2008-04-01
In college, as an underclassman, you can take abnormal psych, child development, personality, all of these are in-depth classes. We are going to do the survey of abnormal psych. One of the first things that we have to identify is, what is abnormal behavior? I am not saying mental illness, that's different. If you have a pie of behavior, what chunk is the abnormal one? About 60% of behavior is normal, and 40% is abnormal. When you're doing statistics, that means you really do have two norms, but within that, you have mental illness. So, abnormal behavior is not stuff that puts you in jail or in a mental institution, it's just outside of the norm. When do we recognize behavior as being abnormal? Socially unacceptable things. Like facing the wrong direction in an elevator. Inappropriate body space (Europeans do it differently). We must not ignore culture norms, relative to the society in which the child developed in. And then we have the fringe movements. The fringe may sometime include maladaptive behavior. What about a really good job but causal clothing? That's definitely maladaptive behavior. First, we look for things like deviance from the norm (your cultures norm). So we have to do some investigation of the culture: we don't want multiculturation necessarily. The second measurement is maladaptive behavior - those behaviors that do not help you (drugs, excess drinking). Third, personal distress - if your behavior is stressing you out, and you're not happy with it, that's an indication that your behavior is abnormal. You can be a good observer of where you are in the spectrum of normal. And some parts of mental disorders include you not knowing how to observe where you are in the spectrum of normal. Within personal stress includes depression and anxiety. You can use intensity and combination in these factors. The short version of it: you need to have two of the three, unless you have one that is extreme to be considered abnormal behavior. This is just outside the norm, you do not necessarily have a disease.
Imagine that you have schizophrenia and you live in England in 1400. And why would you be scared? Witches, yes. When we started diagnosing mental illnesses, we started to refer to the maladaptive behavior as a disease, so we used a medical model to talk about mental illness, because that brings with it many preconceptions: you can be diagnosed (we can figure it out), we can treat it, we can cure it, and there could be a prognosis. It's an assistance to medical science. There's a trajectory. Diagnosis is the distinction of the illness, and then you have the etiology - refers to the apparent causation and developmental history of the illness (socially and then your individual etiological history of the disease). In your medical records at the doctor's office, there'd be notes, and also a prognosis (or a foreward-looking prospect). We can say what stages the illness will cross through, what symptoms you could expect, this is all included in prognosis. Zimbardo talked about Thomas Szasz. Szasz did not like the idea of making mental illness a medical issue, we're talking about how somebody fits into a society, so he said it's a social issue, relatedness, and not something that is a disease. I bet Szasz was talking about diseases that cause injury, otherwise yeah he's right, since yes this is about you and your process.
So, in the 1400s, you are probably behaving differently from the societal norms. In these societies they did have ways to treat schizophrenia. The first theory was demonology: you are possessed by a demon. So, now how do we remove it? Well, one way to get the demon out is to punch a hole in the skull. This is called trepaning. Fenieaces Gauge, he had the spike through his head from the throat. This could have done something. Is it likely that it would cure depression? In ancient cultures, some people volunteered for trepaning. There was also exorcism, trephining, flogging/starvation, noisemaking, herbs. So with trephining, they have to make sure they don't break the mininges. The next idea we had was, hey, let's beat the demon out of you. Beat the hell out of you, in other words. Another way was to do noisemaking throughout the days and night, constant noisemaking until the demon leaves. Many cultures had different herbal concoctions. Foxglove. Herbs make sense, since they can effect dopamine and serotonin levels. Life didn't improve until 1984 until Pope Innocent the VIII (Hammer of the Witches) -- he wrote the book Malleus Mallificarum, and his theory was that all abnormal behavior was sign of a contract with satan. And the only way you can save somebody is by purifying their flesh once they are in league with satan. You have to make them confess (via torturing them), and once they confess that they are in league with satan, you purify them with fire. This is the Salem witch trials. You put them through tests. Let's put a witch in water, and if she floats, she's clearly a witch, and if she sinks and dies she is innocent. There are all kinds of tests. There was one where they would cut you and see if you bleed. If you bleed, you're a witch, because if you were innocent and you would live. "I would be more worried if I didn't bleed." - Watts. "Yep, I'd be cutting off the pounds. Don't need this any more, now do I?" -- Puckett.
