psych 303-1

• Statistical
• SOcial Deviance
• Moral
• Medical
• Ecological/impairment
• Harmful dysfunction
• Transactional

• mental illness is behavior at extremes of normal distribution
• BUT -
• - where do we draw the line
• - it may leave out problems that are not rare
• - are both extremes abnormal?

• behavior that violates a society's social norms/standards are abnormal
• BUT
• - unpopular/politically controversial as abnormal??
• - some deviant behavior is a benign norm violation (standing too close to someone)
• - its an extreme of cultural relativity - different cultures have determinants

• moral violations are a product of mental illness
• moral weakness/moral deficits/evil
• BUT
• - the morality thing changes with time (homosexuality as disorder?)
• - cultural relativity again

• disease processes operating at level of brain and then mind (look for signs/symptoms for a certain disease)
• affects treatment
• neuroimaging
• BUT
• - no environment factor is taken into account
• - some mental illnesses don't have a objective marker
• - the same symptoms may have different neural signatures (hard to deduce down to single problem in the brain)

• theres a mismatch between the person and the context (not just faulty environment alone, or faulty inner dysfunction alone)
• BUT
• - some behavior could be adaptive in one environment and harmful in another (can be interpreted differently)

• behavior creates HARM and reflects an underlying dysfunction in a naturally-selected mental function (like evolutionarily related - Wakefield)
• BUT
• - understanding natural selection in producing htese behaviors is hard
• - how do you define dysfunction?

• psychopathology is a product of development
• strongest theory
• continuum
• deflect from normal development pathways
• childhood disorders extend into adulthood
• source of adult disorders are form childhood
• environment effects on genotype

• 46%, very high
• its a pervasive problem
• and these prevalence rates are comparable around the world

• severe - 6%
• moderate - 20%
• child forms (25%)

• high prevalence!
• impairment (relationships, health, skills, shame)
• debilitating (5 of top 10 most disabling = mental disorders)

• suffering (neither sufficient nor necessary)
• maladaptiveness (self or society)
• deviancy (must be stat. rare and undesirable)
• violation of standards of society
• social discomfort
• irrationality or unpredictability (no control)
• cultural factors

• tries to be impartial to causality (does not mention etiology)
• 1. clinically significant behavioral/psychological syndrome
• 2. associated with distress/disability (impairment)
• 3. not predictable or culturally sanctioned response
• 4. reflects behavioral/psychological/biological dysfunctions

• borderline cases
• how to define clinically significant?
• how do you measure impairment?
• the behavior could meet the descriptive criteria but not really feel pathological (eyebrow trichotillomania)

• loss of information - (b/c of shorthand classification)
• labelling - a persons self concept can be affected by having a label
• stereotyping
• stigma- negative perception of those with a diagnosis

• different ways of talking about depression - somatic vs. feelings
• taijin kyofusho (Japan, don't want to upset people with their gaze/facial expression)
• ataque de nervios (Caribbean, loss of control, crying, screaming, faint)

the trend away from the use of traditional hospitalization (long in patient stays)

• psychiatrist - prescribe medications
• clinical psychologyist - individual therapy
• clinical social workers - family problems
• psychiatric nurse - checks in with patient

• case studies - bias, low generalizability
• self-report data - people aren't good reporters of own states, etc.
• observational - direct observations, brain imaging,

• fMRI (use magnetic field on water molecules)
• transcranial magnetic stimulation (magnetic field on top of head - brian tissue is stimulated)

• criterion group: people with disorder
• comparison group: control group (no disorder but comparable to other group)

• observational: no manipulation, like correlation (we use the natural groupings of people)
• correlational: determines associations between phenomena
• Retrospective vs. prospective strategies
• experimental methods
• treatment research - difference between two groups, one treated, one not
• single case experimental designs
• animal research

• retrospective: looking back in time, how they behaved earlier in life, events earlier in life (difficulties involved, because of biases in procedure)
• prospective: look ahead in time (identify those with higher than average likelihood of becoming psychologically disorders and focus on them before hte disorder manifests itself)

• two or more treatments are compared in differing yet comparable groups
• control group - efficacy of htat treatment has been established
• see if NEW treatment has greater improement

