College Level Abnormal Psychology

COLLEGE LEVEL Abnormal Psychology

Abnormal Psychology

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TABLE OF CONTENTS Preface........................................................................................................ 1 Chapter One: Historical and Current Paradigms of Abnormal Psychology .................................................................................................. 5 History of Mental Illness Paradigms ............................................................................... 5 Evolution of Mental Health Treatment Throughout History ......................................... 9 Models of Mental Illness in the Twentieth Century ...................................................... 12 Emergence of the DSM .................................................................................................. 16 Different Psychological Paradigms ................................................................................ 19 Sociological and Cultural Issues in Mental Illness ........................................................ 21 Key Takeaways ............................................................................................................... 24 Chapter One: Quiz ......................................................................................................... 25 Chapter Two: Mental Illness Diagnostic Testing ........................................ 28 Psychological Examination or Psychiatric Interview .................................................... 28 Personality Testing ........................................................................................................ 33 MMPI .......................................................................................................................... 33 The Sixteen Personality Factor Questionnaire or 16PF ................................................ 36 Cognitive Testing ........................................................................................................... 37 Intelligence Quotient Testing ..................................................................................... 37 Cognitive Questionnaires ........................................................................................... 38 Depression and Anxiety Screening Tests ...................................................................... 41 Tests for Dissociation ................................................................................................. 42 Neuropsychological Testing ....................................................................................... 43

Behavioral Testing ...................................................................................................... 44 Brain Imaging in Mental Illness .................................................................................... 45 Key Takeaways ............................................................................................................... 48 Chapter Two: Quiz ......................................................................................................... 49 Chapter Three: Mood Disorders ................................................................ 52 Epidemiology of Mood Disorders .................................................................................. 52 Etiology of Mood Disorders ........................................................................................... 53 Categorizing Mood Disorders ........................................................................................ 53 Bipolar Disorder............................................................................................................. 55 Major Depressive Disorder ............................................................................................ 57 Persistent Depressive Disorder ..................................................................................... 59 Cyclothymia ................................................................................................................... 60 Premenstrual Dysphoric Disorder ................................................................................. 61 Seasonal Affective Disorder ........................................................................................... 61 Postpartum Depression ................................................................................................. 63 Depression and Suicide ................................................................................................. 63 Key Takeaways ............................................................................................................... 66 Chapter Three: Quiz ....................................................................................................... 67 Chapter Four: Anxiety Disorders .............................................................. 70 Epidemiology ................................................................................................................. 70 The Science of Fear .........................................................................................................71 Etiology of Anxiety Disorders ........................................................................................ 73 Specific Phobias ............................................................................................................. 74 Social Anxiety Disorder ................................................................................................. 76

Panic Disorder................................................................................................................ 77 Agoraphobia ................................................................................................................... 79 Generalized Anxiety Disorder ........................................................................................ 81 Key Takeaways ............................................................................................................... 83 Chapter Four: Quiz ........................................................................................................ 84 Chapter Five: Obsessive-Compulsive-related Disorders ............................ 87 The Science of OCD-related Disorders .......................................................................... 87 Obsessive-Compulsive Disorder ....................................................................................88 Body Dysmorphic Disorder ........................................................................................... 91 Hoarding Disorder ......................................................................................................... 92 Trichotillomania ............................................................................................................ 93 Key Takeaways ............................................................................................................... 96 Chapter Five: Quiz ......................................................................................................... 97 Chapter Six: Trauma-related Disorders .................................................. 100 Types of Psychological Trauma ................................................................................... 100 The Biology of Trauma................................................................................................. 103 Post-traumatic Stress Disorder ....................................................................................110 Depersonalization and Derealization Disorder ............................................................ 112 Dissociative Amnesia .................................................................................................... 113 Dissociative Identity Disorder ...................................................................................... 115 Somatic Symptom Disorder .......................................................................................... 116 Illness Anxiety Disorder ............................................................................................... 118 Conversion Disorder ..................................................................................................... 119 Key Takeaways .............................................................................................................. 121

Chapter Six: Quiz ......................................................................................................... 122 Chapter Seven: Schizophrenia and related Psychotic Disorders ...............125 Epidemiology of Schizophrenia ................................................................................... 125 The Biological Phenomenon of Psychosis ................................................................... 125 Symptoms of Psychosis ................................................................................................ 128 Clinical Course of Schizophrenia ................................................................................. 130 Brief Psychotic Disorder .............................................................................................. 132 Delusional Disorder ..................................................................................................... 133 Key Takeaways ............................................................................................................. 136 Chapter Seven: Quiz......................................................................................................137 Chapter Eight: Substance Use Disorders ................................................. 140 Epidemiology of Substance Use Disorders.................................................................. 140 Etiology of Substance Use Disorder ............................................................................ 143 Tobacco Abuse .......................................................................................................... 144 Alcohol Abuse ........................................................................................................... 145 Marijuana Abuse ...................................................................................................... 146 Opioid Abuse ............................................................................................................ 147 Amphetamine Abuse ................................................................................................ 148 Cocaine Abuse........................................................................................................... 149 Sedative Abuse ........................................................................................................... 151 Hallucinogen Abuse.................................................................................................. 152 Solvent Abuse ........................................................................................................... 152 Key Takeaways ............................................................................................................. 154 Chapter Eight: Quiz ......................................................................................................155

Chapter Nine: Eating Disorders .............................................................. 158 Epidemiology of Eating Disorders ............................................................................... 158 Etiology of Eating Disorders ........................................................................................ 162 Anorexia Nervosa ......................................................................................................... 165 Bulimia Nervosa ........................................................................................................... 167 OSFED Types ............................................................................................................... 168 Binge Eating Disorder .................................................................................................. 169 Key Takeaways .............................................................................................................. 171 Chapter Nine: Quiz .......................................................................................................172 Chapter Ten: Sexual Disorders................................................................. 175 Sexual Norms ................................................................................................................175 Epidemiology of Sexual Disorders................................................................................ 177 Disorders of Sexual Arousal......................................................................................... 179 Orgasmic Disorders ..................................................................................................... 182 Sexual Difficulties in Men ............................................................................................ 183 Paraphilic Disorders .................................................................................................... 184 Key Takeaways ............................................................................................................. 188 Chapter Ten: Quiz ........................................................................................................ 189 Chapter Eleven: Childhood Neurobiological and Psychological Disorders ................................................................................................ 192 ADHD ........................................................................................................................... 192 Oppositional Defiant and Conduct Disorder ............................................................... 195 Conduct Disorder ......................................................................................................... 197 Intellectual Disabilities ................................................................................................ 199 Autism .......................................................................................................................... 201

