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PSYC02H3 Lecture Notes - Tabular Islamic Calendar, Narcissistic Personality Disorder, Encyclopedia

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Lecture #27
Mental Disorders (Part I)
ŸMental disorders have at the heart that people have abnormal thoughts and behaviours, not entirely
clear what abnormal refers to
ŸFor e.g. abnormality can be a deviation for the average, statistically rare, however this treats all
abnormal behaviours as equally abnormal, genius incurs as much as stupidity, positive deviations and
classified the exact same way as negative deviations, not preferred
ŸAbnormalities reflect deviations from group, developmental or cultural norms, generally accepted
expectations of how we should think, feel and act (behave), abnormalities would then be the failure to
meet those expectations, but the problem is the expectations are changing from one cultural context to
the next, and we would prefer a definition that does not depend on the characteristic thats depend on
the viewer (man or woman, young or old, all with different expectations)
ŸSpecify an ideal for mental health, a standard, and say that abnormality is the failure to achieve that
idea, on the basis of a theory, this is what good mental health looks like, so abnormality is the failure to
show that mental health (e.g. sense of personal integration, healthy person has well integrated ego,
superego and id, ability to cope with stress, see things in the world as they are, unconditional sense of
self acceptance)
Ÿ Many theories of what a person is and looks like, but all of these standards together is a depiction of
functioning which none of us can achieve, meaning we are all abnormal
ŸAbnormality is what is personally distressing about us, this definition covers a lot of ground, almost
every disorder in encyclopaedia or dictionary involves a type of distress
ŸProblem is its ALMOST all, there are occasions where there are abnormal behaviours where there is no
distress, for e.g. narcissism, abnormal behaviour in which narcissists aren’t bothered by their
behaviour, odd but not distressing to the person
ŸPragmatic point of view, you will not be locked up and towed away just because you have odd
thoughts, delusions or odd thoughts, once you become bothersome to other people, then they lock you
up, extremely important quality, abnormality and mental health have an interpersonal quality
ŸNarcissistic personality disorder, they are not bothered about it, but their attitude annoys everyone else
that makes him abnormal, similar with anti-personality disorder
ŸFinal notion critical is impairment, whatever abnormality is, it involves failure of a functioning, ability
to thrive in personal, occupational of social domains, at the end of the day, a very critical idea
ŸTo what extent do the symptoms you experience, impair your behaviour in love, friendships, etc.
ŸYou are no disordered from the dsm point of view, unless your social (14 minute)
ŸAll of these definitions tap into what we think about mental disorders, we are talking about
infrequencies, negative ideas of social standards, etc.
ŸLot of theories about what caused abnormality, psychodynamic model originating with Sigmund
Freud, what we see constituting for abnormal behaviour most likely is an issue of the unconscious to
the personality between id, superego or ego. (source of anxiety, or other frameworks, hidden
underlying unconscious problems)
ŸCognitive-behavioural model, learning theorist point of view, we expect normal behaviour to be
learned, because they learn to act that way, abnormal behaviours are discouraged or punished, what is
the reinforcement behaviour of this individual
ŸHumanistic-existentialist model, abnormal behaviour as a failure to receive unconditional positive
regard, like from or parents, failure to become a fully complete, functioning person
ŸThe most prevailing widely used model, is the medical model, most prevalent model for describing
mental disorder (inappropriate application), explains symptoms by postulating disease, you see signs of
symptoms and the explanation for that is a disease, and the disease is different from the symptoms
Ÿe.g. you have symptoms of exhaustion, fatigue, difficulty concentrating, runny nose, and the
explanation is the flu, the cause of the symptoms
ŸThis works in all sorts of domains, all sorts of tests to indicate diseases, but this is th esame framework
used for disordred behaviour, so when you ask why is she sad, its because she has depression, the
disease entity that explains sadness
ŸWhy is that wrong? Int aht case, the symptom and disease is wrong, why is she sad? She has
depression, what is depression? Depression is sadness
ŸTries to explain symptom with the symptoms, circular reasoning
ŸWhat we call disorders are not diseases, it is diagnostically and statistical recognition that they are
group of symptoms that tend to cluster together
ŸVery common practise that symptoms and diseases interchange, when we speak of something like
depression, you speak about underlying disease, biological based, which medicine is cure
