4700 final

why can’t psychological testing define what’s normal

“normal” is defined by normal curve and SD and context relative to others, arbitrary

why are there no lab tests that define normal in psychiatry

there is more variability of bio results within a disorder than between it and normal/other disorders. causes only explain a small percent of cases. because no biomarkers, diagnosis is based on subjective judgements.

why cant anthropologists and sociologists define normal

normal depends on time, place, culture. there is too much human variation.

what was normal according to freud

saw pathology in everyone, no allowance for normal. emphasized no real difference between the artist and the lunatic, everyone is neurotic and could use more insight

why is abnormal hard to define

normal and disorder are amorphous with no fixed boundaries. “liquid, elusive, indefinite, and mutable”. no clear def = which to include in dsm? disorders made it into dsm by historical accident and practical necessity.

what is the umpire analogy

1. great faith in our ability to detect the true essence of reality, sees mental disorder as disease, clearly observable in biological processes.

2. understands that reality is liquid, but does not fall into skepticism. believes our senses evolved to perceive reality not as it is but well enough. not distracted by biological reductionism or rationalist doubt. sees mental disorder as neither myth nor disease, but a useful construct (FRANCES ENDORSES)

3. skeptical, based in doubt. sees mental disorders are arbitrary and potentially harmful myths.

what was shaman role in mental

“one who knows, diagnose + explain malevolent spirit/curse/taboo.

what was ancient greece on abnormal

priests as intermediaries between man and god, minister the mentally ill, madness attributed to action of gods. healing temples combined mental and physical care

what was hippocrates in abnormal

observation of natural world, reasoning, biological. introduced four humours.

what was galen in abnormal

expanded humoural theroy to explain personality + its physical manifestations.

what was the european dark ages on abnormal

demonic possession, sin as the cuase. crude treatments. christian theology and pagan demonology

what was arab golden age on abnormal

quran = enlightened view of ab behav. psychiatric specialists and hospitals. sophisticated classification and treatment based on clinical observation

what was the enlightenment on abnormal

sydenham advocated for a return to hippocratic method of observation and classification in europe. focused on identifying and classifying based on symptom clusters. believed diseases were uniform.

what was 18th century on abnormal

linnaeus sorted plants and animals by similarities. was inspo

pinel believed mental illness had natural causes, championed new model of humane asylum care, humanistic, combined sydenham and linnaeus initiating the systematic classification of mental disorders.

what was post ww2 on abnormal

psychiatry gained more prominent role, ama published dsm because we needed a systematic reliable diagnostic system for treatment and research

what was dsm 3 on abnormal

• introduced specific diagnostic criteria

• sought precision

• more systematic

• atheoretical

• became bible of psychiatry

when was dsm III

1980

when was DSM I

1952

when was dsm II

1968

when was dsm III-R

1987

what was dsm III-R

• more consensus

• less stringent on empirical data

• less based on clear rules and more on opinion

• pharma companies benefited from expansion of diagnostic categories

when was dsm IV

1994

what was dsm IV

• aimed for rigour, objectivity, transparency

• lit reviews, data reanalyses, field trials

• sought to prevent inflation

• pharma exploited dsm IV, increased inflation via advertising.

what was psychoanalysis in the 40s

peak acceptance and popular interest

what ideologies was psychoanalysis challenged by?

behaviourist psychology and biomedical psychiatry

what did popper (1963) say about psychoanalysis

pseudoscientific, unfalsifiable, lacking rigour

what did grunbaum (1990) say about psychoanalysis

discredited attempts to justify psychoanalysis on grounds other than
scientific

what happened to psychoanalysis in the 50s and 60s

attacked on empirical grounds.

what happened to psychoanalysis by the 80s

eclipsed by other theories and methods

what did eysenck say about psychoanalysis and psychotherapy

no different from now treatment at all, promoted behaviour therapy as more scientific

what was a breakthrough example of behaviour therapy as more scientific

in 50s wolpe and lazarus claimed 90% cure rate for phobias bia behav therapy

eysencks attacks resulted in what?

• better methods to evaluate and compare therapies were required

• resulted in more researchers publishing qualitative reviews of the psychotherapy literature

  • supported the effectiveness of psychotherapy

  • psychoanalysis was still largely unsupported

  • weaknesses of qualitative reviews comparing various therapy approaches, methods

glass innovated the use of ________ to compare psychotherapies

effect sizes

what was the conclusion of the smith and glass meta analysis

all therapies seemed to be effective, including behavioural and psychoanalytic

what were the critiques of behaviour therapy

• weak methods

• eysenck biased

• wolpes work was based on absurd and unsupported theory

• lazarus’ work included to control groups

why was behaviourism popular in the US

• seem as more scientific

• challenged elitism of psychoanalysis

  • psychoanalysts seen as dogmatic arrogant and condescending

meta analysis replacing the quantitative review as the standard resulted in what

• two main types of psychotherapy researchers:

  • 1) EST/ clinical science crowd: Eysenckian old guard that ignored meta-analyses in favour of finding support for their primarily cognitive- behavioural approaches using methods favoured by pharmaceutical companies, i.e., the randomized controlled trial. became congenital bedfellows of biomed.

  • 2) meta-analytic researchers that began to recognize that many types of
    therapies were effective, and shared “common factors”

in addition to the est crowd and the common factors crowd, there remained practitioners who:

• endorsed uncontrolled, qualitative, naturalistic studies of psychotherapy, or

• believed that what happens in psychotherapy may not be studied effectively using our current methods

what are the characteristics of the EST/ clinical science crowd? (5)

• studied manualized treatments (usually CBT) using DSM categories

• used RCTs, comparable to pharmaceutical studies

• dismissive of approaches that are not empirically supported therapies
  (ESTs)

• became “congenial bedfellows of biomedical psychiatrists”

• intervention is more important than relationship

what are the characteristics of the common factors crowd (3)

• considered their statistical methods to be better science

• recognized that different forms of therapy were more similar, and similarly effective

• concluded that the quality of the therapy relationship was more important therapeutic technique

what was the civil war within psychiatry

• biomedical psychiatry usurped dominant psychoanalytic tradition

• changed how we think about psychopathology, mental health

• saw psychopathology as brain disease

• diminished role of psychotherapy

what was the effect of the biomedical revolution on meds?

• prozac and others developed

• oversimplification of neurotransmitter models

• psychiatry stopped doing psychotherapy (meds more profitable)

• drug protocols developed for non-psychiatrists (first drug, then if fail second drug, then refer)

• est crowd allies with biomed psychiatry

• psychologists gave up justified critiques of dsm and collabd on drug trials

• some biomed eventually accepted cbt as secondary treatment

what are the weaknesses of dsm 3 (4)

• poor reliability and validity

• categorical, rather than dimensional

• high comorbidity

• atheoretical

  • without a coherent or sound scientific basis of classification

  • laid the foundation for the problems of subsequent DSM