PSYCH 105: Week 10 Flashcards

# tactiq.io free youtube transcript

# Digital Intro: Treatment

# https://www.youtube.com/watch/IxseHWtXauE

00:00:04.420 [Music]

00:00:24.930 [Music]

00:00:30.160 early forms of treatment arose from the

00:00:32.238 belief that mental disorders were caused

00:00:34.320 by evil spirits

00:00:36.079 in some cases large holes were cut in a

00:00:38.480 person's skull so that demons could be

00:00:40.480 driven out

00:00:41.680 other treatments tried to calm the

00:00:43.040 demons with music chase them away with

00:00:44.960 prayers or drive them out with

00:00:46.320 starvation or flogging

00:00:48.559 beginning in the 16th century asylums

00:00:50.960 were established throughout europe

00:00:52.800 individuals who had committed crimes

00:00:54.559 people with epilepsy and even the poor

00:00:56.640 were all institutionalized along with

00:00:58.559 people experiencing severe mental

00:01:00.320 illness the goal of asylums was to

00:01:02.480 remove these individuals from society

00:01:04.959 the result was barbaric treatment

00:01:06.960 including filthy living conditions the

00:01:08.880 use of chains and shackles and many

00:01:10.720 other forms of abuse

00:01:12.720 gradually reforms emerged the french

00:01:15.840 physician philippe pennell for example

00:01:18.320 was put in charge of the parisian

00:01:19.759 hospital system in 1793.

00:01:22.400 pannell wanted to remove the patient's

00:01:24.320 shackles and chains and talk to them

00:01:26.240 give them exercise and fresh air

00:01:28.159 patients benefited from this more humane

00:01:30.159 treatment and many were able to leave

00:01:31.759 the hospital

00:01:33.119 around the same time william tuke an

00:01:35.280 english quaker founded the york retreat

00:01:37.680 where people with severe mental

00:01:38.880 disorders could engage in reading light

00:01:40.640 manual labor and conversation

00:01:43.280 25 years later in the united states a

00:01:45.759 group of physicians opened the hartford

00:01:47.439 retreat a small semi-public institution

00:01:50.000 that focused on using a moral curative

00:01:52.000 approach in a tranquil and caring

00:01:54.000 environment

00:01:55.119 but these reforms were not to last

00:01:57.640 industrialization the expanding

00:01:59.600 population the rise of large cities and

00:02:01.920 the resulting pressures to admit more

00:02:03.680 and more people all contributed to

00:02:05.600 replacing moral treatment with larger

00:02:07.759 institutions providing little more than

00:02:09.758 custodial care

00:02:11.200 also in the second half of the 19th

00:02:13.280 century the optimism surrounding moral

00:02:15.360 treatment was replaced by the eugenics

00:02:17.440 movement which viewed mental disorders

00:02:19.200 as a defect that required

00:02:20.760 institutionalization and even for

00:02:22.560 sterilization

00:02:24.239 public residential institutions in the

00:02:26.000 us continued to grow in size and number

00:02:28.640 from the 1880s until 1955.

