Psychological Disorders Psychology 12
What is Normal? • What are examples of “normal” adolescent behaviour? • Imagine the following four settings: 1) a rural village in India 2) a formal dinner with the Queen 3) a funeral 4) a city courtyard in the city of Beijing, China • Defining “normal” is not simple. It depends upon such variables as behavioural setting, cutural perspective, public expectation, and so on…
“Giraffe Women” of Thailand • Have you heard of the “giraffe women” of the Kenyan tribe in Thailand who wear heavy copper coils around their necks to push their faces up and make their necks look longer? At the age of 5, the first coil is normally added, but some little girls are “coiled” at the age of 2. Year after year, new coils are added. Once fastened, the rings are worn for life because the neck muscles weaken and deteriorate to the point they can no longer support the weight of the head. These coils weigh up to 12 pounds and depress the clavicle and the ribs about 45 degrees from their normal position. • Would you consider this behaviour abnormal? What about the following cases taken from our own culture…
Abnormal Behaviour? • “Mary’s troubles first began in adolescence. She began to miss curfew, was frequently truant, and her grades declined sharply. Mary later became promiscuous and prostituted herself several times to get drug money…She also quickly fell in love and overly idealized new friends. But when they quickly (and inevitably) disappointed her, she would angrily cast them aside…Mary’s problems, coupled with a preoccupation with inflicting pain on herself (by cutting and burning) and persistent thoughts of suicide, eventually led to her admittance to a psychiatric hospital at age 26” (Kring et. al., 2007, pp 386-387)
Abnormal Behaviour? • “Rain or shine, day in and day out, 43-year-old Joshua occupies his “post” on a busy street corner wearing his standard outfit—a Red Sox baseball cap, yellow T-shirt, worn-out hiking shorts, and orange sneakers. Sometimes he can be seen, “conversing” with imaginary people. Without apparent cause, he also frequently explodes into shrieks of laughter or breaks down into miserable sobs. Police and social workers keep taking him to shelters for homeless, but Joshua manages to get back on the street before he can be treated. He has repeatedly insisted that these people have no right to keep bothering him. • (Halgin & Whitbourne, 2008, p. 283)
Abnormal Behaviour? Both Mary and Joshua have severe psychological problems, and both of their stories raise interesting questions. What caused their difficulties? Was there something in their early backgrounds to explain their later behaviours? Is their something medically wrong with them? What about the “giraffe women”? What is the difference between being culturally different and being disordered?
Do you recognize these myths? Myth #1 • People with psychological disorders act in bizarre ways and are very different from normal people.
Do you recognize these myths? Fact #1 • This is true for only a small minority of individuals and during a relatively small portion of their lives. In fact, sometimes even mental health professionals find it difficult to distinguish normal from abnormal individuals without formal screening.
Do you recognize these myths? Myth #2 • Mental disorders are a sign of personal weakness.
Do you recognize these myths? Fact #2 • Psychological disorders are a function of many factors, such as exposure to stress, genetic disposition, family background, and so on. • Mentally disturbed individuals can’t be blamed for their illness any more than we blame people who develop Alzheimer’s or other physical illness
Do you recognize these myths? Myth #3 • Mentally ill people are often dangerous and unpredictable.
Do you recognize these myths? Fact #3 • Only a few disorders, such as some psychotic and antisocial personalities, are associated with violence. • The stereotype that connects mental illness and violence persists because of prejudice and selective media attention
Do you recognize these myths? Myth #4 • A person who has been mentally ill never fully recovers.
Do you recognize these myths? Fact #4 • With therapy, the vast majority of people who are diagnosed as mentally ill eventually improve and lead normal productive lives. • Moreover, mental disorders are generally only temporary. A person may have an episode that lasts for days, weeks or months. Afterwards, they may go for years—even a lifetime—without further difficulty.
Do you recognize these myths? Myth #5 • Most mentally ill individuals can work at only low-level jobs.