Specific Learning Disabilities ...................................................................................... 203 Attachment Disorders .................................................................................................. 205 Key Takeaways .............................................................................................................209 Chapter Eleven: Quiz ................................................................................................... 210 Chapter Twelve: Neurocognitive Disorders ............................................. 213 Aging and Cognition .................................................................................................... 213 Structural and Functional Changes in the Brain with Age ......................................... 216 Avoiding Cognitive Decline with Age ...........................................................................217 Alzheimer Dementia .....................................................................................................217 Frontotemporal Dementia ........................................................................................... 219 Lewy Body Dementia ................................................................................................... 222 Vascular Dementia ....................................................................................................... 223 Delirium ....................................................................................................................... 225 Key Takeaways ............................................................................................................. 228 Chapter Twelve: Quiz ................................................................................................... 229 Chapter Thirteen: Personality Disorders ................................................ 232 Epidemiology and Etiology of Personality Disorders ................................................. 232 Narcissistic Personality Disorder ................................................................................ 234 Antisocial Personality Disorder ................................................................................... 235 Borderline Personality Disorder .................................................................................. 235 Histrionic Personality Disorder ................................................................................... 236 Schizoaffective Disorder .............................................................................................. 237 Schizotypal Disorder .................................................................................................... 237 Paranoid Personality Disorder .................................................................................... 238

Avoidant Personality Disorder .................................................................................... 238 Dependent Personality Disorder ................................................................................. 239 Obsessive-Compulsive Personality Disorder .............................................................. 239 Key Takeaways ............................................................................................................. 241 Chapter Thirteen: Quiz ................................................................................................ 242 Chapter Fourteen: Psychological Treatments .......................................... 245 Cognitive Behavioral Therapy ..................................................................................... 245 Behavioral Therapy ...................................................................................................... 246 Sensorimotor Therapy ................................................................................................. 246 Couples and Family Therapy ....................................................................................... 247 Play Therapy ................................................................................................................ 248 Psychodynamic Therapy .............................................................................................. 249 Interpersonal Therapy ................................................................................................. 249 Family Systems Therapy .............................................................................................. 250 Humanistic Therapy .................................................................................................... 250 Integrative or Holistic Therapy ................................................................................... 251 Dialectic Behavior Therapy.......................................................................................... 252 Key Takeaways ............................................................................................................. 253 Chapter Fourteen: Quiz ............................................................................................... 254 Summary ................................................................................................ 257 Course Questions .................................................................................... 261 Course Quizzes Answer Key .................................................................... 306 Chapter One Answers ..................................................................................................306 Chapter Two Answers .................................................................................................. 307

Chapter Three Answers................................................................................................308 Chapter Four Answers .................................................................................................309 Chapter Five Answers .................................................................................................. 310 Chapter Six Answers ..................................................................................................... 311 Chapter Seven Answers ............................................................................................... 312 Chapter Eight Answers ................................................................................................ 313 Chapter Nine Answers ................................................................................................. 314 Chapter Ten Answers ................................................................................................... 315 Chapter Eleven Answers .............................................................................................. 316 Chapter Twelve Answers...............................................................................................317 Chapter Thirteen Answers ........................................................................................... 318 Chapter Fourteen Answers .......................................................................................... 319 Course Quiz Answers ................................................................................................... 321

PREFACE This audiobook course is designed for the college student who wants to get a thorough understanding of abnormal psychology. The prevalence of mental illness in all of the populations of the world is high, with many people being underdiagnosed and undertreated. In this course, we will talk about the history and paradigms of abnormal psychology so you can see how mental illness has been approached in the past and how it is approached today. Methods of diagnosing and treating mental disorders will also be covered as part of the course. Finally, there will be a thorough description of the various mental illnesses in humans of all ages so you will be able to recognize each of them and understand what is known about why they occur.

In chapter one of the course, we will start by looking at how mental illness has been viewed throughout history. You will see how different mental illness has been seen from ancient times until now. We will emphasize some of the ideas regarding mental illness and is treatment that evolved in the Twentieth Century. The Diagnostic and Statistical Manual of Mental Disorders has come out of Twentieth Century thoughts on mental illness. There are different paradigms of psychology and abnormal psychology discussed in this chapter, including how approaches to mental illness must take the patient’s culture into account in the diagnosis and treatment of mental illness.

Chapter two talks about the different ways that diagnostic testing can be used to identify mental illness. The basic psychological examination is used in almost all diagnoses of mental disorders but as you will see, there are multiple other tests that can be done, including cognitive testing, personality testing, and questionnaires used to screen for anxiety, depression, and dissociative disorders. We will also talk about neuropsychometric tests used in the diagnosis of neurological and psychological disorders, behavioral testing, and some of the newer imaging tests that will help in research circles to identify brain changes linked to mental illness.

The focus of chapter three in the course is mood disorders, of which there are several types. Mood disorders involve a disturbance in the brain that leads to episodes of low

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mood, physical symptoms, and sometimes an elevated mood. In this chapter, we will talk about the different types of mood disorders and their management, including bipolar disorder, cyclothymia, major depression, dysthymic disorder or persistent depressive disorder, premenstrual dysphoric disorder, seasonal affective disorder, and postpartum depression. We will also talk about suicide, which is a major complication of untreated mood disorders of all types.

Chapter four focuses on anxiety disorders, of which there are several types. We will talk about the science of fear and how chronic fear states can lead to anxiety disorders. The different types of anxiety disorders include specific phobias and social anxiety disorder, which are related to specific things in the environment. Other anxiety disorders commonly seen that will be discussed are panic disorder, agoraphobia, and generalized anxiety disorder, which are more pervasive and affect a person’s life in a more general way.

Chapter five in the course covers the different interrelated obsessive-compulsive disorders a person may have. The different types of OCD-related diseases seem different on the surface but they have similar etiologies, biological bases, and treatment strategies. The different obsessive-compulsive disorders talked about in this chapter include OCD itself, hoarding disorder, body dysmorphic disorder, and trichotillomania.

The focuses of chapter six are the different types of trauma-related disorders. Trauma is universal and involves several types of traumatic experiences, both acute and chronic in nature. These exposures have relatively predictable bodily and mental responses that will manifest themselves in different disorders. We will discuss post-traumatic stress disorder, which is one manifestation of having been exposed to trauma. There are several dissociative disorders that generally come from childhood trauma. Some will associate somatic disorders as separate but many of these are also related to past traumas, so this is covered as part of this chapter.

