psychological dysfunctioning of an individual does not occur in isolation
it is influenced- sometimes caused by societal and social factors
affects the lives of relatives, friends, and acquaintances
clinical scientists and practitioners do not conduct their work in isolation
they are affecting and being affected by other institutions of society
two social institutions have a particularly strong impact on the mental health profession
legislative and judicial system
also called the legal field
two distinct aspects of the relationship between the legal field and the mental health profession
mental health professionals often play a role in the criminal justice system (psychology in law)
the legislative and judicial systems act upon the clinical field regulating certain aspects of mental health care (law in psychology)
forensic psychology
intersection between the mental health field and the legal and judicial systems
how do clinicians influence the criminal justice system
to arrive at just and appropriate punishments the courts need to know whether defendants are responsible for committing crimes and capable of defending themselves in court
people who suffer from severe mental instability may not be responsible for their actions or be able to defend themselves in court
these determinations are guided by the opinions of mental health professionals
what happens to people who are judged to be mentally unstable
usually sent to a mental institution for treatment
criminal commitment
forms of criminal commitment
mentally unstable at time of the crime
mentally unstable at the time of trial
mentally unstable at time of the crime
if found not guilty by reason of insanity (NGRI) committed until improved enough to be released
mentally unstable at time of trial
committed until competent to stand trial
the judgements of mental instability have stired many arguments
some consider judgements loopholes
others argue that a legal system cannot be just unless it allows for extenuating circumstances such as mental instability
Insanity
is a legal term
defendant may have a mental disorder but may not qualify for legal definition of insanity
original definition can be traced to the 1843 murder case of Daniel M Naghten in England
M Naghten Test
stated that experiencing a mental disorder at the time of a crime did not by itself mean that the person was insane, the defendant also had to be unable to know right from wrong
irresistible impulse test
found in late 19th century
test emphasized the inability to control one's action
fit of passion defense
the durham test
people were not criminally responsible if their unlawful act was the product of mental disease or defect
The American Law institute test
found in 1955
american law institute developed a test that combined aspects of the M'Naghten irresistible impulse and the Durham test
held that people are not criminally responsible if at the time of the crime they had a mental disorder or defect that prevented them from knowing right or wrong or from being able to control themselves and to follow the law
criticized for being too liberal
In 1983 the American Psychiatric association recommended a return to
M' Naghten
this test now is used in all cases tried in federal courts and in about half of state courts
more liberal ALI standard is still used in remaining state court, save 4, which have essentially eliminated the insanity plea altogether
about ____ of defendants acquitted by reason of insanity qualify for a diagnosis of schizophrenia
two thirds
vast majority have a history of past
about 50% are caucasian
about 86% are male
about 65% of cases involve violent crime of some sort
close to 15% of those acquitted are accused specifically of murder
criticisms of the insanity defense
one concern is the fundamental difference between the law and the science of human behavior
law assumes that individuals have free will and are generally responsible for their actions
in contrast several models of human behavior assume that physical and psychological forces act to determine the individuals behavior
second criticisim points to uncertainty of scientific knowledge about abnormal behavior
largest criticism is that defense allows dangerous criminals to escape punishment
number of such cases is small less than 1 in 400
during most of US history a successful insanity pleas amounted to ....
a long term prison sentence
today a successful insanity plea amounts to....
offenders are being released earlier and earlier as a result of the increasing effectiveness of drug therapy and other treatments in institutions, growing reaction against extended institutionlization and a greater emphasis on patients rights
guilty but mentally ill
a new verdict
defendents receiving this verdict are found mentally ill at time of crime but illness was not fully related to or responsible for the crime
guilty with diminished capacity
a defendants mental dysfunction is viewed as an extenuating circumstance that should be considered
sex psychopath law
michigan passed the first one in 1937
places sex offenders in special categories
Mentally disordered sex offenders
Mentally disordered sex offenders
people categorized this way are found guilty of a crime and judged to be responsible but are committed to a mental health facility instead of prison
most states have changed or abolished these laws
sexually violent predator
states are now less concerned about the rights and needs of sex offenders given the growing number of sex crimes taking place
these laws require prison and in addition involuntary treatment
regardless of their state of mind at the time of a crime, defendants may be judged to be mentally incompetent to stand trial
this requirement is meant to ensure that defendants understand the charges they are facing and can work with their lawyers to present an adequate defense
standard competence was specified by by US supreme court in 1960
what happens when you are judged to be mentally incompetent to stand trial
defendant is assigned to a mental health facility until competent to stand trial
many more cases of criminal commitment result from decisions of mental incompetence than from verdicts of NGRI
majority of criminals currently institutionalized for psychological treatment are ....
