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Chapter 14

Chapter 14 - Psychological Disorders.docx

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Psychology 2035A/B
Doug Hazlewood

CHAPTER 14: PSYCHOLOGICAL DISORDERS (pp. 440 – 453) ABNORMAL BEHAVIOUR: CONCEPTS AND CONTROVERSIES THE MEDICAL MODEL APPLIED TO ABNORMAL BEHAVIOUR  Medical model: proposes that it is useful to think of abnormal behaviour as a disease  Basis for many terms used to refer to abnormal behaviour  Mental illness, psychological disorder, psychopathology th th  Medical model = conventional way of thinking during 19 and 20 centuries  influence dominant today  Prior to 18 century: conceptions of abnormal behaviour based on superstition  Possessed by demons  Witches in league with the devil  Victims of God’s punishment  Treatments: chants, rituals, exorcisms, etc.  If threatening  chains, dungeons, torture, death  Rise of medical model  Patients views with more sympathy, less hatred & fear  Gradual process made toward more humane care of mentally ill  Ineffectual approaches to treatment  scientific investigation of causes & cures of psychological disorders  Thomas Szasz  “disease or illness can affect only the body; hence, there can be no mental illness… Minds can be “sick only in the sense that jokes are “sick” or economies are “sick””  Abnormal behaviour usually involves deviation from social norms  Deviations are “problems in living”  Medical model converts moral and social questions about what is acceptable behaviour into medical questions  Medical diagnosis of abnormal behaviour pin potentially derogatory labels on people  Psychotic, schizophrenic, or mentally ill  Carries social stigma that is difficult to shake  erratic, dangerous, incompetent, inferior  Promotes distancing, disdain, prejudice, rejection  Even after recovery… still have to deal with prejudice  Stigma associated with psychological disorders deep-rooted and not easily reduced  Recent decades, general public’s knowledge and understanding of mental disorders gone up  Research  many psychological disorders at least partly attributable to genetic and physiological factors  more similar to physical illnesses  far few negative connotations  Stigmatization of mental disorders increased rather than decreased  Disease analogy continues to be useful, though you should keep in mind that it is only an analogy  Diagnosis: distinguishing one illness from another  Etiology: apparent causation an developmental history of an illness  Prognosis: forecast about probably course of an illness  Shared meanings  better communication among clinicians, researchers, public CRITERIA OF ABNORMAL BEHAVIOUR 1. Deviance: behaviour deviates from what their society considers acceptable  Varies from culture to culture, but all cultures have such norms  When these standards and expectations ignored  labelled mentally ill i.e. transvestic fetishism: sexual disorder in which man get’s aroused by dressing in women’s clothes 2. Maladaptive behaviour: everyday adaptive behaviour impaired  Substance use  Drug (i.e. cocaine)  social or occupational functioning impairment?  substance use disorder Alcohol & drug use not terribly unusual or deviant  Maladaptive quality of behaviour makes it disordered 3. Personal distress: individual’s report of great personal distress  Usually criterion for people troubled by depression or anxiety Depressed might not exhibit deviant or maladaptive behaviour  labelled with disorder when describe subjective pain & suffering to friends, relatives, health professionals  People often viewed as disordered if even 1 criterion met  Diagnosis involves value judgments about what represents normal/abnormal behaviour  Criteria of mental illness not value-free as criteria of physical illness  Judgments about mental illness reflects prevailing cultural values, social trends political forces, scientific knowledge  Normality and abnormality exist on continuum; matter of degree, not either/or proposition  Deviance  Normal  Personal distress  Abnormal  Maladaptive behaviour  PSYCHODIAGNOSIS: THE CLASSIFICATION OF DISORDERS  1952: American Psychiatric Association unveil Diagnostic and Statistical Manual of Mental Disorders (DSM)  Described about 100 disorders  1968: DSM-II, guidelines still sketchy  1980: DSM-III, diagnostic criteria made more explicit, concrete, detailed  facilitate more consistent diagnoses across clinicians  1994 (current): DSM-IV, refine criteria introduced in DSM-III  Each revision expanded its list of disorders The Multiaxial System  Judgments about individuals on 5 separate dimensions (“axes”)  Diagnosis made on Axis I and II  Axis I: record most types of disorders  Axis II: list long-running personality disorders or mental retardation  Supplemental information recorded on remaining axes  Axis III (General Medical Conditions): patient’s physical disorders  Axis IV (Psychosocial and Environmental Problems): makes notations regarding types of stress experienced by individual in past year  Axis V (Global Assessment of Functioning): estimates made of individual’s current level of adaptive functioning & individual’s highest level of functioning in past year  Axes system recognizes importance of information besides traditional diagnostic label  2011: DSM-V (Proposed), new syndromes & diagnostics! Controversies Surrounding the DSM  Enormous overlap among various disorders in terms o how people score on a limited number of continuous dimension  can people really be placed in discontinuous diagnostic categories?  debate about merits of categorical vs. dimensional approach heating up and will be major bone of contention in future revisions of DSM system  recent additions of DSM add everyday problems that are not traditionally thought of as mental illnesses to the diagnostic system i.e. nicotine dependence & pathological gambling disorder  bill insurance companies for professional treatment THE PREVALENCE OF PSYCHOLOGICAL DISORDERS  epidemiology: study of the distribution of mental or physical disorders in a population  prevalence: percentage of population that exhibits a disorder during a specified time period  lifetime prevalence estimates  most interesting data  most common types of psychological disorders 1. substance use disorders (alcohol and drugs) 2. anxiety disorders 3. mood disorders  high prevalence of psychological disorders  economic costs of mental illness in modern societies enormous  $150B  1.3B days of role performance  3x disability days as CVD & cancer  Cost of suffering from family of mentally ill ANXIETY DISORDERS  Anxiety disorders: class of disorders marked by feelings of excessive apprehension and anxiety GENERALIZED ANXIETY DISORDER  Generalized anxiety disorder: marked by chronic high level of anxiety that is not tied to any specific threat  Gradual
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