Models of psychological disorders Flashcards
Spiritual model explanation for psychological disorders
Psychological disorders arise because the individual is out of harmony with some larger force - Spiritual and biological process are often intertwined in this model
Spiritual explanations in past societies
imbalance in vital energy, relationship to nature, spiritual forces, equilibrium between soul and body, soul loss, possessions , magical insertion, offenses, Satanic possessions, holy punishment
Tabu deaths
a person is convinced they are cursed. The person isolates from society and dies
Healing spiritual cerimonies work?
Beliefs are powerful - effective because the person believes they will be cured, so they are.
West-European medieval societies: Treatment
religious ceremonies, persecution and death. The insane were treated with cruelty, or thought to be witches (3 consequences: confession by torture, trial by water, examination for skin marks)
Spiritual treatments today
Fundamentalist western religions
Alternative therapies - yoga, meditation
Ceremonies: purification, religious rituals…
Goal: harmony
How Religion/spirituality can be good for mental health
Involvement in religious practices and communities = sense of meaning and resilience
36% lower depression; fewer suicide rates. Improved drinking outcomes
Medical patients and immune-system functioning
Mortality in the elderly lower
Religions can be bad for mental health
Negative religious coping - Feeling of being punished, alienation from community. Rejection of sexual/gender = Immune system declines
Historical oppression and discrimination
Why do cerimonies work for mental health?
Jerome Frank: Through Persuasion, Healing ceremonies can be:
Calming
Arousal of Positive expectations (optimism) = healthy
Focus on constructive thoughts and actions
Sense of control and meaning (vs. helplessness)
Religious healing ceremonies 3 steps
Socially sanctioned healer - gives explanation for problem and what should be corrected
Healer Provides a Ritual
These rituals can create positive effects
Psychologists and religion
lower level of these beliefs
“Religiosity gap”
Not included in diversity training
Why do psychologists need to study religion?
Asking about spirituality/values is associated with (even if patient is atheist) stronger therapeutic alliance
Patient self-disclosure
It is important to incorporate the patients beliefs to their treatment
Biological model explanation for psychological disorders
Psychological problems arise primarily out of underlying biological processes
Traditional societies: biological model
Folk medicine
Asia - 400 AD: major medical text-sections of insanity and Rauvolfia - herbal treatment for psychosis (Reserpine)
Thai and arab medicines
Hippocrates (400-377 B.C.) - Humoral theory
Postulates that every human had 4 humors - body fluids - ideally in balance - imbalance = psych disoder
Linked to elements, organs, temperament and diseases
Treatment in humoral theory
Diet
Change Physical environment
Bleedings, emetics, purges, leeches
19th century Biological Theories
German school - focus and names
Focused on the psychosis
Griesinger
Wernicker
Emil Kraepelin
Psychoses - Emil Kraepelin
Could be divided into endogenous and exogenous
Exogenous psychoses
caused by external conditions. Ex:
Korsakov- Wernicke - alcoholism
Krafft-Ebing - General paresis (paralitic dementia) caused by siphilis
Endogenous psychoses
Caused by internal conditions. Ex: Dementia praecox = premature dementia - today schizophrenia Involutional melancholia (today depression)
Types of Neuroses
Neurasthenia - passivity, weakness, exhausted nerves - later hysteria
Psychasthenia - phobias, irrational fears or OCD - a week psyche or weak nervous system
Treatment of neurosis 19th century
Mainly targeted women
Elixirs with alcohol, cruises, rest
Early 20th century biological treatments
Custodial care
Radical somatic treatments
Radical somatic treatments 20th century bio
Convulsive therapy - Von Meduna Insulin induced seizures for schizophrenia (was the opposite of epilepsy)
Cerletti and Bini - electro convulsive therapy
Egaz Moniz lobotomies
Freeman and Watts - psychosurgery
Egaz Moniz lobotomies
hoped to avoid chronic delusions by injecting alcohol into the frontal lobe and stabbing the prefrontal lobes - patient became apathetic
Freeman and Watts - psychosurgery
when emotion was higher than rationality. Solution: severing the link between frontal and emotional lobes
Learning from radical somatic treatments
Importance of empirical evidence
Informed consent - people should be told what the likely consequences are
Professional accountability - physicians are responsible
50’s - biological treatments
Neuroleptic medications –> Phenothiazines and
Lithium carbonate
Neuroleptic medications advantages
Allowed for Community management - patients could live in society - control of manic symptoms
Institutional management - didn’t require physical constraints
Neuroleptic medications Limitations
Immediate side effects Long-term health effects Kidney pathology Neuroleptic malignant syndrome Tardive dyskinesia
Contemporary Biological models causes
Genetic
Neurochemical
CNS structure and function
Contemporary Biological models treatment
+ Advance in medication (but not perfect) and somatic procedures (EST, TransMagnaticStimutaion, DBS - for parkinson’s) anesthesia before chocks and muscle relaxers to prevent seizure injury
Psychological models of psychopathology say that
Psychological disorders arise as a result of life experiences
1800s psychological perspective - Moral treatment philosophy
Small facilities.