convicted inmates whose psychological problems have led prison officials to decide they need treatment
decades ago most states required that mentally incompetent defendants be commited to
maximum security institutions
under current law they have greater flexibility and some defendants are treated on an outpatient basis
how has the legal system influenced clinical practice
courts have developed the process of civil commitment which allows certain people to be forced into mental health treatment
the legal system on behalf of the state has taken on responsibility for protecting patients rights during treatment
the protection extends to patients who have been involuntary committed as well as to those who have sought treatment voluntarily
civil commitment
in US large numbers of people with mental disorders are involuntary committed to treatment
typically they are committed to mental institutions but most states also have some form or outpatient civil commitment
these laws have long caused controversy and debate
involuntary commitment of individuals who are considered to be in need of treatment and dangerous to themselves or others
what type of behavior is found in people who can be civil committed
may include suicidal or reckless patients
may include patients who put others at risk intentionally or unintentially
civil commitment laws vary from state to state
family members often begin the proceedings
few guidelines have been offered by the Supreme court
1979 minimum standard proof
supreme court offered this guideline to civil commitment
must be clear and convincing proof of illness and of meeting the states criteria for commitment
emergency commitment
many states give clinicians the right to certify certain patients a needing temporary commitment and medication
requires the agreement of two physicians and or mental health professionals
by tradition these certifications ofter are referred to as 2PCs (two physician certificates)
length of stay is often limited to three days
in the past people with mental illnesses were less likely than others to commit violent or dangerous acts because of
mass hospitalizations
what has deinstitutionalization caused
people with mental illnesses are becoming more likely to commit violent or dangerous acts
although approximately 90% of people with mental disorders are in no way violent or dangerous
studies now suggest at least a small relationship between severe mental disorders and violent behavior
judgement of dangerousness
required for involuntary civil commitment
research suggests that while mental health professionals are very often wrong in making long term predictions of violence, short term predictions- predictions of imminent violence- can be accurate
problems with civil commitment
it is difficult to assess dangerousness
legal definitions of mental illness and dangerousness are vague
civil commitment have questionable therapeutic value
some clinicians are beginning to argue that involuntary commitment should be abolished
trends in civil commitment
flexibility of involuntary commitment laws peaked in 1962
supreme court ruled that imprisoning people who suffered from drug addictions might violate the Constitution's ban on cruel an unusual punishment
as the public became aware of these issues states passed stricture standards for commitment
today fewer people are institutionalized through civil commitment proceedings than in the past
protecting patients rights
over past two decades courts decisions and state and federal laws have greatly expanded the rights of patients with mental disorders, in particular the right the treatment and the right to refuse treatment
how is the right to treatment protected
when people are committed to mental intitutions and do not receivie treatment the institutions become prisons for unconvicted
late 1960s and 1970s large mental institutions were just that
some patients and their attorneys began to demand that the state honor their right to treatment
several court rulings addressed this issue
1972 court rulling about protecting the right to treatment
a federal court ruled that the state was constitutionally obligated to provide adequate treatment to all people who had been committed involuntarily
1975 court ruling about protecting the right to treatment
The supreme court ruled that institutions must review case files periodically and that the state cannot continue to institutionalize against their will people who are not dangerous and are capable of surviving on their own or with willing help of responsible family members or friends
1986 court ruling about protecting right to treatment
congress passed the Protection and Advocacy for mental Ill individuals act
this act set up protection and advocacy systems in all states and US territories
number of advocates are now suing federal and state agencies demanding that they fulfill the promises of the community mental health movement
how is the right to refuse treatment protected
during past 25 years the courts have also decided that patients particularly those in institutions have the right to refuse treatment
most rulings center on biological treatments including psychosurgery
some states have acknowledged a patients right to refuse ECT and or psychotropic medications
as the possible harmful effects of these treatments have become known some states have granted patients permission to refuse them
other rights patients have
patients who perform work in mental institutions are now guaranteed at least a minimum wage
patients released from state mental hospitals have a right to aftercare and appropriate community residence
people with mental disorders have a right to receive treatment in the least restrictive facility available
the rights debate
people with psychological disorders have civil rights that must be protected at all time, many clinicians express concern that patients rights rullings may unintentionally deprive these patients of opportunities for recovery
