All right, so you remember, way back, when we did the history section of this course, and I really highlighted Sigmund Freud, and, and the fact that he kind of created a brand new branch of psychology. That there were the experimentalists, who are really interested in just kind of studying the brain and the mind, and how we all work. And those are the people we've been mostly talking about so far, but then post-Freud, there also became a group of psychologists that became interested in mental illness. And the possible treatment of mental illness. So that branch of psychology is called clinical psychology. That's going to be the focus of this week. So we're going to talk about all sorts of interesting disorders now and, and I'm going to give you a sense of some of the treatment approaches we have to them. But the first step is going to be all about learning how we diagnose disorders. So let's go to that. All right. So the diagnosis of disorders is, is a tricky thing. and, and we're going to kind of talk about, a the process, but b some of the issues surrounding that. Before I jump right into that, though, I want to start with this caution for this week. and it's a caution that people almost always make when they start to talk about disorders. When you learn about these disorders, you will start to think about the symptoms and you will see them all around you. You will see them in people that you know and work with. but you will also see them in yourself. and so one important point that, that I want to make and that will resonate through this lecture is that's normal. That the current thinking is moving towards one where we think that a lot of these symptoms of disorders are not just unique to people have, to have the disorders. We all have them to some extent. It's just a question of how negatively they're interfering with our life. So in fact let's start there. There's this area of psychology sometimes called abnormal psychology because it's studying people with abnormal approaches to living I guess. But it's not just abnormal. So we're all abnormal in lots of ways. I'm not quite as freakishly tall as this guy is, but I am certainly abnormally tall. is that a problem? Not really. I mean this guy is pretty short. Is that a problem for him? Well for these guys their height might be some level of a problem but they're probably able to come up with adjustments in their life that allow them to live perfectly fine. If you can do that, if you have, let's say, a fear of heights, but you're able to control your life so that you never have to be at height, you don't have a problem. And that problem aspect is critical to mental illness. When we define a mental illness, we often want to focus on how maladaptive it is. That's the term we tend to use maladaptive. And what that means is, it's really interfering, either with your happiness in life, or it's interfering with the happiness and maybe security and comfort of people around you. So there has to be some real problem. That either the client or the patient feels themselves, or that those around them feel. so it's not just about being odd. it's about being odd in a way that's causing real problems. so that's the first thing to be clear about. Now, what are we going to do? Well we are going to do something that has a long history in the medical profession, which is if somebody comes to a doctor with problems the first thing the doctor will try to do is classify what disorder they have. Now this again has a long medical tradition. It is often seen as really the first step to trying to understand a disease, and to figure out then how to treat it. So if you first of all can notice, hey, you know, there's a bunch of patients who all seem to have the same sets of symptoms, that does suggest there's some single, underlying cause, perhaps. Or at least related underlying causes, so once you get this group together, almost like detective work, you can try to figure out well, what cause could these people have in common? And that might lead you towards the notion of, well how could we treat that? What's the kind of thing we could do to help these people? So grouping people, and, and classifying them into certain kinds of diseases is, you know, an important part of the process but it also has all sorts of negatives. These are some of the negatives people often highlight, especially with respect to mental illness. That when you classify people, some people argue, you kind of relieve them of some of the responsibility for their behaviors. So if somebody's acting irrationally, and you say, well that person's schizophrenic. And you classify them as schizophrenic. Does that mean now it's no longer their responsibility to behave appropriately? You know, have we just basically said, you now have a blank ticket. You're schizophrenic, you can behave as oddly as you want. Some people worry that there's a hint of that going on. A, a lot of people worry, especially with respect to mental disorders, that there's, there's a lot of noise in the classification. I'm going to come back to that in a moment. But, it's not the case with mental disorders that people seem to cleanly fall into