Mental Disorders

Mental Disorders • Insanity is a legal term, not a medical or psychological diagnosis. It indicates that a person cannot be held responsible for his or her actions because of mental illness. • For centuries, Western law has stated that a person who is mentally incompetent should not be punished if he or she violates the law because the law states that people must be able to understand the significance of their actions – something they are incapable of doing if they are mentally ill.

People who are obviously disturbed – the man in a business suit who shouts at no one in particular in a public place or the woman who has refused to step outside of her apartment for the last three years – upset us momentarily when we are confronted with their behavior. • Our emotional response is not so much the trouble we have in distinguishing his or her differentness as it is the essential sameness with ourselves. • What others experience, we suspect, is in some way within the range of our own experiences. We want to know more about it.

Abnormal vs Normal • Because overt behavior is frequently misleading and because society’s standards change, it is often extremely difficult to distinguish between the normal and the abnormal. • As medical understanding increases so too does our understanding of the psychology of the abnormal. • Fifty years ago a person with uncontrollable “tics” or involuntary sharp body movements or who makes repetitive noises, was seen as being mentally ill and often assigned to a psychiatric ward – now we know that he or she as a neurological condition known as Tourette’s Syndrome and is psychologically normal.

DSM IV • The tool that the medical community (as well as psychologists and psychiatrists) uses is the DSM IV or the Diagnostic and Statistical manual of Mental Disorders Four, as it is called. It is a tome consisting of all of the diagnostic criteria listed for every psychological disorder or mental illness that is recognized by the medical establishment. It covers everything from anorexia to zoophobia. DSM V currently is in the process of being written and

Newest Additions • Internet Addiction Disorder (IAD)is being considered as a new one to add but there are disagreements as to the criteria and even the nomenclature, as there are some who prefer the term Pathological Internet Abuse and it is the subject of heated Net discussion.

Warning • A warning – as you progress through this particular unit in the textbook, some of you may be tempted to “personalize” some of these disorders: “That’s me! That’s definitely me!!” or one of your friends • This often happens when we flip through a medical book and believe that we may have some of the symptoms of the ailments listed. • This is a common temptation – but that is all that it probably is. • Any one of us will have some of the symptoms described – that does not make us psychologically disordered nor are any of us qualified to self-diagnose any of these mental disorders.

Definitions of Abnormal Behavior • It is important to note that there is something “abnormal” in all “normal” people. One very workable definition of those who do need help has three parts to it: • The person suffers from discomfort more or less continuously. The discomfort shows up as extreme anxiety, endless worry, or long periods of depression. In addition, the person feels that something is wrong with his or her life far more than the average person does. • Another possibility is that the person is behaving in a bizarre fashion. He or she constantly misinterprets what is going on and what others are doing or saying. For instance, this person could be afraid to go to work or school. He or she frequently comes apart over minor things or sinks into a depression about them. • Finally, people who need help can be very inefficient. This means that they are unable to perform their life roles properly

Examples: • Alcoholic who refuses to accept that there is a problem • Aperson who does nothing while his or her family life is coming apart • A parent at home with the children who cannot even cope with the dirty dishes • A student who reads no assignments, doesn’t attend class, and has nothing but trouble with most of the teachers. • Any one of these symptoms or a combination can indicate trouble. In addition, just as the degree of disturbance will vary, so will the degree of the symptoms. • For example, the student just mentioned is in far worse shape if we add that he or she has no friends, locks himself or herself in a room most nights, and doesn’t talk to family members.

Inflexibility • Many people in need of help have trouble getting along with others are typically inflexible. • This means that they can’t go with the flow of life but instead plow ahead, with a fixed set of responses to almost everything. • Thus a shy, withdrawn male goes to a party, and a few people are nice to him. This should help his self-image, but instead he misinterprets, just as he always does, and thinks that they are only “feeling sorry” for him. • Or a person who cannot tolerate elevators never accepts that the fact that they are reasonable safe, even after hundreds of forced trips. • So, feelings, thoughts, and actions won’t vary much. These people establish self-defeating boundaries around themselves that won’t budge.

