3 Classification and diagnosis 2

Question 1

According to Freud, when does the Id (Das Es) develop?

Answer 1

You’re born with it.

Question 2

According to Freud, when does the Ego (Das Ich) develop and why?

Answer 2

At age 2, to negotiate drives of the Id.

Question 3

According to Freud, when does the Superego develop and what does it mark?

Answer 3

Around age 6. Marks internalisation of society’s values and resolution of oedipal conflict.

Question 4

What are defence mechanisms for?

Answer 4

To prevent anxiety that would arise from realising drives of the Id (e.g. want to kill father).

Question 5

What is the defence mechanism of displacement?

Answer 5

Shifting emotion from one person to another. E.g. hate father, shift this onto all authority figures.

Question 6

What is the defence mechanism of projection?

Answer 6

Attributing to others what you feel towards them.

Question 7

What is the defence mechanism of sublimation?

Answer 7

Energy of the id is channeled into other outlet. e.g. art.

Question 8

What is the defence mechanism of reaction formation?

Answer 8

Form opposite behaviour to what is happening in subconscious. E.g. homophobic army dad in American Beauty

Question 9

How does the ego protect you from anxiety?

Answer 9

It stops you from knowing what’s going on in the unconscious.

Question 10

What defence is the cause of depression, according to psychoanalysis?

Answer 10

Displacing hatred onto self. e.g. hate father, displace onto self.

Question 11

What defence is the cause of paranoia, according to psychoanalysis?

Answer 11

Projection

Question 12

What defence is the cause of overprotection/dependence, according to psychoanalysis?

Answer 12

Reaction formation. I actually hate my child so I’m going to look after him really, really well.

Question 13

What defence is the cause of obsessiveness, according to psychoanalysis?

Answer 13

Repression.

Repressing everything is a lot of work –must control everything, become OCD.

Question 14

How do the psychoanalytical and medical models conceptualise mental illness differently?

Answer 14

In psychoanalysis, mental illness is on a continuum, rather than a distinct entity. Pathological is severe end of normal. Everyone has unconscious conflict.

No distinction between sick/not sick.

Question 15

How does psychoanalysis distinguish between psychosis and neurosis?

Answer 15

It doesn’t. Psychosis is just when you get so neurotic you lose touch with reality.

Question 16

How did the rise of psychoanalysis lead to a proliferation of mental health professions?

Answer 16

Because illness (neurosis) was seen as ubiquitous, everyone can be treated.

Question 17

What is the mechanism of paranoid SZ, according to psychoanalysis?

Answer 17

Extreme form of defence mechanism of projection – ascribing to others characteristics you can’t accept in yourself. Paranoid SZ is just mega-projection.

Question 18

What was the distinction between organic and reactive conditions in DSM-I (1952) and II (1968)?

Answer 18

Organic conditions - known to be caused by biological factors (brain damage, poisoning).

Reactive –caused by psychological factors.

Question 19

What is the proposed cause of depression in DSM-I & II?

Answer 19

“Anxiety… allayed and partially relieved by depression and self-deprecation”

Question 20

What caused psychoanalysis to be scrapped as model for DSM?

Answer 20

No clear-cut lines between health and illness. So third-party payers dissatisfied.

Question 21

What is the problem with the 1) reliability and 2) validity of DSM-I & II?

Answer 21

1) Low inter-rater reliability.

Different health-care professionals gave different diagnoses based on DSM criteria.

2) Low validity based on unproven theories of aetiology.
e. g. Is depression really reaction formation to loss of someone you feel ambivalent about? May not be valid theory.

Question 22

What approach was taken in DSM-III (1980)?

Answer 22

A Neo-Kraepelian approach.

No assumptions about aetiology.

Clear description of symptoms, and identification of syndromes.

Question 23

How are symptoms measured according to DSM-III?

Answer 23

From patient’s report or from direct observation/measurement –not from speculations about the unconscious.

Question 24

Why were psychoanalytic categories of mental illness not changed in DSM-III?

Answer 24

Because can of worms. If the clients already exist with these disorders, they might suddenly all be cured!

Question 25

DSM-III was much more reliable, but what are 4 problems with its validity?

Answer 25

1) Comorbidity is very high. Having more than one mental disorder is the norm.
2) Diagnostic instability is high –patients move from one disorder to another
3) Lack of treatment specificity. E.g. SSRIs work across

Question 26

What is suggested by the high comorbidity, diagnostic instability and lack of treatment specificity of DSM categories?

Answer 26

Non-independence of disorders. They have common causes/shared aetiology.

Question 27

What was supposed to be the great advance of DSM-V?

Answer 27

A dimensional system, rather than a symptomatic one.

But nothing much changed. Dimensional system is in the appendix. Categories rearranged to SUGGEST dimensionality.