Do you recognize these myths? Fact #5 • Mentally disturbed people are individuals. As such, their career potentials depend on their particular talents, abilities and experience, and motivation, as well as their current state of physical and mental health. Many creative and successful people have suffered serious mental disorders. For example, John Forbes Nash Jr., a nobel prize winner has a lifetime history of schizophrenia (but he is doing well as has been documented in the book and movie—A Beautiful Mind • British PM, Winston Churchill, comedian Stephen Fry, poet Edgar Allen Poe, Pink Floyd band member Syd Barrett, painter Vincent Van Gogh, billionaire Howard Hughes, former PM’s wife Margaret Trudeau are all believed to have suffered from a serious mental disorder
Uppy-Downy Mood-Swing Kind of Guyhttp://bigthink.com/ideas/17869
Normal or Not? The difficulty with drawing the line… “A man living in the Ozark Mountains has a vision in which God speaks to him. He begins preaching to his relatives and neighbours, and soon he has the whole town in a state of religious fervor. People say he has a “calling.” His reputation as a prophet and healer spreads, and in time he is drawing large audiences everywhere he goes. However, when he ventures into St. Louis and attempts to hold a prayer meeting, blocking traffic on a main street at rush hour, and he is arrested. He tells the police officers about his conversations with God, and they hurry him off to the nearest mental hospital.” --from Understanding Psychology, Richard A. Kasschau, 1995 How can a person be viewed as normal in one community and abnormal in the next?
Studying Psychological Disorders • Like personality, consciousness, and intelligence, abnormal behaviour is difficult to define. • Rather than being fixed categories (i.e., normal/abnormal), both “abnormal” and “normal” behaviours exist along a continuum(i.e., from “rare” to “common” or “low” to “high”…) • Abnormality can be viewed as an inability to adjust to getting along in the world—physically, emotionally, and socially.
Studying Psychological Disorders Identifying Abnormal Behaviour: Four Basic Standards • Statistical Infrequency • Disability or Dysfunction • Personal Distress • Violation of Norms
Identifying Abnormal Behaviour: Standards • Statistical Infrequency (e.g., believing others are plotting against you) A behaviour may be judged abnormal if it occurs infrequently in a given population. Statistical infrequency alone does not determine what is normal. For example, no one would classify Albert Einstein’s great intelligence as abnormal Rare (Normal) (Abnormal) Common
Identifying Abnormal Behaviour: Standards 2. Disability or Dysfunction (e.g., being unable to go to work due to alcohol abuse) • People who suffer from psychological disorders may be unable to get along with others, hold a job, eat properly, or clean themselves. • Their ability to think clearly and make rational decisions also may be impaired Low (Normal) (Abnormal) High
Identifying Abnormal Behaviour: Standards 3. Personal Distress (e.g. having thoughts of suicide) The personal distress criterion focuses on the individual’s judgment of his or her level of functioning. Yet many people with psychological disorders (such as antisocial personality disorder) have little or no personal emotional discomfort. The personal distress criterion by itself is not sufficient for identifying all forms of abnormal behaviour Low (Normal) (Abnormal) High
Identifying Abnormal Behaviour: Standards 4. Violation of Norms (e.g. shouting at strangers) The fourth approach to identifying abnormal behaviour is violation of social norms, or cultural rules that guide behaviour in particular situations. A major problem with this criterion, however, is that cultural diversity can affect what people consider a violation of cultural norms Rare (Normal) (Abnormal) Common
Cultural Diversity • Culture has a strong effect on mental disorders—studyingthe similarities and differences can lead to better diagnosis and understanding • Even strongly biological mental disorders, like schizophrenia, can differ greatly between cultures—fortunately, cross-cultural researchers have devised ways to identify disorders across cultures (culture-general symptoms and culture bound symptoms). • Research shows that certain symptoms of depression seem to exist across all cultures: (1) frequent and intense sad affect (emotion), (2) decreased enjoyment, (3) anxiety, (4) difficulty in concentrating, and (5) lack of energy. • Culture-bound symptoms—symptomsthat only occur within a culture. For example—a headache: Chinese report a “fullness in my head,” Mexican respondents report a “problem with memory”
