COP Ch01 2024 default.pdf

COP Ch01 2024 default (0:00 - 0:29) Hello again, so this is the second recording associated with week one. The first one was just an overview of the course and this is the first with content from the textbook where we'll be covering chapter one. This is obviously your textbook and so what we will b...

COP Ch01 2024 default (0:00 - 0:29) Hello again, so this is the second recording associated with week one. The first one was just an overview of the course and this is the first with content from the textbook where we'll be covering chapter one. This is obviously your textbook and so what we will be covering is chapter one plus material that I basically add to it that's not necessarily in the text. (0:34 - 2:27) Learning objectives. These are from the textbook and what I will do more or less will match up with them, but as you can see, we'll be talking about describing difficulties inherent and defining abnormality and mental disorders. In other words, what do we mean when we say something is a mental disorder or a psychological disorder or something is abnormal? Then we will talk about different theoretical approaches to understanding classification, etiology, and treatment. So, in other words, we'll talk about things like psychodynamic, cognitive behavioral, cognitive behavior, all the different perspectives on how we understand and also how we treat disorders. Then the third objective at least is written in text, evaluate changes in psychiatric classification over time. We'll spend a fair amount of time on that. Again, these are the learning objectives. In terms of the actual outline of what I'll cover, it's basically right here. So, as I said, we'll start off talking about the definitions of abnormal behavior, mental disorder, psychological disorder, go through all the perspectives, and then we'll just spend some time talking about classification and diagnosis of these disorders. So, let's start here with the definitions of abnormal behavior and or mental disorder. First of all, we should be clear that there are several terms that you hear in this field that essentially mean the same thing. There's probably others, but the primary ones that I'm referring to are psychological disorder. (2:27 - 3:41) That's the one probably that our text uses the most. Mental disorder, that's the term that the DSM uses. I'll define what the DSM is in case you don't know. There's other terms. Psychiatric disorder, you'll hear quite often. Mental illness, it's not really a term that I like, but when people are referring to mental illness, they're really referring to everything that I've just listed above, the other things on the list too. Psychopathology, that sounds like a more complicated term, but it basically means the same thing. Although it has two meanings, really. So, someone could refer to someone having a psychopathology, which would mean the same thing as they have a psychological disorder or a mental disorder, but it also refers to the field of study. So, for example, the postgraduate course that I teach in abnormal psychology is called psychopathology. It's called adult psychopathology. We also have a class in child psychopathology. (3:41 - 4:33) So, again, that one can mean two different things. And then the other general term, which is part of the name of this course, is abnormal psychology. So, that similarly refers to the field. So, when you're talking about abnormal psychology, you're talking about the study of all these things above, psychological disorders, mental disorders, psychiatric disorder, which again, more or less mean the same thing. If they mean the same thing, what do they mean? So, one thing we have to keep in mind is that there is really no perfect definition of this concept or these concepts. So, if we ask ourselves what is a mental disorder or a psychological disorder, again, the field is not in agreement upon a perfect way to define this. (4:33 - 8:57) Even the developers of the DSM, the Diagnostic and Statistical Manual of Mental Disorders, where we have a whole listing of these things, they'll even come right out and they even came around and said, there is no definition or no definition can capture all aspects of the range of disorders contained in the DSM-5. So, what we have to think about is the different ways in which people have tried to define these things and the different components of an overall sort of comprehensive definition, which is what the DSM has and which is what I'll come back to in a few minutes after we go through some of these things. So, one way that you could define it, one way that has been tried is to think of it in terms of statistical deviation. I mean, what does abnormal mean? Well, it means basically away from normal. So, if we know what's normal or normative, then we can define what's abnormal as things that deviate from the norm. And so, you could think of, like, here's your old normal distribution curve you would have learned about in, I don't know, 1A or 1B or other courses, probably. And we could think of this curve as applying to the various constructs that we'll be talking about in this course. So, for example, we could think of it as mood. Like, when people are in the middle, that's normal. If they're extremely in a negative mood in the low end there, we might call that a depressive disorder. If they're extremely in the positive end, we might call that mania, for example, which isn't quite right anyways because mania isn't always feeling positive. But that's just how you could sort of apply this. And there are certain disorders, for example, intellectual disabilities, what used to be referred to as mental retardation, you had to be below a certain cutoff in terms of IQ to be able to be diagnosed with it. So, in a sense, they were using this approach, but not purely based on this approach. Because the problem is that just because someone is statistically rare in terms of the problems that, or not even the problems, or in terms of whatever the construct is we're talking about, doesn't mean it's necessarily a problem. And so, back to the intellectual disabilities issue, people had to not only have a low IQ, but also have to demonstrate functional impairment. So, it has to actually affect people. The other problem with this is sort of illustrated here, where if we're going to think of things as being abnormal in a negative sense, just because they're statistically rare, then there's a lot of real positive things that would qualify for that definition. But we really don't want to think of those things as abnormal. The flip side is also just because something is common doesn't mean it's not a problem. So, there are certain things, substance use among certain subgroups, body image concerns among certain age groups of women and girls. I mean, I could go on and on of things that are quite common that we think of as problematic, which we may be considered or consider them to be disorders. So, we want to think about statistical rarity or how common things are, but by itself, it's not enough to really define a disorder. So, other things that people have thought about, what about violation of social and cultural norms? So, particularly if you add it to the statistical rarity, if we say something's rare and it goes against what society says is normal, perhaps that would help us define what's abnormal. (8:58 - 20:36) And there's examples like, as I have there, antisocial behavior of the psychopath that certainly goes against social cultural norms. But there's several problems with this one too. First of all, whose norms? I mean, in most societies, there are subgroups, subcultures, and they may have very different cultural norms. So, it's a real problem for one group to be telling another group what's necessarily socially unacceptable. It can also clearly be abused, and there's numerous examples of this in the past. Going back to the U.S. Civil War, for example, or slavery prior to the Civil War, there was actually a disorder in some medical text called drapedomania. And what did that mean? Well, it was actually, allegedly, a disorder which caused American slaves to run away. And in these medical texts, it had information on the causes and the treatment. Causes were treating them like equals, and treatment, look for the warning signs and beat the devil out of them. Which, reading that, you think that's quite hard, and I would agree. So, it's an example of it taking the social cultural part of the definition and using it in a very bad way. You often sometimes hear of certain places around the world where people, if they challenge the government or the country, they get labeled mentally ill and locked up in a mental institution. So, that would be another example of it being misused. So, culture and social norms can be misused, but it's also quite important. Like, we don't want to pathologize things that are culturally acceptable. So, for example, things like when someone has lost a loved one, it seems to be a natural and a culturally acceptable response to go through a sort of bereavement process. And we don't want to label that as disordered. It's actually a bit of a controversy has been in the DSM about whether you should even diagnose a disorder while someone's going through bereavement. In earlier editions of the DSM, you weren't supposed to diagnose a mood disorder, like a depressive disorder, if someone was going through bereavement. Now, you actually can, but they're still allegedly not the same thing. So, if someone's just going through bereavement, then you shouldn't diagnose a disorder. But that doesn't mean someone couldn't be going through bereavement and also be depressed. At least that's the argument that the developers of the DSM-5 have made. So, we talked about statistical rarity. We've talked about culture. What else do we need to talk about in terms of how we define abnormal or define a disorder? What about personal distress? If you think about a lot of the disorders that come to your mind, when you think of a mental disorder, depression or schizophrenia, anxiety and its disorders, obsessive-compulsive disorder, all those things generally cause people distress. So, can we define it based on that, that someone's going through something that causes them a lot of distress? Well, it's probably important, but part of the problem is partially, as I was alluding to earlier, there are certain things in life that it's natural to cause us distress, such as the loss of a loved one. We might not necessarily use that to conclude that someone is experiencing a disorder. Plus, there's also times when people don't experience the pain or the suffering that they probably should. And then it's almost more of a problem that they don't feel the distress. So, again, it's important, but by itself, it's probably not enough. Another term, disability, which basically is synonymous with maladaptive or something along those lines, it causes impairment in someone's life in some key area. So, just an example there, someone is consuming way too much alcohol, it might result in their losing a job, might result in relationship breakup, failing out of school, a whole long list of things. And in general, this is one that we think is important. Like if you see the general definition that I'll get to shortly, you'll see that it's not impairing in some sort of way, you really can't end up considering something a disorder. Another term that this one does have two meanings, this is the idea of a dysfunction, which basically, so one of the meanings is similar to disability or maladaptive. So, if something's dysfunctional, it means it's causing someone problems. But the other definition is basically that something's not working right, something's not functioning the way it's supposed to function. So, for example, if I was to ask you, is it normal to hear voices in your head? It's a complicated question to answer. First of all, if I didn't put the in your head part, is it normal to hear voices? Obviously, it's normal if someone's talking to you. But what if no one is talking to you? Is that normal? Well, in many situations, we would consider that it's not. There are some cultural situations where it is. Another example, is it normal to have your heart racing, to be sweating, to be hyperventilating, numbness and tingling in your body? Well, it actually is if, for example, you're