00:02:31.680 this period was followed by a dramatic

00:02:33.599 reversal with the introduction of

00:02:35.519 antipsychotic medications in the 1950s

00:02:38.560 the classical antipsychotic medications

00:02:40.800 such as thorazine haldol and stellazine

00:02:43.120 effectively reduced symptoms of

00:02:44.480 schizophrenia such as thought disorder

00:02:46.480 and hallucinations

00:02:48.080 unfortunately these drugs were less

00:02:50.160 effective in treating symptoms like flat

00:02:52.160 affect and the inability to feel

00:02:53.760 pleasure which were addressed three

00:02:55.200 decades later with the introduction of

00:02:56.879 atypical antipsychotic medications

00:03:00.000 prior to antipsychotic medications two

00:03:02.239 out of three patients with schizophrenia

00:03:03.840 spent most of their lives in a mental

00:03:05.360 hospital

00:03:06.400 by the 1980s the average stay was about

00:03:08.959 two months

00:03:10.560 in addition to antipsychotic medications

00:03:12.879 movement away from long-term

00:03:14.239 hospitalizations was made possible by

00:03:16.400 the mental retardation facilities and

00:03:18.319 community mental health centers

00:03:19.680 construction act signed by president

00:03:21.840 john f kennedy in 1963 which provided

00:03:25.440 federal funding for community mental

00:03:27.360 health centers

00:03:28.959 this tragic human waste

00:03:31.120 which of course affects not only the

00:03:32.879 child but the family which is involved

00:03:36.080 can and must be stopped and i think we

00:03:38.239 have an obligation of a country

00:03:40.400 especially a country as rich as ours

00:03:42.879 especially a country which has so much

00:03:44.640 money to spend on so many things which

00:03:47.280 may be desirable but maybe not essential

00:03:49.440 in every case

00:03:50.640 we certainly should have the resources

00:03:52.799 to uh spend to make a major effort to

00:03:55.200 see if we can block

00:03:58.080 this

00:03:59.040 stop it and cure it

00:04:01.599 this legislation dramatically changed

00:04:03.920 how mental health services were

00:04:05.200 delivered in the united states and

00:04:06.959 started the process of

00:04:08.599 de-institutionalization the closing of

00:04:10.400 large asylums achieved by providing

00:04:12.319 funding for people to stay in their

00:04:13.920 communities and be treated and supported

00:04:15.680 locally today instead of asylums there

00:04:18.238 are psychiatric hospitals run by state

00:04:20.320 governments and local community

00:04:21.759 hospitals focused on short-term care

00:04:24.479 but de-institutionalization was at best

00:04:26.720 a partial success many individuals have

00:04:29.280 not found appropriate care and support

00:04:31.360 in community settings as many as 200 000

00:04:34.400 people with severe mental illness are

00:04:36.080 homeless in the united states and an

00:04:38.000 equal number are in jail often for minor

00:04:40.400 crimes

00:04:44.960 of course most people experiencing

00:04:47.040 mental disorders have not faced

00:04:48.720 hospitalization if someone is feeling

00:04:50.800 depressed struggling with substance

00:04:52.400 abuse problems need support coping with

00:04:54.320 personal challenges or wants to attain

00:04:56.000 personal growth they might try

00:04:57.759 psychotherapy

00:04:59.600 psychotherapy is a general term for

00:05:01.840 treatment that includes talking with a

00:05:03.520 mental health provider and it's been the

00:05:05.520 most common type of treatment since the

00:05:07.199 early 1900s when sigmund freud developed

00:05:09.919 psychoanalysis

00:05:11.520 in a psychoanalyst office you might see

00:05:13.680 a person lying on a couch speaking of

00:05:15.520 childhood memories and the therapist

00:05:17.199 using free association or dream analysis

00:05:19.440 to help uncover unconscious thoughts and

00:05:21.520 promote insight

00:05:25.440 therapies stemming from freud's original

00:05:27.440 psychoanalysis are known as the

00:05:29.440 psychodynamic therapies

00:05:32.080 the term psychoanalytic and

00:05:33.600 psychodynamic are often confused but you

00:05:35.680 can think of psychoanalysis as freud's

00:05:37.600 particular therapy while psychodynamic

00:05:40.160 theory is a family of approaches that

00:05:41.919 descended from it

00:05:43.759 like psychoanalysis psychodynamic

00:05:46.080 therapy focuses on helping people gain

00:05:48.479 insight on the impact of unconscious

00:05:51.280 internal forces early relationships and

00:05:54.320 critical childhood experiences

00:05:56.560 its hallmarks include self-reflection

00:05:58.800 and self-examination and the use of the

00:06:01.120 relationship between therapist and

00:06:03.039 individual as a window into problematic

00:06:05.600 relationship patterns in a person's life

00:06:10.960 now other types of therapy have grown

00:06:13.039 out of the existential and humanistic

00:06:14.880 traditions and focus on people's

00:06:16.800 capacity for making rational choices

00:06:19.199 achieving self-acceptance and attaining

00:06:21.360 their maximum potential

00:06:26.080 psychologists who take an existential

00:06:27.759 humanistic approach are guided by the

00:06:29.840 idea that people must take

00:06:31.120 responsibility for their lives and their

00:06:33.039 actions and live fully in the present

00:06:36.720 like psychodynamic therapies existential

00:06:39.199 humanistic therapy is still insight

00:06:41.280 oriented but it's more about promoting

00:06:43.360 growth than curing illness

00:06:46.080 in the mid-1900s carl rogers developed a

00:06:48.960 particular humanistic technique called

00:06:51.280 client-centered therapy he encouraged

00:06:53.759 therapists to provide an empathetic

00:06:55.919 genuine and accepting environment and to

00:06:58.160 use active listening where the therapist

00:07:00.240 echoes and clarifies what their clients

00:07:02.240 are saying and feeling

00:07:07.039 rodgers believed these techniques helped

00:07:09.360 provide a safe and non-judgmental space

00:07:12.639 where people could accept themselves

00:07:14.319 feel valued and work towards

00:07:15.919 self-actualization

00:07:17.599 when an existential perspective is

00:07:19.360 included therapists help their clients

00:07:21.360 maximize their potential in the face of

00:07:23.440 existential thoughts and fears

00:07:26.319 behavior therapists behavior therapists

00:07:29.039 view negative behaviors as the problem

00:07:31.039 to be solved that all behavior is the

00:07:33.360 result of learning and that the remedy

00:07:35.360 simply involves new learning behavioral

00:07:37.759 therapists work to replace negative

00:07:39.440 behaviors with more positive or

00:07:40.880 effective ones the goal is to change

00:07:43.280 behavior in order to change emotions

00:07:49.039 behavior therapy is rooted in the

00:07:50.720 experiments of ivan pavlov and his

00:07:52.720 classically conditioned dogs that

00:07:54.319 drooled at the sound of a bell and work

00:07:56.400 by e.l thorndike and b.f skinner on

00:07:58.639 operant conditioning that is changing

00:08:01.120 behavior by using positive or negative

00:08:02.960 reinforcement

00:08:04.400 as an example exposure therapy is used

00:08:07.440 to treat anxiety by having a person face

00:08:10.000 their fears through gradual exposure to

00:08:12.400 situations that they typically avoid

00:08:14.960 and virtual reality has begun to play an

00:08:17.360 important role

00:08:18.879 the idea of flooding someone with

00:08:21.919 the thing that causes them to stress so

00:08:24.240 a really simple example could be if

00:08:26.240 you're afraid to drive couldn't get

00:08:27.840 behind the wheel

00:08:29.120 so this

00:08:30.240 uh is the limbics headset once that

00:08:33.039 therapist knows that you're ready and

00:08:34.640 comfortable to do this exposure the

00:08:36.399 therapist might start you off on a quiet

00:08:38.320 street and so you're in your virtual

00:08:39.919 reality headset as a patient and as the

00:08:42.080 therapist next to me as i'm going

00:08:44.159 through this as a patient

00:08:45.680 all the while sees what i see in vr on

00:08:48.480 their tablet what we have here

00:08:51.600 is the tablet interface and on that

00:08:54.640 tablet they can choose that quiet street

00:08:57.279 they can also choose a busy road like a

00:08:59.600 highway or a tunnel or something much

00:09:02.320 more anxiety inducing like a bridge

00:09:04.480 and so the therapist will slowly but

00:09:06.560 truly gradually exposed me to more and

00:09:09.360 more stressful environments and then

00:09:11.600 while i'm viewing these

00:09:13.519 and going through that that therapist is

00:09:15.680 also teaching me coping techniques to be

00:09:17.680 more comfortable without what i'm doing

00:09:19.519 and things that i can apply to my own

00:09:21.200 life when i'm actually in the car

00:09:22.720 afterwards

00:09:23.760 there's much more serious examples

00:09:25.360 around ptsd and other phobias as well

00:09:28.320 where exposure therapy can be really

00:09:29.760 helpful

00:09:31.279 behavior-based therapies can actually

00:09:33.200 reduce symptoms associated with specific

00:09:35.360 phobias panic disorder traumatic

00:09:37.279 experiences major depression and some

00:09:39.040 other anxiety disorders but it usually

00:09:41.200 is improved with the help that comes

00:09:42.720 from cognitive therapies

00:09:45.600 cognitive therapy focuses on what people

00:09:47.760 think rather than what they do assuming

00:09:50.720 that if you can change a self-defeating

00:09:52.560 thought you can change the related

00:09:54.080 behavior for example people often over

00:09:56.800 generalize or engage in all or nothing

00:09:58.959 thinking taking a small situation and

00:10:01.120 making it huge cognitive techniques help

00:10:03.760 people test the validity of their

00:10:05.360 thoughts and replace maladaptive

00:10:07.120 thoughts with more adaptive ones

00:10:09.440 i did fail that test but that doesn't

00:10:11.279 mean i'll fail out of school

00:10:13.040 or i failed out of school that doesn't

00:10:15.279 mean i failed out of life

00:10:17.120 now if you combine cognitive therapy and

00:10:19.680 behavioral therapy you get cognitive

00:10:22.000 behavioral therapy or cbt and that

00:10:24.480 focuses on present issues rather than

00:10:26.880 the past and includes highly structured

00:10:28.880 sessions and even homework aimed at

00:10:30.800 helping people practice new skills and

00:10:33.120 new ways of thinking

00:10:34.640 patients learn to develop and test

00:10:36.320 hypotheses about their problems so they

00:10:38.720 learn to try out new skills and then

00:10:40.720 gather and monitor their own personal

00:10:42.720 data they become experts in evaluating

00:10:45.360 the data and iterating on the process

00:10:47.519 based on the data collected and these

00:10:49.440 are skills they can take with them after

00:10:51.279 the therapy ends

00:10:56.880 now unlike the therapies we've described

00:10:58.720 so far which were developed in the 20th

00:11:00.560 century a mindfulness approach comes

00:11:03.040 from the buddhist and yoga practices

00:11:05.760 mindfulness or a process that tries to

00:11:07.680 cultivate a non-judgmental yet attentive

00:11:10.160 mental state is a therapy that focuses

00:11:12.720 on awareness of bodily sensations

00:11:15.200 thoughts and the outside environment

00:11:17.360 where other therapies work to modify or

00:11:19.920 eliminate these sensations and thoughts

00:11:22.399 mindfulness focuses on non-judgmentally

00:11:24.959 accepting them

00:11:26.560 mindfulness draws attention away from

00:11:28.640 past and future stressors encourages

00:11:31.120 acceptance of troubling thoughts and

00:11:32.959 feelings and promotes physical

00:11:34.640 relaxation

00:11:36.240 in the words of pima chodron on american

00:11:38.480 tibetan buddhist nun

00:11:40.160 you are the sky everything else is just

00:11:42.880 the weather

00:11:43.700 [Music]

