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the 7 modes of mental illness
- Statistical
- SOcial Deviance
- Moral
- Medical
- Ecological/impairment
- Harmful dysfunction
- Transactional
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statistical mode of mental illness
- 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?
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social deviance mode of mental illness
- 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
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moral model of mental illness
- 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
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medical model of mental illness
- 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)
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ecological impairment model of mental illness
- 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)
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harmful dysfunction
- 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?
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transactional model of mental illness
- 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
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what percept of population will have any disorder at any point in life?
- 46%, very high
- its a pervasive problem
- and these prevalence rates are comparable around the world
-
severe mental illness prevalence?
moderate prevalence?
child forms?
- severe - 6%
- moderate - 20%
- child forms (25%)
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why bother defining abnormality?
- high prevalence!
- impairment (relationships, health, skills, shame)
- debilitating (5 of top 10 most disabling = mental disorders)
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The elements of abnormality
- 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
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DSM definition of diorders
- 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
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why is classifying a mental disorder hard?
- 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)
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the disadvantages to classifying disorders
- 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
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examples of culture specific disorders
- 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)
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deinstitutionalization
the trend away from the use of traditional hospitalization (long in patient stays)
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the mental health professionals
- psychiatrist - prescribe medications
- clinical psychologyist - individual therapy
- clinical social workers - family problems
- psychiatric nurse - checks in with patient
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sources of abnormality research information
- case studies - bias, low generalizability
- self-report data - people aren't good reporters of own states, etc.
- observational - direct observations, brain imaging,
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ways to view the brain
- fMRI (use magnetic field on water molecules)
- transcranial magnetic stimulation (magnetic field on top of head - brian tissue is stimulated)
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criterion group vs. comparison group
- criterion group: people with disorder
- comparison group: control group (no disorder but comparable to other group)
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Research designs
- 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
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retrospective vs. prospective strategies
- 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)
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standard treatment comparison gorup
- 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
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single case research designs
- 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
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analogue studies
- can we generalize the results from animal studies to humans?
- use this
- study an approximation to the true item of interest
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study of abnormal behavior should be based on three principles
- scientific approach
- oppenness
- respect for dignity, integrity and growth potential of all persons
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Monism
- mind is entirely the product of the physical brain
- mental disorder can be entirely traced and reduced to phsyical processes
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dualism
- mind is separate from the body/brain
- mental experiences not contained in cells, bodies, brains
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substance dualism vs property dualism
- 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
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the three core views of human mind
- spritualism
- naturalism
- humanism
- its not a linear progression through the three (waxes and waves over history, current theories tend to blend the views
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spiritualism
- 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)
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naturalism
- 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
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the greek concept of four humors
- 4 material elements - earth, fire, air, water
- (heat, cold, moist, dryness)
- (blood, phlegm, bile, black bile)
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humanism
- 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,
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trephining
- a very early approach to treat mental disorders
- chip away circular area of skull to let the evil spirit escape
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exorcism
- primary means for treatment of possession (spirtualism theory)
- cast an evil spirit out of an afflicted person
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Hippocrates - naturalism
- natural causes/clinical observation/brain pathology
- 3 categories: mania, phrenitis, melancholia
- doctrine of 4 humors --> inbalance = disorder
- importance of dreams (modern psychodynamic psychotherapy)
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Plato
- viewed psychological phenomena as responses of the entire organism (reflects internal state/natural appetites)
- looked at sociocultural influences
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Aristotle
- student of plato
- descriptions of consciousness
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Galen
- greek physicians
- contribution to the understanding of anatomy of nervous system (physical and mental categories!)
