Get Ready for Questions!

1
Get Ready for Questions!
2

• One way to define abnormality is to consider when
  behavior violates social norms or makes other
  _________________.

3

• One way to define abnormality is to consider when
  behavior violates social norms or makes other
  _________________.

• anxious

• happy

• confused

4

• Rosenhan and Seligman (1984) suggested that there
  are _______________criteria that could be used to
  decide whether a person or a behavior is normal
  or not.

5

• Rosenhan and Seligman (1984) suggested that there
  are _______________criteria that could be used to
  decide whether a person or a behavior is normal
  or not.

• five

• six

• seven

6

• Which of the following is not a symptom of
  feeling abnormal?

7

• Which of the following is not a symptom of
  feeling abnormal?

• anxiety

• happiness

• distress

8

• Jahoda (1958) attempted to establish what is
  abnormal by identifying the characteristics of
  people who are normal. She identified
  ___________characteristics of mental health.

9

• Jahoda (1958) attempted to establish what is
  abnormal by identifying the characteristics of
  people who are normal. She identified
  ___________characteristics of mental health.

• five

• six

• seven

10
Abnormal PsychologyConcepts of Normality

• Part II

11
Andrea Yates
12
The mental illness criterion

• The mental illness criterion is rooted in a view
  from the medical world that abnormal behavior is
  of physiological origin, this is called the
  medical model. Example disordered
  neurotransmission causes abnormal behavior.
• Consequently treatment addresses the
  psychological problems, primarily through drug
  treatment.
• Abnormal behavior is referred to as
  psychopathology psychological (or mental)
  illness that is based on the observed symptoms of
  a patient.

13
The mental illness criterion

• The term mental disorder is used in the DSM-IV
  published by the American Psychiatric
  Association.
• The DSM-IV is a handbook used by psychiatrists in
  the US to identify and classify symptoms of
  psychiatric disorders.
• This is a standardized system for diagnosis based
  on factors such as a persons clinical and
  medical conditions. Psychological stressors and
  the extent to which a persons mental state
  interferes with his or her daily life.

14
The mental illness criterion

• There are several ethical concerns about the use
  of the medical model to define abnormal behavior.
• The model argues it is better to regard someone
  suffering from a mental disorder as sick rather
  than morally defective because responsibility is
  removed from the patient.

15
The mental illness criterion

• According to Gross (2002), there have been
  examples of misuse of the medical model, since
  the criteria used for diagnosis are not objective
  and can be influenced by culture and politics.
• In the former Soviet Union political dissidents
  were diagnosed as schizophrenic, implying that
  they were not responsible for their deviant
  political beliefs.
• In the UK in the last century, women who were
  pregnant without being married could be admitted
  to an asylum.

16
The mental illness criterion

• Today, psychiatrists diagnose using a
  classification system that is supposed to be
  objective.
• The traditional medical model in psychiatry is
  now assumed to be reductionist, and most
  psychiatrists use a biophysical approach to
  diagnosis and treatment.
• However, this does not prevent a psychiatric
  diagnosis resulting in the patent being labeled
  as different, or not normal.

17
The mental illness criterion

• Tomasz Szasz is one of the most radical critics
  against the concept of mental illness.
• In The Myth of Mental Illness (1962) he argued
  that while some neurophysiological disorders were
  diseases of the brain, most of the so called
  mental disorders should be considered as
  problems in living.

18
The mental illness criterion

• In Szazs view, even though people behave
  strangely and this is classified as mental
  illness by psychiatrists, such behaviors are not
  a symptom of an underlying brain disease. He
  also says that the concept of metal illness is
  not used correctly by psychiatrists.
• Frude (1998) argues there are relatively few
  psychological disorders that can be associated
  with identifiable organic pathology.

19
The mental illness criterion

• Is Szaszs argument valid today?
• (Pilowsky, 2006) Neuropsychologists have in some
  cases, revealed a possible chemical abnormality
  in the brain in people suffering from
  schizophrenia. But brain scans havent yet
  provided an ultimate answer to Szazs questions.

20
Get Ready for Questions!
21

• __________________ argues there are relatively
  few psychological disorders that can be
  associated with identifiable organic pathology.

22

• __________________ argues there are relatively
  few psychological disorders that can be
  associated with identifiable organic pathology.

• Gross

• Frude

• Szasz

23

• The term mental disorder is used in the
  ________________ published by the American
  Psychiatric Association.

24

• The term mental disorder is used in the
  ________________ published by the American
  Psychiatric Association.

• DSM-I

• DSM-II

• DSM-III

• DSM-1V

• DSM-V

25

• According to ______________, there have been
  examples of misuse of the medical model, since
  the criteria used for diagnosis are not objective
  and can be influenced by culture and politics.

26

• According to ______________, there have been
  examples of misuse of the medical model, since
  the criteria used for diagnosis are not objective
  and can be influenced by culture and politics.

