thoughts,
and feelings we do well to keep in mind that the
subject offers few hard and fast answers. Another
challenge we face in studying abnormal psy chology is
the need to remain objective. Our subject matter is
personal and it is powerfully affecting, making
objectivity diffi cult but no less necessary. The
disturbing effects of abnormal behaviour intrude on
our own lives. Who has not experienced irrational
thoughts, fantasies, and feelings? Who has not felt
profound sadness that is more extreme than
circumstances can explain? Most of you will have
known someone whose behaviour was upsetting and
impossible to fathom, and realize how frustrating and
frightening it is to try to help a person suf fering
psychological difficulties. This feeling of familiarity
with the subject matter adds to its intrinsic
fascination-undergraduate courses in abnormal
psychology are among the most popular in psychology
depart ments and indeed in the entire university or
college curriculum. But it has one distinct
disadvantage. All of us bring to our study
preconceived notions of what the subject matter is.
We have developed certain ways of thinking and
talking about behav iour, certain words and concepts
that somehow seem to fit. As scientists, we have to
grapple with the difference between what we may feel
is the appropriate way to talk about human behaviour
and experience and what may be a more produc tive
way of defining it in order to study and learn about it.
The concepts and labels we use in the scientific study
of abnormal behaviour must be free of the subjective
feelings of appropri ateness ordinarily attached to
certain human phenomena. As you read this book and
try to understand the mental disorders it discusses,
you may be asked to adopt frames of reference
different from those to which you are accustomed. We
will now turn to a discussion of what we mean by the
term "abnormal behaviour." Then we will look briefly at
how our view of abnormality has evolved through
history to the more scientific perspectives of today.
We then continue with a dis cussion of current
attitudes toward people with psychological 1 2
CHAPTER l Introduction: Dcfiritional and Historic;il
Considerations, and Canada's Mental Health System
problems and with an introduction to the system of
mental health care in Canada. Chapter 1 concludes
with a discussion of the issues and challenges in the
delivery of psychotherapy. Before we embark on this
journey, it is important to note that this is an
exceptionally good time to be a student learn ing
about abnormal psychology, especially in Canada.
Impor tant research discoveries continue to emerge,
in part fuelled by developments in neuroscience. The
field is also under great scrutiny as a result of the
introduction in May 2013 of the next edition of the
diagnostic system, the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5; see
www.dsmS.org). Moreover, mental health issues are
very much at the forefront of the public consciousness
at present, and this is partly due to the efforts of
heroic famous Canadians such as Clara Hughes (see
photo) and the many individuals and corporations who
are determined to make a difference. Argua bly, there
has been no time in our past when public interest and
determination to make positive changes in mental
health has been higher. Another important
development is that due to the exceptional efforts of
the Mental Health Commission of Canada and
individuals across our nation, Canada finally has its
first comprehensive Mental Health Strategy (see
http://strategy. mentalhealthcommission.ca/). And
even politicians seemed poised to do their part. For
instance, Canada is now seriously considering a
national suicide prevention strategy as a result of
public support for a nonpartisan motion put forth in
October 2011 by then-federal Liberal leader Bob Rae.
These efforts and initiatives are important because the
challenges still facing us are very significant ones.
Some chal lenges require filling key gaps in
knowledge, but more impor tantly, the remaining
challenges are the sheer prevalence of psychological
problems among people of various ages in Canada
and elsewhere. We will see that the number of people
who Clara Hughes, Olympic champion, also
champions awareness of mental health issues and
has been open about her own bouts with depression.
She is shown here in October 2012 speaking to
graduates when receiving an honorary Doctor of Laws
degree from York University for her tireless efforts.
Among other things, in 2014 her "Big Ride" had her go
across Canada by bike to heighten awareness of
mental health issues. Her new 2015 autobiography
Open Heart Open Mind details the challenges she has
faced. require treatment and other services for mental
health issues far outweighs the services that are
available. Ideally, we will get to the point that,
collectively, we will have all of the resources needed
to put timely preventions in place and thereby substan
tially decrease the suffering that accompanies mental
illness. 1.1 What Is Abnormal Behaviour? One of the
more difficult issues facing us is how to define abnor
mal behaviour. Several characteristics have been
proposed as components. No single one is adequate,
although each has merit and captures some part of
what might be a full definition. Consequently,
abnormality is usually determined by the pres ence of
several characteristics at one time. Our best definition
of abnormal behaviour includes such characteristics
as statis tical infrequency, violation of norms,
personal distress, disability or dysfunction, and
unexpectedness. Statistical Infrequency One aspect
of abnormal behaviour is that it is infrequent in the
general population. The normal curve, or bell-shaped
curve, places the majority of people in the middle as
far as any par ticular characteristic is concerned; very
few people fall at either extreme. An assertion that a
person is normal implies that he or she does not
deviate much from the average in a particular trait or
behaviour pattern. Statistical infrequency is used
explicitly in diagnosing mental retardation. Figure 1.1
shows the normal distribution of intelligence quotient
(IQ) measures in the population. Though a number of
criteria are used to diagnose mental retardation, low
intelligence is a principal one. When an individual's IQ
