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Psychopathology:
the thin line that separates sanity from madness
“To study the abnormal is the best
way of knowing the normal”
W. James
Fun to hear about uncommon
disorders…

Limbic psychotic trigger reactions
 Sudden
brain seizure triggered by harmless
sight or sound causes some men to fly into
violent rage
 18 cases (14 murders): quiet, unassuming
loners suddenly erupt into violence, only to
just as suddenly recoil in horror at their
actions, gripped by remorse!

BUT…
Historical Roots

Caused by evil spirits…
 Need

an opening to escape
Witchcraft, demonic possession, full moon,
supernatural forces…
 Exorcism,
torture, primitive surgery,
bloodletting, bitter poisons, starvation, noisemaking

Today: Medical perspective & Psychological
perspective
Debate

Biological conditions
vs.

Past & present life experiences (natural
disasters to abuse, divorce, illness, etc.)
 Psychoanalytic
 Parental
influences, unconscious, defense mechanisms
 Behaviorial
 Reward,
beliefs
& CB
punishment… perceptions, expectations,
AND…
 Diathesis-Stress Model

“Pibloktoq”

Intense excitement, seizures, then coma.
 Tear
off clothing, break furniture, shout
obscenities, eat feces… later forget
Diagnosis: A Necessary Step

DSM-IV Disorders
 Anxiety-
(we’ll discuss)
GAD, Panic, phobias, OCD, PTSD
 Somatoform- Hypochondriasis, conversion
 Dissociative- Amnesia, fugue, DID
 Mood- Depression, mania, bipolar
 Schizophrenic- Paranoid, Disorganized,
Catatonic, Undifferentiated, Residual
 Personality- borderline, antisocial
Who’s crazy here anyway?

However much we may be personally convinced
that we can tell the normal from the abnormal,
the evidence is simply not compelling
Rosenhan, 1973
“On being Sane in Insane Places”
 “Hollow, Empty, Thud”
 Described true life histories, relationships, etc.
 Ceased any symptoms, tried to convince staff of sanity to be
discharged (BY THEIR OWN DEVICES)
 How many were identified as SANE?
How long did it take…
…had a close relationship with his mother but
was rather remote from his father during his
early childhood. During adolescence and
beyond however his father became a close
friend while his relationship with his mother
cooled. His relationship with his wife was
characteristically close and warm. Apart from
occasional angry exchanges, friction was
minimal, the children had rarely been spanked.
“This white 39-year old male manifests a long
history of considerable ambivalence in close
relationships, which begins in early childhood.
A warm relationship with his mother cools
during adolescence. A distant relationship to
his father is described as becoming very
intense. Affective stability is absent. His
attempts to control emotionality with his wife
and children are punctuated by angry outbursts
and in the case of the children, spankings. And
while he says that he has several good friends,
one senses considerable ambivalence
embedded in those relationships also.”
Role of Expectations

7 Schizophrenic diagnoses; 1 bipolar
“I’m fine, no longer experiencing any
symptoms”
 Pseudopatients’ behavior caused by
situation (e.g. boredom, hunger)

 Interpreted
by staff as reflecting
psychopathology
Length of stay 7-52
days!
 No one detected


EXCEPT…
• Diagnoses are often not reliable or useful
•Sane needlessly stigmatized / feigned insanity excused
Line between
Mental health professionals determine (judge)
where on the continuum behavior lies
 Which criteria to use?

Bizarreness of Behavior
 Persistence of Behavior
 Social Deviance
 Subjective Distress
 Psychological Handicap
 Effect on Functioning

Normal
Abnormal
Beware!

Medical Students Disorder is prevalent among psych
students
Psychological disorders are just exaggerations of
tendencies that all of us have
 Being sad, anxious, or proud does not mean we are
suffering from depression, narcissism, anxiety disorder
or schizophrenia

Detailed Examples
1.
Anxiety- OCD
2.
Somatoform- Hypochondriasis
3.
Dissociative- DID
4.
Mood- Depression
5.
Schizophrenic- Schizophrenia
6.
Personality- borderline, antisocial
1. OCD
Recurrent, intrusive, unwanted thoughts and compulsive actions
 One boy washed hands so much they became raw & bloodied
 One boy ran up and down the stairs 63 times/ day
 Woman determined to keep eyebrows symmetric, plucked them
all out
 Woman spent 8hrs/ day bathing
 Man couldn’t leave subway without picking up all litter
 Man’s apartment stacked to ceiling with dishes, dirty clothes,
collected objects he couldn’t throw away