• Gross

• Szasz

• Pilowsky

27
Are you too shy?

• A recent trend in schools is to diagnose very shy
  children with social anxiety disorder. Young
  students are being diagnosed and treated.
• Shyness is so common among US children that 42
  exhibit it. By the time they reach college, up to
  51 of men and 43 of women describe themselves
  as shy or introverted.
• Psychiatrists say that at least one in eight of
  these people needs medical attention.

28
Are you too shy?

• It is debatable whether medical attention is
  needed. Julie Turner-Cobb says the stress hormone
  cortisol is consistently lower in shy children
  than in their more extroverted peers. This
  challenges the belief that shyness causes
  youngsters extreme stress.

29
Are you too shy?

• GlaxoSmithKline, the maker of Paxil, declared in
  the late 1990s that its antidepressant could also
  treat social anxiety and self-consciousness in
  restaurants.
• The public awareness campaign (Imagine being
  allergic to people) cost the drug maker 92
  million in one year.
• Social anxiety became the third most diagnosed
  mental illness in the US, behind depression and
  alcohol.
• Studies put the total number of children affected
  at 15 - Higher than the one in eight whom
  psychiatrists suggested were shy enough for
  medical help.

30
Diagnosing psychological disorders

• Psychiatrists must rely on the patient's
  subjective description of the problem.
• Diagnosis is accomplished through a formal
  standardized clinical interview a checklist of
  questions to ask each patient.
• After the interview, a mental heath status
  examination is completed, based on the
  clinicians evaluation of the patients
  responses, today the clinician often a
  psychiatrist uses a standard diagnostic system.

31
Diagnosing psychological disorders

• Kleinmutz (1967) has noted that there are
  limitations to this interview process
• Information exchange may be blocked if either the
  patient or the clinician fails to respect the
  other, or if the other is not feeling well.
• Intense anxiety or preoccupation on the part of
  the patient may affect the process.
• A clinicians unique style, degree of experience,
  and the theoretical orientation will definitely
  affect the interview.

32
Diagnosing psychological disorders

• In addition to interviews, other methods can be
  used to assist with diagnosis. These include
• Direct observation of the individuals behavior
• Brain-scanning techniques such as CT and PET
  (especially in cases such as schizophrenia or
  Alzheimers disease.)
• Psychological testing, including personality and
  IQ tests.

33
Diagnosing psychological disorders

• Psychologist refer to the ABCs when describing
  symptoms of a disorder.
• Affective symptoms emotional elements, including
  fear, sadness, anger.
• Behavioral symptoms observational behaviors,
  such as crying, physical withdrawal from others,
  and pacing.
• Cognitive symptoms ways of thinking, including
  pessimism, personalization, and self-image.
• Somatic symptoms physical symptoms, including
  facial twitching, stomach cramping, and
  amenorrhoea (absence of menstruation)

34
Diagnosing psychological disorders

• The two major classification systems used by
  western psychiatrists today, the DSM and ICD
  (International Classification of Diseases), are
  based largely on abnormal experiences and beliefs
  reported by patients, as well as agreement among
  a number of professionals as to why the criteria
  should be used. This explains why the criteria in
  DSM is revised the views of homosexuality.

35
Get Ready for Questions!
36

• Shyness is so uncommon among US children that
  only 42 exhibit it.

37

• Shyness is so uncommon among US children that
  only 42 exhibit it.

• true

• false

38

• What does ABCs stand for in psychology?

39

• What does ABCs stand for in psychology?

• Affective, Biological, Cognitive, Somatic

• Anxiety, Behavioral, Cognitive, Somatic

• Affective, Behavioral, Cognitive, Somatic

40

• The two major classification systems used by
  western psychiatrists today, the DSM and
  _________________, are based largely on abnormal
  experiences and beliefs reported by patients, as
  well as agreement among a number of professionals
  as to why the criteria should be used.

41

• The two major classification systems used by
  western psychiatrists today, the DSM and
  _________________, are based largely on abnormal
  experiences and beliefs reported by patients, as
  well as agreement among a number of professionals
  as to why the criteria should be used.

• APA

• MLA

• ICD

42

• ______________symptoms physical symptoms,
  including facial twitching, stomach cramping, and
  amenorrhoea

43

• ______________symptoms physical symptoms,
  including facial twitching, stomach cramping, and
  amenorrhoea

• Affective

• Behavioral

• Cognitive

• Somatic

44

• _________________symptoms observational
  behaviors, such as crying, physical withdrawal
  from others, and pacing.

45

• ______________symptoms physical symptoms,
  including facial twitching, stomach cramping, and
  amenorrhoea

• Affective

• Behavioral

• Cognitive

• Somatic

46

• __________________symptoms emotional elements,
  including fear, sadness, anger.

