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Psychology 144 Term 3 - 2024 Week 1 & 2 – Developmental Psychology Chapter 3 – Early & Middle Childhood Introduction ! Foundations of adulthood well-being are laid during prenatal development and...
Psychology 144 Term 3 - 2024 Week 1 & 2 – Developmental Psychology Chapter 3 – Early & Middle Childhood Introduction ! Foundations of adulthood well-being are laid during prenatal development and childhood. Domains of developmental psychology: Physical, cognitive, socio-emotional. - ! All development is interrelated and interactive! Physical Development – Prenatal Period Stages of Development: 1. Germinal stage: First 2 Weeks after conception. Zygote: single cell organism resulting from the sperm’s fertilisation of the ovum (conception) => Mitosis = mass of 100 cells, 4 days after conception => Cell mass exits fallopian tube and enters the uterus. Genetic heritage is determined at conception – genes in sperm and ovum combine to create a unique new person. 2. Embryonic stage: End of 2nd Week until 8th Week after conception. Embryo: cell mass now implanted in the uterus. - ! 2 CRITICAL LIFE SUPPORT SYSTEMS DEVELOP: 1. Placenta: complex organ that allows nutrients to pass from the mother to the embryo through the umbilical cord. 2. Umbilical cord: - Arteries in this cord carry oxygen and nutrients to the embryo. - Veins carry waste (Co2 & urea) away from embryo to be disposed of through the mother’s body. Cells of the embryo divide rapidly = different kinds of cells => eventually becomes the baby’s different organs End of embryonic development: - Embryo is 2 cm long. - Heart is beating, - Recognisable as a human being (facial features, hands, feet, fingers, toes etc.). - Essential organ systems & nerve cells of the spine have formed. Embryo is contained in a sac within the uterus that contains *amniotic fluid: cushions and protects the embryo. 3. Foetal stage: +/- End of the 8th week after conception until 36 to 40 weeks (full gestation). Structures and systems that started developing during the embryonic stage, grow in size and efficiency. Before +/- 3 months: danger zone were baby is especially vulnerable to teratogens and most miscarriages occur. 3 – 4 months: male/female sex organs develop. 4 months+: mother can start feeling the baby move. +/- beginning of 5th month: baby responds to sound & orient themselves to mom’s movements. +/- end of 5th month: cerebral cortex (complex, conscious thought) is completed. 6th month: - Eyelids open and eyes begin to move. - Baby can breathe and even cry. 7th month: - Baby’s brain can control breathing, swallowing, and body temperature (medulla oblongata). - Baby has the nerve cell capacity for: sight, hearing, smell, taste, and vocalisation. - Reflexes develop: grasping & sucking (essential for newborn survival). 26 Weeks: *ZONE OF VIABILITY: baby has chance of survival if born prematurely. - ! RISKS OF PREMATURE BIRTH: increased school and behavioural problems & psychiatric disorders in adulthood. Beginning of 9th month: Can’t easily float in amniotic fluid anymore – almost to big now = curls up into foetal position => usually settles with head towards birthing canal, all ready to be born. Factors Influencing Prenatal Development: Mom and Mom’s environment are linked to baby through the placenta and umbilical cord. *Teratogens: harmful, environmental agents that interfere with normal prenatal development – can cause birth defects and death– infections, chemicals, hormones etc. 1. Maternal conditions: Physical, social, and psychological conditions of the mother AND her behaviour can affect baby in different ways. Maternal mal/under-nutrition during AND BEFORE pregnancy: baby needs a variety of nutrients to develop normally which they get from Mom through placenta and umbilical cord – Complications: low birth weight, neurological deficits in newborn. – Big problem in SA due to poverty. Mom has HIV: unborn baby may become infected or infected at birth – can be avoided if mom is taking anti-retroviral medication properly. - Other STIs: syphilis, gonorrhoea, genital herpes. Maternal stress: stress hormones are carried to baby through umbilical cord = possible anxiety conditions later in life. Age of mom: very young or over 40 years (high risk pregnancy). Mom’s physical health: - Malaria (low birth weight, parasite exposure) - Rubella (deafness, blindness, mental retardation) - Diabetes (birth weight too high, stillbirth, neonatal death) - Hypertension (death of baby – may require inducing premature birth). - Alcohol (FAS: baby is short relative to weight, abnormally small heads, underdeveloped brains, mental and motor development are retarded) - Tabacco (nicotine): compromises nutrient and oxygen supply to baby = small, underweight baby, premature birth, miscarriage, stillbirth. - Prescription drugs: OB/Gyns should always be consulted on all prescription and over the counter medication that the mother takes during and in the months after pregnancy as chemicals in them may affect baby in utero as well as breast milk quality. - Recreational narcotics: Marijuana = low birth weight and premature birth. Ecstasy and other drugs = poor motor development and delay in reaching milestones. Whether pregnancy was planned or not: if mom is unaware that she is pregnant until quite late, she may not adjust her lifestyle to accommodate normal development of baby. Neonatal Period (First 2 to 4 Weeks after Birth) Move from safe, warm uterus to loud, cold, nasty outside world – no wonder they cry so much. – Have to now breathe and eat on our own AND interact with environment and make sense of it. APGAR: essential health indicators checked in newborns – Good score: 7+ For a long time, we though newborns were helpless, strictly reflexive, and had limited motor control and perceptual skills – NOT SO! Newborns have 20+ Reflexes – initially involuntary responses to stimuli, geared towards survival – mostly to do with feeding: rooting, sucking, swallowing. - ! ABSENCE of Reflexes = possible neurological issues. Perceptual Development during Neonatal Period: Normal, full-term babies are born with all their sensory capacities, functioning to a certain extent. Vision: - The anatomy of the visual system is present at birth – certain parts of the eye and visual cortex are still coming – also can’t coordinate eye movements just yet. - Newborns can’t focus eyes properly – so everything is kind of blurry. - Can definitely scan their surroundings. - Can see things that are about 21 cm away. - Distinct preferences for looking at faces (especially mom’s). - Like patterned over plain images and patterns with sharp contrast. Hearing: - In the first few hours after birth, newborns can tell human sounds from non- human sounds – preference for mom’s voice. - Are particularly fascinated by baby talk directed at them. Taste and Smell: - Well-developed. - Sensitive to smells AND able to distinguish between them. - Strong preference for sweet tastes over sour ones. Preschool Period 4 – 6 months: birth weight doubles. Trunk grows fastest during 1st year. End of 1st year: birth weight triples. First 2 years of life: rapid growth. 2 – 6 years: slower pattern of growth. Prenatal and Postnatal Growth Patterns: - Cephalocaudal development trend: sequence of physical growth that proceeds from the head and progresses downwards. - Proximodistal development trend: the sequence of physical growth that proceeds from the centre of the body outward. Order of gaining muscle control: head = > neck => arms & abdomen => legs. Change in Body Proportion during Preschool Period: - 2 years: head is ¼ of the body size. - 5 ½ years: head is 1/6 of the body size. - Brain still grows!: from 25% of adult weight at birth to 50% of adult weight by 1 year. -Brain and nervous system also develop increasingly dense neural networks = Increased ability to take in new information essential for progress in schools. 3 Kinds of Major Environmental Influences during Middle Childhood: 1. Quality of care (opportunities to develop). 2. Nutrition (right amount and healthy). 3. Illnesses (meningitis). Brain growth in middle childhood: keeps growing in structure and function (little slower than in earlier childhood). - 5 – 7 years: brain growth spurt – especially the frontal lobes and their connections to other parts of the brain = planning and sequential organisation of thoughts and actions. Cognitive Development *Cognitive development: Cognitive development refers to the age-related changes that occur in mental activities such as paying attention, perceiving, learning, thinking and remembering. Neonatal & Preschool Periods First 2 years of life: basic understanding of the world develops. - Recognising objects and people. - Search for objects that are not in their field of vision. - Understand cause and effect relationships. - Appreciate the concept of space. Preschool = new social situations and activities = > more cognitive development. Cognitive & language development follows a relatively predictable sequence BUT they build *schemas: pattern of thought or behaviour used to organise categories of information and the relationships between them, through the processes of: ! Does not happen instantly – action facilitating new experience must be repeated – continual incorporation of new experiences into baby’s existing world = more complex understanding of the world = progression through levels of development. pretend play = cognitive development.  Pretend play also aids social development: requires taking on different roles, coordinating activities, resolving disputes – helps prepare for adult roles by playing ‘house’ and ‘school’.  Children that participate in a pretend play tend to be: more socially mature and popular. - Play = healthy Emotional development.  Allows for the expression of feelings and resolving emotional conflicts. Early Development Programmes Learning occurs at home, in the community, and informal/formal structures, mostly through the medium of play are in an identity crisis. 4. Identity diffusion: Adolescents have explored alternative choices BUT have NOT been able to settle on one. Nsamenang’s Conceptualisation of Social Selfhood Development – Adolescence: 2 Stages: 1. Social entrée: - Occurs during puberty. - Characterised by appearance of secondary sexual characteristics (breasts, body hair) and initiation ceremonies. 2. Social internship: child is inducted into social roles – prepares adolescents for adult life and trains them to be responsible adults. Adolescents’ Relationships with their Community, Family, and Peers: Adolescence highlighted as a time when children strive for autonomy from their parents – investing more time in the peer group. Parent-adolescent conflict: - Santrock: Frequently involves adolescent becoming disillusioned with their parents and parents attempting to hold onto their control and authority. - Serves an important function in the development of adolescents into an autonomous adult. - Conflict is arguably overstated – not necessarily a universal phenomenon. - Conflict exasperated by: lack of communication between the two generations. Peers have a central role in adolescents’ lives. - Sullivan: friends play a large role in the well-being of the child, and that this role increases in adolescence - supported by contemporary research - In addition, given the emphasis on sexuality in the peer group, dating and romantic relationships become a primary focus for many adolescents. - ! Peer pressure! - conforming to peers is not necessarily negative, as peer groups may also inspire pro-social behaviours. Gender and Sexual Identity: In SA, the outcome of discussion around gender and sexuality for girls is often the impression