Mental disorders can be classified in many ways but the most commonly used in the world are those presented in the Diagnostic Statistical Manual of Mental Disorders IV (DSM-IV),
CASE STUDY 1
Mental disorders can be classified in many ways but the most commonly used in the world are those presented in the Diagnostic Statistical Manual of Mental Disorders IV (DSM-IV), which was published by the American Psychiatric Association Washington DC, 1994. It was devised for the classification of mental disorders and holds diagnostic criteria for the most common mental disorders including descriptions, treatments and research findings. The DSM-IV is organised to help with scientific research as well as clinical practice. It is organised into five different criteria known as axes. These axes are used as guidelines when making decisions based on symptoms.
Axis I contains information on clinical disorders, including major disorders, developmental disorders and learning disabilities, such as depression, schizophrenia and anxiety disorders. In contrast, personality disorders and mental retardation are represented on Axis II, such as paranoid. However diagnosis can be made that include Axis I and II disorders and therefore multiple diagnosis can occur on both axes. (Carlson et al, 2000)
Axis III to V provides information about the life of the person as well as basic classification provided by Axes I and II. Axis III is used to describe the physical disorders of a patient, for example high blood pressure or skin rashes, that are there as well as the psychological disorder. Axis IV shows the stress levels a person has experienced. The axis details the source of stress and indicates how severe and how long it has lasted. Axis V describes the persons overall level of psychological, social or occupational functioning. The purpose of this axis is to show how much the persons life has been affected by the disorder, through a rating system. (Eysenck, 2004)
When evaluating the character in this scenario, through the DSM-IV system, it could be shown that he is suffering from schizophrenia. Schizophrenia is the condition most often associated with the term 'madness'. It is not a split personality ; rather it is a group of psychotic disorders that are characterized by a loss of conduct with reality. Symptoms are mainly disturbances in thought processes, but also extend to disturbances of emotion and behaviour. According to the DSM-IV , the criteria for schizophrenia include delusions, in which this character shows. Delusions arise from mistaking interpretations of actual objects or events. An example in case study one is that this individual thinks people are constantly watching. To be diagnosed with schizophrenia, the individual must display signs of disturbed behaviour, continuously over a period of six months. Another symptom of schizophrenia is social or occupational dysfunction. In case study one, the character seems to be showing both of these characteristics as he would not go out the room if there was others there, because he felt afraid of them, he did not go to work or come out of his room.
The DSM IV provides a systematic way for providing and evaluating different kinds of personal and psychological information about any one specific individual. It carefully and completely describes symptoms of a certain disorder. Classification of the mental disorders can create order. The problem has been given a name and therefore it can be accepted universally. By giving a name to the disorder the next step is to look for ways to treat the problem. Everything needs a name or label, and by giving the problem a title it can help to predict future courses for the same disorder in another individual.
Although the DSM IV is the most widely used classification system for mental disorders, it is not without its problems. There will probably always be dangers when classifying mental disorders as the problem can not be seen as it occurs in the brain. No classification system is likely to be perfect and no two people with the same diagnosis will behave in exactly the same way. Yet once people are labelled, they are likely to be seen to have all the characteristics assumed to accompany that label all of the time- even if the person only has a few of the traits to the label.
According to Szasz (1974) "strictly speaking ... disease or illness can affect only the body. Hence there is no such thing as mental illness."(p ix) Szasz also thought society uses the labels to exclude those whose behaviour fail to conform to the norms of society. Goffman used the term stigma to refer to something which deviates from what society has deemed normal. As a result of this deviation from what is considered normal, society responds to this attribute with interpersonal or collective reactions that serve to 'isolate', 'treat' or 'punish' individuals engaged in such behaviour (Schur, 1971). A significant part of labelling occurs because of stereotyping. If someone is given a name, e.g. schizophrenic, it has negative connotations. This label stays with the person throughout their life. When the patient is being treated as mentally ill his/her behaviour may change to make the label more appropriate than it was initially. Thus, rather than the label helping with diagnosis it may play a part in creating the symptoms.
Abnormal behaviour has proved difficult to define and this could lead to misdiagnosis. Rosenhan (1973) carried out a famous study, which questioned and exposed the decisions made by professionals. Rosenhan's findings demonstrate the lack of scientific evidence on which medical diagnosis can be made. Researchers were sent to different psychiatric hospitals and tried to gain admission by complaining to hear voices. Even though this was the only symptom they had reported they were diagnosed as suffering from schizophrenia, which has been shown above, is a severe condition involving distortion of thought, emotions and behaviour. Rosenhan concluded, "It is ...
