Psychopathology

Psychopathology - The scientific study of mental disorders. It is also used to describe features of people's mental health that are considered abnormal.

For many years psychiatry lagged behind mainstream medicine in finding the cause and treatments for abnormal behaviour. In the early 1900's, treatments were barbaric, with patients being kept in 'lunatic asylums'. 

During this time, a definition for abnormal behaviour was trying to be made, as well as creating classification systems which could group sets of symptoms together into recognisable mental disorders.

There are a variety of ways that psychological abnormalities can be defined.

1) Deviation from Social Norms:

• Behaviour is abnormal if it goes against 'approved of and expected ways' of behaving, e.g. signing loudly in a supermarket queue or washing hands 100 times a day.
• Abnormality is therefore a  relative concept. What is normal in one situation could be abnormal in another.

Limitations:

• Behaviour may simply be eccentric.
• The definition may be used for political or social control, e.g. dissidents in the former USSR were labelled 'insane' and locked away for having counter-political views.
• The definition may vary over time. What is classes as a mental illness today, may be normal tomorrow, e.g. homosexuality was classed as a mental illness in the USA until 1973.
• Social norms are culturally relative, e.g. in some tribal societies it's normal to hear the voices of dead relatives, but we'd class this as schizophrenia.

2) Failure to Function Adequately:

• Is a more practical definition.
• Abnormality is viewed as a disability/dysfunction.
• A characteristic or behaviour is defined as abnormal if it interferes with the ability to pursue some desired goals, or if the person is unable to engage in their normal range of behaviour.
• Rosenham & Seligman (1989) listed some characteristics of abnormal behaviour related to this definition, including: observer discomfort, upredictability, irrationality and mal-adaptiveness.

Limitations:

• The context is important, e.g. prisoners on hunger strike are not failing to function.
• Failure to function may be for other reasons, e.g. discrimination, oppression, economic conditions etc.
• Some disorders may not impair failure to function, e.g. OCD can be well hidden by some sufferers.
• Behaviour is culturally relative.

3) Deviation from Ideal Mental Health:

• This definition approaches the issue from the opposite side, by first attempting to define mental health. Therefore, psychological abnormality deviates from this ideal state.
• Jahoda's Characteristics (1968) - Refers to 6 characteristics for positive mental health: 1) Positive attitude towards self, 2) Self-actualisation, 3) Resistant to stress, 4) Personal autonomy, 5) Accurate perception of reality, 6) Understanding others.
• Atkinson et al (1983) includes self-knowledge/self-awareness to this ideal state.

Limitations:

• Jahoda's Characteristics (1968) reflect a Western view of personal growth and achievement not recognised in collectivist cultures (especially autonomy and self-actualisation).
  
• These characteristics represent an ideal state. Many people are not able to self-actualise but this doesn't mean they're abnormal.
• It's unclear by how much a person has to to deviate before being classed as mentally ill.

4) Statistical Infrequency:

• Uses population data/statistics to make a definition of abnormality.
• A person's behaviour is considered abnormal if it's statistically infrequent. For example, you are average if your IQ falls around the mean number.
• Using statistics can be a helpful way to make a diagnoses, as they provide clear cut off points. They also give a clear picture of what is actually rare (or not) in terms of mental health.

Limitations:

• We still may need a statistical cut off to define abnormality. For example, is behaviour abnormal if it's shared by 1% or 0.1% or 0.01% of the population. If abnormality is classed as being shared by 1% or less, than would 1.02% legitimately be classed as normal?
• It doesn't help us decide between rarity and undesirability. Some behaviours or traits may be rare (e.g. very high intelligence) but also highly desirable - is high intelligence really a psychopathology?
• It doesn't help us where a psychopathology is quite common. For example, in some groups depression is quite high. Also, suicide is one of the main causes of death for men aged 20-34 in England and Wales, but does this mean it's psychologically normal to commit suicide?

It's hard to decide whether someone is abnormal unless you see the behaviour in it's situational or cultural context, as abnormality means different things in different situations.