that: they are passive and vulnerable to men or boys, and that menstruation is a negative, dangerous transition. Non-normative sexual-preference and identity is often ostracised and discriminated against. Sexual Relationships and Health Risks: Most HIV infections occur before the age of 25 – women are more at risk. Sexual debut before the age of 16 and having multiple sexual partners = increased risk for STIs and unwanted pregnancies – also related to challenges negotiating safer sex during adolescence – related to inequalities ito gender, age, and poverty. Another barrier to safe sex: traditional gender roles – socialised sexual practices. Risk-taking Behaviours: Risky sexual behaviour. Substance abuse - consequences. - Academic problems (attendance and achievement). - Increased mental health problems. - Sexual risk-taking. Violence – influenced by: - Social fragmentation - Economic inequalities. - Consequences:  Constraints on personal development.  Irreparable damage to relationships.  Disruption of family and communal life.  Inappropriate allocation of scarce community resources. - Gang Violence. - Interpersonal and Gender-based violence. Social & Emotional Development – Early Adulthood Generally characterised by assumption of critical social roles: marriage, partnerships, parenthood, earning an income, independence. ! Zimbardo: There now seems to be a transitional stage between adolescence and adulthood where young people, having passed through adolescence, delay taking up traditional adult responsibilities such as marriage and parenthood Marriage and Partnerships: Erikson - *Intimacy vs Isolation: resolution of a tension between the drive towards intimacy, on the one hand, and isolation, on the other. Cohabitation is often opted for in Western societies before or in place of marriage. Married people tend to be more content and satisfied than single people. - Marriage eased the mid-lie dip in life satisfaction. - BUT can ALSO result in: relationship conflicts, disillusionment with partners, constraining attachments. Parenthood: For both women and men, earning an income is widely recognised as a priority activity. = Therefore, the opposing demands of working and childrearing may generate considerable frustration and anxiety for many women - the ideal is a situation in which all caregivers assume equal responsibility for the care of their children. Social & Emotional Development – Middle Adulthood Adults in this age range typically have to juggle a range of interests, including family, work, hobbies and self-care. Erikson – Generativity vs Stagnation: the primary psychosocial challenge during middle adulthood is to strike a balance between generativity and self-absorption or stagnation. - Generativity: the urge and commitment to take care of the next generation, and may be expressed in various ways, including nurturing, teaching, guiding and mentoring children and young adults. - If not expressed = *stagnation: self-centred self-absorption typical of earlier stages of development. Nsamenang: middle adulthood is defined by assumption of critical social roles and responsibilities. The Life Cycle Squeeze: * Many people in middle adulthood find themselves in a situation where they do not only have to take responsibility for maturing children, but also for their ageing parents whose income cannot sustain them. Caused by: increased life expectancy, delayed child-bearing, smaller families. Social & Emotional Development – Late Adulthood The older adult has to face and deal with declining independence, retirement and often a reduction in financial resources, transitions in relationships, and the task of constructing a meaningful understanding of their life achievements. Adult Attachment: Adults classified as autonomous are able to relate their early positive and negative attachment experiences in a clear, relevant and concise manner - This type of attachment representation promotes secure attachment in the children of these adults. Adults classified as dismissing discuss their parents in unsupported and contradictory ways. They are unaware of the contradictions in their account. - This type of attachment representation encourages avoidant attachment in the children of these adults. Adults classified as preoccupied demonstrate a confused, angry or passive obsession with their attachment figures When relating their early attachment experiences they tend to become confused or, once they start, they cannot stop speaking. - Children of these adults tend to develop resistant or ambivalent attachment behaviours. Unresolved/disorganised adults are classified as such with respect to previous traumatic experiences only Accounts of their attachment history show a lack of resolution of the trauma Adults are not classified as unresolved/disorganised only, but are given one of the other three classifications as alternatives: - May be classified as preoccupied and, if they have unresolved issues related to early trauma, also as unresolved/disorganised. Retirement and Economic Adjustments: ! Old-age financial grants often = elder abuse. Family and Social Roles: For many people old age remains a period of continued emotional and social growth. Death and Dying: Erikson - *Integrity vs Despair: older people need to confront a tension around integrating their life experiences and stories, versus a despair over the inability to relive their lives differently. Week 3 & 4 – Chapter 24 – Psychopathology Psyche (soul) + pathology (disease or illness) = *Psychopathology Defining Psychopathology – Defining Criteria that Separate Disorders from Normal Behaviour & Experience 1. Statistical Deviance:  CANNOT always be equated to abnormally => ! CONTEXT. Statistical norms for behaviour and experience are used to differentiate normal from abnormal => that which falls far from the norms = abnormal Problem: some behaviours that are just relatively rare/out of their usual context/deviate from cultural norms may be deemed abnormal (talking to oneself, public nudity). ! The norm is dependent on social and cultural perspective. ! What may be considered normal may not be considered healthy or appropriate. More accurate understanding of statistical deviance: the extent to which cultural norms or ideological perspectives are breached. ! Problem: the criterion still fails to distinguish between positive and negative behaviour that deviates from cultural norms. => deviations may just be due to eccentricity or genius rather than pathology. 