Psychology of Dysfunctional Behavior David Valdez The Myth of Mental Illness Does the concept of mental illness even make sense? • Thomas Szasz (1960) claimed it does not. For him (and subsequent writers, eg: Sarbin & Mancuso, 1980; Scheff, 1966), mental illness is a myth. There is no such thing. • The things that psychotherapists treat people for are not illnesses, but simply individual traits or behaviors that society deems unacceptable-- immoral, deviant, etc. • Szasz believes labeling such people as ill harms them - they come to accept the label, and they are treated accordingly. We are telling people that they must act in ways seen as normal by the psychiatric profession, rather that attacking the social factors that don't allow these people to use their own unique abilities, traits, etc. • Goffman: stigma Defining a Disorder What do I call it? • Abnormal Psych. Vs. Dysfunctional Psych Vs. Mental Disorder Criteria • Deviation from statistical norms; the word abnormal means 'away from the norm' • Deviation from social norms; every culture has certain standards for acceptable behavior • Maladaptiveness of behavior; this third criteria is how the behavior affects the well-being of the individual and/or social group. • Personal distress; the fourth criteria considers abnormality in terms of the individual's subjective feelings, personal distress, rather than his behavior. Diagnosis of Mental Illness • The World Health Organization’s International Classification of Diseases (ICD) is the official classification for mortality and morbidity statistics for all signatories to the U.N. Used in US by the Health Care Financing Administration. The DSM IV-TR, the classificatory systems used in the US, assumes mental disorders fall into a number of distinct categories such as anxiety, psychosis, mood disturbance, and cognitive deficits. These categories are broad, heterogeneous, and somewhat overlapping. The DSM organizes mental disorders into 16 major diagnostic classes. For each disorder within a diagnostic class, the DSM enumerates specific criteria for making the diagnosis. DSM-IV also lists diagnostic “subtypes” for some disorders. A subtype is a subgroup within a diagnosis that confers greater specificity. The DSM is descriptive in its listing of symptoms and does not take a position about underlying causation. Disorders usually first diagnosed in infancy, childhood, or adolescence Delerium, dementia, and amnestic and other cognitive disorders Mental disorders due to a general medical condition Substance-related disorders Schizophrenia and other psychotic disorders Mood disorders Anxiety disorders Somatoform disorders Factitious disorders Dissociative disorders Sexual and gender identity disorders Eating disorders Sleep disorders Impulse-control disorders Adjustment disorders Personality disorders The DSM-IV TR It examines the disorder by considering five axes: • clinical syndromes • personality disorders • general medical conditions • psychosocial and environmental problems • global functioning. Assumptions of the Medical Model Assumption of "illness" as distinct category Assumption of perfectibility in humans (some ideal state of health) Assumption of all people as aspiring to same "ideal" Assumption of "patient" as object Search for efficient "quick fix" therapies (Cure vs. Treatment) Neglects important issues of personal responsibility & cultural influences Limitations of the Medical Model • The medical model: abnormal behavior reflects a disease • Some critics claim the DSM is a way to enforce societies norms • Social stigma associated with being labeled mentally ill (Goffman) • We know of no exclusive organic basis for many of these disorders • A DX suggests that people can not control their behavior • Diagnoses are not always based on consistently reliable research. • Diagnosis rests on clinician judgment about whether clients’ symptom patterns and impairments of functioning meet diagnostic criteria. Limitations cont’d. • Cultural differences in emotional expression and social behavior can be misinterpreted as “impaired” if clinicians are not sensitive to the cultural context and meaning of exhibited symptoms. • Some everyday problems are considered disorders • System may be biased against women & minorities. Some critics point to a bias in diagnosing mental disorders in children, older persons, and racial and ethnic minority groups. Strengths of the Medical Model • • • • Helps us research the causes of disorders Allows professionals to communicate Allows for appropriate treatments Diagnosis is essential in all areas of health for shaping treatment and supportive care, establishing a prognosis, and preventing related disability • Diagnosis serves as shorthand to enhance reimbursement and surveillance in order to track the regional trends/prevalence. Jeopardizing Patient Rights • Institutionalized clients have their privacy marginalized by the invasion of clinicians and interested family members. At what point does sincere care become an intrusion? At what point are patient civil rights to privacy and confidentiality compromised for the sake of psychiatric care? HIPAA Privacy Act Webquest activity References • Myers, D. (2004). Psychology. Worth Publishers. Holland, MI. • Glassman, W. Approaches to Psychology. Open University Press. Berkshire, England. • Travis, C. (2001). Psychology in Perspective. Prentice-Hall. Upper Saddle River, NJ.