PSYCHOLOGICAL DISORDERS / LECTURE OPENER SUGGESTIONS: Opening quotes: Madness need not be all breakdown. It may also be break-through.

R.D. Laing (1927-1982). You shall know the truth and the truth shall make you mad. Aldous Huxley (1894-1963) Opening artwork: Vincent Van Gogh (1853-1890) Corridor in the Asylum, 1889 Portrait of Van Gogh Henri Toulouse-Lautrec (1864-1901) OPENING THEMES: For many students, the topic of abnormal psychology represents the high point of the course; what they have been waiting to learn all semester. Therefore, engaging student interest in the topic should not be a problem at all. The challenge is choosing the topics to focus on in this very rich area of content. Working within the structure of the perspectives in psychology will make this content easier for students to grasp, because the basic parameters have already been laid down and developed in other chapters. Thus, presenting the possible causes for psychological disorders should be done in terms of those perspectives. In terms of presenting the disorders, it is crucial to emphasize the role of DSM-IV-TR (the most recent version) in setting the stage for reliable diagnoses. DSM-IV-TR also provides a good organizing structure to use in presenting the disorders. Although there will not be time to devote sufficient attention to all disorders, you should be able to focus on one or two that are of particular interest to you to use in helping students gain a conceptualization of disorders as having multiple causes (and, in the next chapter) multiple approaches to treatment. KEY CONCEPTS Historical perspectives Definitions of abnormality Models of abnormal behavior DSM-IV-TR Anxiety disorders Somatoform disorders Dissociative disorders Mood disorders Schizophrenia Personality disorders Prologue: Chris Coles Looking Ahead MODULE 37: NORMAL VERSUS ABNORMAL: MAKING THE DISTINCTION Defining Abnormality Identifying Normal and Abnormal Behavior: Drawing the Line on Psychological Disorders Perspectives on Abnormality: From Superstition to Science The Medical Perspective The Psychoanalytic Perspective The Behavioral Perspective The Cognitive Perspective 1

The Humanistic Perspective The Sociocultural Perspective Classifying Abnormal Behavior: The ABCs of DSM DSM-IV-TR: Determining Diagnostic Distinctions Conning the Classifiers: The Shortcomings of DSM-IV-TR How can we distinguish normal from abnormal behavior? What are the major perspectives on psychological disorders used by mental health professionals? What classification system is used to categorize psychological disorders? Applying Psychology in the 21st Century Suicide Bombers: Normal or Abnormal? Learning Objectives: 37-1 Discuss the various approaches to defining abnormal behavior. 37-2 Describe and distinguish the various perspectives of abnormality, and apply those perspectives to specific mental disorders. 37-3 Describe the DSM-IV-TR and its use in diagnosing and classifying mental disorders. Student Assignments: Interactivity 61: DSM-IV-TR Students answer questions about the DSM-IV-TR organization and usage. Views on Psychological Disorders Have students complete Handout 12-1, a survey of views on psychological disorders. Perspectives on Abnormality Ask students the following questions: 1. How does the medical perspective of abnormality compare with the behavioral neuroscience perspective in psychology? How are they the same and how are they different? 2. If you were a mental health professional, how would you integrate the best of each perspective in treating your clients? 3. Which perspective is the DSM-IV-TR most closely associated with? Library Research on the DSM-IV-TR Send students to the library (or other source) to look at the DSM-IV-TR. Ask them these questions: 1. How do you feel about the idea of categorizing psychological disorders as is done in the DSM-IV-TR? 2. What was the scientific basis for the DSM-IV-TR? 3. How does the DSM-IV-TR differ from earlier DSMs? 4. What do you think is the most intriguing disorder in the DSM-IV-TR? Lecture Ideas: Summary of History of Mental Illness: Prehistoric times: Demonic possession was thought to cause psychological disorders. Based on evidence of trephined skulls, it was thought that prehistoric people tried to release the evil spirits by drilling a hole in the skull. 2