2. Maladaptiveness: *Maladaptiveness: one way of defining psychopathology that, in order to determine what is abnormal, uses the extent to which certain behaviours or experiences are maladaptive to the self or others. Behaviours that keep the individual from adapting or adjusting for the good of the individual or group = ABNORMAL. Assumption underlying the criterion: the individual should be able to adapt for the good of the self and to ensure the survival of the individual and the broader community. Suicide, depression, and extreme fatigue fit this criterion BECAUSE they stand in the way of the individual’s personal growth and actualisation. ! Maladaptiveness is also is ALSO relative to cultural perspective. Problem: maladaptiveness AND statistical deviance criterion attempt to assess abnormality from a perspective outside the individual’s own experience of the apparent problem => better to consider the criterion of personal distress/distressing to peers. 3. Personal distress: *Personal distress: unbearable negative thoughts about self and the world.  In cases where depression and anxiety are prominent symptoms in association with personal distress = constitutes a mental disorder. EXCEPTIONS: - Those suffering from anti-social personality disorder experience no appropriate level of personal distress – find pleasure in inflicting pain and are often abusive and violent in relationships. IF personal distress is a criterion for abnormality => IMPLIES THAT all personal distress is inappropriate and unhealthy – plenty of cases where personal distress is normal and expected (dangerous situations, grief, stress). ! There is no clear-cut answer to what is normal and what is not. Fun fact: homosexuality was considered a mental disorder until 1973. A Brief History of Mental Illness Evolved through a number of eras – all tied to a specific context and is largely transmitted through a Western perspective. The Early Era: Skulls from 5000 BC have holes made in the cranial region – ancient treatment for insanity. Informed by belief that: individuals suffering from mental illness were possessed by evil, supernatural forces. Hole = free the evil spirits = drive out the mental illness. The Ancient Era: First shift to a naturalistic view of mental illness: Hippocrates (father of modern medicine). Imbalance of the 4 essential humours (blood, phlegm, yellow bile, and black bile) = mental illness. => Rebalance humours = cure mental illness. - Too much black bile = depression. Prescribed naturalistic remedies: solitude, change in diet, abstinence from sexual activity. Rudimentary beginnings of the biomedical approach to psychopathology. The Middle Ages: Naturalistic approach fell out of favour => Religion dominated explanations of psychopathology. Return to earlier supernatural explanations of psychopathology. Mental illness = punishment for sins committed OR demonic possession. Church ‘exorcized demons’ to cure mental illness. Witch hunts - Those appearing to go against Christian faith = accused of being possessed => thought to have many supernatural powers that could harm others = torture and murder of those suffering from mental illness => formal segregation of those suffering from mental illness in the late Middle Ages – Church locked up individuals ‘out of charity (House of St Mary of Bethlehem/Bedlam). The Renaissance Era (1400 – 1600): More humane treatment of those suffering from mental illness. Ideas related to witchcraft were more openly challenged. Johann Weyer: individuals are not possessed by the devil but are mentally unstable and could not be held responsible for their actions. 1584: Reginald Scott publishes Discovery of witchcraft – argued that ‘demonic possessions’ were medical illnesses. The Asylum Era: Scientific understanding of mental illness increased BUT so did institutionalisation (1500). Patients housed in asylums known for inhumane treatment: - Prolonged restraining of patients. - Housing in dark cells. - Torture-like treatments. - Electric shocks. - Bleeding (to get rid of ‘dangerous fluids). - Powerful drugs. - Starvation. 1700: challenging of these inhumane treatments with emergence of humanitarian reforms across the Western world. Philippe Pinel (France): idea that patients need to be treated with kindness and consideration if they are to recover. - No chains or dark cells => sunny rooms, exercise, and constructive activities. Henry and William Tuke: established a country retreat where patients could rest peacefully and work in a caring and supportive atmosphere. - Many patients reported to have recovered completely due to humanitarian treatment. - Gradually, nurses and other professionals became trained to help with care for mental patients. ! Patients around the world are still subjected to extreme restraints like chaining. The Scientific Era (end of 1800): Increase of discoveries related to mental disorders. Central breakthrough: general paresis (syphilis of the brain) which caused paralysis and insanity – had a biological cause and could be successfully treated = fuelled search for biological causes of mental illness = modern day psychiatry. Mental illnesses now largely understood as medical illnesses that could be identified through signs and symptoms. 