- work to use medications to treat mental disorders (apotherapy)
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Early views in China
- 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)
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Middle Ages view of abnormality
- mental hospitals established
- Avicenna from Arabia (humane practices)
- scientific inquiry limited (more characterized by ritual/superstition)
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mass madness
- 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)
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Exorcism/Witchcraft
- in middle ages
- exorcism to get rid of evil spirit
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Paracelsus
- during humanism movement - importance of human interests
- mental disorder = product of disease
- but had elements of spirituality - moons influence
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Johann Weyer
- hated the accusement of witchraft
- one of first physicans to specialize in mental disorders
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The establishment of asylums
- 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
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Pinel
- humanitarian reform in 1792
- chains removed from asylums, sunny rooms, excersize, kindness
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moral management in usa
- 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
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mental hygiene movement
treatment that focused on physical well-being of hospitalized mental patients
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Dorothea Dix
- humane treatment for patients - attention to the conditions fo the asylums and prisons
- mental hygiene movement
- money to build many hospitals
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electric shock therapy
- 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
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Clifford Beers
- followed work on Dix - told of bad treatment -
- campaign to get awareness
- hated straight jackets
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Stuff that lead to the promotion of a scientific approach
- paresis due to syphilis (treatment by malaria)
- brain pathology = a cause (led to labotomies)
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Freud
- psychoanalsis
- inner dynamics of unconscious motives
- free association, dreams, early conflicts, hypnosis to release emotions!
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Nancy school vs. Charcot
- Nancy: hysteria = self hypnosis - psych cause
- Charcot = degenerative changes caused hysteria - bio cause
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Wundt and James
wanted to study psychopathology objectively - American labs and clinics
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Behaviorism
emphasized the role of learning
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classical conditioning:
- unconditioned behavior with neutral stimulus
- Watson
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operant conditioning
skinner - consequences of behavior influence behavior
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interactive vs. additive diathesis stress model
- interactive: some amt of diathesis and some amoutn of stress
- additive: they combine and must go past some critical level
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protective factors
- 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)
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Biological causes of disordres
- neurotransmitters
- hormones
- genetics
- genotype - environment interactions
- genes/evolution
- temperatment
- brain dysfunction/neural plasticity
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which neurotransmitters associated with which diseases?
- norepinephrine: emergency reactions
- dopamine: shizophrenia/addiction
- glutamate
- serotonin: depression/anxiety
- GABA: anxiety
- there are environmental effects on neurotransmitters !! (rhesus monkeys and neurotransmitter)
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problems with HPA axis
- sometimes there are problems in the negative feedback loops
- problems with cortisol usually
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Temperament
- 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)
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Freud's psychodynamic theory to causes of disordrs
- 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
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object relations theory for psycho causes to disorders
- Mahler, Klein
- indivudals relationships with other people, internal/external ojects
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the interpersonal perspective to causes of disorders
- psychopathology is rooted in tendencies in interpersonal environment
- Erikson
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attachment theory
- Bowlby
- early experiences with attachment relaitionships
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Behavioral viewpoints for causes of disorder
- observable behavior!! - learning
- classical conditioning/operant conditions (learn how to get goal)
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generalization vs. discrimination in behavioral learning
- generalization: response evoked by similar stimuli
- discrimination: learns to distinguish between stimuli
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Cognitive Behavioral viewpoint on causes of disorder
- Bandura - cognitive aspects of learning
- internal reinforcement, thoughts
- how thoughts/info processing get distorted
- Schemas - bad ones
- attribtuion theory
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schemas and distortion of them
- 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)
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attribution theory
- 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)
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Psychological Risk Factors
- Early deprivation/trauma, institutionalization, neglect/separation
- Bad parenting styles (authoritative = best)
- Interpersonal Relationships - marital discord, divorce, peers rejection
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parenting styles
- authoritative - competent children
- authoritarian - conflicted, irritable chidlren
- permissive/indulgent - impulsive/aggressive children
- neglectful/uninvolved - moody, sad kids
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sociocultural viewpoints on causes of disorders
- 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
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sociocultural risk factors
- low SES, unemployment
- prejudice/discrimination
- social change/adjustments (helplessness like 9/11)
- violence/homelessness in urban areas
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3 types of classification
- categorical: healthy/disordered
- dimensional: differing intensities on certain dimensions
- prototype: essential characteristics, prototypical criteria, match a description or not?
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benefits of labelling
- communication
- search for causes/treatments
- prognosis
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problems wiht labelling
- leads to expectations
- stigma
- self-fulfilling biases
- subjectivity
- reification
- power issues
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DSM
- cateogircal with sharp boundaries
- multiaxial
- categories of signs/symptoms
- exact, specific dimensions
- IV- incorporated cultural/ethical considerations
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Axis I
syndromes/other conditions that are a focus
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Axis II
personality disorders, metnal retardation
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Axis III
general medical conditions that are relevant
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Axis IV
- psychosocial/environment problems
- stressors
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Axis V
global assessment of functioning (GAF scale)
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criticisms of the DSM
- reliable? valid? interview biased?