in the jungle being chased by a wild animal. It's basically your fight or flight response kicking in to help you survive one way or another. But if that same thing happens while you're sitting in a classroom trying to take a test, or you're on a job interview, or you're trying to go out on your first date with someone and you have that same reaction, something's not right. So, something's not supposed to happen that way. And so, that would be dysfunction. So, that is an important part of the definition. As I noted, it can also mean the same thing as disabling or maladaptive. You would have read in your book a definition by a researcher named Wakefield, Jerome Wakefield, who used the expression, the term harmful dysfunction. That's basically his definition of a mental disorder. The idea that something's not working right, and it's harmful. Now, there's another term, and this one I don't actually think is in your text, but I find it kind of interesting. The idea of discontrolled maladaptivity. So, maladaptivity, we've sort of already talked about. I said it's similar to disability. This one is, by the way, by a researcher named Whitaker. And discontrolled means it's something that you can't control. You're not just doing it on purpose. So, notice underneath. So, intentional harmful behaviors, such as excessive substance use, gambling, child abuse, these wouldn't be considered a disorder if someone's just choosing to do those things. Those are just more like either criminal activity or just bad judgment or whatever. It's when someone says, I really don't want to do this, but I can't stop myself. That's when we would consider something to meet that definition, which again is his definition of mental disorder, of psychological disorder. So, again, you can see there's all these different components, and some of them overlap. Some of them are similar. Some of them are different. If we try to say, what is the DSM set? And again, the DSM, the Diagnostic and Statistical Manual of Mental Disorders, this is their definition. It says a mental disorder, and remember that's any of those other terms. So, mental disorder, psychological disorder, psychiatric disorder, mental illness, although mental illnesses are just sort of broader. Here, we're talking about specific disorders. So, back to the definition. Mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction. So, there's the dysfunction coming to the definition in the psychological, biological, or developmental processes underlying mental functioning. So, dysfunction somewhere. Now, before we keep going with this definition, we need to step to the side and think about one of the words in there. That's a syndrome. So, what exactly is a syndrome? Because this definition is starting by saying the disorder is a syndrome. So, we need to know what a syndrome is. And here's a good definition of a syndrome. It's a grouping of signs and symptoms based on their frequent co-occurrence that may suggest a common underlying pathogenesis course, familiar pattern, or treatment selection. So, the key part of that definition, there's really two keys. One of them is that it's a grouping of signs and symptoms. So, it's not just one thing. In other words, when you think of a disorder, it would be extremely rare to find one where it has only one symptom or one sign. And I'll actually explain the difference between signs and symptoms shortly. But my point here is that most of these disorders have multiple indicators, multiple signs and symptoms. And that's, again, what a syndrome is. It's a group of things that occur. But they don't just co-occur. They also seem to be linked to other things. So, they may suggest some underlying pathogenesis is a complicated way of saying cause. And course is a different term, which means, so, what to predict over time. (20:37 - 20:57) May also tell us something about the family pattern. And if we have it identified right, it might tell us something about treatment selection. So, if we know that this syndrome is different from that syndrome, and this syndrome responds to one kind of a treatment, and that one responds to another one, then that's useful information. (20:58 - 21:03) All right. So, that's what a syndrome is. Now, let's get back to the overall definition. (21:05 - 23:20) Because it's continuing here. This is still from the DSM. Mental disorders are usually associated with significant distress or disability. So, remember, we already talked about distress. And we said it's usually there. But in some cases, it might not be. But if it's not, at least there needs to be some sort of disability. Disability where? So, here's the definition. Social, occupational, or other important activities. And then here's where they work in, at least part of the cultural aspect. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, which is what I talked about earlier when we were talking about bereavement, is not a mental disorder. Now, again, it gets complicated in the sense that it doesn't mean you can't also diagnose one. But you shouldn't diagnose the expectable or culturally approved response per se. Now, the definition keeps going here. This is where they're also continuing with some of the sociocultural kind of stuff. Socially deviant behavior, for example, political or religious, sexual, and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual as described above. So, getting back to the examples I gave you earlier, like where someone disagrees with the government, they lock them up with a mental disorder, that shouldn't be happening by these definitions. But the unless part there is trying to say, unless whatever the person's doing is because they have a disorder. So, if someone disagreed with and tried to kill a world leader, you wouldn't automatically assume that the person had a mental disorder. But if it was because the person was doing it, because he or she really did have, for example, schizophrenia or something like that, then it would be considered a disorder. So, some level becomes a bit circular, but that is the definition. (23:23 - 23:55) Okay. So, we have now talked about that first section, definitions of abnormal behavior and mental disorder, or psychological disorder, abnormal psychology, all those different terms that mean more or less the same thing. What you should do as we move forward in the course is, when we start talking about different specific disorders, ask yourself, do they meet that general definition that we just talked about? Some of them probably meet it more clearly than others. (23:56 - 25:06) So, next topic here is perspectives on the classification, causation, and treatment of mental disorders. So, there are many different perspectives in these areas of classification, causation, treatment. What we're going to do here is talk about some of them and talk about them fairly much in general. Then when we come back to other more specific disorders, we'll talk about them again in the context of those disorders. So, the ones that we'll be talking about and which are discussed in your text are the biological perspective, the psychological perspective, and within that, there's a whole bunch of different sub-perspectives that we'll try to talk about. Then the sociocultural perspective and an integrative approach where basically you don't try to look to any one of those areas as being the complete answer, but you try to integrate them. (25:07 - 27:34) So, let's start with the biological perspective. So, the biological perspective has been around a long time. Remember from your intro course going all the way back to people like Hippocrates. Remember his theory that physical and mental, emotional health required a balance of four fluids which called humors. Remember he thought it was based on the balance of blood, black bile, yellow bile, and phlegm. If people had too much of one of these or too little of another, it would potentially cause problems, which seems kind of silly when you think about it today. But actually, if you think about other theories about balances of neurotransmitters, it's not that far off. Then there was the infectious view, which was really triggered by a particular discovery of a type of what was thought to be a mental illness that was caused by a bacteria, the syphilis bacteria, a condition known as general paresis, which really led the field to continue to search for the infectious causes of other kinds of mental illness. And for the most part, we haven't found any. I mean, we do not know of many disorders where they are triggered by any sort of infection other than something like you have things like AIDS-related dementia and those kinds of problems. But it was a big step in the field, at least from the biological perspective. More recently and currently, the biological perspective focuses on, I mean, a lot of different areas, but these are three of them where you'll see a lot of the research. Genetics, structural abnormalities, particularly talking about structural abnormalities in the brain, and neurotransmitter action. Regarding genetics, we're just talking about things like this, for example. These are data on the concordance rates for schizophrenia. (27:35 - 28:27) Concordance rates refer to how the degree to which one person having a problem would predict that another person would have it. And so, the way you would read these data, that if your monozygotic twin had schizophrenia, there is about a 48% chance that you would. Now, we'll come back to numbers like this when we get to the particular subject matter, schizophrenia, because those numbers actually may be inflated. They're actually kind of old. But anyways, that's quite high relative to, at the very bottom there, the concordance rates with the general population, which is basically the base rate of schizophrenia. So, people would make arguments about, notice how these go up as relatedness goes up. (28:28 - 29:40) Therefore, schizophrenia must be something genetic. Again, we'll come back to these things because there's a lot of counterarguments to some of those arguments. For example, some of the numbers here don't necessarily support genetic influence. If you think, for example, that the heritability for, excuse me, the concordance rates for dizygotic twins and siblings are not the same, even though dizygotic twins and siblings share the same amount of genetic material. So, again, there's different ways you can look at these things. And this is purely looking at concordance rates. Newer genetic research is trying to focus on which genes may be responsible for not just schizophrenia, but all sorts of different disorders. And there is recent research in schizophrenia talking about different genetic subtypes of schizophrenia, for example. And again, we're getting much more specific, not just sort of globally, is it genetic or is it not genetic, but what genes may be involved. (29:41 - 33:42) And again, we'll come back to these things when we talk about specific disorders. Other area, I mentioned brain structure. So, here I'm talking about things like this, which this is also in the context of schizophrenia. These are scans of, I believe, identical twins with one with schizophrenia on the right and one without. And the whole point was looking at the size of the cavities, which are called ventricles in the brain, being larger for the person with schizophrenia and hypothesizing that perhaps that has to do with the etiology or the pathophysiology of schizophrenia. Again, it's quite complicated because an alternative explanation is that actually some of the medications that people take for schizophrenia may cause these problems. And if these are identical twins, then why is one different from the other? So, again, a lot of these data are not exactly conclusive, but these are the kind of things we're talking about when we're talking about the biological perspective. The third or a third area in the biological perspective is the function of neurotransmitters. And I think this table is just… it's in your book, just talking about the different action of different medications on neurotransmitters. And this is often how we study different types of psychological or mental disorders and particular treatments. So, you use particular treatments that affect neurotransmitter levels, and then they try to make inferences about how neurotransmitter levels or action is probably