1883 – Emil Kraepelin: certain symptoms occurred with specific types of mental illness = classification system for a number of disorders (dementia/schizophrenia), manic-depressive psychosis/Bipolar I) = DSM. Development of many psychological theories treatments: - Late 1800s: Freud’s Psychoanalysis – treated ‘hysteric/neurotic’ patients. - 1950s: Behaviourism (Skinner & Pavlov) - *Behavioural therapy: sough to change the factors in the environment that tended to reinforce maladaptive behaviours. - Over the last 50 years: Existential psychotherapy, primal therapy, CBT, gestalt psychotherapy, logotherapy, neurolinguistic programming. - Treatment method chosen often depends on the therapists’ theoretical orientation. - 1950s: introduction of psychotropic (mood influencing) drugs) – lithium, chlorpromazine, imipramine for mania, psychosis and depression = less need for admittance to asylums. Currently, the status of applied psychology appears to be shifting away from adopting a single theoretical or disciplinary approach for understanding, managing and treating psychological problems. ere is a growing awareness that our understanding of psychopathology is always context dependent, and it is this that needs to be addressed first and foremost. Alternate Understandings of Psychopathology China & India: traditions of healing outside Western history of trying to separate the mental and the physical. Southern Africa: - indigenous theories of illness commonly locate the source of personal problems in difficulties in social relationships – these relationships may be with both living people and ancestors – continue to play an important role in social life even after death. - Religious healing (Zionist church): combines indigenous beliefs and Christianity. - People may consult traditional healers (insangoma/igqira) in addition to psychologists and psychiatrists. African traditional approaches: ancestors are family members who died but remain interested in the affairs of the family and influence them. Important factors in considering the appropriate treatment for an individual: cultural heritage, socio-economic status, racial grouping. Classification of Mental Illness Most widely used classification system: Diagnostic and Statistical Manual, 5th edition. - Has had many iterations since 1952. - Purpose: to help clinicians identify and diagnose mental illness. - Allows for appropriate assessment procedures to be done to clarify the mental illness. - Enables practitioners to communicate clearly with each other about illnesses. - First few editions were strongly influenced by the psychoanalytic approach. - DSM III: major shift to a biomedical disease approach to mental disorders.  ALSO: a shift towards an atheoretical stance AND greater reliance on clinical expertise. - DSM IV: drew on research from DSM II AS WELL AS Field Trials – compared diagnostic criteria from previous editions as well as the alternative diagnostic approach: International Classification of Diseases. - DSM V: derived from the *biomedical model: a perspective in psychopathology that claims that all mental illnesses have a biological cause.  Signs and symptoms are grouped together to identify an underlying pathological cause or syndrome. => Attempts to create a taxonomy (organised system of important categories).  This approach is helpful for practitioners and patients BECAUSE: + Classification helps psychologists establish a professional language that ensures that they are communicating about the same categories of mental illness. + Classification is an essential first step towards research, discussion and treatment of the commonly identified categories of mental illness. + If commonalities in types of illness are established through classification, the aetiology (causes) of such problems can be shared. + Classification also makes it possible to perform statistical analyses on groups of disorders in order to establish the epidemiology of the diagnosis. + Classification enables practitioners and patients to understand the course and prognosis of the illness. DSM-V ATTEMPTED to include some dimensional and developmental features of psychopathology – ATTEMPTS TO: address criticisms that some forms of psychopathology cannot be neatly defined into diagnostic categories. DSM-IV-TR: evaluated an individual’s behaviour on 5 axis (each axis explored a different dimension of the person’s problem) DSM-IV-TR AND DSM-V CRITICISMS: - Descriptive emphasis: describes disorders without explaining how the occur. - Biomedical emphasis: to ensure that the study of psychopathology is seen to be scientific, the DSM-5 classifies psychopathology in a similar way to how the medical profession diagnoses and classifies diseases and medical problems – QUESTIONABLE whether this can be applied to mental illnesses in the same way. - Individualistic approach: The DSM-5 adopts an individualistic approach whereby the syndrome is assumed to exist only as an isolated problem in the patient. The group or family context is not given consideration when the diagnosis is being formed. - Cultural bias: The DSM-IV-TR and DSM-V system was criticised for creating diagnostic categories that have a Western cultural perspective. - Concerns about validity and reliability: RELIABILITY is quite good since a common set of criteria is used. BUT in terms of VALIDITY, DSM diagnoses are weak as they are based on consensus about clusters of symptoms rather than objective measures – DSM-V has also been widely criticized for increasing the number of ‘disorders’ which may lead to over-diagnosis/co-morbidities/over- medication. - Labelling: A diagnosis does not describe the person, but only a set of behaviours associated with the person’s problem - classification systems are often blamed for causing the clinician to lose sight of the person behind the diagnosis = stigma = negative impact on identity