The following factors may also influence this problem of definition and diagnosis:

1) Race: Cochrane (1977) says that in the UK, African-Caribbean immigrants are 7x more likely to be diagnosed as schizophrenia as whites, and this cant be explained by biological/genetic factors. These differences may be due to bias in diagnosis and stress, e.g. from poorer living conditions, prejucide and the stress of learning to live in foreign and possibly hositle cultures.

2) Gender: Women are more likely to suffer from depression ,specific phobias and eating disorders. Howell (1981) thinks women's experience in British culture predisposes them to depression, so clinicians are diagnosing a situation, not a person. Cochrane (1995) thinks depression in women can be linked to problems in childhood (e.g. sexual or physical abuse) and female gender-role socialisation, which increases vulnerability. Men are more likely to suffer from alcohol abuse and anti-social disorder. Bennett (1995) blames this finding on the socialisation of men in industiralised societies. The masculine role they are expected to fulfil alienates men from seeking help for psychological problems.

3) Social Class: Cochrane & Stopes-Roe (1980) found that lower social class was linked to higher incidence of psychiatric problem. Several explanations have been offered:

• Clinicians may be less willing to label middle-class individuals with mental disorders. Johnstone (1989) found this was the case when comparing middle and lower class patients with the same symptoms.
• Living conditions for lower class individuals may be more stressful and this leads to more mental illness.

• The Social Drift Hypothesis - Cochrane (1983):

This hypothesis proposes that people who are mentally ill drift downwards due to their inability to function. The higher incidence of schizophrenia in poor areas could reflect the fact that people with the disorder move to poorer areas. Their disorder causes them to be poor (inability to hold down a job, etc.) rather than poverty causing the disorder

There are various therapeutic approaches available to treat psychological abnormalities. During the past 100 years, more and more treatments have been discovered.

Although underpinnd by the medical code, these have broadly followed the various trends in psychology, from psychodnamic psychology through behaviourism and cognitive psychology.

Today, it's recognised that some disorders respond better to certain types of therapy. It's also recognised that a combines therapeutic approach is often more effective than using one approach alone.

Example: Much better outcomes are achieved for depresion if drugs, such as SSRI's, and cognitive behavioural therapy (CBT) are used together. The drugs improve mood, which enable the person to begin to tackle the negative thinking which often underlies the disorder.

Biological Approach:

• This approach suggests some symptoms of abnormality are caused by brain abnormalities but some are caused by problems with living. Some are a combination of both.

+) Where the symptoms are wholly organic (i.e. caused by physical abnormalities), drug therapy will be appropriate.

-) However, the methods by which some drugs work are not fully understood, so the question arises: "Is it unethical to give a patient a druh when we are not sure of long-term side effects?"

-) We are not sure how ECT works, and where psychosurgery is involved, we don't fully understand the changes that may occur in personality when we chop bits of people's brains out.

-) Worse still, many patients don't really understand what the surgery involves.

Psychodynamic Approach:

• This approach is based on the assumption that emotional and personality disorders are caused by childhood experiences.

-) If we reject this theory, then techniques designed to re-live childhood can't produce a 'cure' for adult problems.

-) Sometimes it's argued that by looking backwards for the origins of problems, we may miss the real causes of problems in the here and now.

Example: If being trapped in a tower block with 2 small children is what's making someone sad, there's little point in analysing their early relationship with their mother.

+) However, the uses of psychoanalytical techniques still have benefits if used correctly.

Behavioural Approach:

+) Behavioural techniques have produced considerable success in dealing with phobias and addictions.

-) However, behaviour shaping in the treatment room (a highly controlled environment) doesn't always last when the patient returns to their normal social context.

-) The idea of changing 'abnormal' behaviour for that which is more socially acceptable raises serious ethical concerns.

Example: Using aversion therapy to 'cure' a gay may by showing him pictures of his naked lover and giving him ECT. Yet this would have been an acceptable cure in 1960's America.

-) Behavioural therapies have been criticised for being based on an oversimplified picture of human behaviour where people react to stimuli and learned associations; they don't seem to reason, think or make sense of their experiences.

-) Another criticism is that behavioural therapies aren't able to change the behaviour of some psychotic people whose problems lie in thinking and interpreting things differently from others.

