Introduction (1 & 3)
Mental disorders are not viewed as singular diseases with a common pathology that can be
identified in all people with the disorder. They are collections of problems.
A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's
cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological,
or developmental processes underlying mental functioning.
Equifinality→Same outcome/different origins
Multifinality→Same origin/different outcomes
Normal/abnormal:
Abnormal means deviate from norms.
Cultural relativism→there are no universal standards for labeling behavior abnormal, but only
relative to culture and context.
Statistically infrequency→it is more normal to have a mental disorder in lifetime than not having
one (so it is actually not abnormal anymore??)
Abnormal behavior often violates the social norms of a given culture.
Behavior or feelings may be abnormal if it creates great distress. However, not all mentally ill show
distress (psychopaths) and not all distressed individuals are mentally ill
Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between
the individual and society are NOT mental disorders
The four Ds of Abnormality:
- Dysfunction→behavior impairs individual´s ability to function in life (functioning defined by
society). Some individuals with a diagnosis live functional lives (phobias). Others without a
diagnosis do not live functional lives (homeless people; according to what the society defines
as functioning)
- Distress→behavior or feelings that create great distress
- Deviance
- Dangerousness
There is no clear line between what is normal/abnormal, but every of these dimensions has its own
continuum!
Historical perspectives on abnormality:
Biological theories→abnormal behavior similar to physical diseases, which can be cured by
restoration of bodily health
Supernatural theories→blamed behavior on demonic possession, personal sin etc.
Psychological theories→abnormal behavior result of traumas, chronic stress
The dangers of the “Medical Model”:
- Not enough emphasis on the own responsibility of the patient
- Focus is more directed to therapy than prevention, fighting against the disease instead of
health-advancement
- Focus is on internal instead of external causes, mainly mono causal models
We are less responsible when we talk about “disease”, because it is biological. Mental disorders
always come with stigmatization.
,The emergence of modern perspectives:
- In the late nineteenth century came an increasing focus on biological causes of abnormality.
It was found that general paresis (leads to paralysis, insanity, and death) is syphilis.
- Freud and Breuer→hypnosis, the unconscious and catharsis as curing of mental states
- Behaviorism developed and stimuli and responses to understand behavior rather than
internal workings of the unconscious (conditioning)
- The cognitive revolution shifted perspectives toward internal processes. Self-efficacy beliefs
are crucial for people´s wellbeing. People prone to psychological disorders plagued by
irrational negative assumptions about themselves
Deinstitutionalization→patient´s rights movement promoted it saying that mental patients can
recover more fully or live more satisfying lives if they are integrated into the community with support
of treatment facilities such as (community mental health centers, halfway houses, day treatment
centers)
Managed care→collection of methods for coordinating care that ranges from simple monitoring to
total control over what care can be provided and paid for. Mental health care often is not covered
fully by health insurance and many people do not have it
The Rosenhan study:
Rosenhan convinced eight people to go to psychiatries and made up symptoms that didn’t exist
(hearing a voice that says “thumb” all the time). They answered all questions truthfully, but made up
one symptom that doesn’t exist. All got diagnosed as mentally ill and went to psychiatry. One of the
participants was Martin Seligman. The study revolutionized psychology.
This study showed three major things:
- We cannot diagnose by just looking at the person (learned something about defining and
diagnosing interviews)
- Psychiatries were really bad at that time
- We are heavily influenced by the setting (Milgram experiment); in psychiatry
(overdiagnosing, because of the setting in which the people are).
Why do we classify or diagnose?
We need accurate description. We need to define to have any progress (research; communication)
Efficient transfer of information
Explicit classification is better than implicit classification
Arguments against classification:
Stigmatization which happens due to labeling
Losing information due to labels
NIMH strategical plan: RDoc
Develop, for research purposes, new ways of classifying mental disorders based on dimensions of
observable behavior and neurobiological measures.
Looking at negative, positive valences and cognitive systems and how they change across disorders.
Distancing from the classical diagnoses.
,Assessment tools:
Accuracy of a test in assessing what it is supposed to measure.
Face validity→test appears to measure what it is supposed to measure
Content validity→test assesses all important aspects of a phenomenon
Concurrent validity→test yields same results as other measures of the same behavior
Predictive validity→test predicts the behavior it is supposed to measure
Construct validity→test measures what it is supposed to measure
Consistency in measuring what it is supposed to measure
Test-retest reliability→test produces similar results when given at two points in time
Alternate form reliability→two versions of same test produce similar results
Internal reliability→different parts of the same test produce similar results
Interrater reliability→two or more raters who administer a test come to similar conclusions
Clinical interview→clinicians ask questions about symptoms and scoring of answers; gathering
information about person´s general functioning etc.
Symptom Questionnaires→cover wide variety of symptoms to determine patient´s symptoms
Personality inventories→assess people´s typical ways of thinking, feeling and behaving; ways of
coping etc.
Behavioral observation→clinician looks for specific behaviors and what precedes or follows them;
advantage of not relying on individual´s reporting and interpretation of own behaviors
Neuropsychological tests→like for detecting memory problems etc.
Brain-Imaging techniques→CT, PET, SPECT, MRI
Psychophysiological tests→EEG; can detect changes in the brain and nervous system by showing
different EEG patterns
Projective tests→assumes that when people are presented with ambiguous stimulus, they interpret
it with their current concerns and feelings etc. (Rorschach test); or TAT which is test showing patient
pictures, letting him describe them and looking at the responses
DSM-5:
First DSM´s had low reliability and clinicians often differed in diagnoses for same patient. Later DSM´s
added more specific criteria and how long a person has to show the symptoms. And symptoms have
to interfere with daily functioning. DSM-5 has no axial approach anymore, so just one list of
diagnoses.
People tend to see a diagnosis as real rather than as a judgment. People with a diagnosis often take
over the role as the “disordered person”.
, Models of etiology
Kraepelin: Nature- historical model
Really naturalistic/biological view. You are born with the mental disease.
Freud: importance of first 5 years
Childhood is important. Attachment, bonding, traumata etc.
Shuttle model
Modern views saying that the environment plays a large role in the development of mental disorders
Multidimensional models of abnormal behavior:
Biological, behavioral, emotional, social & cultural, developmental, environmental
Development of a mental disorder:
- Dispositional factors/vulnerabilities (that happen in the very first years) !Not biological
factors!
- Provoking factors trigger the disorder (some kind of stressors) do not have to be negative
stressors; not always major life events, but also accumulation of minor events. The important
point is how we perceive stressors (very subjective) (example: women that got raped and
didn’t develop mental disorder; then she found out that the men killed almost all other
women; this information made it life threatening and the meaning changed, so she
developed PTSD)
- Maintaining factors are the ones that are worked on (more changeable then dispositional
factors).
Behavior-genetics:
To which extend are behavioral tendencies inherited?
Through which processes can behavior be influenced by genetics?
Biopsychosocial approach→development of psychological symptoms often results from a
combination of biological, psychological, and socio-cultural risk-factors
Diathesis-stress model→risk factor is not enough, it may take some other experiences or trigger for
psychopathology to develop
We are looking at changed behavior and not at illnesses! There is not one particular gene responsible
for a mental disorder. But, behavior is influenced be genes…
Polygenic process→most disorders are associated not with a single abnormal gene but with multiple
abnormal genes
Clinical oriented genetic research:
→different environment, however kids
usually get adopted in a very similar background that they come from
