Psychological Disorders: Crash Course Psychology #28


Transcript Provided by YouTube:

00:10
Way back in 1887, a journalist named Elizabeth Cochran assumed the alias Nellie Bly and feigned
00:16
a mental illness to report on the truly awful conditions inside psychiatric hospitals in
00:22
the US, which were known as asylums at the time. She found rotten food, cold showers,
00:27
prevalent rats, abusive nurses, and patients being tied down in her famous expose “Ten
00:33
Days in a Mad House”. What she documented had been pretty standard mental health treatment
00:38
for centuries, but her work led the charge in mental health reform.
00:42
It’s been a long battle.
00:43
Nearly a century later in 1975, American psychologist David Rosenhan published a paper called “On
00:49
Being Sane in Insane Places” detailing the experiment that he conducted on psychiatric
00:54
institutions themselves. The first part of his experiment involved sending pseudopatients
00:58
– a group of eight totally mentally sound associates, including David himself – to knock
01:03
on institution doors and falsely report that they’d been hearing voices. Once admitted,
01:08
the fake patients abandoned their fake symptoms and behaved as they normally did, waiting
01:12
for administrators to recognize them as mentally healthy.
01:15
Like Cochran, Rosenhan and his team learned that it’s easy to get into a mental institution,
01:20
but it is much, much harder to get out. The participants were kept in the institution
01:24
for an average of 19 days, one of them for 52 days. They were forced to take psychotropic
01:28
medication (which they sneakily spit out) and were eventually discharged with a diagnosis
01:33
of paranoid schizophrenia in remission. Of course, being dubbed in remission isn’t exactly
01:38
the same thing as being labeled sane, and that was just one of Rosenhan’s criticisms
01:42
of the system. It viewed mental illness as an irreversible condition, almost like a personality
01:48
trait, rather than a curable illness.
01:49
Part two of his experiment came later when Rosenhan shared his results with a teaching
01:54
hospital and then told the staff that he’d be sending more pseudopatients their way in
01:59
the next few months, and challenged them to detect the imposters. With that in mind, out
02:03
of 193 new patients, 41 were ferreted out as likely or suspected pseudopatients. The
02:09
thing is, Rosenhan never actually sent in any pseudopatients. In the end Rosenhan concluded
02:15
that the way people were being diagnosed with psychiatric issues often revealed less about
02:19
the patients themselves and more about their situation. Like, saying you’ve heard voices
02:24
one time might catch a doctors attention a lot more than weeks of normal behavior.
02:29
Naturally people criticized his methods and his findings, but his experiment raised a
02:33
lot of important questions like: How do we define, diagnose, and classify mental disorders?
02:38
At what point does sad become depressed? Or quirky become obsessive compulsive? Or energetic
02:43
become hyperactive? What are the risks and benefits of diagnostic labeling, and how does
02:47
the field keep evolving?
02:49
When people think of psychology they probably most often think about the conditions that
02:52
it’s been designed to understand, diagnose, and treat – namely psychological disorders.
02:58
From common problems that most of us will experience at some point in our lives to the
03:01
more serious dysfunctions that require intensive care. They’re a big part of what psychology
03:06
is here for and over the next several lessons we’re going to be looking at mental illness,
03:10
as well as wellness. How symptoms are diagnosed and what biological and environmental causes
03:15
may be at work. But, to grasp those ideas, we first have to find out how we came to understand
03:20
the idea of mental health itself and build a science around studying, discussing, and
03:25
caring for it.
03:26
In 2010, the World Health Organization reported that about 450 million people worldwide suffer
03:31
from some kind of mental or behavioral disorder. No society is immune from them, but when I
03:36
say psychological disorder I’m guessing some of you will conjure up all sorts of dramatic
03:39
images like diabolical criminals from Arkham Asylum or Hollywood stereotypes of various
03:45
eccentric, scary, or tragic figures. This roll call of one-sided stock images is part
03:50
of the problem our culture faces – the misconceptions and often destructive stigma associated with
03:55
psychological disorders.
03:56
So, what does that term actually mean?
03:59
Mental health clinicians think of psychological disorders as deviant, distressful, and dysfunctional
04:04
patterns of thoughts, feelings, or behaviors. And yeah, there are a lot of sensitive and
04:08
loaded words in there, so let’s talk about what we mean, starting with deviant.
04:12
Sounds like I’m talking about doing things that are dicey or raunchy, but in this context
04:16
it’s used to describe thoughts and behavior that are different from most of the rest of
04:20
your cultural context. Of course, being different is usually wonderful. Geniuses and Olympians
04:25
and visionaries are all deviants from the norm so it probably goes without saying that
04:29
the standards for so-called deviant behavior change a lot across cultures and in different
04:35
situations. For example, in a combat situation killing people is probably to be expected,
04:39
but murder is definitely deviant criminal behavior back home in times of peace. And
04:44
in some contexts speaking to spirits or ancestors is A-OK, but in other settings say a bar in
04:50
Iowa City at happy hour it might not be quite acceptable.
04:53
But, to be classified as a disorder, that deviant behavior needs to cause that person
04:57
or others around them distress, which just means a subjective feeling that something
05:02
is really wrong. In turn, distress can lead to truly harmful dysfunction – when a person’s
05:07
ability to work and live is clearly, often measurably, impaired.
05:10
So that’s today’s definition but it took a long time for the Western world to come up