despite legitimate concerns, it is important to remember that the clinical field has not always been effective in protecting patients rights
since clinicians themselves often disagree it seems appropriate for patients, their advocates, and outside evaluators to play key roles in decision making
4 major areas in which the paths of mental health and legal professions have crossed
malpractice suits
professional boundaries
jury selection
psychological research of legal topics
malpractice suits
number of malpractice suits against therapists has risen sharply in recent years
claims have addressed a number of different issues including patient suicide, sexual activity with a patient, failure to obtain informed consent, negligent drug therapy, omission of drug therapy, improper termination of treatment, and wrongful commitment
malpractice suit or fear of one can have major effects on clinical decisions and practice for bettor and for worse
profession boundaries
during past several years the legislative and judicial systems have helped change the boundaries that separate one clinical profession from another
these bodies have given more authority to psychologists and have blurred the lines between psychiatry and psychology
how have the lines between psychiatry and psychology been blurred
1991- the department of defense set up a training program for Army psychologists to gain prescription-writing privileges (previously the domain of psychiatrists only)
the success of the program prompted the APA to recommend that all psychologists be granted permission to take such training courses, two states now grant such privileges
Jury Selection
during past 30 years more and more lawyers have turned to clinicians for advice in conducting trials
a new breed of clinical specialist-- jury specialists-- has evolved
they advise lawyers about which jury candidates are likely to favor their side and which strategies are likely to win jurors support during trials
however it is not clear that a clinician's advice is more valid than a lawyer's instincts or that the judgements of either are particularly accurate
two areas that psychologist have developed expertise on that have importance to the criminal justice system
eyewitness testimony
patterns of criminality
eyewitness testimony
in criminal cases testimony by eyewitnesses is extremely influential
research indicates that eyewitness testimony can be highly unreliable
the events are usually unexpected and fleeting
further laboratory subjects can be fooled into misremembering information
research has also found that accuracy in indentifying perpetrators is influenced by the method used in identification
patterns of criminality
study of criminal behavior patterns and the practice of profiling has increased in recent years and has been the topic of an increasing number of media programs
however it is not as revealing or influential as the media and the arts would have us believe
code of American Psychological Association (APA) ethical principles
psychologists are permitted to offer advice
psychologist may not conduct fraudulent research, plagiarize the work of others, or publish false data
psychologists must acknowledge their limitations
psychologists who make evaluations and testify in legal cases must base their assessments on sufficient information and substantiate their findings appropriately
psychologists may not take advantage of clients and students, sexually or otherwise
psychologists must follow the principles of confidentiality
exceptions: a therapist in training to a supervisor Tarasoff's duty to protect
which other fields besides the legislative and judicial systems do mental health professionals interact
business and economic fields
collectively psychological disorders are among the _____ leading categories of work related disorders and injuries in the US
10
business world has often turned to clinical professionals to help prevent and correct such problems
two common means of providing mental health care in the workplace
employee assistance programs
problem solving seminars
Employee assistance programs (EAPs)
mental health services made available by a place of business, are run either by mental health professionals who work directly for a company or by outside mental health agencies
stress reduction and problem solving seminars
workshops or group sessions in which mental health professionals teach employees techniques for coping and solving problems and for handling and reducing stress
economic decisions by the government may influence clinical care of people with psychological disorders
financial concerns were of primary consideration in the deinstitutionalization movement
although government funding has risen for people with psychological disorders over the past five decades that funding is insufficient
large economic role of private insurance companies has had a significant effect on the way clinicians go about their work
managed care programs and peer review systems have been implemented and criticized by many mental health professionals
techonology has had ______ effects on the mental health field
both positive and negative
our digital world provides new _____ and ______ for the expression of abnormal behavior
triggers and vehicles
individuals who grapple for impulse- control problems and or paraphilias
some clinicians believe that violent video games may
contribute to the development of antisocial behavior, and perhaps the onset of conduct disorder
clinicians also worry that social networking can contribute to
psychological dysfunctioning in certain cases
research also indicates that today's techonology also is helping to produce new psychological disorders such as
internet use disorder
internet use disorder
marked by excessive and dysfunctional levels of texting, tweeting, networking, internet browsing etc.