Ancient Greece and Rome: The scientific approach emerged. The Greek physician Hippocrates sought a cause within the body. This approach continued through Roman times with the writings of the physician Galen. Middle Ages: Return to belief in spiritual possession and attempts to exorcise the devil out of the mentally ill. The mentally ill were thrown into prisons and poorhouses. Renaissance: First hospital to house the mentally ill was builtSt. Marys Hospital in Bethlehem (London). Attempts to provide more humane treatment. Witch hunts took place starting in the 1500s and continued through the 1700s. 1700s: Asylums again became overcrowded and conditions deteriorated. By the 1700s, St. Marys was known as bedlam. 1800s: Reform movements began in Europe and the United States: Benjamin Rush attempted to devise new methods of treatment (the tranquilizing chair) based on scientific method. Dorothea Dix, a Massachusetts schoolteacher, originated the state hospital movement as a means of providing moral treatment. Early to mid 20th century: Overcrowding again became prevalent in state mental hospitals. Extreme measures of treatment were used that were thought by many to be inhumane. Era of deinstitutionalizationlate 20th century: Invention of antipsychotic medications in the 1950s made it possible for people with severe disorders to live outside institutions. President Kennedy called for community mental health centers. However, this has not been completely effective as the problem of homelessness has arisen. The Insanity Defense (from Pettijohns Connectext) As discussed in the text, it is difficult to define abnormal behavior. The issue becomes even more complicated when questions are raised in a court of law about a defendants mental condition at the time he or she is alleged to have committed a crime. When the defendant pleads not guilty by reason of insanity, the court must assess his or her mental condition. The issue of insanity is decided by a judge or jury after listening to testimony of experts, who are usually psychologists or psychiatrists. It is important to remember that in a court, the concept of insanity is legal rather than psychological. The insanity plea is used in situations where the defendant is judged to be incapable of knowing right from wrong because of a mental disorder. Although psychologists may examine the individual and testify in court, the final decision is a legal one, made by the courts based on legal precedent. As you are probably aware, even the experts are not in agreement over insanity as a legitimate defense. In some cases, insanity is used as a means to avoid prosecution. Normally, if 3

one is judged insane, he or she is committed to a mental hospital until cured. If later judged sane, he or she is set free, sometimes after only a light sentence. One proposal is to replace the verdict of not guilty by reason of insanity with the verdict of guilty but mentally ill. Individuals found guilty but mentally ill would be given the proper psychotherapy to treat their mental disorders, and when they were judged sane, they would be returned to prison to complete their sentences. A related issue is the ability of the defendant to stand trial. In order to be brought to trial, an individual must understand the charge against him or her and be able to prepare a proper defense with a lawyer. Many times, instead of standing trial, the defendant is judged incompetent to stand trial and is committed to a mental institution for treatment. After being confined for a period of time, he or she is released if judged competent. Unfortunately, it is difficult to predict the future behavior of such a person. More research needs to be conducted on the application of psychological determinations to legal proceedings. Madness and Creativity: The Case of Vincent Van Gogh The case of Vincent van Gogh (1853-1890) provides an excellent opportunity to discuss the relationship between madness and creativity. Van Gogh is generally considered the greatest Dutch painter after Rembrandt. His reputation is based largely on the works of the last three years of his short, 10-year painting career, and he had a powerful influence on expressionism in modern art. He produced more than 800 oil paintings and 700 drawings, but he sold only one during his lifetime. His striking colors, coarse brushwork, and contoured forms display the anguish of the mental illness that drove him to suicide. Illustrate his case with examples of his late art works, completed while he was a patient at the asylum in St. Remy. Discuss the diagnoses that have been ascribed to Van Gogh over the years. They are as follows: 1. Epilepsy 2. Schizophrenia 3. Suppressed form of epilepsy 4. Episodic twilight states 5. Epileptoid psychosis 6. Psychopathy 7. Psychosis of degeneration 8. Schizoform reaction 9. Cerebral tumor 10. Active luetic schizoid and epileptoid disposition 11. Phasic schizophrenia 12. Dementia praecox 13. Meningo-encephalitis luetica 14. Psychotic exhaustion caused by creative effort 15. Atypical psychosis heterogeneously compounded of elements of epileptic and schizoid disposition. 16. Phasic hallucinatory psychosis. 17. Neurasthenia 18. Chronic sunstroke and the influence of yellow. 19. Psychomotor epilepsy 20. Dromomania 21. Maniacal excitement 22. Turpentine poisoning 23. Hypertrophy of the creative forces 4

