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lect - april 2 (2).doc

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University of Toronto St. George

PSYCH - April 2 (final lecture) TA Talk: - memory and imagination are highly related to each other - both involve similar regions of brain - both become impaired in memory-loss - both memory and imagination for specific events seem to get worse as we age -------- "Chase after money and security and your heart will never unclench Care about other people's approval and you will be their prisoner Do your work, then step back The only path to serenity" - Lao Tzu Rise up this mornin, Smiled with the risin' sun, Three little birds Pitch by my doorstep Singin' sweet songs Of melodies pure and true, Sayin, ("This is my message to you") - Bob Marley - he has taught this course with the - everything in the brain is the same - systems perspectives (looking at multiple factors and how they converge) - top down and bottom up processes - interaction btw emotion and cognition - memory and imagination draw on virtually the same systems, sim parts of the brain - very relevant to psych disorders! - bc the way ppl interpret past events is the habit they use to approach the future - thus therapy involves getting ppl to re-interpret past events, which helps them to build habitual ways of thinking which they will use when they go forward into the future - ex: thinking past events are terrible, thinking it was all your fault, thinking life was terrible, then going into the future you think life is hopeless, i can't change things, won't make good decisions, etc. - anxiety disorders very related to this - the science of diagnosing ppl with a specific disorder is not precise and objective - there's no "litmus test" for psych disorders - diagnosing someone with a psych disorder is not precise - the same individual can be a very different person from day to day as well - ppl are complex, variable - thus it's difficult to categorize them into a little box to determine how to treat them Psychopathology: Something to keep in mind - the process of diagnosing someone with a specific disorder is an inexact science, and struggles with precision in diagnosis and treatment, for many reasons - ex: the perceptions, biases, and errors of the psychologists doing the diagnosing (does X meet the criteria? how severely?) and the treatment (ex: drugs vs therapy? that kind of therapy? how effective is the practitioner themselves?) - the person doing the diagnosing also has their own biases, knowledge base, prejudices, look at ppl in diff ways, have diff life experiences themselves, training in diff areas that predisposes them to take a diff approach (ex: psychiatrists think of mental health from a very physiological view, thus when think about treating mental illness they think about prescribing drugs; whereas psychologists are more inclined to think about treatment involving psych processes such as cognitive behavioural therapy, etc.); also diff health care professionals have diff inter-personal skills (it's much easier for ppl to talk to the warm/kind person than the cold person) - the disorders themselves are multi-faceted in nature (ex: people can be considered to have a disorder by meeting a certain ratio of the behavioural indicators; meaning there can be very little overlap in two ppl's experiences, and yet they have the same disorder? and should receive the same treatment?) - thus these background variables add variability in the process of treating someone - DSM is standard manual used for diagnosing psych disorders - ex: if patient meets 5 out of 9 of the symptoms of a particular disorder in the DSM, then they're diagnosed with that disorder; but the problem is that one person could meet symptoms #1-5, while another person could meet symptoms #4-9, and yet both would receive the same diagnosis and same treatment, even thu they only share one symp - ex: rates of DID (dissociative identity disorder) (MPD: multiple personality disorder) have risen from about 70 cases 30 years ago to tens of thousands of cases today; and one to two identities have risen from dozens to hundreds! - is there something in the env that's causing higher rates of DID and MPD? - the more realistic explanation is that the perception of it has changed, and psychiatrists have been diagnosing it more - ex: depression vs the blues; - ex: anxiety disorder vs someone who's kind of worried - ex: OCD vs someone who's more cautious and detail-oriented than the average person - it's difficult to know where to draw the line; there's no precise line; - but the field of psychiatry does has precise definitions for the above and draws a line btw them, in reality it isn't so exact and it can be a gradient - ex: same with ADHD ADHD: - 3 key symptoms: 1) inattention: distractibility, forgetfulness, disorganization, failure to follow instructions, excessive procrastination, frequently losing items 2) hyperactivity: fidgeting, restlessness, inability to remain seated, excessive talking 3) impulsivity: difficulty taking