PSYCH 257 - Chapter 1: Psychopathology in Historical Context

Idea 1 of what a psychological disorder is

1. dysfunction

2. distress

3. deviance (atypical/culturally unexpected)

Idea 2 of what a psychological disorder is

Wakefield

1. failure of a mechanism to do its job (dysfunction)

2. this dysfunction causes harm and distress

Pros of Wakefield’s theory of harmful dysfunction

1. can measure what is wrong in functioning objectively

2. there is space for cultural context in deciding what is harmful and distressing

Idea three of what a psychological dysfunction is

it is out of the individual’s control

ex. compulsions in OCD, number of shots taken in substance use disorder, excessive ruminations in MDD, and fear in phobias

clinical psychologists (what they do + education)

work with severe psychological disorders. have a PhD or PsyD in clinical psychology

counselling psychologists (what they do + education)

work with relatively healthy individuals with day-to-day issues. may provide psychotherapy. can have a PhD or PsyD in counselling psychology or a Ed.D

psychiatrists (what they do + education)

have an MD + 4-year residency in psychiatry. look at disorders from a biological POV. make diagnoses + offer treatments (often drugs)

Psychiatric social workers

MSW. collect info on family and social situation. treat disorders, with a concentration on family problems.

psychiatric nurses (what they do + education)

Masters or PhD. in charge of care and treatment of patients with psychological disorders. work in hospital

MFT, Mental health counsellors

masters, work in hospitals or clinics. often certified. sex therapists have specialized training.

Scientist-Practitioner Model

1. evidence-based practice

2. practice-based evidence

3. research

evidence-based practice

• keep up with developments in the field to use the best empirically supported methods for diagnosis and treatment

practice-based evidence

• evaluate their own assessments + treatments to see if they work, and to collect new data + make new knowlege

research

• conduct research to learn more about disorders

• work in a academic institution, hospitals, clinics

• this practice suppresses the concept of “miracle cures” and makes sure the practice of clinical psychology is rooted in empirical evidence

3 main focuses of studying psychological disorders

1. clinical description

2. causation (etiology)

3. treatment + outcome

clinical description

• just describing clinical disorders

• the behaviours, thoughts and feelings that make up a specific disorder

• ex. anxiety disorder

  • behaviours: basically the act of worrying excessively.

  • thoughts: basically overthinking, rumination, excessive worry. ex. “i’m not good enough, what if everyone’s just pretending that they like me, i’m going to fail at everything I do”

  • feelings: fear and terror that can reach a peak of panic attacks

presenting problem

what problem the patient presents with :)

ex. OCD —> presents with a specific compulsion, panic disorder, presents with a panic attack, the blood-injury-injection phobia —> presents with fainting

prevalence of a disorder

how many poeple in the population as a whole have the disorder?

ex. 50 people out of 1000 in the population have it, so the prevalence is 50/1000 = 0.05 = 5%.

lifetime prevalence

how many ppl in the population have EVER had the disorder?

ex. if 300 people in a population of 1000 have ever had the disorder, the lifetime prevalence is 300/1000 = 30%

incidence

how many new cases occur during a given period. ex. in a year, the incidence rate of MDD is 3-5%, which means for every 100 people, 3-5 have MDD.

• what sets incidence apart, is that it has an GIVEN PERIOD. a time frame. maybe a month, maybe a year. usually a year. always a time period.

at least 1 of which 2 factors of the 3 D’s must apply to diagnose someone with a psychological disorder?

distress or impairment

what’s the difference between impairment and dysfunction?

dysfunction is a breakdown in cognitive, emotional, or behavioural functions. for example, in MDD, dysfunction can present as persistent negative beliefs about themselves. impairment is the negative IMPACT of the dysfunction on the person’s ability to carry out everyday tasks. for example, back to MDD, the dysfunction of negative beliefs may lead to the impairment of not being able to make friends or keep a job.

sex ratio

proportion of males and females who have the disorder (sex-based, not gender-based)

age of onset

the age at which an individual first experiences the symptoms of a disorder. for example, the age of onset for schizophrenia is between ages 16-30.

types of courses a disorder can run

1. chronic course

2. episodic course

3. time-limited course

chronic course

the disorder lasts a long time, maybe a whole lifetime. ex. schizophrenia if the delusions stay forever, or MDD if the depression is forever.

