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What are some important ramifications, or consequences, that we must be aware of pertaining to disorders?
Disorders can define the way we interpret behavior, for example some are scared to ask for reimbursements for treatment from therapy, or legal responsibilities that can come about and simply the connotation towards disabilities.
What are some past and present controversial disorders?
Dreptomania, homosexuality, childhood masturbation disorder
Why is there no single definition for the terms 'psychological abnormality' or 'normality'?
because most behaviors and mental illnesses exist on a continuum.
What are some myths that are associated with mental illness?
Laziness, crazy, dumb, weak character, danger to society, and unable to be treated, hopeless.
What did Jerome Wakefield believe when it came to defining abnormal behavior?
He believed that disorder could be defined as different things such as a pure value concept, as whatever professionals treat, as statistical evidence, and as a biological disadvantage.
What did Wakefield mean by 'pure value concept?
The judgement of desirability according to social norms and ideals. This was very subjective.
What did Wakefield mean by saying disorder can be defined as "whatever professionals treat"?
He meant that people would come in for treatment for normal behaviors and those who do present abnormal behaviors tend to not come in for treatment.
What is the issue with Wakefield definition of disorder as "statistically deviant"?
A patient's behavior can be statistically deviant but not be disordered, per say.
How does Wakefield believe that a disorder can be a biological disadvantage?
If it results in lowered reproductive fitness, if a mental mechanism is not performing its specific function that it was designed to perform, or if a mechanism fails to perform what is designed to AND causes impairment (this is known as harmful dysfunction)
What is psychological dysfunction?
The breakdown of cognitive, emotional, or behavioral functioning within an individual.
What is personal distress or disability and what is this also known as?
Difficulty performing appropriate and expected roles; also known as functional impairment. Some disorders may emphasize one over the other.
What makes a response atypical or unexpected?
If it is a reaction that is outside of cultural norms.
Widget argued that what two constructs are fundamental when defining a mental disorder?
Dyscontrol and maladaptivity
What kind of behaviors does the DSM contain diagnostic criteria for?
If the behaviors fit a pattern, cause dysfunction or subjective distress, are present for a specified duration, or are based on prototypes.
How does the clinical description of abnormality begin?
With the presenting problem. Why is the client coming for treatment?
What does the clinical description aim to distinguish?
Clinically significant dysfunction from common human experience.
What must be included in clinical description?
Demographics, relevant symptoms, age of onset, and other precipitating factors.
The following things must be kept in mind when thinking about clinical abnormalities:
prevalence (# of people with the disorder), incidence (#of new cases during given period of time), course of disorder (episodic, time-limited, or chronic), and the onset.
What are the two different types of onsets for a disorder?
Acute (random and very quick, typically associated with better recover) and insidious (slow and creeping)
What is etiology?
The origin of the disorder
What are the different types of treatment?
Pharmacological, psychosocial, or combined treatments
What does treatment outcome research aim to do?
Determine how we know that the treatment helped. This is limited in actually specifying the causes of disorders
Where/when have major psychological disorders existed?
In all cultures/across all time periods
What are the three dominant traditions?
Supernatural, biological, and psychological
How is deviant behavior defined under the supernatural tradition?
As a battle of "good" vs. "evil"
What are the causes of deviant behavior under the supernatural tradition?
Demonic possessions, witchcraft, sorcery, and the moon and stars (lunatic came from Luna)
How have causes and treatments of abnormal behavior varied?
Widely across cultures and time periods and depending on prevailing paradigms and world views
What were some of the treatments under the supernatural tradition?
Exorcism, torture, beatings, and crude surgeries.
Who is considered the father of modern medicine?
Hippocrates
What did Hippocrates believe about disorders under the biological tradition?
He believed that disorders could be treated as any other disease and that "disease" was not the only cause and that head trauma and brain pathology could also be a cause.
Who extended Hippocrates' work?
Galen
What theory of mental illness did Galen believe in?
Humoral theory of mental illness (comparable with where we've been for 40/50 years)
What were the 4 major bodily fluids or humors?
Blood (heart), black bile (spleen), yellow bile (liver), and phlegm (brain)
What idea did the humoral theory believe in?
That disease resulted from having too much or too little of a certain humor.
What did the Galenic-Hippocratic tradition link abnormality with?
Chemical brain imbalances.
Interest in biological factors of mental illness fluctuated over centuries until when?
