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Psychopathology

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Study of the nature, development, and treatment of psychological disorders

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Challenges to Psychopathology

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-Maintaining objectivity -Avoiding preconceived notions -Reducing stigma

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Stigma

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-The destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner. -4 characteristics -Mental illness is one of the most stigmatized of conditions in the 21st century.

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Four Characteristics of Stigma

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1.) Distinguishing label is applied("crazy") 2.) Label is linked to deviant or undesirable attributes ("crazy people are dangerous") 3.) People with the label are seen as different from those without, contributing to "us" vs. "them" mentality("we are not like those crazy people") 4.) People with the label are discriminated against ("Clinic for crazy people can't be built in our neighborhood")

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Characteristics of Mental DIsorders

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-Disability -Personal Distress -Violation of Social Norms: -Dysfunction

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Disability

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Impairment in some important area of life -Substance use disorders defined by social or occupational one (arguments with spouse or poor work performance) -Phobias can produce this and distress -Cannot be alone used to diagnose a mental disorder. (bullemia nervosa not experience this)

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Personal Distress

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Emotional pain and suffering. -Anxiety disorders and depression suffer greatly from it (helplesness and hopelesness of depression) -Not all mental disorders cause it (ex: antisocial personality disorder) -Not all behavior that causes it is disordered.

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Violation of Social Norms

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Violation of Social Norms: -Social Norms: Widely held standards (beliefs and attitudes) that people use consciously or intuitively to make judgments about where behaviors are situated on scales suck as good-bad, right-wrong, acceptable-unacceptable, justified-unjustified --They vary across cultures and ethnic groups, so behavior might be accepted in one place but not another. -Behaviors that break these norms might be classified as disordered. --Ex: competitive rituals performed by people with OCD and convos with imaginary people that people with schizophrenia engage in --This way of defining mental disorder is both too broad and too narrow.

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Dysfunction

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-DSM definition: behavioral, psychological, and biological dysfunctions are all interrelated. The brain impacts behavior, and behavior impacts the brain. -Harmful Dysfunction: Wakefield (1992) -Internal mechanisms involved in mental disorders largely unknown, so cant weigh what may not be functioning properly

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Harmful Dysfunction: Wakefield

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Harmful Dysfunction: Wakefield (1992) definition has two parts -A value judgment ('harmful') as an objective, scientific component- the "dysfunction" -Occurs when an internal mechanism is unable to perform its natural function. -Judgment that a behavior is harmful requires some standard, and this standard is likely to depend on social norms and values.

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Critics of Wakefield's Harmful Dysfunction

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argue dysfunction component not easily and objectively identifiable in relation to mental disorders.

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History of Psychopathology

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Demonology -Exorcism Early Biological Explanations -Hippocrates (5th century BC) -Dark Ages -Persecution of Witches -Lunacy Trials -Asylum -Benjeman Rush -Phillipe Pinel -Moral Treatment -Dorothea Dix

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Demonology

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-Possession by evil beings or spirits -Treated with Exorcism: the casting out of them

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Hippocrates

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-Father or modern medicine. -Mental disturbances have natural (not supernatural) causes Three categories of mental disorders - mania, melancholia, & phrenitis (brain fever) He Thought normal brain functioning depended on the balance of Four humors: -blood (changeable tempermant) black bile (meloncholia), yellow bile (Irritibility and anxiousness) , & phlegm (Sluggish and dull)

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Dark Ages

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Monks cared and prayed for mentally ill

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Persecution of Witches

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-Turn back to demonology -Torture sometimes led to bizarre delusional sounding confessions, e.g., concourse with demons. -Historians concluded many of the accused were mentally ill. -Little support for that conclusion.

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Lunacy Trials

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-Trials to determine a person's mental health, held in 13th century England. -hospitals began to come under secular jurisdiction. -English laws allowed people with mental illness to be hospitalized -Municipal authorities assumed responsibility for care of mentally ill

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Lunacy

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-Attributes insanity to misalignment of moon and stars

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Asylums

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-Establishments for the confinement and care of mentally ill -Priory of St. Mary of Bethlehem (1243) --One of the first mental institutions --The wealthy paid to gape at the insane --Origin of the term bedlam -Treatment non-existent or harmful at asylums

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Benjeman Rush

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-Father of American psychiatry -Believed mental disorder caused by excess of blood in brain. Treatment = draw great quantities of blood from people. -Also believed people with mental illness could be cured by being frightened, so treatment was to convince patient death was near.

