Psychology – Behavior 06
Notes
Disorders Part II
Somatoform Disorders
Somatoform disorders are physical illnesses that arise from mental problems. For example
a patient may believe that they have chronic joint pain, and although there is no medical
reason or evidence for joint pain, they still do experience it. The most common forms of
Somatoform disorders include; Conversion Disorder and Hypochondriasis.
Somatoform disorders such as Hypochondriaism can be a real problem for the sufferer
because they will often go from medical doctor to medical doctor looking for a medical cure
and never finding it because what they are really suffering from is a mental illness, not a
physical one.
Dissociative Disorders
Dissociative Disorders are rare, but can result in a sudden loss of memory or identity.
Often, traumatic events such as a car accident or violent acts can bring about a dissociative
disorder. Often people who have suffered sexual abuse as children develop multiple
personalities as a way of “protecting” the individual. Often an alternate personality is
formed and is the one that ends up taking the abuse, while the original personality remains
unaware that the acts are occurring.
Psychology – Behaviour 06
Assignment
Disorders Pt. 2
Directions: READ pages 508-512 from Psychology – An Introduction by Ben B. Lahey and
answer the following questions.
1.
Define the following terms:
somatization disorders
dissociative disorder
fugue
hypochondriasis
amnesia
multiple personality
2. Answer the following questions using COMPLETE SENTENCES.
a.
Aside from medical complaints, what other problems are often associated with
somatization disorders and what are some of the dangers? (4 marks for quality of
response)
b. Describe the differences between the patient reactions to hypochondriasis and
conversion disorder. (4 marks for evidence of thought and effort)
c.
In your own words, explain the differences between amnesia and fugue. (4 marks
for quality of response)
3. Opinion Question: Read the handout Multiple Personalities taken from Psychology by
David G. Myers and answer the following question.
What is your opinion of Multiple Personalities? Discuss whether you think multiple
personalities are a real “defense mechanism” for a person’s psyche or whether it is just
a “con job” for criminals not wanting to accept responsibility for their actions.
You will be marked out of 8 for the quality of your thoughts and insights.
Total: ____/ 26
Psychology – Behaviour 06
Reading
Disorders Pt. 2
Excerpt from Psychology – An Introduction by Ben B. Lahey.
Somatization Disorders and Hypocondriasis
Somatization disorders are intensely and chronically uncomfortable conditions that
indirectly create a high risk of medical complications. They take the form of chronic and
recurrent aches, pains, fever, tiredness, and other symptoms of somatic (bodily) illness. In
addition, individuals with these disorders frequently experience memory difficulties,
problems with walking, numbness, blackout spells, nausea, menstrual problems, and a lack of
pleasure from sex. These complaints are often expressed in dramatic ways that increase
the probability of sympathy and special treatment from others.
Individuals with somatization problems also typically experience other psychological
difficulties as well, particularly anxiety and depression. They frequently have problems with
their jobs, schoolwork, or in meeting household responsibilities. The most dangerous aspect
of somatization disorders, however, concerns the measures the affected individuals take to
find relief from their discomfort. They frequently become addicted to alchohol or
tranquilizers, and often take medications prescribed by many different physicians whom
they are seeing simultaneously (without telling the other physicians), thus increasing the
risk of dangerous chemical interactions among the drugs. Worse still, because of their
frequent complaints to physicians, they are often eventually the recipients of unnecessary
surgery, especially unnecessary hysterectomies (removal of the uterus in women).
Hypochondriasis can be though of as a milder form of somatizations disorder with some
special features of its own. The hypochondriac experiences somatic symptoms, but they are
not as pervasive or as intense as in somatization disorders. Hypochondriacs also do not
experience most of the serious side effects, such as depression, drug addiction, and
unnecessary operations. Their lives, however, are dominated by their concerns about their
health. They show a preoccupation with health, overreact with concern to minor coughs and
pains, and go to unreasonable lengths to avoid germs, cancer-causing agents, and the like.
Conversion Disorders and Somatoform Pain Disorders
Conversion disorders are the most dramatic of the somatoform disorders. The name comes
from the Freudian theory that anxiety has been “converted” into serious somatic symptoms
in this condition rather than being directly experienced as anxiety. Individuals with these
problems experience functional blindness, deafness, paralysis, fainting, seizures, inability to
speak, or other serious impairments in the absence of any physical cause. In addition, these
individuals appear to be generally ineffective and dependent upon others. These symptoms
understandably impair the individuals’ lives, particularly their ability to hold a job or to do
house work. Conversion disorders can usually be distinguished from medical problems
without great difficulty. In most cases, the symptoms are not medically possible. For
example, in conversion disorders the areas of paralysis and loss of sensation are not shaped
in the way they would be if there was actual nerve damage. Similarly, people with conversion
paralysis of the legs can be observed to move their legs normally when sleeping.
Perhaps the most interesting characteristic of conversion disorders is known as la belle
indifference, "the beautiful difference.” Individuals with conversion disorders often, but
not always, are not upset by their condition. The individual with conversion disorder who
wake up paralyzed one morning may show some emotional response, but not nearly to the
extent as a person who is physically paralyzed, for example, in an automobile accident.
Some psychologists believe that the conversion symptoms are welcome, in a sense, as they
serve to get these people out of responsibilities or to force others to let them be
dependent.
Somatoform pain disorders are very similar to conversion disorders except that the
primary symptom is pain that has no physical cause. Sometime somatoform pain can be
distinguished from physically caused pain because it does not follow nerve pathways. But in
the case of low back pain, joint pains, and chest pains, a diagnosis of somatoform pain
disorder can be made only after all possible physical causes have been carefully ruled out.