24. Acute mania with generalized delirium 25. Epileptic crises and attacks of epilepsy 26. Glaucoma 27. Frontotemporal dementia 28. Xanthopsia caused by digitalis (as treatment for mania)seeing the world through a yellow haze. Numerous web sites discuss Van Goghs condition and possible diagnoses; http://www.psych.ucalgary.ca/PACE/VA-Lab/AVDE-Website/VanGogh.html http://www.uchsc.edu/news/bridge/2003/jan1/art1.html Most recently, this diagnosis was published in The American Journal of Psychiatry:
Vincent van Gogh (1853-1890) had an eccentric personality and unstable moods, suffered from recurrent psychotic episodes during the last 2 years of his extraordinary life, and committed suicide at the age of 37. Despite limited evidence, well over 150 physicians have ventured a perplexing variety of diagnoses of his illness. Henri Gastaut, in a study of the artists life and medical history published in 1956, identified van Goghs major illness during the last 2 years of his life as temporal lobe epilepsy precipitated by the use of absinthe in the presence of an early limbic lesion. In essence, Gastaut confirmed the diagnosis originally made by the French physicians who had treated van Gogh. However, van Gogh had earlier suffered two distinct episodes of reactive depression, and there are clearly bipolar aspects to his history. Both episodes of depression were followed by sustained periods of increasingly high energy and enthusiasm, first as an evangelist and then as an artist. The highlights of van Goghs life and letters are reviewed and discussed in an effort toward better understanding of the complexity of his illness.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=PubMed&list_uids=11925286&dopt=Abstract Blumer, D. (2002). The illness of Vincent Van Gogh. American Journal of Psychiatry, 159, 519-526. The Medical Perspective: Genes and Depression NIMH Report: Gene More Than Doubles Risk of Depression Following Life Stresses Among people who suffered multiple stressful life events over 5 years, 43 percent with one version of a gene developed depression, compared to only 17 percent with another version of the gene, say researchers funded, in part, by the National Institute of Mental Health (NIMH). Those with the short, or stress-sensitive, version of the serotonin transporter gene were also at higher risk for depression if they had been abused as children. Yet no matter how many stressful life events they endured, people with the long, or protective, version experienced no more depression than people who were totally spared from stressful life events. The short variant appears to confer vulnerability to stresses, such as loss of a job, breaking up with a partner, death of a loved one, or a prolonged illness, report Drs. Avshalom Caspi and Terrie Moffitt, University of Wisconsin and Kings College London, and colleagues, in the July 18, 2003, Science. The serotonin transporter gene codes for the protein in neurons, brain cells, that recycles the chemical messenger after its been secreted into the synapse, the gulf between cells. Since the most widely prescribed class of antidepressants act by blocking this transporter protein, the gene has been a prime suspect in mood and anxiety disorders. Yet, its link to depression eluded detection in eight previous studies. 5