Chapter seven in the course talks about schizophrenia and related psychotic disorders.

There are psychotic disorders ranging from acute psychosis, which doesn’t last very long, to schizophrenia, which is a chronic and lifelong condition characterized by disordered thinking, hallucinations, delusions, and mood difficulties. As we will discuss,

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diseases like schizophrenia can be very debilitating because they involve such severe symptoms preventing the acquisition of normal life skills.

The topic of chapter eight is substance use disorders. We will talk about the epidemiology and biology of substance abuse and what effects substances have on the body and brain. There are numerous different substance use disorders possible that we will discuss in the chapter, including tobacco and alcohol abuse, amphetamine and cocaine abuse, opioid addictions, sedative addictions, and abuse of less common substances, such as solvents and hallucinogens, which are not addictive but can still have devastating consequences on the person who abuses these substances.

Chapter nine in the course talks about the different eating disorders a person can have.

Eating disorders vary greatly and can include binge eating disorder, anorexia nervosa, or bulimia nervosa. There is a miscellaneous category called OSFED we will talk about, which stands for other specified feeding and eating disorder. These all have significant implications on the person’s health and carry a risk of death for various reasons, depending on the type of disorder the person has.

Chapter ten involves a discussion of some of the different sexual disorders seen as part of abnormal psychology. We first talk about what some normal sexual behavior looks like, including how many people exhibit some aspects of a sexual disorder that do not actually qualify as being one. There are disorders of sexual arousal and sexual interest as well as orgasmic disorders that affect women to a greater degree than men. Men have their own disorders related to sexual performance that are discussed in this chapter.

Finally, there are a number of paraphilias discussed in the chapter. Some of these are harmless but unusual sexual interests, while others are more dangerous because they harm others and are considered illegal in almost all societies.

Chapter eleven in the course discusses the different neurobiological and psychological disorders seen primarily in children. Some of these disorders have strong genetic and biologic components that are little affected by the environment. Others are mainly environmental in nature and involve things like early childhood trauma or lack of caregiver attachment. Each of these will be outlined as part of the topics covered in this

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course, including autism, ADHD, conduct disorder, attachment disorders, and learning disabilities.

The main topic of chapter twelve is cognition and neurocognitive disorders seen mainly in older adults. While there is a tendency toward mild cognitive decline with age, there are degenerative cognitive disorders in this population that affect thoughts, emotions, and behaviors in a dramatic way and that often lead to death from the disorder or its complications. In the chapter, we will also talk about delirium, which is different from dementia but is important to recognize when it exists.

Chapter thirteen in the course covers the different personality disorders that can affect a person as part of what the DSM refers to as an Axis II disorder. These are enduring patterns of behaving, thinking, and feeling that can be seen as traits beginning in early childhood. There are three different clusters of personality disorders that are similar to one another. As you will see, because these are enduring patterns in a person, they are more difficult to treat than other mental illnesses.

In chapter fourteen, the focus will be on the many different psychological therapies that can be applied to the treatment of psychological disorders and mental illness. For each disorder, there are many possible effective treatments with some being more advantageous than others. Most psychotherapists will have specific approaches they prefer with a range of other ways they use to treat people who have minor or major psychological issues. In this chapter, we will touch just briefly on what each of these treatment strategies is all about.

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CHAPTER ONE: HISTORICAL AND CURRENT PARADIGMS OF ABNORMAL PSYCHOLOGY In this chapter, we will start by looking at how mental illness has been viewed throughout history. You will see how different mental illness has been seen from ancient times until now. We will emphasize some of the ideas regarding mental illness and is treatment that evolved in the Twentieth Century. The Diagnostic and Statistical Manual of Mental Disorders has come out of Twentieth Century thoughts on mental illness.

There are different paradigms of psychology and abnormal psychology discussed in this chapter, including how approaches to mental illness must take the patient’s culture into account in the diagnosis and treatment of mental illness.

HISTORY OF MENTAL ILLNESS PARADIGMS It’s safe to say that mental illness has not been seen the same throughout the ages.

Scientists have found evidence of trepanation or burring holes into the head, most likely to treat mental illness far back as 6500 BCE. The ancient Mesopotamians believed that all disease, including mental illnesses, were caused by different deities. Deities were said to control people through their hands so that a disease might be called the “Hand of Shamash”. It isn’t known which disease name matched with what illness but doctors in the time period felt that hallucinations, for example, had spiritual meanings.

In ancient Egypt, what little has been written about mental disorders indicated that emotional distress, concentration difficulties, or lack of attention could be attributed to either the heart or to the mind. They sometimes used magic spells, the application of body fluids, or even known hallucinogens to treat mental illnesses. Religious temples were used for both therapy and religious reasons as it was there that people had their dreams interpreted or their symptoms treated.

In ancient Hindu cultures, diseases like anxiety and depression were described as having metaphysical sources, being a part of witchcraft or sorcery. Writing from about 600 BCE indicated that poor health in general was an imbalance of the three major body 5

fluids. They were aware of different personality types as being related to different balances in body fluids and related various diseases as being linked to disrespect of others or the gods, mental shock, faulty activities inside the body, or poor dietary choices. Herbs, prayer, ointments, and charms, along with direct persuasion were common illness treatments for both mental and physical illnesses.

The ancient Chinese also wrote about mental illness from as long ago as 1100 BCE. Even then, treatments for mental and physical illnesses made use of Traditional Chinese Medicine therapies like acupuncture, herbs, and specific emotion-based therapy techniques. They placed a strong emphasis on a bodily cause of mental illness in some cases, while others believed mental illness was due to demonic possession. They also recognized the role of trauma in the development of certain mental illnesses, which was believed to open up the person to demonic possession. Imbalances of yin and yang were also causes of mental illness just as they were believed to be causative of physical illnesses.

In both ancient Rome and ancient Greece, there were descriptions of “madness” that rendered the sufferer violent with wandering tendencies. On the other hand, mania was sometimes seen as a positive thing and they recognized positive forms of madness that led to creativity and inspiration. Socrates himself who was felt to be a logical person admitted to having psychotic demand hallucinations. Hippocrates recognized different categories of mental illness, such as melancholia, epilepsy, and paranoid diseases.

Bloodletting was used for the management of these disorders.