a better word than levels, how that may be related to the etiology of the disorder. It's a bit of a logical fallacy in some ways to infer etiology from treatment. We'll come back to that. But clearly, this type of research is important for identifying which types of neurotransmitters are associated with different types of psychopathology, even if we're not completely sure how. This slide, just a big summary of the different neurotransmitters that have been implicated to be associated with different types of disorders. So, serotonin, dopamine have been implicated in depressive disorders, depression, mania, schizophrenia, norepinephrine, anxiety, and stress-related disorders. Also, mood disorders, also depression, just don't have them on the list there. GABA, gamma- aminobutyric acid, is one that you see often associated with anxiety, anxiety disorders. And so, the medications also that are often used with these different disorders often target these neurotransmitters. So, some target GABA, some target norepinephrine, some serotonin, dopamine, some target more than one, some selectively target one and not the others. The other types of research in this area is trying to understand, as I said, we know that they might be implicated somehow, but how? Is it that there's just too much or not enough? So, that's the bullet point about excessive or inadequate levels. Those are some of the simple theories you hear about, that the idea that you just have too much of something or too little, which is probably not correct, even though it gets… you see it discussed in the media that way. It could also be excessive or, excuse me, insufficient reuptake. It could have something to do with sensitivity of the postsynaptic receptors. (33:43 - 35:11) So, probably much more complicated mechanisms than we completely understand at this point in time. But again, this is the area or one of the areas within the biological perspective. A couple other terms, just to know there at the bottom, it kind of relates to that figure, previous slide, showing the different types of drugs. In terms of the effect of drugs on neurotransmitter activity. So, agonist drugs stimulate the neurotransmitter receptor sites. So, like a dopamine agonist would be a drug that behaves as dopamine would, whereas an antagonist drug seems to dampen or block the neurotransmitter site. So, a lot of what you learn about has to do with how different drugs have one action or the other at the site of neurotransmission. So, what I've talked about thus far, really, I mean, I've alluded to treatment, but I've mainly been talking about etiology in terms of different areas of research. What are some of the areas in which the biological perspective has affected treatment? Well, the early stuff, in the same way that the theories were probably wrong, the early treatments were probably not based on science and not things that were effective. (35:11 - 36:28) That's when they used to do things like cold baths, bleeding, leeches, all those kinds of things. Then, in the early 20th century, you started seeing things like ECT, electroconvulsive therapy, shock therapy sometimes goes by, psychosurgery, which had reputations as being quite cruel sorts of treatments. And certainly, as they were done at certain points in time in our history, they were, and they may not have been very effective at all. But some of these things are still practiced today, particularly ECT, particularly in certain types of difficult-to-treat depression, which we'll talk about when we get to that particular topic. The most effective medications probably arrived in the 1950s. Here, we're talking about psychotropic medications, which I've alluded to some of them in previous slides, but these are things designed to, again, target various types of neurotransmitters. (36:28 - 37:10) And you have medications that are referred to based on the disorder they allegedly treat. So, you'll hear about an antidepressant medication or anti-psychotic medication, anti-anxiety medication. Really, these things were, these effects were sort of discovered accidentally, and it's not like they developed them with that intention in mind, but those labels come about based on how they're used, which confuses a lot of people because, for example, antidepressant medication may be used for all sorts of other things like eating disorders, for example, which are quite different than depressive disorders. (37:11 - 39:23) But anyways, when we start talking about different types of disorders, we'll spend time talking about the medications that are used to treat them with varying levels of success. So, if we think kind of broadly about the contributions of the biological perspective, one of them would be the medications that I was just talking about. So, there has been significant development of, at least in some cases, effective drug treatments for a wide range of different disorders. How effective they are varies depending on the disorder or the problem. We do have a better understanding of the role of brain structure and neurochemistry in the etiology of mental disorders, but certainly not a complete understanding. I mean, if you start talking about mental or psychological disorders as being biologically based illnesses like medical illness, you basically have to go, well, if they are, we don't understand how they are. Like we understand the pathophysiology of cancer and viruses and all that sort of stuff. But for the most part, we're not to that point with mental psychological disorders, which may mean that they simply are not based on those sort of factors or may mean we just don't understand them yet. So, the limitations, criticisms of the biological perspective, sort of as I was just saying, much of the evidence about causation is really inconclusive. There's often alternative explanations. For example, I was mentioning with schizophrenia how it could be medications cause some of the structural abnormalities that have been implicated as being related to the cause. So, if we really don't know whether it's a cause or effect of something, then we're definitely inconclusive in terms of how we understand the causal role. (39:25 - 39:50) In terms of medications, although they may be effective in many cases, there's also very high rates of relapse if individuals stop taking them. Many of the side effects of medications have been really underestimated or under published. I mean, like you don't hear as much about them, even though they're quite significant. (39:51 - 43:24) And are they really side effects or are they just effects? I mean, medications often the main effect is the sort of the stated effect. A side effect may actually be more common than the main effect. And again, that's just a limitation of the biological perspective. Another one, which is slightly different and something we'll come back to when we talk about the DSM next week, is the idea that the medical biological perspective, for the most part, these perspectives, for the most part, assume a categorical approach to classification rather than a dimensional approach. By that, I mean, a categorical, I mean, you either have something or you don't. Because when we're talking about medical illnesses, for example, let's talk about coronavirus, COVID-19, you have it or you don't. I mean, you get tested. They don't test you. And for the most part, they don't say, well, on a 10-point scale, you're a 5. They just say you either have it or you don't. And if you have it, you can certainly vary in terms of how severe it can be. But that's what I mean by a categorical approach. And most other medical sorts of conditions, cancer, you either have it or you don't. So, with mental psychological disorders, is it that simple? Is it the same? Is it really the case that we either have these things or we don't? Or are they better conceptualized on dimensions? And we'll come back to this again in the context of a slightly different discussion. But that is part of what comes from the biological perspective because it's trying to apply the same model that we apply in medicine to psychology and behavior. So, that's quick. And as I said, with each disorder, we'll come back and talk about biological factors. But here, the point is just to sort of go through them broadly. And that's all I'm going to say about the biological perspective at this point. Next, let's turn to the psychological perspective or perspectives. There's really a long list of possible psychological perspectives that we could be talking about. We'll talk about the primary one sort of grouped into a small number of categories. Specifically, talk about the psychoanalytic perspective, then the behavioral and cognitive, and then the sort of integration of those two known as the cognitive behavioral perspective. And last on this list, at least, the humanistic perspective. So, starting with psychoanalytic perspective, here we definitely need to go back to Sigmund Freud, who is known as the founder of psychoanalysis, probably the most influential thinker in this particular area. Freud was actually a neurologist, at least originally. He was from Austria. And although he gets a lot of the credit, he didn't do all the work himself. (43:24 - 47:21) Like he had some co-authors, colleagues at the time. One of them quite well-known was Joseph Breuer. So, Breuer and Freud jointly published the Studies in Hysteria in 1895, which is credited by many as sort of the basis for Freud's theory. The paper he wrote that I liked best, and this was just Freud, was Ideology of Hysteria, which soon after that, he published another paper claiming that he completely changed his mind about what he wrote in Ideology of Hysteria. And my opinion is he was probably right the first time, and not so much the second time, even though all the stuff subsequent to that in the second paper and beyond has really stood the test of time. What else about psychoanalytic perspective? It basically takes the position that much of the reason for human behavior in general lies in the unconscious. In other words, we're not necessarily aware of it, which is the old story of someone going to see a psychoanalytic therapist presenting with a problem. The psychoanalyst may not be so interested in the problem itself as much as the unconscious motivations or reasons for the problem. Psychothology, according to the psychoanalytic perspective, results because of conflicts and these different types of unconscious forces. And as you would recall from your intro courses, part of psychoanalytic theory involved the complex interaction between the Id, the Ego, and the Superego. You probably remember in general what these were about. So, the Id, it was basically driven by instincts. And everything, at least according to Freudian theory, was going back either to sexuality or aggression. The Ego was more based on reality. And Superego was more based on sort of the conscience, the attempt to uphold societal moral standards. And at least according to Freudian psychoanalytic theory, failure to manage conflicts between these different structures resulted in anxiety, which would be dealt with then through a variety of defense mechanisms. So, we had a whole long list of defense mechanisms. I believe this table is in your text. It's worth knowing these. They're definitely sort of interesting. Whether or not they really all exist, who knows? Some of them are hard to study. Some of them have been studied more than others. Some of them are relatively obvious and apply to things outside of psychoanalytic theory. Denial, for example. There's others that I've always found interesting. Reaction formation, for example, is the idea that people do the exact opposite of what you would predict they would do, which, again, is hard to prove or disprove because if someone does what you would predict they would do, you would say that would support the theory. But they also do the exact opposite. Instead of disconfirming the theory, they take it as evidence for the theory. So, anyways, at the very least, be familiar with this group. And this is some nice little definitions for you. (47:23 - 50:40) So, there are also other newer psychodynamic perspectives, including a couple that are mentioned here. I think one of these is described in your text. I don't think the second one is, at least not in chapter one, but I actually think it's quite important. The