Psychopathology: the thin line that separates sanity from madness

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Psychopathology the thin line that separates
sanity from madness

• To study the abnormal is the best way of knowing
  the normal W. James

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Fun to hear about uncommon disorders

• Limbic psychotic trigger reactions
• Sudden brain seizure triggered by harmless sight
  or sound causes some men to fly into violent rage
• 18 cases (14 murders) quiet, unassuming loners
  suddenly erupt into violence, only to just as
  suddenly recoil in horror at their actions,
  gripped by remorse!
• BUT

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Historical Roots

• Caused by evil spirits
• Need an opening to escape
• Witchcraft, demonic possession, full moon,
  supernatural forces
• Exorcism, torture, primitive surgery,
  bloodletting, bitter poisons, starvation,
  noise-making
• Today Medical perspective Psychological
  perspective

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Debate

• Biological conditions
• vs.
• Past present life experiences (natural
  disasters to abuse, divorce, illness, etc.)
• Psychoanalytic
• Parental influences, unconscious, defense
  mechanisms
• Behaviorial CB
• Reward, punishment perceptions, expectations,
  beliefs
• AND
• Diathesis-Stress Model

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Pibloktoq

• Intense excitement, seizures, then coma.
• Tear off clothing, break furniture, shout
  obscenities, eat feces later forget

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Diagnosis A Necessary Step

• DSM-IV Disorders (well discuss)
• Anxiety- GAD, Panic, phobias, OCD, PTSD
• Somatoform- Hypochondriasis, conversion
• Dissociative- Amnesia, fugue, DID
• Mood- Depression, mania, bipolar
• Schizophrenic- Paranoid, Disorganized, Catatonic,
  Undifferentiated, Residual
• Personality- borderline, antisocial

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Whos crazy here anyway?

• However much we may be personally convinced that
  we can tell the normal from the abnormal, the
  evidence is simply not compelling

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Rosenhan, 1973 On being Sane in Insane Places

• Hollow, Empty, Thud
• Described true life histories, relationships,
  etc.
• Ceased any symptoms, tried to convince staff of
  sanity to be discharged (BY THEIR OWN DEVICES)
• How many were identified as SANE?
• How long did it take

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• had a close relationship with his mother but
  was rather remote from his father during his
  early childhood. During adolescence and beyond
  however his father became a close friend while
  his relationship with his mother cooled. His
  relationship with his wife was characteristically
  close and warm. Apart from occasional angry
  exchanges, friction was minimal, the children had
  rarely been spanked.

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• 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.

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Role of Expectations

• 7 Schizophrenic diagnoses 1 bipolar
• Im fine, no longer experiencing any symptoms
• Pseudopatients behavior caused by situation
  (e.g. boredom, hunger)
• Interpreted by staff as reflecting
  psychopathology

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• Length of stay 7-52 days!
• No one detected
• EXCEPT

Situation???

• Diagnoses are often not reliable or useful
• Sane needlessly stigmatized / feigned insanity
  excused

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Line between

• Mental health professionals determine (judge)
  where on the continuum behavior lies
• Which criteria to use?
• Bizarreness of Behavior
• Persistence of Behavior
• Social Deviance
• Subjective Distress
• Psychological Handicap
• Effect on Functioning

Normal Abnormal
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Beware!

• Medical Students Disorder is prevalent among
  psych students
• Psychological disorders are just exaggerations of
  tendencies that all of us have
• Being sad, anxious, or proud does not mean we are
  suffering from depression, narcissism, anxiety
  disorder or schizophrenia

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Detailed Examples

• Anxiety- OCD
• Somatoform- Hypochondriasis
• Dissociative- DID
• Mood- Depression
• Schizophrenic- Schizophrenia
• Personality- borderline, antisocial

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1. OCD

• Recurrent, intrusive, unwanted thoughts and
  compulsive actions
• One boy washed hands so much they became raw
  bloodied
• One boy ran up and down the stairs 63 times/ day
• Woman determined to keep eyebrows symmetric,
  plucked them all out
• Woman spent 8hrs/ day bathing
• Man couldnt leave subway without picking up all
  litter
• Mans apartment stacked to ceiling with dishes,
  dirty clothes, collected objects he couldnt
  throw away
• MENTALLY NEUTRALIZE unacceptable thoughts and
  behaviors
• Treatment refocusing to unlock the area
  stuck in its pattern. Label refocus to
  constructive activity