05:14
with a way of thinking about psychological disorders that was rooted in science and investigative
05:20
inquiry. It wasn’t until around the 18th and 19th centuries that we really started to put
05:23
forth the notion that mental health issues might be about a sickness in the mind. For
05:28
example, by the 1800s doctors finally caught on to the fact that advanced syphilis could
05:32
manifest in serious neurological problems like dementia, and irritability, and various
05:37
mental disorders. So eventually a lot of so-called mental patients were removed from asylums
05:42
to full medical hospitals where all of their symptoms could be treated.
05:46
This “a-ha” moment is just one instance of how perspectives on mental health began to
05:50
shift towards what is called the Medical Model of Psychological Disorder. The Medical Model
05:56
champions the notion that psychological disorders have physiological causes that can be diagnosed
06:00
on the basis of symptoms, and treated, and sometimes even cured. That way of thinking
06:05
about mental health was an important step forward, at least at first. It took us past
06:08
the old days of simply locking people up when they didn’t seem quite right to others.
06:12
But even if it was an improvement, the medical model was seen by some in the field as kind
06:16
of narrow and outdated. Most contemporary psychologists prefer to view mental health
06:20
more comprehensively through what is called the Biopsychological Approach. You’ve heard
06:24
us say over and over again that everything psychological is simultaneously biological
06:28
and that truism is particularly useful here. The Biopsychological view takes that holistic
06:33
perspective, accounting for a whole number of things clearly physiological and not in
06:38
order to understand what’s happening to us, what might be going wrong, and how it can
06:42
be treated.
06:42
It takes into account psychological influences for sure like stress and trauma and memories,
06:47
but also biological factors like genetics and brain chemistry, and social-cultural influences
06:52
like all the expectations wrapped up in how a culture defines normal behavior. So by considering
06:57
the whole host of nature and nurture influences, we can take a broader view of mental health,
07:02
realizing that some disorders can be cured while others can be coped with, and still
07:05
others may end up not being disorders at all once our culture accepts them.
07:10
But another important part of handling disorders with scientific rigor is attempting to standardize
07:14
and measure them. How we talk about them, how we diagnose them, and how we treat them.
07:18
So the field has literally come up with a manual that shows you how to do that. But
07:23
it is not without it’s flaws. It’s called the American Psychiatric Association’s Diagnostic
07:28
and Statistical Manual of Mental Disorders; or, DSM-5 because it’s currently in its fifth
07:34
edition. And it is used by practically everybody: clinicians obviously, but also by insurance
07:39
and drug companies, and policy makers, and the whole legal system.
07:43
The first edition came out in 1952, and this newest version was released in 2013. What’s
07:48
particularly interesting about it is that it’s designed to be a work in progress…
07:53
forever. Each new edition incorporates changes based on the latest research but also how
07:58
our understanding of mental health and behavior evolves over time. For example, believe it
08:01
or not the first two editions actually classified homosexuality as a pathology, basically a
08:06
disease. The 1973 third edition eliminated that designation, reflecting changing attitudes
08:11
and a developing understanding of sexual orientation. And just by looking at the changes between
08:16
the edition used today and the previous version released in the year 2000, you can get a picture
08:21
not only of how quickly things change but also how classification can affect diagnosis
08:26
– for better or worse – and also what the risks are of classifying psychological disorders
08:31
in the first place.
08:31
For instance, the new edition reflects our growing understanding of the symptoms of Post
08:35
Traumatic Stress Disorder, and it changed the name of Childhood Bipolar Disorder to
08:39
Disruptive Mood Dysregulation Disorder because kids were being over-diagnosed and over-treated
08:45
for bipolar disorder when the condition that they had didn’t actually fit that description.
08:49
And totally new diagnoses are being explored as well, like Gambling Addiction and what’s
08:53
called Internet Gaming Disorder, showing that new disorders continue to arise with changing times.
08:58
But the DSM is not perfect, even though we’ve come a long way since the Rosenhan experiment,
09:03
critics still worry about how the DSM might inadvertently promote the over- or mis-diagnosis
09:08
and treatment of certain behaviors. Others echo Rosenhan’s concerns that by slapping
09:12
patients with labels we’re making them vulnerable to judgments and preconceptions that’ll affect
09:17
how others will perceive and treat them.
09:19
In the end, it’s just important to keep in mind that definitions are powerful and things
09:23
can get tricky pretty fast in the world of mental health.
09:25
Today you learned about how we define psychological disorders, and looked at medical and biopsychological
09:30
perspectives on mental illness. We talked about how professionals use the DSM to diagnose
09:35
disorders and how it’s constantly evolving to incorporate new thinking. Thanks for watching,
09:39
especially to all of you who are Subbable subscribers who make Crash Course possible.
09:43
To find out how you can become a supporter, just go to subbable.com.
09:46
This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant
09:50
is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins, the script supervisor
09:54
is Michael Aranda, who is also our sound designer. And the graphics team is Thought Cafe.


This post was previously published on YouTube.

Photo credit: Screenshot from video.

Back to Top