and well-being Because of all the issues with the DSM – Arguments made for the use of the ICD-11 (produced by WHO): - ! BOTH systems have been criticised in terms of the VALIDITY of their criteria – proved by the fact that the two systems describe/classify illnesses in differing ways. Other approaches to classification include: - Dimensional model (disorders as lying along a continuum). - Holistic approaches: incorporate social and spiritual elements. Current Perspectives in Psychopathology The Biomedical Perspective: Central assumption: all mental illnesses have a biological cause. - Other factors are secondary: social pressures, parenting, environmental factors. Biological abnormalities are understood to occurs in 3 Main Areas: 1. Genetic predisposition: - Inherited from parents. - Genes are arranged in a specific order along chromosomes - responsible for determining things such as physical appearance and sex. - Normal number of chromosomes: 46. - Abnormalities in genetic make up = predisposition to particular illnesses. - Twin research: identical twins whose mother has a mental illness have a greater likelihood of developing mental illness – NOT the case with fraternal twins. - Genetic predisposition proven for: schizophrenia, personality, depression, alcoholism. 2. Abnormal functioning of neurotransmitters: - Neurotransmitters: chemicals released by axons that help conduct nerve impulses across the synapse to the next neuron. - Increase in certain neurotransmitters (Dopamine & Serotonin) = associated with many psychiatric illnesses. 3. Structural abnormalities in the brain: - Different parts of the brain play different roles in relation to the individual’s functioning.  Limbic nerves => regulate emotional reactions (fear, aggression, sexual expression) => DAMAGE = consequences on ability to control emotions. - Causes of structural abnormalities in the brain:  Genetic disorders  Birth abnormalities  Drug-related brain-damage  Physical injury. The Psychodynamic Perspective: *Psychodynamic perspective: approaches to psychopathology that believe that the way we relate to others and ourselves is largely influenced by internal forces that exist outside of consciousness. – derived from Freud’s psychoanalysis. Freud: sexual and aggressive instincts, as well as associated thoughts and feelings, become repressed and unconscious once they are perceived to be forbidden by society. - Though these thoughts and feelings are repressed to the unconscious, they still exercise partial control over the individual BY expressing themselves as psychopathological symptoms. - Compromise between expression of forbidden wishes and their total repression = psychopathological symptoms. - Psyche divided in to 3 parts: Id, ego, and superego. adds to the nature of their personality. – internalised mother => ! THERE IS A RELATIONSHIP BETWEEN INTERNALISED OBJECTS AND YOUR OWN INTERNALISED SELF- OBJECT. - Object relations theorists believe that EARLY RELATIONSHIPS (especially Mother) SHAPE PERSONALITY => set foundations for other relationships in the person’s life.  Early trauma and deprivation = key factor in psychopathology. - Contemporary psychodynamic perspectives EMPHASISE EMOTIONAL RELATIONSHIPS + SURROUNDING ENVIRONMENT in personality formation. - Less emphasis on the role of instinctual drives than Freud’s original approach. The Cognitive Behavioural Perspective: *Cognitive behavioural perspective: a perspective in psychopathology that has as its central notion the idea that cognitions, or learned ways of thinking, directly impact on the individual’s emotions and behaviours. Cognitive therapists: Irrational beliefs and automatic thoughts are principally responsible for the development of psychopathology. Aaron Beck: negative automatic thoughts = negative cycle of thought, emotion, and behaviour => person accepts such distorted thoughts as truth => looks for ways to confirm such thoughts through adopting negative behaviours => impact on the person’s emotions = DEPRESSION = vicious cycle: the more depressed people feel, the more negatively they think of themselves. - Depressed persons display negative thoughts about self, the world, and the future = Cognitive Triad of Depression. The Community Psychology Perspective: Ahmed & Pretorious-Heuchert: Community psychology regards whole communities, and not only individuals, as possible clients - There is an awareness of the interaction between individuals and their environments, in terms of causing and alleviating problems. Emphasis: importance of social, political, and cultural contexts in understanding, identifying, and treating psychological problems. - Political context:  Community psychology developed out of a need to challenge oppressive forces in society.  Community psychologists are sensitive to the impact of socio-political factors on mental health. - Social context:  Social factors need to be considered if we are to fully understand the development of psychological problems.  Social factors: socio-economic status of the community, access to resources, nature of social interaction in the community. - Cultural context:  Emphasis in community psychology: An individual’s actions always take place in a cultural context.  How an individual experiences distress or makes sense of psychological problems is DEPENDENT ON deeply ingrained cultural beliefs and practices. + THEREFORE: how we understand various psychological symptoms is often dependent on a particular cultural perspective. – Ukuthwasa (calling to be a traditional healer).  