Cognitive Approach:

• Cognitive restructuring theories tend to direct the client's preceptions and cognitions to focus on positive, rather than negative thoughts.
• The emphasis in therapy must be on changing undesired behaviour into desired behaviour.
• Thought influences behaviour, and behaviour influences thought. Since these two are inseperable, cognitive therapy should emphasise behaviour as well as thought processes.

-) Gaining a better understanding of ourselves is good, but understanding out thoughts isn't the same as changing our actions.

+) Most modern therapies are described as cognitive behavioural therapies (CBT), and there is mounting evidence that they were successful in treating depressive/anxiety disorders, nd those where low-self image and poor self-control lead to difficulties in coping with life.

Effectiveness of Therapies:

• The best way to compare the effectiveness of therapies is to carry out studies in which patients diagnosed with the same disorder are put into different treatment groups and monitored over a period of time.
• Some therapies are more effective for certain disorders and some disorders benefit from a combined treatment approach.

+) Using this method, Elkin et al (1989) found that drugs, CBT and psychotherapy are all more effective than a placebo (a fake pill) in treating depression.

+) Similarly, Davidson et al (2004) found that CBT and drugs are equally effective in treating depression and combining them doesn't improve their effectiveness.

+) Although, Otto et al (2000) found that the benefits of CBT last longer than those of drugs.

-) In all studies, there are some patients who do not respond to therapy.

Phobias - Irrational fears which generate a feeling of dread, fear and foreboding of a thing and/or situation, resulting in the individual going to some lengths to avoid the thing/situation.

Types of Phobias:

Specific - An intense, irrational fear of a thing and/or object, e.g. mice, spiders, blood etc.

Social (Social Anxiety Disorder) - The fear of social situations; of being embarrassed, meeting new people etc.

Agoraphobia - The fear or being in open, public or exposed places. 

Characteristics of Phobias:

Behavioural - The response will be avoidance of the phobic object/thing/situation that generates a severe anxiety response

Emotional - Severe fear and anxiety can cause distress if presented with the phobic thing/object/situation.

Cognitive - Have fearful thoughts about the phobic thing/object/situation.

The aim of this approach is to identify the behaviours that are causing problems and to replace them with more appropriate ones. Phobias can be a learned response or can be aquired by modelling the behaviour of others.

The Two-Process Model - Mowrer (1947):

He created a two-factor theory of avoidance and phobias, also known as the two-process model, which is: classical conditioning + operant conditioning = phobia

Classical Conditioning - A learning process that occurs when 2 stimuli are repeatedly paired, e.g. toucing the white rat, and the sound of the metal bar (Little Albert Experiment), generating an irrational fear response (phobia). 

Operant Conditioning - Is negative reinforcement through avoidance, making it more likely that the phobia will be experienced again resulting in the same fear response. Therefore, avoidance of the think that triggers the phobic response may reduce the fear at the time, but reinforce that fear as a result of the avoidance.

The 'Little Albert' Experiment - Watson & Rayner (1920):

Method:

• A 9 month old child was given a white rat, a monkey, a rabbit and various other items, none of which he had any particular response to or exhibited any fear towards, showing the expected level of curiosity for a child his age.
• Every time he touched the white rat a metal bar was hit, making a loud sound that startled the child, causing him to burst into tears. This was done consistently over a period of time.

Findings/Results:

• After a while it wasn't necessary to hit the bar to make the child affraid.
• Simply seeing the white rat and anything white and fluffy would generate an irrational fear response (phobia) in the child.

Conclusion:

• The outcome suggested that some but not all phobias can be from to classical conditioning.
• Ost (1987) suggested some people have no recollection of any experience of the thing that generates the fear response associated with the phobia.

Behavioural Therapies:

Extinction - The disappearance of a previously learned behaviour (classical conditioning) when the behaviour is not reinforced. This never happens in phobias, since the person avoids the feared object.

1) Flooding: Flooding is a quick way to treat the phobia, but raises ethical issues, so SD is used instead.

• The person is put into an inescapable situation with the feares object.
• The person reaches a heightened state of anxiety, but eventually the fear subsides (probably due to exhaustion on the part of the patient).

2) Systematic Desensitisation (SD): SD is a much kinder method than flooding.