We found the connection only because we looked at the study members stress history, noted Moffitt. She suggested that measuring such pivotal environmental eventswhich can include infections and toxins as well as psychosocial traumasmight be the key to unlocking the secrets of psychiatric genetics. Although the short gene variant appears to predict who will become depressed following life stress about as well as a test for bone mineral density predicts who will get a fractured hip after a fall, its not yet ready for use as a diagnostic test, Moffitt cautioned. If confirmed, it may eventually be used in conjunction with other, yet-to-be-discovered genes that predispose for depression in a gene array test that could help to identify candidates for preventive interventions. Discovering how the long variant exerts its apparent protective effect may also lead to new treatments, added Moffitt. Everyone inherits two copies of the serotonin transporter gene, one from each parent. The two versions are created by a slight variation in the sequence of DNA in a region of the gene that acts like a dimmer switch, controlling the level of the genes turning on and off. This normal genetic variation, or polymorphism, leads to transporters that function somewhat differently. The short variant makes less protein, resulting in increased levels of serotonin in the synapse and prolonged binding of the neurotransmitter to receptors on connecting neurons. Its transporter protein may thus be less efficient at stopping unwanted messages, Moffitt suggests. Moffitt and colleagues followed 847 Caucasian New Zealanders, born in the early l970s, from birth into adulthood. Reflecting the approximate mix of the two gene variants in Caucasian populations, 17 percent carried two copies of the stress-sensitive short version, 31 percent two copies of the protective long version, and 51 percent one copy of each version. Based on clues from studies in knockout mice, monkeys, and functional brain imaging in humans, the researchers hypothesized that the short variant predisposed for depression via a gene-by-environment interaction. They charted study participants stressful life events employment, financial, housing, health and relationship woesfrom ages 21 to 26. These included debt problems, homelessness, a disabling injury, and being an abuse victim. Thirty percent had none, 25 percent one, 20 percent two, 11 percent three, and 15 percent four or more such stressful life experiences. When evaluated at age 26, 17 percent of the participants had a diagnosis of major depression in the past year and three percent had either attempted or thought about suicide. Although carriers of the short variant who experienced four or more life stresses represented only 10 percent of the study participants, they accounted for nearly one quarter of the 133 cases of depression. Among those with four or more life stresses, 33 percent with either one or two copies of the short variantand 43 percent of those with two copies of the short variantdeveloped depression, compared to 17 percent of those with two copies of the long variant. The stressful life events led to onset of new depression among people with one or two copies of the short gene variant who didnt have depression before the events happened. The events failed to predict a diagnosis of new depression among those with two copies of the long variant. Among those who had experienced multiple stressful events, 11 percent with the short variant thought about or attempted suicide, compared to 4 percent with two copies of the long variant. These self-reports were corroborated by reports from participants loved ones. The researchers suggest that effects of genes in complex disorders like psychiatric illnesses are most likely to be uncovered when such life stresses are measured, since a genes effects may only be expressed, or turned on, in people exposed to the requisite environmental risks. 6

http://www.nimh.nih.gov/events/prgenestress.cfm The DSM-IV-TR Summarize the 5 axes of the DSM-IV-TR: (an axis is a diagnostic dimension) 1. Primary disordersyndromes, like illnesses 2. Long-standing personality problems 3. Physical disorders or illnesses 4. Severity of stressors 5. Level of functioning over past year Summarize the assumptions of the DSM-IV-TR: descriptive need for standardized language Present two areas of criticism of the DSM-IV-TR: descriptive dimensional ratings may be preferable Media Presentation Ideas: Media Resources DVD: History of Mental Illness (6:01) Outstanding video presenting a summary of beliefs about the causes of psychological disorders from ancient times to the present. Media Resources DVD: Alcohol Addiction (6:25) Show this segment to illustrate the role of the brain in psychological disorders involving substance abuse. Media Resources DVD: Freuds Contribution to Psychology (3:28)
Show this segment, which provides a summary of Freuds theory and a reenactment of his methods of treatment.