Cultural Diversity Culture Bound Symptoms Latin America: “attack of the nerves” Symptoms: trembling, palpitations, and seizure-like episodes Southeast Asia: “running amok” Symptoms: Wild, out-of-control, aggressive, attempting to kill others West Africa: “brain tiredness” Symptoms: ‘brain tiredness’ a mental and physical response to challenges of schooling Ethiopia: “possession by the zat” Symptoms: involuntary movements, an incomprehensible language South China: “koro” Symptoms: belief that the penis is retracting into the abdomen and that when it is fully retracted, death will result; attempts to prevent retraction may lead to severe physical damage Western Nations: “anorexia nervosa” Symptoms: severe loss of weight resulting from self-imposed starvation and obsessive fear of obesity
Gender & Cultural Diversity 12 Culture-General Symptoms of Mental Health Difficulties • Nervous (2) trouble sleeping (3) Low spirits (4) Weak, all over (5) Personal worries (6) Restlessness (7) feel apart, alone (8) can’t get along (9) Hot all over (10) worry all the time (11) can’t do anything worthwhile (12) nothing turns out right
Explaining Abnormality: Superstition to Science How do we explain it? Historically, evil spirits and witchcraft have been the primary suspects • Stone Age people, believed that abnormal behaviour stemmed from demonic possession—the therapy was to bore a hole in the skull so that evil spirits could escape. • Middle Ages: a troubled person was sometimes treated with exorcism; an effort to drive the Devil out through prayer, fasting, noise-making, beating, and drinking terrible-tasting brews. • 15th Century: many believed that some individuals chose to consort with the Devil—many of these supposed witches were tortured, imprisoned for life, or executed. • As the Middle Ages ended, special mental hospitals, called asylums, began to appear in Europe—they eventually became overcrowded and inhumane prisons.
An example of the “Historical Model” of Abnormal Behaviour --An early Catch 22: (Catch 22: is a paradoxical situation in which an individual is incapable of avoiding a problem because situations are such that solving one part of a problem only creates another problem) In the Middle Ages, “dunking tests” were used to determine whether people who behaved abnormally were possessed by demons. Individuals who did not drown while being dunked were believed to be guilty of possession and then punished (usually by hanging). Those who did drown were judged as innocent.---the ultimate no-win situation!
Classifying Abnormal Behaviour The Diagnostic and Statistical Manual IV-TR • This is a classification system developed by the American Psychological Association used to describe abnormal behaviours; the “IV-TR” indicates it is the text revision (TR) of the fourth major revision (IV) • Each revision of the DSM has expanded the list of disorders and changed the descriptions and categories to reflect both the latest advances in scientific research and changes in the way abnormal behaviours are viewed within our social context
Classifying Abnormal Behaviour For example, take the terms “neurosis” and “psychosis” • In previous editions, neurosis reflected Freud’s belief that all neurotic conditions arise from unconscious conflicts—now conditions that were previously grouped under the heading “neurosis” have been redistributed as anxiety disorders, somatoform disorders, and dissociative disorders • Unlike “neurosis” the term “psychosis” is still listed in the DSM because it helps distinguish the most severe mental disorders, such as schizophrenia and some mood disorders. • FYI: Psychosis is: serious mental disorder characterized by extreme mental disruption and defective or lost contact with reality • Somatoform disorder, is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained • Dissociative disorders are defined as conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception
What about the term “insanity” where does it fit in? • Insanity is a legal term indicating that a person cannot be held responsible for his/her actions, or is judged incompetent to manage his/her own affairs, because of a mental illness. • In law, the definition of mental illness rests primarily on a person’s inability to tell right from wrong. • For psychologists, insanity is not the same as abnormal behaviour---see the next example…
What about the term “insanity” where does it fit in? • The insanity plea—guilty of a crime or mentally ill? • On the morning of June 20, 2001, Texas mother Andrea Yates drowned her five children in the bathtub, then calmly called her husband to tell him he should come home. At Yates’s trail, both the defense and the prosecution agreed that Yates was mentally ill at the time of the murders, yet the jury still found her guilty and sentenced her to life in prison. • In 2006, this was overturned and was found not guilty by reason of insanity. How could two courts come to such opposite conclusions? • Insanity is a complicated legal term—despite cases like this one, it is important to keep in mind that the insanity plea is used in less than 1% of all cases that reach trial, and when used, it is rarely successful.