episodic course

individuals may recover from this within a few months, and have another recurrence, or “episode” of it later. ex. bipolar disorder consists of episodes of mania and depression. ex. people with MDD may experience episodes of depression with periods of remissions

time-limited course

good one! the disorder will likely improve WITHOUT TREATMENT in a short period of time, with little-to-no risk of recurrence. ex. adjustment disorder (the anxiety of moving to a new city all by yourself. feel it for like 6 months, and then you’ll get used to it and you’ll be fine)

types of onsets a disorder can have

1. acute onset

2. insidious onset

acute onset

the disorder begins suddenly! ex. panic disorder (think katie having a panic attack right before the SATs)

insidious onset

the disorder develops gradually over an extended period of time. ex. schizophrenia, with delusions and hallucinations that sneak up on you, or show a little by little

why is it important to know the course of a disorder?

• so we know what to expect, and how to deal

• are we going to go for expensive treatment for a disorder with time-limited course? no, prolly not, it’ll resolve itself

• are we going to tell someone to take it easy if the disorder has chronic course? no!! they need long-term help!!

prognosis

the anticipated course of a disorder. if prognosis is good, individual will recover, if prognosis guarded, it doesn’t look good

remember children + adults present psychological disorders differently!

ex. children with extreme anxiety often present to be physically ill cause they dont get that theres nothing wrong physically, theyre just really stressed. ex. “i have a stomachache”, when really theyre stressed about going to school, they dont have an infectino in their stomach.

etiology

what causes a disorder. viewed through biological, psychology, and social lenses

why is it important to know what causes a disorder?

• because if we know what causes a disorder, we can make the most effective treatment plan

• if we know (FOR EXAMPLE), that schizophrenia is caused by a surplus of dopamine, we can suggest ways to decrease dopamine in the indivdiual’s life, either through a drug or through social interventions.

• ex. cutting the corpus callosum helps with grand mal seizures because someone figured out that hyperactivity between the two hemispheres was what was CAUSING the seizures (i think, don’t come for me)

supernatural model

the belief that magical or spiritual agents (moon and stars, magnetic fields, angels, demons, spirits) influence our behaviour, thinking and emotions. ex. mercury is in retrograde, thats why i cant focus this week!

common treatments for stress + melancholy (or acedia, the sin of sloth as identified by the church at the time)

• rest

• community —> healthy environment (these still check out)

  • neighbours would take turns taking care of them :)

• self care —> baths, ointments, various potions

is there serious evidence that the position of the moon + stars has an impact on human behaviour? (ex. astrology)

no, but it also isnt testable

biological model

the role of biological factors in psychological disorders. ex. genetics, brain structure + function, neurotransmitters…

ex. TBI damaged hippocampus, that caused a direct impairment in the individual’s ability to retain memories

hippocrates’ thoughts on psychological disorders

• wanted to treat them like any other disease (shift from supernatural model to biological model)

• thought about brain pathology and genetics

• recognized interpersonal contributions (like family driving you litearlly crazy) BUT he is known for shifting from supernatural to biological

galen’s thoughts on psychological disorders

adopted hipprocrates theories and made humoral theory of disorders

humoral theory of disorders

functioning related to four bodily fluids: blood (heart), black bile (spleen), yellow bile (liver) and phlegm (brain). too much or too little from either one of these was thought to cause disorders. ex. too much black bile —> melancholia —> depression

• nowadays, this is chemical imbalance!!

hippocrates’ hysteria

somatic symptom disorders actually. called them hysteria, and a wandering uterus which could be cured by marriage or fumugation to lure uterus back. hysteria is now a term used to invalidate women’s pain

john p. grey

• loved biological model

• said psychological disorders alwys have physical causes

• advocated for rest, diet, ventilation

• conditions in hospitals became more humane under his leadership

insulin shock therapy

• use of electric shock to make patients convulse

• sometimes worked, but too dangerous so they abandoned it

ECT

• electroconvulsive therapy

• shock treatment, little knowledge on how this works to this day

consequences of biological tradition

• focus shifted from treatment to diagnosis and study of brain pathology

• interest in etiology as well

• treatment was also now based on humane principles now

• treatment wasnt a focus now tho, which was bad

psychological tradition

role of mental processes, behaviours and emotional states in psychological disorders

psychosocial approaches

• psychological factors as well as social and cultural ones

• ex. family systems therapy which focuses on improving family dynamics and communication

• considers individual’s social context and relationships and how they influence psychological processes, which contributes to mental health

moral therapy

moral —> emotional

• treat patients normally!! give them space to make friends and have fun!!

