15.1: Conceptions of Mental Illness: Yesterday

• The videos of the three patients you just watched brought into bold relief the different ways in which psychological disorders affect the lives of people and often interfere with their ability to work, play, and live life to the fullest.

• Martha has been diagnosed with depression.
• She can't taste her favorite foods even when she does eat.
• She feels weak, her energy is low, and she is trembling in her arms and bones.

• Dave is a white man in his late 30s.
• repetitive behaviors that serve no purpose other than to temporarily alleviate his anxiety are what he feels compelled to engage in.
• He can lock his front door and walk away.
• When it comes to someone else's front door, it can take him 20 times to lock it and he doesn't feel good about it.
• He broke the keys in the locks while trying to make sure the door was closed securely.
• His relief is short-lived.

• Larry is a white man in his 40s.
• He speaks in a flat voice and has pauses in his speech.
• He sometimes hears voices in his head.
• His voices are fiction and nonfiction.
• He had a mental disorder when he was young.
• Each fictional baseball player had a name that he invented.
• It is not unusual for a child to have a passion for baseball and mental games, but it can lead to more serious problems later in life.

• In this chapter, we'll see many examples of mental disorders.
• We will look at how psychologists have thought about and diagnosed mental illness historically and right up to the present, describe the symptoms of psychological disorders, and discuss researchers' increasingly sophisticated efforts to understand the causes of mental conditions.

• Determine criteria for defining mental disorders.

• A host of criteria has been proposed for what mental disorder is.

• Each criterion captures something important about mental disorder, but it has flaws.

• Many mental disorders are rare.

• We can't rely on statistical rarity to define mental disorder because not all conditions are pathological or indicative of mental illness.

• Not all mental disorders cause emotional pain for people afflicted with them.
• During the manic phases of bipolar disorder, people feel better than normal and perceive nothing wrong with their behaviors.

• Marriages, friends, and jobs can be destroyed by these disorders.
• The presence of impairment alone can't define mental illness because some conditions, such as laziness, can produce impairment but aren't mental disorders.

• In 1960, Thomas Szasz argued that "mental illness is a myth" and that "mental disorders are nothing more than conditions that society dislikes".
• Szasz was correct and wrong.
• He was correct that our negative attitudes towards those with mental illnesses are widespread.
• Szasz was correct that societal attitudes affect our views of abnormality.

• The views of the times have been mirrored by psychiatric diagnoses.

• Szasz was wrong that society regards all disapproved conditions as mental disor prescribed whipping and toe amputation ders.
• Racist behavior is deplored by society, but not as "treatments" for a mental disorder.
• Neither is rudeness or messiness.

• Many mental disorders are caused by breakdowns or failures.
• Schizophrenia is often marked by an under activity in the brain's frontal lobes.
• Specific phobias, which are intense and irrational fears, appear to be acquired largely through learning experiences and can be triggered by a weak genetic predisposition.

• It's not likely that any one criterion distinguishes mental disorders from normal.

• Mental disorders don't all have the same thing.
• Mental disorders are similar to brothers and sisters in that they don't all have the same features.
• Statistical rarity, subjective distress, impairment, societal disapproval, and loss of control over one's behavior are some of the features described.

• People have recognized certain behaviors as abnormal in the past.
• The witch scares of the 16th and 17th century made expla popular, but treatments for these behaviors have changed.
• According to dreams.
• The story of the dunking test, if a woman drowned, is told in the history of society's evolving views of mental illness.

• She needed to be a MODEL if she floated to the top of the water.
• Many people in Europe and America were executed during the Middle Ages.
• She died either way.

• They said that they heard voices, talked to themselves, and behaved oddly because of the actions of evil spirits.
• The treatments of the day flowed from the demonic model.

• The medical treatments of that era were just as barbaric as those of the demonic era.

• The patients of this era deteriorated and some of them died.
• The expectation of improvement leads to improvement.
• The placebo effect was not considered a rival Ruling Out Rival Hypotheses explanation for the effectiveness of treatments.
• Most of these treatments seem crazy today, but psychologi have important alternative cal and medical treatments are products of the times.

• Reform was on the way.
• Before the approach to mental illness called moral treatment, patients in asylums were often bound in chains; following moral treat for dignity, kindness, and respect for ment, they were free to roam the halls of hospitals, get fresh air, and interact freely with staff those with mental illness and Many people continued to suffer for years with no hope of relief despite the fact that effective treatments for mental illnesses were notexistent.

• The treatment of mental illness changed dramatically in the early 1950s.
• It wasn't a miracle cure, but chlorpromazine did offer some effective treatment for symptoms of schizophrenia and similar 578 Chapter 15 disorders marked by a partial loss of contact with reality.
• Many patients with these conditions were able to function on their own.