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Phillipe Pinel (1745-1826)

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-Pioneered humanitarian treatment at LaBicetre -Began to treat patients as sick human beings instead of beasts. Light airy rooms replaced dungeons. -Patients should be approached with compassion and understanding and treated with dignity. -Could restore their reason through comforting counsel and purposeful activity.

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Moral Treatment

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-Small, privately funded, humanitarian mental hospitals -Friends Asylum (1817) -Patients engaged in purposeful, calming activities (e.g., gardening) -Talked with attendants

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Dorothea Dix (1802-1887)

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-Crusader for prisoners and mentally ill -Urged improvement of institutions -Worked to establish 32 new, public hospitals -Hospitals staffed with physicians

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Early Foundations: Biological Approaches

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-General Paresis -Louis Pasteur

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General Pariesis

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-Degenerative disorder with psychological symptoms -Caused by syphilis -Since had biological cause, other mental illness might also.

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Louis Pasteur

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-established the germ theory of disease -Disease caused by infection of the body by minute organisms.

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Early Foundations: Genetics

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-Galton -Behavioral Genetics -Eugenics

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Francis Galton

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-Originator of genetic research -Twins study late 1800s England. Attributed many behavioral characteristics to heredity -Coined terms nature and nurture -Created Eugenics Movement -His work led to notion that mental illnesses could be inherited

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Behavioral Genetics

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Extent to which behavioral differences are due to genetics

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Eugenics

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-Promotion of enforced sterilization to eliminate undesirable characteristics from the population -Many state laws required mentally ill to be sterilized

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Early Biological Treatments

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-Sakel's Insulin-Coma Therapy 1930's -Electroconvulsive Therapy (ECT) -Prefrontal lobotomy

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Sakel's Insulin-Coma Therapy

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-1930's practice of inducing a coma with large dosages of insulin. -Claimed that ¾ of the people with schizophrenia he treated showed significant improvement. -Later findings were less encouraging.

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Electroconvulsive Therapy (ECT)

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-Cerletti and Bini (1938) -Induce epileptic seizures with electric shock -admistered to people with schizophrenia and severe depression, sometimes still used for depression.

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Prefrontal lobotomy

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-Moniz (1935) -surgical procedure that destroys tracts connecting frontal lobes to other areas of the brain -Used on people with violent behavior -Often led to listlessness, apathy, and lack of some cognitive abilities

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Emil Kraepelin (1856-1926)

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-Pioneered classification of mental illness based on biological causes -Published 1st psychiatry text (1883) --Mental illness as syndrome -Cluster of symptoms that co-occur -Proposed two major syndromes --Dementia praecox --Manic-depressive psychosis

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Early Foundations: Psychological Approaches

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-Mesmer -Charcot -Bruer -Freud -

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Franz Anton Mesmer (1734-1815)

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-Treated patients with hysteria using "animal magnetism" -Early practitioner of hypnosis

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Hysteria

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-Physical incapacities, such as blindness or paralysis, for which no physical cause could be found.

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Jean Martin Charcot

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-Believed hysteria was problem with nervous system and had biological cause. -Support in hypnosis as worthy treatment for hysteria. Helped legitimize that in Parisian society.

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Josef Breuer (1842-1925)

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-Used hypnosis to facilitate catharsis -Worked With Freud

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Catharsis

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-Reliving an earlier emotional trauma and releasing emotional tension by expressing previously forgotten thoughts about the event.

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Freud: Psychoanalytic Theory

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- Human behavior determined by unconscious forces. -Psychopathology results from conflicts among these unconscious forces. -Structure of The Psyche -Personality Structure -Defense Mechanisms -Therapy

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Structure of the Mind (psyche)

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-The mind is like an iceberg. It is mostly hidden, and below the surface lies the unconscious mind. The preconscious stores temporary memories -3 parts: Id, ego, and superego

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Id

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-Present at birth and is the repository of all of the energy needed to run psyche, including basic urges for food, water, elimination, warmth, affection, and sex. -Libido -Pleasure principle -Primary process thinking [fantasy, dreams, hallucination] Energy of Id; "psychic energy"

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Libido

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-Source of Id's energy. Biological. Individual can't perceive this energy because unconscious (below level of awareness

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Pleasure Principle

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-Seeking immediate gratification of urges. What Id operates on. -When id isn't satisfied, tension is produced, and id impels a person to eliminate this tension as quickly as possible.