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Abnormal behaviour has proved difficult to define and this could lead to misdiagnosis. Rosenhan (1973) carried out a famous study, which questioned and exposed the decisions made by professionals. Rosenhan's findings demonstrate the lack of scientific evidence on which medical diagnosis can be made. Researchers were sent to different psychiatric hospitals and tried to gain admission by complaining to hear voices. Even though this was the only symptom they had reported they were diagnosed as suffering from schizophrenia, which has been shown above, is a severe condition involving distortion of thought, emotions and behaviour. Rosenhan concluded, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals". Studies such as these have led to pressure to revise and improve the accuracy of the classification systems.
The purpose of psychodynamic therapy is to uncover unconscious conflicts and anxieties, in order to gain an insight into the causes of the psychological disturbance. According to Freud, neuroses such as anxiety disorders occur as a result of conflicts among the three parts of the mind: the ego (rational mind), superego (conscience), and the id (basic instincts). These conflicts cause the ego to use various defence mechanisms to protect itself from this anxiety. A key defence mechanism is repression. Repression consists of forcing painful and threatening memories out of the conscious into the unconscious mind.
Freud emphasised that clients should gain access not only to the oppressed event but also to the accompanying feelings. This can be helped through transference, which involves the client transferring onto the therapist the emotions previously directed at something important in their life. Transference could result in a problem; if the client has repressed feelings of great love, it could be transferred onto the analyst who would have to respond by explaining this emotional outburst as a result of the repressed feelings not because the client has feelings for the therapist.
Psychodynamic theory fails to produce a testable hypothesis and the theory behind the therapy is unscientific, based on instincts and urges. Many have questioned the reliability of psychoanalysis as there is no empirical data. The unconscious mind can not be seen. No one is aware of this part of the mind and there is no evidence to prove or disprove Freud's writings.
During therapy a patient may lie, fantasise or exaggerate when free associating. Everything the patient says is based on memory, where important parts could be missed. The patient may remember things to say after they have left the analyst and become fixated on this information. This could lead to other problems. The ultimate aim of psychoanalysis is to make the unconscious conscious, to cure neurotic symptoms, and to help the patient gain greater insight and self understanding.
Eynsenck(1952) published figures which suggested psychodynamic therapy to be useless in the treatment of psychological disorders. However, in America, therapy is usually conducted over a number of years and can last right through a persons entire adult life, which makes it expensive. However, Freud's own case studies lasted only a few weeks. And some recent studies suggest short-term psychodynamic therapy can be beneficial to some patients. After many years often many times a week a patient may become mentally exhausted.
The humanistic model provided one of the first psychologically based alternatives to psychoanalysis. Person-centred therapy concentrates on the uniqueness of the individual. In contrast to Freud, humanistic psychologists believe human beings are different from animals and that they are driven by the need to fulfil their potential rather than the basic instincts such as sex and aggression. Like psychodynamic therapy, humanistic person-centred therapy is an insight therapy, in that it involves looking into deeper emotions. Rogers, however, believed that therapy should focus on the present rather than the past as it is now that the person has the problem.
Rogers believed there had to be a correct relationship between the client and therapist in order for the client to recognise and value their capacity to direct their own life. The main goals are to allow clients to become self actualised by thinking of themselves in an honest and accepting way. These goals are achieved by the therapist displaying three qualities. The therapist must constantly be supportive; be genuine and open; and show empathy towards the client by showing a good understanding of the clients feelings and concerns. Like Freud, this therapy is fairly expensive and there is a low success rate.
CASE STUDY 2
A large body of evidence suggest that organisms can learn that they are powerless to affect their own destinies. Learned helplessness involves learning that an aversive event can not be avoided or escaped. Seligman (1976), demonstrated, in a series of experiments, that animals can learn that their own behaviour has no affect on the environment. Seligman investigated Pavlovian's conditioning in dogs. Dogs were exposed to electric shocks they could not avoid. Afterwards they were put into a box with a barrier in the middle. The dogs were given shocks after a warning signal. Although the dogs could escape by jumping over the barrier into the other part of the box, most did not learn to avoid or escape the shocks by jumping over the barrier as soon as the warning signal were presented. Dogs in the control group learned to step over the barrier and therefore avoid being shocked.