• Deinstitutionalization was a mixed blessing.

• Some patients returned to a semblance of a regular life, but tens of thousands of others were left without adequate follow-up care.
• A Massachusetts school went off their medication and ended up wandering the streets.
• The establishment of more humane deinstitutionalization is a tragic legacy of the home teacher's lobbying efforts.

• Psychiatric diagnoses are shaped by culture and history.

• When one man begins to experience its symptoms, others follow suit, triggering widespread panic.

• Over the past several decades, the number of hospitalized psychiatric penises with rulers has declined.

• There is a private hospital that gives off a terrible body odor.

• There are separate psychiatric services in non-Federal general hospitals.

• Common Culture-Bound Syndromes are not discussed in the text.

• Abrupt episode accompanied by extreme excitement and frequently followed by convulsive seizures and coma.

• Symptoms include uncontrollable shouting, attacks of crying, trembling, heat in the chest rising to the head, and verbal or physical aggression.

• Difficulties in concentrating, remembering, and thinking are symptoms.

• A loss of control, cursing, and mimicking others' actions and speech followed the Asia startle reaction.

• There is a Morbid state of anxiety.

• The way people express anxiety may be influenced by culture.
• Japanese culture is more collectivistic than Western culture, so they are more concerned about the impact on others.

• Some conditions may be more frequent in Western cultures.
• The media bombards viewers with images of thin models in the United States and Europe, making already self-conscious women even more self-conscious.
• Body integrity identity disorder, in which people experience persistent desires to amputate their limbs or body parts, has only been reported in the United States and Europe.

• It is believed by its victims that it will be brought on by the glance of cultural homogeneity.
• Jane Murphy looked at two isolated societies, one of which had a group of insomniacs crying for nos in Nigeria and the other of which had a group of Eskimos vomiting near the Bering Strait.
• Customers here don't have any contact with Western culture.
• These cultures used terms for Egypt to ward off disorders that are strikingly similar to schizophrenia, alcoholism, and psychopathic per evil eye.

• Inuit don't like psychopaths as much as we do.

• We'd be lost without a system of diagnostic classification because there are so many ways in which psychological adaptation can go wrong.
• There are at least two crucial functions.
• It's easier to choose a treatment once we've identified the problem.
• When a psychologist diagnoses a patient with schizophrenia, he or she can be certain that other psychologists know the patient's main symptoms.

• Diagnoses simplify complex descriptions of problematic behaviors into convenient summary phrases.

• We'll look at four of the most common mental health myths here.

• According to this criticism, when we diagnose people with a mental disorder, we deprive them of their individuality; we imply that all people within the same diagnostic category are alike.

• People differ vastly in their other psychological difficulties, race and cultural background, personality trait, interests, and cognitive skills, even if they are diagnosed with a mental disorder.
• People are more than disorders.

• Diagnostic diagnoses are unreliable.

• For major mental disorders such as schizophrenia, mood disorders, anxiety disorders, and alcoholism, interrater reliabilities are typically about as high-- correlations between raters of.8 or above out of a maximum of 1.0--as for most medical disorders.
• The picture is not entirely rosy.
• For many personality disorders--a class of disorders we'll discuss later--interrater reliabilities tend to be lower.

• Psychiatric diagnoses are not valid.
• According to the Thomas Szasz Trials, psychiatric diagnoses are useless because they don't give us any new information.
• They're just labels for public perception that psychologists can't describe behaviors we don't like.

• Szasz probably had a point when it came to some pop psychology labels.
• Codependency, sexual addiction, Internet addiction, road rage disorder, and chocoholism are all diagnostic labels that lack scientific support.
• These labels aren't recognized as formal psychiatric diagnoses because they are frequently used in talk shows, television programs, movies, and self-help books.

• The criteria for determining whether a psychiatric diagnosis is valid was outlined by Samuel Guze.

• Over time, what tends to happen to them.

• There is good evidence that many mental disor ders fulfill the criteria for validity.

• People are stigmatized by Psychiatric diagnoses.
• According to theorists, once a mental health diagnoses exert powerful negative professional diagnoses, others perceive us differently.
• This diagnosis leads others to treat us differently, in turn leading us to behave in weird, strange, or crazy ways.

• In a famous study, eight people with no symptoms of mental illness were asked to pose as fake patients in 12 psychiatric hospitals.
• In all 12 cases, the psychiatrists admitted these pseudo patients to the hospital, almost always with a diagnosis of schizophrenia.
• They remained there for an average of three weeks despite showing no symptoms of mental illness.
• The diagnosis of schizophrenia led doctors and nursing staff to view these individuals as disturbed.