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Ego

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-Begins to develop from the id during second 6 months of life. -Contents are primarily conscious. -Reality principle -Attempt to satisfy Id's demands within reality's constraints -Secondary process thinking [rational reasoning]

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Reality Principle

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-What the ego operates on. Mediates between the demands of reality and the id's demands for immediate gratification

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Superego

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-The conscience -Develops throughout childhood, arising from the ego. As children discover many of their impulses are not acceptable to their parents, they begin to incorporate parental (and societal) values as their own in order to receive the pleasure of parental approval and avoid the pain of disapproval

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Personality Structure

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-Personality develops as a result of our efforts to resolve conflicts between our biological impulses (id) and social restraints (superego).

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Psychoanalitic Therapy (Psychoanalysis)

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-Still practiced today, though not as common. -Goal of therapist is to understand the person's early-childhood experiences, the nature of key relationships, and patterns in current relationships. to gain insight into the unconsious. -To uncover repressed material -To understand the "psychodynamics"— Interactions among the id, ego, and superego Example: Freudian Dream Analysis—the "royal road" to the unconsious Latent content vs manifest content

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Major Techniques of Psychoanalysis

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-Free Association -Analysis of Transference -Interpretation

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Free Association

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-Patient tries to say whatever comes to mind without censoring anything

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Analysis of Transference

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The patient responds to the analyst in ways that the patient has previously responded to to the important figures in his or her life, and the analyst helps the patient understand and interpret these responses.

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Interpretation

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Analyst points out to the patient the meaning of certain of the patient's behaviors.

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Freud's Stage Theory of Psychosexual Development

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Oral Stage (birth to 18 mos.) -Primary satisfaction from sucking & chewing Anal Stage (18 mos. to 3) -Pleasure derived from elimination Phallic Stage (3 to 5 or 6) -Pleasure derived from sexual organs Latency Period (6 to 12) -Id impulses not a factor Genital Stage (adulthood) -Heterosexual interests predominate

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Problems in passing through the Psychosexual Stages

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-Too much or too little gratification at a stage -Trauma occurring during a stage -Fixation or Regression

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Fixation

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-Too little or too much gratification leads to fixation at that stage

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Regression

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-When stressed, individual regresses to earlier stage. -Behaves in ways that were appropriate at an earlier age

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Oedipus Complex

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-A boy's sexual desire for his mother and feelings of jealousy and hatred for the rival father. Conflict: Castration anxiety for boys -Drives repression of desire for mother - Resolution with Identification with father -Emergence of superego

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Electra Complex

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-Girl's desire for her father Conflicts: -Penis envy -Anger toward mother -Repression of desire for father (incomplete; not driven by strong anxiety as for boys) -Identification with mother -Emergence of superego -Weak superego

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Identification

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-Children cope with threatening feelings by repressing them and by identifying with the rival parent. Through this process of identification, their superego gains strength that incorporates their parents' values.

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Defense Mechanisms

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Psychological maneuvers used to manage stress & anxiety -Id, Ego, & Superego continually in conflict -Conflict generates anxiety -Repression, denial, projection, displacement, reaction formation, regression, rationalization, sublimination

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Repression

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Intentional, although unconscious, forgetting Memories, impulses, traumatic events

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Neo Freudians

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-Jung -Adler -Ego Analysis

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Carl Jung Analytical Psychology

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-Hypothesized that in addition to personal unconscious postulated by Freud, there is a collective unconscious -Incorporates Freudian and humanistic psychology -Archetypes

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Collective Unconscious

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The part of the unconscious that is common to all humans and consists primarily of archetypes. Each of us has masculine and feminine traits that are blended and that people's spiritual and religious urges are as basic as their id urges

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Archetypes

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-Basic categories that all human beings use in conceptualizing about the world. He cataloged various personality characteristics: -Extraversion: Orientation toward the external world -Introversion: An orientation towards the inner, subjective world

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Alfred Adler Individual Psychology

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-Regarded people as inextricably tied to their society because he believed that fulfillment found in doing things for the social good. Stressed importance of working toward goals.