first one, object relations, just refers to objects are basically significant others with main emphasis on significant others in childhood. So, the first object that a person comes into contact with is typically their mother. And according to these sort of theories, what happens during those times, the formation of these object relations determines people's personality later in life. And so, if things go wrong during these critical time periods, then forms of psychopathology can develop. The interpersonal perspective is particularly noteworthy because there are therapies developed from it, specifically interpersonal therapy, which we'll talk about in the context of various other disorders. Because even though there's not a heck of a lot of empirical support for psychoanalytic psychotherapy, there's actually quite a bit of empirical support for interpersonal psychotherapy, which again, is a psychodynamic type approach. And basically, based on the idea that problems, psychopathology occurs in the context of relationships. So, dealing with problems and relationships, resolving these relationship problems can help resolve psychological problems. And so, from an ideological perspective, the idea again is that basically the problems that we know as psychopathology are reflections of interpersonal problems. So, that's a quick summary of the psychoanalytic and subsequent psychodynamic perspectives. Next one we're going to talk about is the behavioral perspective, which is something that's changed quite a bit over time. I mean, the early behavioral view is very different than current behavioral view. And you can think of it in terms of both the perspective on science and a perspective on, and sort of the clinical perspective on working with problems and understanding psychopathology. A lot of this goes back to the work of people like John Watson, who I'll get to in just a minute, who argued basically that psychology at that time wasn't scientific because it was focusing on things that we couldn't measure, we couldn't directly study. And his argument was that psychology should concern itself with things that are readily measurable. (50:40 - 52:40) So, if we can't measure things happening inside the mind, what can we measure? Behavior. And that's the whole idea behind the behavioral perspective. Also, according to the perspective, causes of behavior are also things that we can measure. They're observable and identifiable because they're in the environment. Another sort of hallmark of the behavioral perspective is that behavior is whether we're talking about normal or abnormal, or basically the result of learning and types of learning that we can study, specifically classical learning, operant learning, and also social learning. So, if you're interested, I believe I put this link on the course website, and I'm not going to click on it as part of this lecture, just because that would make the recording a bit confusing. But it takes you to this original article by John Watson from 1913, which is sort of his manifesto on psychology, and he called psychology as the behaviorist views it, where he basically went through everything I just said, arguing that psychology at that point in time was really, had sort of failed as a science, and the way to make it a science was to, again, study what we can actually directly observe, which is specifically behavior. Made some of the other points that I just said, his words, there's no dividing line between man and brute, was the way he put it. In other words, the same principles of learning apply to humans that apply to animals. (52:41 - 55:31) And he made some other interesting points that if we redefine psychology this way, we won't actually have to leave out most of the interesting, important things. In other words, if we sort of redefine how we measure them, we'll be able to study the same things we've been trying to study before, but just in a more scientific way. So, if you're interested in it, take a look at the article. I won't hold you accountable for anything more than what I've pretty much said here. Certainly worth knowing who wrote that. The other researcher, writer, theorist, scientist, whatever we want to call him, who was quite influential with regard to the behavioral perspective would be Pavlov. Obviously, Pavlov is the name associated with Pavlovian learning or classical learning is the other term you hear for it. Sometimes you hear the words conditioning, classical conditioning, Pavlovian conditioning. Learning is probably really a better term though. And sometimes the word conditioning, some people argue it's actually been mistranslated and they were referring to conditional things, not conditioned things, which actually means something slightly different. There's also a link there that I have, I believe, put on the website. If not, I'll double check and put it there. Again, it's not something that you need to read for this class, but if you're really interested in some of this original work and you want to completely understand it, it would be useful to go back and take a look at it. This is a table from your text trying to sort of summarize the process, the procedure for Pavlovian or classical, and notice they do use the word conditioning, even though I don't think that's necessarily the best term. This is in your text, I believe, and I mean, you would have covered this in intro course in either 1A or 1B, whichever one it is. The truth of the matter is, it's often taught in a way that is incorrect, and most people's understanding of classical learning, Pavlovian learning, is not quite accurate. The main part that's probably worth commenting on, because it's not exactly right, is the middle part there about training. Unconditioned and conditioned stimuli are presented together several times. (55:32 - 1:03:07) That's just not necessarily correct in many ways. First, it doesn't have to be several times. There's such a thing as one trial learning where someone has a bad conditioning experience and they have a learned response from that one occasion. So, it doesn't have to be several times, as noted there. It also doesn't have to be together. That's where people get confused and you think they only had to ring the bell at the same time they were feeding the dogs. It has to be presented in such a way that one predicts the other one, so that ringing the bell actually predicts the presentation of the food, going back to Pavlov's paradigm. But that can happen over long periods of time. So, if you want to think of sort of the better way to understand this, think of things in terms of a contingency rather than a contiguity. Contiguity means things occur together in time. Contingency means one thing predicts the other one. And, again, that seems to be what's most important with regards to classical learning. But the point with regard to psychopathology is that classical learning may explain a lot of psychopathology. So, going back to Watson for a minute, you would have learned about in your intro course, the famous study experiment, whatever we want to call it, by Watson and Rayner. Remember the old little Albert experiment where they tried to demonstrate that using classical learning, they could create basically a phobia in a young child. And there's a lot of problems with what they did, both ethically and scientifically. But it is pretty much still the case that we believe that classical learning plays a pretty significant role in our understanding of phobias and other anxiety disorders. Other disorders too, but phobias and anxiety disorder is probably the most clear examples. And treatments also that are used for these things are really based on this classical learning perspective. We'll come back to this in week four, treatment of phobias, where we look at an exposure-based treatment, which is really based on this classical learning perspective. So, the other person we need to talk about here is Skinner. And the other type of learning is operant learning. Again, I prefer learning over conditioning, even though you see conditioning, the term used pretty much everywhere. And Skinner is not the only person who is well known in this area. Actually, probably Thorndike was the person who sort of came before Skinner in terms of his research on operant learning. He's a person you associate with the law of effect, which is worded more or less as I have there, behavior that's followed by a satisfying or by satisfying consequences will be repeated, behavior that's followed by unpleasant consequences will be discouraged. This basically led to Skinner's work and the principles of reinforcement that he stated, which are also often poorly understood. And I got a couple definitions there. And these are pretty much correct. But again, what you often are taught or what it's not so much what you're taught, but what people seem to remember is incorrect, particularly negative reinforcement. People will often use that term correctly, or excuse me, incorrectly. Even in the field, you might be talking to a working with a client in a hospital setting, and someone may be talking about negative reinforcement when they really mean punishment or just sort of colloquially, you know, if you're having an argument with somebody, you're criticizing them, they'll say, oh, that's negative reinforcement, don't do that. That's not what they mean. That's actually punishment. It's actually positive punishment. But negative reinforcement is noted there, behaviors that terminate or prevent a negative stimulus will increase. So, the behaviors that terminate will increase. So, it can be demonstrated in animal research where animals learn if they can turn off a shock or if they can prevent a shock, whatever they did to turn it off will increase in frequency in the same situation. And this is actually the aspect of operant learning that I think is most important in terms of understanding psychopathology, not positive reinforcement. Positive reinforcement is noted above it is behaviors followed by a pleasant stimuli increase. So, the idea like, you know, you reward someone for something and it increases the frequency of that behavior, a reward and a reinforcement are not necessarily the same because reinforcement actually implies the behavior did increase. So, if you reward someone and it doesn't increase their behavior, then it actually didn't reinforce it. And you can also do stuff that is intended to decrease a behavior, but if it increases it, it may actually be positive reinforcement. So, for the classic example here is where a child is misbehaving and the parent punishes the child, but then the behavior actually increases. And you're going like, well, how is, why is that? And it may be that, for example, the parent is not paying any attention to the child when the child is behaving better, is behaving well. And so, any sort of attention that you're giving the child is better than nothing for the child. And therefore, it is positively reinforcing the behavior. But back to negative reinforcement, again, I would say, and you'll see me say this at other times during the course, that it is perhaps the most important type of operant learning that there is in terms of understanding psychopathology. So, I mean, I gave the example with rats turning off, pressing a bar to turn off a shock. But with regard to human behavior, if you think about so many things that we consider psychopathology, getting anxiety-related disorders, yes, there may be a classical learning component to how they get started. But what do people then do when they have a fear of something? They avoid it. (1:03:07 - 1:04:31) So, if you have a fear of dogs, you avoid dogs. That avoidance behavior can then get reinforced because it's terminated or prevented some sort of negative emotional state. And you think about drugs. I mean, people may initially take drugs or alcohol for positive reinforcement, social reinforcement. They may feel better, feel high. But then after a while, it gets to where when they're not taking it, they feel really, really bad. And you can make that bad feeling go away by taking the drug or taking the alcohol. So, again, that's negative reinforcement. Even things like eating disorders, where you might be thinking, well, how is that negative reinforcement? Well, someone with bulimia nervosa, for example, has a high fear of weight gain, but