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Psychological Disorders

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Title: Psychological Disorders


1
Chapter 16
  • Psychological Disorders

2
What is Normal?
  • Psychopathology Scientific study of mental,
    emotional, and behavioral disorders
  • Subjective Discomfort Feelings of anxiety,
    depression, or emotional distress
  • Statistical Abnormality Having extreme scores on
    some dimension, such as intelligence, anxiety, or
    depression
  • Social Nonconformity Disobeying societal
    standards for normal conduct usually leads to
    destructive or self-destructive behavior

3
What is Normal? (cont.)
  • Situational Context Social situation, behavioral
    setting, or general circumstances in which an
    action takes place
  • Is it normal to walk around strangers naked? If
    you are in a locker room and in the shower area,
    yes!
  • Cultural Relativity Judgments are made relative
    to the values of ones culture

4
Fig. 16.1 The number of people displaying a
personal characteristic may help define what is
statistically abnormal. Social non-conformity
does not automatically indicate psychopathology.
5
Fig. 16.2 This MRI scan of a human brain (viewed
from the top) reveals a tumor (dark spot). Mental
disorders sometimes have organic causes of this
sort. However, in many instances no organic
damage can be found.

6
Clarifying and Defining Abnormal Behavior (Mental
Illness)
  • Maladaptive Behavior Behavior that makes it
    difficult to function, to adapt to the
    environment, and to meet everyday demands
  • Mental Disorder Significant impairment in
    psychological functioning
  • Those with mental illness lose the ability to
    adequately control thoughts, behaviors, or
    feelings

7
Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)
  • Psychotic Disorder Severe psychiatric disorder
    characterized by hallucinations and delusions,
    social withdrawal, and a move away from reality
  • Organic Mental Disorder Mental or emotional
    problem caused by brain pathology (i.e., brain
    injuries or diseases)
  • Substance Related Disorders Abuse or dependence
    on a mind- or mood-altering drug, like alcohol or
    cocaine
  • Person cannot stop using the substance and may
    suffer withdrawal symptoms if they do


8
Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)
  • Mood Disorder Disturbances in mood or emotions,
    like depression or mania
  • Anxiety Disorder Feelings of fear, apprehension,
    anxiety, and behavior distortions

9
Fig. 16.5 The Mad Hatter, from Lewis Carrolls
Alices Adventures in Wonderland. History
provides numerous examples of psychosis caused by
toxic chemicals. Carrolls Mad Hatter character
is modeled after an occupational disease of the
eighteenth and nineteenth centuries. In that era,
hatmakers were heavily exposed to mercury used in
the preparation of felt. Consequently, many
suffered brain damage and became psychotic, or
mad (Kety, 1979).
10
Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)
  • Somatoform Disorder Physical symptoms that mimic
    disease or injury (blindness, anesthesia) for
    which there is no identifiable physical cause
  • Dissociative Disorder Temporary amnesia,
    multiple identity, or depersonalization (like
    being in a dream world, feeling like a robot,
    feeling like you are outside of your body)
  • Personality Disorder Deeply ingrained,
    unhealthy, maladaptive personality patterns

11
Clarifying and Defining Abnormal Behavior (Mental
Illness) (cont.)
  • Sexual and Gender Identity Disorder Problems
    with sexual identity, deviant sexual behavior, or
    sexual adjustment
  • Neurosis Archaic once used to refer to anxiety,
    somatoform, and dissociative disorders, also used
    to refer to some kinds of depression

12
General Risk Factors for Contracting Mental
Illness
  • Social Conditions Poverty, homelessness,
    overcrowding, stressful living conditions
  • Family Factors Parents who are immature,
    mentally ill, abusive, or criminal poor child
    discipline severe marital or relationship
    problems
  • Psychological Factors Low intelligence, stress,
    learning disorders
  • Biological Factors Genetic defects or inherited
    vulnerabilities poor prenatal care, head
    injuries, exposure to toxins, chronic physical
    illness, or disability

