PSYCH 202 Lecture 12: Introduction to Psychopathological Conditions of Adulthood and their Treatment I
Introduction to Psychopathological Conditions of Adulthood and their Treatment
The Value and Danger of Labels--Categorization and psychiatric diagnosis:
Essential to the study of. Still learning. Will be able to diagnosis via genetic markers.
facilitates professional communication Need vocab, know what to talk about
leads to shorthand description, rich with implicative meaning Words and identification of
symptoms
entails predictive/postdictive probabilistic implications implies what they’re like now, in the
past, and future. If they get treatment or not.
can assist planning maximally relevant treatments
can trick us into thinking we understand when we don’t distance between them and person
and seeking help. Can be extremely misleading
can stigmatize and lead to self-fulfilling prophesies Create a loop where people are treated as
limited. Act how others expect you to.
David Rosenhan’s Classic Study: “On Being Sane in Insane Places”
(Science, 1973, Vol. 179, pp. 250-258)
Went into mental hospitals and faked that they heard voices, “empty, thud, dull”. They were dehumanized. No one
talked to them, 6.5 minutes a day. No one comes to visit. No one came to visit. “Storehouses for people you don’t
want or understand.” No one recognized that they were “sane”.
Critique, and Impact on Development of DSM’s:
Critique:
Was it unreasonable to label them “insane”?
Only heard voices one time,
After admitted, “we acted the way we usually behaved”?
Took notes, tried to talked to workers and patients, “What are you doing here? You don’t belong here”. See as
paranoid when writing. Danger of stigmas and SFP. Funneled through a lens of perception.
Impact of Study on the DSM and Diagnostic Practice:
Needed to change. Committee led to convo that basing a diagnosis for a single symptom at a single time wasn’t
enough to make diagnosis. What number are sufficient? Looking at disorder through lens as diagnostic criteria,
history, background, family history, drugs, alcohol, another medical problem
single symptoms are inadequate bases for diagnosis
DSM’s subsequently articulated detailed “diagnostic criteria”
see p. 86 Jamison for list of diagnostic questions, the answers to
which form the basis for the clinical judgment about
presence/absence of “criteria”
Symptom overlap and distinguishing
Diagnosis of a “Mood Disorder” begins with assessing present Mood Episodes:
Episodes are part of a disorder, but themselves don’t lead to an ultimate final diagnosis.
Major Depressive Episode
Manic Episode
Hypomanic Episode
Psychotic Features as an Episode-Specifier:
Hallmarks of Psychosis: Delusions and Hallucinations.
See things, hear things, disconnected, paranoid, integrated beliefs that aren’t true
Presence of Psychotic Features in Mood Disorders is seen in:
Mood misorders
Mood-Congruent Delusions (Depressive Delusions of utter
worthlessness/repulsiveness of self-Manic Delusions of Grandeur,
Unlimited Power and Influence)
Hallucinations (typically auditory)
Audio Example: Manic Mood Episode with Delusions of Grandeur and Power?
“Well I stand up next to a mountain, and I chop it down with the edge of my hand
(Repeat; but irritable--grrrr ; insistent/demanding)
You know I pick up all the pieces and make an island; I might even raise a little
sand. Yeah!
Cause I’m a VooDoo Child, Lord knows I’m a VooDoo Child baby ….”
--Jimi Hendrix, 1967, Electric Ladyland 0:00 - 2:27, track 6
Illness or Art?
I vote “art” with a dash of political empowerment and Freudian “sublimation” (see
table on “defense mechanisms”)
Channeling “flaws” into constructive skills. What civilization is built off of
Consider the artistic-political context in 1967:
Civil rights movement, Vietnam War, feminism, Black Panther movement, black power, etc.
What is a “Manic Episode”? DSM Diagnostic Criteria:
Stuck in moods,
Manic Mood Episodes show as a distinct period of abnormally and persistently
elevated, expansive, and/or irritable mood, indicated by three or more of
following:
inflated self-esteem or grandiosity
decreased need for sleep
more talkative than usual or pressure to keep talking (pressure of speech)
flight of ideas or subjective experience that thoughts are racing (p. 82 KRJ)
distractibility (i.e., attention too easily drawn to unimportant or irrelevant
external stimuli)
increase in goal-directed activity or psychomotor agitation
Lots of plans
excessive involvement in pleasurable activities that have a high potential for
painful consequences (e.g., unrestrained buying sprees, sexual
indiscretions, foolish business investments)
Do things b/c you want to feel good but ultimately fuck you over.
The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with
others, or to necessitate hospitalization to prevent harm to self or others, or
there are psychotic features
(note that this criterion distinguishes hypomanic episodes from manic
episodes:
In a Hypomanic episode there is NOT “marked impairment” NOR are
there ever “psychotic features.”
Hypo is less than manic
In Manic episodes there is always “marked impairment” (symptoms are
interfering with marketing) and sometimes psychotic features. Thus
the Sx’s are more severe, more interfering with adaptive functioning,
in mania than in hypomania)
What is a “Hypomanic Episode”?
See Manic Episode severity discussion above
Symptoms are not getting in the way of person’ life. No current or present psychotic features. Hypomania precedes
mania. Sometimes act as if there’s no problems.
Document Summary
Introduction to psychopathological conditions of adulthood and their treatment. The value and danger of labels--categorization and psychiatric diagnosis: If they get treatment or not. can assist planning maximally relevant treatments can trick us into thinking we understand when we don"t distance between them and person and seeking help. Can be extremely misleading can stigmatize and lead to self-fulfilling prophesies create a loop where people are treated as limited. David rosenhan"s classic study: on being sane in insane places (science, 1973, vol. Went into mental hospitals and faked that they heard voices, empty, thud, dull . No one talked to them, 6. 5 minutes a day. Storehouses for people you don"t want or understand. no one recognized that they were sane . Impact of study on the dsm and diagnostic practice: Committee led to convo that basing a diagnosis for a single symptom at a single time wasn"t enough to make diagnosis.
