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PSY100- Dec 1, 2011.docx

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University of Toronto St. George
Dan Dolderman

PSY100 PSYCHOLOGICAL DISORDERS  We are a complex dynamic system  Top down processing is changeable  Person is not an entity, it’s a continual process of structure  Any therapy is catalyzing your process to change yourself o We have control over his  Eg if stuck in middle of ocean, you have no control and will go wherever the wind takes you power of situation (conditions, situation)  Now you take your shirt or anything to make a sail (eg) and now you have a little bit of control (even though you’ll be in the same spot as you were before, wind still overpowers you)  However, within time you could get somewhere if you consistently do this in one direction (not in short time though)  Our choices are constrained by our past emotions and conditions o Has to do with genetics but a lot with conditions  Its not magic, but overtime can make a difference Psychopathology: something to keep in your mind…  As we will see, the process of diagnosing someone with a specific disorder is fraught with uncertainty and subjectivity. This is an inexact science, and the perceptions and judgments of therapists can play a major role in whether someone is seen as “sick” what diagnosis is made, what treatment is prescribed and how subsequent behaviours are interpreted.  Plays huge role in how patient contributes and how sick they are  DSM categorization system/scheme where there’s a bunch of disorders and each one has characteristics symptoms associated with them  If you pass the threshold (eg, if you have 5 of the 9 symptoms) means you have the disorder o Whether or not you have the symptom is determined by the therapist and their interpretation o How do you determine if its severe or not?  Diagnosis means you have a certain amount of symptoms o Drugs just alleviate symptoms (don’t cure disorder)  Who you choose to see has differences on how you’re treated (eg. psychologist or psychiatrist)  Eg. Rates of DID (MPD) have risen from about 70 cases 30 years ago to tens of thousands of cases today; also 1-2 identities dozens to hundreds! o People change or diagnoses did?  How you feel at one point in time doesn’t mean you’ll feel that away another point in time  multiple personalities?  Eg. Depression vs. the blues; anxiety disorder vs. being worried; OCD vs. bring cautious and detail oriented o How do you decide? They are basically the same o There is no line (if you’re looking at extreme endpoints then there is a problem, but most of the time just in between) ADHD  3 key symptoms: o Inattention: distractibility, forgetfulness, disorganization, failure to follow instructions etc o Hyperactivity: fidgeting, restlessness, inability to remain seated etc o Impulsivity: difficulty taking turns, interrupting, impulsive spending etc  Most people have some of these in them  Eg. Children have this too (will find in every class, does that mean they all have ADHD?)  How different is this from the average kid? Where’s the line between normal and abnormal? o There is no line Normal? ADHD  Strangely, there is a lot of variability in ADHD diagnoses…  Eg. From 1987 to 1997, rates quadrupled  Did our way interpreting children change?  10% of 13-17 year olds in Gallup were reported to be on ADHD medication o is this necessary?  HUGE variability in the frequency of different teachers referring kids for assessment  Rates of ADHD vary but up to a factor of 10 in different countries in same areas of US  Go into mental health field with eyes wide open doctors don’t have the truth, they have HUGE biases, important to get different opinions o People tend to see things and treatments different The self-fulfilling prophecy of labels  Once someone sees you with the disorder, you start to see through those lens  A good accurate diagnoses serves a function (helps you understand what’s wrong and specific treatment options)  But if diagnoses is off then whole system is off  Once someone has been labeled with a disorder, that label carries a great deal of weight, affecting both how they see themselves, how the behave, and how others will see them  This tendency to categorize ourselves and others can sometimes be dysfunctional because after all, YOU are more than category X. its just a partial, temporary descriptor, not who you really are..  Eg. Label= “schizophrenic” how might this affect interpretations of a persons behaviour? Opportunities provided to that person? How their experiences are evaluated? Eg. Rosenhan: “on being sane in insane places”  How important labels are  Got 8 normal students with no disorders  And volunteered to go to doctor and complain of hearing voices that said “empty” “hollow” and “thud”  All admitted to hospital, 7 diagnosed as schizophrenic  Now professionals believe you are really, cant say “no I don’t have it”  How long before they got out of the mental institution? 7 to 52 days! (and 2100 pills later…) o They took none of them though, just spit them out (other patients doing it too)  Doctors had a difficult time telling them apart from normal people (real patients could tell difference but doctors couldn’t)  Doctors don’t respond to question, not responding to normal, polite question I normal way- because the good Docs don’t believe they are dealing with a normal person  Ignoring situational factors: eg. one “patient” observed: o Sitting outside a cafe half an hour before it opens, why? Because they have schizophrenia (has to do with that), but really there’s just nothing else to do/random/like talking/get best food  But once you have label, you don’t see anything outside of it Biased interpretations of person’s experiences  Fake patients say that their early childhood was basically normal (good relations with parents, loves his wife and don’t spank kids)  Staff doctors interpretation: basically fucked up, and is messed up with his emotions and out of control So how do the good doctors tell if someone has a disorder?  Eg. When dolderman eavesdropped on convo and doc just gave the woman a diagnoses for depression and said see ya  Doctors should use multiple criteria when figuring out a diagnoses Evaluating psychopathology: 3 macro criteria  Deviance: is the persons behaviours or experience outside of social norms? o A lot of people are though; eg. a lot of tattoos  Maladaptive: is it interfering with other, normal aspects of life, responsibilities, etc?? o Eg. what is you want success or a 4.0 average?  Personal distress: is the person greatly distressed? A continuum, not a dichotomy  One side is clearly functional/ normal: o Socially normative  ** slide Psychological assessment and diagnosis  Assessment begins with observing behavior and manner, discussing personal and family history, health issues, stress, etc  This helps guide ones diagnosis. Eg. is the person really distressed or just going through a rough time. Overview of the DSM  = Diagnostic and statistical manual of mental disorders  Multiaxial system o Axis 1: Clinical disorders o Axis 2: personality disorders and mental retardation  Personality disorders are generally long standing patterns, resistant to change (although not reliably differentiable form Axis 1) o Axis 3: general medical condition  Many physical illnesses can cause or exacerbate mental illnesses o Axis 4: psychosocial and environmental problems  Emphasis on family  Problems include relationship factors (support, isolation) o Axis 5: global assessment of functioning Rates of psychopathology  Are extremely common  10% of the population suffers from a disorder each year
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