Mental Disorders

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 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.

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