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MENTAL DISORDERS
• Insanity is a legal term, not a medical or
psychological diagnosis. It indicates that a person
cannot be held responsible for his or her actions
because of mental illness.
• For centuries, Western law has stated that a person
who is mentally incompetent should not be punished
if he or she violates the law because the law states
that people must be able to understand the
significance of their actions – something they are
incapable of doing if they are mentally ill.
MENTAL ILLNESS AND
LAW
• Defence of mental illness is a legal defence by using the
excuse that the defendant cannot be held criminally
responsible for what they did because they were mentally ill at
the time of the alleged criminal actions.
• Unfit to stand trial means that the person cannot understand
the charges against them, are unstable to sit through a long
trial or the person accused cannot communicate with their
lawyer. Basically means that they may have understood what
they were doing when they committed the crime, but right now
they cannot understand what is happening in the courtroom
• People who are obviously disturbed – the man in a
business suit who shouts at no one in particular in a
public place or the woman who has refused to step
outside of her apartment for the last three years – upset
us momentarily when we are confronted with their
behavior.
• Our emotional response is not so much the trouble we
have in distinguishing his or her differentness as it is
the essential sameness with ourselves.
• What others experience, we suspect, is in some way
within the range of our own experiences. We want to
know more about it.
ABNORMAL VS NORMAL
• Because overt behavior is frequently misleading and
because society’s standards change, it is often extremely
difficult to distinguish between the normal and the
abnormal.
• As medical understanding increases so too does our
understanding of the psychology of the abnormal.
• Fifty years ago a person with uncontrollable “tics” or
involuntary sharp body movements or who makes
repetitive noises, was seen as being mentally ill and often
assigned to a psychiatric ward – now we know that he or
she as a neurological condition known as Tourette’s
Syndrome and is psychologically normal.
DSM IV
• The tool that the medical
community (as well as
psychologists and
psychiatrists) uses is the
DSM IV or the Diagnostic and Statistical manual of
Mental Disorders Four, as it is called. It is a tome
consisting of all of the diagnostic criteria listed for every
psychological disorder or mental illness that is
recognized by the medical establishment. It covers
everything from anorexia to zoophobia. DSM V currently
is in the process of being written and
NEWEST ADDITIONS
• Internet Addiction Disorder (IAD) is being considered as a
new one to add but there are disagreements as to the criteria
and even the nomenclature, as there are some who prefer the
term Pathological Internet Abuse and it is the subject of heated
Net discussion.
WARNING
• A warning – as you progress through this particular unit in the
textbook, some of you may be tempted to “personalize” some
of these disorders: “That’s me! That’s definitely me!!” or one of
your friends
• This often happens when we flip through a medical book and
believe that we may have some of the symptoms of the
ailments listed.
• This is a common temptation – but that is all that it probably is.
• Any one of us will have some of the symptoms described – that
does not make us psychologically disordered nor are any of us
qualified to self-diagnose any of these mental disorders.
DEFINITIONS OF
ABNORMAL BEHAVIOR
It is important to note that there is something “abnormal” in all
“normal” people. One very workable definition of those who do need
help has three parts to it:
(1) The person suffers from discomfort more or less continuously.
The discomfort shows up as extreme anxiety, endless worry, or
long periods of depression. In addition, the person feels that
something is wrong with his or her life far more than the average
person does.
(2) Another possibility is that the person is behaving in a bizarre
fashion. He or she constantly misinterprets what is going on and
what others are doing or saying. For instance, this person could
be afraid to go to work or school. He or she frequently comes
apart over minor things or sinks into a depression about them.
(3) Finally, people who need help can be very inefficient. This means
that they are unable to perform their life roles properly
EXAMPLES:
•
Alcoholic who refuses to accept that there is a problem
•
A person who does nothing while his or her family life is coming
apart
•
A parent at home with the children who cannot even cope with the
dirty dishes
•
A student who reads no assignments, doesn’t attend class, and
has nothing but trouble with most of the teachers.
Any one of these symptoms or a combination can indicate trouble.
In addition, just as the degree of disturbance will vary, so will the
degree of the symptoms.
•
For example, the student just mentioned is in far worse shape if
we add that he or she has no friends, locks himself or herself in a
room most nights, and doesn’t talk to family members.
INFLEXIBILITY
• Many people in need of help have trouble getting along with others
are typically inflexible.
• This means that they can’t go with the flow of life but instead plow
ahead, with a fixed set of responses to almost everything.
