Chapter 16

Psychological Disorders

z
z
 z
In a nutshell…

 There is so much variation to what is normal and

in essence, you have to be able to live with
ambiguity

 A disorder is a syndrome marked by a clinically

significant disturbance in an individual’s cognition,
emotion regulation, or behaviour (dysfunctional
behaviours interfere with normal day to day living)
 z
Witchcraft

 Malleus Maleficarum (The Witch’s Hammer): a

guidebook to discovering and getting rid of
witches. Written by two monks.
 Only women could be witches

 “All witchcraft comes from carnal lust – which is, in

women, insatiable”

 Tests of witchcraft: fixed

z
z
z
 z

The Biomedical Model

 Popular when behaviourists were popular

 Psychological disorders have physical

causes, therefore
 they can be classified based on the patient’s
symptoms
 they can be treated (with drugs and/or
therapy) and be cured
 z
The Biological Model of
Abnormal Psychology

 Includes the following general areas:

 Neurotransmitter and Hormonal
Imbalances
 Genetic Vulnerabilities
 Brain Dysfunction and Neural
Plasticity
 Physical Deprivation or Disruption
 z
Neurotransmitter
Imbalances
z
The Medical Model is not Without
Criticism
 z
Good and Bad
 He was an early critic of psychiatry’s former
disease model of homosexuality and argued
vigorously against the use of involuntary
hospitalizations, the insanity defense, among other
extremes
 His influence has left both clinical psychiatry and
psychology with a stronger emphasis on social
justice and a legacy of psychiatric skepticism.

 Imaging techniques, etc. do demonstrate structural

differences and different activity patterns – he goes
too far.
 z
Bio-psycho-social Perspective:

 bio – genes, brain/body structure and

chemistry
 psycho – stress and trauma
 social – cultural expectations and support
system
All three of these factors contribute to the
psychological disorder.
Supposedly what we use now. In reality, there
is still a heavy focus on the medical model.
 z
The bio-psycho-social
paradigm used to be called the
Diathesis-Stress Paradigm
 According to Diathesis-Stress models, the cause of
abnormal behavior can be viewed as a combination of or
interaction between two types of factors:
 Diathesis - previous biological (including genetic
predisposition) and environmental factors that
predispose an individual towards developing a
disorder.
 Stress - trigger that taxes or exceeds the
individuals personal resource and results in
abnormal behavior.
Paradigms in Abnormal Psychology
z

 Biological Paradigm

 Cognitive-Behavioural Paradigm
 Behavioural perspective

 Cognitive perspective

 Psychoanalytic Paradigm

 Humanistic Paradigms

 Integrative Paradigm
 z Models or Paradigms for
Understanding Abnormal Behavior
 The value of viewpoints is that organize
observations, provide a system of thought,
and suggest areas of research, focus, and
treatment.
 However they can blind or limit us.
 The current viewpoint in psychology is
multidimensional, eclectic, and integrative
 Biopsychosocial viewpoint- an integrative
approach that acknowledges that biological,
psychosocial, and sociocultural factors all interact
and play a role in psychopathology and treatment.
 z Current History

 American Psychological Association (APA)

published the first Diagnostic and Statistical
Manual (DSM) of Mental Disorders in 1952. This
manual had 60 categories of mental illness.
 Subsequent versions came out in 1968, 1980,
1986, 1994 and 2013. Currently using the DSM-5
in which there are more than 300 categories of
mental illness
 Changes based upon research, societal values,
and political pressure (e.g., homosexuality,
premenstrual dysphoric disorder)
 z
Some Criticisms of the DSM
 Historically, some diagnostic labels have marginalized,
stigmatized and harmed those who are different from the
mainstream (e.g., homosexuality was once a DSM
diagnosis).
 There is limited evidence of cross-cultural validity in
diagnostic conceptualizations.
 Counselors who focus narrowly on diagnosis may only look
for behaviors that fit within a medical or biological
understanding of the person’s struggles
 The DSM system does not include sufficient emphasis on
contextual factors (e.g., developmental struggles and
transitions, culture, gender), strengths, resources, and
uniqueness that may better explain the roots of client
struggles and treatment implications.
 z
Criticisms continued

 The DSM system cannot predict treatment

outcomes or point to the etiology of mental
disorders.
 Some people may use diagnosis to accept a self-
fulfilling prophecy that their situation is hopeless
and that they are sick.
 Diagnosing may preclude a focus on the client’s
unique construction of his or her experience.
 There are flaws in the science behind DSM
diagnoses; what is and is not classified as a mental
disorder is often rooted in a political agenda and
historical influences
z
 David L. Rosenhan

Professor of Law and Psychology at

Stanford University, Stanford, CA.
1951 AB Mathematics
1953 MA Economics
1958 Ph. D. Psychology

“However much we may be personally

convinced that we can tell the normal from the
abnormal, the evidence is simply not
compelling.”
D. L. Rosenhan, 1973
Rosenhan’s Questions:
z
Are mental health professionals able to tell the
difference between those who are mentally healthy and
those who aren’t?

Rosenhan wanted to know that if the patients were

misdiagnosed, what the consequences were.

He also wanted to know whether the characteristics

that lead to physiological diagnoses reside in the
patients themselves or in the situations and contexts in
which the observers (those who do the diagnosing) find
the patients. (Hock, 2000)
 Rosenhan’s Study
z

He conducted a study where he had eight

pseudopatients pretend to be mentally ill and
try to gain admittance into various psychiatric
institutions.

There were five men and three women all

from various backgrounds used in the study.
There were three psychologists, one graduate
student, one psychiatrist, one homemaker,
and one painter.
Participants’ Instructions:
Participants were instructed to call the 12 different hospitals on both the east
and west coasts and set up an appointment.

All participants complained of the same thing… hearing voices saying

“empty”, “hollow”, and “thud”.

All participants were admitted into the institutions and all but one were
diagnosed to have schizophrenia.
Hospital Admission

There were 12 hospitals in five different

states located on the east and west coast that
patients tried to gain admittance to.

Immediately after being admitted to the

hospitals the pseudo patients stopped
showing any symptoms of abnormality.

The patients would commonly try to engage

other patients and staff into conversation.
After being Admitted
z

The pseudo patients had no idea of when

they were going to be released, when being
admitted they were told they would have to
get out on their own devices.

Each person was discharged with the label

of schizophrenia in remission.

The length of hospitalization was 7 to 52

days with an overall average of 19 days.
Observations

Each pseudo-patient took notes on their

observations while being in the hospitals.
Many times the patients would witness
physical abuse of other patients.
Powerlessness became a huge issue with
the pseudo-patients.
Rosenhan found that the average daily
contact with psychiatrists, psychologists,
residents, and physicians combined ranged
from 3.9 to 25.1 minutes with a mean of 6.8.
Why was Rosenhan’s Study Important?
People became aware that the basis
for diagnosis might not be correct.

The study also showed in certain

situations the label becomes self-
limiting and self-confirming.

Most of all Rosenhan’s Studies proved that

the hospital could not distinguish the
mentally sane from the insane.
“The hospital itself imposes a special environment
in which the meaning of behavior can be easily
misunderstood.” Rosenhan, 1973
 z Questions The Study Created:

How valid are psychological diagnosis across

mental health settings?

Is diagnosing more of a biased opinion then

science?

Do labels injure patients rather than help

guide therapy?
Has Psychology Changed?

Could you replicate this study today and achieve the same results?