[15.1] Defining and Classifying Psychological Disorders

Question 1

A History of Mental Illness

Answer 1

• as the ascension of scientific thought began to displace the religious domination of the Middle Ages, explanations for mental illness shifted from demon possession to physical illnesses
• asylums: residential facilities for the mentally ill
• across Europe, medical treatments ranged from draining up to 40% of a person’s blood volume to throwing them in a pit of snakes; the hope was to shock the person out of the diseased state
• 1955: Chlorpromazine (or Thorazine in the US) was introduced; the success of medications led to widespread deinstitutionalization
• however, this greatly increased the number of homeless people as a result of former in-patients quitting their medications and slipping back into their disorders
• as well, medications are not cures
• medical model: sees psychological conditions through the same lens as Western medicine tends to see physical conditions—as sets of symptoms, causes, and outcomes, with treatments aimed at changing physiological processes in order to alleviate symptoms
• could be critiqued as being overly narrow, more focused on “cure” than on promoting wellness and helping the person become stronger more generally
• the biopsychosocial model includes physiological processes within a more holistic view of the person as a set of multiple interacting systems
• the biggest challenge is reliably identifying who has a mental disorder in the first place; given the immense range of “normal” human behaviour and experience, how can we determine what is “abnormal?”

Question 2

Defining Abnormal Behaviour

Answer 2

• your own beliefs and values and lifestyle are also culturally bound, and would look very different from other perspectives
• the way we see things seems to make so much sense that we often become trapped in a particular perspective
• one way to overcome this is to understand the appropriate cultural framework and then find out whether most people in that culture would have similar experiences
• problem: the way that “most people” experience things may itself not be very healthy or desirable, or the way that a small subgroup experiences things may be quite healthy or desirable
• the key criterion used is whether or not feelings, thoughts, or behaviours are maladaptive: whether it causes distress to oneself or others, impairs day-to-day functioning, or increases the risk of injury or harm to oneself or others

Question 3

Psychology’s Puzzle: How to Diagnose Psychological Disorders

Answer 3

• Diagnostic and Statistical Manual of Mental Disorders (DSM): a standardized manual to aid in the diagnosis of disorders
• the original DSM was rooted in a psychobiological view, which argued that mental disorders represented specific reactions that an individual’s personality had to psychological, social, and biological processes
• the DSM-5 (May 2013) describes three important pieces of information for each disorder:
• a set of symptoms and the number of symptoms that must be met in order to have the disorder;
• the etiology (origins or causes) of symptoms;
• and a prognosis or prediction of how these symptoms will persist or change over time
• the DSM-5 does not resolve the critiques of past versions; the diagnosis of specific disorders is often not highly reliable, definitions are not always based on empirical evidence, and different disorders often share many common symptoms
• one solution for improving the diagnostic accuracy of the DSM is to develop more objective, biological indicators such as genetic markers, indicators of neurotransmitter dysfunction, or brain abnormalities, that are involved in the symptoms and functional deficits experienced by the individual
• the diagnosing of mental disorders can be a highly subjective process
• the DSM can often lead to overdiagnoses because it provides labels that apply to people for a variety of reasons

Question 4

Labelling and Mental Disorders

Answer 4

• diagnostic labels can be very helpful; they can help people understand their experiences and communicate in a standardized way with whoever they may need to as they manage their symptoms and navigate the mental health-care system
• being labelled with a mental illness can also potentially damage a person’s material, social, and psychological well-being

Rosehan (1973): a group of eight people volunteering with David Rosehan pretended to be hearing voices and were admitted into a hospital for observation and treatment

• once in, the challenge was to behave “normally” and convinve the doctors they were fine; regular behaviours were interpreted by doctors as being abnormal
• none of the volunteers had any symptoms of schizophrenia or bipolar disorder, but it took them from 7 to 59 days to be released
• during that time period, they were given a total of 2100 pills to take

Question 5

Applications of Psychological Diagnoses

Answer 5

• being able to reliably diagnose particular disorders is a central and ongoing challenge to the mental health fields, having an impact on problems that range from:
• individuals knowing how to effectively navigate the mental health system (i.e. getting the appropriate treatment they need)
• to the stigmatization of the mentally ill (i.e. the problem of being misdiagnosed or having labels misapplied)
• to the use of the insanity defence in criminal trials (i.e.å being able to accurately determine whether or not a person is criminally responsible for a crime they committed)

Question 6

The Mental Disorder Defense (“Insanity Plea”)

Answer 6

• mental disorder defense: claims that the defendant was in such an extreme, abnormal state of mind when committing the crime that he or she could not discern that the actions were legally or morally wrong
• however, determining someone’s level of “sanity” is difficult and may go against intuition
• in the legal sense, “insanity” most generally accepted as the inability to differentiate between right and wrong during the time the crime was committed