Slide Show: Vincent Van Gogh

On PowerPoint, display a collection of images from the latter years of Van Goghs life, at the same time playing the song Vincent by Don McLean. This is a very effective way to begin a discussion of Van Goghs art and madness. The Vincent Van Gogh museum online can be found at:

http://www.vangoghgallery.com/painting/main_az.htm

Overhead: Historical Perspectives on Abnormality Historical Views on Treatment of Mental Disorders Time Reformer Technique Purpose Stone Ages Trephining Drill hole in head to let evil spirits out of the body Fourth Century B.C. Hippocrates (460-377 B.C.) Rest, exercise, abstinence from alcohol and sex Restore balance of fluids, or humors, in body Fifteenth Century Exorcism, torture, hanging Release evil spirits Eighteenth Century Philippe Pinel (1745-1826) Reform at Bicetre Asylum in Paris, released patients from chains, classified different types of psychological disturbances Restore humanity to patients Nineteenth Century Dorothea Dix (1802-1887) Separated mentally ill from prisoners, established state mental hospital system Give good care Twentieth Century Clifford Beers (1876-1943) National Committee for Mental Hygiene (1909), research Improve conditions in mental hospitals

Eclectic orientation of therapists Return patients to society

Popular Movie: Historical Perspectives on Abnormality

One Flew Over the Cuckoos Nest is the classic depiction of life in a psychiatric hospital in the late 1950s, when ECT was used as punishment.

Overhead: Genetic Contributions to Depression

From the NIMH web sites description of the 2003 study on genes and depression, show this overhead: (http://www.nimh.nih.gov/events/prgenestress.cfm)

Overhead: Heritability of Schizophrenia This overhead provides support for genetic contributions to schizophrenia by showing the higher concordance rates with increasing familial relationships.

MODULE 38: THE MAJOR PSYCHOLOGICAL DISORDERS Anxiety Disorders Phobic Disorder Panic Disorder Generalized Anxiety Disorder Obsessive-Compulsive Disorder The Causes of Anxiety Disorders Somatoform Disorders Dissociative Disorders Mood Disorders Major Depression Mania and Bipolar Disorders Causes of Mood Disorders Schizophrenia Solving the Puzzle of Schizophrenia: Biological Causes Environmental Perspectives on Schizophrenia The Multiple Causes of Schizophrenia Personality Disorders Childhood Disorders Further Disorders What are the major psychological disorders? Learning Objectives: 38-1 Describe the anxiety disorders and their causes. 38-2 Describe the somatoform disorders and their causes. 38-3 Describe the dissociative disorders and their causes. 38-4 Describe the mood disorders and their causes. 38-5 Describe the types of schizophrenia, its main symptoms, and the theories that account for its causes. 38-6 Describe the personality disorders and their causes. Student Assignments: Interactivity 62: Schizophrenia Symptoms Students watch a brief video of an interview with a client who has schizophrenia and answer questions about the clients symptoms and other features of the disorder. Interactivity 63: Bipolar Disorder Symptoms Students watch a brief video of an interview with a client who has bipolar disorder and answer questions about the clients symptoms and other features of the disorder. Interactivity 64: Agoraphobia Symptoms Students watch a brief video of an interview with a client who has agoraphobia and answer questions about the clients symptoms and other features of the disorder. Interactivity 65: Borderline Symptoms Students watch a brief video of an interview with a client who has bipolar personality disorder and answer questions about the clients symptoms and other features of the disorder. 10

