Psychological Disorders: Crash Course Psychology #28

Summary

This script recounts the history and evolution of mental health treatment and diagnosis, from Nellie Bly's undercover expose in 1887 to David Rosenhan's 'On Being Sane in Insane Places' experiment in 1975. It discusses the medical model, the biopsychological approach, and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), highlighting the complexities and challenges in defining and treating psychological disorders.

Takeaways

• 🕵️ Nellie Bly's undercover investigation in 1887 exposed the deplorable conditions in US asylums, leading to mental health reform.
• 📜 David Rosenhan's 1975 experiment 'On Being Sane in Insane Places' revealed the ease of being admitted to a mental institution and the difficulty of being recognized as mentally healthy.
• 💊 Rosenhan's participants were forced to take psychotropic medication and were discharged with a diagnosis of paranoid schizophrenia in remission, highlighting flaws in the diagnostic system.
• 🤔 Rosenhan's experiment raised questions about the definition, diagnosis, and classification of mental disorders, and the impact of diagnostic labeling.
• 🌐 The World Health Organization reported in 2010 that 450 million people worldwide suffer from mental or behavioral disorders, emphasizing the global reach of these conditions.
• 🏥 Psychological disorders are viewed as deviant, distressful, and dysfunctional patterns of thoughts, feelings, or behaviors within a cultural context.
• 🧬 The Biopsychological Approach considers a holistic view of mental health, incorporating psychological, biological, and social-cultural factors.
• 📚 The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a work in progress, evolving with new research and understanding of mental health.
• 🔄 Changes in the DSM reflect societal and scientific advancements, such as the removal of homosexuality as a pathology and the renaming of Childhood Bipolar Disorder.
• 🚫 Critics argue that the DSM may inadvertently promote over- or mis-diagnosis and treatment of certain behaviors, and reinforce stigmatizing labels.
• 🌟 The script emphasizes the importance of understanding the definitions and perspectives on mental illness, as well as the ongoing evolution of diagnostic tools like the DSM.

Q & A

Who was Nellie Bly and what did she do to expose the conditions in psychiatric hospitals?

Nellie Bly was the alias of journalist Elizabeth Cochran. She feigned mental illness to infiltrate and report on the deplorable conditions inside psychiatric hospitals, known as asylums, in the US. Her exposé 'Ten Days in a Mad House' detailed rotten food, cold showers, rats, abusive nurses, and patients being tied down, which contributed to mental health reform.

What was the significance of David Rosenhan's experiment 'On Being Sane in Insane Places'?

David Rosenhan's experiment aimed to test the validity of psychiatric diagnoses by sending pseudopatients—mentally sound individuals—to psychiatric institutions. Once admitted, they behaved normally, but it was difficult for them to be recognized as healthy and discharged, highlighting flaws in the system and the ease of misdiagnosis.

What was the average duration of stay for Rosenhan's pseudopatients in the psychiatric institutions?

The pseudopatients were kept in the institutions for an average of 19 days, with one participant staying for as long as 52 days.

How did Rosenhan's experiment challenge the psychiatric system's view of mental illness?

Rosenhan's experiment criticized the system for viewing mental illness as an irreversible condition akin to a personality trait rather than a curable illness. It also questioned the validity of diagnostic labels and the impact of situational factors on diagnoses.

What is the Biopsychological Approach to understanding mental health?

The Biopsychological Approach is a comprehensive perspective that considers psychological, biological, and social-cultural factors to understand mental health. It acknowledges that mental disorders can have physiological causes and can be influenced by stress, trauma, genetics, brain chemistry, and cultural norms.

What is the DSM-5 and why is it significant in the field of psychology?

The DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, is a manual published by the American Psychiatric Association. It is significant because it provides standardized criteria for the diagnosis of mental disorders and is used by clinicians, insurance companies, policymakers, and the legal system.

How has the DSM evolved over time to reflect changing attitudes and understanding of mental health?

The DSM has evolved with each edition to incorporate new research and societal attitudes. For example, homosexuality was classified as a pathology in earlier editions but was removed in the 1973 edition, reflecting a growing understanding and acceptance of sexual orientation.

What are some criticisms of the DSM and its use in diagnosing mental disorders?

Critics argue that the DSM may inadvertently promote over-diagnosis or mis-diagnosis of certain behaviors. There are also concerns that diagnostic labels can lead to stigmatization and preconceived judgments about individuals, affecting how they are perceived and treated.

What is the definition of psychological disorders according to mental health clinicians?

Psychological disorders are defined as deviant, distressful, and dysfunctional patterns of thoughts, feelings, or behaviors that differ from the cultural norm, cause subjective distress, and impair a person's ability to function in their daily life.

How did the concept of mental health and psychological disorders evolve in the Western world?

The concept evolved from viewing mental health issues as a sickness of the mind during the 18th and 19th centuries to the Medical Model of Psychological Disorder, which suggests physiological causes for mental disorders. This was further expanded by the Biopsychological Approach, which considers a holistic view of influences on mental health.

What is the impact of cultural context on the perception and treatment of psychological disorders?

Cultural context plays a significant role in defining what is considered deviant behavior and how it is perceived. What might be acceptable or expected in one culture could be seen as abnormal or distressing in another, affecting diagnosis and treatment approaches.

Outlines

00:00

🔍 Nellie Bly's Asylum Expose and Mental Health Reform

This paragraph recounts Nellie Bly's undercover investigation into the deplorable conditions of psychiatric hospitals in 1887, under the guise of a mentally ill patient. She documented unsanitary food, cold showers, rampant rats, abusive staff, and the inhumane treatment of patients in her groundbreaking work 'Ten Days in a Mad House.' Her findings, which exposed the standard practices of mental health treatment for centuries, sparked significant reforms in the mental health system. The narrative then transitions to David Rosenhan's 1975 experiment, 'On Being Sane in Insane Places,' where he and seven others feigned hearing voices to gain admission to psychiatric institutions. Once inside, they ceased their symptoms and behaved normally, yet were still diagnosed with schizophrenia and kept for an average of 19 days. Rosenhan's experiment highlighted the difficulty of distinguishing between genuine mental health issues and the influence of situational factors on diagnosis.

