Abnormal%20Psychology%20

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Abnormal Psychology TherapyChapters 16 17
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Part I Psychological Disorders
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A Quick Word before We Begin

• It is normal phenomenon for students of
  psychology and medicine to unconsciously (or
  consciously) to diagnose themselves or others as
  having a disorder because they may have
  experienced related symptoms in the past (or
  present). It is VERY important to fight that
  urge. We are not doctors or psychologists! Only
  they can make diagnoses!
• We laugh at the behavior NOT the people!

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Defining Psychological Disorders

• Mental health workers view psychological
  disorders as persistently harmful thoughts,
  feelings, and actions.

When behavior is unjustifiable, maladaptive,
atypical, and disturbing psychiatrists and
psychologists label it as disordered. Remember
U-MAD
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Deviant, Distressful Dysfunctional

• 1. Deviant behavior (going naked) in one culture
  may be considered normal, while in others it may
  lead to arrest.
• 2. Deviant behavior must accompany distress.
  World-class athletes deviate from the norm but
  that does not cause distress to themselves or
  others.
• 3. If a behavior is dysfunctional it is clearly
  a disorder.

In the Wodaabe tribe men wear costumes to attract
women. In Western society this would be
considered abnormal.
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Medical Perspective

• Philippe Pinel (1745-1826) from France, insisted
  that madness was not due to demonic possession,
  but an ailment of the mind. He suggested humane
  treatment.

Lunatic Ball
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Biopsychosocial Perspective

• Assumes that biological, socio-cultural, and
  psychological factors combine and interact to
  produce psychological disorders.

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Classifying Psychological Disorders

• The American Psychiatric Association rendered a
  Diagnostic and Statistical Manual of Mental
  Disorders (DSM) to describe psychological
  disorders.

The most recent edition, DSM-IV-TR (Text
Revision, 2000), describes 400 psychological
disorders compared to 60 in the 1950s.
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The DSM-IV-TR Multiaxial Classification
Is a Clinical Syndrome (cognitive, anxiety, mood
disorders 16 syndromes) present?
Axis I
Is a Personality Disorder or Mental Retardation
present?
Axis II
Is a General Medical Condition (diabetes,
hypertension or arthritis etc) also present?
Axis III
Are Psychosocial or Environmental Problems
(school or housing issues) also present?
Axis IV
What is the Global Assessment of the persons
functioning?
Axis V
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Goals of DSM

1. Describe (400) disorders.
2. Determine how prevalent the disorder is.

Disorders outlined by DSM-IV are reliable.
Therefore, diagnoses by different professionals
are similar. Also, insurance companies usually
require a firm diagnosis to cover health care
costs.
Others criticize DSM-IV for classifying almost
anything as a disorder/syndrome.
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Anxiety Disorders

• Feelings of excessive apprehension and anxiety
  that cause distress or cause maladaptive
  behaviors to reduce the levels of stress.

1. Generalized anxiety disorders (GAD)
2. Phobias
3. Panic disorders
4. Obsessive-compulsive disorders (OCD)
5. Post-Traumatic Stress Disorder (PTSD)

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Generalized Anxiety Disorder

1. Persistent and uncontrollable tenseness and
   apprehension (worrying).

2. Autonomic arousal.
3. Inability to identify or avoid the cause of
certain feelings.
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Panic Attack Disorder

• Minute-long episodes of intense dread which may
  include feelings of terror, chest pains, choking,
  or other frightening sensations.

Anxiety is a major component of panic attack
disorder, making people avoid situations that
cause it. Panic Attack disorder and agoraphobia
(fear of open/public places) usually go together.
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Phobia

• Marked by a persistent and irrational fear of an
  object or situation that disrupts behavior.

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Kinds of Phobias
Phobia of open places.
Agoraphobia
Phobia of heights.
Acrophobia
Phobia of closed spaces.
Claustrophobia
Phobia of blood.
Hemophobia
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Obsessive-Compulsive Disorder

• Persistence of unwanted thoughts (obsessions) and
  urges to engage in senseless rituals
  (compulsions) that cause distress.