The 19th century
What is syphilis?
A sexually transmitted disease caused by a bacterial infection.
How is syphilis related to mental illness?
An advanced stage can result in delusions/psychosis
Who discovered the cause of syphilis?
pasteur
What was found to be a successful treatment for syphilis?
Penicillin
Under the biological tradition, what did mental illness equate?
physical illness
In the 1930s, what biological treatments were discovered?
Insulin shock therapy, ECT (electroconvulsive therapy), and brain surgery.
In the 1950s, the availability of what's increase?
Medicines
What medicine was discovered in the 1990s and what did they discover it did?
Neuroleptics (antipsychotics); reduce hallucinations, delusions, agitation, and aggressiveness
In the 1970s, what medicine was introduced?
Benzodiazepines (Valium)
Under the psychological tradition, what did Plato and Aristotle believe contributed to psychopathology?
social and cultural environments and early learning experiences
What was moral therapy meant to do (under psychological tradition)?
Normalize the treatment of the mentally ill by reinforcing and modeling appropriate behavior
Why did moral therapy fall out?
They found it worked better with smaller patient populations, Dorothea dix led the mental hygiene movement, and the rise of the biological tradition and its notion that mental illness was due to brain pathology and was incurable.
What did the mental hygiene movement do?
It provided care to all who needed it but led to the switch from moral therapy to custodial care because of the ratio of patients to doctors
Under what three forms does the psychological tradition reemerge in during the 1900s?
Psychoanalysis, humanism, and behaviorism (eventually cognitive-behaviorism)
What two psychologists were under the psychoanalytical tradition?
Freud and Breuer
Breuer had patients describing what under what state?
Psychological problems and conflicts under hypnosis
What two discoveries did Breuer's patient hypnosis admissions lead to?
The unconscious mind (outside of patient's explicit awareness) and Catharsis (patients felt better after reliving/discussing past trauma.
What were the three structures of the mind under the psychoanalytical tradition?
Id, Ego, and superego.
Describe the Id
Operated on the pleasure principle and demonstrated toddler's way of life. Demanded immediate gratitude through the primary process where thinking is emotional, irrational, fantastical, and primal. Contained Eros which was the instinctual drive towards sex, pleasure and fulfillment, and Thanatos (death instinct) which was the drive towards aggression and sex
Describe the Ego
Operated off the reality principle and demonstrated an adult's way of thinking. The ego feels a need to balance the id with rules of society and mediate veteran the id and superego. The thinking style is known as secondary process and is based on logic and reason
Describe the superego
This is ones conscience and is moralistic. Develops as a result of being rewarded and punished for various behaviors (or seeing others experience this—vicarious learning). Meant to counteract the drives of sex and aggression presented by the id
What will supposedly happen if the ego is success or fails to mediate?
If successful people can pursue higher goals, if a failure intrapsychic conflict will be experienced. Anxiety will also occur leading to defense mechanisms
How did Freud feel about the id/superego?
He felt the two were unrelated.
What are defense mechanisms?
Unconscious protective processes that keep primitive emotions associated with conflict in check so that ego can continue with its coordinating function
Are defense mechanisms adaptive or maladaptive?
Can be both!
What are the defense mechanisms?
Affiliation, Humor, Sublimation, Displacement, Intellectualization ,Reaction formation, Repression, Projection
What is affiliation?
Dealing with conflict by turning to others for help and support
What is humor as a defense mechanism?
Emphasizing the amusing or ironic aspects of conflict or stressor
What is sublimation?
Deal with conflict or stressor by channeling potentially maladaptive feelings or impulses into socially acceptable behavior
What is displacement?
The transfer of feelings about, or in response to, onto a substitute object
What is intellectualization?
Excessive use of abstract thinking or making of generalizations to control or minimize disturbing things.
What is reaction formation?
Substituting behavior, thoughts, or feelings that are the direct opposite of unacceptable ones
What is repression?
Blocking of disturbing wishes, thoughts or feelings that are direct opposite of acceptable ones.
What is projection?
Falsely attributing own unacceptable feelings, impulses, or thoughts to another individual.
What are psychosexual stages of development meant to show?
Different ways of gratifying basic needs and satisfying drive for physical pleasure. Inadequate gratification would lead to fixation. Imposed by Freud.
What are the five stages of psychosexual development?