Understanding the DSM The DSM is organized into five major dimensions, called axes, which serve as guidelines for making decisions about symptoms. • Axis I describes clinical disorders that reflect a patient’s current condition. Depression and anxiety disorders are examples • Axis II describes trait disorders, which are long-running personality disturbances (like antisocial personality disorder) and mental retardation The other three axes are used to record important supplemental information. • Axis III lists general medical conditions that may be important to a person’s psychopathology (such as diabetes or hypothyroidism, which can affect mood) • Axis IV is reserved for psychosocial and environmental stressors that could be contributing to emotional problems (job or housing issues) • Axis V evaluates a person’s overall level of functioning, on a scale from 1 (serious attempt at suicide or complete inability to take care of oneself) to 100 (happy, productive, with many interests)
Understanding the DSM • The DSM offers a comprehensive, well-defined system intended for the diagnosis and classification of psychological disorders. It does not suggest therapies or treatment. • The current DSM-IV-TR contains more than 200 diagnostic categories grouped into 17 subcategories. • Also, note that the DSM classifies disorders, not people. Accordingly, we use the terms such as a persons with schizophrenia, rather than describing people as schizophrenic
Anxiety Disorders I was 9 years old and sitting alone in the back of a cab as it rumbled over New York City’s 59th St. Bridge. I noticed the driver was watching me curiously. My feet began tapping and then shaking, and slowly my chest grew tight and I couldn’t get enough air in my lungs. I tried to disguise the little screams I made as throat clearings, but the noises began to rattle the driver. I knew a panic attack was coming on, but I had to hold on, get to the studio, and get through the audition. Still, if I kept riding in that car I was certain I was going to die. The black water was just a few hundred feet below. “Stop!” I screamed at the driver. “Stop right here, please! I have to get out!” “Young miss, I can’t stop here.” “Stop!” I must have looked like I meant it because he squealed to a halt in the middle of traffic. I got out and began to run. I ran the entire length of the bridge and kept going. Death would never catch me as long as my small legs kept propelling me forward. • Adapted from Pearce & Scanlon, 2002, p. 69 (words of actress Patty Duke)
Anxiety Disorders These are the words of actress Patty Duke describing an episode around the time she was starring as Helen Keller, the deaf and blind child in “The Miracle Worker.” • Patty’s flight from the cab and other cases of ANXIETY DISORDER share one central defining characteristic—unreasonable, often paralyzing, anxiety or fear. • The person feels threatened, unable to cope, unhappy, insecure in a world that seems dangerous and hostile. • Anxiety Disorders (diagnosed twice as often in women as in men) are the most frequently occurring category of mental disorders in the general population. • They are also the easiest to treat and have one of the best chances of recovery.
Anxiety Disorders Anxiety disorders are marked by excessive fear, caution, and avoidance. 5 Major Types: • Generalized Anxiety Disorder • Panic Disorder • Phobias • Obsessive-Compulsive Disorder • PTSD
Five Major Anxiety Disorders Symptoms of anxiety such as rapid breathing and increased heart rate, plague most of us at different times in our lives (final exams, important job interviews, public speaking). But some people experience unreasonable anxiety that is do intense and chronic it seriously disrupts their lives.
5 Major Anxiety Disorders: Generalized Anxiety Disorder 1) Generalized Anxiety Disorder • This disorder affects twice as many women as it does men • It is characterized with chronic, uncontrollable, and excessive fear and worry that lasts at least six months and that is not focused on any particular object or situation. • As the name implies, the anxiety is generalized and nonspecific or free-floating. Victims feel afraid of something, but are unable to identify and articulate the specific fear. • Because of specific muscle tension and autonomic fear reactions, people with this disorder may develop headaches, heart palpitations, dizziness, and insomnia, making it ever harder to cope with daily activities
5 Major Anxiety Disorders: Panic 2) Panic Disorder is marked by sudden, but brief, attacks of intense apprehension that causes trembling, dizziness, and difficulty breathing. (Patty Duke suffered from this) • Panic attacks (in the DSM) are classified with or without agoraphobia • Agoraphobia is an anxiety disorder characterized by anxiety in situations where the sufferer perceives the environment as being difficult to escape or get help.
