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Hywel Morgan

LECTURE 1: Concepts ofAbnormality o What is abnormal psychology-easy to recognize but hard to define. Strange behaviour is insufficient reason to diagnose someone A)statistical criteria B) cultural norms C) developmental norms D) frequency, intensity, duration DSM 4: deviation in the norm for language or mathematical ability. DSM: has tried to catch more people. Statistical Criteria A. Average I.Q:100 that means you intlligience for your age is exactly the same for most people your age. Ideally this is what we want to do. Ideally define abnomral a statistical criteria from the norm. Collect a lot of data from people on what they think, feel and do to see what most people think feel and do. Outline frequency is low, a normal distribution curve, not many at extremes. Memory is a behaviour. Angry is an aggression and passive is a behaviour. Thirsty is a behaviour.Abnormal-thoughts, feelings and actions are all behaviours if abnormal. Ie/blowing nose is behaviour which can be abnormal. Too many times can be considered abnormal. Caffeine regularly abused substance. Problem with Statistical criteria as a definition: creates circumstances that are unfavourable ie/caffeine withdrawal 1)disregards to unfavourable common behaviours there are two. In a non-objective world, abnormal means what most of the population does not display. Ideally, psychiatrists would like to determine deviations based on statistical data.What most people do, think, or feel. Behaviours include memories, emotions, actions, thoughts, etc. Restricted to behaviours that are common and disregards deviant behaviours that are favourable. IQ of over 125 is considered gifted but abnormal, IQ of under 75 is also abnormal. Both are considered pathological. To be gifted is favourable.DSM-5 states that substance abuse is pathological. Regularly using any substance that can alter your mind (including caffeine).Includes most people Culture Norms A. What may be normal in one situation or environment may not be normal in another one. Certain behaviours that are distinctive to be considered abnormal in most societies. Ie/so severely different from the norm, this disorder is abnormal: schizophrenia. • Drinking not common in muslim or jewish • Content behaviour differs. Ie/schiz: content of hallucinations differs among cultures Example: public getting naked-abnormal and illegal. All public nudity is not abnormal but normal in such as locker room therefore situationaly defined. • What might be normal in one society, culture, situation, or environment may not be normal in another • Schizophrenia is so severe and distinctive that it is considered pathological in almost all cultures • The content of hallucinations differs between cultures • NativeAmerican rituals • Public nudity is abnormal (and illegal) in most places, but in a locker room, it is okay • Situationally defined • Stealing and violence is okay for a child but illegal for adults Developmental Norms o Some norms change as you age  Bed wetting o Children can intelligibly speak something by age 2 on average  If not speaking yet at 3, some concern; at 4, higher level of concern; by 5, likely seeking professional help • The greater the deviance from the norm, the higher the concern o “Milestones” are averages  Some kids are faster or slower than others • Fast development considered a good thing, slow considered negative Frequency, Intensity, Duration A. Depression, common disorder, sad affect, emotional/mood disorder. Lonely and sad is normal. Clinical sense, depression become abnormal when sad become long. Dog dies and suffers sad is normal. Cant go to work tommorow, functioning with your life is normal, six months still cant go to work is abnormal. Depression- sadness last for a long period of time. •Intensity-harm yourself. •Frequency- anxiety. Not all people with phobias are treated because they can still function normally Ecological models of abnormal behaviour Etiological: What is the cause/course of abnormal behaviour? a) Medical-disease (biological) models • genetic models ♦ Genes are primary determinant for behaviour ◊ Even if you inherit the genetic marker for a psychopathology, you will not necessarily have it ⇒ Concordance twin studies i. 50% chance of twin being schizophrenic if other twin is • biochemical models ♦ Insufficient or too much chemistry in your brain ♦ Neurotransmitters (dopamine, serotonin, norepinephrine) • neurophysiological models ♦ Born with it, congenital, or acquired ♦ Some part of the brain is not developed or damaged • psychoanalytic model ♦ Freud b) Environmental models • sociocultural models ♦ one of the most important when stressing suppressed genes to be expressed ♦ Society and cultural stresses ♦ Family, socioeconomic status, religious, affiliations, urban