Chapter One

Functioning as a Scientist-Practitioner.

1. consumer of science: enhancing the practice 2. evaluator of science: determining the effectiveness of the practice 3. creator of science: conducting research that leads to new procedures useful in practice

incidence

Number of new cases of a disorder appearing during a specific period (compare with prevalence).

What is Psychopathology?

Scientific study of psychological disorders.

Three major categories make up the study and discussion of psychological disorders.

clinical description, causation or etiology and treatment and outcome

3. Atypical or Not Culturally Expected

Finally, the criterion that the response be atypical or not culturally expected is important but also insufficient to determine abnormality by itself. At times, something is considered abnormal because it occurs infrequently; it deviates from the average. The greater the deviation, the more abnormal it is. You might say that someone is abnormally short or abnormally tall, meaning that the person's height deviates substantially from average, but this obviously isn't a definition of disorder. Many people are far from the average in their behavior, but few would be considered disordered. We might call them talented or eccentric. Many artists, movie stars, and athletes fall in this category. Therefore, "deviating from the average" doesn't work well as a definition for abnormal behavior. Another view is that your behavior is abnormal if you are violating social norms, even if a number of people are sympathetic to your point of view. This definition is useful in considering important cultural differences in psychological disorders. For example, to enter a trance state and believe you are possessed reflects a psychological disorder in most Western cultures but not in many other societies, where the behavior is accepted and expected An informative example of this view is provided by Robert Sapolsky (2002), the prominent neuroscientist who, during his studies, worked closely with the Masai people in East Africa. One day, Sapolsky's Masai friend Rhoda asked him to bring his vehicle as quickly as possible to the Masai village where a woman had been acting aggressively and had been hearing voices. The woman had actually killed a goat with her own hands. Sapolsky and several Masai were able to subdue her and transport her to a local health center. Realizing that this was an opportunity to learn more of the Masai's view of psychological disorders, Sapolsky had the following discussion: "So, Rhoda," I began laconically, "what do you suppose was wrong with that woman?" She looked at me as if I was mad. "She is crazy." "But how can you tell?" "She's crazy. Can't you just see from how she acts?" "But how do you decide that she is crazy? What did she do?" "She killed that goat." "Oh," I said with anthropological detachment, "but Masai kill goats all the time." She looked at me as if I were an idiot. "Only the men kill goats," she said. "Well, how else do you know that she is crazy?" "She hears voices." Again, I made a pain of myself. "Oh, but the Masai hear voices sometimes." (At ceremonies before long cattle drives, the Masai trance-dance and claim to hear voices.) And in one sentence, Rhoda summed up half of what anyone needs to know about cross-cultural psychiatry. "But she hears voices at the wrong time." (p. 138) A social standard of normal has been misused, however. Consider, for example, the practice of committing political dissidents to mental institutions because they protest the policies of their government, which was common in Iraq before the fall of Saddam Hussein and now occurs in Iran. Although such dissident behavior clearly violated social norms, it should not alone be cause for commitment.

course

Pattern of development and change of a disorder over time.

marriage and family therapists and mental health counselors

typically spend 1-2 years earning a master's degree and are employed to provide clinical services by hospitals or clinics, usually under the supervision of a doctoral-level clinician.

Psychiatric nurses

have advanced degrees, such as a master's or even a Ph.D., and specialize in the care and treatment of patients with psychological disorders, usually in hospitals as part of a treatment team.

What is the difference between the DSM IV AND DSM-5?

But one of the differences between DSM-IV and DSM-5 is the addition of dimensional estimates of the severity of specific disorders in DSM-5

clinical description

Details of the combination of behaviors, thoughts, and feelings of an individual that make up a particular disorder.

Story of Judy and The Girl Who Fainted at the Sight of Blood

Judy, a 16-year-old, was referred to our anxiety disorders clinic after increasing episodes of fainting. About 2 years earlier, in Judy's first biology class, the teacher had shown a movie of a frog dissection to illustrate various points about anatomy. This was a particularly graphic film, with vivid images of blood, tissue, and muscle. About halfway through, Judy felt a bit lightheaded and left the room. But the images did not leave her. She continued to be bothered by them and occasionally felt slightly queasy. She began to avoid situations in which she might see blood or injury. She stopped looking at magazines that might have gory pictures. She found it difficult to look at raw meat, or even Band-Aids, because they brought the feared images to mind. Eventually, anything her friends or parents said that evoked an image of blood or injury caused Judy to feel lightheaded. It got so bad that if one of her friends exclaimed, "Cut it out!" she felt faint. Beginning about 6 months before her visit to the clinic, Judy actually fainted when she unavoidably encountered something bloody. Her family physician could find nothing wrong with her, nor could several other physicians. By the time she was referred to our clinic she was fainting 5 to 10 times a week, often in class. Clearly, this was problematic for her and disruptive in school; each time Judy fainted, the other students flocked around her, trying to help, and class was interrupted. Because no one could find anything wrong with her, the principal finally concluded that she was being manipulative and suspended her from school, even though she was an honor student. Judy was suffering from what we now call blood-injection-injury phobia. Her reaction was quite severe, thereby meeting the criteria for phobia, a psychological disorder characterized by marked and persistent fear of an object or situation. But many people have similar reactions that are not as severe when they receive an injection or see someone who is injured, whether blood is visible or not. For people who react as severely as Judy, this phobia can be disabling. They may avoid certain careers, such as medicine or nursing, and, if they are so afraid of needles and injections that they avoid them even when they need them, they put their health at risk.