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Obsessions Compulsions

• Dirt, germs, contamination 55
• Aggressive impulses 50
• Need for symmetry 37
• Bodily concerns 35
• Forbidden sexual impulses 32
• Checking 79
• Washing 58
• Counting 21

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2. Hypochondriasis

• Guess who?
• Complained of dizzy spells, numbness in
  fingertips, nausea, indigestion, chest pains, and
  other assorted ailments
• Chronic, unwarranted preoccupation w/ ones
  physical health. Highly sensitive to NORMAL
  bodily sensations
• The whole day was planned out to suit him, to
  be ready for reading aloud to him, to go on his
  walks with him, and to be constantly at hand to
  alleviate his daily discomforts

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Place your foot in this ice water

• Until cant tolerate it
• Heart rate
• Temperature
• Rate unpleasantness

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Heightened Sensitivity

• Hypochondriacs
• Removed their foot sooner
• Rated cold as more unpleasant
• Showed more physiological reactivity to
  stimulation

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3. Dissociative Identity Disorder

• Learn to cope with trauma by mentally divorcing
  part of self from pain suffering
• Construct alternative identities in which to live
• 9X more prevalent in women
• 88 victims of sexual abuse
• Ea. May have own voice, speech pattern, habits,
  memories, sexual orientation, clothing,
  handwriting, brain-wave, BP, eyeglass
  prescription, rxns

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Skeptical?

• 1817-1970 lt 200 cases
• Faking for personal gain? Undetected
• Therapists now more sensitive?
• Therapists overdiagnose OR suggest reinforce
• Billy Milligan

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4. Depression The common cold

• Universal 2x women 12-21 will experience
• Emotional, Cognitive, Motivational and Somatic
  symptoms without discernible cause, gt2 wks
• Profound sadness
• Diminished interest in food, sex, social banter
• Intense worthlessness, guilt, self-blame
• Restlessness, agitation
• Depleted energy
• Recurring thoughts of suicide death

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A cause?

• Power control
• Action consequence
• Imagine feeling unable to have an effect on life
  events
• If expect bad things to happen over which you
  have little control
• Feel hopeless about making positive changes in
  your life

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Learned Helplessness in Humans

• More likely to become depressed if attribute
  failure to
• INTERNAL Its my fault
• STABLE It wont change
• GLOBAL It affects my whole life
• Expectation one cannot control important life
  outcomes pessimism, hopelessness, despair

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Explanatory Styles and Depression

• First-year college
• Two years later, ps w/ negative style (internal,
  stable, and global) were more likely to
  experience a major or minor depressive disorder.

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5. Schizophrenia

• I wish you a happy, joyful, healthy and fruitful
  year, and many good wine years to come as well as
  a healthy and good apple year, and sauerkraut and
  cabbage and squash and seed year
• To E. Bleuler, 1911
• Note Split mind split between thoughts,
  perceptions, behaviors, emotions and other brain
  functions (NOT Selves)

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I felt like I was the only sane person in a
world gone crazy

• Incoherent thinking/ word salad
• Delusions- influence- thoughts being broadcast
  in public, stolen, controlled also reference,
  persecution, grandeur.
• Hallucinations- sensations w/out stimulation
  (e.g. Son of Sams barking dog)
• Disturbance of affect- flattened/ inappropriate
• Bizarre behavior- withdrawal, exile, self-talk,
  statue poses, backwards, circles, lack
  self-insight

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Next time treatment
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Charles Manson
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Reactions of People with Social Phobias I

• Social Phobia
• An intense fear of situations that invite public
  scrutiny
• Socially phobic and non-phobic adults prepared a
  speech.
• Both groups showed increased heart rate in
  anticipation of the speech.

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Anxiety Disorders Reactions of People with
Social Phobias II

• However, only those with social phobia reported
  feeling more anxious.