yet they engage in binge eating. So, they eat and all this food that they're worried is then going to make them gain weight. And they learn either accidentally or someone tells them, you know, if you throw that up, you might feel better. And the person learns that they do, the anxiety temporarily goes down and that behavior gets reinforced. (1:04:32 - 1:05:14) Obsessive compulsive disorder, people learn when they get exposed to something that triggers one of their obsessions, for example, contamination fears. They learn that if they do something, perhaps wash their hands or whatever, the anxiety temporarily goes down or goes away. And so, that behavior, the hand-washing behavior, whatever it is, gets negatively reinforced. So, I could go on and on. And again, I'll just repeat here that I believe negative reinforcement is probably the most important type of operant learning associated with psychopathology. It's often coupled with classical learning. (1:05:14 - 1:07:50) And something we'll come back to in certainly in chapter two, when we talk about anxiety-related disorders, two-factor theory, which basically is the idea that people may acquire fears or other problems through classical learning, but then they are maintained or reinforced through operant learning and in particular, negative reinforcement. So, classical and operant learning are very important, and we'll come back to them when we talk about various disorders, but social learning is important too. Sometimes, people acquire problems, not because they've had some sort of experience themselves, but because they have learned it from observing other people. So, this goes back to some of the social learning research you would have learned about in other courses by people like Albert Bandura. And the idea is that by watching other people and by watching their behaviors, you can acquire fears and other kinds of problems, even without experiencing the direct reinforcement itself. But once you start engaging the behavior, then you may experience the reinforcement. So, again, it can explain how things get started, and then the other types of learning may kick in. It can also be used therapeutically. So, it's not just the acquisition there, but also the reduction. So, like in working with clients, you might model anxiety-free behavior by dealing with a stimulus and not showing anxiety, showing that it's harmless. And so, again, the point is it's related both to our understanding of where the problem came from, but also what you can do about it. Treatment from the behavioral perspective, I've been alluding to this a bit along the way anyways, but I'll spend a little bit more time on it. If you think of it just sort of objectively or generally, treatment from this perspective involves learning new responses and unlearning old responses. So, in other words, the person's been behaving one way, and we're trying to teach them new ways to behave. And by behavior, we can be referring to sort of motoric behavior, things that you actually do, but also these responses that people might have associated with, for example, classical learning. (1:07:52 - 1:08:35) So, often treatments may involve becoming habituated to previously avoided stimuli. So, you go back to those many examples I was giving you of anxiety-related disorders, for example, a person may be avoiding whatever it is they're afraid of, dogs, shopping malls, it's something like agoraphobia, or people, if it's a social anxiety disorder, social phobia. And what you help people do is stop avoiding those things, and eventually they habituate to them, which can also be considered classical extinction, if you remember what that means. (1:08:39 - 1:11:53) So, these treatments are often called exposure therapies. Remember I said in chapter, associated with chapter two, we would look closely at treatment of phobias that involves exposing people directly to what the things that they're afraid of. And this can be other things too. So, aversion therapy, that's sort of the opposite of, it's using classical learning, but in a different way to try to condition a negative reaction to something that you're trying to stop. Like, for example, drug use, or sometimes it's used with sexual offenders and things like that. You really don't see it used too much. You see the exposure-based treatments, though, used for almost everything. And again, we'll spend a lot of time on exposure-based treatments. Operant-based stuff can be used. Examples there like token economies, that's from some of the early research on schizophrenia, where people who really weren't functioning very well, particularly in hospitals or institutions, simply by reinforcing their appropriate behavior with these little tokens that they could then use to exchange for other kinds of things, their behavior could change significantly. And their activities of daily living, self-skills could improve significantly. But operant learning can be applied to all sorts of stuff. I mean, simply clinicians positively reinforcing their clients for making behavior change, or you can teach couples who are working in, for example, couples therapy to reinforce each other, to try to change each other's behavior. So, many examples of all the different types of learning associated with the behavioral perspective being used to treat all kinds of different problems. So, the next general perspective that we're going to talk about is the cognitive perspective. Now, again, this day and age, often these are integrated, and you talk about cognitive behavioral. They weren't necessarily originally, and some people would even argue that they don't go together. Who might argue that, for example? Well, we just talked a few minutes ago about John Watson and his original argument that psychology should focus only on things that we can directly observe. Can you observe cognitions directly? Not really. So, there are some pretty hardcore behaviorists who sort of refuse to study this stuff, and they don't even like the term cognitive behavioral because to them, it's an oxymoron because, again, behavioral is supposed to focus on stuff that you can observe, and you can't really focus on, you can't directly observe cognitions. But anyways, let's talk first about the cognitive perspective, then we'll talk more about the cognitive behavioral perspective. (1:11:54 - 1:13:23) This goes back to, I don't know if you know who these guys are. One of them is Aaron Beck, who developed what's called cognitive therapy. The other is Albert Ellis, who developed a variant of cognitive therapy called rational emotive therapy, or today it's called rational emotive behavior therapy, because they actually tried to introduce the word behavior into their therapy. What are these therapies based on? It goes back long before either of those guys was around. The fundamental idea is that emotional and behavioral problems are the result not of someone's environment per se, but of basically the way they interpret their environment. So, dysfunctional cognitions. So, again, it's not the aversive events per se, but it's how the person interprets these events. And again, saying it goes way back in time, sort of back to the ancient Greek Stoic philosopher Epictetus, who wrote, this is of course paraphrased, people are disturbed not by things, but by the views they take of them. So, and there's obviously some truth to this that can be easily demonstrated. (1:13:23 - 1:17:21) You have two different people, the same event happens, one interprets it in a very negative way, another person interprets it in a very positive way. The person who interprets it in a very negative way is going to feel bad, and the person who interprets it in a positive way will not, and maybe even feel positive about it. The different ways in which this is done, again, it depends on exactly whose type of cognitive therapy or variant of it we're talking about. Albert Ellis, he used something which I think is described somewhere in your text, ABC model to explain this process, where A is basically the antecedent events, B is basically the belief systems and the beliefs that people have about things, and C are the consequences, the emotional consequences. Aaron Beck, the other guy who's really more well-known than Ellis, he emphasized the idea of cognitive distortions, and he has a whole list of them. Interestingly, Beck was originally a psychoanalyst, and so he was trained to do psychoanalysis, and he observed while he was actually working with some of these patients that what seemed to be determining their emotional states was not these deep, dark, unconscious sort of things that psychoanalysts would normally focus on, but rather it was the thoughts going through their mind right at the time that he was trying to do the work with them. So, he basically changed paths in terms of focusing on this sort of psychoanalytic perspective to, again, developing this cognitive therapy. And, again, there's a big, long list of these things. We'll come back to them when we talk about different disorders. They can be applied to most forms of psychopathology, but the depressive disorders are probably where you see them applied the most. And just some examples that we have here. Black and white thinking, where things are either one way or another, good or bad. If you don't get 100% on something, you're a failure in life. Selective attention, focusing only on negative events. So, a person's life may have positive negative things, seem to just only focus on the negative. Overgeneralizing, when one bad thing happens and the person goes, I always lose, I always fail, I never do anything right. A lot of these are kind of, they sort of overlap because overgeneralizing looks a bit like selective attention. And it doesn't really matter. The point is, this is a long list and it helps clients sort of identify when they're doing these things. Last one on there is catastrophizing, where people say they take an event and make it much worse than it really is. And the job of the cognitive therapist is not to minimize these things, but just help people try to look at them more realistically. And so, I'm sort of jumping to what the therapist does, but the point in terms of the types of psychopathology, how this is an explanation for them, is that different disorders are associated with different types of cognitive distortions. And again, the general idea is these thinking patterns that are responsible for the disorder. Here's just an example of the, this is using the ABC model. (1:17:22 - 1:17:41) And again, the B is referring to beliefs. The beckoning approach would be similar and you would just refer to the cognitions. But anyways, you can see the same event happens for either two different people or the same person having two different possible reactions. (1:17:42 - 1:18:37) So, you can see the event, a friend didn't sit next to me in class. Two possible ways that could be interpreted. The negative way, she didn't see me because, or see me the neutral way, really. She didn't see me because she was in a hurry. So, the person doesn't really interpret it personally. And the reaction is no emotional distress, I'll go up and talk to her later. Person who makes a negative interpretation, I've done something to make her dislike me. That person feels upset, leave class as soon as it's over to avoid feeling rejected again, and then never actually approaches the person and never learns that it was wrong. It could be that it was right, but the point here is that the person made this sort of arbitrary inference and had a negative reaction, again, to the same event. (1:18:37 - 1:20:53) So, the key here is the people's interpretations of the events as determining their emotional and behavioral consequences. Here's the list, I did say that I had a long list somewhere. And several of these already talked about, and it is in your text in this chapter. So, it's worth taking a look at these and being familiar with them. And again, when you start working in this field, you help people identify these things and you help change them. At this point, it'd be useful for you to just be able to recognize these, be able to label it, and be able to say, yes, this is associated with Beck's cognitive theory of emotional disorders. We have a couple more we're going to go through, and then we're going to stop for today. The cognitive behavioral