Environmental effect: • Another characteristic is that these people constantly see a threatening environment. • A number of studies suggest that their world is colored a gloomy gray because the worst is always expected or seen. • Their thoughts and feelings are hardly every warm and outgoing, but instead are tinged with fear. • They see danger, rejection, and failure around every corner. Psychosis: • Mild disorders refer to non-psychotic disorders, a severe disorder is a psychosis – when a person is out of touch with reality. • Some of the signs of abnormal behavior are continuous discomfort, acting in a bizarre fashion, inefficiency, inflexibility and constantly perceiving a threatening environment.

Anxiety Disorders • Three categories of problems – 1) panic, 2) phobia and 3) obsessive-compulsive disorder – have in common one thing: the person suffering from them also suffers from severe anxiety. • Hence these are called anxiety disorders. Except for substance abuse, anxiety disorders are the most common type of mental disorder.

Anxiety • Anxiety is a generalized feeling of apprehension and dread that includes many bodily upsets. • The palms sweat, the throat closes up, breathing is erratic, the heart pounds, hands tremble, and the armpits perspire. • All of us experience anxiety, but people with anxiety disorders may have anxiety attacks, a few times a day, and in between they are restless, sleep poorly, don’t eat well, and are not capable of calming down. http://www.youtube.com/watch?v=_Cr7IomSy8s

Panic Disorder • Afflicted by frequent and over-whelming attacks of anxiety. • Sometimes a panic disorder originates in the person’s psyche, probably developing from years of feeling in secure and helpless. • But often such a disorder starts becomes something is physically or chemically wrong with the person. • Once they have occurred, these panic attacks tend to repeat themselves whenever the person is under stress. In other words, the anxiety at first is not really connected to anything specific; it is just a physical occurrence. • Soon, however, the panic begins to spread, as the fear of dying or making a fool of oneself is associated with more and more objects, events, or people. • Eventually the person may reach a point where activities are severely limited because of these fears. • When that happens, the problem is no longer simply physical but is psychological as well. • Still, many who suffer can be treated with drugs that will reduce the symptoms. • Psychotherapy is also very effective.

Phobic Disorders • Person becomes disabled and overwhelmed by fear in the presence of certain objects or events. • Anxiety is still extraordinarily high but usually only in the presence of the problem. • The word phobia means “fear of” and there are two basic types of phobic disorders. • A specific phobia • Agoraphobia

1. Specific phobia • centers on particular objects or situations • Examples: dogs, enclosed spaces, snakes, heights, elevators, water, even knives. • Faced with the object of fear, the person becomes extremely anxious. (Note the difference here: a panic attack is not attached to something specific as the phobia is.) • The most common explanation for phobias today is that they result from association or learning. If a little boy cut himself and the parent began screaming, crying and running around shouting, “You’re bleeding! You’re bleeding!” the child with repeated such incidents, could easily develop hematophobia, a fear of blood (hema). • All of us have mild phobias. Many people fear that they will jump off high buildings; others are hesitant to use public rest rooms for fear of getting germs. But for true phobics, the danger is so real that they live in mortal fear of being anywhere near the object. • Caution: trying to get real phobics to overcome their fears by deliberating forcing them into the feared situation can be very dangerous. Phobics have been known to die from an overload on the system. • The problem usually can be treated both efficiently and safely by a professional in a matter of a month or so.

agoraphobia • Meaning the fear of leaving a familiar environment. • Agoraphobics are so fearful of the world outside that they become virtual prisoners in their own homes. • The following case is interesting because it shows how an accidental event, such as an ear infection, can trigger a mammoth psychological event – the agoraphobic – that will go on and on. • Ex: A 42-year-old married salesman had been in traveling sales work for ten years. One night when on the road at a motel, he developed an infection which spread to the inner ear making him feel very dizzy. He decided to go to the bar and get a drink to “pick himself up”. While sitting at the bar, things began to whirl around and the next thing he knew, he was lying on the floor, looking up at strangers all peering down at him as in a nightmare. He was certain he was dying because his heart was racing and people were saying things about a heart attack. He felt desperately alone, frightened and embarrassed. The infection cleared up and everything seemed to be all right. But a week o so later, when driving down the highway, he started to feel “funny,” weak, dizzy. He pulled off to the side of the road and waited the attack out. Instead of going on, he turned around and went back home where he felt safe. Within a matter of a month, he began to have anxiety attacks every time he left the house, and called in sick more and more often so he wouldn’t have to leave home.