• Although controversial in many respects, the diagnosis of attention-deficit/hyperactivity disorder is valid.

• There are two criteria findings concerning the ADHD diagnosis.
• The child's symptoms can't be accounted for by other similar diagnoses.

• The child is likely to perform poorly in the lab.

• The child has a higher chance of being related to someone with attention deficit disorder than the average child.

• In adulthood, the child is likely to show continued difficulties with inattention, but improvements in impulsivity.

• The child has a good chance of responding to Ritalin.

• There's still stigma attached to some diagnoses.
• If someone tells us that a person has a mental illness, we may be wary of the individual at first, or we may misinterpret his or her behavior as consistent with the diagnosis.
• All pseudo patients were released from the hospital with diagnoses of either schizophrenia or manic depression without any symptoms.
• According to discharge diagnoses, psychiatrists eventually realized that these individuals were behaving normally.

• There isn't much evidence that most diagnoses generate long-term negative effects.

• Major depression shouldn't be diagnosed if a patient's depression appears as a result of hypothyroidism.

• A clinical psychologist would probably first rule out medical causes of a disorder when they see psychological cutting as pathological.

• The lifetime prevalence of major depression is 10 percent for women and 5 percent for men.
• For a woman, the odds are at least 1 in 10 that she will experience a major depression episode at some point in her life; for a man, the odds are at least 1 in 20.

• Diagnosticians are reminded to look at patients' life stressors, past and present medical conditions, and overall level of functioning when evaluating their psychological status.
• It reminds clinicians to take culture into account when assigning diagnoses.

• The previous versions of the manual have received more criticism than it has received.

• There are math reasoning problems.

• It seems that learning problems are more of a label than a diagnosis.

• It's very common for people with major depression to meet criteria for anxiety disorders.

• A mental disorder such as co-occurrence of two or more as major depression is either present or absent in a categorical model.
• A woman is either pregnant or not, that's what fits the diagnoses within the same person.
• The differences in height are not all that different from normal functioning in height.
• The same may be true of many forms of depression and anxiety, which are thought to lie on a continuum of normality.

• Depression is usually characterized by high levels of neuroticism and pressure.

• It's easier to think of the world in terms of black and white than it is in terms of gray.

• Critics worry that the change will lead to the diagnosis of many people with normal grief reactions as disorders.

• Some researchers have successfully Lobbyed for the inclusion of their "favorite" disorder or area of specialty.
• The system of psychiatric classification tends to be self-correcting.

• Doctors don't lower death rates if they have a high temperature.

• Recent work suggests that the underlying disease is to blame for the high temperature.

• There is a possibility that there are problems in the brain.
• The Goodkind approach is controversial, and it's unclear how successful it will be.

• One of the ways in which mental illnesses are seen is as disorders of brain circuits.

• The brain systems that are linked to threat processing and reward processing are among these circuits.

• Major depressive disorder is an example.
• The problem with this system is that it may be a form of depression.
• The symptom of hundreds of different underlying diseases is what a fever is.
• Depression may not be a single disease, but instead a grouping of symptoms that can result from many different diseases.

• Depression might be characterized by deficits in the capacity to experience reward, and it might try to identify promising "markers" that reflect inadequate reward processing in the brain.
• Information about how genes and patterns of social interactions shape the likelihood of developing depression and how symptoms of depression are expressed in everyday life would be included.

• There is a new direction for research on psychopathology.
• It may have its limitations.
• We don't know if most or all attention deficit-hyperactivity disorder has been around since childhood, cians, teachers, and family members.
• You have been wondering if you could also qualify for a diag likely to be well-equipped to rule out rival hypotheses.

• Even though it's fascinating, the principle of scientific thinking is not particularly rele.
• After working for an hour or so on this claim, you feel the need to stretch, walk around, or take some drugs, as the ad does not address potential causality of your schoolwork.

• You've always thought of yourself as a restless person.
• You have a high grade 3 and have done well in your classes.

• To evaluate the claim, it would be necessary to compare the test with other tests on the internet.
• It would be beyond the reach of any researcher to do that.
• The information on the Internet is vast, but it would be difficult to identify all of the tests, and the information on the Internet is constantly changing.

• There is no evidence that the claim is a result of research.

• We should be skeptical of claims regarding tests for psycho past few days to see if the diagnosis of ADHD might apply logical diagnoses in which reference is not made to how the to you.
• On a website called "Diagnose Yourself," you can find information about research conducted or whether independent researchers have been able to reproduce a claim regarding a brief self-test for adult ADHD.

• The only test you will need to self-screen for a diagnosis is the net that screens for adult ADHD.

