[L6] - Mental Disorders Flashcards
The ICD vs. the DSM
American Psychiatric Association = publishers of the DSM-V.
The ICD (International Classification of Diseases) is another such manual – on its 11th edition – It is broader than the DSM; has a chapter on mental disorders but relates to other aspects of medicine, and statistics.
The ICD existed before WWII, and after the war the Americans decided they wanted their own manual. The two are getting more and more similar over time.
The DSM-V criteria are not a clinical diagnosis in and of themselves – clinicians need other supporting data to diagnose: like interviews.
The topic of diagnostic criteria is often in the news - as well as the efficacy of how such disorders are treated
The Constructive Proposal on Free Will
Our decisions are subject to different environmental features (e.g., constraints & stimuli) and psychological processes (e.g., memory, preferences, consciousness).
Freedom is a spectrum, “will” a conundrum: Our degrees of freedom are the higher, the better we understand the internal and external influences on our decisions!
A spectrum perspective allows us to investigate free will under differing circumstances. For example, free will can be constrained by marketing tactics, but understanding them can increase free will (e.g., moving things around to encourage you to look for products and hence spend more time in the shop)
If consciousness doesn’t exist, then there is no free will - but consciousness processing does appear to have an influence on our behaviour: even from an evolutionary perspective, why would we allocate so many resources to this processing if it had no effect?
Freedom can be increased by increasing conscious awareness & reflection (e.g., psychotherapy, meditation)
What does a systems view mean?
To understand behavior, you have to understand the organism’s environment.
Perspectives on the philosophy of mental disorders/classification
Essentialism - a form of philosophical realism (reality exists as is - independent of the observer)
Pragmatism - Similar to instrumentalism, view categories as scientific tools - don’t worry too much about the philosophical elements, just do what works.
Social Constructionism - Our thought shapes our world - interacting with objects serves somewhat to create them with our thought.
Classification in the Natural Sciences
Classification was always an important topic there. Naming has commonly been considered to convey meaning/understanding, even though that is not always the case.
The early attempts at classification may seem mundane to us now - genetics and DNA identification play a greater role in the modern day.
Stier and the Normativity Problem in Psychiatric Classifications
[Classification relies on social norms]
Can natural sciences/biology distinguish normal from abnormal behavior/experiences?
We call behavior/experiences deviant by comparing it to non-deviant behavior/experiences, i.e. by using norms.
Therefore, psychiatric disorders cannot completely be reduced to the natural/biological level! We need social norms.
However, biological psychiatry is still the most dominant view! Even though what we deem to be normal or abnormal is grounded in societal/cultural norms. So is it not wrong to complete reduce psychiatric disorders to a biological level? These norms are central.
Essentialist view on psychiatric classification
Essentialist:
o Mental disorders are just like the periodic table – something is gold if and only if it has 79 protons,
o Advantages: easy classification; guides what you should treat.
o Disadvantages: does not come with examples, and has low clinical utility
Socially Constructed view on psychiatric classification
o Mental Disorders are brought into being through the process of categorizing mental disorders.
o Advantages: partially explains cross cultural and historical variability (i.e., hysteria vanishing across time/the role of norms)
o Disadvantages: Fear of relativism (would such an approach mean that anything could be a mental disorder?), no guidance for classification, low clinical utility.
Pragmatist view on psychiatric classification
o It is not important what KIND of things mental disorders are, so long as the patient can be treated adequately (although some researchers have argued that knowing what is actually happening is a natural desire of many patients)
o Advantages: High clinical utility, high adaptability
o Disadvantages: Somewhat arbitrary; guidance for classification.
Fuzzy boundaries around what is and isn’t a disorder and the historical example of drapetomania (and schizophrenia in protestors)
Greek drapetes = a runaway (slave)
Drapetomania - a slave’s uncontrollable urge to run away from slavery
Causes: too harsh or too equal treatment
Following proper medical advice, ‘disease’ can be prevented: keep slaves in a comfortable dependency, like children or cattle.
Who assess clinical significance?
The clinician (subjective)
Issues with defining addiction
Addiction is something we have struggled to define – think substance use/misuse as a label over addiction – although sometimes substance use is representative of an underlying psychological issue, and treating it as substance misuse alone is a treating of the coping mechanism as opposed to the root cause.
APA definition of a mental disorder
- A clinically significant disturbance in cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological/biological/developmental processes underlying mental functioning.
- Associated with significant distress or disability in social, occupational, or other areas.
- . An expectable or culturally approved response to a common stressor is not included (e.g., less than a year of grief). Neither is socially deviant behavior (conflicts between individual and society).
The History of MDD
Melancholia (meaning black bile - an imbalance of one of the 5 bodily fluids) preceded the term depression – would be considered severe depression in the present day: impairment across the board.
In the 60s – 80s it was termed melancholic depression, and then major depressive disorder (why is there no minor MDD? – the common understanding was that less severe cases can be treated with psychotherapy, more severe need drugs – it wasn’t included as a term because insurance companies would not cover psychotherapy for a MINOR condition)
MDD is so broad in the present day, that now it includes many “minor” cases – all depression deemed major.
MDD classification now = (the necessary symptoms for a diagnosis - depressive mood and diminished interest/pleasure) – 5 out of 9 with at least 1 necessary. It must of course be associated with clinically significant disturbance.
How much variation is there within this heading? = 227 different presentations (over 1,000 for ADHD).
Some of these symptoms are conflicting, there is no specifications about intensity, some may share only 1 symptom. How likely is it, therefore, that this broad range of presentations/patients can have some sort of specific and biologically traceable signature?
How many symptoms of depression did Fried identify?
He took the symptoms featured on seven surveys seeking to measure depression - and came up with a list of 52 symptoms.
Is it really clear to everyone what depression is then?