perspective is, as I said before, an interesting one in that some people don't even like the term. So, as noted here, in simplest terms, this is really an integration of the cognitive and behavioral perspectives. It's not really a separate perspective on its own. And as I also said, some people don't really like the term because there's some hardcore behaviorists who think behavioral stuff, or excuse me, cognitive concepts really don't belong in the behavioral perspective. And there's other people who actually say it's redundant because cognitions are just another kind of behavior. So, there's a lot of people who want to stick just to the term behavioral. But they haven't really sort of won that battle because if you think about it, CBT, cognitive behavioral perspective, is really the dominant psychological approach to understanding and treating psychological disorders. Even though, again, it varies a lot in terms of exactly what it means, exactly what people are doing. (1:20:54 - 1:21:41) It has probably been studied the most, both in terms of ideological models and certainly treatments. It doesn't mean it's necessarily the best treatment, but it's been studied probably the most. And we'll return to this in most of the chapters. We'll talk about cognitive behavioral theories of different disorders and cognitive behavioral interventions for them. So, just to say a few words about it here, it incorporates most of the things we've been talking about already. So, the cognitive side of things, helping clients identify and replace unhelpful cognitions, but also involves identifying and replacing unhelpful behaviors. (1:21:42 - 1:23:38) Plus those things that I was talking earlier about exposure-based therapies, they're generally considered cognitive behavioral interventions too. Often there's a cognitive component to them, but there are some people who would say, no, really these are strictly behavioral sort of interventions. So, not everyone agrees on these things. And as I said just a minute ago, this approach has been studied as a treatment for a wide variety of psychological disorders, and we will return to it quite frequently. It's definitely the dominant approach in Australia. And if you were at our information session just last night for me, you will have heard us say that it's the prominent treatment approach that you would learn if you were to go into our program or a similar postgraduate program. One more perspective that we'll talk briefly about, and then we will break for this week, is the humanistic perspective. This was sort of a rebellion against the psychoanalytic and behavioral perspectives. Psychoanalytic perspective viewed people as sort of primitive. Everything came back to sexuality and aggression. And the behavioral perspective, at least initially, viewed people as almost nothing but a product of their environment. The humanistic approach sort of emphasized some of the positive aspects of humans, the potential for human growth, uniqueness of the individual, and emphasized, as noted there, people have the freedom and responsibility to make choices, not just sort of robotically respond to the environment. (1:23:38 - 1:29:25) So, again, there's a bit of a rebellion against some of the behavioral ways of looking at things. And also, as I said, the psychoanalytic perspective, yeah, as noted there, critical of some of these overly reductionist approaches to studying human emotions and behaviors. People associated with this, Carl Rogers, for example, Maslow, and concepts such as self-actualization, sort of the idea that people strive to become all they can be. And when something gets in the way of that, that's really what causes what we consider psychopathology or psychological disorders. Therapies that stem from this, you have like client-centered therapy, which is still fairly popular and particularly among sort of the counseling profession. And there are parts of that that we teach as a part of our program too, even though we might be focusing more on cognitive behavioral interventions for the majority of what we do. You'll see that we left off basically right around here. And so, the big scheme of things, just to review what we've been talking about, at this point, it's perspectives on classification, causation, and treatment. So, in other words, thinking broadly about psychopathology, what are the different theoretical perspectives on what causes different types of psychopathology? And so, we talked about the biological perspective very broadly. Again, it will come back to more specific discussions when we get to other disorders. But we went through biological and psychological with all the different sub-perspectives like behavioral, cognitive behavioral, psychoanalytic. Now, we're going to say a few things about the sociocultural perspective and then try to integrate things. To talk about sociocultural perspective, ask yourself, why do I have these pictures up here? What on earth do they have to do with psychopathology? This would be for a topic we'll probably come back to when we start talking about eating disorders and things related to body image. The idea here is just to illustrate contrasting views of what's considered attractive, which is basically a sociocultural phenomenon. And when we talk about eating disorders, you'll see that over time, the prevalence of eating disorders has varied depending on the sociocultural perspective on what was considered attractive. So, when it's viewed as being extremely thin, you have higher rates of eating disorders or at least disordered eating. So, we're talking about the sociocultural perspective. What in general are we talking about? Well, it's basically the relationship between different sociocultural factors and psychopathology or psychological disorders. So, many different sociocultural factors, but things like what I have here, culture, ethnicity, socioeconomic status, SES stands for. And so, for example, there is research suggesting that some ethnic groups may have higher rates of certain disorders, psychosis, for example, or at least have higher rates of diagnosed disorders. Sometimes the argument is it's more of a diagnostic bias, and it certainly may be in some cases, but there's also some evidence that there is variability based on that factor. Socioeconomic status, clearly, there's quite a bit of evidence that certain disorders vary as a function of that. Exactly why that is, there's competing theories. Sometimes it's a causal factor, but it can also be a result, like when people have certain types of psychopathology, they may end up losing their job and end up in a lower socioeconomic status. There's also research suggesting sort of the opposite, that certain groups may have lower rates of psychopathology, and therefore, there may be cultural factors or factors associated with ethnicity that may work as a buffer, sort of protective factor against psychopathology. For example, might be more social support in certain groups than others. Another general concept associated with the sociocultural perspective is the idea of what are called culture-bound syndromes. It's strange that they actually use the term syndrome rather than disorder, even though like the DSM uses the term disorder. But the idea of a culture-bound syndrome is something that basically occurs only within a particular culture or cultural group. And there is a section in the DSM on these things, and there's a couple examples there. (1:29:26 - 1:31:06) Ataque de nervios is something seen in certain Latino cultures, sort of like panic disorder, sort of like panic attacks, but not exactly the same. So again, it's something sort of unique to that culture. And I won't mispronounce the Japanese variant there, but there are many examples of that. So again, that's just another concept related to the sociocultural perspective. And there's many more. And the other point I should make is that basically certain disorders are probably more influenced by sociocultural factors than others. So when we talk about the different disorders, we'll spend more time on some of those in certain topics. So for example, I've already alluded to the idea that there may be more sociocultural influences associated with eating disorders and other body image-related problems, and perhaps less related to things where there may be more of a biological component, like perhaps bipolar disorder or schizophrenia. But we'll definitely see that they're certainly not unaffected by sociocultural factors. So that was a little bit briefer than the other two. We spent more time on the biological perspective and the psychological perspective, probably because there's more research on those, at least in general. And as I said, it really sort of varies in terms of which type of disorder, which type of psychopathology we're talking about. (1:31:07 - 1:33:29) But the last topic I want to cover here before moving on to something a bit different is the idea of what I have known as an integrative approach, which basically implies that none of the things that we've talked about above are enough by themselves to explain all the things we have above classification, causation, treatment. You really need to sort of integrate biological, psychological, and sociocultural kinds of factors. And that's basically what I'm referring to here. So a couple concepts we need to think about here. One is, and this is just basically what I just said, that none of these are sufficient to explain abnormal behavior. One of the concepts we need to think about is the biopsychosocial model, which is basically a model that attempts to integrate those classes of factors. So biological, psychological, and social or sociocultural factors. A related term, not exactly the same, but it's the idea of a diathesis stress model. A diathesis is basically a vulnerability, and stress is something that basically triggers that vulnerability. So it may be that there are many predisposing factors, which could be biological, for example, but then there may be stressors that are psychological or sociocultural that lead to the expression of a disorder. And most disorders that we will be talking about, most people in the field do try to explain them in these ways, the biopsychosocial approach and diathesis stress models. Here's just sort of a figure trying to illustrate the idea of including biological, psychological, and social or sociocultural factors into the overall explanation of a disorder. (1:33:30 - 1:33:58) And what those biological factors could be, it could be a variety of things. What's listed here, just some examples, evolution, genetics, brain structure, chemistry, some of the things we talked about. Psychological factors, stress, which could be psychological or sociocultural really, trauma, learned helplessness, all of the cognitive stuff that we talked about, all of the learning that we talked about in the first half of this lecture. (1:34:00 - 1:34:16) And then sociocultural influences, all the stuff I talked about in the previous slide, but also roles and expectations. Sometimes in certain cultures, there's more of an expectation that people react a particular way to particular events. We talked about bereavement last week. (1:34:17 - 1:36:54) So for example, in most cultures, it's acceptable to react in a particular way when one is lost a loved one, exactly how may vary depending on the person's culture. The last thing that is important too, I mean, we spent a whole part of the last lecture talking about what's considered normal and what's considered a disorder. And those factors may differ somewhat depending on sociocultural factors. So that may actually affect whether or not we define something as a disorder or not, if that makes sense. So now let's talk about this last area for week one, the classification and diagnosis of mental disorders. So in doing that, I'm going to talk about a couple of things. First, what is classification, at least in this field, and why do we do it? And then second, we'll talk about the DSM, which is something I've mentioned before, but we'll go into some more details about it. So regarding the first question, what is classification and why do it? Here's a general couple definitions. First one, sort of independent of abnormal psychology, a general definition, effort to assign objects or people to categories on the basis of their shared