this category or that category. We're going to talk about these categories as if they're nice, clean, little categories with, with a set number of symptoms. But in fact patients are often in multiple categories. They have, they have symptoms that are parts of multiple categories. And they often do not have all of the symptoms of a given category. And so, for example, if we say somebody's schizophrenic, we might call them schizophrenic simply because of one symptom that they have that's really strong and that's associated with schizophrenia. But when we do that, we're implying that they have all the symptoms of schizophrenia. and that might not be true. So that, that may, you know, be a problem as well. Certainly it can result in negative stereotypes. You know, if you are labelled as having some disorder, it may become very had for you to find a job. Maybe hard for you to find friends people might just, be scared of you quite honestly. in their ignorance. That sort of prejudice kind of issue. Oh, he's schizophrenia, I don't know what that means but I don't trust him now, he's, he's, you know, whatever, creepy, I'm going to keep my distance. so there's that issue of labeling somebody and then this last issue a, a lot of people point to as, as the real, as a real important problem. If I ask you to look out your window and, look at a tree. And I say, hey, are the leaves blowing on that tree? Sorry, are the leaves moving on that tree, and if you say, yes, they are, if I say, what causes that? You might say, wind. But really what you've done is you've just labelled what you're seeing. We call that phenomenon wind. But saying it's wind does not explain how it's moving leaves. You know, you obviously have to get into some issue of you know, we have high pressure air and low pressure air, and, and that moves the molecules in a certain way and, you know, that's the real description of why the, the leaves are moving. But we just say wind and we use that label. And often we use it probably without even really knowing what wind is. Like, how does it really happen. And so the worry is with, with mental illness that if you say somebody has manic disorder, manic depression, let's say. You, it's like you've explained it, but then there's the question of well, what's manic depression? Like, how does that all come about? So labeling can imply false understanding. And that can be a problem. And yet, again, it seems like this is the only path to really try to understand mental disorders and to ultimately treat them. So, classify and labeling is what we do. In fact, we use this book to do it. It's something called the Diagnostic and Statistical Manual of Mental Disorders, the DSM. It's gone through multiple revisions through time. There are things, there are certain disorders that, that used to be considered. There are certain behaviors that used to be considered a disorder. homosexuality, for example, which no longer is. And there are new behaviors that never used to be considered a disorder that now are. I'll show you one of those in a second, you might have it. Given you're watching movies, I'm worried about you we'll get to there in a second. Let me tell you how this manual works. Imagine you come into a doctor, you have some issue, let's say feeling really anxious, okay? What are they going to do? Well, they're going to ask you a bunch of questions. And these questions will relate to five axes. axis one will be questions about major clinical syndromes, things like schizophrenia, for example. trying to get a sense of, or mood disorders, or something like that. Trying to get a sense of whether you have one of the very severe mental disorders. Uh,axis two is about a different kind of disorder that are called personality disorders. Sometimes personality disorders have more of an effect on others than they do on, on ourselves, but they may be suggested if you have trouble in relationships and such; they may be looking at personality disorders, so they'll talk about that. So these two are sort of the, the mental illness groups. This is about physical disorders. We actually want to know about your health. we know that health issues can cause psychological issues. If you have been diagnosed with cancer, you're going to be anxious, quite possibly. it suddenly makes you worry about things. and so, in that case, if we know someone's anxious but we find out that they've been diagnosed with cancer, okay, that makes us think about the anxiety in a different way. Stress is also very important. there, there's a lot of evidence now showing that a lot of psychological disorders are related to levels of stress. Sometimes in fact, a psychological disorder can be short-lived because it's related to just some short-term stressful event, like going through a divorce for example. other disorders can be triggered by stress, and that makes them, you know, full blown mental disorders. So we want to know about the severity of stress in your life to get an understanding of what might be going on there. And then finally, remember when I said the behavior has to be maladaptive, we want some notion of how much of a negative impact is this having