- comorbidity
- need more axes?
- not scientific! - biased, subjective, conflict of interests
- hard to fit real people to criteria
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purpose of assessments
- understand the person, predict behavior, plan treatment, evaluate treatment outcome
- starts broad then narrows down
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procedure of assessments
- 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)
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intelligence tests
- WAIS-III, Stanford-Binet
- Verbal (vocab) and performance (digit span)
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objective personality tests
- MMPI - T/F questions
- compare answers to the norms, detect lying
- can you really test individuals complexities?
- actuarial data - behavior can be scored
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projective testing
- 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?
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5 ethical issues of assessment
- cultural bias
- theoretical orientation
- underemphasis on external stuff
- insufficient validation
- inaccurate data/premature evaluation
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SCAN
- a systematic diagnostic schedule for classifying disorders
- diagnostic algorithms
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emotion vs. mood
- emotion: interupts thinking, very short lasting
- mood: affects environment/thinking, lasts much longer
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Affective styles
- 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!
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dysthmic disorder
- low, longstanding depressivity, depressed mood + 2 more symptoms
- at least for 2 years
- never without it for more than 2 months
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major depression
- more symptoms/persistent than dysthmic
- fatigue, guilt, hopelessness, no pleasure, lazy, appetite changes, sleep changes, suicide
- incidence rises in adulthood
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major depression specifiers
- 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
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cultural differences in prevalence of major depression
- 2x as likely in women
- more in w. industrialized nations
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Biological Causes to major depression
- genetics, serotonin transporter gene
- neurotransmitters
- HPA abnormality
- Brain changes
- abnormal sleep REM patters, circadian rhythm dysfunctions
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brain changes in depression
- 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
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psychological causes to major depression
- stress events and how they are perceived
- vulnerabilities (neuroticism/negative affect, early adversity)
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psychodynamic theories to cause of MD
- Freud: anger turned inward (ambivalence between love and hate)
- emphasize the importane of loss
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behavioral theories to MD
dont' get positive reinforcment, increasing negative reinforcments
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Beck's cognitive thoery
- dysfuntional beliefs
- negative automatic thoughts
- Negative Cognitive Triad
- Think in extremes, attention to negative stuff, arbitrary evidence
- errors in thinking
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Becks' negative cognitive triad
neg. thoughts abotu self, experiences, future
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the helplessness/hopelessness theory
- no control leads to helplessness
- internal/external, global/specific, stable/unstable
- Rumination (may be why women are more depressed than men)
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cycothymic disorder
- less serious than bipolar, more chronic,
- hypomania and moderate depression
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Bipolar I disorder vs. II
- I: one or more manic episodes and major depression
- II: no full blown manic episode (hypomania + MDE)
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biological causes to bipolar disorder
- 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
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psychological causes to bipolar disorder
- stressful events
- low social support
- attritbution styles
- thought processes
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suicide, prevalence, common themes
- 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
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3 things for suicide prevention
treat disorders, crisis intervention, focus on high risk groups
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Biological treatments for mood disorders
- Monoamine theories
- Drugs
- Other treatments - electroconvulsive therapy, transcranial magnetic stimulus, bright light therapy
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drugs for mood disordrs
- Lithium - mood stabilizer for mania, prevents cycling
- anticonvulsants
- antipsychotics
-
monoamine theories
- MAOI's - inhibit monoamine oxidase from breaking down serotonin/norepinephrine
- tricyclics- bad side efects, increased transmission of hte neurotransitters
- SSRI's - stops reuptake!
- Buproprion
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behavioral treatments for mood disorders
- focus on symptoms
- teach new skills
- change environment
- reinforce good behaviors
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cognitive treatment for mood disorders
- cognitive revolution in depression (bad schemas, thought processes)
- Beck's cognitive triad for negative thinking
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5 errors in thinking
- 1. dichotomous/polarized
- 2. overgeneralizations
- 3. magnification
- 4. personalization
- 5. arbitrary inference (not enough evidence!!)
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