The Romans assimilated a great many of the Greek theories on mental and physical diseases but gradually the idea of bad humors or humoral imbalance as causes of disease abated to some degree. There were some doctors who believed that humane treatments were best and used natural therapies to treat them. The cause of mental illnesses was not altogether understood but doctors like Galen felt that treating symptoms made more sense than finding broad categories of mental illnesses to treat separately. A physician called Celsus felt that bloodletting, dietary changes, incubation spaces, incantations, amulets, drugs, exorcism, and talk therapy were good treatments, although torturing patients to restore their sanity was also advocated. Few patients, though, were actually offered treatments and some were simply arrested.

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The Old Testament spoke of mental disorders as not being caused by God but by being a problem of one’s poor relationship between themselves and God. There was also the belief that some insane people were possessed or being punished by God in some way.

Punishment by God involved a withdrawal of God’s protection, which led to an invitation to be possessed by evil spirits.

Persian and Arabic researchers in the Middle Ages studied Greek theories on everything, including those on medicine and mental illness. Muslims took up Greek beliefs on mental illness, describing different mental illnesses or disease manifestations such as delusions, hallucinations, mania, and melancholia. There was some sense that the brain was connected to mental illness but they were also said to have some type of spiritual or even mystical meaning. There were those who thought that genies could possess a person, leading to mental diseases. Genies were either good or bad so not all possessions were bad ones.

In Europe during the Middle Ages, there were many different theories on mental illness, including an imbalance of the four humors, which were yellow bile, black bile, blood, and phlegm), magical causes, divine or religious causes, evil spirts, and others. This was also a time when trephination was used to cure disease by letting humors and evil spirits to escape the brain. Other treatments included bloodletting, purging, and whipping, which were believed to address the lack of morality seen in the mentally ill. Christians advocated prayer, fasting, and exorcism to cure diseases. Sin was believed to cause mental illness but other issues like excessive work poor diet, grief issues, and alcohol use were contributing factors.

In the Middle Ages, the mentally ill were called lunatics but there were no places to put these people at the time. This led to the family as primary caregivers of the mentally ill but there was considerably more community support for those afflicted than existed at other times in history. People who had visions were thought to have insights that were spiritual or visionary in nature rather than having something related to mental illness itself.

Some of the more modern theories on mental illness started in the sixteenth century and spread through the eighteenth century. This was the time of witch hunts starting in

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Europe because of the idea that those who were insane were actually witches. Others were committed to poorhouses or workhouses. This was also the time of private “madhouses” where restraints and confinement were common practices. Families were less involved in the care of the mentally ill than they used to be.

By the end of the 1600s and onward, there was an increase in the belief that there was some type organic disease state behind mental illness rather than it being a sinful or moral issue. The mentally ill were treated much like wild animals, confined and chained when necessary. There were some treatments, such as exercise and diet but this was uncommon. Whipping and other barbaric treatments were commonplace and in some parts of Europe, the observation of mentally ill inmates was considered a sport.

Attempts were made then to classify the different mental illnesses known at the time.

It was during this time that the term “crazy” was used as well as the term “insane”, which meant unhealthy in Latin. Lunacy was also a term used to describe the mentally ill, while madness meant the loss of total reason. Other terms used during this time were psychosis and nervous, which meant slightly different things. The idea of nervousness meant that mentally ill had something related to the nervous system. The term obsession was specifically applied to those believed to be possessed by an evil spirit.

Medical doctors became involved in the care of the mentally ill by the end of the 1700s.

In fact, they became the source of most of the treatment strategies used in the management of mental illness. Treating the mentally ill was very lucrative at the time. It was near the end of this century that the care of the mentally ill involved more moral treatment, such as personalized management, psychosocial approaches, and improved overall care.

Insane asylums became very popular in the 1800s along with an increase in the overall population of humans and the industrialization of the western world. Large numbers of the mentally ill were confined to these asylums so they became very impersonal and overpopulated, with few real treatments given. The mentally ill were mixed in with those who had social or economic problems and many doctors opposed the previous attempts at more humane and personalized treatment.

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The 1800s brought the first use of the term “psychiatry” and some early attempts at classifying the different psychiatric and mental disorders were made. Psychiatrists were called alienists because they often dealt with people most alienated from society in general. Most psychiatrists were managers who just dealt with the day to day management of people with psychiatric conditions. Asylums were places of abuse and neglect rather than therapeutic places for healing. There were ex-patient advocates who felt that the care of the mentally ill should be more humane.

The three main paradigms seen in the history of mental illness were psychogenic, somatogenic, and supernatural. Those who believed in supernatural causes thought that eclipses, demonic spirits, the displeasure of the gods, sin, and curses were to blame for these disorders. Those who inclined toward a somatogenic cause though that there might be genetic or physical causes or that brain damage or chemical imbalances caused mental illness. Psychogenic causes included maladaptive thoughts, trauma, or stress were responsible.

EVOLUTION OF MENTAL HEALTH TREATMENT THROUGHOUT HISTORY The treatment strategies used for mental illness varied according to the differing beliefs that have existed throughout history as to the causation of these diseases. When in ancient times it was mostly believed that the causes of mental illness were supernatural, the treatments were often related to that idea. Trephination has been used since at least 5000 BCE, presumably for the management of mental illness. By having a medicine man or the equivalent bore a hole into the skull, it was thought that evil spirits could have a route of escape from the head in order to cure them. Some people survived the treatment and some might have improved for other reasons, giving validity to the practice.

There were also priests who were doctors in Mesopotamia that used religious rituals and prayer along with exorcisms and other similar spiritual techniques to cure people of their mental illness. Some would punish or threaten sufferers if their original treatments were unsuccessful in changing their “patient’s” behaviors.

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Ancient Egyptians were rather progressive for their time when it came to treating the mentally ill. There were Egyptian medicine men who recommended dance, music, painting, or exercise to manage mental illness. Ancient medical texts from about the sixth century BCE identified the brain as a major source of mental dysfunction.

The four humors theory of all illnesses was prominent in ancient times to the Middle Ages. Hippocrates did not at all believe in supernatural origins of mental illness and felt that these mental imbalances had some kind of natural or neurological basis. It was from Hippocrates, Socrates, and Galen that the four humors idea began. If these were not in balance, the end result was some type of illness, including mental illness.

Treatments included medications to induce vomiting, purgatives to cause diarrhea, leech application, and cupping in order put the humors back in balance. Bad humors could also be drained to remove bad humors.