is below 70, his or her intellectual functioning is
considered suf ficiently subnormal to be designated
as mental retardation. 20 100 Intelligence quotient
The distribution of intelligence among adults,
illustrating a normal, or bell-shaped, curve. 200 1.1
What Is Abnormal Behaviour? 3 Although some
infrequent behaviours or characteristics of people do
strike us as abnormal, in some instances, the rela
tionship breaks down. Having great athletic ability is
infre quent (see photo), but few would regard it as part
of the field of abnormal psychology. Only certain
infrequent behaviours, such as experiencing
hallucinations or deep depression, fall i nto the
domain considered in this book. Unfortunately, the
statistical component gives us little guidance in
determining which infrequent behaviours
psychopathologists should study. Violation of Norms
Another characteristic to consider is whether the
behaviour violates social norms or threatens or makes
anxious those observing it. Violation of norms
explicitly makes abnormality a relative concept;
various forms of unusual behaviour can be tolerated,
depending on the prevailing cultural norms. Yet vio
lation of norms is at once too broad and too narrow.
Criminals and prostitutes, for example, violate social
norms but are not usually studied within the domain of
abnormal psychology, and the highly anxious person,
who is generally regarded as a central character in the
field of abnormal psychology, typically does not
violate social norms and would not be bothersome to
many lay observers. In addition, cultural diversity can
affect how people view social norms. What is the
norm in one culture may be abnormal in another. This
subtle issue is addressed throughout the book (see
especially Chapters 2 and 3). Personal Suffering
Another characteristic is personal suffering; that is,
behaviour is abnormal if it creates great distress and
torment in the person experiencing it. Personal
distress clearly fits many of the forms of abnormality
considered in this book-people experiencing anxiety
disorders and depression truly suffer greatly-but some
disorders do not necessarily involve distress. The
psychopath, for example, treats others cold-heartedly
and may continually violate the law without
experiencing any guilt, remorse, or anx iety
whatsoever. And not all forms of distress-for example,
hunger or the pain of childbirth-belong to the field.
Disability or Dysfunction Disability-that is, impairment
in some important area of ~ life (e.g., work or personal
relationships) because of an ~ abnormality-can also
be a component of abnormal behav- .3 ~ iour.
Substance-use disorders are defined in part by the
social -~ or occupational disability (e.g., poor work
performance, seri- ~ ous arguments with one's
spouse) created by substance abuse ~ and addiction.
Similarly, a phobia can produce both distress and
disability; for example, a severe fear of flying may pre
vent someone from taking a job promotion. Like
suffering, disability applies to some, but not all,
disorders. Transvestism (cross-dressing for sexual
pleasure), for example, which is currently diagnosed
as a mental disorder if it distresses the person, is not
necessarily a disability. Most transvestites are
married, lead conventional lives, and usually cross-
dress in pri vate. Other characteristics that might in
some circumstances be considered disabilities-such
as being short if you want to be a professional
basketball player-do not fall within the domain of
abnormal psychology. We do not have a rule that tells
us which disabilities belong and which do not.
Unexpectedness We have just described how not all
distress or disability falls into the domain of abnormal
psychology. Distress and dis ability are considered
abnormal when they are unexpected responses to
environmental stressors (Wakefield, 1992). For
example, an anxiety disorder is diagnosed when the
anxiety is unexpected and out of proportion to the
situation, as when a person who is well off worries
constantly about his or her financial situation. We
have considered here several key characteristics of a
defi nition of abnormal behaviour. Again, none by itself
yields a fully satisfactory definition, but together they
offer a useful framework for beginning to define
abnormality. In this volume we will study a list of
human problems that are currently considered
abnormal. The disorders on the list will undoubtedly
change with time, for the field is continually evolving,
and it is not possible to offer a simple definition of
abnormality that captures it in its entirety. The
characteristics presented constitute a partial
definition, but they do not equally apply to every
diagnosis. Focus on Discovery 1.1 describes the
education and train ing of professionals who study
and treat mental disorders. Goering, Wasylenki, and
Durbin (2000) estimated that approxi mately 3,600
practising psychiatrists, about 13,000 psycholo gists
and psychological associates, and about 11,000
nurses specialize in the mental health area in Canada.
Thousands of Si Although abnormal behaviour is
infrequent, so, too, is great athletic talent, such as
that of the proud members of the Canadian multiple
gold medal-winning Olympic women's hockey team.
Therefore, infrequency is not a sufficient definition of
abnormal behaviour. 4 CHAPTER l Introduction:
Definitional and Historical Considerations, and
Canada's Mental Health System Focus on
Discovery .1 The Mental Health Professions The
training of clinicians, the various professionals
authorized to provide psychological services, takes
different forms. Here, we dis· cuss several types of
clinicians, the training they receive, and a few related
issues. To be a clinical psychologist typically requires
a Ph.D. or Psy.D. degree, which entails four to seven
years of graduate study. However, in Canada,
professional regulation of the psychology profession
is within the jurisdiction of the provinces and
territories and, depending upon regulatory statutes, a
psychologist may have either a doctoral- or a
master's-level degree (Hunsley & Johnston, 2000). In
some jurisdictions the title "psychologist" is reserved
for doctoral-level registrants, whereas master's-level
registrants are referred to as "psychological
associates." Specific curriculum requirements vary
across jurisdictions.