or rural living • learning models ♦ Behaviourist conditions ♦ Classical or operant conditioning ◊ You have learned to interact with the world in a faulty way ♦ Treatment is relearning • humanistic models ♦ Stresses the individual’s reactions to themselves and the world ♦ Capitalizing on skills they have ♦ Respects right and worthiness of the patient’s choices Depression is a biochemical disorder, more showing that to be the case. More treatment in situational environment. You inherit behaviour through genes. For disorders there are genetic markers including depression. More than one genetic marker. Problem: if you inherit a genetic marker for a behaviour that does not mean you will develop the disorder. Lecture 2: Mental Disorder and the Law Legal vs Ethical issues Laws-set of rules about behaviour you must follow, ambiguous What are laws? Aset of rules of how you must behave and must not behave Rules about behaviour that are codified Based on ethics and morals What you HAVE to do Dictates social interaction with each other Prof. argues that almost all laws dictating private behaviour are gone Trudeau wanted laws to stay out of people's bedrooms Violence is the most salient example of a social interaction that is illegal The legal system determines whether the defendant is culpable or mental ill Do defendants who are deemed culpable still received rehabilitation? In Canada and in scandinavian countries, YES; in the U.S., NO What the judge and what the mental health practitioner say are different -hinds dilemma: man couldn’t afford drug to save his wife. -morals are fluid, vary from culture and time. Ie/things immoral 5- years ago are acceptable today -ethics-set of core values doing the right thing, guideline you should follow Legal issues: • people in social conflict. Thomas szasz-argues that pyschological issues are not medical, there are people who are not functioning probably, are able to get along with other people, get a job and do normal things-social conditions. Pyschopathology doesn’t get treated unless interferes with somebody else known as social conflict because that’s a legal issue. Ie/ cutting somebody else ut if given conscent then maybe. • power of mental health professionals- there power in the legal system, mental stability, dysfunctional behaviour break the rules of law and caused by mental dysfunction. Ie/ substance abuse disorder and taking a drug that impairs judgement and reaction time and a car accident has hurt someone else because of that-broke the law and have a mental disorder. Will still be in jail despite the mental disorder. Doctor has to testify for the mental disorder if responsible for their actions. The only power they have in the legal system is as witnesses. For individual to get out of jail is judge or jury only but will take consideration of psychology as they cannot claim a person to be legally insane. Canadian Legal System: not changeable, • Constitutional law- charter of rights and freedoms, rules you must follow, highest limit on the types of law. Only country that documents people with health issues that have rights, at the federal level. People with mental disorders have to be protected by government. • Stautory law: provincial level and municipal level. Can be changed and differ from provinces. People with mental disorders- cant cover everything, decisions have to be made until they become significant. • Common law: all three terrirtories, 9 out of 10 except quebec which has civil law. What is legal but no ethical addressed here. Judge's or jurys intrepretation of stautory laws. Frequently ambigious not by accident because of the hind's dilemma. Common law comes from precedence. When decisions are made about mental disorders that become a law. To intrepret consitituion that includes parents contry- government is responsible and their authoirty to care for all individuals-leads to a dilemma ie/people on the streets but the constitution says everyone has the right to make own decisions-conflict. People living on streets are mentally ill but they have constitutional rights. o Parents patriate (responsibility and authority to care) o Involuntarily commitment (civil and criminal): occurs when someone is perceived to have mental illness so taken out of society and harmful to others and yourself, havt done the act but possibility may happen so must be isolated- civil involuntarily commitment, part of common and stautory law. Criminal-is apart of constitutional and stautory law. Putting in a secure mental health facility. • Must be suffering from a mental disorder • Unwilling or incabable of consent- consent to treatment • Be at risk of harming (self or others) • Rules here in ontario- someone suffering from substance abuse, thinking about homicidal thoughts is eligible for commitment, not a disorder. If you are