internet has brought a new exhibitionistic feature to certain kinds of abnormal behavior such as
posting videos of self cutting
cybertherapy
growing as a treatment option by leaps and bounds
long distance therapy using skype
therapy offered by computer programs
treatment enhanced by video game like avatars
internet based support groups
problems with cybertherapy
wealth of misinformation and lack of quality control
survey have found that as many as ____ of therapists have reported being in therapy themselves at least once
84%
reasons are largely the same as those of other clients, with emotional problems, depression and anxiety topping the list
it is not clear why so many therapist report having psychological problems
possible theories include: job stress, increased awareness of negative feelings, biased entry into the field itself
the science and profession of abnormal psychology seeks to understand, predict, and change abnormal functioning but we must not loose sight of the fact that
mental health researchers and clinicians are human beings living within a society of human beings working to serve human beings
One who systematically gathers information in order to describe, predict, and explain
abnormality is a clinical:
scientist
if you wanted a career in which you focus on detecting, assessing and treating abnormal patters on functioning, you should look into becoming a clinical
practitioner
the history, values institutions technology and arts of a society make up that society's
culture
The finding that
syphilis causes general paresis is important because it supports the idea that:
A) mental patients should be
deinstitutionalized.
B) organic factors can cause mental illness.
C) antibiotics cannot “cure” viral diseases.
D) physicians should be the ones treating mental illnesses.
B) organic factors can cause mental illness
“Understanding a person's unconscious
processes is critical in explaining abnormality.” Which model of abnormality
does this quote MOST closely represent?
psychodynamic
Which of the
following statements would a behavioral therapist be MOST justified in saying?
its cause or causes as well.
B) our treatments work especially well with specific fears and social deficits
Jamal observed
his parents' generous behavior throughout his childhood. As a result, he
developed a positive and generous attitude toward the world. According to the
behavioral model, Jamal has acquired his lifestyle through the process of:
modeling
If a client-centered therapist were treating a very anxious woman, the therapist
would try to:
show unconditional positive regard for her statements
a person who is so miserable that he or she can see no reason for living BEST fits which of the following definitions of abnormality
distress
which aspect of the definition of abnormality includes the inability to care for oneself and work productively
dysfunction
the stated and unstated rules for proper conduct that a society establishes are referred to as
norms
the fact that some people in the advanced stages of AIDS experience neurological damage that results in the psychological abnormality supports what type of perspective about abnormal psychological functioning
somatogenic
which perspective was supported by the discovery that the symptoms of hysteria (mysterious paralysis) could be induced by hypnosis
psychogenic
the diathesis-stress model of abnormality emphasizes that
abnormality arises from an interaction between stress and predisposition
Studies of diagnostic conclusions made by clinicians show that:
A) they underemphasize information gathered
early in the assessment process.
B) they pay too much attention to some information and too little to other information.
C) they don't allow enough of their own
expectations to enter into the decision.
D) they do not allow their own biases to play a
role in their decisions.
B) They pay too much attention to some information and too little to other information
Which of the following statements is the BEST example of the biopsychosocial perspective?
A) There is one legitimate approach to
understanding mental disorders.
B) Abnormality is best explained by
sociocultural stresses a person experiences.
C) Eclectic approaches fail to take interactions
of various model
D)Abnormality results from the interaction of genetic, emotional, and cultural influences.
D) Abnormality results from the interaction of genetic, emotional, and cultural influences
According to ________ the drive to self actualize plays an important part in human functioning
humanist
therapies that have received clear research support are called
evidence-based
The Diagnostic and Statistical Manual of Mental Disorders (presently DSM-5) was developed by
The American Psychiatric Association
A friend says to you, “I wonder how likely I am to qualify for a DSM diagnosis in my lifetime.” Based upon survey results, your MOST accurate answer would be (assuming your friend is “typical”):
A) “Unlikely; about 10 percent of people would ever qualify for a DSM diagnosis.”
