Mental Illness

Scene III – Biography

 Mental illness
• Different terms:
– Mental disorders; Psychopathology;
Psychological disorders…
– Abnormal Psychology; Abnormal behaviors

• What exactly does it mean by “abnormal”?

 History of mental disorders
• As early as the pre-history times
• Archeological findings of “trepanning”
• Releasing “demons” from the person
 History of mental disorders
• Hippocrates (460-377 B.C.) – Greek
physician
• Imbalance in body’s fluids (humors)
– Phlegm, black bile, blood, and yellow bile
• First documented biological cause
 History of mental disorders
• Middle Ages – spirit possession
• Treated by “exorcism”
• Renaissance – demonic possession
(victim) -> witches
 History of mental disorders
• From demonic to medical model
• Asylums – where bloodletting and snake
pits as commonly used treatment
 History of mental disorders
• Modern era of psychopathology – by the
turn of the twentieth century (esp. after
1950s)
– Development of Psychology and Psychiatry
– Availability of drug treatment
– Deinstitutionalization
– Community mental health centers; half-way
houses etc.
Modern era
 History of mental disorders
• Modern era of psychopathology – by the
turn of the twentieth century (esp. after
1950s)
– Development of Psychology and Psychiatry
– Availability of drug treatment
– Deinstitutionalization
– Community mental health centers; half-way
houses etc.
What is abnormal?
 What is abnormal?
• Statistical rarity
• Social norm deviance (cultural relativity)
• Subjective discomfort
• Inability to function normally (maladaptive)
• Causing harms to oneself / others
 Why abnormal?
• Biological model
• Psychological model
• Biopsychosocial perspective
 Why abnormal?
• Biological model
– Chemical imbalance, genetic problem, brain
damage or dysfunction
– Drawing analogies from medical science;
terminologies used
– Controlled vs. Cured
 Why abnormal?
• Psychological model
– A) Psychodynamic view
– B) Behavioral perspective
– C) Cognitive perspective
 Why abnormal?
• Psychological model
– A) Psychodynamic view
– Problem of hiding or repressing thoughts in
unconscious mind
– E.g., sexual drive -> feel dirty -> hand
washing -> obsessive compulsive disorder
 Why abnormal?
• Psychological model
– B) Behavioral perspective
– Principle of learning:
– Behavior 1 -> +ve outcome -> repeat in future
– Behavior 2 -> -ve outcome -> not to repeat

– Abnormal behaviors are the results of learning

– E.g., girl & spider -> fear & scream -> attention
& comfort from others -> phobia
 Why abnormal?
• Psychological model
– C) Cognitive perspective
– Problem of irrational or distorted thinking

– E.g., “all spiders are horrible and will bite me,

and I will die!”
 Why abnormal?
• Biopsychosocial perspective
– All of the above!

– E.g., development of an anxiety disorder

– Genetic or biological factors set the tendency
– Stressors in the environment and their timing
– Socialcultural factors
 Diagnosis today
• Diagnostic and Statistical Manual of
Mental Disorders (DSM) is a system that
contains the criteria for mental disorders.
• Currently on fifth edition (DSM-5)
• Has 18 different classes of disorders
(>300 diagnosis)
 DSM 5
• As a diagnostic tool…
• E.g., Depressive disorder
– Five of nine symptoms
– E.g., depressed mood and/or loss in interest
in everyday activities + fatigue, insomnia,
problems in concentrating, significant weight
loss for over two weeks
 DSM 5
• As a source book…
• Prevalence of various disorders
• E.g., Major depression
– Lifetime prevalence (10% in women; 5% in
men) (APA, 2013)
 DSM 5
• Adopts the biopsychosocial approach
• Information about cultural influences
 Mental disorders
• Dissociative Identity Disorder (DID)
• Schizophrenia
Dissociative Identity Disorder (DID)
• Formerly known as “multiple personality” disorder
• At least two or more distinct personalities
• One reported case of 4500 (Acocella, 1999)
• Can be of different names, genders, or races…
• “core” personality usually knows nothing about
other personalities
• Experience “blackouts” or “awakening” in
unfamiliar places
Dissociative Identity Disorder (DID)
• Psychodynamic view – repression of
traumatic experiences