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Ego Analysis

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-Emphasized individual's control of environment

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Rise of Behaviorism

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-Watson -Classical Conditioning -Operant Conditioning -Modeling -Behavior Therapy

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John Watson (1878-1958)

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Behaviorism -Emphasis on learning rather than innate tendencies -Focus on observable behavior -make a dozen infants into specialists

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Classical Conditioning Pavlov

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-Pavlov (1849-1936) -Learning through association -Dog bell meat experiment -Unconditioned Stimulus (UCS) meat powder -Conditioned Stimulus (CS) bell (in association to meat) -Unconditioned Response (UR) salivation to meat -Conditioned Response (CR)salivation to bell -As number of presentations of bell and meat powder increases, number of salivations elicited by bell alone increases. -Extinction

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Extinction

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-What happens to CR If CS is no longer followed by the UCS, then fewer and fewer CR's are elicited and the CR gradually disappears.

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Classical Conditioning Watson and Raynor (1920)

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- Classically conditioned fear in Little Albert

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Operant Conditioning

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E. Thorndike (1874-1949) -Learning through consequences -Law of Effect -B.F. Skinner (1904-1990): Principle of Reinforcement

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The Law of Effect (Thorndike)

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-Behavior that is followed by consequences satisfying to the organism will be repeated, and behavior that is followed by noxious or unpleasant consequences will be discouraged.

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B.F. Skinner and Operant Conditioning

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-Applies to behavior that operates on the environment. Renamed law of effect principle of reinforcement and distinguished two types of reinforcement: positive and negative. -Shaping

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Positive Reinforcement

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-Behaviors followed by pleasant stimuli are strengthened

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Negative Rienforcement

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-Behaviors that terminate a negative stimulus are strengthened

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Shaping

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-Reward a sequence of responses that approximate the final response

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Modeling

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Learning by imitating others' behavior -Can occur without reinforcement Bandura & Menlove (1968) - Modeling reduced children's fear of dogs, by having them see positive interactions with other people and dogs

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Behavior Therapy

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-Applications of principles of classical conditioning (systematic desensitization; aversive conditioning, intermittent reinforcement ) -Applications of principles of operant conditioning (social skills training; token economies; ABA: Applied Behavior Analysis) -Applications of principles of Modeling

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Systematic Desensitization

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-behavior therapy used to treat phobias and anxiety. Includes two components: • Deep muscle relaxation • Gradual exposure to a list of feared situations, starting with those that arouse minimal anxiety and progressing to those that are the most frightening.

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Aversive Conditioning

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the use of something unpleasant, or a punishment, to stop an unwanted behavior

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Intermittent reinforcement

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-Rewarding a response only a portion of the times it appears.

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Applied Behavior Analysis

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the science of controlling and predicting human behavior

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Roots of Cognitive Therapy

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-Aaron Beck Cognitive Therapy -Albert Ellis rational-emotive behavior therapy REBT

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Cognitive Therapy Aaron Beck

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Based on idea that people not only behave, but also think and feel. All cognitive approaches have one thing in common: -Emphasize that how people construe themselves and the world is a major detriment of psychological disorders. -Therapist begins by helping clients become more aware of their maladaptive thoughts. By changing cognition, hope people can change their feelings, behaviors, and symptoms.

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Rational-Emotive Behavior Therapy (REBT)

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-sustained emotional reactions are caused by internal sentences that people repeat to themselves. -These self statements reflect sometimes unspoken assumptions - irrational beliefs- about what is necessary to lead a meaningful life. -Aim is to eliminate self-defeating beliefs. -Demandingness

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Demandingness

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The musts or should that people impose on themselves and on others.

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Mental Health Professions

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Clinical Psychologist -Ph.D. or Psy.D. Psychiatrist -M.D. -can write prescriptions Social Workers M.S.W. Counseling Psychologist

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Psychotherapy

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-Primary verbal means of helping people change their thoughts, feelings, and behavior to reduce distress and to achieve greater life satisfaction.

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