Chapter 2 (4th Edition)_186112d9b198c154e86094552664f330.pptx

 Chapter 2 Describing and classifying abnormal behaviour  Mapping the chapter 1 2 3 4 Introduction History of Classification of Conclusion psychopatholog mental...

 Chapter 2 Describing and classifying abnormal behaviour  Mapping the chapter 1 2 3 4 Introduction History of Classification of Conclusion psychopatholog mental y disorders Psychopatholo International gy in South Classification Africa of Diseases (ICD) Content Understanding Global summary mental perspectives Diagnostic and disorders Statistical Critical Manual of perspectives Mental Disorders (DSM)  Introduction How to best define and conceptualise mental disorders? An unresolved question This chapter concerns: o The description and classification of mental disorders o Debates about definitions o History o Contemporary approaches to nosology. Nosology = the science of disease classification and description Common terms in nosology: o Abnormal behaviour o Psychopathology o Mental or emotional disorders.  Introduction (cont.) How to choose the best definition is influenced by: o How the person who ‘suffers’ or is ‘diagnosed’ with the disorder is viewed. o Psychiatric disorder implies a patient that is diagnosed. o Emotional disorder implies a client that is coping with adversity in ways that distress the client andBethose close to mindful: These kinds of them. contrasts are o Illness = symptoms increasingly difficult o Disease = mechanisms that underlie symptoms. to defend. The cause(s) of the disorder: Psychotherapy can alter brain function o Psychiatric disorders = biomedical factors and o Emotional disorder = psychological factors pharmacotherapy o Mental disorder = biopsychosocial approach.alters psychological function. Treatment: o Psychiatric disorders = medical treatment (e.g. ECT,  Introduction (cont.) An integrative approach is taken: o i.e. a comprehensive appreciation of psychopathology requires an understanding of both MECHANISM (disease) and MEANING (illness). Mental disorders are socially constructed. Mental disorders are real entities underpinned by biological, psychological and social structures and processes. ‘Psychopathology’ and ‘mental disorders’ are preferred terms in this chapter.  Introduction (cont.) Defining criteria that separate mental disorders from ‘normal behaviour’ Statistical deviance: o Determine what is normal (far from norms = ‘abnormal’). o Norm is influenced by cultural/social perspectives. o What is considered normal does not necessarily mean healthy. Maladaptiveness: o Behaviours that prevent the individual adapting for the good of the individual / group are considered abnormal (e.g. depression). o Maladaptiveness is relative to culture. Personal distress: o Psychopathology is often accompanied by distress and suffering. o The diagnosis of abnormality must be set in a person’s context (e.g. ‘normal’ distress from bereavement).  Class DISCUSS: What is abnormal? activity Your uncle drinks a quart of whiskey a day and can’t remember names of family members. Your grandmother believes that part of her body is missing and cries out about this missing part all day long. You show her the part but she refuses to acknowledge this information. Your neighbour has vague physical complaints and sees 2 to 3 doctors weekly. Your neighbour sweeps, washes, and scrubs his driveway daily. Your cousin is pregnant, and she is dieting (800 calories per day) so that she will not get ‘too fat’ with the pregnancy. She has had this type of behaviour since she was 13 years old. A recent widow talks to herself, doesn't dress in clean clothes, and has lost a lot of weight. A 23-year-old smokes 5 joints a day, gets good marks and has a solid relationship. A person experiences several panic attacks each week, but is happily married, functions well at work, and has an active lifestyle.  Introduction (cont.) Distinguishing between normality and abnormality is not easy o There is much debate. o Complication: culture, society and communities are dynamic. o Complication: through dynamism, we see norms change. What is to be done? Helpful o Define mental disorders using a combination of features. hint: When o Highlight the presence of distress and impairment. in doubt, o Draw a distinction between underlying dysfunction use an integrative (mechanisms) and evidence of symptom severity or approach. chronicity or distress or impairment (consequences). Remember: ‘mental o Note facts and value judgements (e.g. what is harmful?). disorders o Is it a harmful dysfunction? involve o Specificity vs universality must be noted. both mechanism and  A brief history of Psychopathology 1950s- Mid-1900s 2000s Existential Frantz Fanon: psychotherap critical and Late 1800s community