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Ms. Cohens Obsession!!!
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Post-Traumatic Stress Disorder

• Four or more weeks of the following symptoms
  constitute post-traumatic stress disorder (PTSD)

1. Haunting memories

2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
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Explaining Anxiety Disorders
Freud suggested that we repress our painful and
intolerable ideas, feelings, and thoughts,
resulting in anxiety.
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The Learning Perspective
Learning theorists suggest that (classical) fear
conditioning leads to anxiety. This anxiety then
becomes associated with other objects or events
(stimulus generalization) and is reinforced.
Investigators believe that fear responses can
be passed along to others through observational
learning.
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The Biological Perspective
Natural Selection has led our ancestors to learn
to fear snakes, spiders, and other animals.
Therefore, fear preserves the species.
Twin studies suggest that our genes may be partly
responsible for developing fears and anxiety.
Twins are more likely to share phobias.
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The Biological Perspective

• A PET scan of the brain of a person with
  Obsessive-Compulsive Disorder (OCD). High
  metabolic activity (red) in the frontal lobe
  areas are involved with directing attention.

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Dissociative Disorders

• Conscious awareness becomes separated
  (dissociated) from previous memories, thoughts,
  and feelings.

Depersonalization Disorder

1. Having a sense of being unreal.

2. Being separated from the body.
3. Watching yourself as if in a movie.
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Dissociative Identity Disorder (DID)

• Formerly called Multiple Personality Disorder
  (MPD), it is a disorder in which a person
  exhibits two or more distinct and alternating
  personalities
• (each with its own name, voice, mannerisms,
  occupations, etc).

Chris Sizemore, the basis for the movie The
Three Faces of Eve
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Other Dissociative Disorders

• Dissociative Amnesia amnesia caused by some
  kind of trauma (not by injury)
• Dissociative Fugue Person totally forgets who
  they are and may develop a completely new
  identity, personality, etc. in a new place.

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Mood Disorders

• Emotional extremes of mood disorders come in two
  principal forms.

1. Major depressive disorder
2. Bipolar disorders

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Major Depressive Disorder
Depression has been called the common cold of
psychological disorders.
Major Depressive Disorder
Slightly/Situationally depressed mood
Chronic shortness of breath
Gasping for air after a hard run
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Major Depressive Disorder

• Major depressive disorder occurs when signs of
  depression last two weeks or more and are not
  caused by drugs or medical conditions.

Signs include

1. Lethargy and fatigue
2. Feelings of worthlessness
3. Loss of interest in family friends
4. Loss of interest in activities

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Dysthymic Disorder
Dysthymic disorder lies between a blue mood and
major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.
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Bipolar Disorder

• Formerly called manic-depressive disorder, it is
  an alternation between depression and mania
• (highs lows).

Manic Symptoms
Depressive Symptoms
Elation
Gloomy
Euphoria
Withdrawn
Desire for action
Inability to make decisions
Hyperactive
Tired
Multiple ideas
Slowness of thought
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Bipolar Disorder
Many great writers, poets, and composers suffered
from bipolar disorder. During their manic phase
creativity surged, but not during their depressed
phase.
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Explaining Mood Disorders
Since depression is so prevalent worldwide,
investigators want to develop a theory of
depression that will suggest ways to treat it.
Lewinsohn notes that a theory of depression
should explain the following

1. Behavioral and cognitive changes
2. Common causes of depression

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Theory of Depression

1. Gender differences

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Theory of Depression

1. Depressive episodes usually self-terminate.
2. Depression is increasing, especially in the teens.

Post-partum depression
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Suicide
The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.
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Biological Perspective
Genetic Influences Mood disorders run in
families. The rate of depression is higher in
identical (50) than fraternal twins (20).
Linkage analysis and association studies link
possible genes and dispositions for depression.
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Biological Perspective
Neurotransmitters A reduction of norepinephrine
and serotonin has been found in
depression. Drugs that alleviate mania reduce
norepinephrine.
Pre-synaptic Neuron
Serotonin
Norepinephrine
Post-synaptic Neuron
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Biological Perspective

• PET scans show that brain energy consumption
  rises and falls with manic and depressive
  episodes.

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Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
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Depression Cycle

1. Negative stressful events.
2. Pessimistic explanatory style.
3. Hopeless depressed state.
4. These hamper the way the individual thinks and
   acts, fueling personal rejection.

