Summary Psychopathology & Psychodiagnostics PART I
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Course
Psychopathology & psychodiagnostics (202000352)
Institution
Universiteit Twente (UT)
Book
Psychopathology
Summary for the element psychopathology & psychodiagnostics, part of the module mental health at the University of Twente.
It only includes the theory for part I of the exam.
It includes three sources
- Book psychopathology by Davey (3rd edition). Chapter 1, 2.1, 7, 10 and 13
- Psycholog...
,Psychopathology (Davey)
Chapter 1: introducing psychopathology: concepts, procedures and practices
Psychopathology = the study of deviations from normal or everyday psychological or behavioral functioning.
However, just because someone’s behavior deviates from the normal, doesn’t mean they are suffering from
a mental or psychiatric illness.
Clinical psychology = the branch of psychology for understanding and treating psychopathology
1.1. A brief history of psychopathology
Throughout history labels as “mad”, “crazy” etc have been appointment to people who behave unpredictable,
irrational, harmful or when behavior deviates from the norm. Views about what causes “mad” behaviour
have changed a lot over the course of history. A historical perspective on psychopathology learns us how our
views have changed and how treatment has changed.
1.1.1. Demonic possession
= historical explanations of psychopathology such as “demonic possession” often alluded to the fact that the
individual had been possessed in some way.
Mostly whenever there is a mental illness present, someones personality will changes. Historically people
tended towards describing these exhibiting symptons (neglecting daily tasks, harming self and others,
changing in personality) as being “possessed” in some way. That is, their behaviour has changed in sych a
way that their personality appears to have been taken over and replaced by the persona of someone or
something else.
Demonology = many ancient civilizations (Egypt, China, Greece) believed that those exhibiting symptoms
of psychopathology were possessed by bad spirits – known as demonology. Exocism of these spirits went
through ceremonies etc. In Western society demonology was used till the 18th century, mostly using withcraft
and demonic possession as arguments. Demonic possession explanations are still used nowadays, for
example in third world countries.
1.1.2. The medical or disease model attempts to explain psychopathology in terms of underlying
biological or medical causes
As cultures develop, so does the understanding of diseases. Psychical diseases were more understood, as we
discovered the biological basis of this. Therefore, mental illnesses were better understood too and treated as
an illness, rather than “madness”.
General paresis = a brain disease occurring as a late consequence of syphilis, characterized by dementia,
progressive muscular weakness and paralysis. This understanding developed into
Somatogenic hypothesis = the hypothesis that the causes or explanations of psychological problems can be
found in physical or biological impairments.
The somatogenic hypothesis > led into the medical model of psychology. This was important because it
introduced scientific thinking into psychopathology.
Psychiatry = a scientific method of treatment that is based on medicine, the primary approach of which is to
identify the biological causes of psychopathology and to treat them with medication or surgery.
!! not all psychopathologies can be explained by biology. Nor is biological dysfunction a necessity for all
psychopathologies.
Psychodynamic and contemporary cognitive accounts of psychopathology argue that psychological problems
are a result of an individual aquiring dysfunctional characteristics. Is this sense its not the individual or any
part of their biology which is disfunctional, the experiences they’ve had were disfunctional.
!! the medical model attempts to reduce the complex psychological and emotional features of
psychopathology to simple biology. This is not always possible, because people are formed by experiences,
environmental factors, and personality etc.
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,!! the medical model is focused on “something is broken and needs fixed”. This view is changing too.
1.1.3. From asylums to community care
Asylums = in previous centuries asylums were hospices converted for the confinement of individuals with
mental health problems. Life was cruel in asylums and treatment was often crude and painful.
In the 19th century a gradual movement towards humane treatments starts. Philippe Pinel is considered to be
the first to introduce humane treatments.
Moral treatment = approach to the treatment of asylum inmates, developed by the Quaker movement in the
UK, which abandoned contemporary medical approaches in favor of understanding, hope, moral
responsibility and occupational therapy.
Social breakdown syndrome = confrontational and challenging behavior, aggression, and lack of interest in
personal welfare and hygiene coming from patients, as a result of being restrained a lot, because nurses did
not have enough knowledge to treat the mentally ill patients.
Milieu therapies = the first attempts to structure the hospital environment for patients, which attempted to
create a therapeutic community on the ward in order to develop productivity, independence, responsibility
and feelings of self-respect. Mutual respect between staff and patients is central here.
Token economy = a reward system which involved patients receiving tokens for engaging in certain behavior,
which at a later time can be exchanged for a variety of reinforcing or desired items. Based on operant
reinforcement. However the token economy has declined a lot for a few different reasons
- Legal and ethical issues. Patients always have the right for some basis needs, this cannot be earned
by tokens or anything.