Gauthier (2002) concluded that there was effectively

no consensus among the provinces on the minimal
academic requirements, the required length of super
vised practice, and the timing of such practice (i.e.,
before or after the degree is achieved). The 1995
Agreement on Internal Trade stipulated that a frame
worl< for mobility had to be developed so that the
credentials of professional psychologists from one
part of Canada would be rec ognized in other parts of
Canada. A Mutual Recognition Agreement was signed
in June 2001. According to Gauthier (2002), this
requires a person to obtain five core competencies in
order to become a registered psychologist: (1)
interpersonal relationships, (2) assess ment and
evaluation (including diagnosis), (3) intervention and
consultation, (4) research, and (5) ethics and
standards. Training for a Ph.D. in clinical psychology
requires a heavy emphasis on laboratory work,
research design, statistics, and the empirically based
study of human and animal behaviour. The Ph.D. is
basically a research degree, and candidates are
required to research and write a dissertation on a
specialized topic. But can didates in clinical
psychology learn skills in two additional areas, which
distinguishes them from other Ph.D. candidates in
psychology.

First, they learn techniques of assessment and

diagnosis of mental disorders. Second, they learn how
to practise psycho therapy, a primarily verbal means
of helping troubled individuals change their thoughts,
feelings, and behaviour to reduce distress and to
achieve greater life satisfaction. Students take
courses in which they master specific techniques
under close professional supervision; then, during an
intensive internship or post-doctoral training, they
gradually assume increasing responsibility for the
care of clients. Other clinical graduate programs are
more focused on prac tice. These programs offer the
relatively new degree of Psy.D. (doc tor of psychology).
The curriculum is similar to that required of Ph.D.
students, with less emphasis on research and more
on clini cal training. The Ph.D. approach is based on a
scientist-practitioner model, while the Psy.D.
approach is based on a scholar-practitioner model,
which is described below. Note that a survey of
clinical psychology students in Ph.D. programs in
Canada found that most students enrolled in current
programs were satisfied with their level of science
training, and as was the case in the United States,
students felt that the training received was slightly
more weighted toward research than toward clinical
practice (Peluso, Carleton, & Asmundson, 2010). The
Canadian Psychological Association (CPA) Psy.D.