• The client is asked to list the scenarios that frighten them the lost, with the least frightening first.
• The client then learns a relaxation technique.
• Next, the client imagines the first level of fear whilst practicing the relaxation technique.
• As the client becomes more comfortable at that level, they are then able to move onto the next level, until they are able to visualise each situation without fear.

Behavioural Therapies (cont.):

3) Aversion Therapy: Most controversial therapy as it involves using the principles of classical conditioning to create a fear or an object/behaviour (often an addiction) that the therapist wants to remove.

• Typically the person being treated will have an addiction to e.g. alcohol.
• The therapise will get them to take an emetic drug (induces severe nausea and vomiting) at the same time as drinking alcohol.
• Eventually an association is made between alcohol and the unpleasant feeling of being sick.
• Therefore, the person learns to avoid alcohol in the future.

However, a person's desire to drink alcohol can be so strong that extinction will take place.

Evaluation of Behavioural Therapies:

-) They only target the behaviour, and don't cure the underlying causes.

+) Barlow et al (2002) said "SD has extemely effective success rates of 60-90% for spider and blood infection phobias."

-) There are significant ethical issues, especially with aversion therapy.

Behaviour Modification

These techniques use the principles of operant conditioning to train desired behaviour.

1) Token Economy (TE): Is based on the principle of secondary reinforcement where tokens (secondary reinforcers) are given for socially acceptable behaviour. These tokens can then be exchanged for certain primary reinforcers such as sweets and cigarettes.

TE Trial - Ayllon & Azrin (1968):

• Tried the TE technique with a group of chronic schizophrenics.
  
• At the start, some patients screamed for long periods, some were mute and most could no longer eat with a knife and fork. Some buried their faces in their food.
• They were rewarded for ward work and self-care with tokens that could later be exchanged for special privilages.
• In all cases, behaviour imrpoved.

Behaviour Modification (cont.):

TE Study - Paul & Lentz (1977):

• Used a social learning/TE where patients were rewarded for good behaviour as well as having the opportunity to see appropriate behaviour modelled by staff and other patients.

• They found that the number of patients using neuroleptics (anti-schizophrenic drugs) fell to 22% compared with a group under routine hospital care, 100% of whom remained on drugs.

Evaluation of Behaviour Modification:

+) TE's are a useful way of improving antisocial behaviour.

+) Early studies on TE also helped to highlight the fact that poor patient handling by staff actually contributed to antisocial behaviour.

-) Often behaviour returned once out in the community where no such programme operates.

-) It's a reductionist approach; it treats behaviours but not the underlying cause.

Depression - A disorder that negatively affects an individual's mood and how they feel. It's often equated with feelings of extreme sadness where an individual may feel worthless and lack the ability/desire to engage in day-to-day or pleasurable activities. It can occur as a result of biological, psychological and social factors.

Characteristics of Depression:

Behavioural - Individual's may exhibit changes in behaviour, from eating habits (eating more or less or not at all) to changes in physical activity, from extreme hyperactivity to extreme lethargy.

Emotional - The extent and enormity of the negative emotion being experienced is what distinguishes depression from just feeling 'upset' or 'a little down/sad'. Feelings of helplessness, hopelessness, frustration, irritation, powerlessness, infiltrate all facets of an individual's life and their ability to function fully on a daily basis.

Cognitive - An individual's past negative schema, developed during childhood, can result in negative and pessimistic views of themselves or situations and circumstances that may result in a negative interpretation of facts that places the individual at the centre of blame. This could generate feelings of suicide.

Cognitive behavioural therapies (CBT) emphasise the need to alter the thinking and reasoning processes of the client, but also make use of some of the techniques of traditional behavioural therapies.

CBT's assume that mental disorders are caused partly by the way the client views themselves and the world. The therapist tries to help people to control symptoms, such as anxiety and depresion, by teaching them more adaptive ways of thinking about their experiences.

Althought past events are not disregarded, cognitive behavioural therapies focus on the patient's current state of functioning. There are several approaches to CBT.

Albert Ellis offers one of the most notable explanations of depression from a cognitive perspective, with examination of peoples thought processes, judgements and perceptions.

Albert Ellis - ABC Model: Ellis suggests that those who suffer from depression experience what he calls 'basic irrational assumptions'.

