Concepts of Mental Illness, Stress, and

Diagnosis of Mental Disorders

HCS 3041 Mental Health Education

Sheung-Tak Cheng

Chair Professor of Psychology and Gerontology, EdUHK

Hon. Chair, Norwich Medical School, Univ. of East Anglia
Hon. Professor, Gender Studies Program, Chinese Univ. of HK
What Is Normal and Abnormal?

A woman still
cooks for her
A woman
A man dead husband &
slapping a
kissing places utensils
child
another on table
man

A woman
A man refusing to A man
barking like eat for driving a nail
a dog several days through his
hand
What Is Normal and Abnormal?

A man lives in
the mountain
A woman
A child and forms no
who
who keeps relationships
laughs all
doing math
the time
wrong

A woman
A man exposing her A student
having sex body in the afraid of
with his media giving a
daughter presentation
 Standards For What Is
Normal and Abnormal
 Social norm violations
 Unusualness of behavior/statistical infrequency
 Personal distress/discomfort of the person exhibiting
the behavior
 Mental illness???
 Maladaptiveness/Dysfunctioning
Standard 1: Social norm violations

 No universal standards or rules for labeling a

behavior as abnormal.
 Instead, behaviors can only be abnormal relative
to social norms in particular cultures (hence
cultural relativism)

Example: Parents lining up in order to enrol their kids into

preschools.
In Spain, preschool kids are sent home for lunch and a nap.

Some cultures have norms for women very different from

those for men.
Standard 2: Unusualness

 Is the behavior rare?

(Depends in part on the norms for that behavior in a
culture.)
Standard 3: Discomfort

 Proponents of this view argue that a behavior is only

abnormal if the individual suffers as a result of the
behavior(s) and wishes to be rid of them.
 Some therapists object to the subjective discomfort
criterion because people are not always aware of
problems that their behavior may create for
themselves or others.
Standard 4: Mental Illness

 Is the behavior caused by an identifiable disease?

 There is no medical test that identifies this process if
it does exist.
Standard 5: Maladaptiveness

 Does the behavior prevent normal daily functioning?

 Role expectations for age and gender subgroups are
important
How are men expected to act? What types of
behaviors are discouraged?
How are women encouraged to act …?
How are children expected to act …?
 Role expectations are partly based on norms (hence
also culturally relative)
How do people
explain mental
illness
historically?

trephination
5th century B.C. - Hippocrates

Imbalance of bodily fluids:

An excess of blood  emotionality

An excess of black bile  melancholia
An excess of yellow bile  irrability & anxiety
An excess of phlegm  sluggishness
Middle ages
The Growth of Asylums During the
Renaissance
 As early as the 12th century A.D., hospitals began to
include special rooms for people with mental
disorders
- Treatment was often inhumane
- Example: La Bicetre Hospital, France
 Some established and run by people who thought
mental disorders were medical illnesses
- Example: Benjamin Rush, a physician, singer,
politician, & social reformer
 By 15th century, asylums became custodial
institutions for the outcast (lepers, beggers…)
- Example: Priory of St. Mary of Bethlehem, London
Moral Treatment Of the 18th Century (Pinel)

 Movement toward a more humane treatment of

the mentally ill
 Incorporated a sociological view:
People become mad because they are
separated from their natural social
surroundings and succumb to the stresses
imposed by the society.
Emergence of Psychodynamic Perspectives

19th century A.D.

 Mesmer treated patients with magnets (mesmerism)

 Charcot characterized hysteria
 Breuer & Freud treated hysteria with hypnosis 
cartharsis; theorized the unconscious
 Psychoanalysis

• Theory developed
Sigmund Freud
while treating 弗洛伊德
patients with
neurotic disorders (presently aware)

• Determinism (not aware but (internalized

– Stressed accessible) value/ideals)
importance of
early childhood (not accessible)
experiences and
unconscious
psychic energies (repressed impulses/desires;
eg, Oedipus Complex)
Modern Perspectives
 Classification systems using objective criteria and
definitions, along with the discovery of syphilis as the
cause of general paresis, gave credence to
biological factors as a cause of abnormality
 Psychoanalysis perspective focused on the role of
the unconscious
 Behaviorism examined the role of reinforcement
and punishment in determining behavior
 Cognitive approach recognized that how people
think about their world determines their emotions
and behaviors
 Biological approach emphasizes brain chemistry
and genetic factors
Patient’s Rights Movement

 Mental patients could recover more fully or live

more satisfying lives if they were integrated into the
community, with the support of community-based
treatment facilities.
Chinese Theories

 Ancient China
- Yin & Yang

 Western ideas introduced to China by

priests during early 20th century

 During Cultural Revolution, mental illness

is defined as deviation from communism
From the Diagnostic and Statistical Manual
of Mental Disorders, 5th ed. (DSM-5):

"A mental disorder is a syndrome characterized by clinically

significant disturbance in an individual's cognition, emotion
regulation, or behavior that reflects a dysfunction in the
psychological, biological, or developmental processes underlying
mental functioning. Mental disorders are usually associated with
significant distress in social, occupational, or other important
activities. An expectable or culturally approved response to a
common stressor or loss, such as the death of a loved one, is not
a mental disorder. Socially deviant behavior (e.g., political,
religious, or sexual) and conflicts that are primarily between the
individual and society are not mental disorders unless the
deviance or conflict results from a dysfunction in the individual, as
described above."
Gathering Information
for Diagnosis
Symptoms and History

 Current symptoms
– How much do they interfering with the client’s
ability to function?
– How does he/she cope with stressful situations?
 Course
– When did the different symptoms appear and how
did they progress?
Symptoms and History, continued

 Recent events
– Have any negative or positive events happened
lately?

 History of psychological disorders

– Has the client experienced symptoms similar to
the current symptoms at some time in the past?

 Family history of psychological disorders

– Does the client’s family have a history of
psychological disorders or symptoms?
Physiological and
Neurophysiological Factors
 Physical Condition
– Any medical conditions?

 Drug and Alcohol Use

– Is the client taking any drugs that could cause symptoms?
– Is the client taking any prescriptions that could interact
negatively?

 Intellectual and Cognitive Functioning

– Any cognitive deficits that could cause symptoms?
Sociocultural Factors

 Social Resources
– Friends and family, amount of contact, and the quality of
these relationships
–

 Sociocultural Background

 Acculturation
– To what extent do they identify with group of origin vs. the
mainstream dominant culture?
Problems in Assessment

 Evaluating Children
– Difficulties in communication and reporting

 Cultural Bias
– Language barriers
– Different cultures experience different
psychological disorders differently
Diagnosis means defining and looking
for syndromes, a collection of signs
and symptoms that coexist and follow
a certain pattern of development