chapter 15

Introduction to Psychological Disorders

On Monday, September 16, 2013, a tragic event unfolded at the Washington Navy Yard, where a gunman named Aaron Alexis killed 12 people as the workday began. Alexis had a troubled history, believing he was under control via radio waves, and had previously reported hearing voices and being surveilled by mysterious forces. Although Alexis's actions are inexcusable, they raise questions about mental illness and its role in violence. Studies suggest that mental disorders alone do not cause violence; instead, socio-demographic and economic factors play significant roles, underscoring the need for appropriate mental health interventions to potentially avert such tragedies.

Understanding Psychological Disorders

Defining Psychological Disorders

According to the American Psychiatric Association (2013), a psychological disorder, or mental disorder, is defined as a syndrome characterized by clinically significant disturbances in cognition, emotion regulation, or behavior, reflecting dysfunction in psychological, biological, or developmental processes. These disorders are frequently associated with significant distress affecting social, occupational, or other critical activities.

The Study of Psychopathology

Psychopathology studies psychological disorders, including their symptoms, causes, and treatments. The consensus among mental health professionals about defining abnormal thoughts, feelings, and behaviors is critical for accurate diagnosis and treatment.

Criteria for Abnormality

Harmful Dysfunction

The concept of harmful dysfunction proposed by Wakefield (1992) argues that psychological disorders are defined by significant disturbances in thoughts, feelings, and behaviors, which must also lead to negative consequences for the individual or others. Examples include extreme fear, like that exhibited by someone with a phobia. Dysfunction must translate into harmful consequences—internal anguish, significant behavioral changes, or disruption of daily life.

Signs of Psychological Disorders

Psychological disorders are identified through specific signs: significant disturbances in inner experiences, behavioral dysfunction, and distress. A differentiation between merely atypical characteristics, such as having red hair, and those that are disordered is important; while red hair is uncommon, it does not indicate a disorder.

Cultural Expectations and Definitions

Behavior that varies from cultural norms could be marked as disordered, yet cultural context is vital in this assessment. For example, communication norms differ across cultures, affecting perceptions of social behaviors, such as eye contact. Labeling phenomena such as hallucinations varies greatly between cultures, highlighting the subjective nature of defining mental disorders.

Historical Perspectives on Mental Illness

The Myth of Mental Illness

In the mid-20th century, the concept of mental illness faced criticism. One key critique posited that mental illness was a societal construct aimed at addressing socially disapproved behaviors. This has led to an increased awareness of the stigma attached to mental health issues, emphasizing that these illnesses are not choices and require legitimate treatment and support.

Szasz's Perspective

Psychiatrist Thomas Szasz (1960) famously argued against the legitimacy of mental illness, suggesting that what were considered symptoms of mental disorder should be classified as "problems in living." This perspective emphasized individual responsibility for behavior and the non-existence of mental illness in a medical context. Historical shifts in understanding mental illness have led to a greater emphasis on the realities of psychological suffering experienced by affected individuals.

The Role of Classification in Psychopathology

Importance of Diagnostic Systems

Classification systems are essential for organizing psychological disorders to facilitate accurate diagnosis and treatment. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, serves as the primary reference for diagnosing psychological disorders. The DSM outlines categories and provides diagnostic criteria for various disorders.

Evolution of the DSM

From its inception in 1952, the DSM has undergone several revisions to reflect evolving understandings of mental health. The current DSM-5 includes comprehensive details about each disorder, including diagnostic features, criteria, prevalence rates, and associated risk factors.

Issues Surrounding the DSM

Despite its utility, the DSM-5 faces criticism for potentially overpathologizing normal behaviors and for its criteria, which some argue may lead to diagnostic inflation—where increased numbers of classifications may attribute psychiatric diagnoses to common human experiences. Additionally, cultural norms and changes over time affect which behaviors are classified as disorders.

Comorbidity and its Implications

Understanding Comorbidity

Comorbidity refers to the simultaneous presence of multiple disorders within an individual. This is particularly prevalent among anxiety disorders, depressive disorders, and substance use disorders. Understanding comorbidity is crucial for effective treatment strategies since the interaction between symptoms can complicate diagnosis and treatment approaches.\

The Role of Substance Use Disorders

A significant overlap exists between mental health disorders and substance use, where around 25% of individuals with severe mental illness also exhibit substance use disorders. Careful observation and diagnosis are necessary, especially after drug use has ceased, to ensure accurate treatment and recovery plans.

Conclusion

Understanding psychological disorders involves navigating complex definitions and perspectives shaped by cultural expectations, historical criticisms, and the evolution of classification systems. While academic definitions set the stage for diagnosis and treatment, the lived realities of individuals suffering from these disorders offer insight into the vital need for compassion and comprehensive support.