• Cognitive and behavioral models – thought

avoidance -> reduction in anxiety ->
reinforcement -> habit of “not thinking
about” -> extreme form
Dissociative Identity Disorder (DID)
• Biological perspective
– Different brain activity levels between people
with and without DID
– Different brain activation patterns between
different personalities
– Recent studies suggest a link between
childhood abusive experience and the
observed neurological differences
Dissociative Identity Disorder (DID)
– At least two or more distinct/opposite personalities
– Can be of different names, genders, or races…
– “core” personality usually knows nothing about other
personalities
– Experience “blackouts” or “awakening” in unfamiliar places
– Controversies exist…
Dissociative Identity Disorder (DID)
– Evidence for having hundreds of personalities is slim
– Might be a product of people’s expectations and beliefs
• Prior to 1800s: non-existent
• 1970s: 79 cases
• 1980s: 6000 cases
• 21st century: > 100,000
– Certain practices (e.g., hypnosis) in therapy sessions
might encourage the creation (rather than discovery) of
the alters
 Mental disorders
• Dissociative Identity Disorder (DID)
• Schizophrenia
 Schizophrenia
• Dividing (schizo~) the brain (phren)
• “split mind” – thoughts, feelings, and
behavior
• *** A long-lasting psychotic disorder
involves an inability to tell the difference
between reality and fantasy
 Schizophrenia
• *** Delusions – false and strongly held
beliefs about the world
• Commonly seen schizophrenic delusions
– Delusions of persecution
– Delusions of reference
– Delusions of influence
– Delusions of grandeur…
 Schizophrenia
• plus symptoms like…
– Sudden interruption of thoughts – difficulties
in thinking logically
– Disturbed emotions– flat effect
– Disturbed speech – making up words
meaninglessly
– Disorganized and odd behavior (e.g., weird
facial grimaces and odd gesturing)
 Schizophrenia
• *** Hallucinations
– Hearing voices (most common; different from
inner voices/ self-talk) or seeing things that
are not physically present
– Other senses like touch, smell, and taste are
less common but possible
 Schizophrenia
• Several sub-types, including…
• Catatonic schizophrenia
– Very disturbed motor behavior (totally off or
totally on)
• Paranoid schizophrenia
– Auditory hallucinations are common;
persecution or grandeur delusions; bizarre but
systematic
 Schizophrenia
• Relation with brain functioning
– Over-production of dopamine in the
subcortical (inner) part of the brain
– Lower than normal level of blood flow and
dopamine in the prefrontal cortex (the frontal
surface of the brain)
– Dilemma of drug use…
 Schizophrenia
• Prevalence
– Less than 1% but over half in mental
institutions
– 7 – 8 individuals out of 1000 in their lifetime
– Regardless of cultures (Saha et al., 2005)!

• *** Family, twin, and adoption studies

show evidence for a genetic link
 Schizophrenia
• Biopsychosocial model

• Diathesis-stress models propose that disorder

is a joint product of a genetic vulnerability
(diathesis) and stressors that trigger it

• Psychosocial factors play a role in

schizophrenia, but only trigger it in persons
with genetic vulnerabilities.
 Schizophrenia
• Critical times in development, e.g., puberty

• Family members can influence whether

patients relapse

• Early warning signs of schizophrenia

vulnerability:
– Social withdrawal
– Thought and movement problems
– Lack of emotions, decreased eye contact
 Schizophrenia
• Different from DID; Only one personality

• Typically onset in mid-20s for men and late-

20s for women (but not absolute)

• Vivid visual hallucinations are usually signs of

substance abuse
 Points to ponder
• Mental illness and the law

• Mentally ill vs. insane

• Insanity defense – a mentally ill person

who has committed a crime should not
be held responsible?
 Points to ponder
• A large proportion of criminals escape
criminal responsibility by using the
insanity defense?
• ~1% of criminal trials in US; success rate
of about 25%
• On average, insanity acquittee spends
about 3 years for hospitalization; longer
than a typical sentence duration