Understanding how mental illness is experienced and treated by different cultures is also inextricably linked to concerns about access to treatment. Integrated approaches to Psychopathology: Separate approaches are often integrated in a way to gain a fuller understanding of psychopathology. = 2 PARTICULARLY USEFUL APPROACHES: 1. Diathesis-stress model (Meehl): a perspective in psychopathology that proposes that some people inherit or develop predispositions (diathesis) to psychopathology, although mental disorders will not emerge until stressors become intense enough to convert predispositions into actual psychological disorders 2. Bio-psychosocial approach: a perspective in psychopathology that attempts to integrate biological, psychological and social factors to gain a better understanding of why mental disorders occur. Contemporary and Emerging Frameworks in Psychopathology Concern around the DSM approach to psychopathology classification and its subsuming biomedical model of mental illness = number of transdisciplinary and novel approaches to the study of mental disorders. The Research Domain Criteria: Proposed by: National Institute of Mental Health. RDoC: mental disorders are nor discrete categories – THEY ARE specific behavioural dysfunctions INDEPENDENT of DSM diagnostic domains. DOES NOT: categorise symptoms into domains or clusters. DOES: identify neurobiological mechanisms or causes (genetics, cells. Circuity, physiology). 6 Domains of the RDoC: 1. Negative valence systems. 2. Positive valence systems 3. Cognitive systems. 4. Systems for social processes 5. Arousal/regulatory systems 6. Sensorimotor systems. The General Psychopathology Factor: Problems with DSM diagnostic: co-occurrence/co-morbidities of disorders AND poor VALIDITY. Alternative view: psychopathology is understood with regards to a general factor of psychopathology (P) – represents the common comorbidity of a broad spectrum of symptoms and transcending diagnostic domains. Basically: there is just something generally wrong/abnormal and the person experiences it through these and these symptoms. Computational Network Approaches: Clinical network theory: mental disorders are a result of a network of dynamic self- reinforcing causal interactions between symptoms. Differs from traditional approach because it does NOT: view the link between symptoms to be caused by an underlying syndrome. The Hierarchical Taxonomy of Psychopathology (HiTop): Addresses limitations of traditional diagnostic by: NOT including arbitrary boundaries between normality and abnormality, diagnostic instability and high comorbidity. HiTop consists of: - 6 Higher Order Spectra: 1. Somatoform. 2. Internalisation. 3. Antagonistic externalising. 4. Detachment. 5. Thought disorder. 6. Disinhibited externalising. - 3 Superspectra: 1. Emotional dysfunction 2. Psychoses 3. Externalisation. - General Psychopathology (P) factor. Common Disorders in South Africa Post-traumatic Stress Disorder (PTSD): Occurs when: a person experiences OR witnesses a situation that involves a threat of death or an actual death. Symptoms of PTSD: - MUST PERSIST FOR MINIMUM 1 MONTH after the event. - Symptoms can FLUCTUATE OVER TIME and are MORE APPARENT DURING PERIODS OF STRESS. 1. distressing re-experiencing of the event through mental flashbacks to the scene, recurrent distressing dreams, recurrent and intrusive thoughts of the event, and hypersensitivity to cues associated with the event 2. avoidance and emotional numbing, where the patient persistently avoids anything that might be associated with the event and experiences a psychic numbing in response to current surroundings 3. possible negative alterations in cognition and mood, evident in terms of some dissociative amnesia (inability to recall key features of the event) and persistent distorted blame of self and others, as well as increasing detachment from others or from activities. 4. increased arousal, where patients have difficulties falling asleep, experience irritability and have exaggerated startled responses. One of the most frequently diagnosed forms of psychopathology in SA DUE TO HIGH CRIME RATE. The Aetiology of PTSD: Major factors in the aetiology of a disorder: 1. The stressor. 2. The social environment in which the trauma took place. 3. The character traits of the individual. 4. The biological vulnerability of the individual. The intensity of traumatic reactions is dependent on: - Suddenness of the threat. - The duration of the threat. - The amount of fear associated with the event. General findings: - Young children and the elderly have even greater difficulty coping with traumatic events = higher risk for developing PTSD. – Pre-school subtype of PTSD included in the DSM for kids under the age of 7 years. - Those with a higher vulnerability to anxiety = greater risk for PTSD. - Those with PTSD = increased production of catecholamine (hormone that prepares the body for an emergency) while re-experiencing trauma. - 30% of patients recover. - 60% continue to experience mild anxiety symptoms associated with trauma. - 10% remain unchanged or become worse. Psychodynamic perspective: traumatic events reactivate unresolves conflicts from early childhood – to cope with trauma, EGO repeats distressing events associated with trauma IN ORDER TO master them and reduce the level of anxiety experienced by the individual. Schizophrenia: *Schizophrenia: a disorder found in the DSM-5 characterised by disorganised and fragmented emotions, behaviours and cognitions. Shares many symptoms with ukuthwasa (calling to be traditional healer) and amafufunyana (spirit possession). Common misconception: it refers to people with a split-personality – This is actually DID (condition in which an individual develops two or more separate identities or ego states) - Each identity exists separately and has its own set of emotional and behavioural characteristics – this is NOT what happens with schizophrenia. Schizophrenia describes a condition characterised by: - The splitting of EMOTIONS AND THOUGHTS. - Gross distortions of reality testing = individual feels disoriented and fragmented = *psychosis: psychological disorders characterised in part by beliefs not based in reality (delusions), perceptions not based in reality (hallucinations) or both 2 Categories of Schizophrenic Symptoms: - Positive symptoms: presence of behaviours and feelings that are usually not present in a normal individual. 