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Cultural universality in defining mental illness

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fixed set of disorders exist whose obvious symptoms cut across cultures -culture and where you come from doesn't matter cause we are all human beings at the core

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Cultural relativism in defining mental illness

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Values and worldviews affect expression and determination of deviant behavior -looking at within culture groups and how they influence mental disorders

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how is abnormality viewed

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- almost all people have difficulty coping at times - in US 30% of adults, and 20% of children have mental illness - todays theories are built on old theories - theories and themes circle around; progress is not a steady movement forward

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prehistoric views

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- evil spirits -demons

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trephination

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holes in skull; putting hole in someone's head to give room for the demon to escape; 92% of people died due to brain leakage and infection

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Hippocrates' four humors

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Body composed of various liquids and when imbalanced, causes problems such as abnormal behavior; to help the person balance the liquids by adding or subtracting - yellow bile - black bile - blood - phlem - 1st person to argue biology is possible reason for mental illness - leeches and blood letting are treatment

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middle ages

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- return to demonology - mass outbreaks of madness - ex: tarantism and lycanthropy (spider bites and warewolves) - stress and fear from social unrest and mass illness - inhumane use of asylums to house the "mad" because of no treatment

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tarantism

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person believes were bitten by a spider of different reality and venom will kill them so they have to do extensive physical activity to purge posion; dancing

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lycanthropy

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you will turn into animal or werewolf

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the renaissance and beyond

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- 19th century - moral treatment (hospital staff is intelligent and sensitive, read and talked with patients...) -by 1850, slipped back into horrible conditions (money and staff shortages, still no effective treatment for severely mentally ill)

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20th century

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- somatogenic (abnormality causes physical causes) (ex: fatigue) - psychogenic (abnormality = psychological causes; rise in popularity; Freud)

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freud

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(Psychoanalysis) Austrian physician who approached psychology while trying to treat mental disorders--focused on the unconscious

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how are severe disturbances treated

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- pre-1950's = insulin shock treatment, electro convulsive therapy, lobotomy - 1950's = psychotropic medications, deinstitutionalize and rise in outpatient care - outpatient care= primary mode; short term hospitalizations, outpatient therapy, and medication - community mental health= rise in prevention movement; correct social conditions associated with psychological problems

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psychoanalysis

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Freud's theory of personality that attributes thoughts and actions to unconscious motives and conflicts; the techniques used in treating psychological disorders by seeking to expose and interpret unconscious tensions

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biological model

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- malfunctions in brain and nervous systems (brain anatomy, abnormal neurotransmiter activity, abnormal hormone activity, genetic, viral infections) - biological treatments= drug therapy (tranquilizers, antidepresants, psychotropics); electroconvulsive therapy; psychosurgery (experimental and used in only extreme cases)

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drug therapy

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biological treatment Psychopharmacology Tranquilizers (target central nervous system and calm it down), antidepressants (target serotonin or epinephrine), psychotropics (reduce psychotic symptoms like hallucinations; target dopamine) Typically need to try a lot until find right match 70-80% effective at reducing symptoms otherwise people are considered medication resistant

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electroconvulsive therapy (ETC)

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biological treatment Send electrical current through brain to induce artificial seizure to activate dormant parts of brain In 60% of severe cases, can lift symptoms within a few weeks Can cause brain damage & memory loss Trans-cranial magnet stimulation (TMS): very similar, activate parts of brain that don't work so well; sends magnetic pulses into brain; not as damaging (STILL EXPERIMENTAL)

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model

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set of assumptions to help explain and interpret

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critiques of biological model

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- strengths= respected in field; credible explanation - weaknesses= evidence incomplete or inconclusive; treatments can produce undesireable side effects

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psychological models

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Psychodynamic- Freud; aka psychoanalysis Learning/Behavior Cognitive

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psychodynamic model

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- oldest and most fameous - behavior determined by underlying dynamic psychological forces of which we are not aware (id= basic instincts; ego= problem solving; superego= moral side)

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id

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A reservoir of unconscious psychic energy that, according to Freud, strives to satisfy basic sexual and aggressive drives. Operates on the pleasure principle, demanding immediate gratification.