Seligman (1975) put forward this theory of learned helplessness to try and explain depression. Seligman suggested that people are generally able to influence many aspects of their environment, but sometimes things just happen, no matter of their own behaviour. If this occurs too often, people will loose motivation and just give up, because they have learned they are helpless in everyday life situations. Hopelessness has been identified as one of the main characteristics of depression. The character in this scenario does not socialize with her workmates because she does not enjoy it, maybe because she is feeling without energy. Instead of seeing that she has turned down her colleagues so many times before, they do not think to ask anymore, the character seems to think they do not like her. Attribution Theory is when we do not offer explanations to why things happen. There are two types; external, claims that some outside agent or force motivated the event to take place; internal, claims that the person was directly responsible for the event. Donna blames herself for her friends not asking her out anymore not looking at the fact she has turned them down before.
Also this character does not look at the good side of things, she did not recognise a compliment from her manager. Donna had took it to mean she had done a bad job in other areas of her work because the boss did not comment on them. She has feelings of worthlessness and feels she can not control her own environment. Seligman suggests this character will generalize this situation to other aspects of her life.
Cognitive-behavioural therapy by Aaron Beck, is a combination of cognitive therapy with attempts to change behaviour directly. Beck believes that depression is maintained because some patients are unaware of the negative thoughts that they automatically and often say to themselves, such as "I will never be as good as my friends" or "I'm not smart enough to be at this school'. The therapist then uses different tactics to change the cognitive thinking that helps the depression (Beck 1991). Evaluate what the patient thinks about their own automatic thoughts, try to push the blame away from the patient themselves and teach them there are other factors to blame. The therapist will then discuss with the patient different solutions to the problems they face in every day life.
Beck (1976) recommended the use of homework assignments involving the client to behave in ways he/she finds different. Treatment is based on the understanding of each clients individual problems. The therapist and client will then work together to identify goals and to agree with a shared treatment plan. The focus of cognitive therapy is mainly on the here and now rather than the past. The aim of cognitive behavioural therapy is to enable the client to generate solutions to their problems that are more helpful than their present ways of coping. Individuals with social phobia may argue that talking to everyone in the office everyday will make them look stupid and lead to rejection. But if the hypothesis is tested they will find out the fears were exaggerated. Disproving their hypothesis and expanding the social behaviour of the individual, assisting the process of recovery.
Aaron Beck developed a treatment for anxiety and depression based on cognitive theory. Patients tune into their internal dialogue in order to change maladaptive thinking patterns. Beck developed specific procedures to help challenge a depressive client's assumptions and beliefs. Patients learn how to change their thinking. Depression and anxiety can be treated with medications, or psychotherapy, or both. Some research has shown that the combination of medications and therapy can be particularly effective. While some anxiety medications can result in dependence, this is rarely true of antidepressants.
CASE STUDY 3
Erikson saw personality development as advancing through eight invariant stages, certain aspects of personality development are best dealt with at particular stages in life. These stages are called psychosocial as he gave greater emphasis to the role of the social world which includes friends and relatives as well as culture and society as a whole.
Each stage presents the individual with a series of psychological conflicts. The third crisis for Erikson is initiative versus guilt. This takes place in early childhood. The most important event at this stage is independence. The child continues to be assertive and to take the initiative. Playing and hero worshipping are an important form of initiative for children. Children in this stage are eager for responsibility. It is essential for adults to confirm that the child's initiative is accepted no matter how small it may be. If the child is not given a chance to be responsible and do things on their own, a sense of guilt may develop (Erikson, 1974). The child will come to believe that what they want to do is always wrong. In order for a positive outcome in this stage, the children must be guilt free when using imagination. They must be reassured that it is okay to play certain adult roles.
Stage 4, for Erikson is industry versus inferiority. The age range of this stage is from 6 to 12 years of age. Social focus is on the neighbourhood and school, and once a child has completed this stage successfully they will have a sense of confidence in one's own abilities. During the industry versus inferiority stage, Erikson stated a child "will receive some systematic instruction" from adults and "the child becomes ready to handle the utensils, tools, and weapons" used by the adults. The danger at this stage is a sense of inadequacy and inferiority the child feels if he or she cannot master the tools and skills needed. A feeling of inferiority can jeopardize the child's sense of identity within his/her society. (Woolfolk, 1987)
According to Erikson children in this age enjoy playing games, but they also want to do other things, such as producing something, to get recognition and satisfaction. There is a movement from play to work. The child soon learns that he can win recognition from parents, teachers and peers by being proficient in his school work. The attitudes and opinions of others become important.
