Download Psychological Disorders are:

"Everybody Hurts" by REM
We all have bad days –
so what is the difference between
feeling depressed and being
diagnosed as clinically depressed?
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
Medical Model Improves Conditions
• Eventually the medical model came to
dominate understandings of mental illness.
• The medical model assumes that diseases
have physical causes that can be diagnosed
based on their symptoms and be treated and in
most cases cured.
• Assumption of the medical model drastically
improves conditions in mental hospitals.
• BUT, the medical model often times promotes
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.
• Because of this there was a policy of
deinstitutionalization instituted where 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 they become
a disorder.
Psychological Disorders are:
Atypical (deviant)
Disturbing (distressing)
Maladaptive (dysfunctional)
Unjustifiable
“You Become Psychotic”
Activity - Handout
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).
What percentage of mental health patients are violent?
“Here’s Johnny!”
While some people with symptoms are violent, fewer that 10% are
dangerous. Nearly all people who suffer from mental illness are
withdrawn, timid and are non-violent.
Defining Disorders
DSM IV-Diagnostic and statistical manual vol. 4.: attempts to
describe 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:
Axis II:
Axis III:
Axis IV:
Axis V:
refers to clinical disorders which need clinical attention.
Includes most mental disorders
Ex: Depression, Schizophrenia, Phobia, etc.
Includes personality disorders and mental retardation.
Ex: Antisocial, Narcissistic, Avoidant, etc.
relates to physical conditions which may contribute to
mental illness. Ex: brain injury, cancer, HIV, etc.
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.
relates to a rating clinician gives patient on how well they are
functioning in life presently and within the last year.
Handout 16-5 Group Activity
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
• Diagnosis is not theoretically neutral
• 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.
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?
“You Become Psychotic”
Activity - Discussion
(labeling acttivity)
Psychological Disorders: Causes
Are not usually caused by a single factor.
The bio-psycho-social school argues that 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)
Somatoform: a mental disorder, where
physicals symptoms suggest
physical injury.
Facticious: deliberately producing or
exaggerating symptoms, usually to
gain sympathy.