y, logical therapy, John P. Grey: psychology, gestalt mental the idea: psychotherap disorders are ‘returning of y and CBT Late always caused freedom to the Ongoing 1700s by physical mad’ debates – Philippe factors (1854) Behaviourism: best therapy, Pinel and Emil Kraeplin: Pavlov, best 1584 classification Skinner, moral treatment Reginald Scott: The therapy, system, basis Watson and often driven Discovery of humanitaria for current Wolpe (SA) by theoretical Witchcraft n reforms DSM (1883) Psychotropic orientation Institutitionalisatio Sigmund Freud drugs n common, and inhumane psychoanalysi practices s  A brief history of Psychopathology (cont.) Psychopathology in South Africa Global perspectives Critical perspectives  A brief history of Psychopathology (cont.) Psychopathology in South Africa Psychology was established as a formal discipline in the 1920s. Culturally biased psychological tests were used to endorse racial oppression. Be mindful: Colonial psychiatry racially segregated medical facilities. colonial Human rights violations and health disparities – TRC. treatment SA still dealing with colonial and apartheid legacy. disparities that were justified Added to this: newer public health threats. by arguments in Research is now funded, and includes: psychology and psychiatry, First nationally representative epidemiological survey these of mental disorders in Africa arguments were never based on Development of locally relevant psychometric measures good evidence. Study of a range of psychotherapeutic interventions.  A brief history of Psychopathology (cont.) Global perspectives Other views and histories do not conform to Western approach: o China and India do not agree with the separation of physical and mental illness. o Indigenous theories of illness: problems caused by difficulties in social relationships (with the living or with ancestors) o Religious healing: e.g. Zionism (combines indigenous and Christian beliefs) o Indigenous healers, herbalists, prophets o Different frameworks lead to a range of explanatory models. o Combined perspectives = multiple co-existing explanatory models of mental disorder. o Cross-cultural psychiatrists o Discipline of global mental health  A brief history of Psychopathology Critical perspectives (cont.) Mental disorders = socially constructed Treatment = social control 1960s – early ‘anti-Psychiatry’ movement (David Cooper) ‘Illness’ refers to abnormalities in physical functioning and therefore cannot be applied to any psychological disorder that has no evidence of physical pathology. Be mindful: Critique is This puts patients in a passive role; it leads to inhumane treatment useful if we use it to of patients (as objects). reflect on potential cultural bias and context- Anti-authoritarian position against the use of: bound meanings of o psychiatric diagnoses disorders. It can be harmful to support o drug treatments incoherent criticisms. o electro-convulsive treatments o involuntary hospitalisation.  Contemporary classification of mental disorders Two classifications of mental illness: International Classification of Diseases (ICD) o Published by WHO o Includes a section on mental, behavioural, and neurodevelopmenta disorders. o Latest version: ICD-11, tabled May 2019, takes effect: 2022. The Diagnostic and Statistical Manual of Mental Disorders (DSM): o Published by APA o Solely focused on mental health disorders o Latest version: DSM-5-TR published in 2022.  Contemporary classification of mental disorders (cont.) Problems associated with these systems: o Diagnostic categories does not reflect current neuroscientific knowledge. o Borders between DSM diagnostic categories and normality can be fuzzy. o Many categories overlap or co-occur. o Nonetheless: these classification systems are widely used. Contemporary classification of mental disorders (cont.) The Diagnostic and Statistical Manual of Mental Disorders (DSM) The International Classification of Diseases (ICD) Comparison and critique Contemporary classification of mental disorders (cont.) The Diagnostic and Statistical Manual of Mental Disorders DSM-I: 1952 o Psychoanalytic theory influenced DSM-II: 1968 o Understanding underlying conflicts of an illness DSM-III: 1980 o Biology and not psychological conflict primary cause of a mental illness DSM-IV: 1994 o Field trials, empirical orientation, cultural applicability DSM-IV-TR: 2000 o Textual revisions DSM-5: 2013 o Revised organisational structure, consultation, increased representation, scientifically rigorous. Contemporary classification of mental disorders (cont.) The Diagnostic and Statistical Manual of Mental Disorders (cont.) DSM-5 is organised on developmental and lifespan considerations. It begins with disorders that first