00:11:46.480 it's important to remember that

00:11:47.680 psychotherapy is not always experienced

00:11:49.920 as just you and a therapist there are

00:11:51.839 also many groups where people who have

00:11:53.760 the same experiences might gather a

00:11:56.320 classic example is alcoholics anonymous

00:11:58.959 and other 12-step programs that give

00:12:00.800 those recovering from alcoholism drug

00:12:02.800 abuse gambling or other addictive

00:12:04.320 behaviors the knowledge that they are

00:12:06.000 not alone

00:12:07.279 in these we are all in the same boat

00:12:09.200 groups the primary aim is to manage the

00:12:11.600 challenges that all the members share

00:12:13.839 and to support one another against

00:12:15.360 suffering relapses

00:12:18.320 groups are not always strangers either

00:12:20.160 couples therapy and family therapy also

00:12:22.320 have become major therapeutic movements

00:12:25.200 psychotherapy can be delivered in person

00:12:27.519 or online and by a wide range of

00:12:29.839 professions including clinical

00:12:31.360 psychologists psychiatrists psychiatric

00:12:33.839 nurses marriage family and child

00:12:36.000 therapists school and vocational

00:12:37.600 counselors mental health counselors

00:12:39.200 clinical social workers and even

00:12:40.800 religious leaders but

00:12:42.480 does it work

00:12:43.760 and how do we know well when an

00:12:46.079 individual's perceptions or those of

00:12:48.000 their therapists are relied on not

00:12:49.760 surprisingly impressions on

00:12:51.279 psychotherapy tend to be pretty positive

00:12:53.760 one study found that 89 of people said

00:12:56.399 they were at least

00:12:57.839 fairly well satisfied with their

00:12:59.440 treatment but of course perceptions are

00:13:01.760 inherently subjective and the

00:13:03.200 therapeutic relationship can lend itself

00:13:05.120 to a positive bias

00:13:06.880 basically if you stuck to your treatment

00:13:08.800 then you probably liked your therapist

00:13:10.959 the therapist perspective can also be

00:13:12.800 skewed not only in terms of a

00:13:14.639 self-serving bias but also because they

00:13:17.200 may not be around to see future

00:13:18.720 struggles or relapses

00:13:21.519 so how can we objectively evaluate

00:13:24.079 whether psychotherapy works

00:13:26.160 the gold standard approach for treatment

00:13:28.480 outcomes research is the randomized

00:13:30.639 control trial or rct these are studies

00:13:33.680 in which each participant is randomly

00:13:35.760 assigned to either a control group or

00:13:38.720 one of the experimental groups of

00:13:40.240 interest

00:13:41.279 this design accounts for individual

00:13:43.199 differences and other factors so

00:13:45.760 if people in the experimental group get

00:13:47.680 better and the people in the control

00:13:49.440 group don't

00:13:50.880 then the treatment made the difference

00:13:53.360 if we're testing medications we

00:13:55.199 generally test for placebo effects by

00:13:57.040 giving a patient a medically neutral

00:13:58.880 substance the placebo in principle the

00:14:01.600 same logic regarding a placebo control

00:14:04.000 applies to the study of psychotherapy

00:14:06.560 in practice though it's not always clear

00:14:08.480 what the placebo would be would we want

00:14:10.959 to replace the placebo group to work

00:14:13.040 with a therapist who listens but without

00:14:15.120 warmth a therapist who expresses warmth

00:14:18.000 but provides no guidance a therapist who

00:14:20.399 offers guidance irrelevant to the

00:14:22.000 person's problems

00:14:23.600 the choice between these options depends

00:14:25.600 on the mechanism by which the

00:14:27.199 experimental treatment is expected to

00:14:29.199 work for example if a researcher is

00:14:32.000 trying to test whether the particular

00:14:34.480 skills taught in a therapeutic approach

00:14:36.959 are an important aspect of the treatment

00:14:39.120 they may choose a control condition with

00:14:41.279 a similar number of sessions and

00:14:43.120 similarly warm therapists but without

00:14:45.519 teaching the skills

00:14:47.279 another approach rather than having a

00:14:49.120 controlled condition is to compare the

00:14:51.519 treatment of interest to other standard

00:14:53.760 treatments or to a weightless control

00:14:56.160 group

00:14:56.959 the waitlist control group is just a

00:14:58.800 group of people who haven't started

00:15:00.399 therapy yet there's another important

00:15:02.560 way in which rct procedures differ for

00:15:05.279 psychological treatments compared to

00:15:07.040 medication when we're testing a

00:15:08.880 medication it's easy to ensure that each

00:15:11.360 person gets the same number of pills and

00:15:13.600 that the chemical constituents of the

00:15:15.360 pills are the same for everyone but how

00:15:17.920 can we ensure in a study of therapy that

00:15:20.480 each person gets the same treatment and

00:15:22.240 the same dose

00:15:24.240 investigators usually address this point

00:15:26.480 by developing a treatment manual that

00:15:28.399 tells the therapist exactly how to

00:15:30.320 proceed during the study what steps to

00:15:32.560 take what instructions to offer and so

00:15:34.399 on this manualized therapy limits the

00:15:37.360 degree that the therapist can improvise

00:15:39.440 or adjust procedures

00:15:41.279 sessions will also typically be audio or

00:15:43.680 video recorded with everyone's knowledge

00:15:45.600 and consent and reviewed for fidelity

00:15:48.240 this means that other research

00:15:49.680 assistants familiar with the therapeutic

00:15:51.279 conditions will watch the sessions and

00:15:53.199 rate how well the therapists are doing

00:15:55.040 with sticking with each condition as

00:15:56.720 designed in addition we need to assure

00:15:59.199 that the participants in our rct are

00:16:01.519 reasonably uniform in the problems that

00:16:03.199 bring them to therapy we would want to

00:16:05.199 make certain that all the participants

00:16:07.440 were truly depressed and that their

00:16:08.880 depression was not complicated by other

00:16:10.959 problems that might mask the effects of

00:16:12.959 the treatment

00:16:14.079 likewise we would probably want to make

00:16:16.079 sure the participants were somewhat

00:16:17.680 similar to one another in the duration

00:16:19.600 and severity of their depression

00:16:21.519 otherwise

00:16:22.560 variations from one participant to the

00:16:24.399 next might prevent us from detecting the

00:16:26.480 therapy's effects

00:16:28.160 once there is a group of independent rct

00:16:30.480 studies the data can be summarized

00:16:32.720 through meta-analysis combining results

00:16:35.199 across multiple trials to see whether

00:16:37.360 the treatment works and how well in a

00:16:39.199 variety of settings

00:16:40.800 meta-analyses are very helpful because

00:16:43.040 they allow us to get a better picture of

00:16:44.800 the treatment's typical effect rather

00:16:46.720 than relying on one particular study rct

00:16:49.519 studies usually measure either the

00:16:51.360 efficacy of a treatment under ideal

00:16:53.440 conditions or the effectiveness of

00:16:55.759 treatment how well it works in real

00:16:57.519 world situations

00:16:59.519 what has rct research told us about the

00:17:02.000 efficacy and effectiveness of

00:17:03.680 psychotherapy

00:17:04.959 well that depends on which specific

00:17:07.760 mental disorder is being examined the

00:17:10.000 type of therapy with the most support is

00:17:12.480 cognitive behavioral therapy hundreds of

00:17:14.959 studies have shown the effectiveness in

00:17:16.839 cbt in the treatment of depression ptsd

00:17:20.319 anxiety disorders eating disorders

00:17:22.160 bipolar disorder and substance abuse

00:17:24.559 it has also been found to be effective

00:17:26.319 in decreasing levels of hopelessness and

00:17:28.319 suicidal thoughts in previously suicidal

00:17:31.200 teenagers and it is consistently found

00:17:33.600 to be equally or more effective than

00:17:35.600 other forms of treatment

00:17:39.840 most psychotherapists take an eclectic

00:17:41.600 approach to treatment drawing on

00:17:43.280 multiple perspectives and tailoring an

00:17:45.039 approach to the specific needs and

00:17:46.640 symptoms of each person

00:17:48.480 proponents of eclecticism argue that

00:17:50.400 mental disorders are multi-causal and

00:17:52.400 that evidence-based treatments have been

00:17:54.080 developed and tested to treat highly

00:17:55.919 specific disorders while many people

00:17:58.000 have a range of symptoms that don't fit

00:17:59.679 neatly into one category or another

00:18:02.559 they believe that results of trials

00:18:04.000 cannot be applied to individuals that

00:18:06.480 determinations regarding treatment

00:18:08.320 should be based on a therapist judgment

00:18:11.440 opponents of eclecticism argue that

00:18:13.520 evidence-based treatment is critical for

00:18:15.520 reducing variability between therapists

00:18:17.840 and ensuring that specific approaches

00:18:19.440 are delivered with integrity they remind

00:18:21.360 us that many therapists wrongly believe

00:18:23.280 they can perceive patients problems

00:18:25.039 objectively and they encourage education

00:18:27.600 about cognitive biases such as the

00:18:30.400 tendency to favor information that

00:18:32.000 confirms our beliefs confirmation bias

00:18:35.360 the tendency to perceive causal

00:18:36.880 relationships when there are none

00:18:38.400 illusory correlation

00:18:40.880 and the inclination to perceive biases

00:18:42.720 in others but not ourselves the bias

00:18:44.799 blind spot

00:18:46.240 although psychotherapy doesn't work for

00:18:48.160 everyone it often improves the lives of

00:18:50.480 adults who suffer from psychological

00:18:52.320 problems and benefits people from a wide

00:18:54.559 range of socioeconomic backgrounds

00:18:57.039 interestingly research has shown that

00:18:58.880 more experienced providers are not

00:19:00.400 always more effective than less

00:19:01.600 experienced ones and even specific

00:19:03.360 professional credentials are not

00:19:04.799 necessarily a good predictor of

00:19:06.240 therapeutic success

00:19:08.640 but psychotherapy is just one way to

00:19:10.480 treat mental disorders biomedical

00:19:12.720 treatments can be an effective option in

00:19:14.320 many cases in combination with

00:19:15.919 psychotherapy we've already talked about

00:19:17.840 antipsychotic medications but additional

00:19:19.919 medications have been just as important

00:19:21.600 in the treatment of other mental

00:19:22.720 disorders shortly after the introduction

00:19:24.880 of antipsychotics as a treatment for

00:19:26.480 schizophrenia medications were found

00:19:28.480 that seemed to specifically relieve

00:19:30.000 depression symptoms

00:19:31.679 antidepressants fell into two major

00:19:33.520 classes monoamine oxidase mao inhibitors

00:19:37.039 and tricyclic antidepressants

00:19:39.679 both appear to work in part by

00:19:41.760 increasing the amount of norepinephrine

00:19:43.760 and serotonin available for synaptic

00:19:45.919 transmission though little is known

00:19:47.760 about their mechanisms

00:19:49.600 these two classes of drugs accomplish

00:19:51.600 this in different ways but both are

00:19:53.840 effective in alleviating depression

00:19:55.600 producing marked improvement in up to 65

00:19:57.760 percent of patients who take them

00:19:59.760 but use of medication for treating

00:20:01.280 depression changed dramatically in 1988

00:20:04.159 with the introduction of the first

00:20:06.000 designer drug called prozac

00:20:08.400 prozac was engineered to act minimally

00:20:11.200 on norepinephrine and dopamine and

00:20:13.200 mainly act on serotonin and began a new

00:20:15.919 class of antidepressants known as the