on your life. So it's called a global assessment of functioning. But it's really about how much of a problem is this. and so these are the things a clinician will get at. Here's the kind of process they might go thorough. So you come through, you come in and you say, I have these symptoms of anxiety. First, everything up here is going to be, well, let's make sure that this is a psychological issue related to anxiety and not something else. So, could this be a brief reaction to stressful events? if something really stressful was going on, you just got fired you might be really anxious about finding a job or whatever, but this is considered a, a an adaption disorder. That you're going through some very stressful situation. And okay, yes, you have anxiety, but this is probably not, a, a long term problem. It's something we gotta get you through but we don't really consider it a major anxiety disorder. this is the cancer one. So let's say, no, you don't have any stress. noth, nothing, no, no immediate stressful event. Have you been diagnosed with any sort of illness lately or anything like that, well if yes, maybe that's what's causing the anxiety. But let's say no, that's not true either. Do you consume a lot of alcohol or other substances, you know, if we're related to anxiety, especially, you know, something like an amphetamine, cocaine or speed. if your doing something like that, well maybe that's what's causing the anxiety and we should look into that first. not focusing on the anxiety so much it's more of a consequence of another behavioral problem, substance abuse. But if that's not the case, now we look at some of those other major disorders first, the axis one stuff. are you having major psychotic issues, are you schizophrenic, do you have a strong depression?. If those things are there and if they're strong, then that's what we really want to worry about as well. But if it's none of these things, so if it's not stress, it's not illness, it's not substance abuse, and it's not some more serious psychological issue, then we say okay, this is an anxiety disorder, and now we want to figure out what kind of anxiety disorder. and so here are some examples of different anxiety disorders. And we'll talk about these in the next lecture. Some of them, anyway. And here's the predominant symptom. This is the thing we want to know. Like, if you're re-experiencing some traumatic event, if a person had been say raped, or if they were in a, a war time situation and they keep re-experiencing that, then that's post-traumatic stress disorder. It's a fear of objects or situations. It's phobic disorder, et cetera. So we can go through here and now try to categorize you very specifically as suffering from one of these disorders. Okay, so that's the kind of process that we would go through to categorize. Now, a couple of caveats. One is I want to, there's two things here I want to show you. So don't look at the one on the right for a second. Let's go here. I want to emphasize that point I made earlier. You characterize somebody into a category but it's very important that you understand that people don't tend to fall nicely within a single category. this is an example of patients who have been diagnosed as having a opioid addictions okay, so they are substance abuse disorder is, is what that's called in this case opioid. When you look at these patients you will notice that they also tend to have a lot of other disorders they could also be diagnosed as. Being depressed, being bipolar in some cases, many of them are bipolar, that's depressed mixed with mania, we'll talk about that, some of them have this generalized anxiety disorder, they just think things are bad, bad things are going to happen, some of them have PTSD, et cetera, all the way down, schizophrenic, eating disorders, impulse control, sleep disorders. So, yes, they have that substance abuse disorder, but they often fit in other categories, too. And that's the real challenge with mental illness, is it's not, people aren't having these nice clean little things that we can figure out and solve. it seems like one mental disorder kind of triggers others, or at least that people who suffer from one have these wide, much wider symptomology. Okay. Now here, this is the one I, I, I threatened you with, that maybe you have. This is an example, I, I present this for two reasons. One is it's an example of something that would never used to be in the DSM quite obviously because there never used to be an internet. Can't be addicted to something that didn't exist. so this is a, a checklist for internet addiction. That's the other reason I'm presenting it. I want to give you a sense that when you are trying to categorize somebody, there's typically a large set of symptoms, in this case, eight. And you would consider somebody having this disorder if so many of these symptoms are present, in this case, five or more. Do you have five or more? Are you preoccupied with the internet, that is do you think about it even when you're not on it, do you remember your last internet session and look forward to your next. Do you need more and more internet all the time to feel satisfied. Have