committed involuntarily must be assessed and treated, can refuse treatment in ontario, only three provinces. Someone who is committed in ontario only 72 hours, differs between provinces, if they refuse treatment having stayed can leave. People assessing can have them committed further for one to three months and can be extended. Involuntarily treatment • Substitute decision maker (advocate): cant make decisions for themselves, automatically signed to somebody during assessment and treatment, after 72 hours.Advocates are trained professionally. Can be a psychologist, social worker • Capabe wished principle-advocate works under this. The advocate tries to do what is right for the patient and considers patients wishes. • Compulsry treatment orders- three provinces. If advocate is satisfied even though patient is still disordered they can be released if they promise as an out patient to conitue in therapy at regular intervals. Pychologist environment -ethics: have ethical obligations and still get in trouble not with the legal system • Clinical: interacting with a client or a patient • Research: researcher tells participant what is expected and then consent form is signed and you participate and can discontinue experiment any time even after leaving. If didn’t tell you then ethical not legal issue. • Teaching: similar codes guideline of ethics, • Forensic-ethical obligation in court and legal obligation otherwise purjury. • Adminstration-adminstering psychological data, gathering data of testing, collect data on people, not analyze Informed consent: quasi-legal • History: government requires this, because in past people have been treated without consent medically and psychologically invasive ways that may hurt individual in other domains. In our society, legal system requires this form. Concept of this is less than 70 years old. Started from WWII-experimenting on people in concentration camps without their will and consent. Numbreg trials, the data was used but unethical dilemma • No harm-primary concern of clinician is that no harm comes to the patient or client, even hurting ones feelings, deception-one pyschologist tell you one things and another-not ethical • Confidentiaity (limits)- informed consent form includes that all data is in confidence. There are limits to this: important limit is legal issue. informed consent will disclose this. Or if you tell me that you have an intent to hurt yourself or somebody else the researcher has to inform others. If you indicate an instance of child abuse that you know then researcher has to inform authorities which is also a legal obligation. • Psychologists' behaviour: • Risk/harm ration • Tarasoff case: going to murder someone, confidentiality is broken. In common law if already have murdered somebody then legally no obligation because legal issue called privilege, but if tell the authorities to arrest then harms the client so now can lose their licence. Privilege- two people know info about each other is not testified legally against each other or allowed to give evidence about each other. Doctor cannot by law release that info called privilege. Other people that have privilege- lawyers, spouses, clergy, rabbi, and one relationship always privileged is lawyers. Ie/paul bernardo -knew about the tapes- because of esponia means authorities have more information and are required to testify. If they do espoinae you and testify then are harming the client. Or psychologists says no and doesn’t testify then is charged for contempt and sentenced to jail. Otherwise risk of losing licence. But if intent to hurt people then legal obligation to tell authority. -people what are in custody cant consent and has been removed, others have intellectual disability. Do you treat them anyway? Some children with autism self-mutilate-electric shock, doesn’t hurt but not ethical. Informed Consent: Started in late 1940s, WWII "Medical research" experimentation in concentration camps People not only did not consent, they right out said, "I don't want to!" Invasive behavioural and medical procedures; potential lethal outcome Nuremberg trials A lot of the ethical rules about conduct within medical research and legal informed consent come from these trials (that's the history) #1 ETHIC: We do not harm the people we are taking care of The law does require consent for medical procedures but it's not so clear on behavioural intervention and research! Deception: You consent to certain information in a psychology experiment, and at the end they say, "Ha! Fooled you. We were looking for something else." Is this ethical? No (not really); Can it do harm? Yes possibly Most of the time, mild deception like deception in experiments is harmless Some unis think it's not appropriate to run experiments like this Laws are clear on confidentiality (in clinical, and