- The effects of token community tend to disapper when patients go back to normal life.
- Token community are also considered to be non-effective, non-individual oriented, etc.
1.2. Defining psychopathology
How do we define what is a problem that should be considered suitable for support and treatment and what
is not? Psychopathology can’t base definitions on the existence of a psychological cause, unlike medicine for
example.
- Because often psychological problems don’t have underlying physical or biological causes
- Because the aetiology of psychopathologies is in its infant shoes, we are not yet in position to classify
psychopathologies on causal factors.
Abnormal psychology = an alternative definition of psychopathology, albeit with stigmatizing connotations
relating to not being normal.
Service user groups = groups of individuals who are end users of the mental health services provided by, for
example, government agencies.
When considering how to define psychopathology we must considered whether a definition is useful in the
scientific and professional sense, but also whether is provides a definition that will minimize stigma and
facilitate the support people need to function as inclusive members of society.
1.2.1. Deviation from the statistical norm
Statistical norm = the mean, average or modal example of a behaviour. In some areas this is used as a deciding
factor whether a particular disorder meets the diagnostic criteria. For example in IQ-testing. However, this
results in two problems
- Rather than forcing someone into a diagnostic categorie (for example in “mentally disabled” with
an IQ below 70), a better approach would be looking into individual characteristics and needs.
- Falling out of the average, doesn’t always mean “bad”, for example when someone has a high IQ.
These candidates might not need psychological care, even though they are not average.
The cut-off point between normal and abnormal is subjective judgement.
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, !! emotions such as anxiety or depression that underlie the most common mental health problems are not
statistically rare emotions. They are experienced almost daily by everyone.
1.2.2. Deviation from social and political norms
There is often a tendency within individual societies for members to label a behaviour or activity as an
indicator for psychopathology, if it is far from the social norm of that society. We often assume that socially
normal and acceptable behaviors have evolved to presenting adaptive ways of behaving and that someone
who deviates from this, is exhibiting psychopathology. However, using this way of thinking is very difficult
for defining psychopathology because of two reasons
- Different cultures often differ significantly in what they consider to be socially normal and
acceptable.
- It is difficult to use cultural norms to define psychopathology because cultural factors seem to
significantly affect how psychopathology manifests itself. For example
o Social and cultural factors will affect the vulnerability of an individual to causal factors
o Culture can produce culture bound symptoms of psychopathology which seem confined to
specific cultures and can influence how stress, anxiety and depression manifest itself (for
example Ataque de Nervious and Seizisman)
o Society or culture can influence the course of psychopathology – for example schizophrenia
in developing countries has a more favorable course and outcome than in developed
countries
1.2.3. Maladaptive behaviour and harmful dysfunction
It is often tempting to define psychopathology in terms of whether an individual is capable of adapting to
what most of us would consider normal daily living. In an extreme form, maladaptive behaviour can result
in someone harming himself or others. Current diagnostic criteria (including DSM-5) do use deficits in social,
occupational and educational functioning as a criteria for defining many psychological disorders.
- One problem; not all maladaptive behaviour, leads to a psychological disorder. For example; murder
is very maladaptive but not all murderers have a psychological disorder. Oh the other side a phobia
is maladaptive, but also functional in a sense because it “protects” from the phobic object such as
heights or spiders etc.
A similar approach is to assume that mental health problems can be defined as harmful dysfunction =
assumption that psychopathology is defined by the “dysfunction” of a normal process that has the
consequence of being in some way harmful. For example, hearing voices during episodes of psychosis may
be caused by the brains inability to turn of unwanted thoughts.
1.2.4. Distress and disability
One of the most common requirements of diagnosis is that the symptoms must cause clinically significant
distress or impairment in social, academic or occupational functioning. This is useful in a few ways
- It allows people to judge their own normality rather than subjecting them to judgements about their
normality made by others in society
- Defining psychopathology in terms of distress and impairment is independent of the type of lifestyle
chosen by the individual.
As attractive as this manner of defining psychopathology seems, it also has its challenges
- This approach does not provide any standards by which we should judge behaviour itself. For
example, hearing voices may not be distressful or impairing for someone, but it is also not normal.
- Psychopathology classification do include disorders in which diagnosis doesn’t require suffering.
For example in personality disorders.
1.3. Explanatory approaches to psychopathology
Explanations within different paradigms (such as genetically, biologically, behaviourally and
psychologically) are not mutually exclusive – they supplement each other and provide a fuller, richter
understanding of psychopathology.
1.3.1. Biological models attempt to explain psychopathology in terms of processes such as genetics
and brain structure and function
Genetics and neuroscience are the two most important biological paradigms.
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