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WARM UP 1. Before we begin Abnormal Psych, what do you hope to learn in this unit? 2. Have you had any experience dealing with psychological disorders – people connected to you or any past reading on this topic? 3. Prior to going on break next week, what goals do you need to make new or recommit to? HISTORY OF UNDERSTANDING PSYCHOLOGICAL DISORDERS In Ancient times, disorders were thought to have been caused by movements of the sun and moon (lunacy is full moon) or by evil spirits. Treatments for people with mental illness were very inhumane even up until the mid 1900’s. Patients were often chained like animals, beaten, burned, castrated, etc. CONDITIONS FOR PSYCHOLOGICALLY DISABLED Ancient Greek Trephines European Trephines “released evil spirits.” CONDITIONS FOR PSYCHOLOGICALLY DISABLED CONDITIONS FOR PSYCHOLOGICALLY DISABLED Forced sterilization of mentally ill in 19th and early 20th century. Japan until 1950s. Nazis killed thousands of mentally ill as part of their eugenics program. Better today? Yes, but not perfect. MEDICAL MODEL IMPROVES CONDITIONS Eventually the medical model came to dominate understandings of mental illness. The medical model assumes diseases have physical causes, can be diagnosed based on their symptoms, can be treated, in most cases cured. Assumption of medical model drastically improved conditions in mental hospitals. BUT, the medical model can promote the myth that disorders are brought on by single causes. HISTORICAL TREND OF DEINSTITUTIONALIZATION Starting in the 1950s and 1960s more and more drugs began being used to “cure” psychological disorders. Policy of deinstitutionalization --> patients were removed from mental institutions to live in family based or community based environments. PSYCHOLOGICAL DISORDERS PSYCHOLOGICAL BEHAVIORS RUN A CONTINUUM FROM VERY MILD TO EXTREME. EVERYONE HAS THESE BEHAVIORS TO ONE DEGREE OR ANOTHER. IT IS NOT UNTIL A BEHAVIOR OR FEELING INTERFERES WITH YOUR QUALITY OF LIFE THAT IT BECOMES A DISORDER. PSYCHOLOGICAL DISORDERS ARE: Atypical (deviant) Disturbing (distressing) Maladaptive (dysfunctional) Unjustifiable What is “insane”? Insanity is a legal definition, not a psychological one. The term of insanity is applied to someone who is incapable of determining if an act is wrong and cannot control their behavior. The insanity defense is rarely used – just 0.9% of the time (9 times in 1000). The success rate is less than 20% of the time it is used. People who are declared not guilty by reason of insanity generally spend more time institutionalized than they would have been imprisoned. Being declared insane is not the same as being declared not competent to stand trial – this simply means you are unable to understand the charges against you and the proceedings of the court (could apply to very young children, for example). Defining Disorders DSM IV - Diagnostic and statistical manual vol. 4.: describes psychological disorders, without explaining the causes, predicts the future course, and suggests treatments. It focuses on observable behaviors to make diagnoses. Categorizes 400+ disorders, in 17 categories. Axis I: refers to clinical disorders which need clinical attention. Includes most mental disorders Ex: Depression, Schizophrenia, Phobia, etc. Axis II: Includes personality disorders and mental retardation. Ex: Antisocial, Narcissistic, Avoidant, etc. Axis III: relates to physical conditions which may contribute to mental illness. Ex: brain injury, cancer, HIV, etc. Axis IV: relates to psycho-social events in a persons life which may contribute to mental illness. Ex: death of a loved one, divorce, new job, etc. Axis V: relates to a rating clinician gives patient on how well they are functioning in life presently and within the last year. Advantages of Diagnosis and the DSM-IV Diagnosis can facilitate communication Diagnosis can provide etiology (study of causation) clues Diagnosis provides prognosis (likely outcome) Diagnosis can give direction for treatment plans Disadvantages of Diagnosis and the DSM-IV No clear line between normal and abnormal in many cases Reliability is still a problem (if 5 psychologists examine a patient will they all come up with the same diagnosis?) Diagnostic labels may take on a life of their own and are hard to remove – LABELING THEORY – Rosenhan – this can lead to self-fulfilling