13
Insanity
  • Definition A legal term refers to an inability
    to manage ones affairs or to be aware of the
    consequences of ones actions
  • Those judged insane (by a court of law) are not
    held legally accountable for their actions
  • Can be involuntarily committed to a psychiatric
    hospital
  • Some movements today are trying to abolish the
    insanity plea and defense desire to make
    everyone accountable for their actions
  • How accurate is the judgment of insanity?
  • Expert Witness Person recognized by a court of
    law as being qualified to give expert testimony
    on a specific topic
  • May be psychologist, psychiatrist, and so on

14
Personality Disorders Antisocial Personality
Disorder (APD)
  • Definition A person who lacks a conscience
    (superego?) typically emotionally shallow,
    impulsive, selfish, and manipulative toward
    others
  • Oftentimes called psychopaths or sociopaths
  • Many are delinquents or criminals, but many are
    NOT crazed murderers displayed on television
  • Create a good first impression and are often
    charming
  • Cheat their way through life (e.g., Dr. Michael
    Swango, Scott Peterson)

15
APD Causes and Treatments
  • Possible Causes
  • Childhood history of emotional deprivation,
    neglect, and physical abuse
  • Underarousal of the brain
  • Very difficult to effectively treat will likely
    lie, charm, and manipulate their way through
    therapy

16
Fig. 16.3 Using PET scans, Canadian psychologist
Robert Hare found that the normally functioning
brain (left) lights up with activity when a
person sees emotion-laden words such as maggot
or cancer. But the brain of a psychopath
(right) remains inactive, especially in areas
associated with feelings and self-control. When
Dr. Hare showed the bottom image to several
neurologists, one asked, Is this person from
Mars? (Images courtesy of Robert Hare.)

17
CNN Serial Killer Motives
18
Anxiety-Based Disorders
  • Anxiety Feelings of apprehension, dread, or
    uneasiness
  • Adjustment Disorders When ordinary stress causes
    emotional disturbance and pushes people beyond
    their ability to effectively cope
  • Usually suffer sleep disturbances, irritability,
    and depression
  • Examples Grief reactions, lengthy physical
    illness, unemployment

19
Anxiety-Based Disorders (cont.)
  • Generalized Anxiety Disorder (GAD) Duration of
    at least six months of chronic, unrealistic, or
    excessive anxiety
  • Free-Floating Anxiety Anxiety that is very
    general and persuasive

20
CNN Anxiety Disorders in Kids
21
Panic Disorders
  • Panic Disorder (without Agoraphobia) A chronic
    state of anxiety with brief moments of sudden,
    intense, unexpected panic (panic attack)
  • Panic Attack Feels like one is having a heart
    attack, going to die, or is going insane
  • Symptoms include vertigo, chest pain, choking,
    fear of losing control
  • Panic Disorder (with Agoraphobia) Panic attacks
    and sudden anxiety still occur, but with
    agoraphobia

22
Agoraphobia
  • Agoraphobia (with Panic Disorder) Intense,
    irrational fear that a panic attack will occur in
    a public place or in an unfamiliar situation
  • Intense fear of leaving the house or entering
    unfamiliar situations
  • Can be very crippling
  • Literally means fear of open places or market
    (agora)
  • Agoraphobia (without Panic Disorder) Fear that
    something extremely embarrassing will happen away
    from home or in an unfamiliar situation

23
Specific Phobias
  • Irrational, persistent fears, anxiety, and
    avoidance that focus on specific objects,
    activities, or situations
  • People with phobias realize that their fears are
    unreasonable and excessive, but they cannot
    control them

24
Social Phobia
  • Intense, irrational fear of being observed,
    evaluated, humiliated, or embarrassed by others
    (e.g., shyness, eating, or speaking in public)
  • Barbra Streisand, Woody Allen perhaps?

25
Obsessive-Compulsive Disorder (OCD)
  • Extreme preoccupation with certain thoughts and
    compulsive performance of certain behaviors
  • Obsession Recurring images or thoughts that a
    person cannot prevent
  • Cause anxiety and extreme discomfort
  • Enter into consciousness against the persons
    will
  • Most common Being dirty, wondering if you
    performed an action (turned off the stove), or
    violence (hit by a car)
  • Compulsion Irrational acts that person feels
    compelled to repeat against his/her will
  • Help to control anxiety created by obsessions
  • Checkers and cleaners