ŸAnother approach, socio cultural approach, acknowledges the general to use symptoms as explanatory
mechanisms for symptoms and postulates the he we regard kinds of things people bring into clinics as
general problems of living
ŸWithin any cultural context there are expectations and constraints between how and where people
strive, and not all of us can work well within requirements of culture, and this is experienced as
distress, and then bearing this set of complaints to psychologists, people in community that would help
ŸThese problems are best seen as that, problems in living a life
ŸIf someone is depressed or anxious, best question to ask is what are you depressed ABOUT? And that
is usually about something immediate in their environment (e.g. I am stressed about losing my job)
ŸFinal model, which is pretty good, based largely in clinical research, a-theoretical model, the diathesis
stress model, which assumes or argues that symptoms area result of two things, vulnerability inside
the individual (diathesis), and exposure to some stress related to that vulnerability
ŸE.g. why is she distressed? She is perfectionist, personal vulnerability relevant to failure to achieve and
she didn’t do so well on her midterm, explanation of symptoms of depression is a combination of her
perfectionism, her vulnerability and the factor of her failure in performance in the mid term
ŸDiathesis stress model, (slide 7) individuals who have vulnerability factor who are exposed and not
exposed to stress, and individuals who have low vulnerability and are exposed and not exposed to
ŸOne column stands out, the fourth column, symptoms are predicted not by stress, or diathesis but the
combination of both having the vulnerability and being exposed to the stress
ŸSo those of us who walk around with the vulnerability, we will act the same unless stress is present
ŸClassifying abnormal behaviour (dsm) multi-dimensional classification, various levels of which you
can be screwed up, and in reference to the dsm-IV, the general idea is that there are 5 sets of general
ŸFirst is clinical disorder, very clear clusters of problems, very clear beginning and end points, like
depression, anxiety, schizophrenia, etc., things that people complain about, or what others complain
about, concrete start and end points (my depression started after I lost my job)
ŸAxis two is how screwed up is this person generally, all the set of problems that you will not complain
about but you have nevertheless, you’ve been this way your entire life, reflect your general type of
impairment, distinct in that they don’t have clear beginnings or ends, patterns of behaviours well back
in childhood, personality traits, like narcissistic, avoidant, etc
ŸThird axis of diagnosis is medical problems of why these symptoms appear, cause certain mental states
ŸPsychosocial and environmental problems, stressful stuff that has happened to one in the last year,
divorce, death, loss of job, unsettling events, rated from 1-7
ŸFifth axis is notion of impartment, you the counsellor, doctor, have a global assessment of how this
person is doing in the world, social, occupational personal life, from 0-100
Ÿe.g. a person who presents an immediate presentation for being there is problems with alcohol
depression, perhaps tied to recent divorce and job loss, with underlying personality disorder, prone to
criminal behaviour and sensation living, and liver problems, 30/100 overall àdescription of person
with respect to the five things
ŸHow does this process derail? What are the problems that show up with classifying, the first involves
distinctions between clinical and statistical judgement, one of the first problems is that human beings
are making the diagnosis, an experience clinician of some kind will be giving many types of tests and
interviews with the patients (sources of data), and all of this has to be summarized, make a judgement
of what disorder they have, not accurate, they use their head, their intuition, their knowledge
ŸAlternate approach is the actuarial or statistical approach, which is to say you approach this a way an
accountant would, you have all of this information, and you develop a formula that puts them all
together weighting how important it really is, you don’t use anything else but the formula
ŸVery rarely done in practise, most clinicians will never use a formula, which is a shame because the
formula usually wins every time, the expert on whose judgment we rely is outperformed by a computer
almost every time, formulas are more reliable
ŸWhy? Clinicians are vulnerable to many things, they get tired, have personal biases, affected by recent
events, very large volumes of data to process, humans have limits, all of which formulas don’t
ŸSame information may evolve into two different diagnoses by different clinicians, but with formula
this wont happen
ŸTo this day we rely on ‘expert judgment’ of clinician
ŸEvery now and then you need to make exception, even with formulas, problem is clinicians allow for
too many exceptions, exceptions to rules should be rare, but to clinician exceptions become rule and
they often do so recklessly