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Therapy
Therapeutic Interventions
Why do people go to counsellors? What good does it do?
No sick person is cured until enabled to fill the same, or equally as good
a place in the community as before sickness… often where the work of
the surgeon, the trained nurse, the physiotherapist ends, our hardest
work begins…
— Occupational therapist Edith Griffin, Winnipeg, 1923
Therapists can be many different people  Counsellor, Shrink, Priest,
etc...
Therapy: Planned emotionally charged, Confiding integrations
between a trained healer and a sufferer.
Pre- 1950  Only psychiatrist
Post 1950 to NOW  EVERYONE. Counsellors, group homes,
reflexologists, etc
Both patients and clinicians report psychotherapy as very effective...
However you must ask/reflect on these questions
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1) Placebo Effect: Belief that someone is helping might cause us to
get better faster than the therapy itself. “if the therapist says it is
helping then it must be” “I have a rock that repels tigers, the
proof? Do you see any tigers?”
2) Crisis: Lowest point before we get help. The phrase hitting rock
bottom applies here. Some say that when someone gets to their
lowest point they make a decision to improve their life. So is this
state of hitting rock bottom in of itself a form of therapy?
Rock Bottom.
There are two things that motivate people to make dramatic
changes in their lives: inspiration and desperation. As crazy it might
sound, there is actually tremendous power in hitting rock bottom, or
a low-point in your life.
Ex: The last year has been one of dramatic positive changes for me
because my life more or less fell apart in front of my eyes when I
finished graduate school a year ago:
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I literally ran out money and my bank balance was ZERO.
I had to move back to my parent’s house at the age of 31
(kind of embarrassing)
I couldn’t find a job for 8 months
I had no choice, but to start making some major changes in my life. I
was at a personal low point. The great thing however was there was
nowhere to go but up. My blog served as a great personal
development tool to make changes in my life and continues to do so
today:
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I have a job that I absolutely LOVE
I’m more financially responsible than I’ve ever been
I have a great network of contacts/supporters
Let’s look at how you can use the power of hitting rock bottom to
your advantage.
How To Take Advantage of Hitting Rock Bottom
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Reframe the Situation: The first thing you will need to do if
you have hit rock bottom is reframe the situation. In my
commencement speech that I wrote on my blog a while back I
talked about the distinctions between being
spiritually/emotionally broke and financially broke. The latter
actually is much easier to recover from if you can conquer the
former. The key is viewing your current situation as an
opportunity to take your life to a level far beyond where you
are at today.
Nothing to Lose: The beauty of hitting rock bottom is that you
truly have nothing to lose. When you hear stories of homeless
people spending their time in libraries and filling their minds
with knowledge to eventually become millionaires, it makes
you realize that you have tremendous power to change your
life if you can just tap into it. The beauty of having nothing to
lose is that it gives you the power to be completely detached
from outcomes, one of the biggest things that gets in the way of
accomplishing goals.
Big Risks/Big Goals: With absolutely nothing to lose, you are
in the in perfect position to take big risks and set big goals.
When you are not at rock bottom you can actually get caught in
the trap of your comfort zone. When you are at a low point,
then you have a tendency to really push the envelope of what’s
possible
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What makes a good therapist / Counselor?
1) Empathetic  Caring, creates a personal relationship
2) Provides Hope
3) Provides new perspective on the problem
Gives insight and new information in order to look at the
situation in a different way
4) Someone you can confide upon. (Confidentiality) Assume
they won’t phone mom.
There are over 260+ recognized forms of therapy. We are only doing
5... and some drugs.
1)
Psycho Analysis: “ Analysis of the
mind” (Freud)
a) Aim: To provide insight  Reason I am having the
problem. You’ve seen this on TV as well as read
about it in books. This is the patient laying on a
couch and free associating with a psychiatrist. (
Much like dream interpretation, the Therapist is
there in a minimal capacity... you must let the
patient dictate the session with the therapist as a
guide only.) Then the Therapist will come to the
hidden meaning.
b) Problems occur when:
i)
Childhood fixations unconsciously interrupt
daily living. Ex: Mouthy at work which can
be an oral fixation and results in you always
getting fired.
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ii)
Defence mechanisms are interrupting daily
living. Meaning Unconscious desires. (Big
time Athletes, Actors, blowing their fame
and fortune because they don’t believe they
deserve it, acting antisocial etc. Best
Example Kurt Cobain.
iii) Methods
- Free association
- Hypnosis
- Projection Testing
c) Drawbacks
1) Freud’s theories could have just been plain
wrong. (repression for instance)
2) It depends on the premise that whatever
screwed you up happened in childhood
3) Time consuming and expensive
- 150$ an hour / once or
more a week. 600$ a
month and must take
about 2-3 years to
permanently fix.
d) Resistance: Resistance to therapy is why it takes so
long. Patient chooses not to divulge all info in the
subconscious. Meaning you can actually be lying to
yourself. Ever convinced yourself you like something
or disliked something which turned out to not be
true?
e) Transference: happens in any
therapy/dentist/doctor. You place your emotions
onto the therapist. You can actually become
physically attracted to therapist because they are
understanding, they listen to you, they are there for
you. This is not true.