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ego

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According to Freud, the decision-making component of personality that operates according to the reality principle.

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superego

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The part of personality that, according to Freud, represents internalized ideals and provides standards for judgment (the conscience) and for future aspirations.

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conscious

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our awareness of ourselves and our environment

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preconscious

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in Freud's theory, the level of consciousness in which thoughts and feelings are not conscious but are readily retrieveable to consciousness

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unconscious

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According to Freud, a reservoir of mostly unacceptable thoughts, wishes, feelings, and memories. According to contemporary psychologists, information processing of which we are unaware.

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defence mechanisms

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- unconscious ways of coping with anxiety or disturbing impulses (denial; projection= blame someone else for impulse; reaction formation= acting opposite to your impulse; regression= act in a way that you used to act that was safer when you were younger)

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regression

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Psychoanalytic defense mechanism in which an individual faced with anxiety retreats to a more infantile psychosexual stage, where some psychic energy remains fixated.

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reaction formation

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psychoanalytic defense mechanism by which the ego unconsciously switches unacceptable impulses into their opposites. Thus, people may express feelings that are the opposite of their anxiety-arousing unconscious feelings.

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projection

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Psychoanalytic defense mechanism by which people disguise their own threatening impulses by attributing them to others.

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denial

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Defense mechanism by which people refuse to accept reality.

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freudian falsehoods

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many people not comfortable with some of his theory Freud used his personal experiences to form his "universal theory" Parts have been entirely discredited Based on traditional gender roles in sexually restrictive Victorian-era women

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psychodynamic techniques

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- therapist interpretation (transference- attribution of an impulse to someone; you change the target of the impulse) - working through the transference -catharsis

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transference

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In psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).

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catharsis

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Emotional release

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critiques of the psychodynamic model

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- strengths= recognized importance of psychological theories and treatment; internal conflict as important source of both health and abnormality - weaknesses= unsupported ideas; difficult to research

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The behavioral model

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- began in laboratory - actions determined by life experiences (emphasize observable behavior and environment; behavior is acquired and maintained)

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Behaviorism

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- operant conditioning= organism operates on environment (produces an effect that is either reinforced or punished) - modeling= individuals learn behavioral responses by observing and repeating behavior without direct reinforcement - classical conditioning= learning by association (two events repeatedly occur together and become fused; phobias=ex.)

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behavioral therapies

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- behavioral training to replace problematic behaviors with appropriate ones - therapist as teacher

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critiques of behavioral model

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- strengths= can be observed and measured; significant research support - weakness= too simplistic and unrealistic at times; downplays role of cognition

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the cognitive model

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- teaches new ways of thinking to prevent maladaptive behavior; challenges dysfunctional thoughts; tries out new interpretations; applies new ways of thinking in daily life (ex: bullhorn technique= develop a more appropriate thought and have them repeat it every time they have the dysfunctional thought)

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critiques of cognitive model

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- strengths= broad appeal; clinically useful and effective for several disorders - weaknesses= singular narrow focus; overemphasizes present

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the sociocultural model

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- behavior is best understood with social and cultural influences - must examine social surroundings to understand abnormal behavior

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sociocultural abnormal functioning

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Family structure and communication Family systems theory = abnormal functioning within family leads to abnormal behavior Insane behavior becomes sane in insane environment Talk louder than someone to interrupt so yelling from across the room - norm for that family Role of media- tells us stereotypes of specific groups Decide if you will behavior the behavior or not Societal conditions Abnormality more common in lower classes

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downward drift hypothesis

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Role of media- tells us stereotypes of specific groups Decide if you will behavior the behavior or not Societal conditions Abnormality more common in lower classes (postulates that people suffering from schizophrenia are unable to function well in society and hence enter lower socioeconomic groups)

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sociocultural treatments

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- group therapies - family therapy - couples therapy - community treatment

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critiques of sociocultural model

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- strengths= adds to understanding of abnormality; successful when other treatments fail - weaknesses= research is difficult to interpret; unable to predict abnormality in individuals

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biopsychosocial model

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interaction of genetic, biological development, emotional, behavioral, cognitive, social, and societal influences -apply all factors -commonly used