26
Stress Disorders
  • Occur when stresses outside range of normal human
    experience cause major emotional disturbance
  • Symptoms Reliving traumatic event repeatedly,
    avoiding stimuli associated with the event, and
    numbing of emotions
  • Acute Stress Disorder Psychological disturbance
    lasting up to one month following stresses from a
    traumatic event
  • Post Traumatic Stress Disorder (PTSD) Lasts more
    than one month after the traumatic event has
    occurred may last for years
  • Typically associated with combat and violent
    crimes (rape, assault, etc.)
  • Terrorist attacks on September 11th, 2001, likely
    led to an increase of PTSD

27
CNN Mental Health and Traumatic Events

28
CNN - Prostitution
29
Dissociative Disorders
  • Dissociative Amnesia Inability to recall ones
    name, address, or past
  • Dissociative Fugue Sudden travel away from home
    and confusion about personal identity

30
Dissociative Identity Disorder (DID)
  • Person has two or more distinct, separate
    identities or personality states previously
    known as Multiple Personality Disorder
  • Sybil or The Three Faces of Eve are good
    examples
  • Often begins with horrific childhood experiences
    (e.g., abuse, molestation, etc.)
  • Therapy often makes use of hypnosis
  • Goal Integrate and fuse identities into single,
    stable personality

31
Somatoform Disorders
  • Hypochondriasis Person is preoccupied with
    having a serious illness or disease
  • Interpret normal sensations and bodily signs as
    proof that they have a terrible disease
  • No physical disorder can be found
  • Somatization Disorder Person expresses anxieties
    through numerous physical complaints
  • Many doctors are consulted but no organic or
    physical causes are found

32
Somatoform Disorders (cont.)
  • Pain Disorder Pain that has no identifiable
    organic, physical cause
  • Appears to have psychological origin
  • Conversion Disorder Severe emotional conflicts
    are converted into physical symptoms or a
    physical disability
  • Caused by anxiety or emotional distress but not
    by physical causes


33
Fig. 16.4 (left) Glove anesthesia is a
conversion reaction involving loss of feeling in
areas of the hand that would be covered by a
glove (a). If the anesthesia were physically
caused, it would follow the pattern shown in (b).
(right) To test for organic paralysis of the arm,
an examiner can suddenly extend the arm,
stretching the muscles. A conversion reaction is
indicated if the arm pulls back involuntarily.
(Adapted from Weintraub, 1983.)

34
Theoretical Causes of Anxiety Disorders
Psychodynamic
  • Psychodynamic (Freud) Anxiety caused by
    conflicts among id, ego, and superego
  • Forbidden id impulses for sex or aggression are
    trying to break into consciousness and thus
    influence behavior person fears doing something
    crazy or forbidden
  • Superego creates guilt in response to these
    impulses
  • Ego gets overwhelmed and uses defense mechanisms
    to cope


35
Other Theoretical Causes of Anxiety Disorders
  • Humanistic Unrealistic self-image conflicts with
    real self-image
  • Existential Anxiety reflects loss of meaning in
    ones life
  • Behavioristic Anxiety symptoms and behaviors are
    learned, like everything else
  • Conditioned emotional responses that generalize
    to new situations

36
More Theoretical Causes of Anxiety Disorders
  • Avoidance Learning When making a particular
    response delays or prevents the onset of a
    painful or unpleasant stimulus
  • Anxiety Reduction Hypothesis When reward of
    immediate relief from anxiety perpetuates
    self-defeating avoidance behaviors
  • Cognitive When distorted thinking causes people
    to magnify ordinary threats and failures, leading
    to anxiety and distress

37
Psychosis and Hallucinations
  • Psychosis Loss of contact with shared views of
    reality
  • Delusions False beliefs that individuals insist
    are true, regardless of overwhelming evidence
    against them
  • Hallucinations Imaginary sensations, such as
    seeing, hearing, or smelling things that do not
    exist in the real world
  • Most common psychotic hallucination is hearing
    voices
  • Note that olfactory hallucinations sometimes
    occur with seizure disorder (epilepsy)

38
Some More Psychotic Symptoms
  • Flat Affect Lack of emotional responsiveness
    face is frozen in blank expression
  • Disturbed Verbal Communication Garbled and
    chaotic speech word salad
  • Personality Disintegration When an individuals
    thoughts, actions, and emotions are uncoordinated