00:20:18.000 selective serotonin reuptake inhibitors

00:20:20.320 or ssris

00:20:22.400 for most patients prozac and other ssris

00:20:25.440 reduce depression as effectively and

00:20:27.840 completely as mao inhibitors and

00:20:29.919 tricyclics but with fewer side effects

00:20:33.280 ssris have become so popular both for

00:20:35.679 depression and for other disorders that

00:20:37.600 they are now widely prescribed

00:20:40.000 for patients who are bothered by the

00:20:41.520 side effects of ssris and can't take the

00:20:43.679 tricyclics or mao inhibitors atypical

00:20:46.480 antidepressants are available which work

00:20:48.400 in various ways on serotonin

00:20:50.000 norepinephrine and dopamine systems

00:20:52.799 while some believe these new

00:20:54.159 antidepressants are a panacea they like

00:20:56.640 all other medications have limitations

00:20:59.280 first the beneficial effects of the drug

00:21:01.360 fully emerge only after the medication

00:21:03.360 is taken for a month or so considerable

00:21:05.840 uncertainty also persists about why each

00:21:08.240 of the antidepressants helps some people

00:21:10.159 but not others

00:21:11.520 as a result physicians often resort to a

00:21:14.080 process of trial and error prescribing a

00:21:16.080 variety of drugs one at a time until

00:21:17.919 they find one that helps the particular

00:21:19.360 individual

00:21:20.480 medications to treat bipolar disorder

00:21:22.720 are called mood stabilizers

00:21:24.880 for example lithium is effective in

00:21:27.039 reducing manic episodes in 60 to 70

00:21:29.280 percent of patients with bipolar

00:21:30.640 disorder

00:21:31.760 antidepressants are often prescribed

00:21:33.679 along with lithium to reduce depression

00:21:35.520 symptoms

00:21:36.799 lithium can also cause unpleasant side

00:21:39.039 effects such as weight gain feeling

00:21:40.880 sedated dry mouth and tremors

00:21:43.280 lithium is toxic at higher doses so

00:21:45.280 patients must have their blood tested

00:21:46.880 frequently

00:21:48.480 patients suffering from disabling

00:21:50.080 anxiety are often treated with

00:21:51.440 medications called tranquilizers

00:21:53.360 technically known as anxiolytics most

00:21:55.679 anxiolytics apparently work by

00:21:57.200 increasing neurotransmission and

00:21:58.559 synapses containing the neurotransmitter

00:22:00.480 gaba

00:22:01.600 physicians also sometimes treat the

00:22:02.960 anxiety disorders by prescribing a beta

00:22:04.880 blocker a medication intended to control

00:22:07.120 autonomic arousal

00:22:09.120 for the uncomfortable feelings

00:22:10.480 associated with anxiety they might

00:22:12.320 prescribe one of the benzodiazepines

00:22:14.799 some of these medications are prescribed

00:22:16.480 so often that they've become household

00:22:18.240 names

00:22:19.520 they're useful as short-term treatments

00:22:21.600 usually taking effect in 30-40 minutes

00:22:24.000 for generalized anxiety disorder panic

00:22:26.320 disorder post-traumatic stress disorder

00:22:28.640 alcohol withdrawal insomnia and various

00:22:30.880 other stress-related disorders

00:22:32.960 benzodiazepines are rarely used for

00:22:34.720 long-term treatment however because

00:22:36.240 they're highly addictive and interact

00:22:37.919 dangerously with alcohol

00:22:39.679 some of the newer anxiolytics such as

00:22:41.280 busbar are not addictive and are

00:22:42.960 becoming popular substitutes

00:22:44.960 psychoactive drugs are increasingly used

00:22:47.120 to treat a wide variety of conditions in

00:22:49.120 children and adolescents

00:22:51.200 some researchers have raised questions

00:22:52.799 about whether ssris may increase the

00:22:54.880 risk of suicide in some young people and

00:22:57.200 despite limited research supporting this

00:22:59.120 the us food and drug administration now

00:23:00.960 requires black box warnings on ssris

00:23:03.679 regarding possible increased risk of

00:23:05.440 suicide there's also controversy around

00:23:07.600 the number of prescriptions for

00:23:08.960 stimulants such as adderall and ritalin

00:23:11.039 that are being written to treat symptoms

00:23:12.640 of attention deficit hyperactivity

00:23:14.400 disorder critics claim that active

00:23:16.799 children are being medicated so they

00:23:18.240 will behave themselves in crowded or

00:23:19.840 under-stimulating classrooms

00:23:22.640 while medications are the most popular

00:23:24.159 biomedical treatment they aren't the

00:23:25.919 only kind another treatment that

00:23:27.760 continues to be used although

00:23:28.880 infrequently is electroconvulsive

00:23:30.960 therapy or ect

00:23:32.799 it involves using electrical current to

00:23:34.640 induce seizures to help alleviate the

00:23:36.480 effects of severe depression

00:23:38.480 the exact mechanism is unknown although

00:23:40.640 it's very effective in alleviating

00:23:42.159 symptoms for people with severe

00:23:43.520 depression who have not responded to

00:23:45.440 traditional drug therapy

00:23:47.200 however the memory loss associated with

00:23:49.520 repeated administrations has led to ect

00:23:52.240 being used only after several

00:23:53.840 medications have failed and when

00:23:55.600 symptoms are severely disabling there

00:23:57.600 are a couple examples of other brain

00:23:59.279 stimulation treatments too

00:24:01.039 one is repetitive transcranial magnetic

00:24:03.120 stimulation or rtms which involves the

00:24:06.000 painless application of repeated

00:24:07.600 electromagnetic pulses

00:24:09.600 when used to treat medication-resistant

00:24:11.279 depression rtms has been shown to be as

00:24:13.760 effective as ect but without any

00:24:15.679 cognitive side effects another treatment

00:24:18.080 deep brain stimulation or dbs includes

00:24:20.799 surgically implanting a kind of brain

00:24:23.120 pacemaker that sends out electrical

00:24:25.440 impulses to specific parts of the brain

00:24:27.520 to help normalize brain activity a

00:24:29.520 fourth type of brain stimulation

00:24:31.039 treatment on which efficacy data is

00:24:32.720 still being gathered is vagal nerve

00:24:34.799 stimulation which involves implanting a

00:24:37.200 battery-powered stimulator in the chest

00:24:39.440 just underneath the skin

00:24:41.360 this stimulator delivers carefully

00:24:43.039 calibrated electrical pulses to the

00:24:44.880 vagus nerve while brain surgery in the

00:24:47.760 form of prefrontal lobotomies is bound

00:24:50.159 to a dark and tragic past more recently

00:24:52.880 a highly refined version of

00:24:54.559 psychosurgery has emerged in very rare

00:24:57.600 cases neurosurgeons can create small

00:25:00.000 precise lesions in specific brain areas

00:25:02.480 to reduce severe symptoms of treatment

00:25:04.320 resistant depression or

00:25:05.840 obsessive-compulsive disorder

00:25:08.559 so with this array of promising options

00:25:10.799 who actually seeks treatment

00:25:12.880 surveys have revealed that in the united

00:25:14.480 states only about 40 percent of those

00:25:16.400 with clinically significant disorders

00:25:18.320 have received treatment in the past year

00:25:20.640 common barriers include insurance the

00:25:22.480 availability of providers and an

00:25:24.080 individual's motivation to seek

00:25:25.520 treatment and adhere to the treatment

00:25:26.799 recommendations

00:25:28.320 public awareness of available effective

00:25:30.240 treatment options is also limited

00:25:32.400 in a report by the institute of medicine

00:25:34.559 one of the leading reasons those with

00:25:36.159 mental or substance use disorder don't

00:25:38.000 seek treatment is a fear of needing to

00:25:39.919 take medication

00:25:41.520 in the u.s individuals from ethnic

00:25:43.520 minority groups tend to utilize mental

00:25:45.279 health services less frequently than

00:25:47.120 white middle-class americans

00:25:49.679 although reduced access based on

00:25:51.679 socioeconomic status lack of insurance

00:25:54.159 transportation and time may partially

00:25:56.159 explain these differences even when

00:25:58.000 these factors are taken into account the

00:25:59.919 disparities in mental health service

00:26:01.440 utilization remain for example while

00:26:04.080 women are more likely to seek mental

00:26:05.600 health treatment compared to men

00:26:07.120 hispanic and african-american women tend

00:26:09.039 to seek and engage in treatment less

00:26:10.880 often than white women

00:26:12.480 these disparities can be driven by

00:26:13.919 biases and clinical and referral

00:26:15.600 practices that prevent hispanic and

00:26:17.200 african-american women from receiving

00:26:18.799 care including lack of bilingual

00:26:20.880 treatment options lack of culturally

00:26:22.640 competent providers stigma fear of not

00:26:25.279 being understood family privacy and

00:26:27.279 limited information about mental

00:26:28.720 disorders

00:26:30.240 perceptions and attitudes toward mental

00:26:32.320 health services can also contribute to

00:26:34.159 disparities not seeing the need for help

00:26:36.720 not seeing therapy as effective concerns

00:26:38.880 about confidentiality feeling shame due

00:26:41.039 to stigma

00:26:42.640 in one study of 462 korean americans

00:26:45.360 over the age of 60 many participants

00:26:47.679 reported suffering from depressive

00:26:49.360 symptoms however 71 indicated that they

00:26:53.120 thought depression was a sign of

00:26:54.480 personal weakness and 14 reported that

00:26:57.279 having a family member with a mental

00:26:58.640 disorder would bring shame to the family

00:27:01.520 taken together there's an enormous need

00:27:03.600 for mental health care providers to

00:27:05.120 develop knowledge and skills to become

00:27:06.799 culturally competent

00:27:08.480 those providing therapy need to approach

00:27:10.720 the process from the context of the

00:27:12.640 unique culture of each person while

00:27:15.039 integrating cultural and religious

00:27:16.559 beliefs into the therapeutic process

00:27:20.240 people seek treatment for a wide variety

00:27:22.240 of reasons

00:27:23.360 some seek relief from the pain and

00:27:25.200 dysfunction associated with a

00:27:26.960 diagnosable mental disorder

00:27:28.960 others suffer with psychological pain

00:27:30.720 that doesn't meet the criteria for

00:27:32.159 diagnosis but it still may cause

00:27:34.159 significant problems others seek help

00:27:36.480 with feelings of loss or grief anger

00:27:38.799 relationship difficulties or life

00:27:40.640 decisions

00:27:42.159 treatment can alleviate symptoms provide

00:27:44.799 education on plausible explanations for

00:27:47.200 psychological symptoms and help us

00:27:49.279 regain hope that things can get better

00:27:52.559 today us federal law in the form of the

00:27:55.120 mental health parity and addiction

00:27:56.880 equity act requires group health plans

00:27:59.279 and insurers to provide equal co-pays

00:28:01.679 visits and deductibles for mental health

00:28:03.919 and substance abuse treatment as they

00:28:05.760 provide for physical illnesses and

00:28:07.279 medical problems

00:28:09.039 inexpensive apps have also become

00:28:10.640 available and the food and drug

00:28:11.919 administration recently rolled out a new

00:28:13.679 therapeutic class called prescription

00:28:15.840 digital therapeutics and is attempting

00:28:17.840 to evaluate apps in the same way that

00:28:19.679 they evaluate medication these new

00:28:21.760 therapies are just beginning to shift

00:28:23.440 the paradigm of care in ways that may

00:28:25.600 better empower both patients and

00:28:27.279 providers

00:28:29.630 [Music]

00:28:37.680 [Music]

00:28:46.510 [Music]

00:28:52.320 you

Video 2:

# tactiq.io free youtube transcript

# Digital Intro: Mental Disorders

# https://www.youtube.com/watch/H4viIJz_Fko

00:00:04.410 [Music]

00:00:14.920 so

00:00:19.260 [Music]

