Summary 2019 Psychology 314 Rebecca JvR (19980329)
Week 1: Introduction
Lecture 1:
Psyche = mind or soul, Pathology = sickness or illness
Psychopathology = Abnormal behaviour / Mental illness / Psychological disorder
- Pain, distress, vulnerability. How we defend against it or cope with it.
How to Diagnose:
- List the signs and symptoms
o Signs = clinician’s objective findings and observations
o Symptoms = subjective experiences described by patient
- Evaluate information
- Differential diagnosis
o List of possible diagnoses to be considered in decreasing order of likelihood
- Working diagnosis
o Principal diagnosis
o Non-principal diagnosis
o Provisional diagnosis
o Diagnosis deferred
o Ruled-out diagnosis
- Double check DSM exclusion criteria
Example: Case of Dora
- List symptoms
- List signs
- Can you come up with a diagnosis?
- What are the advantages of diagnosis?
- What are the disadvantages of diagnosis?
Theoretical issues surrounding diagnosis and DSM-5
- Concept of abnormal / normal is subjective and interpretive
- Criteria for abnormal:
o Unusual = statistical – behaviours that deviate from the average
o Non-conformist = societal norms violated (can lead to relativism)
o Impairment (work and love) = interruption / restriction of daily life
o Distressing for others
o Distressing for self (sometimes it is appropriate to be sad or anxious)
- Factors to take into account when diagnosing:
o Age (developmental factors), Gender, Culture, What happened before (recent
trauma), Pattern / once-off, Explanation, How it affects others, Medical
factors, Context.
- History of DSM-5
o Sydenham (1624-1689) – ‘English Hippocrates’
Classification in medicine
Syndromes are:
Recognisable clusters/patterns of Symptoms and signs that run
together in an evolving clinical history
Helped to isolate distinct diseases with distinct causes
Allowed specific treatments
Allowed prediction of course.
Page 1 of 132
,Summary 2019 Psychology 314 Rebecca JvR (19980329)
o 18th and 19th century
3 groups of mental illness
Madness
Disorders of mood
Psychoses based on brain injury
The many different classification systems that have developed differ in
their relative emphasis on phenomenology, aetiology and course as
defining features, as well as their number of diagnostic categories.
They differ in their principal objective being for use in a clinical /
research / administrative setting.
o Kraeplin (1917)
Introduced Sydenham’s syndromal approach
Collected life histories
Three clusters of illnesses
o Freud
Emphasis on dynamic unconscious (motives, wishes, memories,
fantasies)
Sexual and aggressive
Techniques: hypnosis, free association, dream interpretation
Psychoanalysis dominates American Psychiatry
o DSM (1952)
Very psychoanalytic, 108 categories, 8 headings
o DSM-II (1968)
Revised to match ICD, Little interrater reliability, Diagnostic error
o DSM-III (1980)
Goal: to make diagnosis more reliable, not based on clinical consensus
but on scientific evidence, no aetiology, claims that it is a-theoretical
and useful to clinicians from different theoretical backgrounds, not in
prose form, multi-axial, 265 mental disorders
o DSM-IV
- DSM-5 Critique
o Categorical (between disorders, abnormal/normal, axes)
o Focused on the individual
o Clinical judgement still there
o Ignore strengths/resilience
o Danger of labelling
o Culturally specific
o Euro-American outlook
o Male perspective
o Symptom orientated
o No analysis of explanation (like naturalist’s field guide to birds)
o Situate problem in individual
o Context not taken into account (psychological response to adverse situation)
o False positives: level of impairment not correlated with symptom counts
(stems from individual and cultural factors)
o Neurophysiological bias vs importance of social-psychological variables
o Reductionist
o Medicalisation of human nature
o Drug companies
o Instruments of social control
Page 2 of 132
,Summary 2019 Psychology 314 Rebecca JvR (19980329)
o Political problems – Paraphilias, Hypoactive Sexual Desire Disorder.
- DSM-5 advantages
o Communication
o Treatment and prevention
o 3rd party reimbursements
o Legal proceedings
o Predicting course / patterns of disease
o Advise to families
o Classify disorders not people
o Decision-making
o Prognostic implications
o Consumer protection
o Communication of empathy
o Forestalling flights from treatment
o Other
Lecture 2: Aetiological Models
Aetiology = study of origination or causation
Provides a framework for understanding symptoms and making decisions regarding diagnosis
and treatment.
Due to the complex and dynamic nature of disorders, aetiology does not provide direct
answers about causes.