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"Crazy" music video

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Individualized definition to what is crazy Everyone is a bit crazy Who determines? Line between function and dysfunction Ink blots

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DSM

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- diagnostic and statistical manual of mental disorders (used to help figure out if someone has mental disorder) - formerly had 5 axes (5 areas of function and use those areas 5 axes (branches of info) to develop full clinical picture)

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Axis 1

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mostly main diagnosis people would get Most frequently diagnosed disorders Typically transitive (symptoms come and go) & cause significant problems Major depression, mood disorders

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Axis 2

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personality disorders and mental retardation constant Personality disorders and "mental retardation" Developmental disorders

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Axis 3

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relevant general medical conditions (ex. heart disease) physical condition is cause of onset of symptoms Relevant general medical conditions Sometimes symptoms can be similar or make symptoms worse Diabetes, heart disease, cancer

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axis 4

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psychosocial and environmental problems (ex. unemployment can make symptoms worse Psychosocial and environmental problems unemployment

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axis 5

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0-100 scale of global assessment of psychological, social, and occupational functioning (GAF) -rating of how you are doing overall 0-100 scale of global assessment of psychological, social, and occupational functioning (GAF) 0 means you are dead 100 means no issues whatsoever Usually 90 or below or 80 or below 80-100 person is fine 60-80 mild stuff going on- functioning generally okay 40-60 moderate issues that are significantly impacting person but still functioning at some level 40 and below, dealing with significant issues and cant function day to day

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new name for retardation

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intellectual developmental disorder

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reliability

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consistency, same results over and over again; if multiple people using DSM do they come up with same diagnosis? Different diagnosticians agree on diagnosis

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validity

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accuracy, is measuring what it is supposed to? Accuracy of info provided by diagnostic categories

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cautions of DSM

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- need specialized training to diagnose - must also consider non western norms ***Created and used on USA populations Chance of misdiagnosis if working with person from Japan

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criticisms of DSM

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- based too much on medical model - promotes cookie cutter approach -Categorical system- you either fit criteria or you don't

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sign

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Observable- directly; can see overtly

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symptom

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Reported by client- headache

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syndrome

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Cluster of signs and symptoms (unique to person)

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disorder

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Diagnosis linking syndromes

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disease

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purely biologically driven (sole biological cause e.g. diabeties)

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assessment

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Evaluate and measure attributes of behavior Determine problem and beneficial treatment 100s of tools fall into three categories: Clinical Interview- asking questions about symptoms Psychological tests- looking at specifically psychological assessment Observation- what do we see

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clinical interviews

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- most widely used - structured= set of questions from published interview protocal - unstructured= open-ended questions -limitations= may lack accuracy; may be biased/ may make mistakes in judgement

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psychological tests

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- determine cognitive, emotional, or behavioral states and symptoms - more than 500 different tests

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projective tests

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- subjects interpret vague/ambiguous stimuli - used mainly by psychodynamic practitioners - 4 most popular= rorschach inkblot, TAT (series of pictures of scenes; thematic apperception test), early memories (what are your earlies three memories), sentence-completion test (I am most proud of...)

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critiques of projective tests

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Helpful for "supplementary" information Info we wouldn't necessarily get it another way Indirectly getting at unconscious You cant really "fake" a projective test Rarely demonstrate reliability or validity Not at all standardized Left up to clinician to interpret ideas radically different outcomes depending on who clinician is May be biased against minority ethnic groups or low SES

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objective tests

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Personality inventories Measure all aspects of who you are; measure broad personality characteristics Focus on wide range of behaviors, beliefs, and feelings Tend to be extensive but can be quick to administer Usually self-report Generalized overall test standardized ex)MMPI

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MMPI-2

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Minnesota Multiphasic Personality Inventory - 2 -Consists of 567 self-statements that can be answered "true" or "false" Covers a lot of stuff Statements describe things such as physical concerns, mood, morale, attitudes, & psychological symptoms About 1.5 hours Assesses careless responding & lying -Comprised of ten clinical scales Examples: depression (D) or Psychopathic deviate (PD) Scores range from 0 - 120 Higher the score, the more indicative of deviant before Above 65= dysfunctional Graphed to create a "profile"