00:00:25.680 mental disorders were first attributed

00:00:27.519 to supernatural forces like

00:00:29.439 possession by evil spirits displeasure

00:00:31.840 of gods

00:00:32.719 eclipses planetary gravitation curses

00:00:35.360 and sin

00:00:36.320 but in recent centuries a more

00:00:37.920 sophisticated explanation for mental

00:00:39.760 disorders began to develop

00:00:41.440 namely that they're a type of disease

00:00:43.200 that should be understood in the same

00:00:44.719 way as other illnesses

00:00:47.039 proponents of the somatogenic hypothesis

00:00:49.440 argue that mental disorders

00:00:51.120 have physiological causes like illness

00:00:53.840 genetic inheritance or

00:00:55.280 brain damage or brain imbalance and that

00:00:57.600 they can be diagnosed on the basis of

00:00:59.680 symptoms

00:01:00.320 treated and sometimes even cured this

00:01:02.879 position gained considerable credibility

00:01:04.879 in the late 19th century thanks to

00:01:06.640 discoveries about general paresis

00:01:08.960 general parisis is a disorder

00:01:10.479 characterized by broad decline

00:01:12.080 in physical and psychological functions

00:01:14.479 culminating in abnormal feelings and

00:01:16.400 behavior

00:01:16.960 including grandiose delusions and

00:01:18.880 profound depression

00:01:20.720 the breakthrough in understanding

00:01:22.080 paresis came in 1897

00:01:24.080 with the discovery that it was actually

00:01:25.680 a consequence of syphilis

00:01:27.840 but a somatogenic approach can't explain

00:01:30.079 all mental disorders

00:01:31.520 more than a hundred years ago scholars

00:01:33.280 realized that this approach was not

00:01:34.720 appropriate for the disorder then known

00:01:36.400 as hysteria

00:01:37.680 patients with hysteria typically showed

00:01:39.439 symptoms that seemed to be neurological

00:01:41.759 but with other indications that made it

00:01:43.520 plain there was no neurological cause

00:01:46.240 their symptoms therefore had to be

00:01:47.920 understood in terms of a psychogenic

00:01:49.920 hypothesis which holds that the symptoms

00:01:52.079 are caused by psychological processes

00:01:54.799 across much of the late 19th and early

00:01:56.880 20th centuries the most prominent

00:01:58.479 version of this hypothesis

00:02:00.079 was sigmund freud's which described

00:02:02.159 mental illness as resulting from inner

00:02:04.159 conflicts and the defensive maneuvers to

00:02:06.240 deal with those inner conflicts

00:02:08.399 more recently though psychogenic

00:02:10.239 theories tend to focus on traumatic or

00:02:12.160 stressful experiences

00:02:13.599 maladaptive learned associations and

00:02:15.760 cognitions or distorted perceptions

00:02:19.120 it's important to know that most

00:02:20.560 contemporary psychologists view mental

00:02:22.480 disorders comprehensively through what

00:02:24.239 is called the biopsychosocial model

00:02:27.520 this is a holistic perspective taking

00:02:29.760 into account psychological processes

00:02:31.840 like

00:02:32.319 stress trauma and memories biological

00:02:35.040 factors like

00:02:36.000 genetics and brain chemistry but also

00:02:38.800 sociocultural influences like

00:02:41.040 poor living conditions problematic

00:02:43.040 interpersonal relationships

00:02:44.640 gender religious or sexual orientation

00:02:47.360 race and culture

00:02:49.200 modern theorists have also described

00:02:50.879 mental disorders using a diathesis

00:02:52.800 stress model

00:02:53.840 with the diathesis creating a

00:02:55.760 predisposition toward mental disorder

00:02:57.920 and the stress providing a trigger that

00:02:59.920 turns the risk into

00:03:01.280 the actual disorder imagine someone

00:03:04.080 experiences a traumatic event

00:03:06.480 we might be tempted to say that the

00:03:08.080 event caused the development of

00:03:10.239 post-traumatic stress disorder or ptsd

00:03:13.040 but the trauma was not the only force in

00:03:15.040 play some people experience

00:03:17.120 trauma without developing ptsd and this

00:03:19.680 tells us that trauma will cause ptsd

00:03:22.080 only if other factors are present what

00:03:24.480 are those other factors

00:03:25.840 part of the answer lies in a person's

00:03:27.440 biology for example

00:03:29.200 at least one previous study found that

00:03:30.879 people who experience childhood

00:03:32.239 adversity or traumatic experiences

00:03:34.239 during adulthood are at significantly

00:03:36.080 higher risk of developing ptsd

00:03:38.400 if they possess one or two short

00:03:39.840 versions of a gene that regulates the

00:03:41.360 neurotransmitter serotonin

00:03:43.360 the tendency that they have towards ptsd

00:03:46.239 remains

00:03:46.799 unexpressed until they experience the

00:03:48.879 trauma

00:03:49.840 this suggests that the development of

00:03:51.519 ptsd might be influenced by the

00:03:54.000 interaction of psychological and

00:03:55.680 biological factors

00:03:57.280 with one set of factors the diathesis

00:03:59.840 creating the predisposition for the

00:04:01.439 disorder

00:04:02.159 and a different set of factors the

00:04:03.760 stress providing the trigger that turns

00:04:05.840 the potential into the disorder

00:04:08.480 a diathesis is not always a biological

00:04:11.040 vulnerability

00:04:12.159 some diathesis may be psychological like

00:04:14.879 for example

00:04:15.920 thinking about life events in a

00:04:17.680 pessimistic or self-defeating way

00:04:20.000 the key assumption of the diathesis

00:04:22.000 stress model

00:04:23.040 is that both a diathesis and a stress

00:04:25.520 are necessary for the development of a

00:04:27.440 disorder

00:04:28.560 but even this model may be too simple

00:04:31.199 often there are multiple diabetes for a

00:04:33.520 particular individual

00:04:34.880 and a particular mental disorder

00:04:37.199 likewise multiple factors often create

00:04:39.520 the stress

00:04:40.400 including combinations of harsh

00:04:42.080 circumstances and specific events

00:04:44.240 like being the victim of a crime or

00:04:45.919 witnessing a devastating accident

00:04:48.160 for all of these reasons many

00:04:49.680 researchers adopt a multi-causal model

00:04:51.680 of mental disorders

00:04:52.960 acknowledging that many different

00:04:54.320 factors contribute to their development

00:04:56.400 in other words it's complicated

00:04:59.840 so what does the term mental disorder

00:05:02.000 actually mean

00:05:03.520 commonly mental disorders are defined as

00:05:05.680 distressful and dysfunctional patterns

00:05:07.600 of thoughts feelings or behaviors that

00:05:09.280 cause so much pain and suffering that it

00:05:11.120 interferes with a person's daily life

00:05:13.360 a diagnosis is generally made with

00:05:15.360 reference to the categories identified

00:05:17.680 in the diagnostic and statistical manual

00:05:19.919 for mental disorders

00:05:21.199 the dsm or dsm-5 because it's currently

00:05:24.160 in its fifth edition

00:05:25.759 dsm-5 gives definitions of specific

00:05:28.240 mental disorders by providing specific

00:05:30.320 symptoms

00:05:31.039 that are needed for a given disorder to

00:05:32.880 be diagnosed and it's used by pretty

00:05:34.880 much everybody

00:05:35.919 clinicians obviously but also by

00:05:38.000 insurance and drug companies and policy

00:05:40.320 makers and the whole legal system

00:05:42.400 what's particularly interesting about

00:05:43.759 the dsm is that it's designed to be a

00:05:45.520 work in progress

00:05:46.479 forever each new edition incorporates

00:05:48.960 changes based on the latest research

00:05:50.800 but also how our understanding of mental

00:05:52.800 health and behavior evolves over time

00:05:54.720 for example the first two editions

00:05:56.720 classified homosexuality as a

00:05:58.800 psychological disorder

00:06:00.479 and it was until 1973 that that was

00:06:02.560 eliminated

00:06:03.840 it's important to remember that dsm is

00:06:05.759 not a panacea

00:06:07.199 there is for example serious concern

00:06:09.520 that it inadvertently promotes over or

00:06:11.759 misdiagnosis and treatment of certain

00:06:13.840 behaviors

00:06:14.880 the finding that nearly half of all

00:06:16.560 americans will meet the criteria for a

00:06:18.400 mental disorder at some point in their

00:06:20.000 life fuels this skepticism the dsm-5 has

00:06:23.199 also been specifically criticized on the

00:06:25.120 grounds that its diagnostic criteria

00:06:26.960 have been loosened

00:06:28.000 for example in dsm-4 it specified that

00:06:30.800 symptoms of major depressive disorder

00:06:32.960 couldn't be attributed to normal

00:06:34.720 bereavement experienced when losing a

00:06:36.400 loved one

00:06:37.120 the dsm-5 however removed the

00:06:39.600 bereavement exclusion

00:06:41.120 this basically means that grief and

00:06:43.199 sadness after a loved one's death

00:06:45.440 can constitute major depressive disorder

00:06:49.039 also by assigning labels we're making

00:06:51.599 people vulnerable to judgments and

00:06:53.280 preconceptions that'll affect how others

00:06:55.199 will perceive and treat them

00:06:56.560 and not to mention how they will

00:06:58.080 perceive and treat themselves

00:06:59.919 the types of disorders included in the

00:07:01.680 dsm-5 include

00:07:03.280 anxiety disorders obsessive-compulsive

00:07:05.360 disorders trauma and stress-related

00:07:07.520 disorders

00:07:08.400 bipolar disorders depressive disorders

00:07:10.400 schizophrenia and other types of

00:07:12.000 psychotic disorders

00:07:13.520 dissociative disorders eating disorders

00:07:15.759 substance use disorders

00:07:17.199 neurodevelopmental disorders personality

00:07:19.440 disorders and more

00:07:22.639 among the most common are the anxiety

00:07:24.400 disorders affecting 15 to 20 percent of

00:07:26.960 the us population

00:07:28.479 anxiety diagnoses in the dsm-5 include

00:07:31.199 panic disorder