Throughout most of history, the sick patient’s family was responsible for caring for the mentally ill family member. The first mental hospital was built in 792 CE in Baghdad. In Europe, there was a great deal of shame about being mentally ill or having a family member who was mentally ill so families hid their sick loved one in their cellar or in cages, often abandoning them to the streets if that didn’t work. Unfortunately, the social stigma around mental illness still exists to a large degree in many parts of the world. The mentally ill brought dishonor to their family and suggested an inherited defect somewhere in the genetic tree.

The stigma was particularly prevalent in the Middle Ages in Europe, when physical punishment like beating or whipping was commonly used to curb what was believed to be undesirable or antisocial behavior on the part of the mentally ill person. Beating illness out of the person was thought to be an acceptable treatment approach to mental illness.

There were other treatments in place throughout the past few centuries—most of which did not help the patient. There were workhouses or other public institutions for poor people. Sometimes, churches housed the mentally ill, providing them with basic needs in exchange for menial labor. Occasionally, general hospitalization was provided. The

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clergy were important in helping some of these people receive at least minimal treatment.

At some point, these kinds of options could not keep up with the numbers of the mentally ill so mental asylums began to proliferate. The first real psychiatric hospital in the western world was opened in Spain in 1406. There was no treatment given and conditions were largely inhumane. Abuse was rampant and patients were nothing more than mental prisoners. The main goal was the sequestering of patients from the rest of society.

Other forms of therapy in the last few centuries included hot or cold water treatments that would shock these patients, hopefully forcing them into better mental health.

Mental illness was thought to be a choice so the treatment often involved physical restraints and verbal threats in order to force a cure. Strange treatments were sometimes utilized, such as gyrating chairs that would shake the patient until they were free of mental illness.

There were occasional calls for social reform, such as took place in the late 1700s in Paris, France. Theories were developed that, with care and compassion, some of the mentally ill could get better. A hospital was cleaned out and patients were offered exposure to sunshine, exercise, and fresh air as treatments for their condition. The Quaker Society in England picked up on these treatments and placed an emphasis on strict but compassionate treatment of the mentally ill.

While you would think that this kind of treatment would stick, there was a significant trend away from moral treatment in the 1800s in the US by the end of the nineteenth century. Doctors became critical of moral treatment, indicating that it didn’t really work and so asylums once more became places to just house patients who were mentally ill.

Poor sanitation and overcrowding were very common.

In 1927, a novel treatment for mental illness, called an insulin coma, began and was used until the 1960s. Patients were placed into a coma using the drug insulin, with the belief that this caused fundamental changes in brain function if used for up to 4 hours.

The mortality rate of the treatment was up to 10 percent, so it was largely abandoned in favor of electroshock therapy.

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Another treatment for mental illness was to induce seizures using a simulant called Metrazol. The drug was injected, leading to a rapid seizure onset that was often severe enough to break the patient’s bones. This was used in the middle of the twentieth century but was banned in 1982 because it was both dangerous and not helpful to the patient. This was a precursor therapy to electroconvulsive treatments still used today to treat refractory depression.

The frontal lobotomy was a common treatment for mental illness in the 1940s and 1950s. The goal was to break up brain pathways leading to mental illness. While these were used often, they were always controversial and were only used in severe cases. The prefrontal lobe was essentially separated from the rest of the brain in a procedure that took just minutes to do. The side effects were huge and debilitating so it was discontinued onc medical therapy was developed in its place.

As for talk therapy, psychoanalysis became prominent at the start of the twentieth century. This was the beginning of a vast movement that has expanded to involve 400 different types of psychotherapy in use since then. As you will learn later, there are multiple different approaches that focus on things like cognition, behaviors, psychodynamic issues, and family systems approaches that help to provide a wide range of therapeutic options for every type of mental illness and personality type. Most approaches will work to some degree so you can expect treatment to be successful even if the approach is different.

The first medical treatment for psychiatric diseases was developed in the middle of the twentieth century. There are now a number of psychotropic medications used today to manage diseases as diverse as psychosis, bipolar disorder, major depression, and substance use disorders. There were other treatments used through the 1970s that are now not used much at all because psychotropic medication is so successful in many cases.

MODELS OF MENTAL ILLNESS IN THE TWENTIETH CENTURY Some things that came out of twentieth century thoughts on mental illness were those that dealt with mental hygiene and mental health rather than mental illness. The

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movement began in 1908 when it was first written about and proposed. The concept of humanization of the care of the mentally ill was also proposed in order to reduce the brutality, neglect, and abuse of this population. There was an increased focus on prevention of mental illness with the belief that this started in early life. There was also an increased emphasis on community mental wellness rather than on wellness in one person.

The World Health Organization has always had a part of it that has been focused on mental health of the world’s population. The organization has recognized the value of health as being wellness of one’s social, mental, and physical states rather than value based on a lack of disease.

An additional advancement came with the development of the International Congress of Mental Health in 1948. Out of this came recommendations on issues related to mental health. There was a shift in the terms “mental hygiene” to the terms “mental health”.

Mental health was defined as a state where a person has optimal development in the areas of emotions, cognition, and physical states of being. There were four levels of treatment, including custodial treatment, therapeutic treatment, preventative management, and positive management.

As mentioned, the twentieth century was when psychanalysis became popular as a treatment for mental disorders. There was also differentiation between things like mood disorders and psychotic disorders. Asylums were still in existence in the beginning of the century but the term “inmates” was replaced with “patients”. The term “mental illness” became preferred over other labels for mental disorders. Trauma as a cause of mental illness was uncovered when World War I vets developed what was then called “shell shock”.

In World War II and during the time of Nazism in Germany, there was massive sterilization of the mentally ill and euthanasia of these individuals, with about 200,000 being exterminated in the war. Psychiatrists of the time were complicit in these atrocities, deeming these people undesirable along with others, such as homosexuals.

Funding in other parts of the world were cut for the care of the mentally ill, although veterans with mental illness were treated better. Mental disorders became classified in

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documents like the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Mental Diseases put out by the WHO. Psychiatrists during the twentieth century became less focused on institutional care and more on individual outpatient care, starting at 8 percent of psychiatrists in 1917 and ending with 66 percent of psychiatrists in 1970. Stress as a term relating to mental illness was first coined in the 1930s. While electroconvulsive therapy, lobotomies, and insulin shock therapy were popular in the middle of the century, so was the use of psychotropic drugs. Deinstitutionalization started in the 1960s, which left many without adequate treatment if there were no community resources available.

