PSY240 1. Intro Flashcards
1
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Definitions of “Abnormal”
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- Statistical Definition 2. Personal Distress
3. Personal Dysfunction 4. Violation of Norms
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Definitions of “Abnormal”
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- Comparing to avg
- Is it causing someone to be upset? Is it causing other people distress?
- Does it get in the way of functioning as a productive member of society?
- Taking context into consideration. Depending on culture, some acts are acceptable, others are not
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Definitions of “Abnormal”
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Definitions of “Abnormal”
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- Statistical Definition
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Deviation from average – Is the behaviour rare?
• Problems:
– Not all deviations are abnormal – Where is the cut-off
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- Statistical Definition
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Is the response rare?
But not everything rare is not pathological or abnormal
e.g. High IQ, not problematic
at the low end, it becomes problematic
e.g. athleticism
Where is the cutoff between normal and abnormal?
Doesn’t capture every factor of describing abnormality
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- Statistical Definition
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- Statistical Definition
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- Personal Distress
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• Behaviour is only abnormal if:
– The individual suffers as a result, and
– The individual wishes to be rid of the behavior
• Advantage: many disorders are distressing!
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- Personal Distress
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- Personal Distress
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Problems
• “Normal”distress
• Some disorders don’t involve suffering
• Maynotcareaboutdiscomfortofothers • Poor insight
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- Personal Distress
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e.g. Manic Episode
Might have lots of energy and inflated sense of self-esteem so they may not feel like it’s an impairment, but the succeeding depressive episode might
e.g. Schizophrenia - Poor Insight
Idea of reality testing - when intact, you can challenge their hallucinations
Psychosis: cannot argue with them about hallucinations
Forms of Distress completely normal
e.g. bereavement - culturally sanctioned form of distress, thus not considered pathological
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- Personal Distress
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- Personal Distress
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- Personal Distress
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16
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- Personal Dysfunction
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• AKA: Harmful dysfunction
• Disorder causes “functional” impairment – Occupational
– Academic – Social
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- Personal Dysfunction
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Occupational: e.g. depressed - can’t get out of bed
Academic: anxiety - can’t write tests
Social: anti-social personality - can’t make friends
Typically judged by others and professionals, they may not see it as an impairment
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- Personal Dysfunction
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- Personal Dysfunction
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- Personal Dysfunction
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21
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- Violation of Norms
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- AKA Societal / Cultural Relativism
- Norm violation
- No universal standards or rules
- Ab/normality is relative to cultural norms
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- Violation of Norms
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Relative to culture
What might hold in 1 society, doesn’t hold in another
Problematic in pinning down definition when it culturally varies
e.g. Gender Roles: Masculine + Feminine Expectations
These are culturally sanctioned
e.g. Nudity - frowned upon in North America
In some African Tribes - normal to wear less clothing
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- Violation of Norms
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- Violation of Norms
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Problems with Societal Definition
* Emphasizes conformity • Cultural specificity
* Temporal specificity
* Potential for abuse
* Some societies endorse bad things
* Society’s implicit rules are hard to break
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Problems with Societal Definition
Everyone should be the same
Specific to a culture
How come abnormality changes across the world and time
Potential for powerful people to abuse these definitions
Hard to defy social norms once in place
Risk being alienated or worse - consequences for deviating
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Problems with Societal Definition
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Problems with Societal Definition
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DSM-5
• Section I: Basics
• Section II: Diagnostic
Criteria & Codes
• Section III: Emerging Measures & Models
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DSM-5
3 Sections
Basic: caution, purpose
Diagnostic:
Chapters divided into the different types of disorders
Broken down into the specific listing of symptoms needed in order to qualify for a diagnosis
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DSM-5
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DSM Basics
* A mental disorder is a behavioral or psychological dysfunction associated with...Personal distress
* Impairment in work, home, school, or social activities
* “Significantly increased risk of suffering death, pain, disability, or an important loss of freedom”
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DSM Basics
Death - Increased risk for suicide
| Loss of Freedom - going to jail
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DSM Basics
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DSM Definition
• Mental disorders are not:
– An expected or appropriate response to an event – Statistically deviant behavior of minority groups – A conflict between one individual and society
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DSM Definition
e.g. bereavement: expected to be sad
causing severe impairment or lasting a long time not normal in bereavement - considered for clinical attention
Required to be culturally sensitive
Keep in mind the patients context of what’s normal and abnormal