• Thus a shy, withdrawn male goes to a party, and a few people are
nice to him. This should help his self-image, but instead he
misinterprets, just as he always does, and thinks that they are only
“feeling sorry” for him.
• Or a person who cannot tolerate elevators never accepts that the
fact that they are reasonable safe, even after hundreds of forced
trips.
• So, feelings, thoughts, and actions won’t vary much. These people
establish self-defeating boundaries around themselves that won’t
budge.
ENVIRONMENTAL EFFECT:
• Another characteristic is that these people constantly see a threatening
environment.
• A number of studies suggest that their world is colored a gloomy gray
because the worst is always expected or seen.
• Their thoughts and feelings are hardly every warm and outgoing, but
instead are tinged with fear.
• They see danger, rejection, and failure around every corner.
PSYCHOSIS:
• Mild disorders refer to non-psychotic disorders, a severe disorder is
a psychosis – when a person is out of touch with reality.
• Some of the signs of abnormal behavior are continuous discomfort,
acting in a bizarre fashion, inefficiency, inflexibility and constantly
perceiving a threatening environment.
ANXIETY DISORDERS
• Three categories of problems – 1) panic, 2) phobia and 3)
obsessive-compulsive disorder – have in common one
thing: the person suffering from them also suffers from severe
anxiety.
• Hence these are called anxiety disorders. Except for
substance abuse, anxiety disorders are the most common type
of mental disorder.
ANXIETY
Anxiety is a generalized feeling
of apprehension and dread that
includes many bodily upsets.
The palms sweat, the throat
closes up, breathing is erratic, the heart pounds, hands tremble,
and the armpits perspire.
All of us experience anxiety, but people with anxiety disorders
may have anxiety attacks, a few times a day, and in between they
are restless, sleep poorly, don’t eat well, and are not capable of
calming down.
http://www.youtube.com/watch?v=_Cr7IomSy8s
PANIC DISORDER
•
Afflicted by frequent and over-whelming attacks of anxiety.
•
Sometimes a panic disorder originates in the person’s
psyche, probably developing from years of feeling in secure
and helpless.
•
But often such a disorder starts becomes something is
physically or chemically wrong with the person.
•
Once they have occurred, these panic attacks tend to repeat themselves
whenever the person is under stress. In other words, the anxiety at first is not
really connected to anything specific; it is just a physical occurrence.
•
Soon, however, the panic begins to spread, as the fear of dying or making a
fool of oneself is associated with more and more objects, events, or people.
•
Eventually the person may reach a point where activities are severely limited
because of these fears.
•
When that happens, the problem is no longer simply physical but is
psychological as well.
•
Still, many who suffer can be treated with drugs that will reduce the symptoms.
•
Psychotherapy is also very effective.
PHOBIC DISORDERS
• Person becomes disabled and overwhelmed by fear in the
presence of certain objects or events.
• Anxiety is still extraordinarily high but usually only in the
presence of the problem.
• The word phobia means “fear of” and there are two basic types
of phobic disorders.
1. A specific phobia
2. Agoraphobia
1. SPECIFIC PHOBIA
•
centers on particular objects or situations
•
Examples: dogs, enclosed spaces, snakes, heights, elevators, water, even knives.
•
Faced with the object of fear, the person becomes extremely anxious. (Note the
difference here: a panic attack is not attached to something specific as the phobia
is.)
•
The most common explanation for phobias today is that they result from association
or learning. If a little boy cut himself and the parent began screaming, crying and
running around shouting, “You’re bleeding! You’re bleeding!” the child with repeated
such incidents, could easily develop hematophobia, a fear of blood (hema).
•
All of us have mild phobias. Many people fear that they will jump off high buildings;
others are hesitant to use public rest rooms for fear of getting germs. But for true
phobics, the danger is so real that they live in mortal fear of being anywhere near
the object.
•
Caution: trying to get real phobics to overcome their fears by deliberating forcing
them into the feared situation can be very dangerous. Phobics have been known to
die from an overload on the system.
•
The problem usually can be treated both efficiently and safely by a professional in a
matter of a month or so.
WEIRDEST PHOBIAS!
http://www.2spare.com/item_65894.aspx
ARE YOU AFRAID OF
THE DARK?
• Mostly among children but
also some adults
• However children younger than
the age 2 aren’t afraid of the dark
- shows that it’s part of child
development
• Severe fear of the dark = achluophobia
• Fear of night = nyctophobia
• Fear of darkness = scotophobia
• Fear of twilight = lygophobia
• Freud believes that it comes from separation anxiety
AGORAPHOBIA
•
Meaning the fear of leaving a familiar environment.
