1. Defining Abnormality Medical approach Statistical approach
Functional approach
These reflect two basic views of disorders
--brain based
--behavior/experience/situation based
The “two worlds” of psychiatry

8. Some Interim Conclusions
Psychoses (focus on SCZ) is a disorder of heredity
But it’s also a disorder of poverty!
Another view of prevalence and recent dramatic changes in prevalence

10. Different Therapies for Different Conditions
Medical: Brain targeted drug interventions examples:
--SCZ: dopamine receptor blockers
--Depression: ex. Norepinephrine uptake or release, + electro-convulsive shock

14. Psychological Therapies
Psychoanalytic
Behavioral
Client-centered
Cognitive-behavioral
Existential
Eclectic
Situational

18. Commonalities
Just as there are some common underlying aspects of disorders (chemical imbalance, brain disease, stress, social disconnection) there are commonalities of psychotherapy.
Correcting the neurological imbalance can correct our thinking and so can working directly on our thinking and behavior.
A two-pronged approach may be best.

19. One More Outcome Study
In a recent meta-analysis comparing drug with psychotherapy approaches to treating depression, drugs resulted in a 55% improvement, psychotherapy 52% and a combination of the two 85%!! (New England J. of Medicine, 5-18-’00.)
Mind and body interact, we shouldn’t be surprised!

20. Some Over-arching Issues
Therapy works!
Comparative studies
It’s the therapist as much as the theory
Meta analyses
Cost is driving the system now!

21. What to do?
Keep wits about you & get recommendations from knowledgeable people
Don’t try to tough it out--it’s not weakness!
Make sure therapist listens and understands
Realize that there are setbacks along the way and that it takes time
Remember that heredity vs. environment isn’t “either-or” but a set of interactions--so changing situations is important in any case
Finally, remember that most people get better!