Scientist-Practitioner

Mental health professionals who are expected to apply scientific methods to their work. They must keep current in the latest research on diagnosis and treatment, they must evaluate their own methods for effectiveness, and they may generate their own research to discover new knowledge of disorders and their treatment. First, they may keep up with the latest scientific developments in their field and therefore use the most current diagnostic and treatment procedures. In this sense, they are consumers of the science of psychopathology to the advantage of their patients. Second, scientist-practitioners evaluate their own assessments or treatment procedures to see whether they work. They are accountable not only to their patients but also to the government agencies and insurance companies that pay for the treatments, so they must demonstrate clearly that their treatments work. Third, scientist-practitioners might conduct research, often in clinics or hospitals, that produces new information about disorders or their treatment, thus becoming immune to the fads that plague our field, often at the expense of patients and their families.

prevalence

Number of people displaying a disorder in the total population at any given time (compare with incidence).

presenting problem

Original complaint reported by the client to the therapist. The actual treated problem may sometimes be a modification derived from the presenting problem.

Psychiatrists

Psychiatrists first earn an M.D. degree in medical school and then specialize in psychiatry during residency training that lasts 3 to 4 years. Psychiatrists also investigate the nature and causes of psychological disorders, often from a biological point of view; make diagnoses; and offer treatments. Many psychiatrists emphasize drugs or other biological treatments, although most use psychosocial treatments as well.

What is a Psychological Disorder?

Psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response.

psychological disorder

Psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response.

1. Psychological Dysfunction

Psychological dysfunction refers to a breakdown in cognitive, emotional, or behavioral functioning. For example, if you are out on a date, it should be fun. But if you experience severe fear all evening and just want to go home, even though there is nothing to be afraid of, and the severe fear happens on every date, your emotions are not functioning properly. However, if all your friends agree that the person who asked you out is unpredictable and dangerous in some way, then it would not be dysfunctional for you to be fearful and avoid the date.

2. Personal distress or impairment

That the behavior must be associated with distress to be classified as abnormal adds an important component and seems clear: the criterion is satisfied if the individual is extremely upset. We can certainly say that Judy was distressed and even suffered with her phobia. But remember, by itself this criterion does not define abnormal behavior. It is often quite normal to be distressed—for example, if someone close to you dies. The human condition is such that suffering and distress are very much part of life. This is not likely to change. Furthermore, for some disorders, by definition, suffering and distress are absent

An Accepted Definition

The most widely accepted definition used in DSM-5 describes behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment. This definition can be useful across cultures and subcultures if we pay careful attention to what is functional or dysfunctional (or out of control) in a given society.

Prototype

a prototype, and, as described in Chapter 3, the diagnostic criteria from DSM-IV-TR as well as the emerging criteria for DSM-5 found throughout this book are all prototypes. This means that the patient may have only some features or symptoms of the disorder (a minimum number) and still meet criteria for the disorder because his or her set of symptoms is close to the prototype.

Clinical psychologists and counseling psychologists:

receive the Ph.D. degree (or sometimes an Ed.D., doctor of education, or Psy.D., doctor of psychology) and follow a course of graduate-level study lasting approximately 5 years, which prepares them to conduct research into the causes and treatment of psychological disorders and to diagnose, assess, and treat these disorders. Although there is a great deal of overlap, counseling psychologists tend to study and treat adjustment and vocational issues encountered by relatively healthy individuals, and clinical psychologists usually concentrate on more severe psychological disorders. Also, programs in professional schools of psychology, where the degree is often a Psy.D., focus on clinical training and de-emphasize or eliminate research training. In contrast, Ph.D. programs in universities integrate clinical and research training. Psychologists with other specialty training, such as experimental and social psychologists, concentrate on investigating the basic determinants of behavior but do not assess or treat psychological disorders.

Psychiatric social workers

typically earn a master's degree in social work as they develop expertise in collecting information relevant to the social and family situation of the individual with a psychological disorder. Social workers also treat disorders, often concentrating on family problems associated with them.