e.g. Ghandi - not pathological
Clinicians are ethically trained and specialize in diagnosis
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DSM Definition
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DSM Definition
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DSM Example: Major Depressive Episode (MDE)
5+ of the following symptoms nearly every day (2+ weeks):
1. Depressed Mood
2. Anhedonia
3. Weight/Appetite Change
4. Sleep Change
5. Change in Psychomotor Activity
6. Loss of Energy
7. Guilt/Worthlessness
8. Impaired Concentration
9. Suicidality
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DSM Example: Major Depressive Episode (MDE)
Symptom criteria where is a threshold for amount needed to diagnosis
Need either Depressed Mood or Anhedonia (inability to take pleasure in anything)
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DSM Example: Major Depressive Episode (MDE)
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DSM Example: Major Depressive Episode (MDE)
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DSM Example: Major Depressive Episode (MDE)
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Differing Opinions
•“As long as the research community takes the DSM to be a bible, we’ll never make progress. People think that everything has to match DSM criteria, but you know what? Biology never read that book.” – Dr. Thomas Insel
“A classification system is like a map. And just as any map is only provisional, ready to be changed as the landscape changes, so does classification.” – Dr. Sir Simon Wessely
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Differing Opinions
Some people are not fond of DSM-V
It is not the bible - it changes constantly
It is not the absolute truth
To think otherwise impairs the ability to see the truth
Wessely: Take it with a grain of salt
It’s a work in progress, but it’s all we got
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Differing Opinions
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Differing Opinions
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Differing Opinions
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DSM Classification
Advantages
• Increasesscientificcommunication
• Used in forensic situations
• Necessitated by 3rd party payers Disadvantages
• Loseindividualinformation
• Stigma and stereotyping
• Subject to political and social influences
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DSM Classification
Advantages:
Better communication between professionals
e.g. communicating symptoms and treatment when switching clinicians
often
Used in criminal court
e.g. Diagnostic label - qualified for insurance claims
Psychotherapy not covered by OHIP
Disadvantages:
Once labeled, they assume things about them that might not be true
They may live up to the label
Reasons for including homosexuality in early versions of DSM
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DSM Classification
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DSM Classification
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DSM Classification
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DSM Classification
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Historical Perspectives
1. Supernaturaltradition
2. Biologicaltradition
3. Psychologicaltradition
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Historical Perspectives
1. It’s ghosts, curses, demonic possession, witches
2. breakdown of a system in the body
3. result of some trauma
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Historical Perspectives
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Historical Perspectives
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Ancient Stone Age Theories
Demonological or supernatural model – Spirit possession
Potential Treatments – Exorcism
– Trephination
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Ancient Stone Age Theories
comes from archaeological findings - e.g. skulls, inscriptions
Trephination: releasing demons by drilling hole in skull
Other treatments: magic or prayer
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Ancient Stone Age Theories
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Ancient Stone Age Theories
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Ancient Egypt, Greece and Rome
* Origins of the medical model • Primarily “natural” theories
* Still included supernatural/religious views –e.g., wandering uterus (hysteria)
* Treatment: Marriage
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Ancient Egypt, Greece and Rome
more scientific views
e.g hysteria: understood as a wandering uterus
Hippocrates: various humours across the bodies
Treatment: marriage or sweet smelling flowers
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Ancient Egypt, Greece and Rome
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Ancient Egypt, Greece and Rome
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Hippocrates
• Father of modern medicine
• Biological view of psychopathology
• Four basic humours (~400 BC)
1. Choleric: easily angered, bad tempered
2. Phlegmatic:calm,unemotional
3. Sanguine:courageous,hopeful,amorous
4. Melancholic:despondent,sleepless,irritable
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Hippocrates
imbalance of humours: bodily fluids
temperments and behaviour decided by levels of humours
emphasis on natural causes for mental illness
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Hippocrates
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Hippocrates
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Middle Ages / Medieval theories
Late 400s ‐1800s
• Rise of Christianity
• Return to supernatural model – Demonology/Witchcraft
– Psychic epidemics – Animalism
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Middle Ages / Medieval theories
rejection of scientific ways of thinking - great influence of religion
clergy responsible for dealing with mentally ill
people identified as witches - tortured and killed
Mentally ill were treated like animals - abnormal, lived terrible conditions
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Middle Ages / Medieval theories
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Middle Ages / Medieval theories
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Middle Ages / Medieval theories
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Renaissance Era
• The growth of asylums (“storage”) • Treatment often inhumane
to keep them away from everyone else
inhumane treatment
Bedlam: first institution dedicated to mental illness
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Renaissance Era
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Renaissance Era
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Renaissance Era
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Age of Reason and Enlightenment
1700s to 1800s
• Greisinger (1817‐1868): abnormality rooted in brain
• Kraepelin(1856–1926): – Medical model
– Classification of disorders – Discovered cause of syphilis
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Age of Reason and Enlightenment
Kraepelin:
