Psych 102, Week 11

Dancing Mania

-Between the 11th and 17th centuries, a curious epidemic swept across Western Europe. -Groups of people would suddenly begin to dance with wild abandon. This compulsion to dance—referred to as dancing mania—sometimes gripped thousands of people at a time. -Historical accounts indicate that those afflicted would sometimes dance with bruised and bloody feet for days or weeks, screaming of terrible visions and begging priests and monks to save their souls (Waller, 2009b). -What caused dancing mania is not known, but several explanations have been proposed, including spider venom and ergot poisoning.

Comorbitity in the DSM-5

-Comorbidity is the co-occurrence of two disorders -The DSM-5 mentions that 41% of people with OCD also meet the diagnostic criteria for major depressive disorder -Drug use is highly comorbid with other mental illnesses -6 out of 10 people who have a substance use disorder also suffer from another form of mental illnesss

Maladaptivity

-Focuses on counter-productive behaviour -Harmful/dysfunctional behaviour for the individual in question

Subjective abnormality and/or discomfort

-Harmful Dysfunction -Define abnormality when one is actually in a state of discomfort.. either to the "abnormal individuals" or to OTHERS

When was madness considered a mental illness according to Foucalt

-It wasn't until the 19th century that madness was considered as a mental illness. Foucault argues that this medicalization of madness introduced treatment practices that were just as cruel e.g: treatment with cold water, tie up individual, segregation = common practices for treating madness

DSM 1 and 2 is based on what

based on psychodynamic concepts

Structural Stigma

"the policies and practices of institutions in positions of power, that systematically restrict the rights and opportunities for people living with mental illnesses"

Why Stigma matters

- The negative effects of stigma can outweigh the negative effects of the mental disorder itself (see Hinshaw & Stier, 2008). -Stigma by health care professionals results in poorer treatment and worse treatment outcomes. -It can also lead to decreases in help seeking (see Clement et al, 2015). -In fact, stigma is considered to be the foremost barrier to mental health care (see Lam & Sun, 2014). -When a person thinks they are interacting with someone who has a mental illness, they "behave in a wary and even punitive fashion". -Property owners are not likely to rent to a person they think has a mental illness or history of mental illness. -Employers avoid hiring individuals with a history of mental illness.

Significant disturbances in thoughts, feelings, and behaviours.

-A person must experience inner states (e.g., thoughts and/or feelings) and exhibit behaviours that are clearly disturbed - unusual, but in a negative, self-defeating way -Often, such disturbances and troubling to those around the individual who experiences them -For example, an individual who is uncontrollably preoccupied by thoughts of germs spends hours each day bathing, has inner experiences, and displays behaviours that most would consider atypical and negative (disturbed) and that would likely be troubling to family members.

The disturbances lead to significant distress or disability in one's life.

-A person's inner experiences and behaviors are considered to reflect a psychological disorder if they cause the person considerable distress, or greatly impair his ability to function as a normal individual (often referred to as functional impairment, or occupational and social impairment). -As an illustration, a person's fear of social situations might be so distressing that it causes the person to avoid all social situations (e.g., preventing that person from being able to attend class or apply for a job).

International Classification of Diseases (ICD)

-A second classification system, the International Classification of Diseases (ICD), is also widely recognized. -Outside of N.A, this is the alternative. -Published by the World Health Organization (WHO), the ICD was developed in Europe shortly after World War II and, like the DSM, has been revised several times. -The categories of psychological disorders in both the DSM and ICD are similar, as are the criteria for specific disorders; however, some differences exist. Leaves out some categories of the DSM because they suspect/believe they are prone to benefitting the psycho-pharmaceutical companies that were involved in creating some of the categories -Although the ICD is used for clinical purposes, this tool is also used to examine the general health of populations and to monitor the prevalence of diseases and other health problems internationally (WHO, 2013). -The ICD is in its 10th edition (ICD-10); however, efforts are now underway to develop a new edition (ICD-11) that, in conjunction with the changes in DSM-5, will help harmonize the two classification systems as much as possible (APA, 2013).

