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Chapter 15

Intro Psych Chapter 15 Abnormal psych.docx

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Mike Lee

Psychopathology  Field concerned with the nature and development of abnormal behaviour, thoughts, and feelings.  The domain of abnormal psychology, clinical psychology, counselling psychology and psychiatry. Defining Abnormal Behaviour  Statistical infrequency  Violation of norms  Personal distress  Disability of dysfunction  None of these by themselves yield a fully satisfactory definition. However, OCD has all four present. The Four D's of Abnormality  Deviance- norms and averages; culture  Distress- suffering  Dysfunction- disruptive  Dangerosity- threat to oneself or others  Not easy to define what is normal- the line between what I normal and what is abnormal isn't always clear-cut and easy to specify and arbitrary line. Mental disorder is best viewed as a continuum.  Insanity also tends to be confused with mental illness when it is actually a legal term. The insanity defense infrequently used; generally unsuccessful. Insanity is when the individual is unaware of actions and unable to control actions.  In Canada, since 1991, correct designation is "not criminally responsible on account of mental disorder".  A psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response. o Objectivity is always a concern o Meaning of behaviour is jointly determined by its content and context o Judgements about where the line between normal and abnormal should be drawn differ depending on the time and culture o Judgements of abnormality have been made by individuals to preserve their moral or political power  Ex. Drapetomania- the disease called Freedom written by Dr. Samuel Alright  Society Socialist Realism- Stalin required all artists to practice this form of art and people who didn't conform were labelled crazy.  Homosexuality was finally removed from the DSM in 1973  It is current practice in China to institutionalize members of the Falun Gong religion. Mental Illness  Emilie Durkheim, 1895, The Rules of Sociological Method  Ruth Benedict, 1934, wrote about Shamanism; Western doctors would consider Schizophrenia  Sociological Model of Mental Illness- in the mind of the beholder  Thomas Szasz (1961)- mental illness- as myth o What we call "mental illness" is really a contrivance of the medical community, government and organized religion to control, oppress, and manipulate people.  I maintain" o That the mind is not the brain o That mental functions are not reducible to brain functions and that mental diseases are not brain diseases. Indeed that mental diseases are not diseases at all. o Doesn't claim anxiety, depression, and conflict do exist, but are intrinsic to the human condition, but they are not diseases in the pathological sense. o His views part of a small, minority opinion  Influence diminished greatly  Influential in changing law (people used to be locked up without consent).  Remained unrepentant  Latest book (2001) continues his long quest to "comfort the afflicted and afflict and comfortable." Labeling Theory  Diagnosis is a way to stigmatize people a society considers deviant.  Labeling is dangerous as it turns people into "patients" and leads to discrimination. This becomes a self-fulfilling prophecy.  Rosenhan (1973) classic study: being sane in an insane . On Being Deceitful  Critics argued that the study led to some very dramatic, but largely incorrect conclusions.  Clearly labeling has grains of truth, but labeling theory hasn't held up well because the understanding of diseases has increased. o Many disorders are recognized cross-culturally o Need to categorize o Most clinical work is there for those who want it. DSM- IV (Diagnostic and Statistical Manual of Medical Doctors)  APA (1994, 2000); first published in 1952  A descriptive, theoretical aid to diagnosis  Assumes the disease model  Groups~ 230 psychological disorders into 17 major categories.  Novel feature- Multi-axial organizations o When making a diagnosis the clinician must describe the patient's condition according to each. o Axes I and II make up the mental disorders per se (state and trait disorders). o Axis III lists any physical disorders believed to bear on the mental disorder (ex. Hypothyroidism) o Axis IV indicates psychosocial and environmental problems (stressors) o Axis V rates the person's current level of adaptive functions (GAF)- like the continuum shown earlier in this set of notes. This axis helps determine which actions to take. Pros and Cons  Naming and describing disorders facilitates communication, treatment, and research  DSM-1 (1952)- 100 diagnoses  DSM-4 (1994)- Almost 400 o Advocates explain this as a need to distinguish disorders precise to treat them properly o Critics explain this as insurance companies requiring clinician to assign clients appropriate DSM code numbers.  Kutchins and Kirk (1997) o Unreliable and invalid; includes more and more things that we used t think are normal (ex. Bad handwriting). o Danger of over diagnosis o Power of labels o Confusion with normal problems o Illusion of objectivity and universality  DSM-V- "Oppositional Defiant Disorder"  Not getting along with your parents o "Relational Disorders"- completely normal except near spouse. o "Compulsive shopping" o "Self-defeating personality disorder" (thankfully defeated)- described women who stay in abusive relationships o Internet Addiction Disorder proposed by Kimberly Young (1998, 1999)  Pathological Internet use similar to pathological gambling insofar as it also involves a failure of impulsive control without involving and intoxicant  Preoccupation with the internet to the extent of thinking about it when offline  Inability to control internet use  Using the internet to escape problems  Going through withdrawal symptoms  William Glasser- "Few if any, mental health professionals embrace mental health [ rather than mental disorders]".  Canadian Institute for Health Information 2005-2006 o People who are homeless are more likely to experience mental illness or poor mental health, but which comes first? o People with mental illness and/or substance abuse problems are over-represented among the homeless o The biggest increase occurred in the 1990s when many provinces lowered welfare rates and limited investment in social housing. Anxiety Disorders  GAD- excessive/chronic working o Chronic state of diffuse, free-floating anxiety with no ingle identifiable source o Live in a world of perpetual fear  Panic Disorder- recurrent episodes, or attacks, of extremely intense fear or dread. This will occur suddenly and unpredictably. o Cued panic attacks are linked to specific situations and may reflect phobias. o Uncued- recurrent required for diagnosis  Will develop a fear of fear  May be diagnosed with or without agoraphobia  Phobia- persistent, irrational fear of a specific object/situation o May be social or specific  Social- an incapacitating fear of social interactions; this is fair common (occurring in 11% of men and 15% of women). The onset is usually in adolescence.  Specific- highly focused fear of animals, natural environments, or other specific situations.  OCD- Unwanted repetitive thoughts (obsessions) and/or actions (compulsions) o Compulsion is a reaction to obsession o Pursuing cleanliness and orderliness; avoiding particular objects, performing repetitive, magical, protective practices; checking, performing a particular act slowly. o Obsessions tend to focus on fears, doubts, and impulses o Ego dystonic- aware it is irrational Personality Disorders  At least 10 types
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