39
Other Psychotic Disorders
  • Organic Psychosis Psychosis caused by brain
    injury or disease
  • Dementia Most common organic psychosis serious
    mental impairment in old age caused by brain
    deterioration
  • Archaically known as senility
  • Alzheimers Disease Symptoms include impaired
    memory, confusion, and progressive loss of mental
    abilities
  • Ronald Reagan most famous Alzheimers victim

40
Delusional Disorders
  • Marked by presence of deeply held false beliefs
    (delusions)
  • May involve delusions of grandeur, persecution,
    jealousy, or somatic delusions
  • Experiences could really occur!
  • Paranoid Psychosis Most common delusional
    disorder
  • Centers on delusions of persecution

41
Schizophrenia The Most Severe Mental Illness
  • Psychotic disorder characterized by
    hallucinations, delusions, apathy, thinking
    abnormalities, and split between thoughts and
    emotions
  • Does NOT refer to having split or multiple
    personalities


42
The Four Subtypes of Schizophrenia
  • Disorganized (Hebephrenic) Type Incoherence,
    grossly disorganized behavior, bizarre thinking,
    and flat or inappropriate emotions
  • Catatonic Type Marked by stupor,
    unresponsiveness, posturing, and mutism
  • Paranoid Type Preoccupation with delusions also
    involves auditory hallucinations that are related
    to a single theme, especially grandeur or
    persecution
  • Undifferentiated Type Any type of schizophrenia
    that does not have specific paranoid, catatonic,
    or disorganized features or symptoms

43
Causes of Schizophrenia
  • Psychological Trauma Psychological injury or
    shock, often caused by violence, abuse, or
    neglect
  • Disturbed Family Environment Stressful or
    unhealthy family relationships, communication
    patterns, and emotional atmosphere
  • Deviant Communication Patterns Cause guilt,
    anxiety, anger, confusion, and turmoil

44
Fig. 16.6 Over a period of years, Theodore
Kaczynski mailed bombs to unsuspecting victims,
many of whom were maimed or killed. As a young
adult, Kaczynski was a brilliant mathematician.
At the time of his arrest, he had become the
Unabombera reclusive loner who deeply
mistrusted other people and modern technology.
After his arrest, Kaczynski was judged to be
suffering from paranoid schizophrenia.

45
Biochemical Causes of Schizophrenia
  • Biochemical Abnormality Disturbance in brains
    chemical systems or in the brains
    neurotransmitters
  • Dopamine Neurotransmitter involved with emotions
    and muscle movement
  • Works in limbic system
  • Dopamine overactivity in brain may be related to
    schizophrenia


46
Fig. 16.7 Lifetime risk of developing
schizophrenia is associated with how closely a
person is genetically related to a schizophrenic
person. A shared environment also increases the
risk. (Estimates from Lenzenweger Gottesman,
1994.)
47
Fig. 16.8 Dopamine normally crosses the synapse
between two neurons, activating the second cell.
Antipsychotic drugs bind to the same receptor
sites as dopamine does, blocking its action. In
people suffering from schizophrenia, a reduction
in dopamine activity can quiet a persons
agitation and psychotic symptoms.
48
Schizophrenic Brain
  • Computed Tomography (CT) Scan Computer enhanced
    X-ray of brain or body
  • Magnetic Resonance Imaging (MRI) Scan Computer
    enhanced three-dimensional image of brain or
    body based on magnetic field
  • MRIs show schizophrenic brains as having enlarged
    ventricles
  • Positron Emission Tomography (PET) Scan
    Computer-generated color image of brain activity
    radioactive sugar solution is injected into a
    vein, eventually reaching the brain
  • Activity is abnormally low in frontal lobes of
    schizophrenics

