Transcript ppt. version - rci.rutgers.edu

SOPRANOS
• BEHAVIORS VIEWED AS DISEASES
• CHANGE OVER TIME FROM ROWDY
TO SICK
• CONFLICT WITH MUCH LAY
CULTURE
• RISE OF M.H. PROFESSIONALS
• TREATMENT NOT PUNISHMENT
WHY WANT DEFINITION OF
MENTAL ILLNESS?
• DISTINGUISH FROM NORMAL
• INDICATE NEED FOR MENTAL
HEALTH TREATMENT
• WHAT CONDITIONS SHOULD BE
REIMBURSED?
• DETERMINE CRIMINAL LIABILITY PUNISH OR TREAT?
DSM-IV DEFINITION (1)
• “MENTAL DISORDER IS A
CLINICALLY SIGNIFICANT
BEHAVIORAL OR PSYCHOLOGICAL
PATTERN THAT IS ASSOCIATED WITH
PRESENT DISTRESS OR DISABILITY.”
DISTRESS OR DISABILITY
• MUST HAVE EITHER DISTRESS
(MENTAL PAIN) OR DISABILITY (LOSS
OF FUNCTIONING)
• EITHER MUST REALLY BOTHER
PEOPLE - E.G. THINK LEFT STOVE ON
• OR HAVE NEGATIVE IMPACT ON
THEIR LIVES - E.G. ASPD
DSM (2)
• “IN ADDITION, THIS PATTERN MUST
NOT BE MERELY AN EXPECTABLE
AND CULTURALLY SANCTIONED
RESPONSE TO A PARTICULAR EVENT,
FOR EXAMPLE, THE DEATH OF A
LOVED ONE.”
NOT EXPECTABLE RESPONSE
•
•
•
•
•
BEREAVEMENT EXCLUSION
SYMPTOMS ARE NORMAL
ROMANTIC BREAKUPS
SOLDIER ENTERING COMBAT
SYMPTOMS THEMSELVES ARE NOT
SUFFICIENT
• MUST KNOW CONTEXT
DSM (3)
• “WHATEVER ITS ORIGINAL CAUSE, IT
MUST CURRENTLY BE A
BEHAVIORAL, PSYCHOLOGICAL, OR
BIOLOGICAL DYSFUNCTION IN THE
INDIVIDUAL.”
INTERNAL DYSFUNCTION
• SOME PSYCHOLOGICAL SYSTEM
(MOOD, FEAR, THOUGHT, EMOTION,
ETC.) IS NOT FUNCTIONING
APPROPRIATELY - SOMETHING HAS
GONE WRONG
• MANY CAUSES – BIOLOGICAL,
PSYCH., SOCIAL – OF M.I.
DSM (4)
• “NEITHER DEVIANT BEHAVIOR (E.G.
POLITICAL, RELIGIOUS, OR SEXUAL)
NOR CONFLICTS BETWEEN THE
INDIVIDUAL AND SOCIETY ARE
MENTAL DISORDERS UNLESS THE
DEVIANCE OR CONFLICT IS A
SYMPTOM OF A DYSFUNCTION IN
THE INDIVIDUAL.”
MENTAL DISORDER IS NOT
DEVIANCE
• DEVIANCE IS VIOLATION OF MORAL
STANDARDS OR SOCIAL NORMS BAD BEHAVIOR
• PEOPLE WHO DRINK TOO MUCH,
TAKE WRONG KIND OF DRUGS, OR
STEAL, CHEAT, AND LIE NEED NOT
BE MENTALLY ILL
• DEVIANCE IS A CHOICE
DEVIANCE OR M.I.?
• ONLY MENTAL DISORDER WHEN
SOME MECHANISM IS UNABLE TO
FUNCTION AS IT IS SUPPOSED TO
• ALCOHOLIC OR ADDICT WHO CAN’T
STOP DRINKING OR TAKING DRUGS
• NOT JUST DEFIANCE OF RULES
• VERY DIFFICULT TO DISTINGUISH
SUMMARY
• MENTAL DISORDER IS HARMFUL
INTERNAL DYSFUNCTION
• CAUSES CAN BE PSYCHOLOGICAL,
BIOLOGICAL, OR SOCIAL
• DISTINGUISH FROM EXPECTABLE
RESPONSES TO STRESSORS AND
FROM SOCIAL DEVIANCE
MAJOR PROBLEM
• DSM DEFINITION OF MENTAL
DISORDER IS GOOD
• DSM AND SURVEYS BASED ON IT DO
NOT APPLY THE DEFINITION IN
PRACTICE
• VIEW ALL SYMPTOMS AS INDICATING
DISORDER
PSYCHOSES
• MOST SEVERE KIND OF M.I.
• SCHIZOPHRENIA
• BI-POLAR (MANIC DEPRESSION)
SCHIZOPHRENIA
• PERHAPS MOST IMPORTANT MENTAL
ILLNESS
• CREATES STEREOTYPE OF MENTAL
ILLNESS - CRAZY, NUTS, BIZARRE
IMPORTANCE
• MOST ADMISSIONS AND RESIDENTS
OF PUBLIC MENTAL HOSPITALS
• CHRONICITY AND SEVERITY MEAN
COSTLY AND DIFFICULT TO TREAT
• PUBLIC POLICY - HOMELESSNESS,
NOTORIOUS CRIMES
• TREMENDOUS FAMILY BURDEN
SYMPTOMS
• THOUGHT DISORDER
• POSITIVE SYMPTOMS
• THOUGHT INSERTION AND
BROADCAST
• LOOSE ASSOCIATION
• HALLUCINATIONS - AUDITORY
• DELUSIONS - PARANOIA,
GRANDIOSITY