prophecy. Diagnostic criteria for 313.81 Oppositional Defiant Disorder Think of classes you have been in at West Meck. Have you ever met a student who fit these critieria? A. Four of the following are present in 6 months… (1) often loses temper (2) often argues with adults (3) often actively defies or refuses to comply with adults' requests or rules (4) often deliberately annoys people (5) often blames others for his or her mistakes or misbehavior (6) is often touchy or easily annoyed by others (7) is often angry and resentful (8) is often spiteful or vindictive Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. Diagnostic criteria for 309.21 Separation Anxiety Disorder Have you ever known a child or infant who fit three or more of these criteria? (1) recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated (2) persistent and excessive worry about losing, or about possible harm befalling, major attachment figures (3) persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped) (4) persistent reluctance or refusal to go to school or elsewhere because of fear of separation (5) persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings (6) persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home (7) repeated nightmares involving the theme of separation (8) repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated B. The duration of the disturbance is at least 4 weeks. C. The onset is before age 18 years. D. The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning. Diagnostic criteria for 305.90 Caffeine Intoxication Have you ever experienced 5 or more of these after drinking 2-3 cups of coffee or caffeine? (1) restlessness (2) nervousness (3) excitement (4) Insomnia (5) flushed face (6) diuresis (7) gastrointestinal disturbance (8) muscle twitching (9) rambling flow of thought and speech (10) tachycardia or cardiac arrhythmia (11) periods of inexhaustibility (12) psychomotor agitation C. The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (e.g., an Anxiety Disorder). Rosenhan’s study – can you fake insanity? Being Sane in Insane Places http://www.youtube.com/watch?v=xAsqKCQDgmA http://www.youtube.com/watch?v=FG4mOpQpmpw&feature=related DAVID ROSENHAN TESTS POWER OF LABELING AND ITS RELIABILITY Describe Rosenhan’s study: He had colleagues attempt to fake symptoms to get into mental hospitals. Each pseudopatient told the hospitals they had been hearing voices. Apart from that they told no lies other than fake names, addresses, etc. After being admitted, the fake patients acted completely normal. Hospital staff failed to identify the fakers and interpreted all of their normal behavior in terms of mental illness. Ex: guy taking notes was said to have “writing behavior” which seemed pathological. What does this say about the impact of labeling? Psychological Disorders: Causes Are not usually caused by a single factor. Bio-psycho-social school most disorders are caused by a biological predisposition, physiological state, psychological dynamics, and social circumstances. Biological / genetic predisposition + Stress (environment) = DISORDER The diathesis-stress model The model looks at the diathesis or genetic/biologic vulnerability to a disorder/disease and the stress(or)s that may trigger it. The diathesis-stress model uses the analogy of a "walking time bomb" to help explain why, for example, not 100% of identical twins both get schizophrenia. It also helps to explain why a large percent of people in traumatic situations (post 911, rape, etc.) never develop PTSD. The model further talks about a balance -- the greater the diathesis or predisposition, the less the stress required for the disorder to "appear" and visa versa. MOST MENTAL HEALTH PROFESSIONALS ASSUME DISORDERS HAVE INTERLOCKING CAUSES Bio-Psycho-Social Perspective: assume biological, psychological, and socio-cultural factors interact to produce disorders. Biological (Evolution, individual genes, brain structures and chemistry) Sociocultural (Roles, expectations, definition of normality and disorder) Psychological (Stress, trauma, learned helplessness, mood-related perception and memories) KNOW WHAT CATEGORY ANY DISORDER FITS INTO Categories of Disorder: 1. Anxiety 2. Mood 3. Dissociative 4. Schizophrenia 5. Personality 6. Somatoform (Not in Book) 7. Facticious (Not in Book) What about the DSM IV? Is it useful or harmful? DSM IV criticism Diagnosis helps people