Respect for the patient, freedom and kindness
Psychological processes as treatment
First revolution in psychiatry
Moral treatment names
Phillippe Pinel
William took
Eli Todd
Phillippe Pinel
Moral treatment humanistic physician
- insanity should be treated with attention to the mind.
- “The insane are not guilty, they deserve compassion”. - attempts to classify mental disorders. His ideas spread to england
Eli Todd
Moral treatment in North america inspired by William Took.
democracy and freedom causes men to have high hopes for life. Disappointment causes stress which leads to insanity. Society is responsible.
Moral treatment psychological philosophy Effectiveness and goal
They were very effective. Release rate = 50%, from which 50% never relapsed again.
Goal: Direct attention to positive things and arouse dormant facilities
Decline of Moral treatment
- Social reformers - Dorothea Dix
- Institutional size increase
- lack of government funding
- focus on safety rather than treatment (hospital like vibe, not family)
- Rural to urban transition and immigrants = more patients
- Change from psych model to bio
- The release rate went from 50% to 4%
Decline of moral treatment Change in model of psychopathology
Biological models increased due to German influences. Pessimistic ideas. They were hopeless and thought that moral treatment was unjustified.
Early 20th century psychological perspective
Second revolution in psychiatry
French School of psychiatry
Focused on apparent medical conditions with no physiological cause
Focused on hysteria
Early 20th century figures
Mesmer Charcot Janet Breuer Freud
hysteria what is it and today
Hysteria is conversion symptoms
today = somatoform disorders or functional neurological disorders)
Charcot and hysteria
the father of hypnosis and hysteria.
discovered that patients under hypnosis = no medical condition (neurological problem) anymore. This suggested that psychological processes played a role in these conditions.
Janet
Repression and the unconscious. Upsetting events are pushed to the unconscious. All of us have this but in different degrees
Breuer
Talking cure. If patients talk about problems and experience catharsis (getting emotions out) they could be helped. He treated Anna O (Bertha Pappenheim), and later referred her to Freud.
Freud
Controversial figure Built a theory based on hypnosis, repression and hysteria Tripartite mind and psyche Development Freud’s followers took different paths
Freud Tripartite mind and Tripartite psyche
Tripartite mind
Unconscious, subconscious and conscious
Tripartite psyche
Id, ego and superego
Id, ego and superego
The human personality is shaped by these three. The ego runs the interference between ID and superego
ID
id - the source of our strong sexual and aggressive feelings or energies. Pleasure principle.
Ego
ego - operates according to the reality principle. logic and reason and are referred to as the secondary process, as opposed to the illogical and irrational primary process of the id.
Superego
Superego - conscience, represents the moral principles instilled in us by our parents and our culture.
Human’s Primary motivations to Freud
the discharge of biological impulses (humans are a lot like animals)
Early works on drives: Freud
Early works - Sexual drives (broad concept of libido = drive to live and thrive), agressive drives (death instinct -destructive impulses)
Psychosexual development
Oral - Child expresses like forces for sucking and eating (sexual - libido) - or biting (agressive), Anal, Phallic, Latency, Adult
Ideally, we go through all of these stages and learn how to discharge our ID drives
Few of us go through this without distortions and interferences - this causes risk of development of psychological disorders
Freud: Defense Mechanisms
Automatic
Unconscious
Prevents awareness of impulses and conflicts that cause anxiety and stress - helps keep a sense of security
Freud Intellectualization
we channel impulses into study. We are then able to experience aggression without acknowledging that the drive is ours. (e.g study crime, sexual perversions, or medicine). This is a mature way of dealing with urges that may be unacceptable.