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Explanatory style plays a major role in becoming
depressed.
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Psychotic Disorders

• Schizophrenia

Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease.
Schizophrenia strikes young people as they mature
into adults. It affects men and women equally,
but men suffer from it more severely than women.
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Symptoms of Schizophrenia

• The literal translation is split mind but is
  not the same as DID. Schizophrenia is a group of
  severe disorders characterized by the following

1. Disorganized and delusional thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and actions.

John Nash
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Disorganized Delusional Thinking
This morning when I was at Hillside Hospital, I
was making a movie. I was surrounded by movie
stars Im Marry Poppins. Is this room painted
blue to get me upset? My grandmother died four
weeks after my eighteenth birthday.
This monologue illustrates fragmented, bizarre
thinking with distorted beliefs (usually of
grandeur or persecution) called delusions (Im
Mary Poppins). It also demonstrates a principle
called word salad (jumbling up ideas in
sentences).
Other forms of delusions include, delusions of
persecution (someone is following me) or
grandeur (I am a king).
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Disturbed Perceptions

• A schizophrenic person may perceive things that
  are not there (hallucinations). Frequently such
  hallucinations are auditory and lesser visual,
  somatosensory, olfactory, or gustatory.

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Inappropriate Emotions Actions

• A schizophrenic person may laugh at the news of
  someone dying or show no emotion at all
  (apathy/flat affect).

Patients with schizophrenia may continually rub
an arm, rock a chair, or remain motionless for
hours (catatonia).
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Subtypes of Schizophrenia

• Schizophrenia is a cluster of disorders. These
  subtypes share some features, but there are other
  symptoms that differentiate these subtypes.

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Positive and Negative Symptoms

• Schizophrenics have inappropriate symptoms
  (hallucinations, disorganized thinking, deluded
  ways) that are not present in normal individuals
  (positive symptoms - inward).

Schizophrenics also have an absence of
appropriate symptoms (apathy, expressionless
faces, rigid bodies) that are present in normal
individuals (negative symptoms - outward).
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Chronic and Acute Schizophrenia

• When schizophrenia is slow to develop
  (chronic/process) recovery is doubtful.
• Such schizophrenics usually display negative
  (outward) symptoms.

When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually show positive (inward)
symptoms .
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Understanding Schizophrenia

• Schizophrenia is a disease of the brain exhibited
  by the symptoms of the mind.

Brain Abnormalities
Dopamine Overactivity Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
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Abnormal Brain Activity, Etc.

• Brain scans show abnormal activity in the frontal
  cortex, thalamus, and amygdala of schizophrenic
  patients. Schizophrenia patients may exhibit
  morphological changes in the brain like
  enlargement of fluid-filled ventricles.

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Pre-natal/Neo-natal development

• Schizophrenia has also been observed in
  individuals who contracted a viral infection
  (flu) during the middle of their fetal
  development.
• There is also evidence of people who suffered
  from oxygen deprivation at birth and/or poor
  fetal nutrition may also have higher rates of
  schizophrenia.
• Malnutrition, methamphetamine and cocaine abuse,
  and social conditions (urban life, racial
  discrimination, adversity and family dysfunction)
  have also been contributed to the development of
  the disorder.

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Genetic Factors

• The likelihood of an individual suffering from
  schizophrenia is 50 if their identical twin has
  the disease.

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Warning Signs

• Early warning signs of schizophrenia include

A mothers long lasting schizophrenia.
1.
Birth complications, oxygen deprivation and
low-birth weight.
2.
Short attention span and poor muscle coordination.
3.
Disruptive and withdrawn behavior.
4.
Emotional unpredictability.
5.
Poor peer relations and solo play.
6.
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Personality Disorders

• Personality disorders are characterized by
  inflexible and enduring behavior patterns that
  impair social functioning. They are usually
  without anxiety, depression, or delusions.

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Some Personality Disorders

• Avoidant Personality Disorder the person
  commonly
• withdraws due to fear of rejection
• Schizoid Personality Disorder the person is
  emotionally
• disengaged (flat affect)
• Schizotypal Personality Disorder the person
  enjoys social isolation, usually displays strange
  behavior and thinking
• Histrionic Personality Disorder the person
  engages in attention-grabbing emotional outbursts
  and tries to gain others approval
• Narcissistic Personality Disorder the person is
  very self-absorbed and have delusions of grandeur
• Borderline Personality Disorder the person has
  unstable emotions and relationships and
  ultimately an unstable identity
• Antisocial Personality Disorder the person
  (usually male) exhibits a lack of conscience for
  wrongdoing, even toward friends and family
  members. Formerly, this person was called a
  sociopath or psychopath.
• Dependent Personality Disorder the person is
  abnormally dependent on other people
• Paranoid Personality Disorder the person has
  paranoid thoughts and feelings and doesnt trust
  others

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Understanding Antisocial Personality Disorder

• Like mood disorders and schizophrenia, antisocial
  personality disorder has biological and
  psychological reasons. Youngsters, before
  committing a crime, respond with lower levels of
  stress hormones than others do at their age.