5 Major Anxiety Disorders: Phobias 3) Phobias involve a strong, irrational fear and avoidance of objects or situations that are usually considered harmless (fear of elevators, fear of going to the dentist, for example). • Although the person recognizes that the fear is irrational, the experience is still one of overwhelming anxiety, and a full-blown panic attack may follow. • The DSM divides phobic disorders into three broad categories: agoraphobia, specific phobias, and social problems
5 Major Anxiety Disorders: Phobias A) Agoraphobia: • People with agoraphobia restrict their normal activities because they fear having panic attacks in crowded, enclosed, or wide-open places where they would be unable to receive help in an emergency. • In severe cases, people with agoraphobia may refuse to leave the safety of their homes.
5 Major Anxiety Disorders: Phobias B) Specific Phobias: • A specific phobia is a fear of a specific object or situation, such as needles, heights, rats, spiders… • Claustrophobia (fear of closed spaces) and acrophobia (fear of heights) are the specific phobias most often treated by therapists. • People with specific phobias generally recognize that their fears are excessive and unreasonable, but they are unable to control their anxiety and will go to great lengths to avoid the feared stimulus.
5 Major Anxiety Disorders: Phobias C) Social Phobias: • People with social phobias are irrationally fearful of embarrassing themselves in social situations. • Fear of public speaking and of eating in public are the most common social phobias. • The fear of public scrutiny and potential humiliation may become so pervasive that normal life is severely restricted.
5 Major Anxiety Disorders: 4) Obsessive-Compulsive Disorder Do you remember the movie The Aviator? The main character, Howard Hughes, was endlessly counting, checking, and repeatedly washing his hands in a seemingly senseless, ritualistic pattern. What drives this behaviour? The answer is Obsessive-Compulsive Disorder (OCD) • This disorder involves persistent, unwanted fearful thoughts (obsessions) or irresistible urges to perform an act or repeated ritual (compulsion), which help relieve the anxiety created by the obsession. • Common examples of obsessions are fear of germs, of being hurt or of hurting others, and troubling religious or sexual thoughts.
OCD • Examples of compulsions are repeatedly checking, counting, cleaning, washing the body or parts of it, or putting things in certain order. • While everyone worries, and sometimes double-checks, people with OCD have these thoughts and do these rituals for at least an hour or more each day, often longer • Most suffers of OCD realize that their actions are senseless, but when they try to stop the behaviour, they experience mounting anxiety, which is relieved only by giving in to the urges.
5 Major Anxiety Disorders: PTSD 5) PTSD: anxiety disorder following exposure to a life-threatening or other extreme event that evoked great horror or helplessness; characterized by flashbacks, nightmares, and impaired functioning • Children as well as adults may suffer
Explaining Anxiety Disorders Psychological: Faulty cognition and maladaptive learning • Faulty Cognition: People with certain thinking, or cognitive habits that make them vulnerable or prone to fear. They tend to be hyper vigilant. • They constantly scan their environment for danger and seem to ignore signs of safety. • They also tend to magnify ordinary threats and failures.
Explaining Anxiety Disorders Maladaptive Learning: • They may have learned these behaviours. Through classical conditioning, for example: a stimulus that is originally neutral (e.g. harmless spider) becomes paired with a frightening event (a sudden panic attack)so that it becomes a conditions stimulus and brings about anxiety. The person then begins to avoid spiders in order to reduce anxiety. • Social learning theorists propose that some phobias are the result of modeling and imitation, or learned indirectly. • Example of vicarious (indirect learning): Monkeys who watch artificially created videos of other monkeys being afraid of a toy snake, toy crocodile toy rabbit, or toy flower, will develop their own set of phobias. The fact that the “viewing” monkeys only develop fears of snakes and crocodiles, but not flowers or rabbits, demonstrates that phobias are both learned and biological