00:07:32.319 agrophobia social anxiety disorder

00:07:35.360 generalized anxiety disorder and

00:07:37.520 specific phobias

00:07:39.199 other types of disorders that also

00:07:40.960 include extreme anxiety are

00:07:42.560 obsessive-compulsive disorders

00:07:44.240 and trauma and stress-related disorders

00:07:47.199 panic disorder

00:07:48.240 is characterized by having unexpected

00:07:50.240 panic attacks

00:07:51.360 often the person becomes convinced that

00:07:53.440 they're having a heart attack and is

00:07:54.960 near death

00:07:58.240 i'll be doing something pretty normal

00:08:00.160 and then i just start to feel

00:08:02.800 off like i know something isn't quite

00:08:05.680 right

00:08:06.720 this tingling numbness creeps up my neck

00:08:10.720 and then all over my face then like

00:08:13.360 seeps

00:08:14.240 back into my head and i get dizzy so i

00:08:17.840 sit down

00:08:19.199 and as i'm sitting sometimes i'll think

00:08:22.479 oh my god i'm having a seizure or a

00:08:25.039 heart attack or something

00:08:26.960 but i know better i know it's panic

00:08:29.599 attack

00:08:30.879 um because my heart beats harder

00:08:34.559 not like really faster just hard

00:08:38.399 and now i'm feeling scared and

00:08:41.760 thinking oh no not now

00:08:44.880 not here and i just have to wait till

00:08:47.600 it's over

00:08:50.480 panic attacks are frightening enough but

00:08:52.640 even the anticipation of the attacks can

00:08:54.959 be awful

00:08:55.920 people with panic disorder sometimes

00:08:57.760 develop a profound fear of having an

00:09:00.080 attack especially in public places

00:09:02.640 so as a result people with panic

00:09:04.560 disorder often develop a powerful

00:09:06.480 tendency

00:09:07.279 not to even want to go outside their

00:09:08.800 houses or their bedrooms this is why

00:09:10.720 panic disorder is often accompanied by

00:09:12.640 agoraphobia

00:09:13.760 a fear of being in situations in which

00:09:15.680 help might not be available or

00:09:17.279 escape might be difficult or

00:09:18.720 embarrassing

00:09:20.640 all of a sudden i'm between two subway

00:09:22.480 stations my legs are tingling

00:09:25.600 my breath becomes really heavy

00:09:29.040 all i want to do is yell so i get up

00:09:31.120 fast because there's no way i'm gonna

00:09:33.040 yell

00:09:33.440 in the subway i get out of the subway

00:09:37.920 all of a sudden my life changes i

00:09:39.760 dropped my bags

00:09:41.120 i could not talk i could not walk

00:09:44.399 a colleague found me and helped me to

00:09:46.800 the emergency room

00:09:48.720 the doctor there said you don't need me

00:09:51.279 you need a psychiatrist

00:09:53.360 go on home and figure this out so i did

00:09:56.640 go home

00:09:57.920 i went to my bedroom and i stayed there

00:10:00.880 for two years

00:10:02.399 individuals with a condition known as

00:10:04.160 social anxiety disorder are intensely

00:10:06.320 afraid of being watched and judged by

00:10:08.399 others

00:10:09.360 the kinds of social situations in which

00:10:11.279 individuals with social anxiety disorder

00:10:13.360 usually have

00:10:14.000 problems include public speaking having

00:10:16.560 a conversation meeting

00:10:18.000 strangers eating in restaurants and in

00:10:20.160 some cases using the public restroom

00:10:22.880 although many people become anxious in

00:10:24.560 social situations

00:10:25.920 the fear anxiety and avoidance

00:10:28.000 experience and social anxiety disorder

00:10:30.000 are highly distressing and lead to

00:10:31.600 serious impairments in life

00:10:35.040 imagine that you're getting ready to go

00:10:36.480 to a party you feel

00:10:38.480 excited but also nervous and you've got

00:10:40.720 this feeling in your stomach

00:10:42.720 almost like another heartbeat there's

00:10:45.040 something holding you back holding you

00:10:46.320 back from getting

00:10:47.360 too happy better to be cautious

00:10:50.399 otherwise something bad might happen

00:10:54.800 when you arrive at the party someone

00:10:56.959 comes up to you and starts

00:10:58.399 talking with you and as this is

00:11:00.800 happening

00:11:01.600 your mind starts racing your heart

00:11:04.959 begins pounding you start sweating

00:11:08.160 and it feels almost like you're having

00:11:11.680 an

00:11:11.920 out of body experience like you're

00:11:13.760 dissociating from yourself and you're

00:11:15.279 just

00:11:15.839 watching yourself talk pull it together

00:11:18.800 you tell yourself but

00:11:20.640 you can't and it's just getting worse

00:11:24.800 after a few minutes the person you've

00:11:26.720 been speaking to leaves and you feel

00:11:28.800 utterly defeated

00:11:32.160 generalized anxiety disorder or gad is

00:11:35.120 characterized by continuous and

00:11:36.800 pervasive feelings of anxiety

00:11:39.200 people with this condition tend to feel

00:11:40.959 continually tense and apprehensive

00:11:43.440 experiencing unfocused negative and out

00:11:46.000 of control feelings

00:11:47.519 of course feeling this way occasionally

00:11:49.440 is common enough but

00:11:50.880 feeling it consistently for over six

00:11:52.880 months that which is the length required

00:11:54.880 for a formal diagnosis

00:11:56.560 is not folks with gad worry all the time

00:11:59.360 and are frequently agitated and on edge

00:12:01.680 but unlike people with other kinds of

00:12:03.200 anxiety they often can't identify what's

00:12:05.680 causing the anxiousness

00:12:10.079 specific phobias on the other hand

00:12:11.839 include experiences of excessive

00:12:13.680 distressing and persistent fear or

00:12:15.600 anxiety

00:12:16.399 about a specific object or situation

00:12:18.639 like animals enclosed spaces

00:12:20.880 elevators or flying obsessive-compulsive

00:12:24.880 disorder or

00:12:25.839 ocd is a condition that used to be

00:12:28.399 categorized as an anxiety disorder but

00:12:30.720 is now considered complex enough to be

00:12:32.560 in a class by itself

00:12:34.000 you probably know that the condition is

00:12:35.519 characterized by unwanted repetitive

00:12:37.440 thoughts which become obsessions which

00:12:39.120 are sometimes accompanied by actions

00:12:40.880 which become compulsions but

00:12:42.800 being neat orderly and fastidious

00:12:44.560 doesn't mean that you have ocd

00:12:46.000 ocd is a debilitating condition whose

00:12:48.399 sufferers take normal behaviors like

00:12:50.240 washing your hands or double checking

00:12:51.920 that you turned off the stove

00:12:53.360 and perform them compulsively and they

00:12:55.440 often use these compulsive even

00:12:57.360 ritualistic behaviors to relieve intense

00:13:00.000 and unbearable anxiety

00:13:02.959 it was my eighth shower

00:13:06.320 that day and i still couldn't convince

00:13:08.880 myself that

00:13:09.760 i was clean enough i counted in my head

00:13:13.839 one two three four i was terrified

00:13:17.200 of germs burrowing into my skin

00:13:21.440 making their way to my liver which i was

00:13:24.800 certain would fail

00:13:26.560 and these images just looped in my brain

00:13:29.440 as i counted

00:13:30.880 my husband opens the bathroom door

00:13:35.440 baby are you okay

00:13:40.880 no i said

00:13:44.079 i can't get out

00:13:47.199 i was so ashamed of myself

00:13:50.800 mostly because i was caught more than

00:13:54.000 anything

00:13:55.440 and that's the thing about having ocd

00:13:59.040 it's a disease that demands perfection

00:14:03.600 ocd afflicts about two percent of the us

00:14:06.079 population sometime in their lives

00:14:08.480 a striking feature of ocd is how early

00:14:10.959 it often starts

00:14:12.240 one-third of adults with ocd develop

00:14:14.320 their symptoms in childhood

00:14:15.760 often before age 10. ptsd is a type of

00:14:20.000 trauma and stressor related disorder

00:14:22.000 that also includes extreme anxiety

00:14:24.800 with ptsd the stress that precipitated

00:14:27.279 the disorder is often obvious

00:14:29.440 a rape a terrorist attack a battlefield

00:14:32.000 experience

00:14:33.279 its symptoms are classified into four

00:14:35.199 major clusters in the dsm-5

00:14:37.680 one of these clusters involves reliving

00:14:39.680 the event through intrusive memories

00:14:41.440 nightmares or flashbacks

00:14:44.560 the second cluster of symptoms involves

00:14:46.560 avoiding situations you associate with

00:14:48.639 the event

00:14:49.519 while the third generally describes

00:14:51.199 excessive physiological arousal like

00:14:53.519 the heart pounding muscle tension

00:14:55.600 anxiety or irritability

00:14:57.279 and major problems sleeping or

00:14:58.959 concentrating

00:15:02.560 i slept in a chair rather than a bed

00:15:05.120 because that made me feel less

00:15:06.560 vulnerable i slept in clothing

00:15:09.760 rather than undressing because then i

00:15:12.079 was ready

00:15:13.680 i never felt like there were viet cong

00:15:15.680 in the tree line because

00:15:16.800 intellectually i knew i was home and

00:15:19.120 that was a safe place

00:15:20.720 but in my spirit in my anxiety

00:15:24.079 i felt like i was always under a sniper

00:15:25.920 scope and my adrenaline rush was so high

00:15:29.199 that i could go for a long period of

00:15:30.959 time without sleeping

00:15:32.959 but that didn't do me any good at all

00:15:35.680 and finally there's the fourth major

00:15:37.199 symptom cluster

00:15:38.320 pervasive negative changes and emotions

00:15:40.480 and belief

00:15:41.440 like feelings of excessive guilt fear or

00:15:44.079 shame or

00:15:45.040 no longer getting enjoyment out of what

00:15:46.720 you used to

00:15:49.839 in 2006 i attended a very traumatic and

00:15:53.519 very brutal

00:15:54.880 road traffic collision which resulted in

00:15:57.440 the death of a young man

00:15:59.199 who i couldn't save i guess you know

00:16:02.079 when i put on my fire fighting uniform

00:16:05.279 it was a mask i would be someone

