Week 1 Flashcards
Nosophobia
Also called “Medical Student Syndrome”
It is very common for medicine (and psychology) students to develop fears and symptoms of illness
Occurs in as many as 70-79% of students at some stage during training
A particular problem with ‘personality disorders’
E.g., Mark said x…I do that! I must have X Disorder!
Avoid the temptation of self-diagnosis!
Don’t ‘Psychopathologize’
Increasing awareness of psychological disorders can lead to noticing traits of pathology.
Particularly a problem with personality disorders.
Avoid the temptation to pathologize the behaviour, etc. of others.
E.g., It is not professional and you loose credibility!
Remember that ‘diagnosis’ without sufficient training or assessment may be unethical.
E.g., Would like someone to do that to you?
Ancient Attempts at understanding illness and providing Therapy
Earliest known attempts during Stone Age
Demonic possession ideas shared by many ancient cultures
Greeks, Chinese, Hebrew, Egyptian
Trephining
Use of stone tools to chip a hole in the skull
Early Rational Psychiatry – a glimmer of hope
Reformulation by Hippocrates Rejected notions of demonic possession First classificatory system of mental illness Mania (concept differs today) Melancholia (concept differs today) Phrenitis (inflammation of the brain) Treatments included: vegetarian diet exercise sexual abstinence bloodletting
Middle-Ages Psychiatry
Treatments centred around concept of exorcism, using methods such as prayer, holy water…
Mental illness associated with witchcraft
Renaissance Psychiatry
Rediscovery of scientific method and reason in the enlightenment and renaissance
Belief in possession and witchcraft declines
No coherent theoretical model of mental illness remained
Rise of humanitarianism
Gradual movement into asylums.
Little effective treatment
Towards early 1900’s
Treatments became less about torture and shame and more about
“Talking Cures”
E.g., Breuer, Freud, and More
Stimulation of body parts
E.g., treatment of “hysteria…the wandering womb”!
Modern Account of Abnormality
Defining “Abnormal”
The thoughts, behaviours, and emotions are:
Distressing to self and others
Dysfunctional for self or others
Statistical Rarity (Quantitative) or Deviance (Qualitative)
Defining Abnormal - Distress
Personal Distress
Many DSM criteria specify that the disorder must cause significant distress
E.g., Major Depressive Episode Criteria B
“The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”
Other person distress
E.g., Antisocial Personality disorder is more distressing to others than self
Pathology is when…
anyone is personally distressed or unduly distressing anyone else
Defining Abnormal - Dysfunction
Psychological Dysfunction
Impairment of functioning Cognitive – Dysfunctional Thoughts E.g., “I am bad” Behavioural – Dysfunctional Behaviours E.g., Gambling away family savings Emotional- Dysfunctional emotions E.g., Uncontrolled rage Interpersonal – Dysfunctional Relationships E.g., Inability to maintain long-term relationship despite desire to do so
Defining Abnormal – Statistical Rarity (Quantitative)
The pattern is a statistical rarity
E.g. Among one million people, the person is the only one with severe fear of tables
Statistical rarity alone is not sufficient to determine pathology
E.g., What about
Defining Abnormal – Deviance (Qualitative)
Atypicality / Culturally Unexpected
There is considerable cross-cultural variation in acceptable behaviour
E.g., Belief in spirits more accepted in Chile
Abnormality of behaviour must be judged in the context of the cultural group to which the individual belongs
E.g., Believing in spirits in Chile is “normal” so cannot be viewed as Abnormal
Note that cultures are made up of diverse subcultures
E.g., Not everybody in Chile believes in spirits
Abnormality is not sufficient to determine disorder!
Eg the history of homosexuality as a ‘mental disorder’ as per the dsm
for example:
The history of homosexuality as a ‘mental disorder’
DSM-I: Sociopathic personality disturbance
DSM-II: Homosexuality
DSM-II (7th printing): Sexual orientation disturbance
DSM-III: Ego-dystonic homosexuality
DSM-III-R: Removal of homosexuality from DSM
DSM-IV: Sexual disorder NOS
Only for persistent distress regarding one’s sexual orientation
DSM-5: No specific mention of “homosexuality” except as an additional area of distress in Pedophilic Disorder….FINALLY!
Assessment of Abnormality
Assessing Disorders
Clinical Interviews Structured interviews (e.g., ADIS or SCID) Unstructured interview Psychological testing Beck Depression Inventory II Observations Behavioural assessments Psychophysiological assessment Heart Rate Neuroimaging CAT, PET, MRI, fMRI