turns, interrupting, impulsive spending - ADHD is typically diagnosed in middle childhood (7 years or so), a time when children naturally possess these qualities - thus how do we decide where the line is btw normal and abnormal? - we don't know actually know where to draw the line - strangely, there's a lot of variability in ADHD diagnoses - ex: from 1987 to 1997 rates quadrupled - in 2005, 10% of 13-17 year olds were on ADHD medication (ritalin) - HUGE variability in the frequency of diff teachers referring kids for assessment - diff teachers interpret children's behav's differently - rates of ADHD vary by up to a factor of 10 in diff counties in same areas of US - most teachers that Prof has spoken with think that ADHD is overly-diagnosed - think it's a handy label to slap onto kids who are diff to manage - there's also uncertainty about how to treat ADHD - if you think of ADHD as a neurochemical problem, then you're more likely to prescribe ritalin - but if you think about it as the underlying systems being involved (pre-frontal cortex systems of emotional control, etc.), then treatment would involve things like meditation, etc. - it's imp to know this bc 40% will experience mental illness and ALL of us will/do have family/friends with mental illness (it's very common) The Self-Fulfilling Prophecy of Labels: - when you're feeling vulnerable and want help, you want clarity; want the expert to tell you clearly what the problem is, what's the diagnoses, and what to do about it - thus there's an emphasis on clear, simple statements by expert to patient - but it's imp to know in the back of your mind that this is not a litmus test; this is a highly subjective process; thus maybe i should seek a second opinion, maybe I should do my own research on the issue online --> this is definitely worth doing, bc of the huge subjectivity involved with the experts - labels have advantages bc can provides clarity (ex: "ah ok, I have OCD, i understand what it is, i can do something about it") - but labels also have downsides: the patient starts viewing themselves thru the lens of the label; thus they notice the dysfunctional more than the functional (the functional becomes the gorilla on the basketball court) - ex: label = "schizophrenic" - how might this affect interpretations of a person's behaviour? opportunities provided to that person? how that person's experiences are evaluated? think about the huge weight assoc with this label Rosenhan study: "On being sane in insane places" - 8 "normal" ppl - complained of hearing voices that said "empty", "hollow", and "thud" - all admitted to psychiatric institution; 7 diagnosed as schizophrenic; they're told that the moment they leave the psychiatric institution they're normal ppl again - wanted to see how long it would take them to get out of the institution - the only tool they have to leave the institution is to behave "normal" - result: took them a long time to get out! (7-52 days); and they were given 2100 pills! (but didn't take them bc remember it's just an experiment; they're "normal" ppl) - they also took observations in notebooks - result: staff at institution didn't realize that they were normal ppl; they saw them as schizophrenic only - but the other patients did know that they don't have schizophrenia - the staff/doctors didn't speak with them in normal ways, didn't treat them as normal ppl - ex: "good morning doctor, can you tell me what time outdoors activity will occur today? - doctor: "good morning dave. how are you today?" - when the psychiatrists saw a group of patients sitting outside the cafeteria waiting for lunch, he told his psychiatry students that they're doing that bc of the "oral-acquisitive" nature of their syndrome. but it could just be that they're bored, or they need to sit somewhere, etc. - they observed psychiatrists making biased interpretations of patients' experiences - ex: when patient says that they had a close relationship with mother during childhood, but kind of distant with father, but then became with closer with father later on in life - when this person is viewed as a normal person with no mental disorder, this description is just viewed as being normal, no big deal - but when psychiatrist sees the patient as having a mental disorder, they interpret this description in a different way (says they have emotional instability, relationship with father has become intense, etc.) - the point is that labels carry a lot of weight! So how do good doctors determine if someone has a disorder? - doctors (should) use multiple criteria for determining a diagnosis (health history, social history, their work/school, personality traits, etc; holistic look at the person) - use 3 macro-criteria to evaluate psychopathology Evaluating psychopathology: 3 macro-criteria: 1) deviance: is the person's behav or experience outside of social norms? ie. statistically deviate from the average in the population - ex: women who are very career-oriented are outside of social norms; ppl with tattoos, gay ppl, ppl with a religious conversion (ex: Ghandi would be