05:03

📚 The Evolution of Mental Health Understanding and the DSM-5

This paragraph delves into the historical development of the Western world's understanding of psychological disorders, from the 18th and 19th centuries when the medical model of psychological disorder began to take shape, to the more recent biopsychological approach that considers a comprehensive range of biological, psychological, and social-cultural factors. It discusses the shift from viewing mental health issues as moral failings to recognizing them as medical conditions, and the subsequent move towards a more holistic understanding of mental health. The paragraph also introduces the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a tool used for diagnosing mental disorders, which is designed to evolve with ongoing research and societal changes. It notes the manual's history, including the controversial classification of homosexuality as a disorder in earlier editions, and its current efforts to reflect a more nuanced understanding of mental health, including the renaming of certain disorders and the consideration of emerging conditions like Internet Gaming Disorder.

Keywords

💡Nellie Bly

Nellie Bly was the alias of Elizabeth Cochran, a journalist who famously feigned mental illness to expose the deplorable conditions in psychiatric hospitals during the late 19th century. Her undercover work led to significant mental health reforms and is a central narrative in the video's exploration of the history of mental health treatment.

💡Psychiatric institutions

Psychiatric institutions, historically known as asylums, are facilities where individuals with mental health issues are treated. The script discusses the evolution of these institutions from places with poor conditions to more modern settings, highlighting the investigative work of Nellie Bly and David Rosenhan within these establishments.

💡Mental health reform

Mental health reform refers to the changes and improvements made to the treatment and understanding of mental health conditions. The video underscores the impact of Nellie Bly's expose and subsequent efforts to improve conditions and treatment methods within psychiatric institutions.

💡David Rosenhan

David Rosenhan was an American psychologist who conducted an experiment to test the validity of psychiatric diagnoses. His paper, 'On Being Sane in Insane Places,' is mentioned in the script as a pivotal moment that questioned the reliability of mental health diagnoses and the ease of admitting and discharging patients.

💡Pseudopatients

Pseudopatients are individuals who pretend to have symptoms of a mental disorder as part of an experiment or study. In Rosenhan's study, he used pseudopatients to demonstrate that once admitted to a psychiatric institution, it was difficult for them to be recognized as mentally healthy and discharged.

💡Psychotropic medication

Psychotropic medication refers to drugs that affect a person's mental state, often prescribed for mental health conditions. The script mentions that participants in Rosenhan's experiment were forced to take such medication, which they secretly avoided, highlighting the coercive nature of treatment within institutions.

💡Paranoid schizophrenia

Paranoid schizophrenia is a mental disorder characterized by delusions and hallucinations. In the script, it is noted that participants in Rosenhan's experiment were diagnosed with this condition, even though they were not actually suffering from it, illustrating the potential flaws in psychiatric diagnosis.

💡Diagnostic labeling

Diagnostic labeling is the process of assigning a specific diagnosis to a set of symptoms or behaviors. The video discusses the risks and benefits of this practice, emphasizing how labels can influence perceptions and treatments, as well as the potential for mis-diagnosis.

💡Biopsychological Approach

The biopsychological approach is a comprehensive perspective that considers biological, psychological, and social-cultural factors in understanding mental health. The script explains that this approach moves beyond the medical model, offering a more holistic understanding of mental disorders.

💡Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM is a manual published by the American Psychiatric Association that provides standardized criteria for the diagnosis of mental disorders. The script discusses the DSM-5, its evolution, and its role in shaping the understanding and treatment of mental health conditions, including the potential for over- or mis-diagnosis.

💡Post-Traumatic Stress Disorder (PTSD)

PTSD is a mental health condition triggered by experiencing or witnessing a traumatic event. The script notes that the DSM-5 reflects an evolving understanding of PTSD symptoms, indicating the manual's adaptability to new research and insights into mental health.

Highlights

In 1887, Nellie Bly feigned mental illness to expose the deplorable conditions in US asylums.

Nellie Bly's exposé 'Ten Days in a Mad House' led to mental health reform.

David Rosenhan's 1975 experiment 'On Being Sane in Insane Places' questioned the validity of psychiatric diagnoses.

Pseudopatients in Rosenhan's experiment were admitted and misdiagnosed with schizophrenia despite behaving normally.

Rosenhan's experiment revealed the difficulty of discharging patients from mental institutions once admitted.

Mental health clinicians view psychological disorders as deviant, distressful, and dysfunctional patterns.

The Medical Model of Psychological Disorder suggests physiological causes for mental disorders.

The Biopsychological Approach considers psychological, biological, and social-cultural factors in mental health.

The DSM-5 is a work in progress, evolving with our understanding of mental health.

Homosexuality was once classified as a pathology in earlier DSM editions but was removed in 1973.

The DSM-5 reflects changes such as renaming Childhood Bipolar Disorder to Disruptive Mood Dysregulation Disorder.

Critics argue that the DSM may promote over- or mis-diagnosis of certain behaviors.

Rosenhan's experiment raised questions about the impact of diagnostic labeling on patients.

The World Health Organization reported in 2010 that 450 million people suffer from mental or behavioral disorders.

Cultural misconceptions and stigmas surrounding psychological disorders are part of the challenge faced by society.

The DSM-5 is used by various sectors including clinicians, insurance companies, and policy makers.

Transcripts

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.