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HUMANISM ( Rogers/Maslow)
a) Aim: Client centered therapy. Rogers changed the emphasis
from Patient to Client
b) Problems: Low self-esteem in client creates too wide a gap for
conditions of worth to be placed on them. In other words there
is too big a gap in-between who I am and who I want to be.
c) Methods: A-Acceptance – Non judgemental
G-Genuine – The clients knows they can confide in
the therapist
E-Empathy – acting as if they care by using active
listening. (same ability pickup artists/players pick
up women in bars)
d) Disadvantages:
i)
Not directive – Therapist does not tell me
anything
ii) Not all people are good – they don’t want to
get better!
E) Advantages : Strong Client/therapist relationship. Really
necessary for some people.
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3) Behaviourism
(Skinner/Watson/Bandura)
http://www.youtube.com/watch?v=qy_mIEnnlF4
a) Aim : to Change Behaviour
b) Problems: The use of conditioning doesn’t always cause a
permanent change in behaviour. Once you remove the
Conditioned stimulus or the reward, after therapy has
ended, many subjects revert to their original behaviour.
c) Methods:
i. Classical Conditioning
ii. Operant Conditioning
d) Disadvantages: You are training behaviour out of someone
not changing the original stimulus causing behaviour in the
first place. It is time consuming. There is a huge question of
ethics. Is it ethical to train human beings in the same
manner we train animals.
e) Advantages: It works. This is the most used kind of social
therapy. Most schools work on a kind of token economy. It
works with all kinds of people regardless of intelligence.
Everyone from young children to subjects suffering from
schizophrenia can be conditioned
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4)
Cognitive Therapy
a) Aim: To teach people new more constructive ways of
thinking. To teach you to look at life in a positive way. To
remove self-defeating thoughts
b) Problems: Changing the way someone “thinks” is very hard.
You have to break through all the misinformation the person
is telling themselves.
c) Methods: By asking questions and hardly ever giving
answers. Let the client come up with their own answers.
Have the client change their words. We often think in words
therefore getting people to change what they say to
themselves is an effective way to change their thinking. Give
yourself a Pep-Talk. Instead of telling yourself you are going
to fail or that you didn’t study enough you tell yourself that
you are going to pass and that you are prepared. If you tell
yourself something (positive or negative) enough, you will
start to believe it. Remember that Cognitive theory is all
about challenging your Beliefs.
The Best receiver that Ever lived
d) Disadvantages: It takes a highly trained Cognitive therapist
to get the desired results. Unlike behaviour therapy which
can be universally used… Cognitive therapy relies on the fact
that you are asking just the right questions in just the right
way to alter the belief system of the client. The client in turn
must be able to realize this error in belief. This indicates a
high level of intelligence. Cognitive theory also works in the
short term but does little to change the long term underlying
feelings of inadequacy or depression that caused the original
false belief.
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e) Advantages: It works. Motivational speeches, and formal
cognitive therapy sessions help clients “realize” that what
they were thinking was just wrong… Clients leave feeling
better after a successful session, unlike other therapies.
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Cognitive Behavioural Theory.
a) Aim: To change how the client thinks, and then change
the subsequent behaviour. This is extremely successful
with compulsive disorders
b) Problems: Changing the way someone “thinks” is very
hard. You have to break through all the misinformation
the person is telling themselves. To then change
behaviour takes willpower… something that many people
struggle with
c) Methods: Clients are trained to recognize negative
thoughts and the replace the negative behaviour with a
directly positive and enjoyable one. In one study people
learned to prevent compulsive behaviours by relabeling
their obsessive thoughts. Feeling the urge to wash their
hands again they would tell themselves “I’m having a
Compulsive urge” (cognitive therapy) and attribute it to
their brain’s abnormal activity (Not their false belief that
the world is dirty) Instead of giving into the urge they
would then spend 15 min in an enjoyable alternative
behaviour such as practicing an instrument, taking a walk
or gardening (behaviour therapy). This Helped unstick
the brain by shifting attention and engaging other brain
areas. Ultimately the urge to wash their hands was
reduced while the urge to do the positive behaviour was
reinforced.
d) Disadvantages: You are simply replacing one obsessive
compulsion for another, albeit a positive one. It seems
like a kind of patch work system but ultimately a positive
and successful one.
e) Advantages: The Negative behaviour is changed by
making the reward the behaviour. This is different than
most conditioning that uses a neutral stimulus or a
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extrinsic (outside) reward. In cognitive behavioural
therapy the behaviour is its own reward.
6)
Psychopharmacology
By far the mostly widely used biomedical treatments today are
the drug therapies. Since the 1950s psychopharmacology has
revolutionized the treatment of people with severe disorders,
liberating hundreds of thousands from hospital confinement. We
have become a Pill Popping society.
Antipsychotic drugs: Calms patients with Psychosis (disorders in
which hallucinations or delusions indicate some loss of contact
with reality). Drugs such as Thorazine, dampen responsiveness to
irrelevant stimuli. Thus they provide the most help to patients
afflicted with schizophrenia.
A good way to look at it is that you and your friend are trying
to talk but the stereo is playing and it is so loud you can’t
concentrate or hear the entire conversation with your friend.
Thorazine turns down the volume of the stereo so you can
concentrate on what you are trying to concentrate on.
Antipsychotic drugs can cause symptoms similar to
Parkinson’s disease, and they do nothing to alleviate the
negative effects of Apathy and withdrawal in schizophrenia
patients. Newer antipsychotics haven’t improved treatment;
however they have reduced the side effects.