In Bedlam, London, they charged admission to view the lunatics. And if you paid, you could have sex with the asylum people. Benjamin Rush of Williamsburg, Virginia thought that scaretactics would reboot the individuals. He had a bath tub with a lid on it, and he put a person in the coffin, and they would slowly fill it with water all the way, and as you are being terrified that they are going to drown you, you would get the right mind, so when do they let you out? When you calm down. The point at which you stop screaming is the point when you die. Either alive or dead - "Well. Cured you". Then Phillipe Pinel had an interesting idea: these are people. And everybody said, "Woah, no way dude," and then it took us 150 years to figure it out.
Connatonic schizophrenic state. Feed tubes? They woudl run around with hyperactive energy and then they would freeze in place, comatose, for weeks. A hospital in Hawaii in the 1950s for schizophrenics -- the asylums remained until the 1980s as a holding pen. And by presidential order, we opened up asylums and threw out anybody who could not pay to stay, and so our homeless population quadrupled. Most of the people holding signs out there are probably untreated mental patients. If you don't have insurance, you can't be crazy. Only people with insurance can afford to be crazy.
Some people assume that psychological disorders are incurable. As soon as we figure out how to manufacture serotonin, we will help out a ton of people. Some people assume that mentally ill people are violent and aggressive -- but correlation is not causation. People can be violent regardless.
The statistics are interesting. 50% of the U.S. population have mental disorders. Schiozprhenica is 1 to 2% of the population. Mood disorders are 15%. There are mild autisms, extreme autisms, anxiety disorders, etc. There is something about the law that you need to know. You can be insane, or you can be legally insane. As soon as you are legally insane, this changes your life dramatically. You are a danger to yourself and others, and in need of immediate treatment, requriing incarceration, and it's called the M'naughten rule. You are going to a prison that is also a hospital. Very few people are considered legally insane. Hollywood makes it sound like many people get acquitted and off on an insanity plea. If you are put away for insanity, it's for life.
Diagnosing? Secret of Nim.
NIMH: MUUDI (2 weeks). National Institute of Mental Health. According to NIMH, in order to diagnose somebody, you need to watch them for 2 weeks, and they need to be MUUDI: maladaptive, unpredictable, unconventional, distressing, irrational, and they need to meet a combination, and it's intensity/combination stuff. DSM-IV 1994 is the Diagnostic and Statistical Manual of Mental Disorders, started in 1952. 200 illnesses under 16 categories. Categorizes information in 5 axes. Diagonsing in terms of mental health is very difficult, very tedious, and when they say it takes 2 weeks, it's not "Go see a doctor and come back", it's 2 weeks of time with that doctor, so it could be months with that doctor. It's important that you have that amount of time, and misdiagnosis can be tragic. Bipolar disorder can mean a spiral of problem when not diagnosed. Bipolar disorder is always concerning when somebody is in the depressed cycle, and the manic stage? They aren't thinking they are too happy and that they should see a doctor. If you go to a medical doctor, and get a quick decision, and you don't get a diagnosis, and you walk out with Prozac, well, depression will cause mania happen in bipolar disorder (so don't just get depression meds). Go to a psychologist, not your family medical doctor. Mania can be mixed, and there's hypermania, and you can be distressing and irrational, that's where a track croach at a college here in Texas was bipolar and not diagnosed, he hit a mania, and so he went in to pump his kids up, and he pulled a sword out and cut off a kid's hand. It was mania. He was swinging around the sword - "we're gonna get 'em boys!". Prognosis for bipolar is death, unless treated. Bipolar disorder, when unmanaged, has a high prognosis of death. Neurotic - common pattern of distress or self-defeating behavior (mild depression); can manage to function in everyday life. Psychotic - profound disturbance in rational thinking and lack of touch with realit; can not function in society. Neurotic tends to be personal, and psychotic tends to be external, more extreme, more noticable, and puts people in danger. You're not in touch. These are legacies of Freud. Freud talked about neuroses and psychoses.
Memorize DMV.
Diabetes can cause severe depression. This can be fixed with insulin (as opposed to serotonin).
Dementia can be taxing when you are aware of it. It can be caused by overdose. Lots of myths about ectasy and so on, well, OD can cause mental impairment. Alcohol with ectasy will let it cross the blood-brain barrier, and so it dehydrates you, this causes ischemia and your liver stops, and so on.
If you take acid 10 times, you're, by law, legally insane. That's based off of the number of brain cells you take each time. "That explains so much, thank you." - Watts.