• good behaviour was modelled and promoted

• lectures on interesting stuff were provided! they were just given a healthy environment to thrive

phillipe pinel - a psychiatrist

who implemented the system of moral therapy?

LADIES AND GENTLEMEN, DOROTHEA DIX

• implemented the mental hygeine movement!!

• campaigned for reform in the treatment of people with mental illnesses

• reformed asylums and had new institutions constructed

what was the mental hygiene movement?

movement with focus on improving the conditions for indivduals wiht mental illnesses by reforming mental institutions and asylums

also raising awareness, reducing stigma, preventing mental illness through education

psychoanalysis

freud!

theory on role of unconscious processes in behaviour

behaviourism

john b. watson, ivan pavlov, b. f. skinner

how learning affects development and behaviour

catharsis

discovery that recalling and reliving emotional trauma that is unconscious and releasing that tension is therapeutic

psychoanalytic model

1. structure of the mind

2. defense mechanisms

3. stages of early psychosexual development

structure of the mind

1. id

2. ego

3. super ego

id

source of our instinctual drives - the “animal” inside us. operates according to the pleasure principle

pleasure principle

goal of maximizing pleasure and elimiating any conflicts. emotional, irrational, needs to be kept in check.

ego

ensures we act rationally and realistically. the mediator. operates according to the reality principle. mediates superego and id.

reality principle

compromise, delayed gratification, acting with reality and rational decisions in mind, not based on pleasure

superego

conscience, represents moral principles instilled by culture

whats the secondary process

specifically the mental operations involved in the conscious thought that manages the primary process (which is rooted in the pleasure principle).

this one is rooted in the reality principle, the secondary process is just the thought processes BEHIND the reality principle (ex. student deciding between studying and going out with friends. reality principle —> realizing its better for future them to stay in and study. secondary process: the actual evaluating of choosing to stay or go out. the logical PROCESS. ITS THE PROCESS WORK. the process work is ROOTED in the principle)

intrapsychic conflicts

the conflicts between the id and the superego. says that the id and superego are almost entirely unconscious and ego we are aware of, which is the mediator

defense mechanisms

unconscious protective processes that keep “primitive” emotions - that busy themselves with conflicts - in check so the ego can keep functioning

denial

refusal to acknowledge some part of reality that is apparent to others

ex. that you failed a class. but you dont want to admit it to yourself.

projection

falsley attributing own unacceptable feelings to another person

ex. you’re literally gay but you think everyone around you is and is hiding this “perversion” so you can stay safe from admitting it to yourself

rationalization

hiding the true feelings, motivaiotns, or thoughs about something that happened through offering incorrect explanations

ex. you didn’t get into ur dream program, you RATIONALIZE that it wasnt the place for you anyway

ex. you do something pretty mean to someone, but you compare yourself to someone else and say “its not as bad as what they did” to absolve yourself of blame

reaction formation

subbing in behaviour or thoughts or feelings that are the direct opposite of unnaceptable ones

ex. someone who’s gay asf, being very outloud about their support for homophobic policies/attending pride parades wtih homophobic signs

repression

just blocking all ur disturbing or traumatic thoughts out of consciousness, but it still lingers in ur unconscious.

ex. you block out exact memories of trauma but the stress and anxiety stays in ur body

ex. you block out what happened when u got bit by a dog, but ur still terrified of them.

sublimation

directs maladaptive feelings or impulses into socially acceptable behaviour

ex. the loml broke up with me, so im throwing myself into my work and im gonna get a 4.0

psychosexual stages of development

1. oral

2. anal

3. phallic

4. latency

5. genital

fixation

if we didnt recive appropriate gratificaiton during a specific stage, your personal would reflect that in adult life. (he had a bunch of theories about it not quite soundly in evidence)

oedipus complex

the intrapsychic conflict between lust for mom and scared dad will chop penis off

freud says all boy want to kill father and marry mother

but they all have castration anxiety - which is when theyre afraid the father will punish lust for mother by removing son’s penis so they dont do anything

electra complex + penis envy

viewing young girl as wanting to replace mother and be father

wants a penis so bad!!! penis envy

neuroses (neurotic disorders) —> in psychoanalytic literature

nonpsychotic psychological disorders that result from (1) underlying unconscious conflicts, (dysfunction) (2) the anxiety that resulted from those conflicts, (distress), and (3) the implementation of ego defense mechanisms (impairment i guess) ACCORDING TO PSYCHOANALYTICAL THEORY

ego psychology

in which ways do the defensive reactions of the ego determine our behaviour.