47

• __________________symptoms emotional elements,
  including fear, sadness, anger.

• Affective

• Behavioral

• Cognitive

• Somatic

48
Validity and reliability of diagnosis

• The classification system used to identify
  abnormal behaviors is descriptive and does not
  identify any specific causes for disorders.
• It is difficult to make a valid diagnosis for
  psychiatric disorders because there are no
  objective physical signs of such disorders.

49
Validity and reliability of diagnosis

• Reliability this is high when psychiatrists
  agree on a patients diagnosis when using the
  same diagnostic system. This is also known as
  inter-rater reliability.
• Validity this is the extent to which the
  diagnosis is accurate. This is much more
  difficult to assess in psychological disorders,
  for example because some symptoms appear in
  different disorders.

50
Validity and reliability of diagnosis

• Rosenhan (1973) tested the validity of
  psychiatric diagnosis. The study is considered an
  important and influential criticism of
  psychiatric diagnosis.

51
Validity and reliability of diagnosis

• Rosenhan's study was done in two parts. The first
  part involved the use of healthy associates or
  "pseudopatients" who briefly simulated auditory
  hallucinations in an attempt to gain admission to
  12 different psychiatric hospitals in five
  different states in various locations in the
  United States. All were admitted and diagnosed
  with psychiatric disorders.

52
Validity and reliability of diagnosis

• After admission, the pseudopatients acted
  normally and told staff that they felt fine and
  had not experienced any more hallucinations.
  Hospital staff failed to detect a single
  pseudopatient, and instead believed that all of
  the pseudopatients exhibited symptoms of ongoing
  mental illness. Several were confined for months.
  All were forced to admit to having a mental
  illness and agree to take antipsychotic drugs as
  a condition of their release.

53
Validity and reliability of diagnosis

• The second part involved asking staff at a
  psychiatric hospital to detect non-existent
  "fake" patients. No fake patients were sent, yet
  the staff falsely identified large numbers of
  ordinary patients as impostors.

54
Validity and reliability of diagnosis

• The study concluded, "It is clear that we cannot
  distinguish the sane from the insane in
  psychiatric hospitals" and also illustrated the
  dangers of dehumanization and labeling in
  psychiatric institutions.
• It suggested that the use of community mental
  health facilities which concentrated on specific
  problems and behaviors rather than psychiatric
  labels might be a solution and recommended
  education to make psychiatric workers more aware
  of the social psychology of their facilities.

55
Validity and reliability of diagnosis

• The Rosenhan study illustrates the concerns about
  reliability in diagnosis of psychiatric illness.
  The diagnostic classification systems have been
  accused of being unreliable.
• Using the same diagnostic manual, two
  psychiatrists could easily diagnose the same
  patient with two different disorders.

56
Validity and reliability of diagnosis

• Beck et. al (1962) found that agreement on
  diagnosis for 153 patients between two
  psychiatrists was only 54.
• Cooper et. Al (1972) found that New York
  psychiatrists were twice as likely to diagnose
  schizophrenia than London psychiatrists, who in
  turn were twice as likely to diagnose mania or
  depression when shown the same videotaped
  clinical interviews.

57
Validity and reliability of diagnosis

• Di Nardo (1993) studied reliability of the
  DSM-III for anxiety disorders. Two clinicians
  separately diagnosed 267 individuals seeking
  treatment for anxiety and stress disorders. They
  found high reliability for obsessive compulsive
  disorder (.80), but very low reliability for
  assessing generalized anxiety disorder, (.57),
  mainly due to problems with interpreting how
  excessive a person worries were.

58
Validity and reliability of diagnosis

• Lipton and Simon (1985) randomly selected 131
  patients in New York and conducted various
  assessment procedures to arrive at a diagnosis
  for each person. This diagnosis was then compared
  with the original diagnoses. Of the original 89
  diagnoses of schizophrenia, only 16 received the
  same diagnosis on re-evaluation 50 were
  diagnosed with a mood disorder, even though only
  15 had been diagnosed with a mood disorder.

59
Validity and reliability of diagnosis

• If the same diagnosis has a 5050 chance of
  leading to the same or different treatment, this
  suggests a serious lack of validity, probably due
  to bias in diagnosis. Since diagnostic
  classification systems are not 100 objective,
  the diagnosis may be influenced by the attitudes
  and prejudices of the psychiatrist.

60
Validity and reliability of diagnosis

• Clinicians may expect certain groups of patients
  to be more prone to depression, and therefore
  more likely to interpret symptoms as related to
  depression even though the same symptoms would be
  interpreted as something else of they were
  presented by a different person. When this occurs
  consistently it is called overcategorization.

