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Chapter 16

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Philosophy 1020
Mark Cole

Chapter 16 – Adjustment & Maladjustment (Psychological Disorders) Terminology • Psychological Term: o A) Crazy o B) Insane (***a legal term) o C) Nuts o D) None of TheAbove • “Split Personality” Term: o A) Siamese Twins o B) Schizophrenia o C) Dissociative Identity Disorder o D) None of theAbove • Not a Psychiatric Disorder: o A) Neurosis o B) Psychopathy o C) Homosexuality o D) All of the above • Performed in Ontario: o A) Lobotomy o B) Electroconvulsive Therapy o C) Psychoanalysis o D) All of the above The Problem of Diagnosis of Mental Disorders - line between normal and abnormal is indistinct - as a society, we value eccentricity - but we deplore extreme deviancy - when does eccentricity become concern? - the three D’s criteria for abnormal behaviour: 1. deviancy (in a particular area) 2. dysfunctionality 3. distress - still a tough call, even after finding all 3 The Demonological View • Belief that abnormal behaviour is caused by supernatural forces; attributing deviance to the work of the devil trying to escape the body • Trephination – a procedure to release the spirit by putting a hole in the skull • Either processed involuntarily or made a pact with the dark side • Tested by binding a women’s hands and feet together, throwing her into lake or pond (impurities float to surface so if you sank your ok) Early Biological Views • Hippocrates suggested mental illnesses are diseases lie physical disorders • Believe people were sick, not possessed • It begins in the brain and mental disorders can cause physical dysfunction • Medical Model – assumes that symptoms will vanish when the cause (pathogen) is discovered and eliminated; causes of diseases were usually unknown • General paresis – (Tomas Szasz critic of medical model) a disorder caused by mental deterioration and bizarre behaviour from brain deterioration from syphilis (1) 2000+ years of research has failed to find organic causes - a rare exception is general paresis caused by syphilis - when contracted syphilis, just have genital warts, but comes back in 20 years with the warts and general paresis (2) treatment has been replaced by custodial care and “restraint” (3) the label mental illness has stigmatized, not protected them Szaz’sAlternatives - “mental disorders” are failures of adjustment to life events - the behaviours that define them are not symptoms of disease - the Vulnerability-Stress Model builds on this idea - it suggests that people vary in their resilience to stress - variablie resilience can result from biology or environment - if sufficient stressors do not occur, this predisposition may never result in a disorder - however, when stressors come, a disorder may be triggered in the vulnerable - but the Medical Model has endured - we continue to favour terms like “treat”, “cure” and “patient” - and with medicine comes diagnosis Psychological Perspectives (Freud) • Freud’s theory of psychoanalysis emerged as a new way to view deviant behaviour • Physical symptoms can have non-organic causes (symptoms serve the needs of the mind) • They are functional and serve the needs of the psyche • Caused by unresolved childhood conflicts that make someone vulnerable life events that arouse anxiety and cope with this by using a defense mechanism • Inappropriate use of the defense mechanism results in maladaptive behaviour • Neuroses – disorders such as obsessions, phobias and depression that don’t involve a loss of contact with reality • Psychoses – anxiety from unresolved conflicts leas to a person no longer dealing with reality. Ex) schizophrenia • Hysteria – failures such as paralysis that they believe are true until tested • Behaviours are learned responses with the influence of the environment • Aaron Beck identified maladaptive patterns linked to disorders; isolate these patterns, beliefs and attitudes to understand behaviours • Environmental forces frustrate peoples self-actualization tendencies to search for the meaning of life Abnormal • Abnormal behaviours – a behaviour that is personally distressful, personally dysfunctional or culturally deviant • Judgments about what is considered abnormal is based on time and culture • The final analysis in social construction; can affect value judgments and political agendas • Drapetomania – a mental disorder with an obsessive desire for freedom that drove slaves to flee from captivity; any slave that escaped more than twice • Self-defeating/masochistic personality disorder – diagnostic system applied to people who repeatedly involve themselves in hurtful circumstances • 3 D’s ofAbnormality: 1) Distress - Anxious, depressed and dissatisfied - When suffering is disproportionate to the situation 2) Dysfunctional - Behaviours interfere with ability to work and experience satisfying relationships with other people are likely to be seen as maladaptive - Interfere with the well-being of society 3) Deviance - Societies judgments of a given behaviour - Conduct regulated by norms, and rules of how we are expected to behave - If violating unstated norms it can lead to environmental causes that make others uncomfortable Ex) Rosenhahn ▯ mental patients said they heard voices; would assume schizophrenia Diagnosing Disorders (Kraepelin) • Reliability – clinicians using the system that should high levels of agreement in their diagnostic decisions; should be couched in terms of observable behaviours minimizing judgments • Validity – diagnostic categories should capture the essential features of various disorders; categories should allow us to differential between different disorders • DSM IV (Diagnostic and Statistical Manual of Mental Disorders) ­ Axis I o Primary diagnosis represents the persons primary clinical symptoms, most disorders o Childhood disorder, mental disorder, substance-related disorder, psychotic disorder, mood disorder, anxiety disorder, anxiety disorder, somatoform disorder, dissociative disorder, sexual and gender-identity disorder, eating disorder ­ Axis II o Personality or developmental disorders (mental retardation) o Influence the person’s behaviour and response to treatment. Ex) down’s syndrome ­ Axis III o Any physical conditions that might be relevant. Ex) high blood pressure ­ Axis IV o The intensity of environmental stressors in a persons recent life ­ Axis V o Persons coping resources as reflected in assessment of level of adaptive functioning Diagnostic Labeling Issues • Social and Personal Implications ­ Once diagnosed and labeled it becomes too easy to accept the label as an accurate description of the individual rather than the behaviour ­ Hard to not judge without preconceptions about how one will act and affects your behaviours towards others ­ When people are aware of disorders, they apply them and accept it as their new identities and label sticks with them as they improve • Legal Consequences ­ People judged to be dangerous to themselves and society may be committed and lose some of their civil rights ­ Competency – a defendants state of mind at the time of a judicial hearing; if deemed to be too disturbed to understand the proceeds they can be labeled as not competent to stand trial and institutionalized until judged competent ­ Insanity – presumed state of mind of the defendant at the time the crime was committed; judged to be guilty by reason of insanity if they are so impaired during the crime they lacked capacity to understand the wrongfulness of actions • Self-Diagnosing ­ Medical students disease ▯ when people read descriptions of disorders, they see these symptoms in themselves ­ Does not mean you have the disorder Anxiety Disorders • The frequency and intensity of anxiety responses are out of proportion to the situations that trigger them • 4 components of anxiety responses: 1) Subjective-emotional - ex: feelings or apprehension or tension or discomfort 2) Cognitive - ex: feelings of apprehension, danger and inability to cope, worry, threat 3) Physiological responses - ex: increased heart rate, muscle tension, nausea, shaking 4) Behavioural responses - ex: avoidance, escape, impaired performance • Phobic Disorder ­ Phobias ▯ strong irrational fears of certain objects or situations ­ Realize fears are out of proportion but feel helpless when dealing with fears ­ Make efforts to avoid phobic situations or objects ­ Degree of impairment depends on how often situation has occurred ­ Agoraphobia ▯ fear of open and public places ­ Social phobias ▯ fear of situations which a person might be evaluated and embarrassed ­ Specific phobias ▯ fear of dogs, snakes, spiders, airplanes, etc. • GeneralizedAnxiety Disorder ­ Excessive anxiety and worry for at least 6 months about differing events and activities ­ Difficult to control the worry ­ Worry is associated with at least 3: 1) Restlessness or feeling on edge 2) Being easily fatigued 3) Difficulty in concentrating 4) Irritability 5) Muscle tension 6) Sleep disturbance ­ Anxiety is not focused on fear of panic attacks, being embarrassed or being contaminated ­ Deficit causes significant distress and/or social and occupational dysfunction ­ Disturbance not due to direct effects of drugs or medical conditions • Panic Disorder ­ Occurs suddenly and unpredictably and is more intense than generalized anxiety ­ Occur in the absences of any identifiable stimulus and therefore many people develop agoraphobia as well as they fear having these attacks in public • Obsessive-Compulsive Disorder (OCD) ­ Consists of two components although they can occur alone ­ Obsessions ▯ repetitive and unwelcome thoughts, images or impulses that invade consciousness and are difficult to dismiss or control ­ Compulsions ▯ repetitive behavioural responses that can be resisted only with great difficulty; responses to obsessive thoughts to reduce anxiety associate with thoughts Onset, Course and Statistics • Can occur at any age • Lifetime prevalence is 5% in the general population • GAD diagnosed more often (55%-66%) in women • Symptoms vary across cultures • Scores on anxiety tests correlate much more in monozygotic than in dizogotic twins • Concordance rate for anxiety is 40% in monozygotic twins and only 4% in dizogotic twins Biological Factors ofAnxiety Disorders • Genetics may create a vulnerability to anxiety disorders • Automatic nervous system can overact to perceived threat and creating high levels of physiological arousal • Hereditary factors may cause over activity of neurotransmitter systems in emotional response • Trauma-produced over activity in the emotional system of the right hemisphere • Ex) Identical twins ▯ are similar in anxiety test scores compared to fraternal even when separated (50-60% genetics; 40-50% life experiences) • GABA – an inhibitory neurotransmitter that reduces neural activity in the amygdala and other brain structures that stimulate physiological arousal; low levels can cause highly reactive nervous systems that produce anxiety and stress • Low GABA levels lead to anxiety disorders, leading to an overactive libic system • Many anxiolytics are GABA agonists • More susceptible to conditioned phobias because they already have unconditioned arousal response in place • Women exhibit anxiety disorders more than men suggesting a sex-linked biological predisposition for anxiety • Biological preparedness – makes it easy to learn to fear certain stimuli and to know what to focus on Psychological Factors ofAnxiety Disorders • Psychodynamic Theories ­ Neurotic anxiety ▯ occurs when unacceptable impulses threaten to overwhelm the egos defenses and explode into action ­ How defense mechanism deals with neurotic anxiety determines form of anxiety disorder ­ In phobic disorders, neurotic anxiety is displaces onto external stimuli ­ Ex) Hans – fear of bitten by horse; horse represented father and fear of being hurt if acted on sexual desire for mother ­ Obsessions and compulsions handle anxiety by “taking back” or undoing unacceptable urges ­ Panic attacks occur when ones defenses aren’t strong enough to contain anxiety • Cognitive Factors ­ The role of maladaptive thought patterns and beliefs in anxiety disorders ­ People magnify demands and threats; anticipate the worst and feel powerless ­ Social phobic’s judge likelihood and costs of events occurring to be much higher (did not experience these feelings in non-social situations) ­ Panic attacks are triggered by exaggerated misinterpretations of normal anxiety symptoms ­ Person appraises these symptoms as signs of a heart attack or loss of control and create even more anxiety until spiraling out of control into a full panic attack • Anxiety as a Learned Response ­ Anxiety disorders result from emotional conditioning ­ Some fears are acquired as a result of traumatic experiences that produce a classically conditioned fear response ­ Many phobic’s never have a traumatic experience with the phobic object ­ Phobias can be acquired through observational learning or biological dispositions ­ Once anxiety is leaned, it can be triggered through cues either internal or external ­ Behaviours that successfully reduce anxiety are strengthened through negative reinforcement Sociocultural Factors ofAnxiety Disorders • Culture-bound disorders – disorders that only occur in certain places • Kora – belief penis will retract into abdomen and kill him • Taijin Kyofushu – social phobia of emitting odors, blushing, etc. • Windigo – fearful of being possessed by monsters Mood (Affective) Disorders • Set of emotion based disorders which involve depression and mania (excessive excitement) • Depression ­ Everyone has experienced depression at some point ­ 25-30% of undergraduates experience mild depression ­ Clinical depression the frequency, intensity and duration of symptoms are out of proportion to the persons life situation ­ Major depression ▯ leaves person unable to function effectively in their lives ­ Dysthymia ▯ less dramatic affect on ones functioning but is more chronic and long-lasting which can occur for years ­ Negative mood state ▯ core feature of depression; commonly are sad ­ Cognitive Symptoms ▯ difficulty concentrating and making decisions; low self-esteem, feel inferior, inadequate and incompetent; constantly believe they will fail ­ Motivational Symptoms ▯ inability to get started and perform behaviours that can produce pleasure or accomplishment. Ex) unable to get out of bed, go to class, etc. ­ Somatic (bodily) Symptoms ▯ loss of appetite and weight loss; sleep issues and weakness • Bipolar Disorder ­ Depression which alternates with periods of mania ­ There is a single manic episode (with or without any depressive episode) ­ Mania – a state of highly excited mood and behaviour that is opposite of depression ­ In mania state person is euphoric and believes there are no limits ­ Motivational level – manic behaviour is hyperactive and engages in frenetic activity ­ Speech is often rapid and must say as many words as possible and can go days without sleep Prevalence and Course of Mood Disorders • Mainly disorders of emotion or motivation (not cognition) • Mood disturbances characterized by manic and depressive episodes • Episodes are the building blocks of disorders, they are not disorders • 1/20 NorthAmericans are severely depressed • Chances of having a depressive episode at least once in your lifetime is 1/5 • No age group is exempt from depression; young groups is increasing recently • Similar across socio-economic and ethnic groups but there is a major sex difference • Women are twice as likely to suffer unipolar depression (just depression, not manic) • Unipolar Disorder 1) Must have at least one depressive episode 2) No previous manic episode • Manic Episode 1) Elevated, expansive or irritable mood for at least one week 2) Social/occupational dysfunction (get in the way of your life) 3) Symptoms not due to a stimulus 4) At least 3 of the following: o Inflated self esteem o Decreased need for sleep o Excessive talkativeness o Flight of ideas or racing things o Distractibility to unimportant details o Hyper goal-directed activity or psychomotor agitation o Excessive pursuit of dangerous activities • Women are taught to be passive and in the face of stress or loss to focus on feelings • Most people never seek treatment and it goes away overtime • After episode has occurred it can either 1) never reoccur 2) recovery with recurrence 3) not recover and maintain chronically depressed Characteristics of Mood Disorders • Five must be present over a 2-week period and represent a change from normal functioning: ­ Depressed mood: most of the day, nearly every day ***must include 1/2 ­ Loss of interest or pleasure: in almost all activities ***must include 1/2 ­ Significant weight loss or gain or increases and decrease in appetite: 5% per month ­ Insomnia or hypersomnia: either can’t sleep or can’t stay asleep ­ Psychomotor agitation or retardation: do all motor functions slow ­ Fatigue: can be a reason for the above ***has to
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