disordered behaviour starts when the ego has trouble mediating impulses

they believed that the basic quality of human nauture is positive and most people actually want to self actualize, and if barriers are removed, they can flourish

what did adler and jung believe as opposed to freud

free association + goal

patients are told to say whatever tf comes to mind without censoring. the goal is to bring forth repressed content

dream analysis

content of dreams supposedly reflects the id and is related to unconscious conflicts. therapist uses free association + dream content to figure out unconscious conflicts.

psychoanalyst

the therapist using psychoanalytical thought

transference

where patients relate to therapist like they did towards an important figure in their childhood (could be parents). see the therapist as that model and act accordingly

counter transference

therapists project personal feelings onto patient

ex. see their patient as their younger self (maybe you should talk to someone), or see them as their neglectful parent

therapists are human too!! therapists should take into account how they feel about their patient and keep it in mind during treatment

symptom substitution

basically, the concept that the issue is based on a fixation of a psychosexual stage, so eliminating the symptom doesnt do anything, or another symptom is just going to replace it.

psychodynamic psychotherapy

• emphasis on unconscious processes, trauma, and defense mechanisms

• social and interpersonal focus

• focus on releiving suffering associated with psychological disorders

therapeutic alliance

relationship between therapist and patient

the process of self-actualization and what maslow believed we needed to self-actualize

we can all reach our highest potential if we have hte freedom to grow because every person is good and whole at our core, we just need help removing barriers

abraham maslow

ranges from physiological needs up to self-esteem and self-actualization. said that we can’t progress until each of those needs are fulfilled step by step (proven wrong! think wire monkey experiment! we still want attachment even when we’re hungry)

hierarchy of needs + person

person-centered therapy (and person)

carl rogers

therapist takes on passive role, letting the indivdiual devleop themselves during course of therapy, low suggestions, letting the indivdual talk essentially

unconditional positive regard

complete and unconditional acceptance of all of the client’s feelings and actions. no judgment, just be warm and empathetic and let the patient figure it out

psychotherapy process

research on how the process of psychotherapy works

gesalt therapy

therapy focused on

1. the present (as opposed to the past + unconscious conflicts like freud)

2. awareness of thoughts, feelings and actions (why are you actually always dating the exact person in a different skin?)

3. personal responsibility (i know why i always date this kinda person, how can i change? how can i be better for myself?)

classical conditioning

1. before conditioning

   1. unconditioned stimulus generates the unconditioned response (US - food, UR - salivating)

2. during conditioning

   1. the conditioned response is acquired (the bell is the CR, and it is ringing, and the dog associates the ringing of the bell with food)

3. after conditioning

   1. the conditioned stimulus (CS, the bell) invokes the conditioned response (salivating) without the uncondtioned stimulus (the food) (ringing the bell triggers salivation)

father of classical conditioning

ivan pavlov

stimulus generalization

the response generalizes to similar stimuli

ex. little albert is now scared of all small fuzzy white things after the mouse experiment

ex. you got bit by a rottweiler, now you’re scared of all rottweilers.

extinction

gradual weaking of a conditoned response that reuslts in the response decreasing or just disappearing.

ex. you ring the bell too many times without producing food, the dog will stop associating the bell with the food and now the response is extinct

who was edward titchener + what was his theory

• experimental psychologist

• linked with wundt (student!)

• took introspection and applied it to the school of thought of structuralism

  • structuralism —> figuring out how the brain works by looking at its structure THROUGH introspection

introspection + person associated with it

experimental psychology specifically, observors would report SENSORY experiencesin reponse to stimuli UNDER SIMULATED SITUATIONS.

aimed to analyze “building blocks of consciousness”

• buuut its subjective, so its not very reliable.