Interesting fact: • One oddity of agoraphobics might be of interest. Most of them have a specific boundary beyond which they cannot go. • It varies from person to person. • Thus, some people can go up to three blocks, some ten, some another number, from home. • If they go even a few feet beyond, they come apart, but if they stay within the boundary, they are all right.

Obsessive Compulsive Disorder (OCD) • Anobsession refers to an endless preoccupation with some type of urge or thought. All of us have experienced this to a limited degree when we can’t get a popular song out of our minds. Eventually it disappears, but magnify this many hundredfold and you have the concerns of the person suffering from this disorder. The thoughts simply will not leave such a person alone. • A compulsion is a symbolic, ritualized behavior that a person must repeatedly act out. Each time the person does so, whatever anxiety he or she feels is decreased, so the behavior becomes self-rewarding and is repeated. • Most people have minor compulsions, such as a desire to step on a crack in the sidewalk. • Genuine compulsions are different because the people must carry out the act or they get more and more anxious. Some, for instance, wind up checking dozens of times to be certain that the front door is locked before going to bed each night. That’s not normal.

OCD • The two words, obsessive-compulsiveare generally used together. Most compulsive people are obsessed with their compulsion; • For instance, the compulsive hand washer is obsessed with the thought that he or she is “dirty.” And being obsessed with cleanliness leads to compulsive washing. • “As Good As It Gets” with Jack Nicholson = http://www.youtube.com/watch?v=44DCWslbsNM • Howie Mandel = http://www.youtube.com/watch?v=kUlbCBk77N0

Somatoform Disorders • In somatoform disorders, psychological issues are expressed in bodily symptoms, but there is no actual physical problem. • Most of us feel worse physically when life is not going too well. Somatoform disorders, though, present a far more dramatic picture. • Hypochondriasis • Hypochondriacs are overly concerned about their health. • They see disastrous illness in the most minor physical complaint. Thus, a slight headache is interpreted as a symptom of brain cancer; a case of the sniffles is really pneumonia, and so on. • Often, such people, as children, were given affection or support from other people only when they were sick. • They never learned better ways of getting attention. Having spent years focusing on their health, they have trouble breaking the cycle. Needless to say, these people spend a great deal of time in doctor’s offices.

Conversion Disorder • You may have heard of “hysterical blindness” or “hysterical paralysis.” • The technical term for both of these situations is conversion disorder. • In a conversion disorder, a serious psychological trauma is unconsciously changed (converted) into a symbolic physical dysfunction. • For example, a person who has witnessed terrible human torture and slaughter may be overwhelmed by the horrors, so the mind shuts the visual system down. The person can no longer see. • Or someone else was in an awful automobile accident and managed to get free of the car. He or she could hear other people screaming, but, frozen by fear, was unable to move, to go get help. • That person might develop some type of paralysis in response. These people are not faking it. Say that someone has, psychologically, lost feeling in the right leg, • If you sneak up behind the person and stick a pin in that leg, he or she will not feel it. The dysfunction is real. There simply is no physical basis for it. Interestingly, however, such people show very little concern about their physical condition. As you might imagine, conversion disorders are quite rare.