considered deviant) - this doesn't necessarily mean anything, but is used as a WEAK red flag 2) maladaptive: is it interfering with other, "normal" aspects of life, responsibilities, etc? - but this isn't perfect either (ex:olympic athletes, highly career-oriented ppl, etc. may have maladaptive practises bc have to sacrifice a lot; but doesn't mean they have mental illness) 3) personal distress: is the person greatly distressed? - this isn't perfect either bc for example, psychopaths think they're normal and fine - although the above are not perfect, they can help to diagnose - it's a continuum, not a dichotomy! - there's a gradient btw what's clearly functional/normal and what's clearly dysfunctional/abnormal - when we read about these disorders in the textbooks, we'll see ourselves in the descriptions of these disorders; but this just means that we're somewhere on the gradient, as everyone is Psychological Assessment and Diagnosis: - assessment begins with observing behaviour and manner, discussing present symp's, personal and family history, health issues, stress - ex: Prof was in hospital ER, overheard conversation btw patient and doctor in stall beside him; it was clear that doctor had never met her before - but after just 5 mins she was given prescription for anti-depressants; this shouldn't happen! doctor is supposed to get a holistic picture of the patient's life first - this has huge implications bc being prescribed with anti-depressants carries a lot of weight, it's a label, involves lots of side-effects, etc. - the systemic nature of mental disorders is highly under-appreciated - ex: exercise works just as effectively as anti-depressants in treating a big portion of mental disorders - nutrition is also just as effective! - a huge chunk of disorders can be treated just as effectively with exercise and nutrition than drugs - but we don't usually think of these things; bc we think in top-down ways (ie. when we think about mental disorders we think of the brain, neurochemicals; thus we treat the disorders by involving brain- related and neurochemical-related drugs) Rates of Psychopathology: - psych disorders are extremely common! - 10% of the pop suffers from a disorder each year - estimates of lifetime prevalence = 20-44+% (there's a wide range of such estimates) - this shouldn't share you away from going into the mental health field - rather it is to empower you; know that you have a voice; know that you don't have to lead down a certain path by an expert (they're not the be all and end all; they have lots of biases, etc.) Disorders involve a multifaceted system of factors - neurochemical - physiological - cognitive - affective (emotional) - behav's (ex: goal striving, interpersonal engagement/withrawal, hygiene, work) - env (ex: pollutants, crime, home/community organization) interpersonal (ex: family conflict, social isolation) - thus when someone has depression, it doesn't just mean that they have a prozac deficiency; there are many other factors that can be involved! - thus there are many treatment pathways! - best treatment approach involves addressing these multiple factors - ex: depression web (shows all the diff factors involved) --> look at in more detail in future lecture - structural factors: money, credit cards, doctor's appointments - thus helping ppl at this practical level can help them with depression! - emotions - interpersonal - successful outcomes, related to motivation, etc. Depression: Cognitive Factors - person with depression has negative attribution style - blame themselves excessively for neg outcomes (internal attribution) - over-emphasize internal attributions - assume one cannot change (stable attribution) - catastrophize and overgeneralize (global attribution) - ex: if get bad mark on one test, overgeneralize by thinking they're bad in school, they're a failure - the result: hopelessness and inability to make pos changes in one's life - when something bad happens to person, they make internal or external attributions to explain why this happened - doing this in a health way is good bc it allows you to take control of your life - but depressed ppl do this excessively and in a very negative way The role we play in others' psych disorders: - humans are fundamentally social creatures - social factors (belonging vs loneliness, identity validation, social support, criticism, etc.) play a huge role in psychological disorders, serving as contributing causes to disorders, determine whether ppl seek help for their disorder, play a key role in the therapeutic process itself (ie. relationship with warm, empathetic, trusted therapist) can help or hinder therapy, and are a primary resource for coping (social support) - stigma plays a big role in whether or not ppl will seek help **** - ex: fear of being judged by doctor and other professionals - ppl may be genetically pre-disposed to a particular disorder, but certain environmental factors can trigger this underlying disposition - this is very common - ex: you can have the geneti
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