49
Fig. 16.9 (left) CT scan of would-be presidential
assassin John Hinkley, Jr., taken when he was 25.
The X-ray image shows widened fissures in the
wrinkled surface of Hinkleys brain. (right) CT
scan of a normal 25-year-olds brain. In most
young adults the surface folds of the brain are
pressed together too tightly to be seen. As a
person ages, surface folds of the brain normally
become more visible. Pronounced brain fissuring
in young adults may be a sign of schizophrenia,
chronic alcoholism, or other problems.
50
Fig. 16.10 Positron emission tomography produces
PET scans of the human brain. In the scans shown
here, red, pink, and orange indicate lower levels
of brain activity white and blue indicate higher
activity levels. Notice that activity in the
schizophrenic brain is quite low in the frontal
lobes (top area of each scan) (Velakoulis
Pantelis, 1996). Activity in the manic-depressive
brain is low in the left brain hemisphere and
high in the right brain hemisphere. The reverse
is more often true of the schizophrenic brain.
Researchers are trying to identify consistent
patterns like these to aid diagnosis of mental
disorders.
51
Stress-Vulnerability Model
  • Stress-Vulnerability Hypothesis Combination of
    environmental stress and inherited susceptibility
    cause schizophrenic disorders

52
Fig. 16.11 Various combinations of vulnerability
and stress may produce psychological problems.
The top bar shows low vulnerability and low
stress. The result? No problem. The same is true
of the next bar down, where low vulnerability is
combined with moderate stress. Even high
vulnerability (third bar) may not lead to
problems if stress levels remain low. However,
when high vulnerability combines with moderate or
high stress (bottom two bars) the person crosses
the line and suffers from psychopathology.
53
Mood Disorders
  • Major disturbances in emotion, such as depression
    or mania
  • Depressive Disorders Sadness or despondency are
    prolonged, exaggerated, or unreasonable
  • Bipolar Disorders Involve both depression and
    mania or hypomania
  • Dysthymic Disorder Moderate depression that
    lasts for at least two years
  • Cyclothymic Disorder Moderate manic and
    depressive behavior that lasts for at least two
    years

54
Dysthymic Disorder
  • A. Depressed mood for most of the day, more days
    than not, as indicated by subjective account or
    observation by others, for at least 2 years

55
Dysthymic Disorder
  • B. Presence, while depressed, of two or more of
    the following
  • poor appetite or overeating
  • insomnia or hypersomnia
  • low energy or fatigue
  • low self esteem
  • poor concentration or difficulty making
    decisions
  • feelings of hopelessness

56
Dysthymic Disorder
  • C. During the 2-year period, the person has
    never been without the symptoms in Criteria A or
    B form more than 2 months at a time
  • D. NO Major Depressive Episode has been present
    during the first 2 years of the disturbance (not
    accounted for by something else

57
Major Mood Disorders
  • Lasting extremes of mood or emotion and sometimes
    with psychotic features (hallucinations,
    delusions)
  • Major Depressive Disorder A mood disorder where
    the person has suffered one or more intense
    episodes of depression one of the more serious
    mood disorders
  • Bipolar I Disorder Extreme mania and deep
    depression one type of manic-depressive illness
  • Mania Excited, hyperactive, energetic, grandiose
    behavior
  • Bipolar II Disorder Person is mainly sad but has
    one or more hypomanic episodes (mild mania)

58
Major Depressive Disorder
  • A. Five or more of the following symptoms have
    been present during the same 2 week period and
    represent a change from previous functioning at
    least one symptom is either 1) depressed mood or
    2) loss of interest or pleasure

59
Major Depressive Disorder
  • depressed mood most of the day, nearly every day
  • Markedly diminished interest or pleasure in all,
    or almost all, activities most of the day, nearly
    every day
  • Significant weight loss or weight gain, or
    significant decrease or increase in appetite
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every
    day (as observed by others)
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or
    inappropriate guilt
  • Diminished ability to think or concentrate or
    indecisiveness
  • Recurrent thoughts of death or suicidal ideation

60
Major Depressive Disorder
  • B. Dont meet criteria for a Mixed Episode
  • C. The symptoms cause clinically significant
    distress or impairment in social, occupational or
    other important areas of functioning.
  • D. The symptoms arent due to substance abuse
  • E. The symptoms are not better accounted for by
    bereavement, persist longer than 2 months. . .