• same individual is studied over time (behavior at one point is compared to another point)
• ABAB - treat, then return to baseline, treat, then regturn to baseline

• can we generalize the results from animal studies to humans?
• use this
• study an approximation to the true item of interest

• scientific approach
• oppenness
• respect for dignity, integrity and growth potential of all persons

• mind is entirely the product of the physical brain
• mental disorder can be entirely traced and reduced to phsyical processes

• mind is separate from the body/brain
• mental experiences not contained in cells, bodies, brains

• substance dualism: the mind and the body are completely different materials
• property dualism: mind and body may emanate from same substances, but can't reduce one to other
• - can see chemical acitvity, but not content
• - can see location of activity, but not "thoughts" "feelings" per se

• spritualism
• naturalism
• humanism
• its not a linear progression through the three (waxes and waves over history, current theories tend to blend the views

• dualistic viewpoint
• uniqueness of mind from spirits (higher religious powers, devils, demons, mysterious forces)
• bodies are just the holding binds for spiritual forces/souls
• treatment by religious institutions
• disorders are due to possession by particular spirits (lycanthropy - possessed by wolves, or tarantism by spiders)
• the social context is essential! (black death, koro in Nigeria)

• the mind and disorder are a product of observable physical properties
• a science
• roots to ancient greece, china, egypt (hippocrates)
• Paracelsus
• "nervous exhaustion"
• promoted the scientific approach
• behaviorism

• 4 material elements - earth, fire, air, water
• (heat, cold, moist, dryness)
• (blood, phlegm, bile, black bile)

• rationality, reason, ethics, justice = guide for human behavior and disorder
• humans actively shape own behavior and give meaning to life
• psychological influences on disorder - psychoanalytic theory, humanistic psychology,

• a very early approach to treat mental disorders
• chip away circular area of skull to let the evil spirit escape

• primary means for treatment of possession (spirtualism theory)
• cast an evil spirit out of an afflicted person

• natural causes/clinical observation/brain pathology
• 3 categories: mania, phrenitis, melancholia
• doctrine of 4 humors --> inbalance = disorder
• importance of dreams (modern psychodynamic psychotherapy)

• viewed psychological phenomena as responses of the entire organism (reflects internal state/natural appetites)
• looked at sociocultural influences

• student of plato
• descriptions of consciousness

• greek physicians
• contribution to the understanding of anatomy of nervous system (physical and mental categories!)
• work to use medications to treat mental disorders (apotherapy)

• earliest civiliaitons that focused on medicine/attention to mental disorders
• belief in natural not supernatural
• focused on restoring balance in treatment
• Chung Chiang (hippocrates of china)
• but these views regresesd to belief in supernatural! (just like in the west)

• mental hospitals established
• Avicenna from Arabia (humane practices)
• scientific inquiry limited (more characterized by ritual/superstition)

• occurred in middle ages
• whoel gorups of people affected simultaneously (hysteria)
• tarantism (impulse to dance)
• Saint Vitus's dance ( same as tarantism)
• lycanthropy (possessed by wolves)
• koro: fear of genital retraction (a view help today in Nigeria)

• in middle ages
• exorcism to get rid of evil spirit

• during humanism movement - importance of human interests
• mental disorder = product of disease
• but had elements of spirituality - moons influence

• hated the accusement of witchraft
• one of first physicans to specialize in mental disorders

• places of refuge for care of the mentally ill
• grew in number in 16th century
• Bedlam = first asylum - bad conditions/practices
• treated like beasts, chaining, inadequate food, uncleanliness

• humanitarian reform in 1792
• chains removed from asylums, sunny rooms, excersize, kindness

• by benhamin rush
• treatment that focused on a patient's social, individual, and occupational needs
• moral/spiritual development (not focus on the disorders)
• effective but abandoned in 19th century

treatment that focused on physical well-being of hospitalized mental patients

• humane treatment for patients - attention to the conditions fo the asylums and prisons
• mental hygiene movement
• money to build many hospitals

• benjamin franklins - explore shock to treat mental illness because he was shocked and it changed his memories
• but not till later htat it was used as treatment for depression

• followed work on Dix - told of bad treatment -
• campaign to get awareness
• hated straight jackets

• paresis due to syphilis (treatment by malaria)
• brain pathology = a cause (led to labotomies)

• psychoanalsis
• inner dynamics of unconscious motives
• free association, dreams, early conflicts, hypnosis to release emotions!