61
Ethical considerations in diagnosis

• Szasz in Ideology and Insanity (1974) argued that
  people use labels such as mentally ill, criminal,
  or foreigner in order to socially exclude people.
  People who are different are stigmatized. The
  psychiatric diagnosis provides the patient with a
  new identity for example, schizophrenic.
• Criticism raised by Szasz have influenced the
  classification systems in DSM-IV it is
  recommended to refer to an individual with
  schizophrenia.

62
Ethical considerations in diagnosis

• Ethical concerns about labeling remain, which
  result from identifying someones behavior as
  abnormal, since a psychiatric diagnoses may be a
  label for life.
• Even if a patient no longer shows any symptoms,
  the label disorder in remission still remains.

63
Ethical considerations in diagnosis

• Scheff (1966) argued that one of the adverse
  effects of labels is the self-fulfilling prophecy
  people may begin to act as they think they are
  expected to. They may internalize the role of
  mentally ill patient and this could increase in
  symptoms.
• Doherty (1975) points out that those who reject
  the mental illness label tend to improve more
  quickly than those who accept it.

64
Ethical considerations in diagnosis

• Langer and Abelson (1974) tested social
  perception of the mentally ill. They showed a
  videotape of a younger man telling an older man
  about his job experience.
• If the viewers were told beforehand that the man
  was a job applicant, he was judged to be
  attractive and conventional-looking, whereas if
  they were told that he was a patient he was
  described as tight, defensive, dependent, and
  frightened of his own aggressive impulses.
• This clearly demonstrates the power of schema
  processing.

65
Ethical considerations in diagnosis

• There are several types of bias that may affect
  the validity of a diagnosis
• Racial/ethnic The study of the 'Effect of
  client race and depression on evaluations by
  white therapists' by Jenkins-Hall and Sacco
  (1991) involved white therapists being asked to
  watch a video of a clinical interview then to
  evaluate the female interviewee. There were four
  conditions representing the possible combinations
  of race and depression. In one condition the
  woman was African American and nondepressed, in
  another condition she was a white American and
  nondepressed. In the other two conditions she was
  each of these races but depressed. Although the
  therapists rated the nondepressed African
  American and the white American in much the same
  way, their ratings of the depressed women
  differed in that they rated the African American
  woman wit more negative terms and saw her as less
  socially competent than the depressed white
  American woman.

66
Ethical considerations in diagnosis

• Confirmation bias
• Clinicians may tend to have expectations about
  the person who consults them, assuming that if
  the client is here, there must be some disorder
  to diagnose. Since their job is to diagnose
  abnormality, they perhaps over-react and see
  abnormality wherever they look. This is most
  clearly by Rosenhan (1973).
• institutionalization refers to individuals in
  institutions, once admitted, all their behavior
  is seen as a symptom of their mental illness.

67
Ethical considerations in diagnosis

• Powerlessness and depersonalization this is
  produced in institutions through a lack of
  rights, constructive activity, choice, and
  privacy, as well as frequent verbal and even
  physical abuse from attendants.

68
Ethical considerations in diagnosis

• Clinicians might believe that the more assessment
  techniques they use the more valid their
  interpretation will be. Kahneman and Tversky
  (1973) point out that this is not the case, there
  is not a positive correlation between the number
  of assessment techniques used and the accuracy of
  eventual diagnosis.

69
Cultural considerations in diagnosis

• Culture-Bound Syndromes - abnormalities thought
  to be culturally specific.
• Depression (absent in Asian societies)
• Reporting Bias people tend to avoid doctors and
  sort it out within family.
• Data based on hospital admissions
• Chinamental illness carries stigma
• Difference in Symptoms
• Affective (emotional symptoms) - individualistic
• Somatic (physiological symptoms) - collectivist
• Culture Blindness the problem of identifying
  symptoms of psychological disorder if they are
  not the norm in the clinicians own culture.

70
Get Ready for Questions!
71

• The mental illness criterion is rooted in a view
  from the ____________world that abnormal behavior
  is of physiological origin

72

• The mental illness criterion is rooted in a view
  from the ________________world that abnormal
  behavior is of physiological origin

• psychological

• pseudoscience

• medical

73

• _________________tested social perception of the
  mentally ill. They showed a videotape of a
  younger man telling an older man about his job
  experience.

74

• _________________tested social perception of the
  mentally ill. They showed a videotape of a
  younger man telling an older man about his job
  experience.

• Langley and Weber

• Lynn and McCall

• Langer and Abelson

75

• _____________________ point out that this is not
  the case, there is not a positive correlation
  between the number of assessment techniques used
  and the accuracy of eventual diagnosis.

76

• _________________tested social perception of the
  mentally ill. They showed a videotape of a
  younger man telling an older man about his job
  experience.

• Kahneman and Tversky

• Lynn and McCall

• Langer and Abelson

77

• ______________________ people tend to avoid
  doctors and sort it out within family.

78

• ______________________ people tend to avoid
  doctors and sort it out within family.

• Culture-bound

• Difference in symptoms

• Reporting bias