Perspectives on Specific Disorders Ask students the following questions: Choose the psychological disorder that is of greatest interest to you and answer these questions: 1. State which disorder it is and summarize its diagnostic criteria. 2. Explain why this disorder is considered abnormal behavior. 3. Compare two approaches to understanding this disorder (such as biological vs. sociocultural) and state which approach you prefer (and why). Abnormal Psychology in the Media Have students complete Handout 12-2 on representations of abnormality in the popular media. Movie Depictions of Psychological Disorders Ask students the following questions: 1. Describe a movie character who you think is a good example of a psychological disorder. 2. What disorder does this character represent? Why? 3. Do you think that the movie did a good job or a bad job of depicting this disorder? Why? 4. What impact do you think that movies can have on how people feel about psychological disorders? PowerWeb: Schizophrenia The Schizophrenic Mind, Sharon Begley, Newsweek, March 11, 2002. Recent movies and cases in criminal courts have brought the baffling illness schizophrenia to our attention. This article discusses what schizophrenia is and how it can be treated. Lecture Ideas: Summary of Disorders Provide brief summaries of the major disorders and their symptoms using the following guide: Major Diagnostic Categories: Use Figure 38-2 to provide an overview of the major disorders covered in the text. Anxiety disorders: Phobic disorder (specific phobia)intense and irrational fears. Panic disordersense of impending doom Generalized anxiety disorderlong-term consistent anxiety resulting in physiological problems Obsessive-compulsive disorderobsessions are recurring, irrational thoughts compulsions are repetitive, purposeless behaviors. (Note: Social Phobia is not covered) Somatoform disorders: Two major forms of somatoform disorder are: Hypochondriasisconstant fear of illness and physical sensations interpreted as signs of disease. Conversion disorderphysical disturbance with psychological cause. Dissociative disorders: Dissociative identity disorderformerly called multiple personality disorder, involves several alters and a host personality. 11

Dissociative amnesiaforgetting of personal events with no physiological cause. Dissociative fugueentering into an altered state of behavior or actions.

Mood disorders: Major depressive disorder: Unusually sad mood along with physiological symptoms, feelings of guilt, low self-esteem, and suicidality. Bipolar disorder (formerly manic depression): at least one period of mania, involving euphoria; may alternate with period of depressed mood. Schizophrenia Decline from previous level of functioning Disturbances of thought and language Delusions (false beliefs) Hallucinations (false perceptions) Emotional (affective) disturbance Withdrawal [In addition to these symptoms, there are five subtypes of schizophrenia (see Figure 38-7)] Personality Disorders: Symptoms: Little personal distress May lead seemingly normal lives Rigid, inflexible maladaptive personality traits Three types discussed in text: Antisocial personality disorderimpulsiveness, criminal behavior, lack of remorse. Borderline personality disorderinstability of self and relationships. Narcissistic personality disorderextreme preoccupation with ones own appearance, needs, and concerns. Forms of Specific Phobia Below are some of the less common but interestingly named phobias. See how many your students can guess (knowledge of Latin helps!!). Be careful, though, not to make fun of any of these phobias, as some students may actually have one of these, though the odds are low. More phobias can be found on this unauthorized but entertaining web site: http://www.phobialist.com/ AblutophobiaFear of washing or bathing AerophobiaFear of swallowing air AmbulophobiaFear of walking AnablephobiaFear of looking up AnemophobiaFear of wind AnthrophobiaFear of flowers ArachibutyrophobiaFear of peanut butter sticking to the roof of the mouth. ArithmophobiaFear of numbers AulophobiaFear of flutes AuroraphobiaFear of Northern Lights 12

BarophobiaFear of gravity BasophobiaFear of walking BatophobiaFear of being close to high buildings BibliophobiaFear of books BlennophobiaFear of slime BogyphobiaFear of the bogeyman CathisophobiaFear of sitting CatoptrophobiaFear of mirrors ChaetophobiaFear of hair ChionophobiaFear of snow ChromatophobiaFear of colors ChronophobiaFear of time ChronomentrophobiaFear of clocks CibophobiaFear of food ClinophobiaFear of going to bed CnidophobiaFear of string DeciophobiaFear of making decisions DendrophobiaFear of trees DextrophobiaFear of objects at the right side of the body DidaskaleinophobiaFear of school EisoptrophobiaFear of mirrors EleutherophobiaFear of freedom EosophobiaFear of daylight EpistemophobiaFear of knowledge ErgophobiaFear of work EreuthophobiaFear of the color red GeliophobiaFear of laughter GeniophobiaFear of chins GenuphobiaFear of knees GeumaphobiaFear of taste GnosiophobiaFear of knowledge GraphophobiaFear of writing HeliophobiaFear of the sun HelmintophobiaFear of being infested with worms HemophobiaFear of blood HippopotomonstrosesquippedaliophobiaFear of long words HomichlophobiaFear of fog HypnophobiaFear of sleep IchthyophobiaFear of fish IdeophobiaFear of ideas KainophobiaFear of anything new KathisophobiaFear of sitting down LachanophobiaFear of vegetables LeukophobiaFear of the color white LevophobiaFear of objects to the left side of the body LinonophobiaFear of string LogophobiaFear of words MelanophobiaFear of the color black MelophobiaFear of music MetrophobiaFear of poetry MnemophobiaFear of memories 13

