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WHS AP Psychology Unit 11: Mental Illness and Therapies Essential Task 11-1:Describe contemporary and historical conceptions of what constitutes psychological disorders, recognize the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) as the primary reference for making diagnostic judgments with specific attention to five axis, and identify the positive and negative consequences of diagnostic labels (e.g., the Rosenhan study). Mood Disorders Personality Disorders Unit 11 Anxiety Disorders Abnormal Psych: Disorders Schizophrenia History, DSM Somatoform Disorders Childhood Disorders Dissociative Disorders Electroconvulsive Therapy We are here Psychosurgery Psychoanalysis Biological Insight Therapies Treatments ClientCentered Gestalt Unit 11: Treatment of Psychological Disorders Antipsychotic Drugs Behavior Token Economy Therapies Stress Inoculation Cognitive Therapies Beck’s Cognitive Therapy Rational Emotive Therapy Aversion Therapy Classical Systematic Desensitization Flooding Operant Behavior Contracting Abnormal psychology • the scientific study of abnormal behavior in order to describe, predict, explain, and change abnormal patterns of functioning Mental Disorders • "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom."--Diagnostic & Statistical Manual of Mental Disorders 4th Ed. National Institute of Mental Health Statistics • An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. Or 57.7 million people. • About 6 percent, or 1 in 17 —suffer from a serious mental illness. • In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. • Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity. • Most common disorders were anxiety, phobias, and mood disorders What makes a Behavior a Mental Illness? • Many definitions have been proposed, yet none are universally accepted • ¨ Most definitions, however, share some common features… • “The Four Ds” – Deviance – Different, extreme, unusual – Distress – Unpleasant & upsetting – Dysfunction – Causes interference with life – Danger – Poses risk of harm Understanding Psychological Disorders Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal’s blood. John W. Verano Trephination (boring holes in the skull to remove evil forces) Medical Perspective George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago Philippe Pinel (1745-1826) from France, insisted that madness was not due to demonic possession, but an ailment of the mind. Dance in the madhouse. Models of the Causes of Psychological Disorders • Biological model – Physiological or biochemical basis • Psychoanalytic model – Disorders are the result of unconscious conflicts • Cognitive-Behavioral model – Disorders are the result of learning maladaptive ways of behaving and thinking • Diathesis-Stress model – Biological predisposition to disorder which is triggered by stress Systems theory Biopsychosocial Model Assumes that biological, socio-cultural, and psychological factors combine and interact to produce psychological disorders. Medical Approach When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders. 1. 2. 3. 4. Etiology: Cause and development of the disorder. Diagnosis: Identifying (symptoms) and distinguishing one disease from another. Treatment: Treating a disorder in a psychiatric hospital. Prognosis: Forecast about the disorder. Classifying Psychological Disorders The American Psychiatric Association rendered a Diagnostic and Statistical Manual of Mental Disorders (DSM) to describe psychological disorders. The most recent edition, DSM-IV-TR (Text Revision, 2000), describes 400 psychological disorders compared to 60 in the 1950s. The DSM spells out the specific diagnostic criteria • An example of this can be seen in the diagnosis of a major depressive episode. • A person must exhibit at least five or more of the listed nine characteristics and the symptoms must be evident for at least the last two weeks for that person to be diagnosed with this disorder. • When diagnosing a client the American Psychological Association recommends that the clinician use a multiaxial Assessment System. Multiaxial Classification Axis I Is a Clinical Syndrome (cognitive, anxiety, mood disorders [16 syndromes]) present? Is a Personality Disorder or Mental Retardation Axis II present? Is a General Medical Condition (diabetes, Axis III hypertension or arthritis etc) also present? Axis IV Are Psychosocial or Environmental Problems (school or housing issues) also present? What is the Global Assessment of the person’s functioning? (GAF Scale is out of 100 with the Axis V lower the school the more limited their functionioning. Sample • Axis I 296.21 Major Depressive Disorder 303.90 Alcohol Dependence • Axis II 301.6 Dependent Personality Disorder • Axis III None • Axis IV Recent Divorce, unemployment • Axis V 58 Multiaxial Classification Note 16 syndromes in Axis I Multiaxial Classification Note Global Assessment for Axis V Goals of DSM 1. 2. Describe (400) disorders. Determine how prevalent the disorder is. Disorders outlined by DSM-IV are reliable. Therefore, diagnoses by different professionals are similar. Others criticize DSM-IV for “putting any kind of behavior within the compass of psychiatry.” Diagnostic Labeling 1. Critics of the DSM-IV argue that labels may stigmatize individuals. Elizabeth Eckert, Middletown, NY. From L. Gamwell and N. Tomes, Madness in America, 1995. Cornell University Press. Asylum baseball team (labeling) Diagnostic Labeling 2. 3. Labels may be helpful for healthcare professionals when communicating with one another and establishing therapy. Rosenhan study - Diagnostic Labeling 3. Elaine Thompson/ AP Photo “Insanity” labels raise moral and ethical questions about how society should treat people who have disorders and have committed crimes. Theodore Kaczynski (Unabomber)