B) “Somewhat unlikely; about 20 percent of
people would ever qualify for a DSM diagnosis.”
C) “Pretty likely; about one-third of people
would ever qualify for a DSM diagnosis.”
D) “Likely; almost half of people would ever qualify for a DSM diagnosis.”
D) “Likely; almost half of people would ever qualify for a DSM diagnosis.”
Which of the following statements BEST reflects the impact of deinstitutionalization?
A) Deinstitutionalization has been positive;
most people with severe disturbances are still receiving treatment.
B) Deinstitutionalization has placed many people with severe disturbances
in jail or on the street and not receiving the services they need.
C) Deinstitutionalization is better than
hospitalization; at least care is consistent and there is no shuttling back and
forth through different levels of care.
D) Deinstitutionalization has worked well and communities have been able to pick up the care of those with severe disturbances and provide effective treatment for most of them.
B) Deinstitutionalization has placed many people with severe disturbances in jail or on the street and not receiving the services they need
an intense persistant and irrational fear that is accompanied by a compelling desire to avoid the object of fear to the point of interfering with the life of the person is called
phobic disorder
every once in a while, Ona feels nervous to the point of terror. It seems to come on suddenly and randomly. Her experience is an example of
panic disorder
Leila always feels threatened and anxious-imagining something awful is about to happen. But she is able to work and care for her family, althrough not as well as she would like. Lelia is probably experiencing
a generalized anxiety disorder
a person who see life in right or wrong or all or none terms is engaging in
dichotomous thinking
when someone checks the stove 10 times to make sure it is turned off before leaving in the morning that person is exhibiting
compulsion
to receive a diagnosis of dysthymic disorder, an individual must have experienced symptoms for at least
two years
steve is afraid of eating in public, expecting to be judged negatively to feel humiliated. as a result he always makes up excuses when asked out to eat. His diagnosis would Most likely be:
social anxiety disorder
a person who witnessed a horrible accident and then became unusually anxious and depressed for 3 weeks is probably experiencing
acute stress disorder
in response to a threat we perspire, breathe more quickly, get goose bumps, and feel nauseated. The responses are controlled by the
sympathetic nervous system
imagine that you just had a close call while driving but now you feel your body returning to normal. which part of your nervous system is controlling this return to normalcy
parasympathetic nervous system
the be classified as having a major depressive episode, depression must last for a period of at least
two weeks
a state of breathless euphoria or frenzied energy, in which individuals have an exaggerated belief in their power describes
mania
Dorian was only 10 miles away when St Helens exploded with one of the largest blasts in history. There was ash and lava everywhere and he was terrified and sure he was going to die. When rescue teams found him a week later he was cold, hungry and scared. More than a year later he still has nightmares and wakes up in a cold sweat. This description BEST fits a
posttraumatic stress disorder
The study of sexuality that led to a revolution in the treatment of sexual dysfunction and treatment was done by
Masters and Johnson
a person who experiences vomiting and shaking when he tries to stop drinking alcohol has developed
withdrawal reactions
abnormalities that are thought to have both biological and psychological causes are
psychological factors affecting ones medical condition
the drug which when misused would MOST quickly result in dependence or addiction would be
opium
a frequent drug user finds that larger doses of a drug are necessary to produce the same high that much lower doses once produced. the drug user is developing
tolerance
Which of the following would lead you to suspect a conversion disorder rather than
medical symptoms?
A) a great number of accidents and an
inability to get around in a “blind” person
B) muscle atrophy in the “paralyzed” body
part
C)uniform and even numbness in the “damaged” hand
D)symptoms consistent with the way the
neurological system is known to work
C) uniform and even numbness in the damaged hand
while under the influence of LSD Matilda believes that she can feel the sounds around her. this effect is known as
synesthesia
what is the term for the use of and attraction to inanimate objects as a preferred method of achieving sexual excitement
fetishism
drinking alcohol during pregnancy can damage the developing embryo and fetus resulting in
fetal alcohol syndrome
otherwise healthy man reports almost no interest in sexual activity and has had very few sexual experiences in the past several years. the person MOST likely is experiencing
hypoactive sexual desire
Which of the following people would be MOST likely to cut out sweets, then eliminate more and more types of foods, but not force vomiting?