in research) Confidentiality: In research, you are a number. Your name doesn't go on anything. In clinical, the psychologist has the responsibility to protect your client's information The LAW says you have the OBLIGATION (and right) to not disclose/divulge any information to anyone, even POLICE! If police come to your door and demand your client's information because they have committed a crime, you have the legal obligation to say, "Get lost." Legal term: privilege Right not to disclose any information about yourself: selfincrimination And the right to say, "I don't know" or "I'm not telling you." If in court, regular person say, "I know what happened but I'm not telling you." ---> Contempt of court (will get you thrown in jail) But as a psychologist, you can do this because you have privilege. You say, "I cannot because of my profession with the client." Other ex of privilege: Spouses, lawyers, clergy, physicians, mental health practitioners Which mental health practitioners? (tricky! because still unclear) psychologists, psychiatrists, and more recently other professions added Relationship between parent and child is NOT privileged Courts have argued recently that everyone except lawyers DON'T have privilege Limits: You have a responsibility as a clinician to inform the client of the limits to confidentiality If client is planning to harm others or themselves If you know of an instance of child abuse If subpoenaed (summoned) by the court If, as a clinician, you decide during the assessment of the client that the client is unable to operate a motorized vehicle, you have the responsibility (by law) to inform the ministry of transportation (in Ontario and other places) Can't comply informed consent: Intellectually compromised Children The incacerated Lecture 3: Theoretical Perspectives Biological Models: A. The Role of the Nervous System B. The Role OF Chemistry C. Genetics and Behaviour D. 3. Biological• Emphasises role of: i) nervous system in mental disorders ii) brain malfunction iii) neurotransmitter imbalance iv) genetic factors• Many mental disorders show a high degree of concordance amongst close relatives.• Techniques for observing brain functions have improved (MRI, PET) Psychosocial Theories: A. Psychodynamic Theories B. Behavioural Theories C. Cognitive Theories D. Humanistic Theories Assessment – When the psychologist gather information on a new patient (kind of problems, current conditions, responses to various psychological tests).• Diagnosis – identification of the person’s problem(s).• Psychologists and other mental health professionals have an agreed-upon system for describing and classifying mental disorders.• Most widely used – Diagnostic and Statistical Manual of Mental Disorders – IV (DSM-IV) First step in identifying psychopathology is assessment-what am I looking at? Explore details. Going to compare your behaviour to others behaviour is an assesment. Second step is diagnosis. Third step is treatment. In this order but all three steps are ongoing processes. Diagnosis: • Benefit-research shows that if you are diagnosed having schizophrenia, psychotherapy is not the paramount therapy for this. Will not work very well. Treatment selected would be a pharmalogical intervention Classification and Diagnosis Diagnosis benefit is in the selection of the treatment. Contenscious issue in psychlogy. There is a harm, when we provide a diagnosis for someone who has a mental disorder, the most harm is stigma. Ex/ someone giving diagnosis for schizophrenia. That person is labelled chizophrenia. That person lifetime label, negative connation. The acknowledgement of the disorder is made. Typically, schizophrenia does come back, have acute episodes. Like depression tends to come back. In mental health do apply same labels, stigmizing, unlike flu. Ex. Cancer, ongoing battle but those people are not labelled. Don’t label people as their order,-most harm. DSM5- current classification. To divide statiscal norms and look at behaviours outside of these statistical norms. DSM3- revised to reflect different statistics. No different diagnostics. DSM4- new categories, some removed and do not exist. Ie multiple disorder replaced. DSM4 TR- text revision, new version same categories, no different statistics only txt revised. More elaborative text. DSM5- may 2013- make more norrmative statistical data, whats average and what most people do. Twenty year time span to do more research. Classification- to identify syndromes of abnormal behaviour is the goal of a classification system. Syndromes are a set of symptoms that occur together regularly. The DSM 5 is the goal of this throughout the incaranation- identify symptoms that go together. Can purchase dsm but cannot diagnose unless have an md. It is not the tool the rest of the world uses, only in north america. ICD