PSYA02H3 Chapter Notes - Chapter 15: Impulsivity, Schizophrenia, Chlorpromazine

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21 Mar 2015

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PSYA02 Chapter 15 Notes
15.1 – Defining and Classifying Psychological Disorders
-Asylums: Residential facilities for the mentally ill that hoped to shock the person out of the diseased
state by inflicting fear
- Phillipe Pinel & Dorothea Dix: Advocacy for the mentally ill led to widespread reforms that ushered in a
new approach, called moral treatment, leading patients being treated with kindness and decency (being
allowed to roam around the hospital and outside)
- Chlorpromazine (called Thorazine in the US) was introduced in 1955, helped people with schizophrenia
and other disorder involving being “out of touch” with reality to function independently, even holding
down jobs and living at home with their families
- Patients who are treated may be increasing the number of homeless people as a result of former
inpatients quitting their medications and slipping back into their disorders
- The problem that prevents the field of psychiatry from sufficiently focusing on the larger, systemic
challenge of helping people with mental illness learn to function effectively in the world is essentially a
problem in the whole approach to mental illness
-Medical model: Sees psychological conditions through the same lens as Western medicine tends to see
physical conditions – as sets of symptoms, causes, and outcomes, with treatments aimed at changing
physiological processes in order to alleviate symptoms
oThe guiding paradigm for mental health and mental illness
oDepression, post-traumatic stress disorder, or autism can be approached in the same manner as
conventional medicine would approach diabetes or cancer
oCritiqued are being overly narrow, more focused on “cure” than on promoting wellness and
helping the person become stronger more generally
- From the inside perspectives of the people living in a particular culture, their practices seem perfectly
normal and even right
- It’s problematic to be judging normalcy by using your own particular cultural framework, although it’s
also practically impossible not to do so, since we’re always operating within our cultural framework
- First we need to understand the appropriate cultural framework and perspective, and then find out
whether most people in that culture or having that perspective would have similar experiences
- Determining what is normal and what is abnormal is fraught with difficult and subjective bias; a process
that should be approached sensitively and with a great deal of self-awareness
-Maladaptive: According to the American Psychiatric Association, is determined by three key criteria,
whether is causes distress to oneself or others, impairs day-to-day functioning, or increases the risk of
injury or harm to oneself or others
- Behaviours that fulfill the criteria but not necessarily indicate mental illness
oHeavy drug users and people with psychopathic tendencies may not think they have a problem
oFamily members may be concerned about a persons involvement in a new relationship, or may
disapprove of body modifications such as tattoos or piercings
oMourning the loss of a love one or having a religious conversion may interfere with one’s day-to-
day’s activities
oActivists may get arrested for protesting government actions and extreme sports enthusiasts may
risk death or injury out of passion for their sport
- US government wanted to collect data on mental illness in the country and included in the official
census a single category to denote mental illness “idiocy / insanity”, later involving into a guide for the
mental hospitals called the “Statistical Manual for the Use of Institutions for the Insane”
-Diagnostic and Statistical Manual of Mental Disorders (DSM): Created by the American Psychiatric
Association, it’s a standardized manual to aid in the diagnosis of disorders
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oPurpose was to provide mental health workers with a reliable method for diagnosing mental
illness and to ensure consistency across different institutions and hospitals
oMental disorders represented specific reactions that an individual’s personality had to
psychological, biological, and social processes
- DSM describes three important pieces of information for each disorder:
oA set of symptoms and the number of symptoms that must be met in order to have the disorder
oEtiology: Origins or causes of symptoms
oA prognosis or prediction of how these symptoms will persist or change over time
- Problems with the increasing number of disorders:
oAs clinical science has progressed we are now better able to diagnose people, and the new
disorders are entirely valid categorizations of symptoms
oThe creation of ever-more categories of disorders has been engineered in part by pharmaceutical
companies as a way of increasing the number of disorders people will need to be treated for
- DSM made their evaluations along five separate axes or dimensions of functioning (DSM-5), assuming
that integrating these different types of information would result in a more complete diagnostic
understanding of the individual:
oAxis I: Clinical disorders (including depression, anxiety disorders, ADHD, or substance abuse
oAxis II: Personality disorders and mental retardation
oAxis III: General medical conditions
oAxis IV: Psychosocial and environmental problems (i.e., life circumstances, such as relationship
or work problems, which can impact psychological functioning)
oAxis V: Global assessment of function (GAF)
- “Mental retardation” was replaced with the term intellectual disability (or intellectual developmental
disorder) and obsessive-compulsive and related disorders became their own category, whereas they used