Antianxiety Drugs:
Like alcohol antianxiety drugs such as Xanax or Ativan depress
the central nervous system and so it calms you down (This is why
you should NEVER take antianxiety drugs and alcohol at the same
time) . Much like behaviour therapies, antianxiety drugs do the job
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but don’t resolve the thing that is making you anxious in the first
place. So ultimately it is a Band-Aid for your problem. You can easily
become psychologically dependent on antianxiety pills. Say you “pop
a Xanax” every time you have the “bad” feeling of anxiety… then the
pill makes you feel “good” by removing the “bad” feeling. You then
start to associate the pills with making you feel good, and not simply
removing the bad.
Happiness Scale
Good
By starting in the bad…
and then associating the
move up as good… then
“normal” becomes your
new “good”… which isn’t
healthy and may lead to
depression.
Normal
Bad
Antidepressant Drugs
The antidepressants were named for their ability to lift people up
from a state of depression, and this was their main use until
recently. The label is a bit of a misnomer (misnomer is a term that is
ALWAYS used for something yet is incorrect... like photographic
memory is a misnomer for eidetic memory). These drugs are
increasingly being used to successfully treat anxiety disorders such
a obsessive compulsive disorder. They work by increasing the
availability of norepinephrine and serotonin which has an elevating
effect on mood. It makes you in a better mood... not necessarily
happy though.
In the United States 11 percent of women and 5 percent of men take
antidepressants.
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Note: Patients with depression who begin taking antidepressants do
not wake up the next morning “cured”. It takes around four weeks
for the desired effect to be clearly felt. This also has the unfortunate
side effect of lowering sexual desire... which may cause a NEW
source of depression.
Antidepressants are not the only way to give the body a lift. Aerobic
exercise which helps calm people who feel anxious and energize
those who feel depressed does about as much good for some people
with mild to moderate depression and has additional positive side
effects.
Also across many studies it was found that Antidepressants worked
very well in reducing anxiety and depression... however when the
results are looked at more closely they can be debated. It is now
suggested that most mild to medium cases of depression are actually
cured by the placebo effect as effectively as they are the actual
depression... Meaning the same number of people got better from
the actual drugs as the sugar pills. Only the severe or clinical
depression patients were actually helped by the drugs.
Now I’m sure some of you have heard that these drugs cause people
to have a higher chance to commit suicide... this is simply not true.
This is the same logic as air travel is safer than cars... the reason
being there are more cars so more people die... this is the same with
antidepressants... There are more suicides because more depressed
people are on these drugs. Correlations at work again folks!
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Psychosurgery:
Because it’s effects are irreversible, psychosurgery, or surgery that
removes or damages brain tissue, is the least used type of treatment
or therapy. The most famous form of psychosurgery is of course the
lobotomy.
Simpsons Lobotomy.
If you cut the nerves connecting the frontal lobes with the emotion
controlling centers of the inner brain you can calm uncontrollably
emotional and violent patients. In a crude but easy and inexpensive
procedure that took only about 10 minutes a neurosurgeon would
shock the patient into a coma, hammer an ice-pick-like instrument
through each eye socket into the brain, and then wiggle it to sever
the connections running up to the frontal lobes. Tens of thousands
of severely disturbed people, including president John F Kennedy’s
sister, were lobotomized between 1936 and 1954. The founder of
the procedure, Egas Moniz, was given a Nobel prize.
Today Lobotomies have been abandoned for more pharmaceutical
avenues.
Disorders.
Most people would agree that someone who is too depressed to get
out of bed for weeks at a time has a psychological disorder. But what
about those who, having experienced a loss, are unable to resume
their usual social activities? Where should we draw the line between
sadness and depression? Between zany creativity and bizarre
irrationality? Between normal and abnormal?
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We need to ask these questions
1) How should we define psychological disorders?
2) How should we understand disorders: as
sicknesses that need to be diagnosed and
cured, or as natural responses to a troubling
environment?
3) How should we classify psychological
disorders? And can we do so in a way that
allows us to help people without stigmatizing
them with labels.
I.
Defining Psychological disorders:
Mental health workers view psychological disorders as patterns of
thoughts feelings or behaviors that are deviant, distressful and
dysfunctional. Being different (deviant) from most other people in
one’s culture is part of what it takes to define a psychological
disorder. Basically if you are different, we look to see why. If the
reason why is something psychological then we label it a “disorder”
Question: What is the problem with defining a disorder by what is
considered “normal”?
Answer: That normal may change with any given situation or time. A
sociopath that kills is labeled a murderer... yet put that same
sociopath in a wartime situation and they may be labeled a soldier...
or even a war hero. Someone who hears voices may be considered
deranged yet put those same people in a religious society and they
become profits or saints (Joan of Arc for instance). This also changes
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as per the time. On December 9 1973, homosexuality was classified
as an illness. As of December 10 1973, it was not. The current hot
topic illness that is plaguing our cultural media and social
consciousness is ADHD.
But being deviant isn’t enough. Olympic athletes are by definition
deviant... they are way away from the norm. But we wouldn’t classify
them as having a disorder. So the deviant behavior must be harmful
or cause distress to the subject for it to be considered a disorder.
This harmful deviation is called a harmful dysfunction.
II.
Understanding Disorders
We have had a hard time in our history understanding disorders.