DSM vs ICD

-A study that compared the use of the two classification systems found that worldwide the ICD is more frequently used for clinical diagnosis, whereas the DSM is more valued for research. -Most research findings concerning the etiology and treatment of psychological disorders are based on criteria set forth in the DSM (Oltmanns & Castonguay, 2013). -The DSM also includes more explicit disorder criteria, along with an extensive and helpful explanatory text (Regier et al., 2012). -The DSM is the classification system of choice among U.S. mental health professionals

Harmful Dysfunction

-A term proposed by Wakefield (1992) used to define psychological disorders -Wakefield argued that natural internal mechanisms/psychological processes honed by evolution, such as cognition, perception, and learning - have important function - such as enabling us to experience the world the way others do and engage in rational thought, problem solving, and communication -For example, learning allows us to associate a fear with a potential danger in such a way that the intensity of fear is roughly equal to the degree of actual danger. -Dysfunction occurs when an internal mechanism breaks down and can no longer perform its normal function. But, the presence of a dysfunction by itself does not determine a disorder. -The dysfunction must be harmful in that it leads to negative consequences for the individual or for others, as judged by the standards of the individual's culture. -The harm may include significant internal anguish (e.g., high levels of anxiety or depression) or problems in day-to-day living (e.g., in one's social or work life). -Similar to how the symptoms of physical illness reflect dysfunctions in biological processes, the symptoms of psychological disorders presumably reflect dysfunctions in mental processes. -The internal mechanism component of this model is especially appealing because it implies that disorders may occur through a breakdown of biological functions that govern various psychological processes, thus supporting contemporary neurobiological models of psychological disorders

Foucault's Madness and Civilization

-Central thesis in book is that in the middle ages, people with leprosy were socially and physically excluded from society for their illness: Leper colonies, houses for individuals with leprosy -Foucault argued that as leprosy disappeared, the concept of "madness" developed as its replacement because leprosy served a particular social function in societies, it segregated those individuals who were poor to those who were more well off. More likely to get leprosy if poor b/c leprosy associated with squalor -As leprosy disappeared, the concept of madness developed as a replacement means of segregating individuals that were undesirable from society -Foucault describes a social movement In the 17th century, that he termed "The Great Confinement": The mad/undesirables were now locked up in institutions (e.g., Pitié-Salpêtrière Hospital in Paris, Bedlam in London).

Violation of socially-accepted standards

-Crafts particular disorders to suit political ends (potentially political) -The violation of socially-accepted standards is still considered to be a component of most modern diagnoses -Unavoidable that we will be defining what is abnormal and normal in terms of socially-acecepted standards

Major criticism of the concept of mental illness in the 1950s and 1960s

-Criticisms focused on the notion that mental illness was a "myth that justifies psychiatric intervention in socially disapproved behaviour" -Thomas Szasz (1960), a noted psychiatrist, was perhaps the biggest proponent of this view. -Szasz argued that the notion of mental illness was invented by society (and the mental health establishment) to stigmatize and subjugate people whose behavior violates accepted social and legal norms. Indeed, Szasz suggested that what appear to be symptoms of mental illness are more appropriately characterized as "problems in living". -Szasz argued that mental illness is a social construct created by doctors. "Mental illness" or any of the names for its subtypes (e.g., depression, schizophrenia), Szasz argued, is no different than names like "sinner," "pagan," and "witch. -In his 1961 book, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, Szasz expressed his disdain for the concept of mental illness and for the field of psychiatry in general. -The basis for Szasz's attack was his contention that detectable abnormalities in bodily structures and functions (e.g., infections and organ damage or dysfunction) represent the defining features of genuine illness or disease, and because symptoms of purported mental illness are not accompanied by such detectable abnormalities, so-called psychological disorders are not disorders at all. -Szasz (1961/2010) proclaimed that "disease or illness can only affect the body; hence, there can be no mental illness" (p. 267).

Disturbances do not reflect expected or culturally approved responses to certain events

-Disturbances in thoughts, feelings, and behaviours must be socially unacceptable responses to certain events that often happen in life. -For example, it is perfectly natural (and expected) that a person would experience great sadness and might wish to be left alone following the death of a close family member. Because such reactions are in some ways culturally expected, the individual would not be assumed to signify a mental disorder.

Disturbances reflect some kind of biological, psychological, or developmental dysfunction.

-Disturbed patterns of inner experiences and behaviours should reflect some flaw (dysfunction) in the internal, biological, psychological, and developmental mechanisms that lead to normal, healthy psychological functioning -For example, the hallucinations observed in schizophrenia could be a sign of brain abnormalities.

