This is the 7th lecture of [[Keith Campbell]]’s [[PA Intro to Psychology]] course from [[Peterson Academy]]. This lecture is about [[Clinical Psychology|clinical psychology]] also known as abnormal psychology or the psychology of mental illness or psychopathology. There is a two-part series on Peterson Academy on [[PA Abnormal Psychology]] by [[Robert O. Phil]] that goes in depth on this. >[!note] Psychologists and Physicians >Mental health is as much an issue that psychologists deal with as it is for the physicians. >[!attention] Equivalent terms >Clinical psychology = Abnormal psychology; Mental illness = psychopathology ## What is psychopathology - The WWE definition for a mental disorder is that it is a clinically significant disturbance in **cognition**, **emotion**, or **behavior** in an individual. It is up to the practitioner to determine whether a disturbance is ‘clinically significant’ to the point of affecting a person’s regular functioning. - Another thing that determines the presence of a psychopathology is whether the observed disturbance in cognition, emotion or behavior is grounded in some underlying psychological, biological or developmental issue. - Mental illnesses cannot be culturally normative behavior. - Mental illnesses are not supposed to be conflicts between individual and society. - The full list of mental illnesses are outlined in the DSM by physicians. --- ## Axis 1 and 2 Disorders This is a simple and old way of categorizing mental illnesses into two big buckets. ### Axis 1 — Psychological Disease Thinking of mental illnesses like contracting a disease. Usually you are healthy, then one day you fall sick to a disease and you get treated for that disease. The mental illness is then treated like how a physician would treat a disease. ### Axis 2 — Personality Disorder Personality or character disorders are mental illnesses that are a result of an extreme or inflexible configuration of personality. Narcissistic Personality Disorder is one example of such. People have certain maladaptive personality configurations that end up growing into a disorder. ### What to make of this Recent views on mental illnesses are favoring the idea that most mental illnesses are more Axis 2 than Axis 1. People are wired a certain way, and different wirings when put under stress looks like different disorders. Diathesis-stress Model is one such theory that suggests that stress can push you into full blown disorder, but when the stress is taken care of you return to normal. --- ## Hierarchical Taxonomy of Psychopathology (HiTOP) This is an attempt to look at the landscape of psychopathologies not as a uniform group like the DSM, but as a hierarchy. ### P-factor — Overall factor This is the high order factor or what they call the factor of pathology (P-factor) which is comprised of things that lead to overall lower mental health. They are: - Impulsivity, fear, inability to control oneself - Antagonism or meanness - Introversion or social isolation - Psychotism—most likely low openness to experience accompanied with delusional beliefs ### Six Subfactors 1. Somatoform Spectrum - Conversion Disorder. Victorian Freudian Disorder. Something like hysterical blindness or paralysis. Maybe they are neurological. Not sure what to make of this. 2. Internalizing Disorders - Taking anger or other negative emotions and turning it towards the self. Expressed as depression, eating disorders etc. - Highly linked to neuroticism in terms of Big Five. - Largely has to do with mood or affect regulation. - Fear is often seen in these, with anxiety disorders—breaks down further into generalized anxiety disorder and free-floating anxiety disorders, phobias, panic disorders, and agoraphobia—fear of being in public spaces, could be conditioned by panic attacks. Phobias are treated with progressive desensitization. - Different kinds of depression: dysthymia—everyday depressive mood or depressive affect, and major depressive disorder. 3. Thought Disorders - Maniacs. Weird ideas, delusional beliefs - Major disorders are bipolar and schizophrenia. See below. 4. Disinhibited Externalizing Disorders - Impulsive externalizing - Mostly substance abuse and addictions, like drug, alcohol, gaming, gambling maybe porn. What qualifies as an addiction is hard to pin down. Is it about overuse, or feeling bad doing it? Both of those seem to matter. [[Jordan Peterson]] argued it is a problem when it is functionally impairing. 5. Antagonistic Externalizing Disorders - Externalizing that involves meanness. I immediately thought of egging someone’s house, or throwing a baseball through somebody’s window. - Antisocial disorders, narcissistic disorders, bleeds into criminality. 6. Detachment Disorders - Low extraversion, high introversion - Lack of joy, lack of reward. - Schizoid personality disorder—split between person and their affect. - Avoidant personality disorder—fear of attachment. >[!caution] Detachment disorders were initially proposed as introversion disorders, but that did not sit well with the Jungians. #### Major depressive disorder A kind of depression, which makes it a kind of internalizing disorder. It is accompanied with anhedonia—major drop in joy, lead to various issues like weight gain, sleep—either can’t sleep or can’t get out of bed, psychomotor issues like shakiness and fatigue, and feelings of worthlessness—which is why self-esteem works against depression, thinking and memory slowing down, and suicidal ideation. #### Bipolar Disorder Formerly known as manic depression. Maps onto both internalizing disorders and thought disorders as it involves both depression and mania. Manic episodes are spans of time where you are in a state of mania, feeling energized, has a bunch of ideas and spirals out of control to go do odd things. But when they come out of the episode their positive emotion collapses and feels awful. Bipolar 1 is the classic with full manic episodes; Bipolar 2 is characterized with milder manic episodes, but longer depression periods. #### Schizophrenia Thought disorder. Delusions of grandeur—"I am a great person," of paranoia, and of persecution. Characterized by hallucinations—more audio less visual, disordered thinking—word salads, neologism—making up new words, loose associations, odd or disordered laughter. Kicks in at 18, 19, 20s, this onset is called prodromal syndrome. Keith's guess is that there are a few different delusional disorders that are all labeled schizophrenia. #### Narcissistic Personality Disorder Outgoing, mean people that have a sense of entitlement and a sense of superiority over others on any dimension, and is willing to exploit or manipulate people. #### Borderline Personality Disorder Originally came from the idea of being right in between neurotic and psychotic. Today it is largely seen as a problem of emotional regulation, like the problem of managing anxiety or attachments which could lead to damaged relationships. It could go various other directions as well, like internalizing (ie cutting yourself). Keith thinks this can be broken down further to multiple disorders based on their various different expressions. --- ## Treatments ### Psychotherapy - Psychoanalysis - The talking cure: Just speak and do free association. - Dream analysis, and have dreams be a jumping point to free associate. - Transference - Cognitive behavioral therapy - Breaking down your thoughts and behaviors, figuring our habits and strategies as solutions - Dialectical behavioral therapy - For borderline personality disorder - Acceptance and commitment therapy - Just embracing reality ### Medication - Antidepressents - Selective serotonin reuptake inhibitors aka SSRIs - Benzodiazepines—anti-anxiety meds - Valium - Xanax - Klonopin ### Everyday practical changes Exercise, diet, sun, social or environment change. Alcohol Anonymous works great for alcoholics. Social groups just work great in general. [[Jordan Peterson]] has this checklist for keeping one's mental health in check that seems relevant here: 1. Do you have a job or are you in school? 2. Do you have at least one or two real friends? 3. Are you capable of intimate relationships? 4. Can you take care of yourself and your environment? 5. Are you avoiding compulsive escapism (addiction)? 6. Do you have a vision, goal, or higher aim? ### Psychotherapy - Electroconvulsive therapy (ECT) works well for extreme depression --- Back to: [[PA Intro to Psychology]] Previous Lecture: [[Love and Attraction]] Next Lecture: [[Social Navigation]]