Münchausen syndrome • Quite opposite from Conversion Disorders • These people fake their illnesses/injuries to get attention • Also known as hospital addiction syndrome • Unclear whether or not people are conscious of drawing attention to themselves • The affected person exaggerates or creates symptoms to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. • Sometimes they are highly knowledgeable about medicine and are able to produce symptoms that result in lengthy and costly medical treatment • Ex. Eminem’s mom

Dissociative Disorders • Dissociative disorders are best knownfrom soap operas on television. • Ex. The major character develops amnesia and forgets she is married to a prominent attorney. She falls in love with a wealthy physician at the local hospital where she is treated for the flu. The physical is married to the head nurse, who has dissociative identity disorder and who got the woman-of-the-year award but steals drugs, which she sells on the street. Meanwhile… • If one paid any attention to television, it would seem that this sort of thing goes on all the time. • Actually, dissociative disorders – amnesia, fugue, and dissociative identity disorder – are extremely rare. • People with dissociative identity disorder often have an aspect of themselves that causes such guilt (for example, a repeated tendency to violate the law) that they cannot face this aspect and thus block it off. • Since this part won’t disappear, for these people it grows and grows until eventually they form a separate personality that can do these acts and not be responsible and guilty for them when they return to their “good” personality.

Amnesia • In psychogenic amnesia, memories related to a terrible trauma “disappear”. • They are still “in” the person, but they are cut off from consciousness. • While some amnesiacs can be caused by a high fever or a blow to the head, the term psychogenic means the problem is psychological (psycho) caused (genic). • In fact, people with this problem often show little concern that parts of their past seem to be gone. Hence, there must be a psychological benefit involved, or they would indeed be alarmed at losing some of their memories. • Ex. soldier’s loss of memory for nightmarish events that happened in battle. • In such cases of amnesia, selective forgetting is involved which means that only the traumatic portion of the memories disappear. • For example, a soldier may completely blot out the part of the identity connected with his fighting battalion and everything in the more recent past leading back to a horrible war experience. • The terror and guilt these memories produce therefore disappear, occasionally reappearing in nightmares. But only certain events are gone: the soldier doesn’t forget how to tie a shoe, childhood friends, old memories, and so forth. In fact, amnesia in all these cases is selective.

Fugue • The fugue state is an extensive, complicated type of amnesia. The person disconnects all of his or her current life from awareness, moves somewhere else, and starts all over. More men than women exhibit this problem. • It seems to be caused by serious and unresolved conflicts, often with a spouse. • Fortunately, this condition usually does not last very long. • When the person “comes out of it,” he or she cannot remember what happened during the fugue state.

Dissociative Identity Disorder • Dissociative identity disorder, formerly called multiple personality, in the basic form is also similar to amnesia. • Instead of forgetting specific events, though, such individuals “forget” a portion of themselves, and that portion begins to live a life of its own. • Although multiple personalities are all over television and are usually called schizophrenics, which they AREN’T(!), they are usually extremely rare. • Dissociative identity disorder is probably so rare because a number of conditions must align themselves in just the right way in order to produce it. • Such conditions typically include a haunted, confusion personality, a history of very upsetting traumatic experiences or childhood abuse, and a long-term habit of escaping from almost any problem. • Usually these people have very strong, conflicting desires and needs in their life-styles. • For example, a withdrawn and righteous man (call him A) who desperately wants to give vent to animal impulses develops mammoth guilt over these desires. To distance himself from this pain, another personality gradually creeps into the picture containing these unacceptable desires. This is evil personality “B”. He can then go about doing whatever he wants as long as he is B. When A returns, he becomes very self righteous, even prim, prissy, and obnoxiously good. Complete amnesia can be involved, with A not knowing about B and vice versa. Sometimes, however, the dominant or stronger personality knows about the weaker; the weaker rarely knows about the stronger one. • http://www.youtube.com/watch?v=0tITzDjPf4g

IT IS NOT SCHIZOPHRENIA • The dissociative identity disorder is not schizophrenia. • In dissociative identity disorder, there is really only one person involved with two or more sides that tend to live independently. • But the basic core personality is the same, and this one is well aware of general reality as we know it, does not have trouble thinking or communicating, and does not believe things that don’t exist. • These facts are the opposite of what happens in schizophrenia, discussed in later.

