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Chapter 17

PSYA02H3 Chapter Notes - Chapter 17: Schizophrenia, Elizabeth Loftus, Dissociative Identity Disorder

Course Code
John Bassili

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Chapter 17 – The Nature and Causes of Mental Disorders
Classification and diagnosis of Mental Disorders
What is Abnormal?
Abnormal = any departure from the norm; it’s become a pejorative connotation and we
use the term to describe characteristics we dislike or fear
Distinction between normal and abnormal behaviour is subjective
The most important feature of a mental disorder isn’t whether person’s behaviour is
abnormal (different from most other people), but whether it’s maladaptive
Making it impossible to people to hold jobs, raise families, or relate to others socially
Understanding cultural difference in beliefs is important; the fact that diagnoses are
affected by social or cultural contexts doesn’t mean that they’re invalid
Perspectives on the Causes of Mental Disorders
Interaction of hereditary, cognitive, and environmental factors
Some mental disorders—especially the less severe ones, appear to be caused by
environmental factors or by peoples perception of these factor, stress
A child who is constantly criticized by a parent may learn to be passive and non-
responding (this strategy may be adaptive in interactions with the parent but would be
maladaptive in other social situations)
Many of the more severe mental disorders appear to be caused by hereditary
Mental disorders are characterized by abnormal behavior, thoughts and feelings
The difference between normal and abnormal is whether the difference is maladaptive
Understanding the cognitive factors involved in mental disorders requires identification
of the origins of distorted perceptions and maladaptive thought patterns
The Psychodynamic Perspective
Freud’s early work
Mental disorders originate in intrapsychic conflict produced by the 3 components of the
mind: id , ego, and superego
Conflict becomes so severe that the mind’s defence mechanisms can’t produce a
resolution adequate for mental health; so defence mechanisms distort reality or
individual functions in some areas of life in a manner characteristic of an earlier
developmental stage
Symptoms include, extreme anxiety, obsessive thoughts and compulsive behaviour,
depression, distorted perceptions, and patters of thinking and paralysis or blindness
for which there is no physical cause
The Medical Perspective
The origins of the medical perspective lie in the work of Hippocrates
Formulated the idea that excesses of the 4 humours led to emotional problems
Extension of his ideas led to concept of mental illness - illness of the mind
Early asylums were poorly run, problems were poorly understood and often mistreated
Medical model is based on the ideas that mental disorders are caused by specific
abnormalities of the brain and nervous system and they should be treated in the same
way as physical illnesses
Biological factors are known to at least contribute to the development of schizophrenia

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and bipolar disorder, and drugs are usually used for treatment
Not all mental disorders can be traced directly to physical causes, so other perspectives
that focus on cognitive and environmental factors emerged
The Cognitive-Behavioural Perspective
Mental disorders are learned maladaptive behavior patterns that can be best understood
by focusing on environmental factors and a person’s perception of those factors
Doesn’t rise spontaneously in a person
Caused by the person’s interaction with their environment and their ongoing subjective
interpretation of the events in the environment
Encouraging clients to replace/substitute maladaptive thoughts and behaviours with
more adaptive ones
The Humanistic Perspective
Proponents of humanistic perspective believe that proper and natural personality
development occurs when people experience unconditional positive regard and
mental disorders arise when people perceive that they must earn the positive regard of
others (thus they become overly sensitive to the demands and criticisms of others and
define their personal value in terms of others’ reaction to them)
They lack confidence in their abilities and feel as though they have no stable, internal
value as persons (symptoms accompany depression)
Purpose of humanistic therapy is to persuade people that they do have intrinsic value and
help them achieve their own unique, positive potential as human beings
The Sociocultural Perspective
The cultures in which people live in play a significant role in the development of mental
Proper treatment involves an understanding of cultural issues
Cultural influences influence the nature and extent to which people interpret their own
behaviour as normal or abnormal
Culture bound syndromes: some mental disorders that seem to occur only in certain
The Diathesis-Stress Model of Mental Disorders
Diathesis-stress Model: the combination of a person’s genetics and early learning
experiences yields a tendency (a diathesis) for a particular mental disorder
However, the mental disorder will develop only if that person is confronted with
stressors that exceed their coping capabilities
The DSM-IV Classification Scheme
Diagnostic and Statistical Manual IV (DSM-IV): a widely used manual for classifying
mental disorders
devised to provide a reliable, universal set of diagnostic categories having criteria
specified as explicitly as possible
DSM-IV provides descriptions of an individual’s psychological condition using five
criteria called axes; individuals are assessed on each of the axes:
1.Axis 1: contains information on major psychological disorders that require clinical
attention, including disorders that may develop during childhood

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-alcohol dependence, major depression
2.Axis 2: Personality disorders
-marital problems, antisocial personality
(Axes III - V give information about the life of the individual in addition ot ht
basic classification provided by axes I and II)
3.Axis 3:used to describe any physical disorders, such as skin rashes or heightened
blood pressure accompanying the psychological disorder
-physical problems such as cirrhosis (excessive drinking)
4.Axis 4: Specifies the severity of the stress that the person has experienced (with in
the last year), e.g. details the source of the stress, indicates its severity and
approximate duration
5.Axis 5: Describes the persons overall level of psychological social, or occupational
-purpose is to estimate the extent to which a person’s quality of life has been
diminished by the disorder (ratings are made on a 100 point Global Assessment of
Functioning (GAF) scale with 100 = absence of impaired functioning, 50
representing serious problems of functioning and 10 representing impairment that
may result in injury to the individual or others)
-GAF = 30 represent vary serious impairment of functioning
See example on p.567
Problems with DSM-IV Classification
Diagnosis and treatment based on the DSM-IV emphasizes (medical perspective) the
biological factors which means that potential cognitive and environmental
determinants may be overlooked
Not reliable - users should be able to diagnose each case in the same way; mental
disorders don’t have distinct borders that allow a mental health professional to
diagnose a disorder in a person with 100% accuracy all the time
E.g. acute stress disorder (less than 30 days) and post traumatic stress disorder (30+)
Once people are labelled they’re likely to be perceived as having all characteristics
assumed to accompany that label
Diagnosing a psychological disorder only describes the symptoms of the disorder; it
doesn’t explain the underlying causes and psychological processes
The Need for Classification
Labelling can have negative effects
Szasz suggested that we should abandon all attempts to classify and diagnose mental
He argued that the concept of mental disorder has done more harm than good because of
the negative effects it has on the those diagnosed
he claimed that labelling people places the responsibility for their care with the medical
establishment, thereby relieving them of the responsibility for taking personal steps
toward improvement
Advantages of proper classifications include:
- the recognition of a specific diagnostic category precedes the development of
successful treatment for that disorder (Graves syndrome, characterized by irritability,
restlessness, confused and rapid thought process, and delusions/hallucinations, caused
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