If you were in the Middle Ages you might diagnose a disorder by
demonic possession... or in ancient Greece you might think they
were talking to the gods. People suffering from disorders were
further made to suffer by inhumane conditions and, frankly,
insane remedies. Everything from: the removal of internal organs,
to blood transfusion, to the cauterizing the clitoris.
So you can see why it is so important to truly understand
disorders so we don’t over react or act inhumanly.
This can be very difficult... as seen in the recent case with Vince
Weiguang Li.
Today psychologists contend that ALL behavior, whether called
normal or disordered, arises from the interaction of nature and
nurture. To presume that a person is mentally ill, they say
attributs the condition to a sickness that must be found and
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cured. But instead or additionally, there may be a difficulty in the
person’s environment, in the person’s current interpretations of
events or in the person’s bad habits and poor social skills. This is
demonstrated by the difference in disorders by culture. Eating
disorders for example occur mostly in western cultures. Latin
America has a condition called Susto. Susto is a severe anxiety
and restlessness and a fear of black magic. Taijin-kyofusho is a
social anxiety about one’s appearance combined with a readiness
to blush and a fear of eye contact is very common in Japan.
So while there are, culture specific disorders, there still are the
biggies... the ones that transcend culture: Depression and
schizophrenia
III.
Classifying psychological disorders
Why do we classify things in general? Well it’s because we like
everything to make sense and to make sense quick. If I asked you
what a Marjoram was you’d have no idea. Yet if I say a Marjoram
is a flower then automatically you have an idea of what it is.
Because we have a clear classification of what a flower is, it
becomes easy for us to identify it by that classification.
To help psychologist and therapists diagnose and help people
suffering from disorders we have classified different symptoms
under different disorder names. This has helped us identify and
predict the future symptoms and prevent them. The harm... if we
misdiagnose the disorder we might do more harm than good.
To this effect the psychiatric community has published the
Diagnostic and statistical manual of mental disorders. , or the
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DSM. The fifth edition... labeled DSM-V-TR was released this year
(2012) and will probably be the go to for the next half decade.
The DSM-V-TR is used as a diagnostic process and 16 clinical
syndromes. (Kind of a mental disorders Checklist)
The problem with labeling:
When we label, we attribute a perceived notion to something. A
flower is supposed to smell nice, for instance. However smell the
wrong flower and you can literally die. Same idea with Disorders.
If you are labeled with a disorder, then people with react to you in
a very specific way and may limit you in others. For instance
would any of you hire Mr. Li after he has been “cured”? An
extreme example to be sure but the danger of labeling is that you
risk limiting the individual simply because of who they are... and
no one wants that.
As mentioned above, Labeling also leads to misdiagnosis. If you
are initially labeled as schizophrenic, you may develop additional
symptoms that are never diagnosed because a treatment is
already in place for the schizophrenia. The TV show house is
fantastic for demonstrating the difficulty of labels and how they
can prevent a correct diagnosis.
Anxiety Disorders
Anxiety is part of life. Think of a time in your life you were
nervous... really nervous. Now what if that feeling didn’t go away?
This persistent, dysfunctional or distressing anxiety is what we
call an anxiety disorder.
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There are 5 classifications of Anxiety disorders
1) Generalized anxiety disorder: a person is unexplainably and
continually tense and uneasy
2) Panic disorder: a person experiences sudden episodes of
intense dread
3) Phobias: a person feels irrationally and intensely afraid of a
specific object or situation
4) Obsessive compulsive disorder: a person is troubled by
repetitive thoughts or actions.
5) Post-Traumatic stress disorder: a person has lingering
memories nightmares and other symptoms for weeks after a
severely threatening uncontrollable event.
1) Generalized Anxiety Disorder (GAD)
Out of control negative feelings are common with generalized
anxiety disorder. The symptoms of GAD are common however
their persistence is not. Meaning we all get anxious... but it
shouldn’t last. People with this condition (two thirds women)
worry continually, and they are often jittery, agitated and sleep
deprived. Concentration is difficult as attention switches from
worry to worry. And their tension and apprehension may leak out
through furrowed brows, twitching eyelids and trembling hands.
The worst part about GAD is that people can’t figure out what is
causing the anxiety. Usually it’s pretty clear what is making you
nervous.. For people with GAD... the world in general makes them
feel that way. This psychological condition may have
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physiological effects such as high blood pressure. As time passes
emotions tend to mellow and by age 50 GAD becomes rare.
2) Panic Disorder
Panic disorder is an anxiety tornado. It strikes suddenly, wreaks
havoc and disappears. Fir the 1 person in 75 with this disorder,
anxiety suddenly escalates into a terrifying panic attack. A
minutes long episode of intense fear that something horrible is
about to happen. Heart beating faster, shortness of breath,
choking sensations, and trembling or dizziness typically
accompanies the panic, which may be misperceived as a heart
attack or other serious physical ailment. Smokers double their
risk of a panic attack.
3) Phobias
Phobias are anxiety disorders in which an IRRATIONAL fear
causes the person to avoid some object, activity or situation.
Many people accept their phobias and live with them. But others
are incapacitated by their efforts to avoid the feared situation.
Specific phobias may focus on: animals, insects, heights, blood or
close spaces. Not all phobias have such specific triggers. Social
phobia is shyness taken to an extreme.