Mood Disorders • The mood of an individual is his or her emotional state – elated depressed, angry, neutral, and so forth. Thus, mental disturbances characterized by a depressed mood, an exaggerated “up” mood, or an alternation between up and down are called mood disorders. • Dysthymic Disorder • The term dysthymic disorder comes from the Greek for “low spirits.” Hence, it is a moderate depression. • In any given year, between 4 -12% of the population will be affected by it. • Fairly common problem and it is most likely to clear up eventually without treatment • Typical symptoms are lack of energy, unhappiness, loss of interest in activities and people, loss of sense of humor, sadness, and rock bottom feelings of self-worth. All of these feelings can occur in the normal person who, for instance, loses a loved one. • The best way to know whether depression of this sort is normal is to see if it has served its “function” or instead has taken on a life of its own that just keeps on going. • Loss of a friend, for instance, would trigger these problems in any normal person, but if they go on and on with the same degree of severity, something else is probably wrong. • Of if they appear “out of nowhere” or arise following an insignificant event, again one’s emotional makeup may include a tendency to become depressed.

Major Depression • Typical symptoms of severe or major depression are very slow speech, deep ongoing depression, disturbances in appetite and sleep patterns, lack of energy, a sense of hopelessness, extreme feelings of worthlessness, and frequent thoughts of death or suicide. • Most patients in this category have trouble carrying out simple daily tasks. • Some may even lie motionless in a rolled-up fetal position for hours at a time. It is as if all the joy has gone out of their lives. • Underneath it all, though, there is frequently a great deal of anger, sometimes directed at the self, sometimes broad and unfocused. • The depression may last from a couple of weeks to a matter of months. • Some psychologists view depression as the flip side of anxiety; rather than feeling anxious, which can be quite disturbing, we become depressed. • This is slowly being proven as many antidepressant drugs are used now to treat anxiety even though no depression is exhibited. • Depression Hurts commercial = http://www.youtube.com/watch?v=9EyXUY8ubc8

Mania • Some people have extreme upmoods. • This might sound at first like something that wouldn’t be all that bad, but unfortunately that is not the case. • This behavior, called mania from the Greek for “mad excitement,” involves agitation, restlessness, inability to concentrate, and extremely rapid speech. • This speech problem is the most notable part of the behavior. • The patients’ thoughts are moving so quickly through their minds that they literally collide with one another into a mass of confused speech, making comprehension almost impossible. • This problem is called a flight of ideas, meaning that thoughts are running so fast that they are flying in all directions. • Here is a brief example: “I went to the store where they keep the containers of milk which all babies should have in order to survive which not everybody can do because of the threat of nuclear war between countries which are divisions of various parts of the land which is filled normally with rock and dirt.” • These patients often get so excited that they begin to have delusions that they have special powers or great influence, so they make plans for controlling the world or some such project.

Bipolar Disorders • On occasion, people experience mood swings between the ups of mania and the downs of major depression. • The official term for this problem is “manic depression.” • So, people who have these wild swings from up to down and back • Causes of Mood Disorders • We don’t understand the origin of mood disorders too well. • In fact, strangely enough, they disappear all by themselves (at least 80 to 90 percent of them) within about six months, although they tend to recur in many people. • Just as the dysthymic disorder may be caused by the loss of a loved one, major depression, we suspect, may come from a lifetime of many separations, losses, and unpleasant setbacks • These people often have a very poor self-image. They see themselves as responsible for many bad events and don’t even struggle to put up a defense against such an unrealistic burden. • The problems associated with mood disorders can be so bizarre and severe and they can appear (and disappear) so rapidly that we suspect some chemical imbalance is involved. • Probably psychological components then help send the person over the edge, so to speak. • Studies show a pretty clear pattern of a chemical defect in the brain. • One brain chemical that helps keep the brain active in normal people, called serotonin, is very high – much higher than normal – in many manics; the same chemical is very low in depressives.

Mental Disorders