Oral Anal Phallic Latency Genital
What is the oral stage?
From birth to 1.5/2- central focus on food, sucking, lips, tongue and mouth. No gratification can lead to oral fixation
What is the anal stage?
From age 2 to 3- central focus is anus and the expulsion vs. retention of feces. This stage is resolved when toilet training is completed. Also associated with action anally; controlling/frugal)
What is the phallic stage?
From ages 3 to 5- central focus is genital region as the child becomes interested in own and others genitals.
What were some of the major conflicts with the phallic stage?
Oedipus complex: young men having sexual fantasies towards their mom, leading to anger towards father because they see their father as an obstacle but also fear father (castration anxiety). This results in identification with father Electra complex; young girls want to replace their mothers and possess father. Girls can also desire to have a penis (penis envy) to be more like father. This conflict is resolved once a healthy heterosexual relationship is developed.
What is the latency stage?
From ages 5 or 6 to puberty- sexual interest lies dormant and energy (libido) is put into non-sexual interests like friendships, school, sports, and play.
What is the genital stage?
From puberty til- central focus returns to genitals and interest in sexual relationships increase.
What is psychoanalysis in therapy meant to do?
Unearth the hidden intrapsychic conflicts through catharsis and insight. This would leave to restructuring of personality, instead of symptom reduction
What is the timeline of psychoanalysis therapy like?
t is long term (2-5years) and high frequency (3-5/week)
What are techniques used in psychoanalysis?
Patient lies on couch, therapist sits on couch Free association—no censoring Dream analysis Examine transference and counter-transference issues
What is the concept of the psychodynamic theory
Everything has a meaning and nothing is coincidental
What 7 things does the psychodynamic theory intend to do?
Focus on affect and patient's expression of emotion
Explore patients' avoidance of topics or decisions to engage in behaviors that hinder therapy (skipping sessions, not paying bills, showing up late, unwilling to have painful talks)
Identify patterns in patients' behaviors, thoughts and feelings
Emphasis on role of past experiences
Focus on interpersonal experiences
Emphasis on therapeutic relationships (therapeutic alliance)
Exploration of patients' fantasies, dreams and wishes
What was the ideology of the humanistic theory and biological tradition?
That there was a positive, uplifting quality of humanity and that humans are beings that strive for improvement and excellence
What is self-actualization?
he act of attaining ones highest potential; only positive if obstacles are overcome (more basic needs, psychological problem, interpersonal problems)
Who are major players in humanistic theory?
Carl rogers, Abraham Maslow, and Fritz Perls
What are the major themes of the humanistic theory?
That people are basically good and that humans strive for self-actualization
What was carl rogers form of therapy?
Client (or person)-centered therapy; involved mirroring, emphatic, unconditional positive regard and genuineness. There is minimal therapist interaction. There is a belief that clients have the resources to solve their own problems if given adequate support and the client-patient relationship is most important
What did Maslow hierarchy of needs include?
Self-actualization, ego, social, security
Who developed classical conditioning?
Pavlov and Watson
What does classical conditioning consist of?
Pairing neutral stimuli and unconditioned stimuli. Meant to explain fear acquisition (little Albert) If the conditioned stimulus is presented without the unconditioned stimulus for a long time then extinction will occur
What are the four aspects of classical conditioning?
Unconditioned stimuli Unconditioned response Conditioned stimuli Conditioned response
Who is the father of behaviorism?
Watson; he was uninterested in studying unobservable processes (thoughts)
Who developed operant conditioning?
Thorndike and Skinner
What does operant conditioning consist of?
Voluntary behavior is controlled by consequences (positive and negative) Skinner noted that many behaviors are not elicited by an unconditioned stimulus
What of Thorndikes is operant conditioning based on?
Law of effect: behavior is either strengthened or weakened depending on consequences of behavior.
What were skinner's concepts?
Reinforcement (positive and negative: meant to increase behavior), punishment (positive and negative; meant to decrease behavior) and shaping (reinforcing successive approximations of desired behavior)
What was the reactionary movement against?
Psychoanalysis and non-scientific approaches
Who were the early pioneers of behavior therapy and what were their ideologies?
Wolfe; systematic desensitization, Beck; cognitive therapy. And Bandura; social learning/cognitive-behavior therapy
What are some concepts pertaining to CBT?
Tends to be time-limited, direct, here-and-now focused, and have widespread empirical support