• Nancy: hysteria = self hypnosis - psych cause
• Charcot = degenerative changes caused hysteria - bio cause

wanted to study psychopathology objectively - American labs and clinics

emphasized the role of learning

• unconditioned behavior with neutral stimulus
• Watson

skinner - consequences of behavior influence behavior

• interactive: some amt of diathesis and some amoutn of stress
• additive: they combine and must go past some critical level

• make it less likely you'll respond badly to stressors
• leads to resiliency!
• Biological - genes, temperament
• Psychological - high self esteem, high IQ
• Social (parents, friends)

• neurotransmitters
• hormones
• genetics
• genotype - environment interactions
• genes/evolution
• temperatment
• brain dysfunction/neural plasticity

• norepinephrine: emergency reactions
• dopamine: shizophrenia/addiction
• glutamate
• serotonin: depression/anxiety
• GABA: anxiety
• there are environmental effects on neurotransmitters !! (rhesus monkeys and neurotransmitter)

• sometimes there are problems in the negative feedback loops
• problems with cortisol usually

• reactivity/ways of self regulation
• fearfulness/irritability, frustration, affect, control
• --> neuroticism/extraversion/constraint
• modulated by the environment - these effects can be passed on (epigenetic changes)

• Id - instinct/pleasure
• Ego: reality, manages the id
• Superego: internalize moral views/taboos, conscience
• disorders occur when there are conflicts between the 3!
• Anxiety plays a huge role - ego-defense mechanisms
• Psychosexual stages of development
• Oedipus/Electra complex

• Mahler, Klein
• indivudals relationships with other people, internal/external ojects

• psychopathology is rooted in tendencies in interpersonal environment
• Erikson

• Bowlby
• early experiences with attachment relaitionships

• observable behavior!! - learning
• classical conditioning/operant conditions (learn how to get goal)

• generalization: response evoked by similar stimuli
• discrimination: learns to distinguish between stimuli

• Bandura - cognitive aspects of learning
• internal reinforcement, thoughts
• how thoughts/info processing get distorted
• Schemas - bad ones
• attribtuion theory

• representations of knowledge, our guides to information
• assimiliation: new info is distorted to fit existing schemas
• accomodation: schmeas are changed to incorporate new info (harder)

• how people assign causes to events
• non-depressed people have self serving biases for the positive things that happen in their lives (blame it on their goodness)

• Early deprivation/trauma, institutionalization, neglect/separation
• Bad parenting styles (authoritative = best)
• Interpersonal Relationships - marital discord, divorce, peers rejection

• authoritative - competent children
• authoritarian - conflicted, irritable chidlren
• permissive/indulgent - impulsive/aggressive children
• neglectful/uninvolved - moody, sad kids

• there is a universality of symptoms but the culture shapes the disorder/how its is viewed/its course
• cultural bound syndromes
• interpret behavior differently because of different norms

• low SES, unemployment
• prejudice/discrimination
• social change/adjustments (helplessness like 9/11)
• violence/homelessness in urban areas

• categorical: healthy/disordered
• dimensional: differing intensities on certain dimensions
• prototype: essential characteristics, prototypical criteria, match a description or not?

• communication
• search for causes/treatments
• prognosis

• leads to expectations
• stigma
• self-fulfilling biases
• subjectivity
• reification
• power issues

• cateogircal with sharp boundaries
• multiaxial
• categories of signs/symptoms
• exact, specific dimensions
• IV- incorporated cultural/ethical considerations

syndromes/other conditions that are a focus

personality disorders, metnal retardation

general medical conditions that are relevant

• psychosocial/environment problems
• stressors

global assessment of functioning (GAF scale)

• reliable? valid? interview biased?
• comorbidity
• need more axes?
• not scientific! - biased, subjective, conflict of interests
• hard to fit real people to criteria

• understand the person, predict behavior, plan treatment, evaluate treatment outcome
• starts broad then narrows down