Lithium was the first psychotropic drug developed for the long-term treatment of mental illness. This was followed by antipsychotics, barbiturates, benzodiazepines, tricyclic antidepressants, and SSRI antidepressants, among others. Now, just about any mental disorder can be treated with a psychotropic drug.

Sigmund Freud first introduced psychoanalysis in 1896. He also focused on the interpretation of dreams. Others developed their own psychanalytic approach that was built on Freud’s initial work. Freud’s work focused on the subconscious as well as on dreamwork as a way to understand mental illness and its recovery. Most of his work was on case studies rather than on extensive evidence-based practices so his work has largely been in question ever since. Still, he attempted to explain things like hysteria in ways that could be helpful to people. Freud’s work was based on sexually motivated subconscious wishes and dreams but this has largely been discounted since. He did, however, indicate that some of his female patients had symptoms based on sexual abuse in the past but he himself came to disbelieve these memories were true.

By 1905, Freud laid out five psychosexual phases, which were the oral, anal, phallic, latency, and genital phases. He had the idea that people got stuck in one of these stages and used hypnotism and other practices to help improve the patient’s symptoms. He addressed self-destructive behaviors but called it self-masochism. He later expanded his beliefs beyond sexual issues in mental illness to the concepts of self-identification and identification within a group. Finally, he developed the concepts of the ego, superego,

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and id. The Oedipus complex was felt to be the center of many neurotic illnesses, among other things.

Freud moved to London in the pre-World War II years as Nazism rose in Europe. He died shortly thereafter but there were other psychoanalysts who took his placed and developed their own ideas, such as attending defense mechanisms rather than exploring the subconscious. Child psychoanalysis became more commonplace. There are still about thirty-five institutes in the US that train doctors and psychologists in psychoanalysis.

The twentieth century became the time when things like electroshock therapy were developed. This and other methods of treatment, like drugs and psychosurgery, were based on a biological approach to mental illness. The belief that people had mental illness because of biochemical imbalances became more prominent but it was more plausible than the four humors ideas of mental illness.

Electroshock therapy was first done in Europe and was found to be helpful but dangerous because of so many side effects and the fear people had around having this type of treatment. Some patients who would not cooperate with other therapies were threatened with electroshock therapy. This type of treatment was modified over time to involve general anesthesia as part of what helped make it more palatable so it is more commonly used now for the management of severe depression.

Psychosurgery was first developed in the 1930s and was initially quite crude, with doctors using an ice pick-like device to cut the nerves connecting the frontal lobes to other brain centers related to emotions. The goal was to calm patients with bipolar disorder, schizophrenia, and hysteria. Again, it was only used in serious patients and was still very controversial. Frontal lobotomies left patients lethargic and unable to control their emotions.

Eventually, lobotomies gave way to psychopharmacology or to the use of drugs to manage psychiatric diseases. While drugs like barbiturates were used as early as the late 1800s, these were short-term treatments. Lithium was the first long-term treatment for mental illnesses, first used in 1949. Antipsychotics were used shortly thereafter and

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many other followed these medications so that now drug therapy is a huge part of mental illness treatment.

The twenty-first century brought many other commonly used drugs for mental health management, such as Prozac and other SSRI drugs, which are also called selective serotonin reuptake inhibitors. This has led to even fewer hospitalizations and commitments with a bigger emphasis on outpatient management of mental illness. This is helpful for many but not helpful for those who need to have inpatient stays or who cannot afford medications for their mental illness. Others use drugs for recreational purposes and there is always the potential for abuse or a black market for certain drugs.

EMERGENCE OF THE DSM The DSM or Diagnostic and Statistical Manual of Mental Disorders came out of a need to classify the different mental illnesses. The 1840 census was the first to ask about insanity or idiocy in the population, providing a general way of understanding the epidemiology of mental illness. This was fraught with problems because there were parts of the country that labeled all African Americans as having insanity of some kind.

The American Psychiatric Association or APA existed under a different name as of 1844 but became what it is now called in 1921. Later censuses began describing people in terms of more specific mental illnesses, such as melancholia, mania, epilepsy, and paresis. The APA also adopted these categories. They developed a manual in 1917 to guide mental hospitals. It was called the Statistical Manual for the Use of Institutions for the Insane. There were just 22 diagnoses in it.

A brand new classification method was developed in 1943 known as Medical 203. This was a psychiatric manual less focused on institutions and more on mental illness in general. It was put out by a division of the US Office of the Surgeon General. It was adopted by the US Armed Forces in dealing with mentally ill soldiers and veterans.

In 1949, the WHO put out its International Statistical Classification of Diseases or ICD that first had a section about mental disorders. It was similar to the Medical 203 document using categories based on the 1943 document.

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The APA became officially involved in classifying and standardizing mental illnesses by creating the DSM-1 out of information taken from prior sources already in use. It basically reviewed and revised the Medical 203 classification method and called It the DSM-1, first published in 1952. Much of it was identical to passages in the Medical 203 document with a total of 106 mental disorders listed. Things like homosexuality, neurosis, and personality disturbances were some of the categories.

The DSM-II was then modified from the DSM-I and reflected the many changes in psychiatry during that time period. There were advocates that opposed to the concept that homosexuality was a mental illness. This was published in 1968 and listed 182 separate diseases. It was just 134 pages in length. Both of these versions touched on the idea that psychiatric diseases had biological bases. One of the problems was that there were vague distinctions between what is normal and what wasn’t.

The opposition to homosexuality as a psychiatric diagnosis continued after the DSM-II came out. Homosexuals in general had a great deal of opposition to psychiatry in general, which only intensified during the 1970s. The sixth printing of the DSM-II in 1974 removed the diagnosis of homosexuality in its volume. It was, however, replaced with the diagnosis called “sexual orientation disorder”.

The year 1980 brought another big change in psychiatry with the publishing of the DSM-III. The idea at the time was to match the DSM information as much as possible with the ICD put out by the World Health Organization. There was also an effort to make the diagnosis of mental disorders roughly the same as it was in Europe. There was a new multiaxial system used to broaden psychiatric diagnoses. There were Axis I disorders that were a primary diagnosis, an Axis II disorder, which was a personality disorder or metal retardation. Axis III meant that there would be an underlying medical condition to consider.

There were several changes made in 1980. Any reference to homosexuality or sexual orientation was replaced with ego-dystonic homosexuality and neurosis was removed as a primary diagnosis because it was too vague. PTSD was added as a new diagnosis in the DSM-III. The volume expanded to almost five hundred pages and there were 265 different diagnoses.