A) one experiencing restricting type anorexia nervosa
the central feature of bulimia nervosa is
binge eating followed by a compensatory behavior
a patient in an alcohol rehabilitation center with a history of vitamin B deficiency tells you a detailed story about growing up in the mountains of Tennessee. Later you find out that the person in fact never even visited Tennessee. a day later you visit the patient again and the patient does not recognize you. Most likely the patient is suffering from
Korsakoff' syndrome
Which of the following is an example of malingering?
A)experiencing chest pains in response to
intense stress
B) enjoying unnecessary medical tests
C)intentionally faking an illness because
one likes being a patient
D)intentionally faking a back problem in order to avoid military service
D) intentionally faking a back problem in order to avoid military service
a paraphilia is
a response to a socially inappropriate object or situation
psychosis means
loss of contact with reality
delia does not display all the full blown schizophrenia symptoms any more. occasionally a shadow of a symptom appears. she is a bit withdrawn and not entirely clear all the time, but she can marginally function in the world. this is an example of
residual schizophrenia
delusions, disorganized thinking and speech, heightened perceptions, and hallucinations, and inappropriate affect are examples of
positive symptoms of schizophrenia
the stage of development of schizophrenia marked by deterioration of functioning and the display of mild symptoms is called the
prodromal phase
the main difference between hallucinations and delusions is that
hallucinations involve perception and delusions involve beliefs
according to the diathesis stress model of schizophrenia
people with a biological predisposition for schizophrenia will develop it if certain psychosocial stressors are also present
for the first two weeks after starting college a student cant seem to talk coherently and is generally unresponsive to the moods of other students in the same dorm. soon the student resumes normal patterns of speaking and social interaction. this is an example of
brief psychotic disorder
poverty of speech, restricted and flat affect, loss of volition, and social withdrawal, are examples of ____ symptoms of schizophrenia
negative
the schizoid personality disorder differs from paranoid personality disorder in that
those with schizoid personality disorder desire to be alone, those with paranoid personality are alone because of suspiciousness
a middle aged individual shows many of the negative symptoms of schizophrenia and at the same time often appears profoundly depressed. the symptoms have lasted almost a year. this is an example of
schizoaffective disorder
a women has been treated with chlorpromazine for several years. lately she seems to be chewing gum all the time and her arms are always in motion. she has begun to display twitching and facial tics. this is an example of
tardive dyskinesia
the category of odd personality disorders includes the traits of
extreme suspiciousness
social withdrawal
cognitive and perceptual peculiarities
the MOST important similarity among the personality disorders listed in the text is that
they are inflexible, maladaptive, and related to impaired functioning or distress
if a person primarily fears close social relationships, one would MOST likely conclude that the person is experiencing
avoidant personality disorder
an adult has been jailed for the third time for fraud, each time it has been for persuading investors to put money into a phony silver mine.if the adult has received a DSM5 diagnosis, the most likely diagnosis is
antisocial personality disorder
reese is distrustful of others and reacts quickly to perceived threats. even though he has no evidence he is sure his wife is unfaithful. he finds it almost impossible to forgive those he thinks have wronged him. reese displays characteristics of
paranoid personality disorder
a child is openly hostile toward her parents, argues with them constantly and will not do anything they say. they cannot controlher. the diagnosis most likely to receive is
oppositional defiant disorder
when selina sees a report of a train wreck on television, she thinks that it is a sign that she should not take the train to work the next day and so she decides to take the bus instead. if she has a diagnosable personality diorder it would most likely be
schizotypal personality disorder
when dialectical behavior therapy is used with patients with borderline personality disorder those patients compared to patients receiving other forms of therapy make
far fewer suicide attempts and are hospitalized less often
if a person primarily fears close social relationships, one would most likely conclude that the person is experiencing
avoidant personality disorder
a child has repeatedly engaged in shoplifiting and in hitting neighborhood pets with rocks. the child frequently is aggressive and has engaged in an increasing number of fights. the most appropriate diagnosis for this child is