Those with a social phobia, an intense fear of being
scrutinized(criticized) by others avoid potentially
embarrassing social situations, such as speaking up,
eating out or going to parties... or will sweat, tremble or
have diarrhea when doing so.
People who have extreme panic disorder may come to fear panic, in
essence fearing fear. Given this fear of anything that might scare
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you, these people may never leave their homes as it is the only “safe”
environment. This is known as agoraphobia.
4) Obsessive compulsive disorder
As with generalized anxiety and phobias, we can see aspects of our
own behavior in obsessive compulsive disorder or OCD.
OCD is the constant thought that won’t go away or the compulsive
behavior of having to check, order and clean objects repetitively,
whether it needs it or not. Obsessive thoughts and compulsive
behaviors cross the fine line between normality and harmful
deviancy when they persistently interfere with everyday living.
Checking to see if the door is locked or you window closed
repeatedly is normal... checking 10 times is not. Washing your hands
is normal.. washing so often that your skin becomes raw is not.
Usually it is in your 20’s that people will cross that fine line and
become truly compulsive. The obsessive thoughts become so
haunting the compulsive rituals so senselessly time-consuming that
the effective functioning becomes impossible.
Knock Knock Penny
OCD is more common among teens and young adults than among
older people. A 40 year follow up study of 144 Swedish people
diagnosed with the disorder found that for the most the obsessions
and compulsions had gradually lessened though only 1 in 5 had
completely recovered.
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5) Post Traumatic stress disorder
Post traumatic stress disorder or PTSD has been brought to the
forefront of the Canadian consciousness in the past couple years as
our brave service men and women return from the wars in the
Middle East... yet never truly leave the wars behind. Our memories
exist in part to protect us in the future. There is biological wisdom in
not being able to forget our most emotional, or traumatic
experiences, our greatest embarrassments, our worst accidents, our
most horrid experiences. But sometimes for some of us the
unforgettable takes over our lives. The complaints of battle scarred
veterans, recurring haunting memories and nightmares a numbed
social withdrawal, jumpy anxiety and insomnia are typical of what
once was called shellshock or battle fatigue.
PTSD is not only for soldiers...oh no... anyone who has a traumatic
event can have PTSD. Anything from a bad car accident, to a physical
fight to rape (an estimated two-thirds of prostitutes have PTSD...
more than Soldiers).
So what determines whether a person develops PTSD after a
traumatic event? Research indicates that the greater one’s
emotional distress during a trauma the higher the risk for post
traumatic symptoms. A sensitive limbic system seems to increase
vulnerability by flooding the body with stress hormones again and
again as images of the traumatic experience erupt into the
consciousness.
PTSD proves that the old saying “what doesn’t kill you makes you
stronger” is not always true. Those whom experience a traumatic
event and do NOT develop PTSD seems to indicate that some people
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are simply more resilient to the hardships of life. This ability to not
develop PTSD is called Survivors Resiliency
PTSD however has ONE silver lining. Post traumatic growth. This is
where the sufferer of PTSD, once cured or controlled, gains a new
perspective on life and their situation. They actually become better
for it.
How do we develop anxiety disorders?
1) Fear conditioning: when bad things happen and continue to
happen that are of the same type, then we learn to fear and be
anxious around similar things. Remember baby Albert? This is the
same concept. We generalize the stimulus into an anxiety disorder
2) Observational Learning: By observing others fears we learn to
fear the same thing. If your mom is scared of spiders and has a huge
reaction to them while you are young... you may develop a similar
fear just from watching your mom.
3) Natural selection: We, as a species, are biologically prepared to
fear threats faced by our ancestors. Basically things that have killed
us in the past we now fear naturally.
WW2 Plane raids actually didn’t teach us to fear planes but to figure
out how close a plane was. If those raids went on for thousands of
years we would fear planes like we fear snakes.
4) Genes: Some people are genetically more likely to be anxious.
This might be cause, some researchers contend, to the explanation
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of survivors resiliency. And if there is a genetic gene for anxiety...
once found, can be modified to no longer be anxious or fear. Kind of
cool...yet if you believe that evolution is a good thing... maybe not.
5) The Brain: all anxiety disorders are manifested biologically as an
over arousal of brain areas involved in impulse control and habitual
behaviours. When the disordered brain detects that something is
wrong, it seems to generate a mental hiccup of repeating thoughts
or actions. Anti-anxiety drugs dampen this hiccup and help return
the suffer to a more normal life.
Somatorform disorders
Among the most common problems brining people into doctors’
offices are medically unexplained illnesses. In somatoform disorder
the distressing symptoms take a somatic (bodily) form without
apparent physical causes. One person may have a variety of
complaints: Vomiting, dizziness, blurred vision, difficult in
swallowing. Another may experience severe and prolonged pain.
Culture has a big effect on people physical complaints and how they
explain them. In china psychological explanations of anxiety and
depression are socially less acceptable than in many western
countries and people less often to express the emotional aspects of
distress. The Chinese appear more sensitive to and more willing to
report the physical symptoms of their distress. Basically this is when
the pain is “all in your head”, but even so the pain that the brain
creates is still real pain.