No aetiological model is better than others
Strong focus on a cross-cultural, Southern African view of abnormal behaviour
- Biomedical perspectives
o The biomedical model claims that all mental illnesses have a biological cause
o Factors like social pressures, type of parenting, or other environmental factors
seen as secondary in the precipitation of mental disorders
o Biological abnormalities are understood to occur in four different areas:
Genetic predisposition
Abnormal functioning of neurotransmitters
Endocrine dysregulation
Structural abnormalities in the brain
- Psychological perspectives
o Psychodynamic approaches:
Derived from Freud’s theory of psychoanalysis
Behaviour is largely influenced by internal forces that exist outside
consciousness
Psychological disorders emerge from conflict between the id, ego and
superego, as well as deficiencies in the ego
Defence mechanisms are used to ward off excessive psychological
pain
Contemporary approaches include the work of
Melanie Klein – object relations
John Bowlby – attachment theory
Heinz Kohut – self psychology
Donald Winnicott – the independents
Intersubjective psychoanalysis and relational psychanalysis
Page 3 of 132
, Summary 2019 Psychology 314 Rebecca JvR (19980329)
o Behavioural / learning perspectives
Based on the experiments of Pavlov, Watson & Skinner
Behaviour is learned through processes and mechanisms like:
Habituation – gradual adaption
Sensitisation – extreme response to a stimulus
Classical conditioning – association
Operant conditioning – reinforcement
Modelling (Bandura) – observation
Dysfunctional behaviour develops because an individual learns
ineffective or dysfunctional responses or fails to learn appropriate,
adaptive behaviour.
o Cognitive-behavioural perspective
Mental disorders are caused by aspects of the content of thoughts as
well as information-processing factors.
Different perspectives, for example:
Theory of helplessness (Seligman)
Theory of hopelessness (Beck)
Rational-emotive theory (Ellis)
Beck’s cognitive theory of depression suggests that negative automatic
thoughts trigger a negative process of cognition, affect, and behaviour
o Humanistic and existential perspectives
Emerged as a third force in psychology, opposing the determinism of
the psychodynamic and behaviourist approaches
The humanistic approach (Rogers & Maslow) believes in a person’s
free will and ability to choose how to act.
The existential approach (May & Laing) emphasises the uniqueness of
each individual and the quest for values and meaning.
- Social perspectives
o Community psychology perspective
Community psychology is ‘psychology of, with, and for the people’
Focus is on preventing dysfunction, rather than just treating it.
Broad social factors, e.g. social, political, and cultural context need to
be considered to fully understand development of psychological
problems
Community psychologists in South Africa see their role as extending
beyond the traditional consulting room to include such diverse
practices as consciousness-raising, advocacy, and social upliftment.
o Importance of the socio-political context
Socio-political factors impact on our mental health
Role of apartheid:
Impact of racist attitudes & policies
Mental health system as inaccessible & discriminatory
Mainly white psychologists and psychiatrists
Historical discrimination in psychological testing (based on
racial groups) – lack of locally appropriate measures
Training based on American-European models
(individual/therapy rather than collective)
Cross-cultural challenges in diagnosis
Limited mental health services in rural areas
Page 4 of 132
Week 1: Introduction
Lecture 1:
Psyche = mind or soul, Pathology = sickness or illness
Psychopathology = Abnormal behaviour / Mental illness / Psychological disorder
- Pain, distress, vulnerability. How we defend against it or cope with it.
How to Diagnose:
- List the signs and symptoms
o Signs = clinician’s objective findings and observations
o Symptoms = subjective experiences described by patient
- Evaluate information
- Differential diagnosis
o List of possible diagnoses to be considered in decreasing order of likelihood
- Working diagnosis
o Principal diagnosis
o Non-principal diagnosis
o Provisional diagnosis
o Diagnosis deferred
o Ruled-out diagnosis
- Double check DSM exclusion criteria
Example: Case of Dora
- List symptoms
- List signs
- Can you come up with a diagnosis?
- What are the advantages of diagnosis?
- What are the disadvantages of diagnosis?
Theoretical issues surrounding diagnosis and DSM-5
- Concept of abnormal / normal is subjective and interpretive
- Criteria for abnormal:
o Unusual = statistical – behaviours that deviate from the average
o Non-conformist = societal norms violated (can lead to relativism)
o Impairment (work and love) = interruption / restriction of daily life
o Distressing for others
o Distressing for self (sometimes it is appropriate to be sad or anxious)
- Factors to take into account when diagnosing:
o Age (developmental factors), Gender, Culture, What happened before (recent
trauma), Pattern / once-off, Explanation, How it affects others, Medical
factors, Context.
- History of DSM-5
o Sydenham (1624-1689) – ‘English Hippocrates’
Classification in medicine
Syndromes are:
Recognisable clusters/patterns of Symptoms and signs that run
together in an evolving clinical history
Helped to isolate distinct diseases with distinct causes
Allowed specific treatments
Allowed prediction of course.
Page 1 of 132
,Summary 2019 Psychology 314 Rebecca JvR (19980329)
o 18th and 19th century
3 groups of mental illness
Madness
Disorders of mood
Psychoses based on brain injury
The many different classification systems that have developed differ in
their relative emphasis on phenomenology, aetiology and course as
defining features, as well as their number of diagnostic categories.