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Understanding Antisocial Personality Disorder

• PET scans of 41 murderers revealed reduced
  activity in the frontal lobes. In a follow-up
  study repeat offenders had 11 less frontal lobe
  activity compared to non-murders.

Normal
Murderer
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Understanding Antisocial Personality Disorder

• The likelihood that one will commit a crime
  doubles when childhood poverty is compounded with
  obstetrical complications.

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Somatoform Disorders

• Disorders that usually involve
• abnormal bodily sensation or body image
• Hypocondriasis believing that you
• have illnesses that you dont really have
• Pain disorder
• Conversion disorder developing physical
  symptoms without an actual biological cause
• Body Dismorphic Disorder belief that one
• or more of the features/parts of your body
• are abnormal/grotesque and need to be fixed

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Childhood Disorders

• Attention-Deficit Hyperactivity Disorder (ADHD)
• 3 key symptoms
• Inattention
• Hyperactivity
• Impulsivity
• The Big Questions
• Is it overdiagnosed?
• Is it a real syndrome at all?
• How can it be better diagnosed?
• What causes it?

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Childhood Disorders

• Autistic Disorders
• Key symptoms
• Impaired speech or development
• Impaired social interaction (such as decreased
  eye contact and inability to carry on a
  conversation)
• Impaired theory of mind (understanding of others
  point of view)
• Behaviorally inflexible stick to routine
  distress when it changes
• Tends to occur more in males than in females
• Asperger syndrome
• high functioning form of autism with normal (or
  high) levels of intelligence and possible savant
  syndrome
• yet with decreased social functioning
• Possible Causes?
• Differences/damage in the brains
• neural connections?
• Genetic Factors?
• Mercury in Vaccines?

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Other Disorders

• Tic Disorders facial tics, blurted out words or
  sounds
• Tourettes Syndrome
• Factitious Disorders disorders in which the
  person fakes symptoms or inflicts symptoms on
  self or others to gain attention/sympathy
  (malingering sickness for
• personal or monetary gain)
• Munchausen Syndrome person claims to have
  symptoms and undergoes many treatments/surgeries
  to receive attention
• Munchausen Syndrome by Proxy person induces
  illnesses in others (usually parents do this to
  kids) to receive indirect attention
• Causes? Perhaps person was given great care by a
  doctor growing up and neglected by parents?
  Other, underlying personality disorders?

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Rates of Psychological Disorders
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Rates of Psychological Disorders
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Part II Psychological Treatment/Psychotherapy
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History of Insane Treatment
Maltreatment of the insane throughout the ages
was the result of irrational views. Many patients
were subjected to strange, debilitating, and
downright dangerous treatments.
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History of Insane Treatment
Philippe Pinel in France and Dorthea Dix in
America founded humane movements to care for the
mentally sick.
Philippe Pinel (1745-1826)
Dorthea Dix (1745-1826)
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Therapies
Psychotherapy involves an emotionally charged,
confiding interaction between a trained therapist
and a mental patient.
Biomedical therapy uses drugs or other procedures
that act on the patients nervous system, curing
him or her of psychological disorders.
An eclectic approach uses various forms of
healing techniques depending upon the clients
unique problems.
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Psychological Therapies

• We will look at four major forms of
  psychotherapies based on different theories of
  human nature

1. Psychoanalytical theory
2. Humanistic theory
3. Behavioral theory
4. Cognitive theory

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Psychoanalytic Therapy

• The first formal psychotherapy to emerge was
  psychoanalysis, developed by Sigmund Freud.

Edmund Engleman
Sigmund Freud's famous couch
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Psychoanalysis

• Since psychological problems originate from
  childhood repressed impulses and conflicts, the
  aim of psychoanalysis is to bring repressed
  feelings into conscious awareness where the
  patient can deal with them.

When energy devoted to id-ego-superego conflicts
is released, the patients anxiety lessens.
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Psychoanalysis

• Freud developed the method of free association to
  unravel the unconscious mind and its conflicts.
  The patient lies on a couch and speaks about
  whatever comes to his or her mind.