attributes or relations, which again, that could apply to anything. We could apply to medicine, where you're talking about classifying types of illnesses, even biology, you're classifying types of animals as a dog or a cat or a kangaroo or whatever. The second definition would be specific to this field. So abnormal psych or psychopathology, the delineation of various types, categories, or sometimes dimensions of psychopathology. So referring to dimensions sounds a bit contradictory because a category seems to be something that is a grouping variable. You're either in it or you're out, you're not in it. Whereas a dimension is something that everyone is in there to some degree. And the question is where on the dimension you fall. And this is one of the areas of controversy in our field. And there are sort of dimensional classification systems that we'll talk to you about at some point in time. (1:36:54 - 1:37:13) But most of the time it refers to categories, putting people into one group or not, which has advantages and disadvantages. So let's talk about those next. There are no doubt both advantages and disadvantages to having a classification system. (1:37:14 - 1:37:34) And let's just talk briefly about some of those advantages. One of them is that it allows for better communication about whatever it is we're talking about, or at least communication without as much time and details needed. So just think back to an animal example. (1:37:35 - 1:38:08) If I wanted to tell you all about an animal that I saw in my yard, if I had to describe all the details of it, it would take a lot more time to say, you know, it had a long tail and was hopping around and had a pouch and blah, blah, blah. When I could simply say I saw a kangaroo and you would immediately know what I was talking about. And the same would apply to if we were talking about birds and I mentioned a particular type of bird and you knew birds, you would know what I meant without me having to describe it. (1:38:09 - 1:38:40) So when we're talking about mental disorders or psychopathology, if there's such a thing as schizophrenia, and I know that a person has been diagnosed with schizophrenia, I can talk to another psychologist and say, this person has a diagnosis of schizophrenia. And that communicates a lot of information to the other professional. Now, it doesn't imply that all people with schizophrenia are the same, but at least it implies that schizophrenia means something. (1:38:41 - 1:39:39) And so, you know, as noted, it helps with communication with other professionals, but also in terms of like research, which I'll get to in a second. Consistency refers to knowing that we're talking about the same thing. So if somebody is doing a study of schizophrenia in Australia, and they're also doing studies of schizophrenia in Sweden and the United States and wherever else, we know if they're actually studying schizophrenia, that they're studying the same thing. If we didn't have a classification system, it would be much harder at least to study the same thing in different places or over time. Now, the challenge comes when we actually change the disorders over time, change the criteria. But to the degree that we don't, it allows for consistency over time or in different places, different countries. (1:39:41 - 1:40:12) So I've kind of referred to the research aspect of that treatment also. If we develop a treatment, for example, for schizophrenia or for bulimia nervosa or for specific phobias, and then we encounter a person with specific phobias, bulimia nervosa, or schizophrenia, we should know something about what treatments might work well because we know that they've been studied already. So hopefully it would allow for better clinical care. (1:40:12 - 1:45:10) However, there are some disadvantages, some of which might suggest the opposite. One of these is stigma, which is described in your text. And I may spend some more time on this in a tutorial associated with week one, time permitting, definitely the one in week two, you'll spend some time talking about stigma and the readings by Rosenhand that you'll do for that week. Stigma refers to basically negative attitudes towards anything, really. There's stigma towards obesity and stigma towards a variety of health conditions or personality factors. But we're talking about stigma towards mental disorders and certain disorders are stigmatized more so than others. Schizophrenia, I've mentioned several times, does have a lot of negative stigma. Borderline personality disorder is another one. And I'm not saying these are justified. I'm just saying that they exist, probably both among people in the community and among people in the field. And when it is people in the field, and there's a negative stigma, that's a bad thing because it might mean that people, clinicians or people working in the field in some other way, treat people negatively because of the disorder. Which, again, you'll see some examples of that in the reading for week two. But it would apply certainly to the disorders I'm talking about and some others also. And this is an area that we could use a lot of work in. I have a PhD student doing a PhD on this very topic of trying to improve stigma and trying to reduce stigma by improving treatments for stigma. So, it's definitely a potential disadvantage of classification systems. Also, possible loss of individuality. I said earlier, if two people have schizophrenia, they're not necessarily exactly the same. And we don't want to think that they are. They have things in common. They have schizophrenia in common. But we don't want to say that someone, all people with any disorder are exactly the same. They're not. So, it's possible loss of individuality, but it really shouldn't be a loss. The last two things are also discussed in your text, I'm pretty sure, kind of go together. Reification is the idea that that diagnosing a disorder makes it sound more real than it necessarily is. I don't mean it's not real in the sense that someone's making it up. But what I mean is sometimes these diagnostic labels that we use are descriptions of behavior patterns. But it's not necessarily the idea that there's this sort of entity that's out there that someone has, as opposed to it being a description for what they're doing. Now, certainly with certain medical conditions, cancers, viruses, there are these sort of entities that cause the problems that people have. But with mental disorders, psychopathology, it might be a bit different. And that gets to the illusion of explanation, the idea that you can explain why someone has their problems or why they're doing what they're doing. Simply by saying what condition they have. So, for example, why is this person binge eating and purging afterwards? Oh, well, she has bulimia nervosa. But that doesn't really necessarily explain why she's binging and why she's purging. It's a description of the behavior pattern. And we know things associated with treatment and so forth. But there may be other reasons why the person's doing it. Similarly, if we say, why is someone depressed? Well, they have depression. That doesn't really explain it either, because there may be all sorts of life events associated with why they're depressed. So, we don't want to just assume by labeling something that we have explained it. The labels allow us to study various kinds of problems, which allow us to come up with explanations, which still may be individualized quite a bit. So, overall, we've got advantages and disadvantages to a classification system in this field, which is basically the DSM, which we will get to shortly. So, we've now talked about what is classification, why do it, some advantages and disadvantages. And as I said, let's now start talking about the DSM. (1:45:11 - 1:46:56) So, here are some DSMs. Not all of them. The one in front is the almost current one. That's the DSM-5, and we're up to the 5TR, which I'll explain that shortly. And the ones in back seem to start with the 3, the DSM-3. There were actually a couple before that. And we'll talk about the various additions shortly. DSM Diagnostic System. So, what does that stand for? Again, it's the Diagnostic and Statistical Manual. That's what the DSM stands for. So, the full name though, Diagnostic and Statistical Manual of Mental Disorders. What is it? Here's a definition actually from the manual itself. Manual used by clinicians and researchers to diagnose and classify mental disorders. That's really all it is. It's not something more than that. It's not a scientific taxonomy. It's allegedly derived based on science, but again, it's not like a comprehensive scientific taxonomy. Also, what is it not? It's not, it's never claimed to be any sort of Bible of psychiatry. Every time you read people critical of the DSM or psychiatry in general, they always refer to the DSM as being the Bible of psychiatry. Anyone who says that is just basically trying to say something that's not true, to criticize the field, talking about psychiatry as if it's a religion, that they believe it's this infallible sort of thing. It's not the way it is. (1:46:57 - 1:48:08) So, it's a manual, it's imperfect, and it's something that is revised numerous times because we learn more about the information in it. That's one of the reasons why there've been so many of them. We're up to the fifth edition text revision right now. I'll show you, I think on the next slide, all of the editions we've had up to this point in time. This is important. It's published by the American Psychiatric Association. Now, what is the American Psychiatric Association? Well, it's an association of psychiatrists, which are medical doctors. So, it's a very medically oriented organization and a medically oriented text. They often refer to mental disorders as being medical conditions. And this is because that is the way psychiatry and medicine thinks. But that doesn't mean that everyone in psychology, clinical psychology, for example, doesn't necessarily think that way. And so, it's important to realize that it is by the American Psychiatric Association, not the American Psychological Association. (1:48:09 - 1:49:37) Often students get that confused. I've seen students, even after this class in honors or master's or even PhD, sometimes citing the DSM as being written by the American Psychological Association. But it's very different. There are some books that you'll encounter published by the Psychological Association, like the publication manual, for example. But the DSM is definitely published by the American Psychiatric Association. There's a website for it. I think I put this link on our course website. You can check it out. There's all sorts of useful information there. The DSM itself is not there. Like, if you want that, you have to pay for it. Or I think our library has a copy of it, which is different from the ICD system, by the way. The ICD system, it is all online. You can look that up. But this has a lot of useful information about the DSM. It also has some tests that you could use for research purposes and things like that. So it's a useful site. Believe it or not, there's a Facebook page. It's a page actually published by, I guess it's the APA or the DSM committee. It's not just one created by somebody who wanted to criticize the DSM. So you can get some information there. (1:49:37 - 1:49:46) And as with all Facebook pages, it has a lot of people making strange comments about it. But it is real. It might be worth something checking out. (1:49:48 - 1:52:49) So here's the full list of the different DSMs that there have been going all the way back to the 1950s. And as you'll see, they're not named in such a way where it easily reflects how many there have been. We're up to the DSM-5-TR. And so if you're ever playing Trivial Pursuit with your friends, or if I ask a question on a test or the exam of how many DSMs there have been, it's not as easy as just thinking, well, it's the DSM-5, so there have been five of them. There have actually been more than them, more than five. And you can count how many. But it's because they've progressed in various ways. So the first three, they just revised them to be separate editions. But then they created the 3R, which was just a revision of the third, but there wasn't enough changes to make a completely new one. It fixed some mistakes and made a few