medical model: biologically based
classification: at the time he only had schizophrenia and bipolar disorder
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Age of Reason and Enlightenment
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Age of Reason and Enlightenment
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Moral Treatment of the 18th Century
• Movement toward a more humane treatment
• Incorporated a psychological view:
– People become mad when separated from nature
– Succumb to stresses imposed by rapid social changes
Treatment focus on rest and relaxation (Pinel, Dix)
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Moral Treatment of the 18th Century
Rise of moral therapy
humane treatment
removal of chains, exercise, sunny rooms instead of darkness
Penel and Dix
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Moral Treatment of the 18th Century
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Moral Treatment of the 18th Century
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Moral Treatment of the 18th Century
• First Canadian asylum in Beauport, QC (1845) • By 1914, all Canadian provinces had an asylum • Conditions deteriorated with overcrowding
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Moral Treatment of the 18th Century
Gains achieved by moral treatment lost when there was overcrowding
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Moral Treatment of the 18th Century
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Moral Treatment of the 18th Century
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Modern Health Care
• Discoveryofantipsychoticmedications(HeinzLehman)
• Transformedpsychiatriccare:
1. Patients could be treated in the community
2. Recognition of psychobiological factors
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Modern Health Care
1. they can return to live in the community
| not isolated
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Modern Health Care
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Deinstitutionalization
Patients’ Rights Movement
• Re-integration into the community
• Community-basedtreatmentfacilities
• Promote autonomy and enhance quality of life
• Problems: Homelessness and incarceration
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Deinstitutionalization
advocate for better recovery
| discharged into community
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Deinstitutionalization
Biological Approach
• Psychological Approach
• Social Approach
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Contemporary Approaches
Genetic vulnerability, injury
way we think affects how we feel
childhood trauma
relationships with people
social influences such as poverty
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Contemporary Approaches
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Biological Approaches
* StructuralTheories
* BiochemicalTheories
* GeneticTheories
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Biological Approaches
1. abnormality arises from brain damages
2. imbalance in neurotransmitters or hormones
3. disorders run in families
genes that might influence transmission of disorders
they all influence one another
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Biological Approaches
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Biological Approaches
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Structural Abnormalities
Caused damage to frontal cortex - ability to plan and reason, the site of personality
Drastic change to personality
Could not modulate social behaviour, inhibit
Gage was no longer Gage
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Structural Abnormalities
Phineas Gage
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Structural Abnormalities
Key Structures – Hypothalamus – Limbic system
• Structural abnormalities may result from – Brain trauma
– Deterioration or atrophy
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Structural Abnormalities
Lesions to
Hypothalamus: the four Fs and certain aspects of emotion
Limbic system: emotion
trauma: e.g. car accident
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Structural Abnormalities
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Biochemical Theories
• Neurotransmitter (NT) function & imbalances • Hormones & neuroendocrine function
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Biochemical Theories
excess or deficiency in neurotransmitter can affect emotion
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Biochemical Theories
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Basics of Neurotransmission
chemical and electrical in nature
communication between cells
released into the synapse
receptors receive incoming neurotransmitters
transmission affected by type of neurotransmitter, amount of neurotransmitter, duration in synapse affected by reuptake or speed of degradation (speed broken down)
neurotransmitters and amount can affect emotion
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Basics of Neurotransmission
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Biochemical Bases of Abnormality: NT Theories of Disorders
• Too little or too much NT
• Drug therapies designed to affect neurotransmission
– e.g., Selective Serotonin Reuptake Inhibitors
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Biochemical Bases of Abnormality: NT Theories of Disorders
developing treatments of different disorders
SSRIS - low levels of serotonin in depressed people
increase serotonin by blocking reuptake - more time for receiving neuron to get them
designed to affect amount available by influencing reuptake or degradation
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Biochemical Bases of Abnormality: NT Theories of Disorders
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Serotonin (5-HT)
Norepinephrine (NE)
Dopamine (DA)
Gamma-aminobutyric acid (GABA)
• Emotion regulation
• Depression, Anxiety, Sleep, and Eating
stress related disorders
• Too much over-stimulation • Too little depression
• Eating Disorders
implicated in Mood disorders
• Reward systems
• Muscle symptoms
• Psychosis & Parkinson’s Disease
Parkinsons: affect on motion
Inability to inhibit drive toward reward - e.g. substance abuse
• Inhibitory effect
• Tranquilizing effect • Anxiety
reduces symptoms of anxiety
tranquilizers
deficiency causes anxiety
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Biochemical Bases of Abnormality: Four Common NTs
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Biochemical Bases of Abnormality: Four Common NTs
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Biochemical Bases of Abnormality: Four Common NTs
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Biochemical Bases of Abnormality: Four Common NTs
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Biochemical Bases of Abnormality: Four Common NTs
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Biochemical Bases of Abnormality: Four Common NTs
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Biochemical Bases of Abnormality: Four Common NTs
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