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The DSM-III was revised in 1987 and was called the DSM-III-R. There were some changes and reorganization that occurred in this volume with six categories removed. A few categories were added. Contributors looked at adding premenstrual dysphoric disorder and masochistic personality disorder but these were not added to the volume.

The diagnosis of ego-dystonic homosexuality disorder was finally removed and instead there was a nonspecific sexual disorder diagnosis that could be made if a person had symptoms suggestive of this disorder. About 292 separate disorders were included in the volume, which stressed the description of the different disorders rather than efforts to explain things like etiology.

A few years later in 1994, the DSM-IV was produced and published. There were 410 diagnoses in this large volume. Research was included to support the different diagnoses so they could be more valid and based on research evidence. Trials were conducted to show that the diagnoses could be replicated in clinical practice. An addition to the diagnosis was that there needed to be the requirement of a significant impairment in functioning in areas like social, emotional, or occupation life. A few personality disorders were removed or added to the appendix for completeness.

The DSM-IV-TR was a revision of the DSM-IV. Most of the diagnoses and criteria were the same as the original volume but the diagnostic codes were set up to better match with the World Health Organization’s ICD manual. There was a five-part axial system that added axes to include medical, psychosocial, environmental, or childhood factors to explain the main diagnoses. The idea was that doctors and psychologists could look at the different criteria and match the patient’s symptoms to the different criteria. The distress was included as part of most diagnoses except for paraphilias and tic disorders because most of these are not ego-dystonic. Codes were given for insurance purposes.

The DSM-IV-TR multiaxial system can be explained in the five different axes. These are included as these axes: •

Axis I is the main diagnosis except for any mental retardation or personality disorder.

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Axis II involved the different personality disorders and mental retardation or intellectual disability.

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•

Axis III is the medical conditions the patient has.

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Axis IV is the environmental and psychosocial factors that might be contributory.

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Axis V is the global assessment of functioning.

The DSM-5 was published in 2013. There were extensive revisions and broader diagnostic definitions in many cases. Subtypes of schizophrenia no longer existed in this manual as well as the subtypes of autism spectrum disorder.

Over time, many of the different changes in the DSM have been made in order to have a manual that was reliable enough that two different psychologists would make the same diagnosis if given the same patient and his or set of symptoms. The problem is that, even with improvements, this kind of reliability does not exist to the extent that it should be. The DSM also focuses on symptoms while avoiding issues like a person’s genetics or other testing that might be just as important as the different symptoms.

Overall, the biggest issue was related to reliability, which is actually quite low when comparing the diagnosis given by different clinicians examining the same patient. Other issues less commonly argued are that the DSM causes the overdiagnosis of mental disorders and that the division between two diagnoses is somewhat arbitrary. The degree of impairment is also not addressed in every diagnosis and there may also be a cultural bias based on European and American thought processes and approaches.

DIFFERENT PSYCHOLOGICAL PARADIGMS There are different possible approaches to how to describe human thoughts and behavior. There are perspectives that address the biological issues related to mental illness, while others have a more psychosocial approach. As you have learned, there have been different accepted paradigms over the course of history that have attempted to explain psychological disorders. Nowadays, there are different perspectives or paradigms used to talk about mental illness. Let’s look at what these are: The psychodynamic perspective started with Sigmund Freud and emphasizes the subconscious or unconscious in mental illnesses. It also looks at early childhood experiences and relationships a person has with others. Those who use this perspective

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often apply psychanalysis and use the three mind concepts of id, ego, and superego. In this case, the id is a person’s subconscious desires, while the ego is their rational self that deals with everyday issues. The superego develops last and is focused on internal morality.

The behavioral perspective or behaviorism looks not at internal states but on what can be observed by watching the patient. John B Watson and others studied and developed this perspective. It is not as commonly a part of psychological thought now but is concerned with ways to reinforce learned behaviors. It is still used in certain mental health settings to modify unwanted behaviors in the person.

The cognitive perspective has been more prominent since the 1960s and looks at thought processes and issues related to problem-solving, decision-making, language, and memory. Jean Piaget and Albert Bandura both studied and formulated this perspective, which helps patients through managing how information is processed and utilized.

The biological perspective looks at how physiology plays a role in psychological disorders. It is sometimes called biopsychology and looks at things like neurotransmitter problems as causative of mental disorders. Genetics is also related to some mental illnesses and this is part of the biological perspective as well as how the immune system, brain injury, and the endocrine system play into mental illnesses. The newer imaging tests like the PET scan and the functional MRI scan reveal a lot about which areas of the brain are more or less prominent in certain mental disorders.

The cross-cultural perspective is relatively recent and studies the cultural differences in what represents normal behavior and what is a disease state. It turns out that one’s culture strongly influences their thoughts and behaviors. There are two spectra of culture types that control a person’s thoughts about themselves and others.

Individualistic cultures emphasize the individual, while collectivistic cultures look at the interplay between the person and those they live and work with.

The evolutionary perspective attempts to explain the ways in which evolution has influenced our responses to the environment. It looks at natural selection to explain some of the differences between male and female thoughts and behaviors. The

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suggestion is that a person has certain ways of relating to their environment because of how successful these things have been on reproductive capacity and survival in general.

The humanistic perspective was developed by Abraham Maslow and Carl Rogers in the 1950s. It looks at issues like motivation in how people think and behave. One concept is self-actualization or the ability to grow and change to reach one’s maximal potential.

The idea is that people are naturally driven to do this. Out of humanism came positive psychology, which emphasizes achieving happiness and better health through making positive changes in one’s life.

SOCIOLOGICAL AND CULTURAL ISSUES IN MENTAL ILLNESS Culture and society have a strong influence on a person’s mental health, the onset of mental illness, and access to mental health services. Culture is what underlies certain culture-bound syndromes, which are mental disorders seen more commonly in some cultures than in others. Culture determines whether or not a person decides to seek help for their mental symptoms. Coping strategies vary from culture to culture and even the meaning of one’s symptoms varies with cultural biases. The clinician’s culture also plays a role in the delivery of mental health services.

A culture is a group of people with shared belief systems, norms of behavior, and values.

A culture can be based on religious beliefs, common backgrounds, race, or the occupation of the group. Language also determines what culture a person belongs to.

Culture shapes mental health in general so you will see patterns of health and disease in certain cultures but not in others.