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An extreme case of a somatoform disorder is hypochondriasis. In
this relative common somatoform disorder, people interpret normal
sensations (a stomach cramp today, a headache tomorrow) as
symptoms of a dreaded disease. Sympathy or temporary relief from
everyday demands may reinforce such complaints. No amount of
reassurance by any physician convinces the patient that the trivial
symptoms do not reflect a serious illness. So the patient moves on to
another physician, seeking and receiving more medical attention but
failing to confront the disorders psychological root.
Dissociative Disorders
Among the most confusing disorders are the rare dissociative
disorders. These are disorders of consciousness, in which a person
appears to experience a sudden loss of memory or change in
identity, often in response to an overwhelmingly stressful situation.
One Vietnam veteran who was haunted by his comrades deaths, and
who had left his world trade center office shortly before the 9/11
attack lost memory for his personal identity, a rare disorder called
fugue state. He disappeared en route to work one day and was
discovered six months later in a Chicago homeless shelter,
reportedly with no memory of his identity or family. In such cases
the persons conscious awareness is said to dissociate (become
separated), from painful memories, thoughts and feelings.
Dissociation itself is not so rare. Who here has memories that are
more like a movie than a memory? That is dissociation. Ever drive
somewhere or sit on the bus and not remember the trip? Your brain
goes into “auto pilot”.
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Dissociative Identity Disorder (DID)
A massive dissociation from your own
personality is known as dissociative
identity disorder. In the absence of
your personality another takes its
place. This was formally known (and
probably better known) as multiple
personality disorder. Normally the
primary personality (your
personality) isn’t aware of the other.
People diagnosed with DID are usually
not violent but cases have been
reported of dissociations into good and bad or aggressive
personality. A modest version of the dr. Jekyll Mr Hyde split
immortalized in Robert Louis Stevenson’s story or even more
modern incarnations such as Batman’s Two face.
Skeptics question whether DID is a genuine disorder or an extension
of our normal capacity for personality shifts. Are clinicians who
discover multiple personalit8ies merely triggering role playing by
fantasy prone people? Do these patients, like actors who commonly
report “losing themselves” in their roles when convince themselves
of the authenticity of their own role enactments?
Skeptics also find it suspicious that the disorder is so localized in
time and space.
1930-1960 : 2 cases of DID were reported per decade
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In 1980: DID was included in the DSM and cases jumped to more
than 20,000 and is largely, if not completely, a North American
phenomenon.
Schizophrenia
If Depressions is the common cold of psychological disorders,
chronic schizophrenia is the cancer. Nearly 1 in 100 people will
develop schizophrenia, joining the estimated 24 million across the
world who suffer one of humanity’s most dreaded disorders.
Schizophrenia means “split mind”. Not in the sense of split brain, or
DID but rather a split from reality.
Schizophrenics cannot focus properly on what is going on. They will
focus on condensation on their glass for instance rather than the
football game they are at, or at the pendant around someone’s neck
rather than what that person is saying. Imagine trying to
communicate with someone who’s thoughts spill out in no logical
order. Their thoughts are often distorted and fragmented by false
beliefs called delusions. Those with paranoid tendencies are
particularly prone to delusions of persecution.
Activity: Write-out a dream that you have had. What was particular
about that dream? What was strange? Did you know it was a dream
at the time?
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Disturbed perceptions
A person with schizophrenia may have hallucinations,
seeing feeling tasting or smelling things that are not there. Most
often however the hallucinations are auditory, frequently voices
making insulting remarks or giving orders. The voices may tell the
patient that she is bad or that she must burn herself with a cigarette
lighter. Imagine your own reaction if a dream broke into your
waking consciousness. When the unreal seems real the resulting
perceptions are at best bizarre at worst terrifying. Now lets look at
your dream you just wrote out. Imagine now that this was
happening while you were awake. How would you feel? More
importantly how would your interactions be with the rest of the
world... and how would they interact with you?
Inappropriate emotions and actions
The emotions of schizophrenia are often utterly inappropriate,
split off from reality. Laughing at tragedy, crying at happiness or
even becoming angry for no apparent reason, schizophrenics may
even lapse into an emotionless state of flat effect.
Motor Behavior may also be inappropriate. Some perform
senseless compulsive acts, such as continually rocking or rubbing an
arm. Others who exhibit catatonia (not responsive to any stimuli)
may stay still for hours before erupting in a rage. As you can imagine
such disorganized thinking disturbed perceptions and inappropriate
emotions and actions profoundly disrupt social relationships and
make it difficult to hold a job or friendships.
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Onset and development of schizophrenia
Usually strikes young people as they mature into adulthood.
Unlike DID it is a global disorder and affects all nationalities and
peoples. It affects both men and women although men seem to have
a slight advantage in severity than women do. It can manifest (start)
itself all at once as a reaction to a stressful event or gradually over
puberty. Generally if it comes gradually it is often lead by a history
of social inadequacy. Basically gradual schizophrenics have had
problems interacting with others in social situations throughout
their lives, more predominantly in high school.
Sub types of schizophrenia
1) Paranoid – Preoccupation with delusions or hallucinations,
often with themes of persecution or grandiosity
2) Disorganized – Disorganized speech or behavior, or flat or
inappropriate emotion
3) Catatonic – Immobility or excessive purposeless movement,
extreme negativism and or parrot like repeating of another’s
speech or movements
4) Undifferentiated – Many and varied symptoms
5) Residual – Withdrawal, after hallucinations and delusions have
disappeared.
