Term
|
Definition
Judgments of “pathology” shift over time and across cultural communities
All defining criteria have limitations
All definitions involve social judgments
All judgments vary relative to history, culture, and experience |
|
|
Term
| The "Antipsychiatry” Critique |
|
Definition
Thomas Szasz’s (1960) “Myth of Mental Illness”
“Mental illness is a myth, whose function it is to disguise and thus render more palatable the bitter pill of moral conflicts in human relations” (p. 118).
Brain Diseases vs. Problems in Living |
|
|
Term
|
Definition
deviance in behavior from certain psychological, ethical, or legal norms
This deviance is NOT illness, and therefore is not properly within the realm of medical (psychiatric) intervention |
|
|
Term
|
Definition
| Instead, bodily illness involves public, physico-chemical occurrences, NOT private sociopsychological happenings |
|
|
Term
| The Labeling Theory Critique |
|
Definition
Sociological Perspective on “Deviance”
Rosenhan’s (1973) Famous “Pseudopatient” Study
PP diagnoses (i.e., labels) evoke and cement deviant behavior Self-fulfilling prophecies
Implication: Psychiatry as “iatrogenic” (creating the very dysfunction it aims to treat) |
|
|
Term
| Seven Common Definitional Candidates (& Their Limitations) |
|
Definition
Absence of Mental Health
Exposure to Treatment
Receipt of Diagnosis
Performance on Psychological Tests
Personal Distress = Subjective Suffering
Statistical Rarity = Extreme Behaviors
Maladjustment = Functional Interference |
|
|
Term
|
Definition
Three Classic Efforts
Kendall’s (1975) Biological Disadvantage
Wakefield’s (1992) Harmful Dysfunction
Sedgwick’s (1981) Social Construction |
|
|
Term
| Kendall’s “Biological Disadvantage” |
|
Definition
sought objectivity in evolutionary theory
PP = mental conditions that INCREASE mortality or DECREASE fertility
ex. depression- suicide and no sex or kids
harmful elements must be INNATE (not Social)
c-ex. psoriasis- clearly disease but no decreased fertility or decreased mortality |
|
|
Term
| Wakefield’s “Harmful Dysfunction” |
|
Definition
Sought to Merge Objective (Fact) & Subjective (Value) Aspects
Again Invokes Evolutionary Theory
Acknowledges Both Natural & Social Components |
|
|
Term
Natural Component =
Social Component = |
|
Definition
Natural- "inability of some interna mechanism to perform it's natural funciton."
Social= disvalued some way by society judgement. |
|
|
Term
| But How Robust is This Natural Component? |
|
Definition
Consider Specific Mechanisms (e.g., Language)
Adaptation
versus Exaptation- byproducts of Natural Selection.
Is a bird that can't fly diseased?
Falters Under Interrogation, Leaving Only Social Aspect |
|
|
Term
| Sedgwick’s “Social Constructions” |
|
Definition
Disease (including PP) is an “Intentional Concept”
Sedgwick challenges that no branch of medicine is engaged in combating diseases as “objective” entities
Conclusion
There is no such thing as an objectively specifiable mental (or medical) disease
All forms of PP are social constructs depending on consensual or authoritative social judgments for their legitimacy
“Outside the significances that [humanity] voluntarily attaches to certain conditions, there are no diseases in nature.”
Requires a “point of view”
PP akin to concept of weeds or parasites
Mental disorders as social constructions |
|
|
Term
|
Definition
Explains variation across history & culture
Does NOT mean PP is mere “figment of imagination”
Does mean that observed behaviors might be interpreted in many different ways |
|
|
Term
|
Definition
| Specific theory & set of assumptions about how the theory is tested |
|
|
Term
|
Definition
Material events (e.g, neurochemical activity) are sufficient causes for other material events
One-way causality from brain to mind
consciousness and free will are illusions.
