1. Mental Illness and Therapies
AP Psychology
Mental Illness and Therapies
Essential Task:Describe contemporary and historical conceptions of what constitutes psychological disorders, recognize the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) as the primary reference for making diagnostic judgments with specific attention to five axis, and identify the positive and negative consequences of diagnostic labels (e.g., the Rosenhan study).
Logo Green is R=8 G=138 B= Blue is R= 0 G=110 B=184
Border Grey is R=74 G=69 B=64

2. Abnormal Psych: Disorders
Unit 11
Abnormal Psych:
Disorders
Mood
Anxiety
Personality
Schizophrenia
Childhood
Dissociative
Somatoform
History,
DSM

3. Treatment of Psychological Disorders Classical Operant
Unit 11:
Treatment of Psychological Disorders
Biological
Treatments
Insight Therapies
Cognitive Therapies
Behavior Therapies
Psychosurgery
Antipsychotic Drugs
Electroconvulsive
Therapy
Psychoanalysis
Stress Inoculation
Beck’s Cognitive Therapy
Aversion Therapy
Behavior Contracting
Flooding
Systematic Desensitization
Client-Centered
Gestalt
Rational Emotive Therapy
Classical
Operant
Token Economy
We are here

4. Abnormal Psychology
the scientific study of abnormal behavior in order to describe, predict, explain, and change abnormal patterns of functioning

5. Mental Disorders
"a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom."--Diagnostic & Statistical Manual of Mental Disorders 5th Ed.

6. National Institute of Mental Health Statistics
An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. (57.7 million people)
About 6 percent, or 1 in 17 —suffer from a serious mental illness.
In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages
Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity.
Most common disorders: anxiety, phobias, and mood disorders

7. What Makes a Behavior a Mental Illness?
Many definitions have been proposed, yet none are universally accepted
--Most definitions, however, share some common features:
“The Four Ds”
Deviance – different, extreme, unusual
Distress – unpleasant & upsetting
Dysfunction – causes interference with life
Danger – poses risk of harm
OBJECTIVE 1| Identify criteria for judging whether behavior is psychologically disordered.

8. Understanding Psychological Disorders
Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood.
OBJECTIVE 2| Contrast the medical model of psychological disorders with the biopsychosocial perspective on disordered behavior.
John W. Verano
Trephination (boring holes in the skull to remove evil forces)

9. Medical Perspective
Philippe Pinel ( ) insisted that madness was not due to demonic possession, but an ailment of the mind.
George Wesley Bellows, Dancer in a Madhouse, © 1997 The Art Institute of Chicago
Dance in the madhouse.

10. Models of the Causes of Psychological Disorders
Biological model
Physiological or biochemical basis
Psychoanalytic model
Disorders are the result of unconscious conflicts
Cognitive-Behavioral model
Disorders are the result of learning maladaptive ways of behaving and thinking
Diathesis-Stress model
Biological predisposition to disorder which is triggered by stress

11. Systems Theory/ Biopsychosocial Model
Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders.

12. Medical Approach
When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders.
Etiology: Cause and development of the disorder.
Diagnosis: Identifying (symptoms) and distinguishing one disease from another.
Treatment: Treating a disorder in a psychiatric hospital.
Prognosis: Forecast about the disorder.

13. 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-V-TR (Text Revision, 2013), describes over 400 psychological disorders compared to 60 in the 1950s.
OBJECTIVE 3| Describe the goals and content of the DSM-IV.

14. The DSM Identifies Specific Diagnostic Criteria
A person must exhibit at least five or more of the listed nine characteristics and the symptoms must be evident for at least the last two weeks for that person to be diagnosed with this disorder.
When diagnosing a client, the American Psychological Association recommends that the clinician use a multiaxial Assessment System.

15. Multiaxial Classification
Axis I
Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present?
Axis II
Is a Personality Disorder or Mental Retardation present?
Axis III
Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present?
Axis IV
Are Psychosocial or Environmental Problems (school or housing issues) also present?
Axis V
What is the Global Assessment of the person’s functioning? (GAF Scale is out of 100 with the lower the school, the more limited their functioning.)

16. Sample For example, in diagnosing depression, one may consider:
Axis I Major Depressive Disorder
Alcohol Dependence
Axis II Dependent Personality Disorder
Axis III None
Axis IV Recent Divorce, unemployment
Axis V 58

17. Multiaxial Classification
Note: 16 syndromes in Axis I

18. Multiaxial Classification
Note Global Assessment for Axis V

19. Goals of DSM-IV/V
Describe (400+) disorders.
Determine how prevalent the disorder is.
Disorders outlined by DSM-IV and V are reliable. Therefore, diagnoses by different professionals are similar.
Others criticize DSM-IV and V for “putting any kind of behavior within the compass of psychiatry.”

20. Diagnostic Labeling
Critics of the DSM-IV/V argue that labels may stigmatize individuals.
OBJECTIVE 4| Discuss the potential dangers and benefits of using diagnostic labels.
Elizabeth Eckert, Middletown, NY. From L. Gamwell and
N. Tomes, Madness in America, Cornell University Press.
Asylum baseball team (labeling)

21. Diagnostic Labeling
Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy.
Rosenhan study: “On being sane in insane places”
The Rosenhan experiment was a famous experiment done in order to determine the validity of psychiatric diagnosis, conducted by psychologist David Rosenhan, a Stanford University professor, and published by the journal Science in 1973 under the title "On being sane in insane places".[1][2] The study is considered an important and influential criticism of psychiatric diagnosis.

22. Continued
Rosenhan's study was done in two parts. The first part involved the use of healthy associates or "pseudopatients" (three women and five men, including Rosenhan himself) who briefly feigned auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had no longer experienced any additional hallucinations. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All but one were diagnosed with schizophrenia "in remission" before their release.

23. Continued
The second part of his study involved an offended hospital administration challenging Rosenhan to send pseudopatients to its facility, whom its staff would then detect. Rosenhan agreed and in the following weeks out of 193 new patients the staff identified 41 as potential pseudopatients, with 19 of these receiving suspicion from at least one psychiatrist and one other staff member. In fact, Rosenhan had sent no pseudopatients to the hospital.
The study concluded "it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of dehumanization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.

24. Diagnostic Labeling
3. “Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes.
Elaine Thompson/ AP Photo
Theodore Kaczynski
(Unabomber)