manifest in early childhood, followed by disorders that manifest in adolescence and early adulthood, and ends with disorders relevant to adulthood and later life. In contrast to previous editions, the DSM-5 utilises a nonaxial documentation of diagnosis. It attempts to delineate the way in which gender and culture impact on diagnosis. It allows separate notations for key psychosocial and contextual factors (previously axis IV) and disability (previously axis V). This addresses the criticism that previous editions implied that medical Contemporary classification of mental disorders (cont.) The Diagnostic and Statistical Manual of Mental Disorders (cont.) Helpful hint: Major criticisms: Gender dysphoria o ‘Checkbook menus’ and ‘cookbook approach’ overlooks now appears the specific details and circumstances of each patient. in the DSM-5 o Common to find significant co-morbidity. (as opposed o Contains multiple heterogeneous disorders, does not reflect to gender identity dimensional psychobiological realities. disorder) o Not sufficiently consistent with a neuroscientific approach.and is an Specific incremental advances in the DSM-5: example of o Rigorous, reviewed, evidence-based changes new ideas around what o Broad consultation (experts and ICD-11 leaders) we can think o Range of subtle changes were made to reflect biological realities. of as o Delineates how gender and culture impact on diagnosis (e.g. CFI). ‘normal’.  Class activity ROLE-PLAY: Consider the contents of Table 2.3: The DSM-5 CFI. Get into groups of two: one is the interviewer and the other is the interviewee. Role-play the various aspects of the CFI: Cultural definition of the problem Cultural perceptions of cause, context and support Cultural factors affecting self-coping and past / present help-seeking Clinician-patient relationship. DISCUSS: Discuss how this interview process could play out in African clinics. Consider the staffing implications. Is this type of interviewing necessary when the mental health Contemporary classification of mental disorders (cont.) The International Classification of Diseases background and history 1893: Jacques Bertillon introduced the Bertillon Classification of Causes of Death o 6th revision: Classification system now two volumes o Included morbidity and mortality conditions o Title modified to: Manual of International Statistical Classification o Diseases, Injuries and Causes of Death (ICD) 1960s: WHO became actively engaged in improvement in diagnosis and classification of mental disorders.  Contemporary classification of mental disorders (cont.) The International Classification of Diseases (cont.) ICD-10 and DSM-III developed alongside one another: o Used same codes and diagnostic categories o Still differences There were consultations between the developers of the DSM-5 and ICD-11 but important differences include: o Audience o Clinical utility o ICD-11’s novel approach to personality disorders o ICD-11’s controversial diagnostic entities: Gaming Disorder, Compulsive Sexual Behaviour Disorder.  Clip to case WATCH: ‘WHO gaming disorder – questions and answers’ Accessible from: https://www.psychologytoday.com/intl/blog/making-mean ing/201901/debate-over-gaming-disorder-is-not-all-fun-a nd-games (last accessed on 23 September 2019) See Case Study related questions in the Question Bank. Contemporary classification of mental disorders (cont.) Comparison and critique Classification systems are never free from criticism. The most reliable of diagnostic criteria are not necessarily valid (i.e. they do not measure what they are supposed to measure). NB problem = single-word diagnoses: do not necessarily help understanding of the person’s problems (complex personal meanings contained in a simple diagnosis). Is the diagnosis helpful or not? The act of diagnosis National Institute of Mental Health (US): Research Domain Criteria (RDoC) o More biologically grounded, not a paradigm shift. Contemporary classification of mental disorders (cont.) Comparison and critique (cont.) Criticism of ICD and DSM: different nosologies (schemes of classification) have been proposed to replace current descriptive model of mental disorders. Dimensional model: mental disorders lie on a continuum, stages Holistic model: pharmacological, social and spiritual treatments on similar level, alternative approaches Johns Hopkins (perspectival) model: o Disease o Dimensions o Behaviours o Life story.  Conclusion Abnormal behaviour criteria: o Statistical deviance o Maladaptiveness/impairment o Personal distress o Underlying dysfunction. Broader political, socio-cultural and historical factors are important in understanding the nature of normality and abnormality. We need to adopt non-reductionist and integrative approaches.