Psychological Disorders: Crash Course Psychology #28


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

About the author

Comments

  1. The problem is the labels as we see a prying public eye demanding mental illness on everybody and every given label to control them and imprison their lives (this is like a Bill of Attainder and corrupted blood to legislate a person into a non-person, that is like a slave, and outlaw status, that is a like a criminal, to be separated from citizenship and society): The Democrat Party did this to the newly elected President Donald J. Trump (Republican, elected businessman), with former speaker of the house Nancy Pelosi (Democrat, House of Representatives) threatening Trump in a public speech that wait till he sees the mental health laws that she is going to introduce to keep crazy people like him out of office, where it is crazy to not have a Democrat President from the Democrat political party in self-interested election rigging.

    This was illustrated in the Stanford Prison Experiment that was students at Stanford University playing the role of either guard or prisoner. Even though nobody committed a crime because of the labels they held in their minds the prisoners were being abused by the guards and the prisoners themselves became irrational. The labels were taken so seriously that even though the prisoners (who were non-convicted students) could leave at any time that they were making deals with the guards to let them go, such as giving up the pay they were getting for the experiment, and they just want to leave the experiment and go home. The Stanford Prison Experiment was terminated early, because it has degraded into the prisoners had their beds taken away, the guards were punishing them for little things to control them, and it was becoming wicked after only a few days, and all because of the labels. It was like the ideals of justice held in each mind were acted out, where the prisoners were acting out those labels as well as the guards; evil people deserve extra punishment from guards, and the criminals are irrational, thus irrational behavior becomes the prisoners.

    It is a death sentence (spiritual death to the community) to be required to see a mental health professional, because the labels criminalize people as outlaws with corrupted blood, and the society in its competitive nature loves to ruin people as competitors and adversaries themselves. If the health care professionals want to do something about this, then they are going to have to stop reporting to the police and stop taking prisoners, because they should be wearing policeman badges, because they are a feature of law and do practice forms of imprisonment. The trouble is they should also be reporting to the Supreme Court the names of their judges and court records to be constitutional in America, because all courts of law are inferior to the Supreme Court. It is not medicine, if your outcome is worse than before contact with a medical professional, because it is voodoo doctor stuff of sorcery and witchcraft to just harm people and leave their conditions worse than before.

  2. Hmm.. this seems to suit me but I don’t think that I have a specific trauma…I did witnessed.. something but I stopped having flashbacks about it
    But I do suffer from emotional neglect and abuse (not only against me)…I’ve all the symptoms for CPTSD except for specific flashbacks and nightmares
    Most nights I either don’t sleep or don’t dream.. and when I do have a nightmare it’s often about my future and future events I’m scared of.
    But sometimes I get "flashbacks" of certain situations [ often in form of a visualflashback (like in a movie) and I often remember how I felt back than and then feel the same emotions or depending on which situation this flashback is about even worse (involving the emotional neglect and abuse ) and all the other symptoms but that doesn’t happen that often and as I said.. it’s Not like 1 big scary trauma it’s more like a few not that bad ones.
    And also a lot of times I have thoughts (trauma related or not) that come back regularly and I can’t get them out of my head!! And when Im having a normal dream but something happens that I can’t control (like someone jumping up and down and either continuing with it or even going faster even tho I told them too stop) I freak out! I start to cry, scream and even have a panic attack IN the dream
    I also have other diseases.. such as Depression, anxiety, eating disorder etc
    IM SORRY FOR THIS LOOONG TEXT
    But…What could it be that I have?
    Im not seeing a therapist rn bc there are no good ones where i Iive

  3. The craziest person I know is a psychologist , She accused her dad of molesting her when he finally kicked her out of his house at the age of 23 , the truth came out a few years later, Her then psychologist talked her into going into the practice, Sounds like most psychologists are really screwed up people telling other people how to live their lives

  4. Am I the only one that gets excited when someone on YouTube says a place close to me lol when he said Iowa city I freaked out🤣

  5. It's messed up that psych-doctors are the only doctors that don't look at the organ they treat. (I think it was Daniel Amen who said this.) Why the hell wouldn't they look at brain scans???

  6. I have taken a look a look at some of the post here. It has helped me understand a very complex mental disorder is to diagnose . My wife was diagnosed with some form of schizophrenia in March of this year , after a 4 week internment at the hospital. This came about after a altercation with the social services who were trying to help our son with speech therapy . I also from the beginning of marriage notice my wife’s irrational behavior social withdrawal lack of enthusiasm fallouts house cleaning and looking after herself and the children. This and at least 3-4 psychotic events and her complete paranoid behavior towards me for hours every day for months and years made me make my decision to get My wife interned into the hospital base on the fact I had tried many times to ask her to seek help for what I thought was stress at the time. This backfired on me as my wife hated me for helping to incarcerate her. She was released and spent many months blaming me . Over the months her condition has worsened to point that the children and I were put into a refuge . I worked tirelessly to help my wife, but at every level she has refused to accept any diagnosis treatment or help. Along with her mother who believes her daughter to have no such illness, are now perusing me through the court to gain custody of the children. Was I right or wrong to do this it was out of sheer desperation I did this . I love her very much and it’s broken my heart I cannot help her . There is so much more to this story than I have the energy to write. Love to all Vaughan.

  7. Thank you! Diagnosis (labels) can be limiting and can be used to invalidate someone's truth and or abilities. Thank you for carrying the message with clear information and shedding light on this issue so we can work towards a solution.

  8. how they have diagnosed high funtioning autism has also met with critique. I take everything in psychology with a pinch of salt, taking in consideration its bias history in many area. not to mention I was misdiagnosed due to the lack of understanding health professionals about ASD and a lot of things, and then i found out i was definitely not alone. I can make a frikkin list of problems with the system. sigh. but we are slowly progressing.