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example MMPI

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Graphed based on whether male or female Created in 20s and revised in 80s Concerning profile UW-Milwaukee Dept of Psychology did assessment after a charge of "exhibitionism" Jeffrey Dahmer BEFORE he was arrested for murder 5 years later Psychosis, criminal behavior "at some point in time his coping strategies will fail him and, without any outside support, this could lead him to either masochistic or sadistic behavior" (1986 report)

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critiques of objective tests

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- easier, cheaper, and faster to administer - objectively scored and standardized - fail to allow for cultural differences -only as good as populations you compare it to

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self-report inventories

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- focus on one specific are of functioning ex) Beck Depression Inventory

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Beck Depression Inventory

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(BDI) 21 items Each answer 0-3 Above 21, significant depression Even if you get a low score, like a 3, still concerned if it was for suicidal ideas No validity; on the honor system

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critiques of self-report inventories

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Strong face validity (pro and con) Items seem to be related to what measure is looking at Can improve motivation Easy to lie; can deny a symptom Rarely assess careless or inaccurate responding Few subjected to careful standardization, reliability, and/or validity procedures

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psychophysiological tests

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- measure phisiological response as and indication of psychological problems (most popular= biofeedback and polygraph/lie detector) -Measuring physical state and looking for changes You can fake and get past it

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critiques of psychophisiological tests

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- require expensive equipment - can be inaccurate and unreliable (if person isnt really motivated or wants to fake it)

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neuro tests

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- neurological tests -neuropsychological tests

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neurological testing

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directly assess brain function by assessing structure and activity Visual representation of how brain is structured & whether or not there is damage Expensive MRI, fMRI

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neuropsychological tests

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indirectly assess brain function by assessing cognitive, perceptual, and motor functioning Concussion procols Tells you there might be a problem or not Most popular: Bender Visual-Motor Gestalt Test Shown a series of pictures & person has to directly copy what they see on to paper person will struggle and can tell what part of brain may be having issues

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critiques of neuro tests

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- can be very accurate Bender-gestalt can detect general organic impairment in ~75% of cases - at best, they are rough and general screening devices

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intelligence tests

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Designed to measure intellectual ability (verbal and nonverbal (spatial) skills) Generate an intelligence quotient (IQ) Most popular: Wechsler (WAIS, WISC)

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WAIS/WISC

answer

Results based on age group Heavily standardized Average IQ is 100 100 +/- 15 = 66% of population Verbal and spatial most popular intelligence test

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critiques of intelligence tests

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- among the most carefully produced of all tests (highly standardized; very high reliability and validity) - performance influenced by other factors (hunger, anxiety, motivation) - may contain cultural biases in language or tasks

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observation

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- three classes of problems= behavioral excesses; behavioral deficits; inappropriate behavior

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research studies

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- develop a hypothesis - choose your method - operationalize your variables - ethically examine your idea - evaluate your results - report your conclusions

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hypothesis

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testable statement of question we want to evaluate

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clinical method

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- case study= tests and interviews with one or a small group of people; primary advantage is that it's in depth; disadvantage: subjectivity, time, distortion, lack of generalizability

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experimental method

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- determine effect of one variable event on behavior IV-Variable manipulated vs. DV-Variable measured Experimental Group: exposed to treatment/variable vs. Control Group: no treatment/variable Advantages: precision and evidence for possible causal conclusions Disadvantages: limited aspects possible in lab, awareness of observation; sometimes people act differently while being observed (observation bias)

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correlational method

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- measures degree of relationship between 2 variables - allows prediction - indicated by correlation coefficient *Ranges from -1 to 1 (close to -1 or 1 means strong negative or strong positive relationship) High correlation does not mean cause and effect Correlation doesn't prove causation

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ethical research

answer

Informed consent- participants at any time can pull out of study with no negative consequence Understanding study Confidentiality Right to refuse/withdraw Deception- you shouldn't lie; if you must, can do it if: *not harming people in study *cant do it any other way *have to tell them you deceived them after it is over and they can decide whether to pull data Debriefing- have to tell them what study was about after it is completed

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