•
Agoraphobics are so fearful of the world outside that they become virtual
prisoners in their own homes.
•
The following case is interesting because it shows how an accidental event,
such as an ear infection, can trigger a mammoth psychological event – the
agoraphobic – that will go on and on.
•
Ex: A 42-year-old married salesman had been in traveling sales work for ten
years. One night when on the road at a motel, he developed an infection which
spread to the inner ear making him feel very dizzy. He decided to go to the bar
and get a drink to “pick himself up”. While sitting at the bar, things began to
whirl around and the next thing he knew, he was lying on the floor, looking up at
strangers all peering down at him as in a nightmare. He was certain he was
dying because his heart was racing and people were saying things about a
heart attack. He felt desperately alone, frightened and embarrassed. The
infection cleared up and everything seemed to be all right. But a week o so
later, when driving down the highway, he started to feel “funny,” weak, dizzy. He
pulled off to the side of the road and waited the attack out. Instead of going on,
he turned around and went back home where he felt safe. Within a matter of a
month, he began to have anxiety attacks every time he left the house, and
called in sick more and more often so he wouldn’t have to leave home.
INTERESTING FACT:
One oddity of agoraphobics might be of interest. Most of them
have a specific boundary beyond which they cannot go.
It varies from person to person.
Thus, some people can go up to three blocks, some ten, some
another number, from home.
If they go even a few feet beyond, they come apart, but if they
stay within the boundary, they are all right.
OBSESSIVE COMPULSIVE
DISORDER (OCD)
•
An obsession refers to an endless preoccupation with
some type of urge or thought. All of us have experienced
this to a limited degree when we can’t get a popular song
out of our minds. Eventually it disappears, but magnify this many
hundredfold and you have the concerns of the person suffering from this
disorder. The thoughts simply will not leave such a person alone.
•
A compulsion is a symbolic, ritualized behavior that a person must
repeatedly act out. Each time the person does so, whatever anxiety he or
she feels is decreased, so the behavior becomes self-rewarding and is
repeated.
•
Most people have minor compulsions, such as a desire to step on a crack
in the sidewalk.
•
Genuine compulsions are different because the people must carry out the
act or they get more and more anxious. Some, for instance, wind up
checking dozens of times to be certain that the front door is locked before
going to bed each night. That’s not normal.
OCD
The two words, obsessive-compulsive
are generally used together. Most
compulsive people are obsessed
with their compulsion;
• For instance, the compulsive hand washer is obsessed with the
thought that he or she is “dirty.” And being obsessed with
cleanliness leads to compulsive washing.
“As Good As It Gets” with Jack Nicholson =
http://www.youtube.com/watch?v=44DCWslbsNM
Howie Mandel = http://www.youtube.com/watch?v=kUlbCBk77N0
SOMATOFORM
DISORDERS
•
In somatoform disorders, psychological issues are expressed in
bodily symptoms, but there is no actual physical problem.
•
Most of us feel worse physically when life is not going too well.
Somatoform disorders, though, present a far more dramatic
picture.
Hypochondriasis
•
Hypochondriacs are overly concerned about their health.
•
They see disastrous illness in the most minor physical complaint.
Thus, a slight headache is interpreted as a symptom of brain
cancer; a case of the sniffles is really pneumonia, and so on.
•
Often, such people, as children, were given affection or support
from other people only when they were sick.
•
They never learned better ways of getting attention. Having spent
years focusing on their health, they have trouble breaking the
cycle. Needless to say, these people spend a great deal of time
in doctor’s offices.
CONVERSION
DISORDER
•
You may have heard of “hysterical blindness” or “hysterical paralysis.”
•
The technical term for both of these situations is conversion disorder.
•
In a conversion disorder, a serious psychological trauma is unconsciously changed
(converted) into a symbolic physical dysfunction.
•
For example, a person who has witnessed terrible human torture and slaughter
may be overwhelmed by the horrors, so the mind shuts the visual system down.
The person can no longer see.
•
Or someone else was in an awful automobile accident and managed to get free of
the car. He or she could hear other people screaming, but, frozen by fear, was
unable to move, to go get help.
•
That person might develop some type of paralysis in response. These people are
not faking it. Say that someone has, psychologically, lost feeling in the right leg,
•
If you sneak up behind the person and stick a pin in that leg, he or she will not feel
it. The dysfunction is real. There simply is no physical basis for it. Interestingly,
however, such people show very little concern about their physical condition. As
you might imagine, conversion disorders are quite rare.