  9. How does a doctor tell the difference between side effects of medication, and symptoms of the disorder? How does he know the difference between plain bad behavior, lack of discipline and evil, and psychological disorders? How doctors continue to diagnose people in distress with undetectable, non-scientific, made-up diagnoses, that can't be disproof? How do they work without being sued for lack of ethics? One day people will look to the DSM and to the psychiatric drugs with the same horror we look at lobotomy and 19th century asylums. I know at least a couple dozen people that have at least 3 different psychiatric diagnoses, but the only real problem they have is excessive violence, lack of self control and discipline, and just plain evil.

    You will never hear a psychiatrist or psychologist say, "you're not ADHD. You're just lazy." Or "You're not borderline, you're just evil/aggressive." You will also never hear a psychiatrist or psychologist say, "you're completely healthy. Sleep better, work less, take some time to rest, and you'll be fine." People come out of the clinic disappointed for not having a good excuse for their bad behavior.

  10. So something I got from here is that different cultures can think of each other as mentally ill because of how their culture behaves where people can say "oh the xz culture is a culture of mentally ill people" And I can say I heard people say something in this lines

  11. I am diagnosed with adhd. I probebly almost surely have social anxiety quiet borderline and or Cptsd they can be confusing and I am not getting help I also struggle with depressive episodes and an eating disorder alot

  12. Was the first joker you showed the Jack Nicholson one, and if so, was that a reference to how Nicholson was in Cuco's Nest?

  13. I’m a psych nurse student and we like to call the model associated with Mental I’ll Health the biopsychosocial model 👍

  14. Im no lawyer but well they still practice seclusion and restraints in Wisconsin psych hospitals state owned not private

  15. I have ADHD and I am always being told to try harder and how I'm not trying at all. I am also antisocial. I don't talk to people at all. My sister came and told me that some people thought that I was mute because I used to talk but not anymore.

  16. What is called mental illness is actually emotional illness unless there is brain damage. Tame the emotions and symptoms improve. For emotions the best treatment is psychocatalysis using a simple form of meditation over a term of two to five years and continued use thereafter.

  17. "When does sad become depressed?" Way out in the middle of 'the lines do not intersect'-land. "Sad" and "depressed" are totally unrelated.

  18. That whole thing about hearing one voice once becoming more important than weeks of normal behaviour is something I’ve been thinking a lot about recently. I kind of feel like there are some toxic communities online that almost promote mental illnesses? Like instead of saying “you should get help and feel better” they’re saying “everyone has a mental disorder. It’s nothing to be ashamed of.” And this really scares me bc it makes people who have a meltdown over a presentation worth 30% of their grade one time think they have a full blown anxiety disorder and that they should go on meds ASAP to ‘get better.’ Just because you feel sad doesn’t mean you have depression. Just because you feel anxious, doesn’t mean you have anxiety.
    And I know Hank was talking about doctors in that context but I’ve seen people, and myself too as a bit of a hypochondriac, do it to themselves.

  19. GG….
    How was mental health like in Bible times?

    Was it better?
    I think so… Because of spiritual thinking?
    Or walking by the spirit

    Oh lalalah

  20. What if you are a person who cannot have any type of relationships?
    You can only work at a job that keeps you completely isolated from people.
    Just making small talk will offend people. Then it will get you into trouble.
    What if you cannot keep a job. Much less a home?
    What would you call that?

  21. I think there needs to be a correction- In psychology, it would be called the "biopsychosocial model" not the biopsychological model.

  22. I prefer Chemical imballance or brain disorder it’s more specific. Mentally I’m fine and yes we all have behaviors

  23. 1: dsm book = damaged statistic misleading fake book ! Swindler work of fake psychiatrist liars ! Bunch of liars ! Read more dude

  24. Mental illness is not a joke. People think that hearing voices or talking to yourself makes the individual mentally ill. Not true. Also people stereotype individuals with mental illnesses as violent. People are dumb. They try to get ahead in life pointing a finger and just because they have some money they think the world revolves around them. I know plenty of people that are poor and are happy. Doctors make mistakes. That’s life. Maybe people should get to know people with a mental illness and stop being biased.

  25. I have OCD. I swear I'm not a villain. I just overthink (O) and overact(C) a lot more than others (D). The BIG words just scar people.

  26. Guys i want to ask something, it may not related to the vid. I don't know but i want to take an abnormal psychology couse and i decided to take it now, i'm only 13 y/o do you think my mind is in the right condition to take such a big course?

  27. When I get my mental disorder in from Amazon I am going to go down to my local pond and eat all those damn bullfrogs that keep me up at night

  28. Brainswashed innocent client with fake diagnostic describe ! Doctors = swindlers industry psychiatry = swindler selling liars talks !

  29. The Greens teach me more than my school teachers who happen to put all their efforts in making the content dull and boring.

  30. I often recognize something called "Joker Syndrome", the belief that mental disorders inherently make someone dangerous.

  31. I love Crash Course videos and I love that you guys made one on mental health. Thanks for sharing!

  32. and now in 2019 (but it's been around for a while) researches are learning how our biomes affect our mental health.

  33. Its kinda sick that they still strap People to beds even though atleast the People Ive met when Ive been sectioned who were strapped to beds get increasingly worse and tend to have a harder time being let out.

  34. One night in a mental institution for a lion is more than enough reason to not mess with millions of lambs in power.

  35. Nature goes on forever for everyone and everything to return as everyone and everything an infinite number of times.😢 😢 😢 Deal with it.

  36. It is hard to get out of mental institutions once in because people get paid to keep you in. The system is set up to make you crazy to justify their income and to sexual abuse crazy people who have no rights. The priest rapes devilish children.

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