Sublimation Freud
Expression of drive in an indirect way. Channeling unwanted urges into an admissible or productive outlet. (exercise, therapy)
Projection Freud
Placing your impulses on other people. We project our emotions onto other people.
Psychoanalysis Goal
make unconscious conscious through the therapeutic relationship - becoming aware of underlying conflicts makes us be able to deal with it
Psychoanalysis techniques
Free association, dream analysis (superego less powerful), interpretation of transference (project characteristics of a significant other onto the therapist - inside into what was driving their distress)
1940-50s - Interpersonal Dynamic
First recognized by Karen Horney
Harry Stack Sullivan - Our sense of self is determined by our relationships
60’s - Object relations
Began with Anna Freud
Otto Kornberg - Introjection representation, Differentiation and integration, Development of ego boundaries and sense of self
Otto Kornberg
Introjection representation
We Introject representations of significant others (mother) - by interacting with them we take in part of them to build our sense of self
ex: Neglect = primitive introjection
Otto Kornberg
Development of ego boundaries and sense of self Psychopathologies
problem arrives when a person does not develop full ego boundaries and is confused that others are a part of them = borderline
Psychological perspective: Humanistic models figures
Carl Rogers and Maslow
Maslow (1943, 1970)
Hierarchy of needs
Focus on human potential
Deficiency need (basic) vs. Growth needs (cognitive, aesthetic, self-actualization and transcendence)
Seek fulfillment through personal growth (self-actualization)
Client-centered Therapy
Carl Rogers and more
Inner guidance system - guides our behavior in an adaptive way.
Pathology is the denial of true self
Non-directive therapist - Empathy, Genuineness, Positive regard to put patient back in touch with themselves
Behavioural theories
Assumptions
psychological theory should be based on empiricism, and techniques should be validated before use
John watson
psychoanalytic views deal with mentalistic things, which cannot be studied directly and therefore cannot be scientific. Behaviour is explained by learning processes. Goal of psychology should be to predict behaviour.
Classical conditioning
Neutral stimulus is paired with state and starts to elicit it
Joseph Wolpe
Was first a freudian but when working with PTSD gave up. Conditioned fear explained PTSD better
Counter-conditioning - therapy for people with PTSD. remove conditioned fear
Maladaptive conditioned emotional responses (Jack Rachman) 3 types
Fear conditioning (PTSD; Phobias)
Somatic disorders - fear causes somatic symptoms
Appetitive conditioning - motivational salience ex: drug addiction
Maladaptive conditioned emotional responses Treatment
Modify conditioned responses.
like Graduated exposure (EBT), Systematic desensitization, response prevention (OCD), Aversion therapy
Skinner - Behavioural performance depends on
contingencies = consequences
Psychopathology explanation in behaviorism
Some psychopathology is due to maladaptive behaviors or lack of adaptive behaviors
Behaviour modification is done for what?
The treatment for psychopathologies in behaviorism is to teach adaptive responses
Examples of behavioral treatments for psychopathology
Behavioral activation (Derek Hopko - push depressed people to do pleasurable things so that they are reinforced for being active), Problem-solving teaching, Contingency management (arranging to give people rewards for appropriate behavior)
Cognitive revolution 60’s
Albert Ellis
irrational beliefs in neurotic patients - they interpret events negatively
Cognitive revolution
Albert Bandura
Observational learning
Complex behavior is not learned through discrete reinforcement, but through Vicarious conditioning/Observational Learning = watching others
Bandura and psychopathology explanation + treatment
some psychopathology is learned through watching others - like phobias, antisocial, interpersonal prob.
Treatment strategies involved observing, Ex: Participant modeling
Beck (A.T. Beck)
Cognitive therapy for depression
His observation showed that people with depression have: Dysfunctional beliefs and Illogical reasoning schemas