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Mood disorders
Emotional extremes of mood disorders come in two principal forms
1) Major depressive disorder: Prolonged hopelessness and
lethargy
2) Bipolar Disorder: Formerly called manic-depressive disorder,
a person alternates between depression and mania, an
overexcited, hyperactive state.
If you are like most high school students, at some point in the school
year you will exhibit some symptoms of depression. You may feel
deeply discouraged about the future, dissatisfied with your life or
socially isolated. You may lack the energy to get things done or even
to force yourself out of bed, be unable to concentrate eat or sleep
normally or even wonder if you would be better off dead (that
would be NO by the way). You are not alone. In one survey of
American high school students 29% felt so sad or hopeless almost
every day for 2 or more weeks in a row that they stopped doing
some usual activities. In another survey of 90,000 American college
and university students 44%.... 44%!!!!!! Reported that on one or
more occasions within the last school year they had felt so
depressed it was difficult to function. 44% feel that they are alone...
crazy being that that number alone is almost half.
Where anxiety is a response to future potential stress/loss,
depression is a reaction to past stress/loss.
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So if everyone is depressed... at one point or another... is there a
difference in types of depression?
YES
All of us will be depressed at one point or another. This can be a bad
mood or just a down day but someone who suffers from major
depressive disorder is much different.
Major Depressive disorder (MDD) occurs when at least five signs
of depression (including lethargy (laziness), feelings of
worthlessness, or loss of interest in family, friends and activities)
last two or more weeks and are not caused by drugs or a medical
condition. To sense what major depression feels like, suggest some
clinicians, imagine combining the anguish of grief with the
sluggishness of jet lag.
Bipolar disorder
With or without therapy, episodes of major depression usually end.
And people temporarily or permanently return to their previous
behavior patterns. However some people rebound to, or sometimes
start with the opposite emotional extreme.
- The euphoric (really really happy) hyperactive, wildly
optimistic state of mania.
If depressing is living in slow motion mania is fast forward.
Alternating between depression and mania signals bipolar disorder.
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Adolescent mood swings, from rage to bubbly, can, when prolonged
produce a bipolar diagnosis.
During the manic phase, people with bipolar disorder are typically
over talkative overactive and elated, though easily irritated if
crossed. Have little need of sleep and show fewer sexual inhibitions.
Speech is loud, flighty and hard to interrupt. They find advice
irritating yet they need protection from their own poor judgement
which may lead to reckless spending or unsafe sex.
Ever figured something out? Like a secret? Or had an amazing idea...
I bet your mood was elevated and you were super excited. This is
mania.
 Artists, performers and entertainers suffer from mania far
more than say doctors or architects. Manic people are more
creative but the manic disorder is also very descriptive of a
“diva attitude” happy one min.. flying off the handle the next.
 Before long the elated mood either returns to normal or
plunges into a depression. Though bipolar disorder is much
less common than major depressive disorder, it is often more
dysfunctional, claiming twice as many lost workdays yearly.
Understanding Mood disorders
 Many behavioral and cognitive changes accompany depression
 People trapped in a depressed mood are inactive and
feel unmotivated. They are sensitive to negative
happenings more often recall negative information and
expect negative outcomes. Basically they are a Debby
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downer. When depression lifts all of these negative
outlooks disappear.
 Compared with men, women are nearly twice as vulnerable to
major depression.
 The gender gap begins in adolescence; preadolescent girls
are not more depression-prone than boys. The factors
that put women at risk for depression are the same as
men yet women are more vulnerable to disorders
involving internalized states, such as depression, anxiety
and inhibited sexual desire. Men’s disorder tend to be
more external: alcohol abuse, antisocial conduct, lack of
impulse control. When women get sad they often get
sadder than men do. When men get mad the often get
madder than women do.
 Most major depressive episodes self-terminate
 Therapy tends to speed recovery, yet most people
suffering major depression eventually return to normal
even without professional help. The plague of
depression comes and, a few weeks or months later, it
goes.
 Stressful events related to work, marriage, close relationships,
often precede depression.
 As we feel we are losing control of certain things, we
tend to get depressed. It is natural and common.
With each new generation, depression is striking earlier and
affecting more people.
This is true in Canada, the United States, England, France, Germany,
Italy, Lebanon, New Zealand, Puerto Rico and Taiwan. Most young
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people hide it from their parents. In North America today’s young
adults are three times more likely than their grandparents to report
having recently or ever, suffered depression. The increase appears
partly authentic, but it may also reflect today’s young adult’s greater
willingness to disclose depression.
Depressions Vicious Cycle
Depression, as we have seen, is often brought on by stressful
experiences: losing a job, getting dumped, suffering physical trama,
basically anything that disrupts our sense of who we are and why
we are worthy human beings
This disruption in turn leads to brooding, which amplifies negative
feelings. Being withdrawn self-focused and complaining can by itself
elicit rejection (nobody wants to be around someone who is
constantly negative).
Depressed persons induce hostility, depression and anxiety in
others and get rejected. This means that people who are already
depressed are at a much higher risk of getting fired, getting dumped,
and other stressful life situations that disrupts our sense of who we
are and why we are worthy human beings... sound familiar?
This shows how ones attitude can effect a person’s situation. People
who are depressed, on average, have more depressing things
happen to them.
Misery Love Company.
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Stressful experiences (Loss)
Something bad happens
Negative explanatory style.