world uses- international classification of disease, version ten. DSM is published by the american psychiatric association not psychology because it is a medical tool, outlining syndromes and their diagnostic. Psychologist have input. WHO-world health organization- division of united nations, significant overlap between DSM and ICD. Goal was to make it compatible with ICD, hundred percent amking it the same classification system. Problem next year is that ICD 11 comes out next year, introduced by the world health organization. Biological asssessment and diagnosis Biological functioning is an important way • Genetic • Neurochemical • Imaging- of the brain to determine if it is structurally or functionally astound. If you have a psychopahology disorder, more likely tha you will receive on of these imaging process, looking at botht the structure and function of the brain o Structural- is there a part of the brain that looks different statistically to other brains. Ie.smaller, damaged. • Have found ethical ways, most common method is CT scan-computerized tomography, 2d image, x ray machine, x rays from different angles. MRI- magnetic resonance imaging, doesn’t use x rays so no radiation. Strong magnets, changing polarity of the electrons (strong magnets) high definition picture of the tissue inside. • Why don’t we stop using CT scans? because cheaper o Functional- do different parts function differently statistically from other people. Functional imaging looking at the brain that are functioning properly. Function imaging-PET scan-what parts of the brain are active using radiation-positron emmision tomagraphy. The brain uses glucose when there is activity. Pet scan not so much used anymore because new method-fMRI, perfarble and expensive. Function magentoic resonance, measure what parts of the brain are more active to an adjusted mri procedure. What makes a good classifiction system? • Was developed in germany not North America, german scientist first to develop cateogries. 1. Categories should be clearly defined. DSM 5 does a better job of this. In order to be diagnosed with major depressio, must have a certain number of symptoms over a specific period of time-so well defined. IDC uses this to. DSM5- criteria is broader, an intend on doing that was that more people will recive treatment, argument against it is that it may not be a psychopatholoy disorder. 2. Categories exist. Synptoms do occur together regularly. The feature in each categories also exist b,c occur together. DSM doe s good job of this.. Illusions and halucinations for schizophrenia. Does the cateogry exsist. Problem: does hallucinations only occur with szchizophrenia.A: no. they symptoms that occur in this category may occur in another- symptom overlap. System overlap- could lead to mis diagnos. 1. Has good reliability. Test and test retest. Diagnosis is made and same symtoms are shown then same diagnosis should be made.two different people diagnosis you with the same thing-measures good reliabiliy. DSM reliable or unreliable? It is reliable b,c clearly defined, certain degree of realibilty on DSM, not a hundred percent. Is it consistent across time and pp who are assessing 1. Is it valid? Is it measuring what It is intending to. For DSM, there is low validity because of the symptom overlap and mis diagnosis. The treatment wont work so continue to assess and there is a change of disorder which isnt depression anymore. 2. Is the classification have clinical utility. Is ti usefull? DSM is a method, it is useful depite its flaws with validity. Diagnostic Systems • Emprically driven- empirical means we have numerical data and compare numerical data from all people. This is the problem with DSM because diagnotic statistical manuel, they lie, not empircally drived system. It is useful but not empircally driven. Trying to move towards that. DSM is a clinically drived system • Clinically driven - DSM and ICD which means system derived by consensus. DSM is a system drived by a study group that got together professionals and experts in the fields. Drived system in secrecy- criticism. DSM is good, useful, all we have there are crtisisms. Consensus are made from experts have seen a lot of things, havt used statistics but trying to get there. because really difficult to define DSM IVAXES -the first axes on DSM 4 is primary and complaints. • Existing disorders- DSM4 is the axes one- primary and complaints. Comorbid-depression and anxiety uncommon to see. Comorbid disorders went on axes 1. on axes 2- present personality disorders, personality disorders got a separte section on DSM 4, not the case on DSM 5 and go in the respective sections with similar symotpms. This is because there was an acknowldgemetn that personality disorders are permenent. Personality disorder can be treated but it’s a part of who you