Like conversion disorders, somatoform pain usually occurs at times of high stress and is
generally beneficial to the individual in some way, as in getting the person out of a dull job
and onto disability payments.
Dissociative Disorders
Dissociative disorders cover a broad category of loosely related rare conditions involving
sudden alterations in cognition. The various types of dissociative disorders are
characterized by a change in memory, perception, or "“identity”. There are four kinds of
dissociative disorders: amnesia, fugue, and multiple personality.
Amnesia and Fugue
Amnesia is a loss of memory that can have either a physical or psychological cause.
Psychogenic amnesia most often occurs after a period of intense stress and involves loss of
memory for all or part of the stressful experience itself, such as loss of memory for an
automobile accident in which the individual was responsible for the death of another person.
Individuals who suffer amnesia as a result of stress generally have no other psychological
problems and typically recover their memories in time.
Psychogenic fugue resembles amnesia in that there is a loss of memory but the loss is so
complete that the individual cannot remember his or her identity or previous life. The
fugue episode is also typified by a period of semiconscious “wandering” that may take the
individual around the corner or across the continent. In many instances, the individual takes
on a new personality during the fugue episode, usually one that is more sociable, more funloving, and less conventional than the previous one.
Multiple Personality
Individuals who exhibit the kind of dissociative disorder known as multiple personality,
shift abruptly and repeatedly from one “personality” to another, as if more than one person
were inhabiting the same body. This disorder, commonly known as “split personality” is quite
rare, but it has been described in detail enough times now that most clinical psychologists
admit that such a syndrome exists. Generally, the two or more personalities are quite
different from one another. The original one is typically conventional, moralistic, and
unhappy, while the other personalities tend to be quite the opposite. At least one other
personality is usually sensual, uninhibited, and rebellious. In most cases, the individual is not
aware of the other personalities when they are “in” their original personality, but the other
personalities know about their rival personalities and are often antagonistic toward the
original one.
In 1977 Chris Sizemore published an autobiography revealing that she was the case of
multiple personality made famous in the 1950s movie, The Three Faces of Eve. Initially, she
experienced two distinctly different personalities, referred to in the movie as Eve White
and Eve Black. Eve White was depressed, anxious, conventional, and inhibited, while Eve
Black was seductive, uninhibited, and wild. In her autobiography, Chris Sizemore reveals
that she eventually went through 22 separate personalities, but that in recent years she
feels she has a single, well-adjusted personality. A similar pattern was reported for the
case of “Sybil”, a woman who developed 16 personalities during the course of 42 years.
Excerpt from Psychology by David G. Myer
The Insanity Defense on Trial
In defining psychological disorders I have not mentioned insanity. That is because sane and
insane are legal, not psychological terms. You can be a little depressed or greatly
depressed, you cannot be a little insane.
The British created the insanity defense in 1843 after a deluded Scotsman, Daniel
McNaghten, tried to shoot the Prime Minister (who he thought was persecuting him) and
killed the Prime Minister’s secretary by mistake. A furor erupted after McNaghten was
acquitted as insane and sent to a mental hospital rather than to prison. When the
McNaghten verdict was upheld, an insanity rule emerged. It limited the insanity defense to
cases where persons were judged not to have known what they were doing or not to have
known that it was wrong. Shakespeare’s Hamlet anticipated the defense. “If I wrong
someone when not myself,” he explains, “Then Hamlet does it not, Hamlet denies it. Who
does it then? His madness.”
By the time John Hinckley Jr., came to trial in 1982 for shooting President Reagan and his
press secretary, the insanity defense had to be broadened. The prosecution had to prove
that Hinckley was sane. Under the Model Penal Code this meant his having “a substantial
capacity” no merely to “know” his act was wrong but to “appreciate” its wrongfulness and to
act accordingly.
The Prosecution was unable to prove sanity to the jurors’ satisfaction. So Hinckley, like
McNaghten, was sent to a mental hospital. As in the first insanity case the public was
outraged. One newspaper headlined “Hinckley Insane, Public Mad”. The outrage was partly
because Hinckley, like others declared not guilty by reason of insanity, will be released when
declared sane and no longer dangerous – conceivably earlier, though not quite possibly later,
than would have been his release from prison.
Some news commentators complained that the heinousness of a crime had become the very
basis for evading responsibility for it. “Like the person who kills his parents and demands
mercy because he is an orphan”. Are “sick crimes” necessarily the products of sick minds
that need treatment, not punishment? Are the genuinely bad truly mad?
In defense of the insanity plea, psychologist David Rosenham noted that actually, such a
plea is entered only about 2 times in every 1000 felony cases. In 85 percent of those cases,
all parties – mental health experts, prosecutors, and defense attorneys – agree that the
deranged person was not responsible. In fact, the most important issues that involve
psychology and law are not the rare disputes over insanity. They are instead the far more
frequent cases concerning child custody, involuntary commitment to mental hospitals, and
predictions about a criminal’s future behaviour made at the time of sentencing or parole.
In Canada and now in the United States under a 1984 law, the insanity defense survives in a
restricted format that shifts the burden of proving insanity to the defense. Nowadays
defendants must show that they did not understand the wrongfulness of their acts.
By 1987, 13 states instituted a verdict of “guilty but mentally ill.” This verdict recognizes a
need for treatment but holds people responsible and sends them to prison if they are
judged recovered before their sentence is over. Jurors find the verdict a viable option. In
mock trials, defendants who otherwise would have been judged either innocent or not guilty
by reason of insanity are often judged guilty but mentally ill.