Supernatural perspectives of psychological disorders

-For centuries, psychological disorders were viewed from a supernatural perspective: attributed to a force beyond scientific understanding. -Those afflicted were thought to be practitioners of black magic or possessed by spirits. -For example, convents throughout Europe in the 16th and 17th centuries reported hundreds of nuns falling into a state of frenzy in which the afflicted foamed at the mouth, screamed and convulsed, sexually propositioned priests, and confessed to having carnal relations with devils or Christ. -Although, today, these cases would suggest serious mental illness; at the time, these events were routinely explained as possession by devilish forces (Waller, 2009a). -Similarly, grievous fits by young girls are believed to have precipitated the witch panic in New England late in the 17th century (Demos, 1983). Such beliefs in supernatural causes of mental illness are still held in some societies today; for example, beliefs that supernatural forces cause mental illness are common in some cultures in modern-day Nigeria.

John Waller explanation of dancing mania

-Historian John Waller (2009a, 2009b) has provided a comprehensive and convincing explanation of dancing mania that suggests the phenomenon was attributable to a combination of three factors: 1) psychological distress 2) social contagion 3) belief in supernatural forces. -Waller argued that various disasters of the time (such as famine, plagues, and floods) produced high levels of psychological distress that could increase the likelihood of succumbing to an involuntary trance state. -Waller indicated that anthropological studies and accounts of possession rituals show that people are more likely to enter a trance state if they expect it to happen, and that entranced individuals behave in a ritualistic manner, their thoughts and behavior shaped by the spiritual beliefs of their culture. -Thus, during periods of extreme physical and mental distress, all it took were a few people—believing themselves to have been afflicted with a dancing curse—to slip into a spontaneous trance and then act out the part of one who is cursed by dancing for days on end.

Psychological disorder definition

-If your behaviours, thoughts, and inner experiences are atypical, distressful, dysfunctional, and sometimes even dangerous this may be a sign of a disorder -Just because something is atypical does NOT mean that it is disordered -Being atypical is an insufficient criterion (some disorders actually have a high rate of appearance in some populations) -It's hard to define psychological disorders.. just because something is not socially acceptable/atypical does not mean its a disorder -Today, we recognize the extreme level of psychological suffering experienced by people with psychological disorders: the painful thoughts and feelings they experience, the disordered behavior they demonstrate, and the levels of distress and impairment they exhibit. This makes it very difficult to deny the reality of mental illness. -No universal definition of psychological disorder exists that can apply to all situations in which a disorder is thought to be present -From time to time we all experience anxiety, unwanted thoughts, and moments of sadness; our behaviour at other times may not make much sense to ourselves or to others. -These inner experiences and behaviours can vary in their intensity, but are only considered disordered when they are highly disturbing to us and/or others, suggest a dysfunction in normal mental functioning, and are associated with significant distress or disability in social or occupational activities.

Examples of Structural Stigma

-In the UK: until recently, laws prevented people with mental health problems from carrying out jury service or becoming a company director -In Korea in certain areas, people with mental health problems are not permitted to enter a pool -Three major airlines in asia refused to allow passengers with mental health conditions on to a flight unless they were accompanied by a psychiatrist

DSM 3

-Major rewrite of DSM 1 and DSM 2 which was a response to the anti-psychiatry movement and the low reliability in diagnoses found in the uses of DSM 1 and 2 major goals of DSM-3: 1) Increase reliability of diagnoses 2) Include more detail in categorizing abnormal behaviour (make sure that any individual who presented with what might by typified as abnormal behaviour in the emergency room is classified with a condition within this manual.. leave no stone unturned in terms of abnormal behaviour) -DSM 3 and every edition after is filled with categories of disorders that lie in the gray areas between other disorders (often have disorders with qualifying statements such as not otherwise specified, or in remission, etc.)

