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1 Abnormal – Disorders and Approaches

Defining Mental Disorder &


5 Approaches to
Understanding It
 Psychiatry
 Branch of the medical profession
 Psychiatrists can prescribe psychotropic drugs
 Can ‘section’ patients
 Clinical psychology
 Branch of psychology that deals with and treats psychological and behavioural
problems
 Clinical psychologists work in NHS and clinical settings
 Cannot prescribe drugs
 Abnormal psychology
 Study of abnormal psychological and behavioural conditions
 An academic discipline, does not train practitioners

Defining Mental Disorder

The “4 D’s” of mental disorder: people traditionally go to see a psychologist or


psychiatrist, or get sent to see one, because of....

 Distress: Behaviours, ideas, or emotions usually must also cause distress or


unhappiness before they can be considered abnormal; comes from three areas
of negative emotion.
 Dysfunction: difficult or unable to function in day-to-day life.
 At work? In social relationships? At home?
 ‘Dysfunctional’ behaviour is situation specific - e.g. levels of aggression or fear
 Someone might be dysfunctional but not distressed
 Deviation: If someone’s behaviour is abnormal / unusual / strange / very eccentric, they
may be sent to a psychiatrist or psychologist to see what is wrong. Behavior, thoughts,
and emotions are considered abnormal when they differ from a society’s ideas about
proper functioning. A society’s values may change over time.
2 Abnormal – Disorders and Approaches

 Danger:
 Always with one of the others
 Mental illness can mean danger to self or others (but in less than 5% of cases)
 Compulsory Detention / Involuntary Commitment (Sectioning)
 Involuntarily detaining a patient in secure mental hospital
 Usually done by doctor, psychiatrist or a social worker

A fifth ‘D’? Diagnostic and Statistical Manual of Mental Disorders (DSM)

When clinicians decide that a person’s symptoms fit the criteria for a particular disorder,
they are making a diagnosis. When people qualify for two or more diagnoses, they are said
to display comorbidity.

Categories of Disorder
 Neurodevelopmental  Eating
 Psychotic  Sleep-Wake
 Bipolar and related disorders  Sexual Dysfunctions / Paraphilic
 Depressive Disorders
 Anxiety  Disruptive, Impulse-Control and
 Obsessive-Compulsive Disorders Conduct Disorders
 Trauma-related  Substance-Related Disorders
 Dissociative  Personality Disorders
 Somatic

Sex, Eccentricity and the Politics of the DSM

 Personality disorder: If you deviate too much from your culture (i.e. you are
eccentric or a bit weird), you could be diagnosed
 Gender Dysphoria: Trans-sexuals still considered ‘disordered’
 Paraphilias: “Pedophilic disorder” – giving pedophilia a medical justification?

Benefits of DSM

 Global standardisation of mental disorder categories


 Permits clear communication between professionals across the world
 Has improved reliability of diagnosis

Drawbacks of DSM

 Links between DSM and the pharmaceutical industry –overdiagnosis?


 Black-and-white approach to mental disorder
 Politically sensitive nature of some diagnoses
3 Abnormal – Disorders and Approaches

1. Biomedical Approach

Key points:

 Dominant model in psychiatry (particularly in America)


 Mental/behavioural problems are illnesses of the body and brain
 Can be diagnosed through observing symptoms
 Problems can be treated with physical treatments
 Drugs (.e.g. antipsychotics, tranquilizers, anti-depressants)
 Psychosurgery

Biomedical Causes

 Brain abnormalities or brain damage


 Hormone imbalance, e.g. menopause, post-natal
 Too much or too little transmitter in the synapses – e.g. Depression linked to low
levels of serotonin,
 Schizophrenia to excessive levels of dopamine activity
 Genetic risk factors: genetic influence on brain and body

Benefits of Medical Model

 Removes stigma and blame of “madness” “idiocy” and “lunacy”


 Remove parental blame, e.g. autism
 Successful in identifying important biological illnesses, e.g. Alzheimer’s
 Standardised understanding and treatment of clearly defined mental disorders
 Establishing physiological and genetic basis of a variety of mental disorders
4 Abnormal – Disorders and Approaches

Dangers and Drawbacks

 History of dehumanising and dangerous treatments


 Biological diagnosis of disorders problematic
 Can miss other important factors in mental ill health (e.g. interpersonal or
environmental factors)
 Excessive use of psychotropic drugs
 Failure in many disorders to find biological basis: eating disorders, depression

2. Psychodynamic Approach
 Mental disorders stem from problems/traumas in early childhood
 Relationship with parents and caregivers critical

Key concepts

 Defence mechanisms
 Unconscious
 Id, ego and superego: a mind naturally in conflict

Psychodynamic Treatment

 Treatment involves the identification and modification of unconscious memories and


conflicts from childhood– bring repressed material into the conscious, change coping
responses
 Free association
 Dream analysis
 Corrective relationship with therapist – “Transference”
 Long-term therapeutic process
5 Abnormal – Disorders and Approaches

3. Behavioural Approach

Key points

 Based on “behaviourist” paradigm


 It’s all about learning and unlearning – Classical and operant conditioning
 Mental disorders are learnt through association (e.g. phobias)
 Disordered emotions and behaviours can be unlearnt

Behavioural Therapy

 Exposure therapy – Phobias: Exposure to fear stimulus, through “flooding” or gradual


extinction of fear response
 Reinforcement Therapy – Applied behaviour analysis for autism
 Aversion therapies
 Linking problematic behavior to aversive stimulus, e.g. electric shocks
4. Cognitive Approach

Causes

 Problematic patterns of thought and belief are the cause of and symptoms of mental
disorders
 Self-bias: self-referencing or self-evaluation
 Attention bias: in anxiety, more likely to pay attention to feared stimulus
 Memory bias: depressed people are more likely to focus on negative events in the
past
 Perceptual bias: anorexic individuals see themselves as overweight

Cognitive Therapy

 Ways of changing maladaptive thoughts to replace them with more healthy thoughts
– “homework” involved to practice new thoughts
 Government and the NHS has invested much time, money and resources in CBT
 Also given in prisons, as part of criminal rehabilitation programmes, e.g. “Enhanced
Thinking Skills”
6 Abnormal – Disorders and Approaches

5. Humanistic Approach

Humanistic Approach

 People are goal-directed - motivated towards personal growth and self-actualisation


 People have basic needs - love, hope, a sense of belonging, a sense of competence, a
sense of growth, and a sense of meaning
 If these needs are not met, or goals are blocked, then mental disorder can result
 Tends not to use abnormal diagnosis labels, but instead uses individual ‘formulations’

Humanistic Therapy

 Logotherapy - Aim is to help patients find a meaning to live for


 Therapeutic communities – Aim to develop an environment that meets basic human
needs, e.g. for dementia

Integration?

The biopsychosocialmodel

Accepts some elements of different approaches in understanding mental disorder:

 The role of the brain


 The importance of learnt habits
 The importance of thinking patterns
 The importance of traumatic memories and childhood experiences
 The importance of an empathic relationship between client and therapist

See chapter 16 in Psychology Around Us and chapter 19 in core text book 