LECTURE NOTES: Mental Illness

DEFINITIONS:

1. Text: Hoeksema
   1. Cultural relativism : Yonomamo.
   2. Statistical deviance: that behavior which the highest percentage of people follow.
   3. Subjective discomfort: a person must be suffering and want to get rid of the behavior.
   4. Lastly viewed as a mental illness or mental disease : abnormal behaviors are those that result from a mental illness- that there is a clear physical or mind process that leads to a set of symptoms.
   5. (For Definition in Hoeksema you can refer to pages 9 and 10 items 1-4.)
2. Definition of mental illness from Wakefield, Jenna.
   1. A condition that causes some harm to the person as judged by the standards of the culture.
   2. A condition results from the inability of some mental mechanism to perform its natural function.
   3. Therefore, we can view mental illness as a harmful dysfunction.
      1. A Psychological Dysfunction: i.e. a breakdown in cognitive, emotional or behavioral functioning resulting in distress, impairment and an atypical response.
3. Definition from The DSM IV
   1. A behavioral or psychological syndrome (groups of associated features) that is associated with;
      1. Present distress (painful symptoms)
      2. Disability (impairment in one or more important areas of functioning) or with
      3. A significantly increased risk of suffering death, pain disability, or an important loss of freedom
   2. Conditions excluded from consideration:
      This syndrome or pattern must not be merely
      1. an expectable and culturally sanctioned response to a particular event such as death of a loved one
         1. Deviant behavior such as the actions of political, religious or sexual; minorities
         2. Conflicts that are between the individual and society(such as voluntary efforts to express individuality.
4. Definition from Nietzel text
   1. Abnormal behavior could best be described as a disturbance of an individual's behavioral psychological , or physical functioning that is not culturally expected and that leads to psychological distress, behavioral disability or impaired overall functioning.

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   HISTORICAL PERSPECTIVES IN EXPLAINING AND CONTROLLING ABNORMAL BEHAVIOR.
   1. 1000's of years humans have tried to explain and control problematic behavior
   2. Efforts derived from theories or models of behavior popular at the time.
   3. Three Major Models : supernatural, biological, and psychological
   4. Outline:
      1. Supernatural- divinities, demons, spirits, or magnetic fields(moon and stars, eg. Lunatics)
      2. The Psyche (soul ) Mind as separate from the body. Which lead to a split historically into the Biological and Psychological.- Due to the belief that the mind can influence the body as well as the belief that the body can influence the mind.
   5. History of Abnormality- Zietzel and Hoeksema
      1. ANCIENT TIMES: - ( supernatural forces) -
         1. 300 B.C. Trephining- surgery during the stone age: drill a hole and let spirits out
         2. Ancient Times: Supernatural continued
            1. Hebrews: King Saul was treated with calming music
            2. King of Babylon: Nebuchadnezzar was stricken with Lycantrophy- he believed he was a wolf and sent to the wild until after he saw a reasoned it out he was reinstated.
            3. Prayer and faith healing also used and astrology
            4. Church: shaved the heads in a pattern of a cross and told to sit out in front of the church until improvement.
            5. Exorcisms were also performed
      2. Medieval and Classical period: (naturalistic)
         1. 600 B. C.- Plato and Aristotle: rationality and reason- Aristotle Empiricism and science eventually led to the science of psychology. - at the time the medical doctors were viewed as experts who recognize and treat disorders.
      3. Middle Ages and Return of Demons:
         1. A phenomenon of Mass Hysteria
            1. TARANTISM: wild parties in Europe lead to mass panic and contagion of madness behavior ( street dancing and bizarre outbreaks).
         2. Religious influences in Europe 1400's- burnings, witchcraft common
         3. Snakepit- belief if you hang the mental ill from a pole with a pit of snakes below they will get better; a % did not necessarily because get cured but traumatically frightened: later on some early institutional practices used the snakepit.
      4. The Renaissance and Humanism:
         1. viewed insanity as a natural phenomenon caused by mental or emotional stress and it was treated and curable by rest, sleep, and a healthy happy environment.
            1. The development of the printing press 1440 books appeared objectifying information other than the church
            2. Copernicus theory initially contested by church; however physicians were again given respect a s knowers of mental activity as well as physical.
      5. Development of Asylums:
         1. 1547 Bedlam: English asylum, but treatment was poor and inappropriate. Dungeons no treatment specific practices.
      6. Classical School
         1. 1764 Free will and Hedonism: differentiated between criminals and mentally ill- not mentally ill were held responsible for their actions punishment to fit the crime.
      7. The Birth of the Science of Psychology
         1. The rise of empiricism and the scientific method in the late 18th century.
         2. Empiricism: is the verification that something exists by the use of one of your senses- hear, smell, taste, feel, and see; if you cannot it is not empirical.
         3. We need to make use of the scientific method in order to make appropriate assessments when determining whether behavior is abnormal.