• physical exam
• neurological exam (EEG, CAT, MRI, fMRI, PET)
• neuropsych exam (cog./perceptual motor performances)
• observation of behavior (natural vs. structured)
• assessment interviews - structured vs. unstructured
• psych tests (intelligence, personality - projective vs. objective)

• WAIS-III, Stanford-Binet
• Verbal (vocab) and performance (digit span)

• MMPI - T/F questions
• compare answers to the norms, detect lying
• can you really test individuals complexities?
• actuarial data - behavior can be scored

• very ambiguous stimuli
• Rorschack - can overpathologize
• Sentence completion - little more structured
• TAT - outdated, but can see concerts

is this an art or a science? reliable? valid?

• cultural bias
• theoretical orientation
• underemphasis on external stuff
• insufficient validation
• inaccurate data/premature evaluation

• a systematic diagnostic schedule for classifying disorders
• diagnostic algorithms

• emotion: interupts thinking, very short lasting
• mood: affects environment/thinking, lasts much longer

• we all have a baseline that we return to
• rooted in temperatment (genetics)
• psotivity vs. negativity

breakdown in the affect regulation system that causes disorders!

• low, longstanding depressivity, depressed mood + 2 more symptoms
• at least for 2 years
• never without it for more than 2 months

• more symptoms/persistent than dysthmic
• fatigue, guilt, hopelessness, no pleasure, lazy, appetite changes, sleep changes, suicide
• incidence rises in adulthood

• with melancholic features (loss of interest)
• with psychosis (no contact with reality)
• with atypical features (mood congruent)
• with catatonic features
• with seasonal pattern
• with postpardum onset

• 2x as likely in women
• more in w. industrialized nations

• genetics, serotonin transporter gene
• neurotransmitters
• HPA abnormality
• Brain changes
• abnormal sleep REM patters, circadian rhythm dysfunctions

• lower activity in L. hemisphere
• increased activity in amygdala
• decreased volume of orbital prefrontal cortex
• decreased volume of hippocampus
• decreased activity in anterior cingulate cortex

• stress events and how they are perceived
• vulnerabilities (neuroticism/negative affect, early adversity)

• Freud: anger turned inward (ambivalence between love and hate)
• emphasize the importane of loss

dont' get positive reinforcment, increasing negative reinforcments

• dysfuntional beliefs
• negative automatic thoughts
• Negative Cognitive Triad
• Think in extremes, attention to negative stuff, arbitrary evidence
• errors in thinking

neg. thoughts abotu self, experiences, future

• no control leads to helplessness
• internal/external, global/specific, stable/unstable
• Rumination (may be why women are more depressed than men)

• less serious than bipolar, more chronic,
• hypomania and moderate depression

• I: one or more manic episodes and major depression
• II: no full blown manic episode (hypomania + MDE)

• 70-80% heritability - big genetic contribution, polygenic genes
• changes in norep/serotonin/dopamine
• HPA abnormalities (increased cortisol)
• deficits in dorsolateral prefrontal cortex
• circadian rythm offsets

• stressful events
• low social support
• attritbution styles
• thought processes

• very likely to ocur during mixed moods (mania and depression)
• more attempts by women, more completed by men
• mood disorders, coduct disorders, substance abuse
• alterations in serotonin
• more whites than blacks

treat disorders, crisis intervention, focus on high risk groups

• Monoamine theories
• Drugs
• Other treatments - electroconvulsive therapy, transcranial magnetic stimulus, bright light therapy

• Lithium - mood stabilizer for mania, prevents cycling
• anticonvulsants
• antipsychotics

• MAOI's - inhibit monoamine oxidase from breaking down serotonin/norepinephrine
• tricyclics- bad side efects, increased transmission of hte neurotransitters
• SSRI's - stops reuptake!
• Buproprion

• focus on symptoms
• teach new skills
• change environment
• reinforce good behaviors

• cognitive revolution in depression (bad schemas, thought processes)
• Beck's cognitive triad for negative thinking

• 1. dichotomous/polarized
• 2. overgeneralizations
• 3. magnification
• 4. personalization
• 5. arbitrary inference (not enough evidence!!)