DSM

-Most used classification system in the US is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association (APA) (not psychological association) -First edition of the DSM was published in 1952 and classified psychological disorders according to a format developed by the U.S Army during WW2 -Most recent addition is DSM-5 published in 2013 -Clinicians, researchers, health care providers, health insurance companies, pharmaceutical companies, policy makers, and even the legal system rely on the DSM as a resource. -The DSM works to provide a common language about mental health issues that everyone can use. This book is like an encyclopedia for psychiatry. -Lifetime prevalence rates = the percentage of people in a population who develop a disorder in their lifetime -Most common = Major Depressive Disorder, least common = Dysthymia. More females than males have depression and more males than females have alcohol abuse and drug abuse -Categorizes as people normal/abnormal, which has dramatic impact on individual + society

Biological injury or abnormality

-Problem: How do you define a brain abnormality? -Epilepsy involves aberrant electrical activity in the brain, or gross brain damage and it is fairly clear what the biological abnormality is -What does a decrease in the volume of a brain structure signify?? small hippocampus = abnormal or not? -If you were to discover MORE or less activation in a particular brain region in a particular individual when scanning their brain this many not be indicative of psychological abnormality -You can have changes in brain functionality that are not necessarily associated with psychological abnormality or abnormal behaviour

Purposes of the DSM-5

-Provides an exhaustive classification system for every possible mental disorder 1) Guide treatment choices 2) Allow clinicians to communicate (common language) 3) Please insurance companies who require concrete diagnoses and reliable diagnoses 4) Meant to permit research using categorization (However, National Institutes for Mental Health have recently moved AWAY from DSM and are against the use of large, all encompassing categories in which the DSM uses in may cases. They are now more interested in researching particular symptoms/patterns of symptoms rather than categories defined by DSM-5) -Entry point into vast body of research accumulated over the years on psychiatric disorders

THE COMPASSIONATE VIEW OF PSYCHOLOGICAL DISORDERS

-Psychological disorders represent extremes of inner experience and behavior. If, while reading about these disorders, you feel that these descriptions begin to personally characterize you, do not worry—this moment of enlightenment probably means nothing more than you are normal. -Each of us experiences episodes of sadness, anxiety, and preoccupation with certain thoughts—times when we do not quite feel ourselves. These episodes should not be considered problematic unless the accompanying thoughts and behaviors become extreme and have a disruptive effect on one's life. -People with psychological disorders are far more than just embodiments of their disorders. We do not use terms such as schizophrenics, depressives, or phobics because they are labels that objectify people who suffer from these conditions, thus promoting biased and disparaging assumptions about them. -It is important to remember that a psychological disorder is not what a person is; it is something that a person has—through no fault of his or her own. As is the case with cancer or diabetes, those with psychological disorders suffer debilitating, often painful conditions that are not of their own choosing. These individuals deserve to be viewed and treated with compassion, understanding, and dignity.

Diathesis-Stress Model of Psychological Disorders

-Psychosocial perspective is important and emphasizes the importance of learning, s tress, faulty and self-defeating thinking patterns, and environmental factors -Perhaps the best way to think about psychological disorders, then, is to view them as originating from a combination of biological and psychological processes. Many develop not from a single cause, but from a delicate fusion between partly biological and partly psychosocial factors. -The diathesis-stress model (Zuckerman, 1999) integrates biological and psychosocial factors to predict the likelihood of a disorder. -This diathesis-stress model suggests that people with an underlying predisposition for a disorder (i.e., a diathesis) are more likely than others to develop a disorder when faced with adverse environmental or psychological events (i.e., stress), such as childhood maltreatment, negative life events, trauma, and so on. -A diathesis is not always a biological vulnerability to an illness; some diatheses may be psychological (e.g., a tendency to think about life events in a pessimistic, self-defeating way). -The key assumption of the diathesis-stress model is that both factors, diathesis and stress, are necessary in the development of a disorder. -Different models explore the relationship between the two factors: the level of stress needed to produce the disorder is inversely proportional to the level of diathesis.

Bedlam

-Real name is Bethlem Royal Hospital and is the oldest Psychiatric hospital in the world -People paid good money to take tours of Bedlam to see the conditions and the types of behaviours that the mad exhibited

Psychiatric Stigma Statistics

-Recently, a news agency conducted a large-scale stigma-based survey and found the following (see Goodwin, 2014): • 33% would not be interested in being friends with someone who had mental health issues. • 20% thought that mental illness was associated with lower intelligence. • 62% would not hire someone with a history of mental illness. • 42% thought that seeking help for mental illness was a sign of weakness

Hallucinations

-Seeing or hearing things that are not physically present -Violation of cultural expectations in Western societies, and a person who reports such inner experiences is readily labeled as psychologically disordered -In other cultures, visions that, for example, pertain to future events may be regarded as a normal experience that are positively valued

