1. PSYC 1000 Lecture 52

2. Perspectives: Defining Psychological Disorder is a “harmful dysfunction” in which behavior is judged to be: –Atypical: not enough in itself, and sometimes disorders widespread –Disturbing: varies with time & culture –Maladaptive: harmful –Unjustifiable: occasionally justified Standards vary with History and Culture –Sexual arousal and orgasm –Homosexuality –Hearing voices

3. What is abnormal? Distress or disability: An individual experiences debilitating functioning, producing risk of physical and/or psychological deterioration or loss of freedom of action Maladaptiveness: An individual behaves in a fashion which hinders goal attainment, undermines well- being, or often interferes significantly with the goals of others and needs of society Irrationality: An individual acts or speaks in ways that are incomprehensible to others Unpredictability: An individual behaves incongruently with environmental demands, often as though the person experiences loss of control

4. What is abnormal? Unconventionality and statistical rarity: An individual violates norms of socially acceptable behaviour in a manner that is statistically rare Observer discomfort: An individual behaves such that it makes others uncomfortable because they feel threatened or distressed Violation of moral and ideal standards: An individual violates expectations for how one ought to behave, according to societal norms

5. Myths related to Mental Illness People with mental disorders are homicidal –No difference in reality although overrepresented in penal system –“A Statistics Canada report found that during the period from 1974 to 1992, a married woman was nine times more likely to be killed by her husband than a stranger.” http://www.cfc-cafc.gc.ca/pol- leg/res-eval/factsheets/domestic_e.asphttp://www.cfc-cafc.gc.ca/pol- leg/res-eval/factsheets/domestic_e.asp –A person with schizophrenia is more likely to be a victim rather than a perpetrator of a violent crime –More information at http://www.mss.mb.ca/concerns.htm

6. Perspective: Etiology Historical Causes and Treatments –Supernatural events Movements of sun or moon, evil spirits, possession, … Lunacy: full moon –Treatments Exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood

7. Medical Model –Diseases have physical causes and can be diagnosed, treated, and often cured –“Mental” illnesses can be diagnosed on basis of symptoms and cured through therapy, which may include treatment in psychiatric hospital –Much attention at present to identify biochemical and genetic factors that underlie mental disorders

8. The myth of mental illness? Inhumane historic treatment of the mentally ill spurred the “anti-psychiatry” movement Thomas Szasz proposed that mental illness is a myth and that what are now considered mental illnesses are simply “problems in living” Other individuals such as R. D. Laing suggested that the hallucinations and delusions that accompany schizophrenia may be beneficial and represent an “alternate” perspective on reality that is no less valid than the “normal” experience.

9. Issues? Physical vs. Psychological? –Does finding a physiological cause or correlate qualify something as a disease? –Isn’t all behaviour, at some level, physiological? Behaviour vs. physical symptoms –If increased heart rate is an indication of a cardiovascular problem is behaviour an indication of brain dysfunction? What about diseases for which there is no known cause? –Epilepsy is considered by Szasz to be a legitimate disease but had no know cause when he decided this.

10. Practical concerns Funding –Diseases receive research funding whereas “problems in living” not as much Obesity “epidemic” Stigma –Does labeling something as a disease increase or decrease stigma?

11. Perspectives: Classifying Taxonomy or Classification –Grouping like elements (e.g., disorders) together –Similar Symptoms, Etiology, Treatment, … DSM-IV-TR –American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) –Widely used system for classifying psychological disorders –Developed in coordination with ICD-10: WHO’s International Classification of Diseases

12. Earlier important distinction –Neurotic disorders (term seldom used now) Distressing but allow one to think rationally and function socially Freud: neurotic disorders are ways to deal with anxiety –Psychotic disorder Lose contact with reality Experience irrational ideas and distorted perceptions (hallucinations) 5 Axes –15+ major categories in Axis I –400 disorders, increased from 60 disorders in 1950s Reliability of Diagnosis –Historically a weak area for psychiatric diagnosis –Now better criteria, structured interviews more common 83% agreement in one recent study

13. Classifying Psychological Disorders Are Psychosocial or Environmental Problems (school or housing issues) also present? Axis IV What is the Global Assessment of the person’s functioning? (100 point scale) Axis V Is a General Medical Condition (diabetes, hypertension or arthritis etc) also present? Axis III Is a Personality Disorder or Mental Retardation present? Axis II Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Axis I

14. DSM-IV-TR Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, phobias, and schizophrenia. Common Axis II disorders include personality disorders: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder, and mental retardation.

15. Perspectives: Labeling Some concern about negative consequences of labeling people with disorders Classic Rosenhan study –Rosenhan and 7 other “normal” people admitted selves to psychiatric hospital complaining of “hearing voices” –Acted normally once admitted –Normal behaviors seen as symptoms (e.g., taking notes) –Possible “causes” found in people’s personal histories –Average of 19 days before release Other studies show behavior interpreted differently depending on label (e.g., Langer interview study) Stigma associated with mental illness –3/4 refused to rent room to someone allegedly being released from mental hospital (same as for jail) –Portrayed as dangerous and frightening in media

17. Next Class Etiology Anxiety and mood disorders