way back in 1887, a journalist named elizabethcochran assumed the alias nellie bly and feigned a mental illness to report on the truly awfulconditions inside psychiatric hospitals in the us, which were known as asylums at thetime. she found rotten food, cold showers, prevalent rats, abusive nurses, and patientsbeing tied down in her famous expose "ten days in a mad house". what she documentedhad been pretty standard mental health treatment
crash diets used by models, for centuries, but her work led the chargein mental health reform. it's been a long battle. nearly a century later in 1975, american psychologistdavid rosenhan published a paper called "on being sane in insane places" detailing theexperiment that he conducted on psychiatric
institutions themselves. the first part ofhis experiment involved sending pseudopatients - a group of eight totally mentally soundassociates, including david himself - to knock on institution doors and falsely report thatthey'd been hearing voices. once admitted, the fake patients abandoned their fake symptomsand behaved as they normally did, waiting for administrators to recognize them as mentallyhealthy. like cochran, rosenhan and his team learnedthat it's easy to get into a mental institution, but it is much, much harder to get out. theparticipants were kept in the institution for an average of 19 days, one of them for52 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. ofcourse, being dubbed in remission isn't exactly the same thing as being labeled sane, andthat was just one of rosenhan's criticisms of the system. it viewed mental illness asan irreversible condition, almost like a personality trait, rather than a curable illness. part two of his experiment came later whenrosenhan shared his results with a teaching hospital and then told the staff that he'dbe sending more pseudopatients their way in the next few months, and challenged them todetect the imposters. with that in mind, out of 193 new patients, 41 were ferreted outas likely or suspected pseudopatients. the thing is, rosenhan never actually sent inany pseudopatients. in the end rosenhan concluded
that the way people were being diagnosed withpsychiatric issues often revealed less about the patients themselves and more about theirsituation. like, saying you've heard voices one time might catch a doctors attention alot more than weeks of normal behavior. naturally people criticized his methods andhis findings, but his experiment raised a lot of important questions like: how do wedefine, diagnose, and classify mental disorders? at what point does sad become depressed? orquirky become obsessive compulsive? or energetic become hyperactive? what are the risks andbenefits of diagnostic labeling, and how does the field keep evolving? when people think of psychology they probablymost 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 willexperience at some point in our lives to the more serious dysfunctions that require intensivecare. they're a big part of what psychology is here for and over the next several lessonswe're going to be looking at mental illness, as well as wellness. how symptoms are diagnosedand 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 builda science around studying, discussing, and caring for it. in 2010, the world health organization reportedthat 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 someof you will conjure up all sorts of dramatic images like diabolical criminals from arkhamasylum or hollywood stereotypes of various eccentric, scary, or tragic figures. thisroll call of one-sided stock images is part of the problem our culture faces - the misconceptionsand often destructive stigma associated with psychological disorders. so, what does that term actually mean? mental health clinicians think of psychologicaldisorders 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 aboutwhat we mean, starting with deviant. sounds like i'm talking about doing thingsthat are dicey or raunchy, but in this context it's used to describe thoughts and behaviorthat are different from most of the rest of your cultural context. of course, being differentis usually wonderful. geniuses and olympians and visionaries are all deviants from thenorm so it probably goes without saying that the standards for so-called deviant behaviorchange a lot across cultures and in different situations. for example, in a combat situationkilling people is probably to be expected, but murder is definitely deviant criminalbehavior back home in times of peace. and in some contexts speaking to spirits or ancestorsis a-ok, but in other settings say a bar in
iowa city at happy hour it might not be quiteacceptable. but, to be classified as a disorder, thatdeviant behavior needs to cause that person or others around them distress, which justmeans a subjective feeling that something is really wrong. in turn, distress can leadto truly harmful dysfunction - when a person's ability to work and live is clearly, oftenmeasurably, impaired. so that's today's definition but it took along time for the western world to come up with a way of thinking about psychologicaldisorders that was rooted in science and investigative inquiry. it wasn't until around the 18th and19th centuries that we really started to put forth the notion that mental health issuesmight be about a sickness in the mind. for
example, by the 1800s doctors finally caughton to the fact that advanced syphilis could manifest in serious neurological problemslike dementia, and irritability, and various mental disorders. so eventually a lot of so-calledmental patients were removed from asylums to full medical hospitals where all of theirsymptoms could be treated. this "a-ha" moment is just one instance ofhow perspectives on mental health began to shift towards what is called the medical modelof psychological disorder. the medical model champions the notion that psychological disordershave 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 stepforward, at least at first. it took us past
the old days of simply locking people up whenthey didn't seem quite right to others. but even if it was an improvement, the medicalmodel was seen by some in the field as kind of narrow and outdated. most contemporarypsychologists prefer to view mental health more comprehensively through what is calledthe biopsychological approach. you've heard us say over and over again that everythingpsychological is simultaneously biological and that truism is particularly useful here.the biopsychological view takes that holistic perspective, accounting for a whole numberof 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 influencesfor sure like stress and trauma and memories, but also biological factors like geneticsand brain chemistry, and social-cultural influences like all the expectations wrapped up in howa 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 curedwhile others can be coped with, and still others may end up not being disorders at allonce our culture accepts them. but another important part of handling disorderswith 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 amanual that shows you how to do that. but
it is not without it's flaws. it's calledthe 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 thewhole legal system. the first edition came out in 1952, and thisnewest version was released in 2013. what's particularly interesting about it is thatit's designed to be a work in progress... forever. each new edition incorporates changesbased on the latest research but also how our understanding of mental health and behaviorevolves over time. for example, believe it or not the first two editions actually classifiedhomosexuality as a pathology, basically a
disease. the 1973 third edition eliminatedthat 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 versionreleased in the year 2000, you can get a picture not only of how quickly things change butalso how classification can affect diagnosis - for better or worse - and also what therisks are of classifying psychological disorders in the first place. for instance, the new edition reflects ourgrowing understanding of the symptoms of post traumatic stress disorder, and it changedthe name of childhood bipolar disorder to disruptive mood dysregulation disorder becausekids were being over-diagnosed and over-treated
for bipolar disorder when the condition thatthey had didn't actually fit that description. and totally new diagnoses are being exploredas well, like gambling addiction and what's called internet gaming disorder, showing thatnew disorders continue to arise with changing times. but the dsm is not perfect, even though we'vecome a long way since the rosenhan experiment, critics still worry about how the dsm mightinadvertently promote the over- or mis-diagnosis and treatment of certain behaviors. othersecho rosenhan's concerns that by slapping patients with labels we're making them vulnerableto judgments and preconceptions that'll affect how others will perceive and treat them. in the end, it's just important to keep inmind that definitions are powerful and things
can get tricky pretty fast in the world ofmental health. today you learned about how we define psychologicaldisorders, and looked at medical and biopsychological perspectives on mental illness. we talkedabout how professionals use the dsm to diagnose disorders and how it's constantly evolvingto incorporate new thinking. thanks for watching, especially to all of you who are subbablesubscribers 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 editoris nicholas jenkins, the script supervisor is michael aranda, who is also our sound designer.and the graphics team is thought cafe.
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