1. "Everybody Hurts" by REM We all have bad days – so what is the difference between feeling depressed and being diagnosed as clinically depressed?

2. History of Understanding Psychological Disorders In Ancient times, disorders were thought to have been caused by movements of the sun and moon (lunacy is full moon) or by evil spirits. Treatments for people with mental illness were very inhumane even up until the mid-1900’s. Patients were often chained like animals, beaten, burned, castrated, etc.

3. Conditions for Psychologically Disabled European Trephines “released evil spirits.” Ancient Greek Trephines

4. Conditions for Psychologically Disabled

5. Medical Model Improves Conditions Eventually the medical model came to dominate understandings of mental illness. The medical model assumes that diseases have physical causes that can be diagnosed based on their symptoms and be treated and in most cases cured. Assumption of the medical model drastically improves conditions in mental hospitals. BUT, the medical model often times promotes the myth that disorders are brought on by single causes.

6. Historical Trend of Deinstitutionalization Starting in the 1950s and 1960s more and more drugs began being used to “cure” psychological disorders. Because of this there was a policy of deinstitutionalization instituted where patients were removed from mental institutions to live in family-based or community-based environments.

8. Psychological Disorders Psychological behaviors run a continuum from very mild to extreme. Everyone has these behaviors to one degree or another. It is not until a behavior or feeling interferes with your quality of life that they become a disorder. Psychological Disorders are: Atypical (deviant) Disturbing (distressing) Maladaptive (dysfunctional) Unjustifiable

9. “You Become Psychotic” Activity - Handout

10. What is “insane”? Insanity is a legal definition, not a psychological one. The term of insanity is applied to someone who is incapable of determining if an act is wrong and cannot control their behavior. The insanity defense is rarely used – just 0.9% of the time (9 times in 1000). The success rate is less than 20% of the time it is used. People who are declared not guilty by reason of insanity generally spend more time institutionalized than they would have been imprisoned. Being declared insane is not the same as being declared not competent to stand trial – this simply means you are unable to understand the charges against you and the proceedings of the court (could apply to very young children, for example).

11. What percentage of mental health patients are violent? “Here’s Johnny!” While some people with symptoms are violent, fewer that 10% are dangerous. Nearly all people who suffer from mental illness are withdrawn, timid and are non-violent.

12. Defining Disorders DSM IV-Diagnostic and statistical manual vol. 4.: attempts to describe psychological disorders, without explaining the causes, predicts the future course, and suggests treatments. It focuses on observable behaviors to make diagnoses. Categorizes 400+ disorders, in 17 categories. Axis I: refers to clinical disorders which need clinical attention. Includes most mental disorders Ex: Depression, Schizophrenia, Phobia, etc. Axis II: Includes personality disorders and mental retardation. Ex: Antisocial, Narcissistic, Avoidant, etc. Axis III: relates to physical conditions which may contribute to mental illness. Ex: brain injury, cancer, HIV, etc. Axis IV: relates to psycho-social events in a persons life which may contribute to mental illness. Ex: death of a loved one, divorce, new job, etc. Axis V: relates to a rating clinician gives patient on how well they are functioning in life presently and within the last year.

13. Handout 16-5 Group Activity

14. Advantages of Diagnosis and the DSM-IV Diagnosis can facilitate communication Diagnosis can provide etiology (study of causation) clues Diagnosis provides prognosis (likely outcome) Diagnosis can give direction for treatment plans Disadvantages of Diagnosis and the DSM-IV Diagnosis is not theoretically neutral No clear line between normal and abnormal in many cases Reliability is still a problem (if 5 psychologists examine a patient will they all come up with the same diagnosis?) Diagnostic labels may take on a life of their own and are hard to remove – LABELING THEORY – Rosenhan – this can lead to self-fulfilling prophecy.

15. David Rosenhan Tests Power of Labeling and Its Reliability Describe Rosenhan’s study: He had colleagues attempt to fake symptoms to get into mental hospitals. Each pseudopatient told the hospitals they had been hearing voices. Apart from that they told no lies other than fake names, addresses, etc. After being admitted, the fake patients acted completely normal. Hospital staff failed to identify the fakers and interpreted all of their normal behavior in terms of mental illness. Ex: guy taking notes was said to have “writing behavior” which seemed pathological. What does this say about the impact of labeling?

16. “You Become Psychotic” Activity - Discussion (labeling acttivity)

17. Psychological Disorders: Causes Are not usually caused by a single factor. The bio-psycho-social school argues that most disorders are caused by a biological predisposition, physiological state, psychological dynamics, and social circumstances.

18. + = DISORDER The diathesis-stress model The model looks at the diathesis or genetic/biologic vulnerability to a disorder/disease and the stress(or)s that may trigger it. The diathesis-stress model uses the analogy of a "walking time bomb" to help explain why, for example, not 100% of identical twins both get schizophrenia. It also helps to explain why a large percent of people in traumatic situations (post 911, rape, etc.) never develop PTSD. The model further talks about a balance -- the greater the diathesis or predisposition, the less the stress required for the disorder to "appear" and visa versa. Biological / genetic predisposition Stress (environment)

19. Most Mental Health Professionals Assume Disorders Have Interlocking Causes Bio-Psycho-Social Perspective: assume biological, psychological, and socio-cultural factors interact to produce disorders. Biological (Evolution, individual genes, brain structures and chemistry) Psychological (Stress, trauma, learned helplessness, mood-related perceptions and memories) Sociocultural (Roles, expectations, definition of normality and disorder)

20. KNOW WHAT CATEGORY ANY DISORDER FITS INTO Categories of Disorder: 1. Anxiety 2. Mood 3. Dissociative 4. Schizophrenia 5. Personality 6. Somatoform (Not in Book) 7. Facticious (Not in Book)

21. Somatoform: a mental disorder, where physicals symptoms suggest physical injury. Facticious: deliberately producing or exaggerating symptoms, usually to gain sympathy.