Task Force (1998) described a scholar-practitioner as

a "flexible, socially responsible, thinking practitioner
who derives his/her skills from core knowledge in
scientific psychology. This comprehensively trained
professional is capable of performing in a number of
roles, and would not be trained simply to be a
technician in specific areas" (p. 13). As of2007 there
were two Psy.D. programs in Canada, at the Universite
du Quebec and Universite Laval, both offered in
French. Later, Memorial University initiated a Psy.D.
program in 2009 and in 2013, a Psy.D. program was
introduced in Vancouver at a campus of the Adler
School of Professional Psychology. According to the
CPA, psychologists are Canada's single larg est group
of licensed and specialized mental health care
providers. Further, psychologists are the primary
researchers and providers of evidence-based
psychological treatments. A st holds an MD degree
and has had postgraduate training, called a residency,
in which he or she has received super vision in the
practice of diagnosis and psychotherapy. By virtue of
the medical degree, and in contrast with
psychologists, psychia trists can also continue
functioning as physicians-giving physical
examinations, diagnosing medical problems, and the
like. Most often, however, the primary aspect of
medical practice in which psychiatrists engage is
prescribing prychoactlve drugs, chemical compounds
that can influence how people feel and think.
None theless, a study (Hadjipavlou & Ogrodniczuk,
2007) concluded that current psychiatry residents in
Canada have a strong interest in psychotherapy
training. A nalyst has received specialized training at a
psy choanalytic institute. The program usually
involves several years of clinical training as well as the
in-depth psychoanalysis of the trainee. It can take up
to 10 years of graduate work to become a
psychoanalyst and there are proportionally fewer
psychoanalysts in modern times. A social worker
obtains an M.S.W. (master of social work) degree.
Programs for counselling osycholo i t are somewhat
similar to graduate training in clinical psychology but
usually have less emphasis on research and the more
severe forms of psychopathology. How does
counselling psychology differ from clinical psychology
in Canada? First, they differ in number. A sur vey
reported in 2012 compared 22 accredited clinical
psychology programs and 4 counselling psychology
programs in Canada (see Bedi, Klubben, & Barker,
2012). While there are many similarities, there also
key differences. Another key difference is that counsel
ling programs tend to be terminal, meaning that
students earn a master's degree and there is no
doctoral progress that follows. Also, clinical
psychology programs tend to have a large propor tion
of their faculty members registered as clinical
psychologists (see Bedi et al., 2012). 1.2
History of Psychopathology 5 social workers also work
in the mental health field. Goering et al. (2000) also
noted that, "The major proportion of primary mental
health care in Canada is delivered by general
practition ers (GPs)" (p. 350). Psychiatrists (who are
medical doctors) have a great deal of clinical
autonomy. The majority are self-employed
professionals whose clinical income is usually based
on billing their provincial health plan. As noted by
Latimer (2005), "Psychiatrists are essentially free to
choose the patient population they wish to care for,
and how" (p. 566). Analyses of the results of the
National Population Health Survey (NPHS; Statistics
Canada, 1995) indicated that approx imately 2% of
respondents had consulted with a psycholo gist one
or more times in the preceding 12 months (Hunsley,
Lee, & Aubry, 1999)-equivalent to almost 515,000
people in the Canadian population aged 12 and older.
Hunsley and col leagues concluded, however, that
psychological services are vastly underused. They
also determined that psychological services are more
available in urban areas than in rural areas and that
psychiatrists tend to practise in major urban centres.
Thus, many areas of Canada are underserved by two
important mental health professions.
There has been a lively and sometimes acrimonious
debate concerning the merits of allowing clinical
psychologists with suitable training to prescribe
psychoactive drugs (see Westra, Eastwood, Bouffard,
& Gerritsen, 2006). Predictably, granting prescriptive
authority to psychologists is opposed by psy chiatrists
for various reasons (see McGrath, 2010). It is also
opposed by many psychologists, who view it as an ill-
advised dilution of the behavioural science focus of
psychology. Is it possible for a non-MD to learn
enough about biochemistry and physiology to monitor
the effects of drugs and protect clients from adverse
side effects and drug interactions? This debate will
undoubtedly continue for some time; at present,
prescrip tive authority has been granted to
psychologists in three U.S. jurisdictions (New Mexico,
Louisiana, and the U.S. territory of Guam) (see
McGrath, 2010). 1.2 History of Psychopathology
"Those who cannot remember the past are
condemned to repeat it." - George Santayana, The Life
of Reason The search forthe causes of deviant
behaviour has gone on for a long time. Before the age
of scientific inquiry, all good and bad manifestations
of power beyond the control of humankind eclipses,
earthquakes, storms, fire, serious and disabling dis
eases, the passing of the seasons-were regarded as
supernat ural. Behaviour seemingly outside individual
control was subject to similar interpretation.

