Psychopathology: the thin line that separates sanity from madnessFun to hear about uncommon disorders…Historical RootsDebate“Pibloktoq”Diagnosis: A Necessary StepWho’s crazy here anyway?Rosenhan, 1973 “On being Sane in Insane Places”Slide 9Slide 10Role of ExpectationsSlide 12Line betweenBeware!Detailed Examples1. OCDObsessions & Compulsions2. Hypochondriasis“Place your foot in this ice water”Heightened Sensitivity3. Dissociative Identity DisorderSkeptical?4. Depression: “The common cold”A cause?Learned Helplessness in HumansExplanatory Styles and Depression5. Schizophrenia“I felt like I was the only sane person in a world gone crazy”Next time: treatmentCharles MansonSlide 31Reactions of People with Social Phobias IAnxiety Disorders Reactions of People with Social Phobias IIPsychopathology: Psychopathology: the thin line that separates sanity from the thin line that separates sanity from madnessmadness““To study the abnormal is the To study the abnormal is the best way of knowing the best way of knowing the normal” normal” W. W. JamesJamesFun to hear about uncommon Fun to hear about uncommon disorders… disorders… Limbic psychotic trigger reactionsLimbic psychotic trigger reactionsSudden brain seizure triggered by Sudden brain seizure triggered by harmless sight or sound causes some men harmless sight or sound causes some men to fly into violent rageto fly into violent rage18 cases (14 murders): quiet, unassuming 18 cases (14 murders): quiet, unassuming loners suddenly erupt into violence, only loners suddenly erupt into violence, only to just as suddenly recoil in horror at their to just as suddenly recoil in horror at their actions, gripped by remorse!actions, gripped by remorse!BUT… BUT…Historical RootsHistorical RootsCaused by evil spirits…Caused by evil spirits…Need an Need an openingopening to escape to escapeWitchcraft, demonic possession, full Witchcraft, demonic possession, full moon, supernatural forces…moon, supernatural forces…Exorcism, torture, primitive surgery, Exorcism, torture, primitive surgery, bloodletting, bitter poisons, starvation, bloodletting, bitter poisons, starvation, noise-makingnoise-makingToday: Medical perspective & Today: Medical perspective & Psychological perspectivePsychological perspectiveDebateDebateBiological conditions Biological conditions vs.vs. Past & present life experiences (natural Past & present life experiences (natural disasters to abuse, divorce, illness, etc.)disasters to abuse, divorce, illness, etc.)PsychoanalyticPsychoanalyticParental influences, unconscious, defense Parental influences, unconscious, defense mechanismsmechanismsBehaviorial & CB Behaviorial & CB Reward, punishment… perceptions, expectations, Reward, punishment… perceptions, expectations, beliefsbeliefsANDAND… … Diathesis-Stress ModelDiathesis-Stress Model““Pibloktoq”Pibloktoq”Intense excitement, seizures, then Intense excitement, seizures, then coma.coma.Tear off clothing, break furniture, shout Tear off clothing, break furniture, shout obscenities, eat feces… later forget obscenities, eat feces… later forgetDiagnosis: A Necessary StepDiagnosis: A Necessary StepDSM-IV Disorders DSM-IV Disorders (we’ll discuss)(we’ll discuss)AAnxietynxiety- GAD, Panic, phobias, OCD, PTSD- GAD, Panic, phobias, OCD, PTSDSSomatoformomatoform- Hypochondriasis, conversion- Hypochondriasis, conversionDDissociativeissociative- Amnesia, fugue, DID- Amnesia, fugue, DIDMMoodood- Depression, mania, bipolar - Depression, mania, bipolar SSchizophrenicchizophrenic- Paranoid, Disorganized, - Paranoid, Disorganized, Catatonic, Undifferentiated, ResidualCatatonic, Undifferentiated, ResidualPPersonalityersonality- borderline, antisocial- borderline, antisocialWho’s crazy here anyway?Who’s crazy here anyway?However much we may be personally However much we may be personally convinced that we can tell the normal from convinced that we can tell the normal from the abnormal, the evidence is simply not the abnormal, the evidence is simply not compellingcompellingRosenhan, 1973 Rosenhan, 1973 “On being Sane in Insane “On being Sane in Insane Places”Places”““Hollow, Empty, Thud”Hollow, Empty, Thud”Described Described true life historiestrue life histories, relationships, etc. , relationships, etc. Ceased Ceased anyany symptoms, tried to convince staff of sanity to symptoms, tried to convince staff of sanity to be discharged (BY THEIR OWN DEVICES)be discharged (BY THEIR OWN DEVICES)How many were identified as SANE?How many were identified as SANE?How long did it take…How long did it take………had a close relationship with his mother had a close relationship with his mother but was rather remote from his father but was rather remote from his father during his early childhood. During during his early childhood. During adolescence and beyond however his adolescence and beyond however his father became a close friend while his father became a close friend while his relationship with his mother cooled. His relationship with his mother cooled. His relationship with his wife was relationship with his wife was characteristically close and warm. Apart characteristically close and warm. Apart from occasional angry exchanges, friction from occasional angry exchanges, friction was minimal, the children had rarely been was minimal, the children had rarely been spanked.spanked.“This white 39-year old male manifests a long history of considerable ambivalence in close relationships, which begins in early childhood. A warm relationship with his mother cools during adolescence. A distant relationship to his father is described as becoming very intense. Affective stability is absent. His attempts to control emotionality with his wife and children are punctuated by angry outbursts and in the case of the children, spankings. And while he says that he has several good friends, one senses considerable ambivalence embedded in those relationships also.”Role of ExpectationsRole of Expectations7 Schizophrenic diagnoses; 1 bipolar7 Schizophrenic diagnoses; 1 bipolar““I’m fine, no longer experiencing any I’m fine, no longer experiencing any symptoms”symptoms”Pseudopatients’ behavior caused by Pseudopatients’ behavior caused by situationsituation (e.g. boredom, hunger)(e.g. boredom, hunger)Interpreted by
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