Incorrect belief about what
happened
Cognitive and Behavioral change
You change your behavior to fit
the bad thing that happened
Negative reaction to bad thing that
happened
Depressed Mood
Remember this Diagram? You should. It is the way cognitive therapy
tries to break you out of your own downward spiral of depression.
When bad moods feed on themselves, when we feel down , we think
negatively and remember bad experiences. But remember we can
break the cycle at any one of these points by moving to a different
environment, by reversing our self blame or faulty beliefs and by
turning our attention outward at things we can control and not
inward on our doubts and inner feelings of inadequacy.
Winston Churchill called depression a black dog that periodically
hounded him. Poet Emily Dickinson was so afraid of bursting into
tears in public that she spent much of her adult life in seclusion.
People struggle with depression; most do at some point in their
lives. It’s... for a lack of a better word... NORMAL.
I'm Nobody! Who are you?
Are you -- Nobody -- Too?
Then there's a pair of us!
Don't tell! they'd advertise -- you know!
How dreary -- to be -- Somebody!
How public -- like a Frog -To tell one's name -- the livelong June -To an admiring Bog!
- Emily Dickinson
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Activity Shades of Abnormality
Personality disorders
Some dysfunctional behavior patterns impair peoples social
functioning without depression or delusions. Among them are
personality disorders.
Personality disorders: Disruptive, inflexible and enduring behavior
patterns that impair one’s social functioning
DSM Characteristics of Several Personality Disorders
Paranoid: suspicious, argumentative, paranoid, continually on the
lookout for trickery and abuse, jealous, tendency to blame others,
cold and humorless
Schizoid: has few friends; a "loner"; indifferent to praise and
criticism of others; unable to form close relationships; no warm or
tender feelings for other people
Sociopath: breaks rules and laws; takes advantage of other people
for personal gain; feels little remorse or guilt; appears friendly and
charming on the surface; often intelligent
Schizotypal: also aloof and indifferent like the schizoid; magical
thinking; superstitious beliefs; uses unusual words and has peculiar
ideas; a very mild form of schizophrenia
Borderline: very unstable relationships; erratic emotions; selfdamaging behavior; impulsive; unpredictable aggressive and sexual
behavior; monophobia; easily angered
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Histrionic: overly dramatic; attention seekers; easily angered;
seductive; dependent on others; vain, shallow, and manipulative;
displays intense, but often false emotions
Narcissistic: grandiose; crave admiration of others; extremely selfcentered; feel they are privileged and special; expects favors from
others; emotions are not erratic
Compulsive: perfectionists; preoccupied with details, rules,
schedules; more concerned about work than pleasure; serious and
formal; cannot express tender feelings
Passive-Aggressive: indirectly expresses anger by being forgetful
and stubborn; procrastinates; cannot admit to feeling angry;
habitually late
Antisocial Personality disorder
The most troubling and heavily researched personality
disorder is the antisocial personality disorder. The person (formerly
called a sociopath or a psychopath) is typically a male whose lack of
conscience becomes plain before age 15, as he begins to lie, steal,
fight or display unrestrained sexual behavior.
About half of such children become antisocial adults.
When the antisocial personality combines a keen intelligence with
amorality the result may be a charming and clever con artist... or
worse.
Despite their antisocial behavior, many
criminals do not fit the description of antisocial
personality disorder.
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Why? Because they actually show responsible concern for their
friends and family members, antisocial personalities feel and fear
little and in extreme cases the results can be horrifyingly tragic.
Henry Lee Lucas confessed that
during his 32 years of crime he
had bludgeoned, suffocated,
stabbed, shot or mutilated
some 360 women, men and
children, the first at age 13.
During the last 6 years of his
reign of terror, Lucas teamed
with Elwood Toole, who
reportedly slaughtered about
50 people he “didn’t think was worth living anyhow”. It ended when
Lucas confessed to stabbing and dismembering his 15 year old
common law wife, who was Toole’s niece. The antisocial personality
expresses little regret over violating others rights. “Once I’ve done a
crime, i just forget it” said Lucas. Toole was equally matter of fact: “I
think of killing like smoking a cigarette, like another habit”.
Understanding Antisocial Personality disorder
Antisocial personality disorder is woven of both biological and
psychological strands. No single gene codes for a complex behavior
such as crime, but twin and adoption studies reveal that biological
relatives of those with antisocial and unemotional tendencies are at
increased risk for antisocial behavior.
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This genetic vulnerability shows up in people as a fearless approach
to life. Awaiting aversive events, such as electric shocks or loud
noises, they show little autonomic nervous system arousal.
Even as youngsters, before committing any crime, they react with
lower levels of stress hormones than do others their age.
Some studies have detected the early signs of antisocial behavior in
children as young as ages 3 to 6.
Young Males whom later become aggressive or antisocial tended as
young children to have been impulsive, uninhibited unconcerned
with social rewards and low in anxiety. Channeled in more
productive directions, such fearlessness may lead to courageous
heroism, adventurism or star-level athleticism.
Lacking a sense of social responsibility, the same disposition may
produce a cool con-artist or killer. The genes that put people at risk
for antisocial behavior also put people at risk for dependence on
alcohol and other drugs. This is why substance abuse and antisocial
behavior are often combined.
Activity: Personality Disorders Party
End of Unit 5 : TEST