BUT challenges cherished notions & cannot explain apparent bi-directional causality |
|
|
Term
|
Definition
Objects vs. processes: States of mind are functional states of brain
Functional states are realized in material systems, but are not in essence material states
“Timepieces” are unified by function, not mechanics
Computer hardware (brain) vs. software (mind) (e.g., MS Word can run on a PC or a Mac)
Two people experiencing depression as a functional state of mind may have different patterns of neurochemical activity
BUT cannot explain meaning, simply rules & operations without true understanding |
|
|
Term
|
Definition
At higher levels of complexity, new features of systems emerge that could not be predicted from more basic levels
Mental phenomena as emergent properties of brain
H20 & wetness
Amino acids & life
Brain & consciousness
BUT assumes unidirectional, bottom-up causality that cannot explain experiential impacts on brain activity |
|
|
Term
| Language of implementation: |
|
Definition
All psychological phenomena are implemented through neural processes
Neural processes do not “underlie” psychological processes
Neural and psychological processed do not “interact”
Just because a given form of PP is associated with specific brain states does NOT mean it is caused by them
Avoid simplistic causal attributions (e.g., chemical imbalances in the brain”)! |
|
|
Term
| Possible Misinterpretations of Genetic Evidence |
|
Definition
Genetic influence = inevitable disorder (highest heritabilities are around .50 [ADHD excepted])
Genetic influence= immutable/unchangeable characteristic (increase of IQ for mental retardation)
Genetic influence= single gene as direct cause (Polygenic influence is the norm) |
|
|
Term
| Mental Disorders are “social constructions” |
|
Definition
Does not mean MDs are mere figments of imagination
Does mean that observed behaviors might be interpreted in many different ways |
|
|
Term
|
Definition
| Use of psychological techniques & the therapist-client relationship to produce emotional, cognitive, & behavior change |
|
|
Term
Improvement Without Treatment (Tx)
Eysenck’s Critique: |
|
Definition
2/3 of clients improve with tx, 2/3 improve without tx, and therefore tx offers no advantage
Tx is difficult to differentiate from informal help-seeking
Half of potential clients improve just through unstructured conversations with professionals |
|
|
Term
| Empirically-Supported Txs |
|
Definition
(Evidence-Based Txs or Best Practices)
Numerous ESTs now available for many disorders
Prediction of tx outcomes is probabilistic (based on group outcomes, not individuals)
Meta-analysis aggregates outcomes from many studies (Smith, Glass, & Miller, 1980)
Average client better off than 80% of untreated (see Figure 3-2)
Average gain (“effect size”) much higher than many established medical txs
Two-thirds in tx vs. one-third not in tx significantly improve (Rosenthal, 1983) |
|
|
Term
| The Neo-Kraepelinian Revolution |
|
Definition
Major Historical Shift Toward a Scientific Psychiatry
Opposed Domination of Psychoanalysis
Committed to Principles of Medicine
Reaction to Limitations of Early DSMs
Theoretical Incompatibilities
Low Diagnostic Reliability |
|
|
Term
|
Definition
Psychiatry as branch of medicine
Psychiatry as modern science
Psychiatry treats sick persons
Boundary between sickness and normality
Psychiatry investigates “real” mental illnesses
Focus upon biology of mental illness
Concern with diagnosis & classification
Importance of diagnostic criteria
Use of statistics to improve diagnosis
Emphasis on classification and reliable diagnosis |
|
|
Term
|
Definition
| Acute or episodic mental disorders (e.g., Posttraumatic Stress Disorder) |
|
|
Term
|
Definition
| Stable and enduring mental disorders (Mental retardation or Personality disorders) |
|
|
Term
|
Definition
| General Medical Conditions (e.g., Hypothyroidism) |
|
|
Term
|
Definition
| Psychosocial and environmental stressors (e.g., divorce, poverty) |
|
|
Term
|
Definition
| Global Assessment of Functioning (0-100) |
|
|
Term
| Categorical Approach in Classification |
|
Definition
Assumes Qualitative Difference (kind/type)
DSM-IV is Usually Considered a Categorical Classification |
|
|
Term
| Dimensional Approach in Classification |
|
Definition
| Assumes quantitative difference (degree) |
|
|
Term
|
Definition
| How comprehensively does the classification specify the domain of interest (PP)? |
|
|
Term
|
Definition
Study of mental disorders via science.
“The field of abnormal psychology” |
|
|
Term
|
Definition
Out of touch with reality
“Persistent hallucinations are an example of a psychotic state” |
|
|
Term
|
Definition
| A group/cluster of symptoms |
|
|
Term
|
Definition
Define abnormal based on experiencing distress.
Person has subjective discomfort which leads them to seek help.
Doesn’t make sense to define abnormal behavior based only on what the person exhibiting the behavior experiences. |
|
|
Term
|
Definition
Define “abnormal” based on deviation from a norm (standard).
Behavior that is not experienced by most/many people.
Example: Kevin’s psychotic beliefs. Other people typically don’t have such beliefs.
Note: requires that we define norm and deviation.
What deviation is still normal? Abnormal?
Definition might be useful for abnormal behavior that is very rare, i.e. very far from normal.
What about abnormal behavior that is quite common (alcoholism affects 1/10 men in U.S.)?
The more common an abnormal behavior, the more “normal” it becomes…
What if deviation isn’t harmful? Example intellectual genius is statistically rare (large deviation from the norm)….but not psychopathology. |
|
|
Term
|
Definition
given data, we want to find the "middle“ …to use as a "norm".
Three ways to define "middle"
Mean: arithmetic average = Sum(data)/ N
Median: midpoint, number for which half of data falls above it and half falls below it.
Mode: most frequent (common) value in the data |
|
|
Term
|
Definition
Dysfunction
Problem with some internal mechanism.
Mechanism could be physical (low dopamine) or mental (process that allows us to distinguish perception from imagination).
Harmful
Condition that causes some harm to the person…
…harm as defined by the standards of the person’s culture.
…harm in terms of experiencing distress and/or difficulty performing social or work-related tasks.
Doesn’t say anything about persistence. What if it is a dysfunction that is harmful for one day and never recurs?
A good idea, but not a system. Is it likely that this approach would lead to consistent diagnoses across therapists and clinics? |
|
|
Term
|
Definition
Study of frequency and distribution of disease/disorders within a population.
Frequency: how often does a disease occur?