61
Bi-Polar I
  • Clinical occurrence of 1 or more manic episodes,
    or Mixed Episodes, and often one or more Major
    Depressive episode

62
Manic Episode
  • A. A distinct period of abnormally and
    persistently elevated, expansive or irritable
    mood lasting at least one weekor requiring
    hospitalization
  • B. During the period of mood disturbance, 3 or
    more of the following symptoms have persisted (4
    if the mood is only irritable) and been present
    to a significant degree

63
Manic Symptoms
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressure to keep
    talking
  • Flight of ideas or subjective experience that
    thoughts are racing
  • Distractibility
  • Increase in goal directed activity
  • Excessive involvement in pleasurable activities
    that have a high potential for painful consquences

64
Major Mood Disorders (cont.)
  • Endogenous Depression Depression that seems to
    be produced from inside the body (due to chemical
    imbalances) and NOT from life events
  • Seasonal Affective Disorder (SAD) Depression
    that only occurs during fall and winter
  • May be related to reduced exposure to sunlight
  • Phototherapy Extended exposure to bright light
    to treat SAD

65
Maternity Blues
  • Maternity Blues Mild depression that lasts for
    one to two days after childbirth
  • Marked by crying, fitful sleep, tension, anger,
    and irritability
  • Brief and not too severe


66
Postpartum Depression
  • Postpartum Depression Moderately severe
    depression that begins within three months
    following childbirth
  • Marked by mood swings, despondency, feelings of
    inadequacy, and an inability to cope with the new
    baby
  • May last from two months to one year
  • Part of the problem may be hormonal

67
Fig. 16.12 Seasonal affective disorder appears to
be related to reduced exposure to daylight during
the winter. SAD affects 1 to 2 percent of
Floridas population, about 6 percent of the
people living in Maryland and New York City, and
nearly 10 percent of the residents of New
Hampshire and Alaska (Booker Hellekson, 1992).
68
Fig. 16.13 An hour or more of bright light a day
can dramatically reduce the symptoms of seasonal
affective disorder. Treatment is usually
necessary from fall through spring. Light therapy
typically works best when it is used early in the
morning (Lewy et al., 1998).

69
Therapeutic Interventions
  • Psychotherapy Any psychological treatment for
    behavioral or emotional problems
  • Typically involves two people talking about ones
    personal problems
  • Medical Therapies Drug therapy, hospitalization,
    or psychosurgery

70
Fig. 16.14 At least one schizophrenic patient in
four had completely recovered 10 years after
being diagnosed. Three out of four had improved.
New treatments for schizophrenia and other major
mental disorders may improve these odds.
(Source FDA Consumer, 1993.)

71
Suicide Major Risk Factors
  • Drug or alcohol abuse
  • Prior suicide attempt
  • Depression or other mood disorder
  • Availability of a firearm
  • Severe anxiety or panic attacks
  • Family history of suicidal behavior
  • Shame, humiliation, failure or rejection

72
Fig. 16.15 Adolescent suicide rates vary for
different racial and ethnic groups. Higher rates
occur among whites than among non-whites. White
male adolescents run the highest risk of suicide.
Considering gender alone, it is apparent that
more male than female adolescents commit suicide.
This is the same as the pattern observed for
adults.
73
CNN Suicidal Tendencies
74
Common Characteristics of Suicidal Thoughts and
Feelings (Shneidman)
  • Escape
  • Unbearable Psychological Pain Emotional pain
    that the person wishes to escape
  • Frustrated Psychological Needs Such as searching
    for love, achievement, or security
  • Constriction of Options Feeling helpless and
    hopeless and deciding that death is the only
    option left

75
Fig. 16.16 Suicidal behavior usually progresses
from suicidal thoughts, to threats, to attempts.
A person is unlikely to make an attempt without
first making threats. Thus, suicide threats
should be taken seriously (Garland Zigler,
1993).
76
Insanity
  • Insanity Defense Person was incapable of knowing
    right from wrong while committing a crime
  • MNaghten Rule Standard for judging legal
    insanity in English common law
  • Must understand wrongfulness of actions to be
    held responsible for them
  • If suffering from mental disease preventing
    person from knowing right from wrong, can be
    deemed insane
  • Taking of a life due to insanity is not murder
  • Irresistible Impulse Uncontrollable urge to act
  • Diminished Capacity Temporary loss of ability to
    control actions or to know right from wrong
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