They differ in their principal objective being for use in a clinical /
research / administrative setting.
o Kraeplin (1917)
Introduced Sydenham’s syndromal approach
Collected life histories
Three clusters of illnesses
o Freud
Emphasis on dynamic unconscious (motives, wishes, memories,
fantasies)
Sexual and aggressive
Techniques: hypnosis, free association, dream interpretation
Psychoanalysis dominates American Psychiatry
o DSM (1952)
Very psychoanalytic, 108 categories, 8 headings
o DSM-II (1968)
Revised to match ICD, Little interrater reliability, Diagnostic error
o DSM-III (1980)
Goal: to make diagnosis more reliable, not based on clinical consensus
but on scientific evidence, no aetiology, claims that it is a-theoretical
and useful to clinicians from different theoretical backgrounds, not in
prose form, multi-axial, 265 mental disorders
o DSM-IV
- DSM-5 Critique
o Categorical (between disorders, abnormal/normal, axes)
o Focused on the individual
o Clinical judgement still there
o Ignore strengths/resilience
o Danger of labelling
o Culturally specific
o Euro-American outlook
o Male perspective
o Symptom orientated
o No analysis of explanation (like naturalist’s field guide to birds)
o Situate problem in individual
o Context not taken into account (psychological response to adverse situation)
o False positives: level of impairment not correlated with symptom counts
(stems from individual and cultural factors)
o Neurophysiological bias vs importance of social-psychological variables
o Reductionist
o Medicalisation of human nature
o Drug companies
o Instruments of social control
Page 2 of 132
,Summary 2019 Psychology 314 Rebecca JvR (19980329)
o Political problems – Paraphilias, Hypoactive Sexual Desire Disorder.
- DSM-5 advantages
o Communication
o Treatment and prevention
o 3rd party reimbursements
o Legal proceedings
o Predicting course / patterns of disease
o Advise to families
o Classify disorders not people
o Decision-making
o Prognostic implications
o Consumer protection
o Communication of empathy
o Forestalling flights from treatment
o Other
Lecture 2: Aetiological Models
Aetiology = study of origination or causation
Provides a framework for understanding symptoms and making decisions regarding diagnosis
and treatment.
Due to the complex and dynamic nature of disorders, aetiology does not provide direct
answers about causes.
No aetiological model is better than others
Strong focus on a cross-cultural, Southern African view of abnormal behaviour
- Biomedical perspectives
o The biomedical model claims that all mental illnesses have a biological cause
o Factors like social pressures, type of parenting, or other environmental factors
seen as secondary in the precipitation of mental disorders
o Biological abnormalities are understood to occur in four different areas:
Genetic predisposition
Abnormal functioning of neurotransmitters
Endocrine dysregulation
Structural abnormalities in the brain
- Psychological perspectives
o Psychodynamic approaches:
Derived from Freud’s theory of psychoanalysis
Behaviour is largely influenced by internal forces that exist outside
consciousness
Psychological disorders emerge from conflict between the id, ego and
superego, as well as deficiencies in the ego
Defence mechanisms are used to ward off excessive psychological
pain
Contemporary approaches include the work of
Melanie Klein – object relations
John Bowlby – attachment theory
Heinz Kohut – self psychology
Donald Winnicott – the independents
Intersubjective psychoanalysis and relational psychanalysis
Page 3 of 132
, Summary 2019 Psychology 314 Rebecca JvR (19980329)
o Behavioural / learning perspectives
Based on the experiments of Pavlov, Watson & Skinner
Behaviour is learned through processes and mechanisms like:
Habituation – gradual adaption
Sensitisation – extreme response to a stimulus
Classical conditioning – association
Operant conditioning – reinforcement
Modelling (Bandura) – observation
Dysfunctional behaviour develops because an individual learns
ineffective or dysfunctional responses or fails to learn appropriate,
adaptive behaviour.
o Cognitive-behavioural perspective
Mental disorders are caused by aspects of the content of thoughts as
well as information-processing factors.
Different perspectives, for example:
Theory of helplessness (Seligman)
Theory of hopelessness (Beck)
Rational-emotive theory (Ellis)
Beck’s cognitive theory of depression suggests that negative automatic
thoughts trigger a negative process of cognition, affect, and behaviour
o Humanistic and existential perspectives
Emerged as a third force in psychology, opposing the determinism of
the psychodynamic and behaviourist approaches
The humanistic approach (Rogers & Maslow) believes in a person’s
free will and ability to choose how to act.
The existential approach (May & Laing) emphasises the uniqueness of
each individual and the quest for values and meaning.
- Social perspectives
o Community psychology perspective
Community psychology is ‘psychology of, with, and for the people’
Focus is on preventing dysfunction, rather than just treating it.
Broad social factors, e.g. social, political, and cultural context need to
be considered to fully understand development of psychological
problems
Community psychologists in South Africa see their role as extending
beyond the traditional consulting room to include such diverse
practices as consciousness-raising, advocacy, and social upliftment.
o Importance of the socio-political context
Socio-political factors impact on our mental health
Role of apartheid:
Impact of racist attitudes & policies
Mental health system as inaccessible & discriminatory
Mainly white psychologists and psychiatrists
Historical discrimination in psychological testing (based on
racial groups) – lack of locally appropriate measures
Training based on American-European models
(individual/therapy rather than collective)
Cross-cultural challenges in diagnosis
Limited mental health services in rural areas
Page 4 of 132