MottephobiaFear of moths NebulaphobiaFear of fog NeophobiaFear of anything new NephophobiaFear of clouds NomatophobiaFear of names OctophobiaFear of the number 8 OmmetaphobiaFear of eyes OneirophobiaFear of dreams OphthalmophobiaFear of opening ones eyes OstraconophobiaFear of shellfish PanophobiaFear of everything PapyrophobiaFear of paper ParaskavedekatriaphobiaFear of Friday the 13th PeladophobiaFear of bald people PhengophobiaFear of daylight PhobophobiaFear of fear PhotophobiaFear of light PhronemophobiaFear of thinking PogonophobiaFear of beards SciophobiaFear of shadows ScolionophobiaFear of school SelenophobiaFear of the moon SiderophobiaFear of stars SitophobiaFear of food SophophobiaFear of learning StasibasiphobiaFear of walking ThaasophobiaFear of sitting TrichopathophobiaFear of hair TriskadekaphobiaFear of the number 13 VerbophobiaFear of words XanthophobiaFear of the color yellow Physician-Assisted SuicideRelationship to Major Depressive Disorder (from Pettijohns Connectext) The right of a terminally ill person to commit suicide with the assistance of a physician is currently a controversial issue in the United States. Suicide is often considered an abnormal behavior that should be prevented at all costs. There are suicide telephone hot-lines dedicated to persuading individuals from committing this act. Can suicide be viewed as a normal, rational behavior? Perhaps the strongest case could be made for terminally ill patients who experience extreme pain (Humphry, 1992). Many people now write living wills that dictate treatments to be given or refused in the event of a terminal illness. If a terminally ill person refuses treatment, this might be considered a type of passive suicide. More controversial is the situation in which a terminally ill person will not immediately die, but will have to endure a long period of pain and suffering. One alternative to this situation is assisted suicide, in which the individual is helped in the suicide by a physician. For the past decade, Jack Kevorkian, a Michigan retired pathologist, has been actively involved in assisted suicides and has lobbied to make assisted suicide legal for mentally competent individuals. Opponents argue that potential suicide victims are not mentally competent. Indeed, many terminally ill patients become severely depressed prior to accepting their situation. It is generally 14

assumed that depressed patients are not rational about suicide. Some people also voice concerns that if assisted suicide is sanctioned, there will be more pressure for the elderly to end their lives prematurely. Someone might not want to be a burden on others, or might believe that relatives dont want them around. The assisted suicide debate involves legal, medical, and psychological issues. The solution will not be easy, but will need the cooperation and understanding of many different factions. Reference Humphry, D. (1992). Rational suicide among the elderly. Suicides and Life-Threatening Behavior, 22, 125-129. Media Presentation Ideas: Media Resources DVD: Beautiful Minds: An Interview with John Nash and Son (8:40) An interview with Nobel prizewinning mathematician John Nash and son provides insight into the experience of schizophrenia. Media Resources DVD: Symptoms of Schizophrenia (3:35) Brief interview with a schizophrenic patient. Media Resources DVD: Depression: Theories and Treatments (4:02) Examines the causes of and medications for depression. Media Resources DVD: Bipolar Disorder (4:34) Case example of a man with bipolar disorder; includes methods of brain imaging. Media Resources DVD: Dysthymia (1:44) Interview of a patient with dysthymia. Media Resources DVD: PTSD (3:25) Interview of a patient with PTSD. Popular Movies and Television Shows The following are a list of films that portray characters with psychological disorders: Fatal Attraction: Borderline personality disorder As Good as it Gets; Matchstick Men: Obsessive-compulsive disorder Iris: Alzheimers Disease A Beautiful Mind: Schizophrenia (Media Resources has interview with Nash) Pollack: Depression (and alcohol abuse) Chicago: Antisocial personality disorder in females (very unusual!) King of Hearts: Mental illness and society Vertigo: Anxiety disorder (acrophobia) Benny and Joon: Schizophrenia What About Bob: Borderline personality disorder Fisher King: Schizophrenia Girl Interrupted: Borderline personality disorder (and/or depression) Gone With the Wind: Histrionic personality disorder Heavenly Creatures: Shared psychotic disorder The Hours: Major depressive disorder I Am Sam: Mental retardation Memento: Amnestic disorder 15