3 Levels of Stigma

-Self-Stigma -Social Stigma -Structural Stigma

Self-Stigma

-Self-Stigma (aka internalized stigma): "characterized by negative feelings (about self), maladaptive behaviour, identity transformation, or stereotype endorsement resulting from an individual's experiences, perceptions, or anticipation of negative social reactions on the basis of their mental illness" -A related construct is perceived stigma, which refers to an individual's beliefs about the attitudes of others to mental illness

Social Stigma

-Social Stigma (aka personal stigma, public stigma): Describes the phenomenon of social groups endorsing stereotypes about and acting against a stigmatized group. -Note: The experience of social stigma has been shown to lead to the development of self-stigma

Statistical abnormality

-Some behaviours that are quite normal are statistically abnormal (like stamp collecting) -Some illnesses like schizophrenia that is quite common, may not be considered "abnormal"

Criticism of DSM-5

-Some believe that establishing new diagnoses might overpathologize the human condition by turning common human problems into mental illnesses. -Indeed, the finding that nearly half of all Americans will meet the criteria for a DSM disorder at some point in their life likely fuels much of this skepticism. -The DSM-5 is also criticized on the grounds that its diagnostic criteria have been loosened, thereby threatening to "turn our current diagnostic inflation into diagnostic hyperinflation" (Frances, 2012, para. 22). -For example, DSM-IV specified that the symptoms of major depressive disorder must not be attributable to normal bereavement (loss of a loved one). The DSM-5, however, has removed this bereavement exclusion, essentially meaning that grief and sadness after a loved one's death can constitute major depressive disorder.

DSM-4 and DSM-4-TR

-TR = text revision -Further elaborations of this system that was set out by DSM 3 -Turned 265 categories in DSM 3 to 297 categories in DSM 4 -A lot of controversy over DSM-4 because authors who were selected to define the various psychiatric disorders within the DSM, roughly half of them had financial relationships with the psycho-pharmaceutical industry at one time or another, raising the prospect of a direct conflict of interest when defining this conditions... they may have been defining conditions that would have increased profits of their companies or companies they were formerly associated with

DSM-5

-The DSM-5 includes many categories of disorders (anxiety, depressive, dissociative) -Each disorder is described in detail, including an overview of the disorder (diagnostic features), specific symptoms required for diagnosis (diagnostic criteria), prevalence information (what percent of the population is thought to be afflicted with the disorder), and risk factors associated with the disorder. -Workers who worked on DSM-5 had to sign a non-disclosure agreement when they were working on it -Major rewrite of the DSM-4 and DSM-4-TR -Now intended to be a living document.. not anticipated there will be another DSM is now a digital document that can be continuously revised as the language and research around mental health changes. DSM-6 for a long time. The subsequent revisions will be DSM version 5.01 or DSM version 5.1 which will be text revision b/c the diagnostic manual itself is largely moving to an online format -Predominantly used in North America

Biological Perspectives of psychological disorders

-The biological perspective views psychological disorders as linked to biological phenomena, such as genetic factors, chemical imbalances, and brain abnormalities; it has gained considerable attention and acceptance in recent decades. -Evidence from many sources indicates that most psychological disorders have a genetic component; in fact, there is little dispute that some disorders are largely due to genetic factors. -Schizophrenia --> if 100 % genes shared, you have a GREAT risk of developing schizophrenia if other twin does -Sophisticated neural imaging technology in recent decades has revealed how abnormalities in brain structure and function might be directly involved in many disorders, and advances in our understanding of neurotransmitters and hormones have yielded insights into their possible connections. The biological perspective is currently thriving in the study of psychological disorders.

Changes in the DSM

-The first 2 editions of DSM listed homosexuality as a disorder but in 1973 the APA voted to remove it from the manual -Beginning with DSM-3 in 1980, mental disorders have been described in much greater detail and the number of diagnosable conditions has grown steadily as has the size of the manual itself -DSM-I included 106 diagnoses and was 130 total pages, whereas DSM-III included more than 2 times as many diagnoses (265) and was nearly seven times its size (886 total pages) (Mayes & Horowitz, 2005). Although DSM-5 is longer than DSM-IV, the volume includes only 237 disorders, a decrease from the 297 disorders that were listed in DSM-IV. -The latest edition, DSM-5, includes revisions in the organization and naming of categories and in the diagnostic criteria for various disorders, while emphasizing careful consideration of the importance of gender and cultural difference in the expression of various symptoms.