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Psychoanalysis Criticism

• During free association, the patient edits his
• thoughts, resisting his or her feelings to
• express emotions. Such resistance becomes
• important in the analysis of conflict-driven
• anxiety. Eventually the patient opens up and
• reveals his or her innermost private
• thoughts, developing positive or negative
• feelings (transference) towards the therapist.
• Psychoanalysis is hard to refute because it
  cannot be proven or disproven.
• Psychoanalysis takes a long time and is very
  expensive.

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Humanistic Therapy

• Humanistic therapists aim to boost
  self-fulfillment by helping people grow in
  self-awareness and self-acceptance.
• Unlike psychodynamic therapies,
• humanistic therapies focus on
• The present and future, not past conflicts
• Conscious issues not unconscious conflicts
• Taking responsibility for ones feelings and
  behaviors,
• not finding what is hidden
• Promoting individual growth, not curing
  illnesses
• - Person in therapy called client (not patient)

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Humanistic Therapy

• Developed by Carl Rogers, person-centered therapy
  is a form of humanistic therapy.

The therapist listens to the needs of the patient
in an accepting and non-judgmental way
(unconditional positive regard) , addressing
problems in a productive way and building his or
her self-esteem. Therapist also demonstrates
empathy and genuineness.
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Humanistic Therapy

• The therapist engages in active listening and
  echoes, restates, and clarifies the patients
  thinking, acknowledging expressed feelings.

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Behavior Therapy

• Therapy that applies learning principles to the
  elimination of unwanted behaviors.

To treat phobias or sexual disorders, behavior
therapists do not delve deeply below the surface
looking for inner causes.
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Behavior Therapy

• Counterconditioning is a procedure that
  conditions new responses to stimuli that trigger
  unwanted behaviors. Expose patients to things
  they fear and avoid. Through repeated exposures,
  anxiety lessens because they habituate to the
  things feared.

Mary Cover Jones
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Behavior Therapy

• Aversive Conditioning is a type of
  counterconditioning that associates an unpleasant
  state with an unwanted behavior. With this
  technique, temporary conditioned aversion to
  alcohol has been reported (but doesnt seem to
  work long-term).

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Behavior Therapy

• Exposure therapy involves exposing people to
  fear-driving objects in real or virtual
  environments.

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Behavior Therapy

• Systematic Desensitization is a type of exposure
  therapy that associates a pleasant, relaxed state
  with gradually increasing anxiety-triggering
  stimuli (commonly used to treat phobias).

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Behavior Therapy

• Operant conditioning procedures enable therapists
  to use behavior modification, in which desired
  behaviors are rewarded and undesired behaviors
  are either unrewarded or punished.

A number of withdrawn, uncommunicative
3-year-old autistic children have been
successfully trained by giving and withdrawing
reinforcements for desired and undesired
behaviors.
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Behavior Therapy

• Therapists may create a token economy in which
  patients exchange a token of some sort (a
  secondary reinforcer), earned for exhibiting the
  desired behavior, for various privileges or
  treats (a primary reinforcer).

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Behavior Therapy Criticisms

• Will the desired behaviors continue and/or
  undesirable behaviors come back when the
  training/reinforcement stops?
• Is it really ethical for one human being to
  train another?

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Cognitive Therapy

• Teaches people adaptive ways of thinking and
  acting based on the assumption that thoughts
  intervene between events and our emotional
  reactions.

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Cognitive Therapy

• Rational-Emotive Therapy - Albert Ellis developed
  a theory that irrational thoughts led to
  self-defeating emotions.
• Ellis developed the ABCD model to explain this
• A Activating event that triggers the emotion
  (e.g. failing a test)
• B Belief System how person appraises the event
  (e.g. Im stupid and no good at this subject)
• C emotional/behavioral Consequences of the
  appraisal in step B (e.g. feeling worthless and
  dumb)
• D Disputing their erroneous beliefs in step B
  (e.g. Im not dumb. I just did not study hard
  enough and go in for the extra help that I
  needed) This is what Ellis wanted to train his
  clients to be able to do through Rational Emotive
  Therapy.
• Therapists present common irrational beliefs to
  clients and help to train them to cognitively
  restructure/reappraise their thinking.

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Cognitive Therapy

• Cognitive therapists often combine the reversal
  of self-defeated thinking with efforts to modify
  behavior.