1. Assessment- defined as a systematic evaluation and measurement of psychological, biological, and social factors in an individual with a possible psychological disorder.
2. Assessment - Gathering of Information - outline overview:
   1. Talking about current symptoms and what is the presenting problem
   2. Recent events
   3. Physical conditions: medical.
   4. Drug and alcohol history
   5. Family history
   6. Self concept.
3. Tools For Assessment:
   1. Clinical Interview
      1. Mental Status exam: the purpose is to make an appropriate assessment for successful treatment. Gives a preliminary determination of the areas to explore more fully,
      2. Critical characteristics of mental health interview is for the examiner to have training, trustworthiness and empathy.
         1. Appearance and behavior
            1. Body twitches, dress, posture and facial expressions.
         2. Thought process
            1. Rate and flow of speech- is it really fast or slow.
            2. Continuity of speech- is it presented connected.
            3. Content of speech.
         3. Mood and affect
            1. Mood: Overall predominant state of their feelings
            2. Affect: determine the appropriateness of expressed feelings or are they,"blunted' or flat."
         4. Intellectual functioning
            1. Vocabulary
            2. Memory
            3. Abstractions and metaphors.
         5. Sensorium
            1. Awareness of their surroundings: does the person know the date, time, where they are? And do they know what they are doing with you during the interview.
      3. Additional aspects essential for the mental status exam to be included for successful treat during the interview.
         1. What are the current symptoms and presenting problem-
            1. Severity of symptoms and chronicity of symptoms-
            2. How serious and how long specific recent events.
               What events in their lives just occurred.
            3. Persons present level of functioning and or how much is the problem interfering with this ability- look at work, school, relationships, personal hygiene.
         2. 2. Recent Events ( positive or negative ):
            1. What events have led to stress.
            2. Note- should be careful with a differential diagnosis when bad or good stress is involved. i.e. a new job, divorce, child's adjustment to first day in school, etc.
         3. Self-concept:
            1. look at coping skills, self-efficacy, and person's ability to adjust.
         4. medical examination required if suspicion of mental or physiological organic diseases and or disorders.
         5. Social supports and resources.
         6. Drug use
         7. Past history of psychological problems
         8. Sociocultural background.
4. Tools For Assessment Other Than the Clinical Interview:
5. Biological tests:
   1. Brain imaging tests- determines brain pathologies such as brain tumors, injuries, and structural abnormalities.
6. Neuropsychological tests- assess brain damage for cognitive and fine motor deficits.
7. Psychological Tests: I.Q. tests, personality inventories and symptom questionnaires- tests general levels of intellectual functioning, stability of personality, and self reported symptoms respectively. Additionally projective tests are also used to assess manifestations of disorders.
8. Behavioral observations and self-monitoring - may determine triggers of symptoms and direct behavioral deficits.
   1. On site visits- schools for children
   2. Role play situations: with individuals or couples
9. Problems in Assessment:
   1. Resistance- deals with both conscious and unconscious forces preventing accurate assessment of the clients actual difficulties. The client may further resist treatment and not allow the therapist to be successful in helping .
      1. Common obvious reasons for resistance include:
         1. being asked by a spouse or family member to go for help,
         2. parents making a child see a therapist or
         3. a school referral, and court orders.
      2. Not so obvious reasons are the unconscious psychological factors which are more difficult to determine for the therapist. These areas may not become apparent for long periods of time even after treatment is designed by the therapist. Several reasons would be not wanting to get better, fears that life may change, and what impact the treatment may have on others in the persons life. Very often we are not aware of these areas of resistance because they are unconscious.
   2. Countertransference: Responding to the client as if they were an important person or significant other in the therapist world or relationships past or present that bias assessment and or treatment.
      Supervision and good insight in their training may help the therapist identify the countertransference but again this phenomenon is both conscious and unconscious.
      In countertransference therapists may experience in their own pathological way their unfinished business.
   3. Three problems for countertransference are:
      1. The conscious effort to heal the client
      2. Relief the therapist may experience from their own problems,and
      3. Narcissism and interference of personal motives when doing clinical work.