Cultural expectations violations

-Violating cultural expectations is not a satisfactory means of identifying the presence of a psychological disorder -Since behaviour varies from one culture to another, what may be expected and considered appropriate in one culture may not be viewed as such in other cultures -Cultural norms change all the time: what might be considered typical in a society at one time may no longer be viewed this way

How have Szasz's views influenced the mental health community and society?

1) Lay people, politicians, and professionals now often refer to mental illness as mental health "problems", implicitly acknowledging the "problems in living" perspective Szasz described 2) Szasz's view of homosexuality. First psychiatrist to openly challenge the idea that homosexuality represented a form of mental illness. He helped pave the way for the social and civil rights that gay and lesbian people now have 3) His work inspired legal changes that protect the rights of people in psychiatric institutions and allow such individuals a greater degree of influence and responsibility over their lives

Diagnostic Categories in the DSM-5

1) Neuro-developmental Disorders (Autisim Spectrum Disorders) 2) Schizophrenia Spectrum and Other Psychotic Disorders 3) Bipolar and Related Disorders 4) Depressive Disorders 5) Anxiety Disorders 6) Obsessive-Compulsive and Related Disorders 7) Trauma and Stressor-Related Disorders 8) Dissociative Disorders 9) Somatic Symptom and Related Disorders 10) Feeding and Eating Disorders 11) Elimination Disorders 12) Sleep-Wake Disorders 13) Sexual Dysfunctions 14) Gender Dysphoria 15) Disruptive, Impulsive Control and Conduct Disorders 16) Substance-Related and Addictive Disorders 17) Neuro-cognitive Disorders 18) Personality Disorders 19) Paraphiliac Disorders 20) Other Disorders

3 main sections of the DSM

1) Simple manual for understanding why the chapters and the rest of the DSM-5 are organized the way they are. This introductory section also explains the process behind how the DSM is revised. It includes a summary of field studies and public and professional reviews. Section 1 also addresses the major revisions in the DSM-5 that distinguishes it from its predecessors. 2) This section covers the diagnostic criteria and codes. Each chapter in Section 2 represents a broad diagnostic category, such as neurodevelopmental disorders, schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, depressive disorders, anxiety disorders, and obsessive-compulsive and related disorders, to name just a few. 3) Addresses future directions for research, including emerging models and systems of measure.

Criteria for Abnormality (types)

1) Statistical abnormality 2) Violation of socially-accepted standards a) Maladaptivity (counter-productive behaviour) 3) Subjective abnormality and/or discomfort a) To the "abnormal" individual b) To others 4) Biological injury or abnormality

According to the American Psychiatric Assocation (APA), a psychological condition is said to consist of the following:

1) There are significant disturbances in thoughts, feelings, and behaviours 2) The disturbances reflect some kind of biological, psychological, or developmental dysfunction 3) The disturbances lead to significant distress or disability in one's life 4) The disturbances do not reflect expected or culturally approved responses to certain events

In this situation, why would Janets condition signify a disorder?: Janet has an extreme fear of spiders. Janet's fear might be considered a dysfunction in that it signals that the internal mechanism of learning is not working correctly (i.e., a faulty process prevents Janet from appropriately associating the magnitude of her fear with the actual threat posed by spiders). Janet's fear of spiders has a significant negative influence on her life: she avoids all situations in which she suspects spiders to be present (e.g., the basement or a friend's home), and she quit her job last month because she saw a spider in the restroom at work and is now unemployed.

1) There is a dysfunction in an internal mechanism 2) The dysfunction has resulted in harmful consequences

Medicalization of Abnormality

In psychology and psychiatry, abnormal behaviour is diagnosed and (increasingly) treated like any other medical disorder. This medicalization of abnormality poses a number of problems for the individual (and advantages because it allows them to get treatment): 1. The individual is told they are ill. This justifies their behaviour to themselves and to others. The control of their "illness" is taken away from them. 2. Diagnoses can be molded to suit political, social, and business goals. 3. Others benefit from their illness (e.g., psychologists, psychiatrists, pharmaceutical companies)