to be under anxiety disorders
- Critics of the new categorization approach have argued that pharmaceutical companies have had too
much influence over the guideline described in the DSM (the net result being to make it easier for
individuals to be given a diagnosis, thereby increasing the demand for pharmacological treatments)
- DSM-5 doesn’t resolve the critiques that have been lodged against past versions; the diagnosis of
specific disorders is often not highly reliable, definitions are not always based on empirical evidence,
and different disorders often share many common symptoms
oA patient may be diagnosed with different disorders based on which mental health professional
they meet with
oSends the message that disorders can be objectively defined, although the entire process of
deciding a given pattern of behaviour implies mental illness is highly subjective and dependent
on cultural factors
- Over-diagnosing could lead to the powerful temptation of using drugs that purport to treat the disorder,
without fully considering the costs that might result, or alternative perspectives and potential solutions to
the problems one is experiencing
- Attention deficit/hyperactivity disorder (ADHD) is more commonly applied to children with problems
adjusting to elementary school (mainly boys, who are more likely to be diagnosed with it)
oSigns include getting in trouble for being restless or misbehaving in class, forgetting to do
homework, interrupting frequently during class and not paying attention
oIf ADHD is so highly subjective and susceptible to being used as a way of pharmacologically
controlling people, then this would be a problem (North American people are more diagnosed
with it compared to the 10% of Europeans)
- A solution to improving the diagnostic accuracy of the DSM is to develop more objective, biological
indicators such as genetic markers, indicators of neurotransmitter dysfunction, or brain abnormalities,
that are involved in the symptoms and functional deficits experienced by the individual
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oBy understanding what isn’t working for a person, we can develop ways of fixing the necessary
systems, thereby “fixing” the disorder
- For each disorder, DSM provides a list of possible symptoms, and guidelines as to how many of the
symptoms the person must have before being given the diagnosis
oPatient must have all the symptoms indicated, even if theres one less, they wouldn’t consider it
as the disorder
oThe diagnosis a person receives, and even whether a person receives any diagnosis at all, can
depend on a single symptom
oEven normal symptoms become severe if they’re long lasting than usual or occur randomly
oThis way, the patient can either be deemed as mentally ill by one doctor, but misinterpreted as
not mentally ill by another doctor who doesn’t notice all symptoms
- Once a person has been labeled as having a disorder, the label itself may change how that person is
viewed by others, and how subsequent behaviours are interpreted
Quick Quiz 15.1a
1. Rosenhans classic study “On Being Sane in Insane Places” showed that once people have been labeled
with a specific disorder, this will change how other people interpret their behaviour and behave toward
2. Problems with DSM include:
a. No objectively definable line separating normal from abnormal; thus, determining whether a
person has a disorder or not relies upon criteria for distinguishing normal from abnormal, and
those criteria are essentially arbitrary
b. The construction of the DSM may reflect the influence of the pharmaceutical industry
c. It may lead to over-diagnoses, because it provides diagnostic labels that can be appealing to
people for a variety of reasons (such as offering hope that treatment is possible, or making a
childs behaviour more manageable)
3. Which of the following is not psychiatric criterion for mental illness? The condition must be categorical
- Being able to reliably diagnose particular disorders is a central and ongoing challenge to the mental
health fields, having an impact on problems that range from individuals knowing how to effectively
navigate the mental health system to the use of the insanity defense in criminal trials
-Mental disorder defense: The defense does not deny that the person committed the offence, but claims
that the defendant was in such an extreme, abnormal state of mind when committing the crime that he or
she could not distinguish that the actions were legally or morally wrong
oEx. Person committing murder when in a severely dissociated state (schizophrenia)
oNot easy in determining whether a person was sane when committing a crime
- Andrea Yates: Drowned all five of her children in the bathtub, one by one, and laid their bodies on her
bed side by side
oIt was found that she experience severe post-partum depression and psychosis, with multiple
suicide attempts and psychiatric hospitalizations, and had been put on anti-psychotic medications
oFound not guilty by reason of insanity
- Jeffrey Dahmer: Murdered at least 15 men, committing utterly horrific acts to them both before and after
their deaths
oThe jury rejected Dahmer’s insanity defense because they had been carefully orchestrated and
planned, and were undertaken with his full intention to commit the harm that he did
oNo doubt that he may have been severely psychologically disturbed, but was still sane
- M’Naghten rule: Daniel M’Naghten was found to have assassinated the Prime Minister’s secretary, but a
jury was convinced that he was not to be found guilty, and they didn’t send him to jail
o1% of federal cases in the US and has a success rate of 20% (very rarely used)
Quick Quiz 15.1b
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