00:16:09.360 who would show up and be courageous

00:16:12.560 and and fearless able to repress

00:16:16.639 and suppress the powerlessness

00:16:19.680 the fear and sometimes terror

00:16:24.240 grief and sorrow i was dying inside

00:16:30.639 roughly six percent of adults in the

00:16:32.880 united states experience ptsd at some

00:16:35.120 point in their lifetime

00:16:36.399 with higher rates among people exposed

00:16:38.399 to mass trauma

00:16:39.600 and people whose jobs involve

00:16:41.040 duty-related trauma exposure like police

00:16:43.440 officers firefighters and emergency

00:16:45.360 medical personnel

00:16:46.800 it's important to note that there is

00:16:48.399 considerable co-morbidity

00:16:50.000 among these disorders in fact more than

00:16:52.480 half of the people with one

00:16:53.600 anxiety-related disorder will at some

00:16:55.440 point also experience another

00:16:57.040 anxiety-related disorder

00:16:58.800 still functional neuroimaging studies

00:17:00.959 show that despite all the disorders

00:17:02.399 having anxiety in common

00:17:04.000 they are different from each other in

00:17:05.199 terms of their biological underpinnings

00:17:11.439 depression is currently the number one

00:17:13.760 cause of disability and lost work days

00:17:16.319 with a lifetime prevalence in the u.s of

00:17:18.880 22 percent

00:17:20.799 a diagnosis of major depressive disorder

00:17:23.199 is given when an

00:17:24.079 individual has experienced at least five

00:17:26.160 signs of depression for more than two

00:17:27.919 weeks

00:17:28.559 these symptoms include not just

00:17:30.080 depressed mood but also significant

00:17:32.240 weight or appetite loss or gain

00:17:34.480 too much or too little sleep decreased

00:17:36.720 interest in activities feeling worthless

00:17:38.880 fatigued or lethargic and difficulty

00:17:41.280 concentrating or making decisions

00:17:43.440 plus for a diagnosis these symptoms need

00:17:46.160 to cause the person or others around

00:17:47.919 them prolonged distress

00:17:50.720 8th grade was hard i was

00:17:54.320 irritable angry at the universe and

00:17:57.679 at myself mostly the thoughts in my head

00:18:02.080 were awful self-loathing

00:18:05.520 and hateful

00:18:09.120 i cried almost every day

00:18:13.200 at the littlest things and i felt

00:18:16.400 nothing

00:18:18.880 i would have happily stopped existing my

00:18:21.919 friends

00:18:23.440 family nobody knew anything was wrong

00:18:27.039 with me

00:18:27.679 until maybe a year and a half ago

00:18:32.960 when i decided to tell them that i had

00:18:34.799 been living with

00:18:36.960 dark thoughts and self-loathing

00:18:40.840 for maybe

00:18:43.600 all of my adult life

00:18:46.880 saying i'm fine and

00:18:49.919 not addressing it not letting anybody

00:18:53.200 in i've sort of realized it's like

00:18:57.440 putting plaster over

00:19:00.720 cancer you're not dealing with

00:19:04.240 anything my depression doesn't hit me

00:19:07.039 like a sledgehammer out of nowhere or

00:19:09.039 leave with sudden relief like waking up

00:19:11.039 from a nightmare

00:19:12.400 it creeps in and then it creeps away

00:19:14.080 again it's like taking a painkiller for

00:19:16.640 a headache

00:19:17.520 you don't know the instant your headache

00:19:19.200 is gone you just realize it's been gone

00:19:21.200 a while bipolar disorder with a lifetime

00:19:25.679 prevalence rate of about three percent

00:19:28.080 includes dark lows of depression but

00:19:30.400 also bouts of mania

00:19:32.400 and a true manic episode doesn't just

00:19:34.240 mean being energetic or happy

00:19:36.160 it's a period of intense restless but

00:19:38.480 often optimistic hyperactivity

00:19:40.799 in which one's estimation of oneself

00:19:42.960 one's abilities and one's ideas can

00:19:44.799 often get skewed

00:19:47.679 being bipolar is the mental equivalent

00:19:50.799 of being on the pirate ship

00:19:52.240 fair ride swinging back and forth from

00:19:55.200 depression

00:19:56.480 which made it impossible to get out of

00:19:58.320 my bed for days and

00:20:00.240 made me fantasize about death on a daily

00:20:02.159 basis

00:20:03.440 or mania which had been able to sleep

00:20:06.080 for as many as five days at a time or

00:20:07.840 spending uncontrollably

00:20:09.600 which led to bankruptcies one time i

00:20:12.720 actually spent

00:20:13.440 200 on post-it notes because everyone

00:20:16.400 needs

00:20:17.039 40 assorted colors of post-it notes

00:20:22.080 mania also includes being severely

00:20:24.080 irritable for no apparent reason

00:20:26.799 and just becoming enraged the slightest

00:20:29.039 thing

00:20:30.240 no one ever tells you how hard it can be

00:20:32.880 to find the right combination

00:20:34.080 of medications or how challenging it is

00:20:36.960 to find a knowledgeable empathetic

00:20:38.559 provider

00:20:40.000 or how the side effects of the drugs are

00:20:41.919 often worse than the disease itself

00:20:46.080 all of this was compounded by the daily

00:20:49.520 struggle to hide my symptoms from those

00:20:51.520 around me

00:20:54.159 for both those with depression and those

00:20:56.240 in a depressive phase of bipolar

00:20:57.919 disorder

00:20:58.720 the extreme emotional pain they

00:21:00.720 experience can feel

00:21:02.000 unendurable because of this depression

00:21:04.559 is the main driver behind suicide

00:21:06.720 which now claims over 1 million lives

00:21:08.960 every year worldwide

00:21:12.400 i remember lying in bed one morning and

00:21:14.559 i was

00:21:16.080 overwhelmed because i was trying to

00:21:18.640 remember what feeling happy

00:21:20.159 felt like and i couldn't remember and

00:21:23.919 i thought to myself there's no point in

00:21:26.720 living

00:21:27.360 if i can't actually remember how to be

00:21:29.039 happy anymore

00:21:30.880 i'd had suicidal thoughts before as most

00:21:33.200 people who suffer from depression do

00:21:35.520 but i always knew i'd never really go

00:21:37.039 through with it because of the pain it

00:21:39.039 would cause the people close to me

00:21:42.000 but that morning as i was lying in bed

00:21:45.440 depression had completely taken over my

00:21:47.600 thoughts it had

00:21:49.440 manipulated and lied its way into making

00:21:51.600 me think that ending my own life was not

00:21:53.360 just best for me

00:21:55.360 it was actually best for everybody else

00:21:57.120 around me because

00:21:58.480 that's what depression does i called my

00:22:01.600 mom that morning

00:22:03.440 not because i needed help i thought i

00:22:05.679 was beyond help

00:22:07.600 but because i thought that day i was

00:22:10.480 going to take my own life and i called

00:22:12.320 her to

00:22:13.039 hear her voice one last time i think

00:22:16.799 by the tone of my voice by the things i

00:22:18.880 was saying she knew something really

00:22:20.559 serious was up

00:22:21.520 and the love in her voice

00:22:25.280 she managed to bring me back for a few

00:22:27.280 seconds and

00:22:28.960 suggested that together we get me some

00:22:31.280 help and that was

00:22:32.320 really all i needed i saw my gp the next

00:22:35.760 day and i did something i thought i'd

00:22:37.280 never

00:22:37.840 do i told someone

00:22:40.960 that i didn't understand what was going

00:22:43.280 on inside my own head

00:22:45.039 and after a little bit of conversation

00:22:47.200 about depression

00:22:48.320 he asked me a question that i can't

00:22:50.799 believe i never thought to ask myself

00:22:52.840 before he said

00:22:55.760 do you actually want to die or do you

00:22:59.200 just not want to feel this way anymore

00:23:02.400 and i thought what an important

00:23:03.840 distinction because when you're in that

00:23:05.520 fog

00:23:06.559 you can't ask yourself questions like

00:23:08.320 that

00:23:10.320 you may already know that schizophrenia

00:23:12.080 is one of the most impairing forms of

00:23:13.679 mental illness

00:23:15.120 once thought of as a single discrete

00:23:16.720 condition it's now included in the dsm-5

00:23:19.360 as a point on a spectrum of disorders

00:23:21.440 that vary in how they're expressed and

00:23:23.200 how long they last

00:23:24.400 but they share similar symptoms

00:23:26.400 schizophrenia spectrum disorders are

00:23:28.159 characterized by disorganized thinking

00:23:30.559 emotions and behaviors that are often

00:23:32.400 incongruent with their situations

00:23:34.320 and disturbed perceptions including

00:23:36.240 delusions and hallucinations

00:23:38.640 they all involve a kind of loss of

00:23:40.720 contact with reality

00:23:42.480 the resulting behaviors and mental

00:23:44.080 states associated with this break from

00:23:45.679 reality

00:23:46.400 are generally called psychotic symptoms

00:23:49.360 hallucinations delusions and

00:23:50.960 disorganized thinking

00:23:52.400 are categorized as positive symptoms but

00:23:54.960 in addition

00:23:55.919 many individuals also experience

00:23:57.760 negative symptoms such as blunted affect

00:24:00.559 reduced speech and social withdrawal

00:24:03.360 during my freshman year

00:24:04.799 in college

00:24:08.960 that's when i had my first full-blown

00:24:11.919 psychotic

00:24:12.559 episode i had also tried to commit

00:24:16.840 suicide

00:24:18.480 i have been hearing voices lots of

00:24:21.840 voices calling out my name

00:24:23.840 um i couldn't figure out where they were

00:24:26.080 coming from we were in a room

00:24:28.240 but nobody was in the room with me and

00:24:29.919 the voices were just

00:24:31.600 calling my name then i had

00:24:35.120 an olfactory hallucination

00:24:38.799 that was really intense i would smell

00:24:41.600 these god-awful things

00:24:43.520 and i couldn't locate where they were

00:24:44.880 coming from it was

00:24:46.559 god awful

00:24:50.240 when someone's experiencing psychotic

00:24:52.400 symptoms their thinking and speech