MENTALLY NEUTRALIZE unacceptable thoughts and behaviors
Treatment: “refocusing” to “unlock” the area stuck in its
pattern. Label & refocus to constructive activity
Obsessions & Compulsions
Dirt, germs, contamination
Aggressive impulses
Need for symmetry
Bodily concerns
Forbidden sexual impulses
55%
50%
37%
35%
32%
Checking
Washing
Counting
79%
58%
21%
2. Hypochondriasis
Guess who?


Complained of dizzy spells, numbness in fingertips,
nausea, indigestion, chest pains, and other assorted
ailments…
Chronic, unwarranted preoccupation w/ one’s physical
health. Highly sensitive to NORMAL bodily sensations
“The whole day was planned out to suit him, to be ready
for reading aloud to him, to go on his walks with him,
and to be constantly at hand to alleviate his daily
discomforts”
“Place your foot in this ice water”

Until can’t tolerate it

Heart rate

Temperature

Rate “unpleasantness”
Heightened Sensitivity
Hypochondriacs:



Removed their
foot sooner
Rated cold as
more unpleasant
Showed more
physiological reactivity
to stimulation
3. Dissociative Identity Disorder

Learn to cope with trauma by mentally
divorcing part of self from pain & suffering
 Construct
alternative identities in which to live

9X more prevalent in women

88% victims of sexual abuse

Ea. May have own voice, speech pattern, habits,
memories, sexual orientation, clothing,
handwriting, brain-wave, BP, eyeglass
prescription, rxns…
Skeptical?
1817-1970*: < 200 cases
 Faking for personal gain? Undetected
 Therapists now more sensitive?
 Therapists overdiagnose OR suggest &
reinforce

 Billy
Milligan
4. Depression: “The common cold”

Universal; 2x women; 12-21% will experience

Emotional, Cognitive, Motivational and Somatic
symptoms without discernible cause, >2 wks
Profound sadness
 Diminished interest in food, sex, social banter
 Intense worthlessness, guilt, self-blame
 Restlessness, agitation
 Depleted energy
 Recurring thoughts of suicide & death

A cause?

Power & control
 Action
consequence
 Imagine feeling unable to have an effect on
life events
 If
expect bad things to happen over which you
have little control

Feel hopeless about making positive changes in your life
Learned Helplessness in Humans

More likely to become depressed if attribute
failure to:
 INTERNAL:
“It’s my fault”
 STABLE: “It won’t change”
 GLOBAL: “It affects my whole life”

Expectation one cannot control important life
outcomes
pessimism, hopelessness,
despair
Explanatory Styles and Depression
First-year college
 Two years later, p’s
w/ negative style
(internal, stable, and
global) were more
likely to experience
a major or minor
depressive disorder.

5. Schizophrenia

“I wish you a happy, joyful, healthy and
fruitful year, and many good wine years to
come as well as a healthy and good apple
year, and sauerkraut and cabbage and
squash and seed year
 To

E. Bleuler, 1911
Note “Split mind” = split between thoughts,
perceptions, behaviors, emotions and other
brain functions (NOT Selves)
“I felt like I was the only sane person
in a world gone crazy”
1.
Incoherent thinking/ word salad
2.
Delusions- “influence”- thoughts being broadcast
in public, stolen, controlled; also reference,
persecution, grandeur.
3.
Hallucinations- sensations w/out stimulation (e.g.
Son of Sam’s barking dog)
4.
Disturbance of affect- flattened/ inappropriate
5.
Bizarre behavior- withdrawal, exile, self-talk, statue
poses, backwards, circles, lack self-insight
Next time: treatment
Charles Manson
Reactions of People with Social
Phobias I

Social Phobia

An intense fear of
situations that invite
public scrutiny
Socially phobic and
non-phobic adults
prepared a speech.
 Both groups showed
increased heart rate in
anticipation of the
speech.

Anxiety Disorders
Reactions of People with Social
Phobias II

However, only
those with social
phobia reported
feeling more
anxious.