• Scientific skepticism requires us to evaluate al claims with never been evaluated in peer-reviewed studies.

• Let's say you take a test and score in the high range.

• People wander from time to time and think about Ruling Out Rival Hypotheses.

• The experiences of the person and the disorder don't interfere with daily functioning, so it's for some symptoms of the disorder.
• This is tall and unlikely to be an appropriate diagnosis for ADHD.

• To arrive at a valid diagno Summary sis and to distinguish ADHD from other disorders--that is, there's no scientific support for the claim that the test adver rule out rival explanations.

• 586 Chapter 15 mental disorders are related to brain circuits.
• Specific phobias, which are intense and irrational fears, often result from adverse environmental experiences, such as a nasty dog bite or a scary plane ride, which can sometimes produce a dogphobia.
• Scientists will need to develop models of psychopathology that integrate biological and sociocultural influences in order to understand mental illness.
• It's not clear if or how RDoC can pull off this feat.

• Medical students focus on their bodily processes as they become familiar with the symptoms of diseases.
• They start to wonder if a twinge in their chest is an early warning of heart trouble or a symptom of a brain tumor.
• As we learn about psychological disorders, it's only natural to see ourselves in some patterns of behavior, because we all experience disturbing impulses, thoughts, and fears from time to time.

• As you learn about these conditions, don't be alarmed because many of them are extreme psychological difficulties that we all experience on occasion.
• If you experience a psychological problem that's disturbing and persistent, you may want to seek help from a mental health professional.

• Legal problems can be caused by psychological problems, and we can be at risk for them.
• The interface between mental illness and the law is one of the few topics that the general public is certain it knows more about than it does.

• The 2012 theater shooting in Aurora, Colorado, and the 2012 Sandy Hook school shooting in Connecticut were acts of mass violence committed by individuals with severe mental illness.

• One of the most common myths in psychology is that people with mental illness are more likely to be violent.

• People with psychotic disorders are more likely to be victims of violence than perpetrators, and the majority of them aren't physically aggressive toward others.
• The parade of "real crime" shows on television might have helped to combat the misconception, but it probably didn't.
• Most of the television characters with mental illness are violent.

• Like many misconception, this one contains a truth.
• Although most people with mental illness aren't at increased risk for violence, a subset--particularly those who are convinced they're being persecution by the government--is.

• Society has another way of committing people against their will with mental illnesses.
• Most U.S. states specify that people with mental illness can be committed against their will if they pose a clear and present themselves.

• In courts of law, mental illnesses and the law occasionally collide, and they see all crimes, including those committed by people with severe on.

• There are many myths about the insanity that we shouldn't hold people responsible for their crimes if they are found guilty.
• They were not of "sound mind" when they committed them.
• Most people think that a large portion of defense comes in the form of insanity, but it's not always the case.
• 15-20 percent of criminals are acquitted on the basis of courts, but that's not always the case.
• The insanity verdict is used in less than 1 percent of the U.S. states, with Utah, Montana, Idaho, and Kansas opting out.

• The M'Naghten rule, which was formulated during an 1843 British trial, is one of the reasons most contemporary forms of this defense are based on.
• The rule states that if a person is acquitted on the grounds of insanity, they must either be insane or not.
• It is possible that what they were doing at the time of the crime was wrong.
• A defen can help to clear up public views about its use.

• The insanity defense tries to determine if the defendants were incapable of controlling their impulses at the time of the crime.

• The insanity defense is controversial.
• This defense is necessary for defendants who have a mental state so deranged that they can't decide whether to commit a crime.
• The defense is a legal cop-out that excuses criminals of responsibility.
• There is a deeper disagreement about free will versus determinism.
• The legal system assumes that our actions are free, whereas scientific psy Diagnosed with postpartum depression assumes that our actions are determined by our five young children in the bathtub.

• In 2006 Yates was acquitted on the basis of insanity, so lawyers and judges tend to view the insanity defense as a needed verdict.
• There are exceptions for the small minority of defendants who lack free will.
• Many psychologists view the insanity verdict defense as illogical because of public misperceptions about the verdict's prevalence.

• A mental term is insanity.

• Insanity is a legal term that only refers to whether the person was responsible for the crime and not the nature of his or her mental disorder.

• The insanity defense requires a judgment of the defendant's incompetence in order to stand trial.

• In about 1 percent of criminal trials, the insanity defense is raised.

• The majority of people acquitted on the basis of an insanity defense are free.

• The length of a criminal sentence for the same crime is often more than the length of an insanity acquittee's hospital stay.

• The majority of people who use the insanity defense are faking mental illness.

• There is a low rate of faking mental illness among insanity defendants.