changes. Then they had the 4, and then they had the 4TR. TR stands for text revision, which basically means they didn't change much in terms of diagnostic categories or criteria, which we'll talk about shortly. But we've just learned more information. I mean, if you look at the difference in time between the DSM-4 and the 5, it would have been 19 years if they didn't have the 4TR. And so as we learn more about various disorders, they put it in the DSM. But if they don't have enough information to completely revise it, they don't call it a complete revision. They've done the same thing with the 5. The 5 came out in 2013. And then a couple of years ago, the DSM-5TR came out, which again is a text revision, not a full revision. Now, the one other thing worth noticing as you look at them is that the first several up through both editions of the DSM-4 were with Roman numerals, whereas they changed to Arabic numerals after that. And you might say, well, why did they do that? Was that just a typographical error? No, they actually did it for a reason, at least according to them, that they went with Arabic 5 because they wanted to potentially be able to refer to a 5.1, 5.2, 5.3, and so forth in the same way that this day and age you have software for Windows or whatever where you have version 10.2, 10.3. And that was what they stated was the reason. Now, if that's the case, why did they not call the 5TR 5.1? I really don't have an answer for that. (1:52:49 - 1:53:21) Maybe they don't either. But that was the stated intention. So, if you ever see it written with a Roman numeral 5, that's actually incorrect. So, also regarding history development of the DSM, this table is from your book. And obviously, the DSMs have changed over time. But the point made in this table is that the biggest change came between the DSM-1 and 2 and everything else. (1:53:21 - 1:55:13) So, in other words, the DSM-1 and 2 were fairly similar. And the DSM-3, 3R, 4, and so forth, all the way up to the current one are fairly similar. Now, there's still changes. But again, the biggest changes happened after the 2. And kind of summarized here, prior or during the 1 and 2, you had the general descriptions of categories, very unspecific, which led to the very unreliable diagnoses. And I'll show you some examples in a minute. With the 3, they came out with specific diagnostic criteria for each category. So, you have to go through and make sure people meet these individual criteria before you diagnose something as opposed to just saying, oh, yeah, it looks like that to me. Another big change was the 1 and 2 were based on psychoanalytic theories of causation, whereas the 3, and since then, are allegedly based on no explicit assumptions. They're really supposed to be descriptive rather than based on causation or etiology. Now, as time has passed, they've moved a little bit back in the direction of including some causation. For example, there's a trauma and stressor disorders category or chapter, which obviously implies something to do with trauma or stress in terms of causation. But a lot of them, there's really not an assumption. They're just grouped based on the similarities of the symptoms, basically. And then that last one there, monothetic versus polythetic format. Monothetic means basically you have one description or one set of criteria that everyone must meet all of them. (1:55:14 - 1:55:50) Everyone in the category would be very similar. Polythetic refers to situations where you might have several criteria, but they don't necessarily need to meet all of them. So, you might have nine and they have to meet five or something like that. And I'll give you many examples of that, which that could actually lead to problems because you get several people with different presenting problems fall into the same general category. But in some ways, you end up getting higher agreement with the polythetic format. So, I'll show you some examples in a minute. (1:55:51 - 1:56:08) And there have been some other changes since the three. I mean, they're not all the same. There was one fairly big change before the DSM-5 where they used to have something called a multiaxial system where you had five axes upon which you would make a diagnosis. (1:56:09 - 2:02:33) And I found that quite useful. You could pass along quite a bit of useful information to someone else by using all five axes. But they got rid of it. It's kind of complicated why, a variety of different reasons. And maybe at some point during the course, I'll go through what they are. But for now, just know that it's not in there. That multiaxial system is no longer part of the current DSM. So, on the previous slide, I mentioned the idea of diagnostic criteria. Here is an example of a set of diagnostic criteria. These are from the DSM-5 and for a major depressive disorder. The specifics of these is nothing that you need to remember at this point. I'm just giving you this as an example. When we do come back to the depressive disorders, you'll probably want to look very closely at them. But you see the beginning under criterion A, it says at least five of the following. So, five out of nine. Remember, I was talking about the polythetic criteria before. So, this is an example of that. They don't need to meet all of them, although they do need to meet the A, the B, and the C. And different disorders have different numbers of criteria and different that you need to meet. But it's quite different from the way it was before, which I'll show you on the next slide. So, in this table, we just have a comparison of what was in earlier DSM. So, I think it's from the DSM-2 at the top. And then the one below is from the DSM-4TR, which is, again, similar to what we currently have. I'm just using this one because it happens to have both of them in there for comparison. But you can see for the two, there was just this sort of general description of what manic depression or a manic episode looked like. And with the current DSMs, including the one here, but also like the DSM-5, you've got the diagnostic criteria. They're very specific and, again, are polythetic, meaning that people wouldn't necessarily need to meet all of those. They might, but they don't necessarily need to. And as with the previous one, you don't necessarily have to try to memorize any of this stuff about what a manic episode looks like. But when we get to the bipolar disorders, you will need to pay much more attention to that. This is just to illustrate the difference between the early descriptions of the DSM and the more recent ones, including the current one. So, in this table, which is just kind of poorly spread across two different slides, but it's in your text. You can go back and look at it more closely. It's just a listing of all the current categories of mental disorders in the main section of the DSM-5. So, pretty much everything that we will talk about in this course will be in there somewhere. And we won't talk about all of them just because we don't really have time to cover them all. But they start with the neurodevelopmental disorders, which includes things like intellectual disability, autism, spectrum disorders, some of the other ones listed there. Then they go through the schizophrenia spectrum, where you'll see, of course, schizophrenia, but some other disorders. Then it's bipolar-related disorders, followed by depressive disorders. And I'll keep going, but I'll make a point here that the organization of these disorders is somewhat on purpose. It's not like a real scientific taxonomy, but they specifically put bipolar-related disorders between the depressive disorders and the schizophrenia spectrum disorders, because bipolar is conceptualized as something sort of in between. It's a combination sort of a psychotic disorder and a mood-related or depressive disorder. So, here, this just continues. And as I was saying, it's kind of awkward to put into slides because the size is different. But these are the remaining categories that we will touch on, and not all of them, but some of them. Certainly, anxiety disorders will go through obsessive-compulsive and related disorders and trauma-related, trauma-stress-related disorders. Those used to be all in the anxiety disorders category. And the current version of DSM is divided now into three separate sections. Then we move to the dissociative disorders, which is, again, there for a reason. It's right next to the trauma and stress-related disorders, because these disorders are generally closely related to trauma and stress. If it was up to me, I would have put them in that category, but they don't always listen to me. Then you move on, somatic symptom and related disorders, feeding and eating, elimination, sleep-wake disorders, sexual dysfunctions, and some of these we won't cover as we're getting into this section. We will cover, as we keep going on the list, the substance-related and addictive disorders. I will try to cover personality disorders toward the end of the term. And then we also have a section on childhood disorders, which if you look at the list, you'll say, well, where are they? And there actually used to be a separate section in the DSM that was just childhood disorders. It was called Disorders First Evident in Infancy or Childhood. And they got rid of that categorization. They didn't get rid of the disorders, but they just basically moved them into different sections. So there are, for example, anxiety disorders that mainly affect children. If you notice the first one there, separation anxiety disorder mainly affects children. Selective mutism mainly affects children. (2:02:35 - 2:03:31) And if you go back to the previous slide, there's some other ones in there, autism spectrum disorder, attention deficit, hyperactivity disorder, those kinds of things primarily affect children, at least initially. So that's where the childhood disorders are. They're dispersed throughout the DSM. So the DSM has been modified, obviously, numerous times. And I mean, it's important to keep updating it. We've certainly learned a lot more than we knew back when the DSM first came out. So it is extremely important to do this. Have there been improvements? Yeah, quite a few. So one, we've talked about the specific diagnostic criteria, meaning that these categories, how you diagnose them, the process is less vague. (2:03:32 - 2:09:16) They're more explicit and concrete than the earlier editions, DSM 1 and 2. The descriptions are much longer. If you, again, compared the DSM 1 and 2 to the others, just size wise, it just really wasn't much in there because we didn't know a heck of a lot about these disorders, heck of a lot. But now we know more. And so there's more in there in various places, like the essential features is just more detailed, but associated features, for example, lab findings, anything like that, anytime we learn more about a disorder, it gets put in there. So there's quite a bit more. Also, there's sections on differential diagnosis, which means how do you determine which disorder it is. So for each disorders in the DSM, there's a whole list of other disorders that are potentially confused with the one that you're looking at. And so there's a whole section in there on how do you tell which one it is. So a couple more improvements, increasing number of diagnostic categories. And I've got in parentheses that that can be good or bad. I'll come back to it about why it's bad in just a minute. But it's good in the sense that if we recognize some new disorder or a disorder appears that it actually is new in itself, then it's important that we identify it and we put it in there so that we can study it and you can assess people with it and treat the problem. There are many things that we just did not know about back when the DSM 1 and 2 came out. So it makes sense that we should be adding to the list, particularly if the disorders are valid. Again, the question or it becomes a question if the disorders perhaps are not valid. But there is also a category. This is the fourth advantage or improvement that allows us to sort of study things before we put them in there officially. So there's a whole section in there on possible diagnostic categories in need of further study. So again, when something appears in the literature, but we're not sure that it belongs in there as an official category, it can move into that. It's basica