Let’s look first at the patient’s culture. There is a strong influence of culture on the mental health consumer, with influences on mental illness definitions and how healthcare is utilized when it comes to mental illnesses. There are symptoms of mental illness in all parts of the world. Certain disorders are universal, such as schizophrenia, bipolar disorder, depression, panic disorder, and obsessive compulsive disorder. There are many culture-bound diseases that may simply be variations on existing mental disorders. Somatization varies greatly from culture to culture.

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Not all cultures are the same when it comes to the meaning of mental illnesses and make sense of them in different ways. There are differences in how cultures see the origin and prevalence of mental illness. Some feel a more biological approach is causative of mental illness, while others look at psychodynamic causation. Some disorders have a similar prevalence across cultures, while others do not. Depression is particularly seen as having different causes, depending on one’s cultural background. PTSD is common in the world as well but its causes are different, depending on one’s culture. The rates of suicide are very different depending on the cultural environment. Different ethnic backgrounds within the US Have differences in their suicide rates.

Family issues and the way a family influences mental health vary across cultures. The family can be protective against or causative of mental illness. If the family is supportive, this will be protective against mental illness. Families with abuse, neglect, poverty, or marital discord tend to promote a higher rate of mental disorders later in life and can contribute to a higher rate of suicide. The importance of family on the raising of children differs among cultures, which can influence the range and type of mental diseases seen in the culture.

Culture determines one’s coping styles. Certain Asian cultures, as an example, will avoid negative thoughts rather than dwelling on them and do not express negative thinking as much as other cultures. African Americans, on the other hand, are more active in handling emotional issues rather than just avoiding them. They tend to handle distress by themselves compared to Caucasians and have a greater emphasis on spirituality as a coping strategy.

Certain races and ethnic backgrounds in the US will be less likely to seek help for their mental symptoms and do not trust mental health providers as much. There is often a delay in seeking treatment until the symptoms are very severe. There is less of an emphasis in some cultures to use psychologists or psychiatrists, instead preferring primary care providers, traditional healers, or spiritual guidance as ways of receiving mental health services. There is often a preference toward seeing a therapist of the same ethnic background or race.

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Mistrust is a big barrier to seeking help for mental disorders in certain ethnic groups.

Some fear hospitalization or stigmatization so they will not seek care voluntarily unless they are very sick. Some of the issues of trust are generational and others are based on discrimination and racism in general. Lack of trust in institutions also plays a role.

Stigma is not necessarily purely a cultural issue but it is influenced by culture.

Immigration to a new country is stressful and related to the onset of many stress-related mental disorders. Immigration-related mental diseases are worse in the first three years of the time of moving to a new culture.

Other issues that result in cultural influences on mental illness is the effect on overall physical health on mental health. Minorities in the US have more common diseases, shorter lifespans, and greater stress placed on them because of their physical infirmities.

Somatic symptoms are more difficult to interpret when a person has a higher risk for physical diseases in the first place.

The culture of the clinician is also important in mental illness treatment. Most providers in the US have a Western approach to mental disorders just as they have in relation to physical disorders. Even as there is an emphasis on biology, social issues have crept into the western understanding of mental disorders. Lifestyle and its effect on wellness is well understood. Talk therapy is a big part of western-based psychological diseases as is biological treatment with medications. If a clinician’s culture is very different from the patients, this will impact the care the person receives. Clinicians who stereotype will have difficulty accurately seeing the origins of their patient’s symptoms and good ways of treating them.

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KEY TAKEAWAYS •

Mental health and its origins have been treated very differently across the ages.

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There was a greater emphasis on spiritual or supernatural causes of mental illness in the past.

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There have been variations in the humaneness of mental illness treatment throughout history, with much of treatment being barbaric or harmful until recent years.

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The first emphasis on a talking cure in psychology started with Sigmund Freud and psychoanalysis.

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The DSM has evolved since it was first created in the 1940s, including some diseases and discarding other diseases over time.

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The DSM is symptom-based and does not have a great deal of reliability in the ability to make a consistent diagnosis, depending on the provider doing the diagnostic testing.

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There are several different paradigms or perspectives that exist today in the field of psychology.

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Culture and ethnicity have a great influence on mental health perceptions, manifestations, causation, and the receipt of mental health services.

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CHAPTER ONE: QUIZ 1.

What was not thought to be a basis for mental illness in ancient China?

A. Demonic possession B. Trauma C. Yin and Yang imbalances D. Imbalances of the four humors

2.

The most common theories on mental illness in ancient and Middle Ages times were based on what causative factor of these diseases?

A. Spiritual or religious issues B. Poor diet C. Psychological stressors D. Heredity

3.

Which therapy for mental illness was popularized in the 1940s and 1950s but is no longer in use today?

A. Psychotropic medications B. Electroshock therapy C. Frontal lobotomy D. Psychoanalysis

4.

What treatment strategy for treating mental illness is used most prominently today?

A. Psychotropics B. Electroshock therapy C. Psychoanalysis D. Insulin coma

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5.

Psychoanalysis was first developed at the turn of twentieth century. What was not a feature of this therapy concept?

A. Repressed sexual desires B. Subconsciousness represented in dreams C. Psychosexual developmental levels D. Behavioral modification of abnormal behaviors

6.

Which method of classifying mental diseases was first used in the US? A. Medical 203 B. US Census C. International Classification of Diseases D. Diagnostic and Statistical Manual I

7.

What is the main issue that makes the DSM a controversial book for psychiatrists, psychologists, and patients?

A. It is not reliable diagnostically.

B. It makes no distinction about severity.

C. It results in overdiagnoses.

D. It is culturally biased.

8.

Which paradigm in psychology has some of its thinking based on the functional MRI scan as part of diagnostic testing?

A. Humanistic B. Behavioristic C. Biologic D. Psychodynamic

9.

What is not true about cultural influences on mental health treatment?

A. Some cultures avoid treatment until the symptoms are severe.

B. Cultures are not much different in the stigmatization of mental illness.

C. Some cultures prefer primary care providers or natural healers to treat their mental disorder.

D. Discrimination is a factor in receiving adequate mental health services.

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10.

What is a true statement about treatment preferences among different ethnic and racial groups?

A. Asians tend to express themselves emotionally to a greater degree so they seek mental health services more readily.

B. African Americans are more likely to choose medications for the management of their mental symptoms.

C. African Americans do not involve their families in their mental health treatment.

D. Most ethnic groups will prefer a mental health provider of their own race or ethnic group.

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