you ever tried to. Cut it out of your life. Even for a brief period. I'll go two days without accessing the internet. I don't know if anybody does that anymore, but, but maybe. are you restless, moody, depressed, or irritable when you're attempting to cut down, or stop the internet use, et cetera? So, you know, you can go through all these, are you lying to family members, therapists, or others to conceal the extent of involvement with the internet? if you had five or more of these then you could be diagnosed as being addicted to the internet. Now, let me come back. Is that a problem? If it fits within your life and you don't feel bothered by it and those around you don't feel bothered by it, it may not be a problem. if your marriage is falling apart because you're online all the time, then it may be a problem. So keep that in mind, the maladaptive sense of it is all, is very important too. So just because you might say yeah, I fit that, don't assume oh I have this mental illness. You know, it depends on, on how maladaptive it is. Okay, the last point that I want to come back to because I want you to think about this when we talk about all the mental disorders. As we move from the DSM four, to the DSM five, the push is to really change the language and accept more of a continuum notion versus a classification. So the classification system we've been talking about. Is, kind of implies if someone has, let's say I don't know, post traumatic stress disorder, then they are experiencing something that the rest of us never experience. You know, reliving some traumatic event over and over and feeling all the emotional stuff that goes with that. is that true? Let's, let's take a more challenging one, schitzophrenics. One of the, with the strongest defining symptoms of a schitzophrenic is that they hear voices in their head, talking to them. I hear voices in my head. I bet you hear voices in your head. Is that really such an odd symptom? Well, in reality when you dig a little deeper it isn't that they hear voices in their head, it's that they hear voices in their head that they don't think came from them. They think the voices came from the outside world. So this is interesting. What they really have a problem with then is not the voices in the head, but the distinction between things that occurred in reality and things that occurred in their mind, they have trouble separating those two. Well don't we all sometimes? Have you ever said to somebody, did I tell you this? Because I meant to tell you this, but I, I can't remember if I actually told it to you. I feel like I told it to you. That's somebody trying to say well I had the thought in my head, we had this conversation here. I just don't know if we had this conversation here. and so we have that split. Even more schizophrenic, I sometimes will be sleeping and almost always happens when I'm laying in bed and I will swear somebody just said something aloud in the room and I will look around for that person and they're not there. Now I'm pretty sure that voice I heard was in my head. But something went a little wrong with the wiring, and my brain heard that voice coming from the outside world. and it startled me, and I woke up. so that symptom of schizophrenia may be present to some extent in all of us. And that may be true of every disorder we talk about, hence when you're looking in the mirror and you see some of this stuff. But, again keep in mind maladaptive, maladaptive, maladaptive. If those sorts of things that I'm talking about, you know. Did we talk about this thing or did I just think it? If it's not negatively affecting your life, if it's not happening so often and so dramatically that it's causing problems, then you do not have a disorder. But in terms of the DSM the notion is if we frame it this way. If people with disorders are just showing extreme versions of natural tendencies, it, it may be a more true depiction of what's going on. And that's kind of a push in the clinical diagnosis area to go that direction, so kind of cool. this notion that, you know, really we all have a balancing act. that we're walking between sanity and insanity. Some and, and it could be just a little bit too much of something that, that makes us become in the mental disorder category. Alright, cool. Cool things for you to, to think about. Here's some videos, a couple on, well, one here on the stigma of diagnosis. This is just sort of a PowerPoint walk-through of the DSM, so if you really want to kind of see it, and the guy kind of struck me as funny, so, I threw that there. This is a little video where people worry about doctors being too willing to diagnose somebody with a mental disorder, and the problems that can cause. so check that out. That's just like a two minute one. Here, you can access the DSM, yourself, if you want to get at it, an, and take a look at it. and this is a Psychology Today article, about, issues with respect to labeling mental illness. So check those out. You'll have a good sense of a diagnostics, diagnosis thing. And we're going to come back, and, and I think we're going to talk about anxiety disorders, next lecture. Don't be afraid.