1. Hallucinations: false sensory perceptions that occur in the absence of a related sensory stimulus (e.g. Sibusiso saw aliens and claimed that the radio was giving him a command) 2. Catatonic behaviour: marked motor abnormalities such as bizarre postures, purposeless repetitive movements and an extreme degree of unawareness (e.g. Sibusiso got up from his chair in a repetitive way) 3. Disorganised behaviour: an inability to persist in goal-directed activity and the performance of very inappropriate behaviours in public (e.g. Sibusiso sang songs to his psychologist, was unable to follow a line of questioning and was not able to perform basic tasks) 4. Disorganised speech: speech that is incomprehensible and only remotely related to the subject under discussion (e.g. Sibusiso’s speech was clearly disorganised and incoherent) 5. Delusions: fixed ideas or false beliefs that do not have any foundation in reality (e.g. Sibusiso thought his mother was poisoning his food). - Negative symptoms: absence of behaviours and feelings that are usually present in a normal person. 1. Flat affect: a lack of emotional responsiveness in gesture, facial expression or tone of voice (e.g. Sibusiso appeared emotionless in his responses to the therapist) 2. Avolition: a negative symptom that involves the inability to begin and sustain goal-directed activity (e.g. Sibusiso did not appear to be able to perform everyday activities) 3. Alogia: a speech disturbance in which the individual talks very little and gives brief empty replies to questions (Sibusiso did not display this symptom). Schizophrenia affects 1% of the population. Usually BEGIN BEFORE the age of 25 years. Persists throughout life. Found among all social classes. No difference in prevalence rates between males and females. 20% of people with schizophrenia are able to lead normal lives. 20% continue to experience moderate symptoms. 40-60% remain severely impaired throughout life. Unlike many other disorders, schizophrenic patients DO NOT often return to their previous level of functioning once a psychotic breakdown has occurred – usually some deterioration in cognitive and behavioural abilities even after positive symptoms have subsided. The Aetiology of Schizophrenia: Not known. Most convincing biological theory: levels of dopamine at receptor sites in the brain. - Dopamine hypothesis: excessive levels of dopamine cause schizophrenic-like symptoms. - Anti-psychotic medications => inhibit dopamine levels = markedly reduce severity of psychotic symptoms. Genetic predisposition: m - Monozygotic twins of a parent with a schizophrenic parent = 47% chance of developing schizophrenia. - Dizygotic twins of a parent with a schizophrenic parent = 12% chance of developing schizophrenia. Psychoanalytic perspective: schizophrenia is caused by a defect in the rudimentary functions of a child’s ego, giving rise to intense hostility and anger, which in turn distorts the child’s ability to relate to others around them = personality organisation that is very vulnerable to stressful situations. Learning and Cognitive-behavioural perspective: schizophrenia develops from learning irrational reactions and distorted ways of thinking from emotionally disturbed parents. Schizophrenia – 1 month+ Schizophreniform – same as schiz, but difference in duration of symptoms (at least 1 month, less than 6) Brief psychotic – less than a month Schizoaffective – mood + psychosis Critical Approaches to Psychopathology As with other areas of psychology, not everyone agrees with prevailing approaches to psychopathology. Criticisms of the field: - A narrow understanding of normativity - Predicated on Westernised frameworks of biomedical knowledge. - Believed that by relegating sociocultural dimensions of human behaviour to the margins, traditional conceptions of abnormal psychology then presuppose that certain behaviours are inherently (either genetically or developmentally) more superior than others. Critical approaches seek to: - Problematise this biomedical approach to abnormality which is grounded in Western colonialism. The Decolonial Approach: Decolonisation entails: doing away with conceptions of human behaviour, normativity, normality and methods that Western frameworks of biomedical knowledge have indiscriminately exported around the world. Decolonial exponents contend that: colonialism in mental health care is evident in how some diagnoses appear in some populations more than others without explanation, or in the way culturally contingent behaviours (e.g. ancestral calling) have been pathologised by professionals who are outsiders or who do not have cultural knowledge of a given community. - By ignoring the social values and experiences of those being diagnosed, common notions of abnormality remain firmly rooted in colonial practices. - Add to this the efforts to globalise the professional reach of Westernised mental health care – through the use of the DSM and ICD as common frameworks for professionals to understand psychopathology. - While it is important to note that the two common classification systems (DSM and ICD) have recently attempted to include culture in their understanding of patients (e.g. the cultural formulation interview in the DSM), these efforts are nonetheless considered to be inadequate because they still relegate sociocultural factors to a secondary status in their deliberations. - INSTEAD, CRITICAL SCHOLARS CONTEND: sociocultural factors such as those covered in DSM V-codes and ICD Z-codes are central in the expression and clinical response to psychological distress – especially in societies outside of the West.