Cognitive-behavior therapy aims to alter the way
people act (behavior therapy) and alter the way
they think (cognitive therapy).
AP Psych Rocks!
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Evaluating Therapies
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Group Family Therapy
Group therapy normally consists of 6-9 people
attending a 90-minute session that can help more
people and costs less. Clients benefit from
knowing others have similar problems.
Family therapy treats the family as a system.
Therapy guides family members toward positive
relationships and improved communication.
Marriage counseling is a form of this.
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Effectiveness of Different Therapies

• Which psychotherapy would be most effective for
  treating a particular problem?

Disorder Therapy
Depression Behavioral, Cognitive, Interpersonal
Anxiety Cognitive, Exposure, Stress Inoculation
Bulimia Cognitive-behavioral
Phobia Behavioral
Bad Habits Behavior Modification
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Alternative Therapies

• Seasonal Affective Disorder (SAD), a form of
  depression, has been effectively treated by light
  exposure therapy.

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Therapists Training

• Clinical psychologists
• They have PhDs mostly. They are experts in
  research, assessment, and therapy, all of which
  is verified through a supervised internship.

Clinical or Psychiatric Social Worker They have
a Masters of Social Work. Postgraduate
supervision prepares some social workers to offer
psychotherapy, mostly to people with everyday
personal and family problems.
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Therapists Training

• Counselors
• Pastoral counselors or abuse counselors work with
  problems arising from family relations, spouse
  and child abusers and their victims, and
  substance abusers.

Psychiatrists They are physicians who
specialize in the treatment of psychological
disorders. Not all psychiatrists have extensive
training in psychotherapy, but as MDs they can
prescribe medications.
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The Biomedical Therapies

• These include physical, medicinal, and other
  forms of biological therapies.

1. Drug Treatments
2. Surgery
3. Electric-shock therapy

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Drug Therapies

• Psychopharmacology is the study of drug effects
  on mind and behavior.

With the advent of drugs, hospitalization in
mental institutions has rapidly declined.
However, many patients are left homeless on the
streets due to their ill-preparedness to cope
independently outside in society.
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Antipsychotic Drugs

• Classical antipsychotics
• Chlorpromazine (Thorazine)
• Remove a number of positive symptoms associated
  with schizophrenia such as agitation, delusions,
  and hallucinations.

Atypical antipsychotics Clozapine
(Clozaril) Remove negative symptoms associated
with schizophrenia such as apathy, jumbled
thoughts, concentration difficulties, and
difficulties in interacting with others.
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Atypical Antipsychotic

• Clozapine (Clozaril) blocks receptors for
  dopamine and serotonin to remove the negative
  symptoms of schizophrenia.

Antianxiety Drugs
Antianxiety drugs (Xanax and Ativan) depress the
central nervous system and reduce anxiety and
tension by elevating the levels of the
Gamma-aminobutyric acid (GABA) neurotransmitter.
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Antidepressant Drugs

• Antidepressant drugs like Prozac, Zoloft, and
  Paxil are Selective Serotonin Reuptake Inhibitors
  (SSRIs) that improve the mood by elevating levels
  of serotonin by inhibiting reuptake.

Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been used
to stabilize manic episodes in bipolar disorders.
It moderates the levels of norepinephrine and
glutamate neurotransmitters.
100
Brain Stimulation

• Electroconvulsive Therapy (ECT)
• ECT is used for severely depressed patients who
  do not respond to drugs. The patient is
  anesthetized and given a muscle relaxant.
  Patients usually get a 100 volt shock that
  relieves them of depression.

101
Psychosurgery
Psychosurgery was popular even in Neolithic
times. Although used sparingly today, about 200
such operations do take place in the US alone.
Psychosurgery (trephination/lobotomy) is used as
a last resort in alleviating psychological
disturbances. Removal of brain tissue changes the
mind and psychosurgery is irreversible
102
Rosemary Kennedys Lobotomy

• We went through the top of the head, I think she
  was awake. She had a mild tranquilizer. I made a
  surgical incision in the brain through the skull.
  It was near the front. It was on both sides. We
  just made a small incision, no more than an
  inch." The instrument Dr. Watts used looked like
  a butter knife. He swung it up and down to cut
  brain tissue. "We put an instrument inside," he
  said. As Dr. Watts cut, Dr. Freeman put questions
  to Rosemary. For example, he asked her to recite
  the Lord's Prayer or sing "God Bless America" or
  count backwards. ... "We made an estimate on how
  far to cut based on how she responded." ... When
  she began to become incoherent, they
  stopped. James W. Watts

http//www.pbs.org/wgbh/amex/lobotomist/program/