00:24:54.880 can become disorganized rambling and

00:24:56.799 fragmented

00:24:58.159 this tendency to pick up one train of

00:25:00.080 thought and suddenly switch to another

00:25:01.679 and then another

00:25:02.559 can make communication painfully

00:25:04.240 difficult people exhibiting these

00:25:06.080 symptoms can also suffer a breakdown in

00:25:08.400 selective attention

00:25:09.840 losing the ability to focus on one thing

00:25:11.919 while filtering other things out

00:25:14.000 in extreme cases speech may become so

00:25:16.640 fragmented it becomes little more than a

00:25:18.480 string of meaningless words

00:25:21.200 i don't take my medications all the time

00:25:23.279 correctly but i do take them

00:25:27.440 but when i'm not taking my math i get

00:25:31.039 disorganized thinking

00:25:34.240 and uh i started speaking of these these

00:25:37.760 phrases i started getting these

00:25:39.520 disjointed signal sets

00:25:41.360 and everything and i put everything

00:25:43.840 together

00:25:44.799 right where words that sound alike but

00:25:47.679 don't have the same meaning in anything

00:25:50.000 and it's kind of confusing for some

00:25:51.840 people but it's okay because i can make

00:25:53.600 it work

00:25:55.120 one time i went to see my law professor

00:25:58.400 um i needed an extension on a paper

00:26:01.440 and i started talking to him and i was

00:26:03.919 jibbering and i was

00:26:05.279 like making all kinds of sounds that i

00:26:08.240 guess he thought were unintelligible

00:26:10.799 to the point that he

00:26:14.480 he wound up taking me to the emergency

00:26:16.480 room

00:26:20.000 i wound up spending five months

00:26:23.120 five months on the psych war

00:26:28.159 that was quite an experience

00:26:31.279 about one percent of the population

00:26:33.120 experiences schizophrenia spectrum

00:26:34.960 disorder in their lifetime

00:26:36.480 usually first diagnosed during late

00:26:38.240 adolescence or early adulthood

00:26:40.559 dissociative identity disorder is

00:26:42.799 sometimes confused with schizophrenia

00:26:44.480 spectrum disorders

00:26:45.760 did is a rare disorder where a person

00:26:48.720 exhibits two or more

00:26:49.840 distinct and alternating identities

00:26:52.080 rather than the disorganized thinking

00:26:53.760 emotions and behaviors that are

00:26:55.200 hallmarks of a diagnosis of

00:26:56.720 schizophrenia

00:26:58.159 the last category of mental disorders we

00:27:00.000 will cover are the most deadly

00:27:01.919 eating disorders the rate of new cases

00:27:04.320 of eating disorders in western cultures

00:27:06.000 has been increasing since the 1950s

00:27:08.400 and today in the u.s an estimated 20

00:27:10.720 million women and 10 million men

00:27:12.640 experience a clinically significant

00:27:14.240 eating disorder at some point in their

00:27:16.000 lives

00:27:16.799 among the syndromes described in the

00:27:18.480 dsm-5 three have been most widely

00:27:20.799 studied

00:27:21.520 anorexia nervosa bulimia nervosa and

00:27:24.320 binge eating disorder

00:27:25.679 anorexia nervosa typically starts during

00:27:27.840 puberty and is most prevalent among

00:27:29.600 adolescent females and essentially

00:27:31.279 involves maintaining a starving diet

00:27:33.360 that leads to abnormally low body weight

00:27:36.080 efforts to maintain a very low body

00:27:37.840 weight are motivated by intense fear of

00:27:39.840 becoming

00:27:40.480 fat and disturbances in the way the body

00:27:42.640 is experienced

00:27:43.679 such as placing inordinate importance on

00:27:46.000 weight or shape or failing to recognize

00:27:47.760 one's own

00:27:48.399 underweight status anorexia nervosa can

00:27:51.360 begin as a diet that quickly spirals out

00:27:53.440 of control as a person becomes obsessed

00:27:55.600 with continued weight loss

00:27:57.279 all while still feeling overweight as

00:27:59.760 the body is denied crucial nutrients it

00:28:02.000 slows down to conserve what little

00:28:03.760 energy it has

00:28:05.039 often resulting in abnormally slow heart

00:28:07.200 rate loss of bone density

00:28:09.120 fatigue muscle weakness hair loss severe

00:28:11.760 dehydration

00:28:12.799 and an extremely low body mass index and

00:28:16.159 it's that low body mass

00:28:17.600 that's the defining characteristic of

00:28:19.279 anorexia nervosa

00:28:20.960 a refusal to maintain a weight at or

00:28:23.360 above what would normally be considered

00:28:25.039 minimally healthy

00:28:26.399 another common eating disorder is

00:28:28.000 bulimia nervosa

00:28:29.600 like anorexia nervosa bulimia nervosa

00:28:32.159 includes body image disturbance

00:28:34.320 however unlike anorexia nervosa bulimia

00:28:37.360 nervosa may occur at any body weight

00:28:39.840 the key behavioral symptoms of bulimia

00:28:42.000 nervosa are binge eating followed by

00:28:44.480 fasting or purging

00:28:46.080 often by vomiting or using laxatives

00:28:48.559 this cycle of binging and purging can

00:28:50.640 seriously damage a wide range of body

00:28:52.799 systems

00:28:53.440 including the whole digestive system

00:28:55.600 leading to a regular heartbeat

00:28:57.279 inflammation of the esophagus and mouth

00:28:59.679 tooth decay and staining

00:29:01.120 irregular bowel movements peptic ulcers

00:29:03.919 pancreatitis

00:29:04.960 and other organ damage at first i

00:29:07.840 started to notice

00:29:08.960 that a sandwich was not just a sandwich

00:29:11.279 anymore

00:29:12.320 instead this sandwich was 460 calories

00:29:15.039 and 26 grams of carbohydrates

00:29:18.080 in my mind those 460 calories would

00:29:20.960 cause me to be nearly double my weight

00:29:22.640 and those two pieces of bread

00:29:24.320 were the devil of all foods because i

00:29:26.159 saw them as pointless

00:29:27.919 carbs i would see myself staring in the

00:29:31.200 mirror

00:29:32.720 truly believing i was 40 pounds heavier

00:29:34.880 than i actually was

00:29:37.039 my gym was a place where i pushed my

00:29:38.480 body to its limits for hours every day

00:29:40.880 just to burn as many calories as humanly

00:29:42.799 possible by the end of each day

00:29:44.799 and if i had even the slightest feeling

00:29:46.640 of being full

00:29:47.840 i would go straight to the bathroom

00:29:49.440 fingers down my throat

00:29:51.440 i had no control over what i was doing

00:29:53.840 feeling

00:29:54.640 or thinking as if throwing up

00:29:57.919 after almost every meal

00:30:01.039 wasn't bad enough i had an immense

00:30:04.240 feeling of shame

00:30:06.880 the dsm-5 added a third category called

00:30:09.520 binge eating disorder which is marked by

00:30:11.600 significant binge eating

00:30:13.039 followed by emotional distress feelings

00:30:14.960 of lack of control

00:30:16.080 disgust or guilt but without purging or

00:30:18.399 fasting

00:30:19.200 although binge eating disorder is not

00:30:20.720 defined by a weight criterion

00:30:22.480 or a disturbance of body image many

00:30:24.640 individuals experiencing this eating

00:30:26.320 disorder

00:30:27.039 do report feeling dissatisfied with

00:30:28.880 their body weight or shape

00:30:31.200 the both genders are affected rates of

00:30:33.440 eating disorders are higher among women

00:30:35.279 than men

00:30:36.559 it's important to understand that gender

00:30:38.480 is not the cause of mental illness

00:30:40.720 though differing demands placed on males

00:30:42.799 and females by society and their culture

00:30:44.880 can influence the development and course

00:30:46.799 of a disorder

00:30:48.240 ocd has an earlier age of onset in boys

00:30:50.799 than girls with most people being

00:30:52.399 diagnosed by age 19

00:30:54.159 and women are at a higher risk for

00:30:55.600 developing an anxiety disorder

00:30:57.120 depression and ptsd compared to men

00:30:59.919 further while men and women experience

00:31:01.679 many of the same mental disorders

00:31:03.360 their willingness to talk about their

00:31:04.880 feelings may be very different

00:31:06.559 this is one of the reasons that their

00:31:08.000 symptoms may be different as well

00:31:09.760 for example some men with depression or

00:31:11.760 an anxiety disorder

00:31:13.039 may appear to be angry or aggressive

00:31:15.039 while many women will express sadness

00:31:17.440 when it comes to other mental disorders

00:31:19.039 like schizophrenia and bipolar disorder

00:31:21.440 research has not found differences in

00:31:23.200 rates that men and women experience

00:31:24.799 these illnesses

00:31:25.840 at the same time it's important to

00:31:27.519 acknowledge that the boundaries

00:31:28.960 associated with many of these diagnoses

00:31:31.519 the lines that separate mentally ill

00:31:33.679 from not ill

00:31:34.799 are actually quite blurry someone who is

00:31:37.039 considered to

00:31:37.840 have a disorder may differ by only a

00:31:40.159 single symptom from someone who is

00:31:41.919 considered

00:31:42.559 not to have a disorder mental disorders

00:31:45.279 have historically been a source of

00:31:46.960 severe stigma both for the person with

00:31:49.120 the disorder and for the person's family

00:31:51.840 while stigma has certainly been easing

00:31:53.679 in the u.s over the past few decades as

00:31:55.600 more and more people have shared their

00:31:56.960 own experiences

00:31:58.559 there's no doubt that it continues to

00:32:00.320 cause distress and often to prevent

00:32:02.240 individuals with mental disorders from

00:32:04.000 seeking treatment

00:32:05.919 speaking out continues to be important

00:32:08.320 it can educate the public

00:32:10.159 help instill courage in others facing

00:32:11.840 similar challenges

00:32:13.200 and increase the likelihood that we will

00:32:14.799 all respond with informed compassion

00:32:17.200 to those of us experiencing mental

00:32:21.550 [Music]

00:32:26.840 disorders

00:32:29.420 [Music]

00:32:44.399 you