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Roshan Singh
Chapter 17 Notes
Some mental disorders (especially less severe ones) appear to be caused by environmental factors or by a
persons perception of these factors such as stress or unhealthy family interactions. Many of the more
severe mental disorders appear to be caused by hereditary and other biological factors that disrupt normal
thought processes or produce inappropriate emotional reactions.
Emil Kraepelin (1856-1926) provided his version of a comprehensive classification system of
psychological disorders.
Psychologists stress that the most important feature of a mental disorder is not whether a persons
behaviour is abnormal but whether it is maladaptive.
In general, mental disorders are caused by the interaction of hereditary, cognitive and environmental
factors. Once genetic factors are identified, the scientist faces the task of determining the physiological
effects of the relevant genes and the consequences of these effects on a persons susceptibility to a mental
disorder. Understanding cognitive factors requires identification of the origins of distorted perceptions and
maladaptive thought patterns. Environmental factors include a wide range of factors, from a persons
family history and present social interactions, to their diet, exposure to drugs or alcohol, and childhood
The psychodynamic perspective suggests that the conflicts between the id, ego and superego may centre
on attempts to control potentially harmful expressions of sexual or aggressive impulses or they may also
arise from attempts to cope with external dangers and traumatic experiences. The result is that the defence
mechanisms themselves distort reality or the individual begins to function in some areas of life in a
manner characteristic of an earlier developmental stage. The consequent may involve symptoms such as
extreme anxiety, obsessive thoughts and compulsive behaviour, depression, distorted perceptions and
patterns of thinking and paralysis or blindness for which there is no physical cause.
The medical perspective originated from the work of the ancient Greek physician Hippocrates. In the past
almost everyone was institutionalized whereas today only people with very severe and intractable mental
problems are institutionalized for long periods of time. The medical model is based on the ideas that
mental disorders are caused by specific abnormalities of the brain and nervous system and that they
should be approached for treatment in the same way as physical illnesses.
The cognitive-behavioural perspective holds that mental disorders are learned maladaptive behaviour
patterns that can best be understood by focusing on environmental factors and a persons perception of
those factors.
The humanistic perspective suggests that mental disorders arise when people perceive that they must earn
the positive regard of others. Thus, they become overly sensitive to the demands and criticisms of others
and come to define their personal value primarily in terms of others reactions to them.
The sociocultural perspective suggests that the cultures in which people live in play a significant role in
the development of mental disorders.

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Roshan Singh
Chapter 17 Notes
Diathesis-stress modelA causal account of mental disorders based on the idea that mental disorders
develop when a person possesses a predisposition for a disorder and faces stressors that exceed his or her
abilities to cope with them.
Diagnostic and Statistical Manual IV (DSM-IV)A widely used manual for classifying psychological
The DSM-IV tends to be more consistent with the medical perspective on mental disorders than with
other perspectives i.e. it only focuses on biological factors and that potential cognitive and environmental
determinants may be overlooked.
Thomas Szasz suggests that we should abandon all attempts to classify and diagnose mental disorders. He
argues that the concept of mental illness has done more harm than good because of the negative effects it
has on those people who are said to be mentally ill.
Advantage of proper classification for a patient is that the recognition of a specific diagnostic category
precedes the development of successful treatment for that disorder. If future research is to reveal more
about causes and treatments of these disorders, we must be able to classify specific mental disorders
reliably and accurately.
In a survey conducted by Newman and Bland (1998), Edmonton was checked for incidence of mental
disorders. In this survey, substance use disorders, mood disorders and anxiety disorders were found to be
the most common types of mental disorders. Their findings are consistent with other prevalence surveys
from different locations and suggest that mental disorders occur at a fairly high frequency.
2 activities contribute to diagnoses and predictions: collection of data and interpretation of data. Both are
essential as unreliable or irrelevant data cannot be interpreted and good data can be spoiled through
In a clinical judgement, it is not the source of information that is important, rather it is the processing of
that information.
Clinical judgementsDiagnoses of mental disorders or predictions of future behaviour based largely on
experts experience and knowledge.
Actuarial judgementsDiagnoses of mental disorders or predictions of future behaviour based on
numerical formulas derived from analyses of prior outcomes.
It was first devised for setting the rates of insurance policies. Goldberg (1986) compared the 2 methods
and found that on average, judges were correct 62% of the time about their patients, the best judge being
correct 67%. The actuarial rule was superior as it was correct 70% of the time which was better than the
best judge.
Actuarial method is better because of its reliability as experts may become tired, their judgement may be
influenced by some recent cases in which they were involved, or the order in which the information is

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Roshan Singh
Chapter 17 Notes
presented to them may affect which items they consider in making their decisions. Another reason would
be the quantity of data and we also have a tendency to pay too much attention to information that is
consistent with our own hypotheses and to ignore or minimize contradictory information. Possible reasons
for the choosing clinical method are clinicians are unaware of the superiority of actuarial method; find the
method dehumanizing i.e. it ignores the fact that each person is unique and a little bit of ego i.e. how their
long training and practice can be duplicated by a formula or computer program.
Perhaps experts should concentrate their efforts on what they do best and what a formula cannot do i.e.
observing peoples behaviour, developing new and useful measurements, and providing therapy and leave
routine diagnosis to the actuarial method to cases where they have been shown to be superior.
From a psychoanalytic perspective, anxiety, somatoform and dissociative mental disorders are known as
neuroses and they are strategies of perception and behaviour that have gotten out of hand. Pathological
anxiety may result from an inadequate number of defence mechanisms, from immature defences that
cannot cope with the anxiety or from defence mechanisms applied so rigidly that they have become
maladaptive. However, they do not suffer from delusions or severely disordered thought processes and
realize that they have a problem. Neurotic behaviour is usually characterized by avoidance rather than
confrontation of problems. To avoid stressors, people with neuroses often turn to imagined illnesses
oversleeping or forgetfulness.
AnxietyA sense of apprehension or doom that is accompanied by many physiological reactions such as
accelerated heart rate, sweaty palms and tightness in the stomach.
PanicA feeling of extreme fear mixed with hopelessness or helplessness.
Panic disorderUnpredictable attacks of acute anxiety that are accompanied by high levels of
physiological arousal and that last from a few seconds to a few hours. The disorder usually has its onset
between the late teen years and the mid-20s; it rarely begins after a person reaches his or her forties. The
symptoms are sometimes mistaken for a heart attack rather than components of a psychological distress.
Anticipatory anxietyA fear of having a panic attack; may lead to the development of phobias.
Panic disorders are difficult to explain as they are extremely maladaptive. Researchers believe that such
disorders are caused either by physical or cognitive factors or by interactions between the two.
A twin studies shows that there is a higher concordance rate for the disorder between identical twins that
fraternal twins and a significant number of first-degree relatives of a person with panic disorder also have
panic disorder (first-degree relatives being a persons siblings, parents and children), giving us the reason
to believe that there are biological influences in the development of panic disorders. People with panic
disorder periodically breathe irregularly both when awake and when asleep. It is also known that panic
attacks can be triggered in people with histories of panic disorder by giving them injections of lactic acid
or having them breathe a high amount of carbon dioxide.
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