are and not going away. AXES three 1. Relevant physical conditions- separate sections b,c phsycial conditions looked like psychological conditions and vice versa. Ie.make noise and front of child, may not be deaf but autism. Deaf is phsycial condition and autism is psychological 2. Severity of psychological stressors- fourth diagnosis received on dsm 4. has prognostic value so doesn’t go away- prognosis:this si what will happen. Whats going in the environment has prognostic value, if a lot of stress then prognosis is not positive. Lots of stress will be difficult to treat axes 1 and axes 2 disorders. All of these things condiered on dsm 5 on one axes.Axes 5 has been eliminated, on dsm 4 used to provide global assessment 3. Global asessment of functioning- how well you are functioning right now, a disorder that prevents you to go to work, be social. Axes 1 through 4 is included in the same diagnosis. THE DSM:psychiatry;s deadliest scam Movie-house of cards Started so psychologists and psychiatrists can be accepted with other scientists. Only three disorders that still exist today Dsm 11- 172 disroders for government money DSM11- not scientific by freud. New diseases are being invented not discovered. Mental disorders are voted in and out ie.homosexulaity-added and removed for politial reasons. Science is a fabrication. Dsm3-1980: freudian psychology- biologically still not scientific. Increased to 259. Chemical imbalance theory -how depression is caused. Medical field promoted the chemical imbalance theory of why these disorders happen No test out there about chemical imbalance No definition for the concept of mental disorder Dsm 4 1990: still no defintion. 374. 120 million diagnosed To test to identify a illness Public kept in the dakr, diagnosis within couple of minutes They percieve a problem must be seen as legitimate and must be solved. Justify drug treatment 42000 deaths using these drugs. Mainstream drugs that the risks are downplayed --> suggested sucidial causes is drugs, alternate is depression. Not sure which one. -50's discovered multiple personality because was very rare. So rare couldn’t study it or report it. Famous case study-sybil 80s-90s- now common to be included in dsm 3 , Hospital in ottawa only for multiple disorder so common. Dsm 4 changed the name, PsychologicalAssessment DSM 5- reorganized categories, added 'hoarding' • diagnosis can be wrong so assessment ongoing process. Usually, first interaction is assessment.Average length of time for an assessment in canada a doctor has with a patient is about 12-15 mins to make an assessment. Not sufficient time for an accurate assessment. Psychological assessment is usually more thorough, 3 hours minutes could be all day or 2 days. Quite lengthy for a mental disorder. DSM not always accurate. There are three tools in assessment, ways to assess a client for abnormal behaviour/psycpathology. To apply a DSM diagnosis to assessment: o Interview-ask questions o Observation-don’t need to be verbal, useful for clients who are not verbal, useful for children. • Social workers, psychaitraist will use above methods o This is where the profession began (freud didn’t do this) 70 years now: compare to other people (gather data and get average). Taking averages and comparing individual data points. Difficult to get deviation, arbitary. The third method is testing, psychological testing. Other professions beginning to use it. Every two years, a pendium is published for past tests, thousands to choose from. Good at compiling statistical data to compare. Early 1940s, psychology took off. Behaviourist movement because were collecting data. Why did it took off in 1940? Became more applied to compare people for occupation skills. Testing began with children not adults. When going to hospital, seen by a nurse intially, determines severity of disorder-triarge. Takes basic symptoms and go to triarge. If not normal then will be sent to a heart specialist, cardiologist. Do the same thing in psychology, process cause referral. Referral comes from.. • Social worker • Psychologist • Physician-a lot of the times a referral is sent from a physician to a psychologist. Family doctor will send to an expert. Important for an assessment to be included bc gives clues to what the problem maybe, clients understanding of the problem, their motivation and willingness for the client to do something about it. • Legal system-court mandate assessment and therapy, low motivation to do something, common. Being a problem for other people. How does legal system enhance this motivation? Court says must, no choice, not free to do something else.Anormal person can stop at any time during the therapeutic session, however motivation- if you participate there will be less punishment. Genera
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