MÜNCHAUSEN
SYNDROME
•
Quite opposite from Conversion Disorders
•
These people fake their illnesses/injuries to
get attention
•
Also known as hospital addiction syndrome
•
Unclear whether or not people are conscious
of drawing attention to themselves
•
The affected person exaggerates or creates symptoms to gain
investigation, treatment, attention, sympathy, and comfort from
medical personnel.
•
Sometimes they are highly knowledgeable about medicine and
are able to produce symptoms that result in lengthy and costly
medical treatment
•
Ex. Eminem’s mom
DISSOCIATIVE
DISORDERS
•
Dissociative disorders are best known
from soap operas on television.
•
Ex. The major character develops amnesia and forgets she is married to a
prominent attorney. She falls in love with a wealthy physician at the local
hospital where she is treated for the flu. The physical is married to the head
nurse, who has dissociative identity disorder and who got the woman-of-the-year
award but steals drugs, which she sells on the street. Meanwhile…
•
If one paid any attention to television, it would seem that this sort of thing goes
on all the time.
•
Actually, dissociative disorders – amnesia, fugue, and dissociative identity
disorder – are extremely rare.
•
People with dissociative identity disorder often have an aspect of themselves that
causes such guilt (for example, a repeated tendency to violate the law) that they
cannot face this aspect and thus block it off.
•
Since this part won’t disappear, for these people it grows and grows until
eventually they form a separate personality that can do these acts and not be
responsible and guilty for them when they return to their “good” personality.
AMNESIA
•
In psychogenic amnesia, memories related to a terrible trauma “disappear”.
•
They are still “in” the person, but they are cut off from consciousness.
•
While some amnesiacs can be caused by a high fever or a blow to the head, the
term psychogenic means the problem is psychological (psycho) caused (genic).
•
In fact, people with this problem often show little concern that parts of their past
seem to be gone. Hence, there must be a psychological benefit involved, or they
would indeed be alarmed at losing some of their memories.
•
Ex. soldier’s loss of memory for nightmarish events that happened in battle.
•
In such cases of amnesia, selective forgetting is involved which means that only
the traumatic portion of the memories disappear.
•
For example, a soldier may completely blot out the part of the identity connected
with his fighting battalion and everything in the more recent past leading back to a
horrible war experience.
•
The terror and guilt these memories produce therefore disappear, occasionally
reappearing in nightmares. But only certain events are gone: the soldier doesn’t
forget how to tie a shoe, childhood friends, old memories, and so forth. In fact,
amnesia in all these cases is selective.
FUGUE
• The fugue state is an extensive, complicated type of amnesia.
The person disconnects all of his or her current life from
awareness, moves somewhere else, and starts all over. More
men than women exhibit this problem.
• It seems to be caused by serious and unresolved conflicts,
often with a spouse.
• Fortunately, this condition usually does not last very long.
• When the person “comes out of it,” he or she cannot remember
what happened during the fugue state.
DISSOCIATIVE
IDENTITY DISORDER
•
Dissociative identity disorder, formerly called multiple personality, in the basic form is
also similar to amnesia.
•
Instead of forgetting specific events, though, such individuals “forget” a portion of
themselves, and that portion begins to live a life of its own.
•
Although multiple personalities are all over television and are usually called
schizophrenics, which they AREN’T(!), they are usually extremely rare.
•
Dissociative identity disorder is probably so rare because a number of conditions must
align themselves in just the right way in order to produce it.
•
Such conditions typically include a haunted, confusion personality, a history of very
upsetting traumatic experiences or childhood abuse, and a long-term habit of escaping
from almost any problem.
•
Usually these people have very strong, conflicting desires and needs in their life-styles.
•
For example, a withdrawn and righteous man (call him A) who desperately wants to give
vent to animal impulses develops mammoth guilt over these desires. To distance himself
from this pain, another personality gradually creeps into the picture containing these
unacceptable desires. This is evil personality “B”. He can then go about doing whatever
he wants as long as he is B. When A returns, he becomes very self righteous, even prim,
prissy, and obnoxiously good. Complete amnesia can be involved, with A not knowing
about B and vice versa. Sometimes, however, the dominant or stronger personality knows
about the weaker; the weaker rarely knows about the stronger one.
http://www.youtube.com/watch?v=0tITzDjPf4g
IT IS NOT
SCHIZOPHRENIA
• The dissociative identity disorder is
not schizophrenia.