Sybil: Dissociative identity disorder Nurse Betty: Dissociative fugue Rain Man: Autistic disorder Single White Female: Borderline personality disorder The Virgin Suicides: Depression in teens The television program ER provided an excellent example of bipolar disorder in the character of Abbys (the nurse) mother, played by Sally Field. Forms of Phobia Show these terms and clip art illustrations for a variety of types of phobias: Panic Disorder Panic attacks occur without a specific trigger or stimulus Agoraphobia Fear of being in a situation in which escape is difficult, and in which help for a possible panic attack would not be available Fear of cats

Ailurophobia

Arachnophobia

Fear of spiders

Cynophobia

Fear of dogs

Equinophobia

Fear of horses

Insectophobia

Fear of insects

Ophidiophobia

Fear of snakes

Rodentophobia

Fear of rodents

Acrophobia

Fear of heights

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Brontophobia

Fear of thunder

Claustrophobia

Fear of small, enclosed spaces

Mysophobia

Fear of dirt

Nyctophobia

Fear of darkness

MODULE 39: PSYCHOLOGICAL DISORDERS IN PERSPECTIVE The Prevalence of Psychological Disorders: The Mental State of the Union The Social and Cultural Context of Psychological Disorders How prevalent are psychological disorders? What indicators signal a need for the help of a mental health practitioner? Exploring Diversity DSM and Cultureand the Culture of DSM Becoming an Informed Consumer of Psychology Deciding When You Need Help Learning Objectives: 39-1 Discuss the other forms of abnormal behavior described in the DSM-IV, the prevalence of psychological disorders, and issues related to seeking help. (pp. 495498) Student Assignments: Interactivity 66: Prevalence of Psychological Disorders Students answer questions about the prevalence of major psychological disorders. Web Research Send students to the Surgeon Generals Report on Mental Health http://www.surgeongeneral.gov/library/mentalhealth/home.html. This is an extensive web site with detailed information about the major psychological disorders. Give students instructions to report on a disorder that they personally found to be the most interesting. Review briefly the symptoms, causes, and prevalence of this disorder. Indicate how it differs among age-groups (children, teens, adults, older adults). What are the prospects for the future of finding a cure for this disorder? Lecture Ideas: Surgeons General Report As noted above, the Surgeon Generals Report contains a wealth of information (http://www.surgeongeneral.gov/library/mentalhealth/home.html). All material in this web site is 17

in the public domain. Reproduce summaries, figures, and tables either as handouts or as lecture overheads and slides. Information on Mental Illness from NIMH Extensive background information on mental illness can be found on this web site: http://www.nimh.nih.gov/publicat/index.cfm. This web site contains NIMH publications, including overheads, statistics, professional publications, and information for the public. Media Presentation Ideas: National Health Interview Survey (NHIS) Results The NHIS tracks the health of Americans. These overheads summarize findings from the portion of the survey concerning mental health (more details can be found at http://www.cdc.gov/nchs/about/major/nhis/released200303.htm#13.)

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