Distribution: in what groups (gender, age, ethnic, geographic) is the disease more/less frequent? |
|
|
Term
|
Definition
| The number of new cases in a population within a period of time. |
|
|
Term
|
Definition
The total number of active cases in a population within a period of time.
Lifetime prevalence: total number of people affected at some point in their lives. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Anything can be explained by breaking it down into its parts |
|
|
Term
|
Definition
| Different levels (e.g. bio, social). |
|
|
Term
|
Definition
psychopathology requires two things:
1) Predisposition to develop disorder (diathesis)
2) A stress: predisposition→disorder |
|
|
Term
|
Definition
| Pattern of behavior that precedes disorder (e.g. extreme bullying behavior) |
|
|
Term
|
Definition
| Typical path that disorder follows |
|
|
Term
|
Definition
the same event can lead to different outcomes (e.g. abuse can lead to
very different outcomes in different children) |
|
|
Term
|
Definition
| a psychological disorder may have multiple causes; there are many routes to the same destination; multiple pathways=equifinality |
|
|
Term
|
Definition
| the direction of causality can be in both directions simultaneously (e.g., children behavior affect parents just as parents’ behavior influence children’s behavior). |
|
|
Term
|
Definition
can treatment work under prescribed situations.
internal validity |
|
|
Term
|
Definition
does the treatment work in the real world?
external validity |
|
|
Term
|
Definition
| How effective is the treatment in terms of relieving symptoms, etc? |
|
|
Term
|
Definition
| What aspects of the treatment are generating positive outcomes |
|
|
Term
|
Definition
| Recognizing a disorder based on its common symptoms. In other fields, it is often causal, the diagnosis is based on understanding “what’s wrong under the hood” – not yet for much of psychopathology |
|
|
Term
|
Definition
| conditions that must be present for a positive diagnosis |
|
|
Term
|
Definition
| conditions that, if present, rule out positive diagnosis |
|
|
Term
|
Definition
→ experimental methods
Use experimental method to do tests using the measures.
If results consistent with predictions, adds to validity of the “construct”.
If results not consistent with predictions, suggests construct may not be valid. |
|
|
Term
|
Definition
how useful is a diagnosis? What does it tell us?
how persuasively does the evidence support the classification in terms of it's meaningfulness and usefulness. |
|
|
Term
| validity: etiological (history) |
|
Definition
| Are the conditions leading up to this thing* we call “Disorder X” consistent? |
|
|
Term
| validity: concurrent (same time) |
|
Definition
| Does this thing* we call “Disorder X” consistently produce a common set of symptoms, behaviors, and test results |
|
|
Term
| validity: predictive (future) |
|
Definition
| Does this thing* we call “Disorder X” allow accurate/consistent prediction of the stability and outcome of a disorder? |
|
|
Term
|
Definition
→ are we consistent.
Are conditions measured consistently?
Are decisions made consistently by individual clinicians?
Are decisions made consistently across clinicians? |
|
|
Term
|
Definition
| therapist only looks for things that support their theory |
|
|
Term
|
Definition
| 1st person, subjective disorders |
|
|
Term
|
Definition
|
|
Term
|
Definition
| age/ stage at which disorder was caught |
|
|
Term
|
Definition
| How comprehensively does the classification specify the domain of interest (PP)? |
|
|
Term
|
Definition
| How precisely does the classification partition the domain of interest (PP)? |
|
|
Term
|
Definition
(Similar criteria among Personality disorders leads to multiple dxs)
Conceptions of pathology require revision |
|
|
Term
|
Definition
focus of N-Ks
How consistently can clinicians sort peoples problems into disorders appearing within the classification?
How often do we get the same and correct diagnosis? |
|
|
Term
|
Definition
| clinical judgement varies |
|
|
Term
|
Definition
| different tools were used in assesment |
|
|
Term
|
Definition
| patients differ from each other and patient differs from self on day to day basis |
|
|
Term
|
Definition
| the way in which data was collected (interview, video tape, etc) was different |
|
|
Term
|
Definition
| does the disorder include attributes and characteristics that have actually been observed (relevant signs and symptoms) |
|
|
Term
|
Definition
| Does the disorder (as conceived) correlate with other relevant variables |
|
|
Term
CRITERION VALIDITY
concurrent criterion validity |
|
Definition
| does the disorder correlate with concurrent variables (those which are present NOW)? |
|
|
Term
CRITERION VALIDITY
predictive criterion validity |
|
Definition
| does the disorder (as concieved) correlate with variables that will occur in the FUTURE? |
|
|
Term
|
Definition
| conceptual abstraction or postulated entity cast within a broader theoretical network |
|
|
Term
| Hypothetical constructs vs. intervening variables |
|
Definition
| (sexual arousal vs. vaginal congestion, intelligence vs. IQ) |
|
|
Term
|
Definition
| specification of measures for intervening variables used to investigate hypothetical constructs (e.g., penile plethysmograph) |
|
|
Term
|
Definition
| Extent to which specific measures produce results that are consistent with the theoretical construct |
|
|
Term
|
Definition
| scientific efforts to assess the construct validity of a given hypothetical construct |
|
|