Many early philosophers, the ologians, and physicians

who studied the troubled mind believed that deviancy
reflected the displeasure of the gods or possession by
demons. Early Demonology The doctrine that an evil
being, such as the devil, may dwell within a person
and control his or her mind and body is called
demonology. Examples of demonological thinking are
found in the records of the early Chinese, Egyptians,
Babylonians, and Greeks. Among the Hebrews,
deviancy was attributed to pos session of the person
by bad spirits, after God in his wrath had withdrawn
protection. Christ is reported to have cured a man
with an unclean spirit by casting out the devils from
within him and hurling them into a herd of swine (Mark
5:8- 13). Following from the belief that abnormal
behaviour was caused by possession, its treatment
often involved exorcism, the casting out of evil spirits
by ritualistic chanting or torture. Exorcism typically
took the form of elaborate rites of prayer,
noisemaking, forcing the afflicted to drink terrible-
tasting brews, and on occasion more extreme
measures, such as flog ging and starvation, to render
the body uninhabitable to devils. Trepanning of skulls
(the making of a surgical opening in a living skull by
some instrument) by Stone Age or neolithic cave
dwellers was quite widespread. One popular theory is
that it was a way of treating conditions such as
epilepsy, headaches, and psy chological disorders
attributed to demons within the cranium.
It was presumed that the individual would return to a
normal state by creating an opening through which evil
spirits could escape. Trepanning was presumably
introduced into the Americas from Siberia. Although
the practice was most common in Peru and Bolivia,
three Aboriginal specimens have been found in
Canada, all on the Pacific coast in British Columbia
(see illustration). One skull is that of a young male
believed to be of high rank, since he received a
"copper burial" (his forehead and chest were covered
by thin sheets of copper). Despite the extensive focus
in Aborigi nal cultures on possession by spirits, the
widely accepted inter pretation of the historical data
has been disputed. Kidd (1946) suggested that the
trepannings "were done to relieve pressure resulting
from depressed fractures caused by war clubs" (p.
515). Somatogenesis In the fifth century B.C.,
Hippocrates (ca. 460- 377 B.c.), often regarded as the
father of modern medicine, separated medi cine from
religion, magic, and superstition. He rejected the pre
vailing Greek belief that the gods sent serious physical
diseases and mental disturbances as punishment and
insisted instead that such illnesses had natural
causes and hence should be treated like other, more
common maladies, such as colds and constipation.

Hippocrates regarded the brain as the organ of

consciousness, of intellectual life and emotion; thus,
he thought that deviant thinking and behaviour were
indications of some kind of brain pathology.
Hippocrates is often consid ered one of the very
earliest proponents of somatogenesis the notion that
something wrong with the soma, or physical body,
disturbs thought and action (see photo).
Psychogenesis, in contrast, is the belief that a
disturbance has psychological origins.

Find The Original Textbook (PDF) in The Link Below

CLICK HERE