• In dissociative identity disorder, there
is really only one person involved with
two or more sides that tend to live
independently.
• But the basic core personality is the same, and this one is well
aware of general reality as we know it, does not have trouble
thinking or communicating, and does not believe things that
don’t exist.
• These facts are the opposite of what happens in
schizophrenia, discussed in later.
MOOD DISORDERS
The mood of an individual is his or her emotional state – elated depressed, angry, neutral,
and so forth. Thus, mental disturbances characterized by a depressed mood, an
exaggerated “up” mood, or an alternation between up and down are called mood disorders.
Dysthymic Disorder
•
The term dysthymic disorder comes from the Greek for “low spirits.” Hence, it is a
moderate depression.
•
In any given year, between 4 -12% of the population will be affected by it.
•
Fairly common problem and it is most likely to clear up eventually without treatment
•
Typical symptoms are lack of energy, unhappiness, loss of interest in activities and
people, loss of sense of humor, sadness, and rock bottom feelings of self-worth. All of
these feelings can occur in the normal person who, for instance, loses a loved one.
•
The best way to know whether depression of this sort is normal is to see if it has served
its “function” or instead has taken on a life of its own that just keeps on going.
•
Loss of a friend, for instance, would trigger these problems in any normal person, but if
they go on and on with the same degree of severity, something else is probably wrong.
•
Of if they appear “out of nowhere” or arise following an insignificant event, again one’s
emotional makeup may include a tendency to become depressed.
MAJOR DEPRESSION
•
Typical symptoms of severe or major depression are very slow speech, deep
ongoing depression, disturbances in appetite and sleep patterns, lack of
energy, a sense of hopelessness, extreme feelings of worthlessness, and
frequent thoughts of death or suicide.
•
Most patients in this category have trouble carrying out simple daily tasks.
•
Some may even lie motionless in a rolled-up fetal position for hours at a time.
It is as if all the joy has gone out of their lives.
•
Underneath it all, though, there is frequently a great deal of anger, sometimes
directed at the self, sometimes broad and unfocused.
•
The depression may last from a couple of weeks to a matter of months.
•
Some psychologists view depression as the flip side of anxiety; rather than
feeling anxious, which can be quite disturbing, we become depressed.
•
This is slowly being proven as many antidepressant drugs are used now to
treat anxiety even though no depression is exhibited.
•
Depression Hurts commercial =
http://www.youtube.com/watch?v=9EyXUY8ubc8
MANIA
•
Some people have extreme up moods.
•
This might sound at first like something that wouldn’t be all that bad, but
unfortunately that is not the case.
•
This behavior, called mania from the Greek for “mad excitement,” involves
agitation, restlessness, inability to concentrate, and extremely rapid speech.
•
This speech problem is the most notable part of the behavior.
•
The patients’ thoughts are moving so quickly through their minds that they
literally collide with one another into a mass of confused speech, making
comprehension almost impossible.
•
This problem is called a flight of ideas, meaning that thoughts are running so
fast that they are flying in all directions.
•
Here is a brief example: “I went to the store where they keep the containers of
milk which all babies should have in order to survive which not everybody can
do because of the threat of nuclear war between countries which are divisions of
various parts of the land which is filled normally with rock and dirt.”
•
These patients often get so excited that they begin to have delusions that they
have special powers or great influence, so they make plans for controlling the
world or some such project.
BIPOLAR DISORDERS
•
On occasion, people experience mood swings between the ups of mania and the downs of
major depression.
•
The official term for this problem is “manic depression.”
•
So, people who have these wild swings from up to down and back
Causes of Mood Disorders
•
We don’t understand the origin of mood disorders too well.
•
In fact, strangely enough, they disappear all by themselves (at least 80 to 90 percent of
them) within about six months, although they tend to recur in many people.
•
Just as the dysthymic disorder may be caused by the loss of a loved one, major depression,
we suspect, may come from a lifetime of many separations, losses, and unpleasant
setbacks
•
These people often have a very poor self-image. They see themselves as responsible for
many bad events and don’t even struggle to put up a defense against such an unrealistic
burden.
•
The problems associated with mood disorders can be so bizarre and severe and they can
appear (and disappear) so rapidly that we suspect some chemical imbalance is involved.
•
Probably psychological components then help send the person over the edge, so to speak.
•
Studies show a pretty clear pattern of a chemical defect in the brain.
•
One brain chemical that helps keep the brain active in normal people, called serotonin, is
very high – much higher than normal – in many manics; the same chemical is very low in
depressives.