Inferiority may occur, if what the child learnt so far is not appreciated at school by his teacher or other children, then the child starts feeling inadequate. Inferiority can take the form of bullying and discrimination. The child must realize their own ability otherwise, according to Erikson, they will not see any reason to perform at school at all.
In all social, academic and athletic events, children in the early school years measure themselves against others and begin to feel very competent in certain areas and pursue these areas strongly to achieve a sense of accomplishment and importance. If parents and teachers do not help children to gain a sense of competence in all three areas, children will develop inferiority complexes that may last a lifetime and keep children from developing their interests and talents and social skills.
Play therapy helps children work through emotional, psychosocial and behavioural difficulties and helps address family problems. Play therapy sessions are usually held in a playroom that has a range of carefully selected toys and materials. In special circumstances, play therapy sessions can also be offered in other settings such as the home and hospital. In the playroom, the child can express feelings, thoughts, experiences and behaviours through play. Toys are used like words and become the child's natural language (Lindon, 2001). It is an opportunity which is given to the child to act out his feelings and problems just as in certain types of adult therapy an individual would talk out his difficulties. Children often have difficulty trying to say in words what they feel or how experiences have affected them. Through the toys and art materials, children can show their inner feelings through what they choose and how they play.
The Play Therapy room becomes a safe place and a relationship of trust develops for the child with the play therapist. This is also known as catharsis, which is the release of fears, anxieties and traumas, children are playing in safe play situation. Play dough, water, sand, and paint are some methods used in play therapy. Sand play is a method of therapy that was developed in the mid-twenties by the English Paediatrician Dr. Margaret Lowenfeld. Lowenfeld, like Klein, Freud and Winnicott understood that children need tools other than language to communicate and make sense of their experiences. It consists of a tray with sand in it and a sufficient number of toys or miniatures so that the child can create a world of their own. As an expressive technique which is not dependent on verbal ability, sand play offers the three year old an age appropriate method for self-expression and therefore, self understanding through self-confidence. Goals for therapy are matched so that the child experiences one-on-one weekly therapy and ongoing classroom work that helps them successfully deal with separation, socialization, self-esteem and motivation. As the children develop a language of toys, they play out fantasy solutions and try out new skills that help them adjust to the emotional demands of school. This encourages them to enjoy the learning process. As children learn to overcome their fears and frustrations, they begin to have energy available for classroom learning. The severity of the block to learning needs to be analysed and addressed both in sand play therapy and in the academic environment.
Art is a method used by play therapists when treating adolescences and children. Through creation of art and discussing art with a therapist, the patient can cope with stress and traumatic experiences as well as enjoying the pleasures of artistic creativity. Therapists often use art when talking one-on-one to adolescence and children. While each drawing is individually configured and unique in meaning, common pictorial symbols and metaphors of human figures and animals, place and weather and toys and games usually convey fairly general meanings. (Davenport, 1994) For example a child may draw a soldier to symbolise conflict or aggression. Negative feelings can be displaced onto pictures or imaginary people, for example a doll. A doll is not just another toy; it is another character in a child's life. The magic of a child's love for the doll endures long after she has ceased to play with it.
REFERENCE
* Beck, A (2001) Cognitive Therapy and the Emotional Disorders. UK: Penguin Books Ltd
* Carlson, N.R. and Martin, G.N. and Buskist, W. (2004) Psychology. Massachusetts: Allyn and Bacon
* Comer, R.J. (2001) Abnormal psychology. (4th ed). New York: Worth
* Davenport, G.C. (1994) An Introduction to Child Development. London: Harper Collins
* Erikson, E.H. (1974) Dimensions of a New Identity. New York: Norton.
* Eyenck, M.W. (2004) Psychology. New York: Psychology Press Ltd
* http://mentalhealth.about.com/cs/psychotherapy/a/cogtx.htm (06/12/2005 : 1500)
* Lindon, J (2001) Understanding Child's Play. UK: Nelson Thorns Ltd
* Schultz D.P. & Schultz S.E. (1987) A History of Modern Psychology. Orlando, Florida: Harcourt-Brace.
* Seligman, M (1991) Helplessness: on depression, development and death. New York: Academic Press
* Seligman, M (1993) Learned Helplessness: A theory for the Age of Personal Control. New York: Oxford University Press
* Shur, E.M. (1971) Labelling Deviant behaviour: Its sociological implications. New York: Harper and Row
* Woolfolk, A.E. (1987). Educational Psychology, (3rd ed). New Jersey: Simon and Schuster.