Basic Irrational Assumptions - Means that an individual may irrationally regard themselves as being a failure or having negative views of themselves which isn't grounded in anything factual. The result of this may be the individual seeking approval of others so as not to feel rejected, but still viewing themselves negatively.

Ellis's ABC Model is fundamental to our understanding of cognitive therapy when dealing with depression. The model works as follows:

A     Activating Events: e.g. your manager says your work hasnt fully met their expectations.

B     Belief: e.g. you believe that none of your work is any good, so you're a failure.

C     Consequent Emotion: e.g. anxiety and depression.

A + B = C          A triggers B, resulting in C

It is the irrational belief/thought (not the event itself) that causes the concequences.

Ellis's Treatment - Rational Emotive Behaviour Therapy (REBT):

REBT is a form of CBT that encourages and teaches an individual who has irrational beliefs to actively identify and dispute them and create rational beliefs that are positive to actively act against the irrational beliefs.

This is now a widely used therapeutic approach.

The task of REBT is to restructure the client's faulty belief system and to substitute 'positive self-talk' for irrational self-statements. The therapist actively disputes false beliefs through rational confrontation, and teaches the client to identify and dispute such beliefs themselves.

Behaviourally-oriented techniques are also used, often in the form of 'homework assignments', for example to reward themselves with an external reinforcer e.g. a food treat after working for 15 minutes disputing their beliefs.

Overall, the focus of this approach is to get an individual to realise that when presented with difficult/challenging events in life, they have a choice in terms of how they respond to it and how they feel. They're in control of their response, not the response in control of them.

Beck's Cognitive Restructuring Therapy: Was initially developed to treat depression, but has since been extended to the treatment of anxiety disorders and phobias.

Beck's Negative Triad - He identified 3 negative thoughts present in depression. It is these negative thoughts that underlie depression as a mental disorder. These negative thoughts were:

1) Negative Thoughts about the World: e.g. "People dislike me because I'm no good at anything."

2) Negative Thoughts about the Future: e.g. "I'll never be able to do anything right because I'm rubbish at everything."

3) Negative Thoughts about Oneself: e.g. "I'm just rubbish."

Beck's approach is to more gently point out the errors of logic and contradictory evidence, encouraging patients to 'reality test' for themselves.

Irrational beliefs are converted into hypotheses which can be tested and proved wrong through experience, and the client is encouraged to decide for themselves whether of not their thinking is accurate.The patient is then encouraged to question and challenge those thoughts by trying to apply new interpretations and ways of thinking.

Beck's Cognitive Restructuring Therapy (cont.)

Again, behavioural techniques are used, in that activities for such hypothesis testing are designed and pleasurable activities are schedules to provide reinforcement.

Evaluation of CBT (both Ellis's & Beck's Techniques):

+) Good success rates for depression and anxiety.

+) More cost-effective and less time consuming than psychoanalysis.

-) Less effective for conditions such as schizophrenia, although may help sufferers so cope with their condition.

-) In focusing on the cognitive, it ignores any genetic or biological factors. There is no real understanding of where the negative thoughts come from in the first place.

OCD - An anxiety disorder that causes an individual to have repetitive feelings, ideas, thoughts, sensations, obsessions or behaviours that makes them feel compelled to perform repetitive or ritualistic behaviour. This may provide some short-term relief, and not performing these behaviours can cause great anxiety.

It is a type of behaviour associated with cognitive bias, which occurs during decision making. It causes an individual processing information to have an error of thinking which causes them to make judgements based on biases and irrational thoughts.

Examples of Behaviours: Hand washing, not touching certain things, placing things in a certain order, checking and rechecking things etc.

OCD can disrupt everyday life such as going to work/school and can be anything from mild to severe. OCD can stem from social pressures, stress, emotional difficultis and individual motivaiton.

Characteristics of OCD:

Behavioural - Mower argues that, as with phobias, the fears associated with OCD are learned. Objects associated with negative events make the individual complete retualistic and repetative  actions to prevent negative outcomes. These actions temporarily relieve their anxiety.

Characteristics of OCD (cont.):

Emotional - Obsessional thinking can result in feelings of anxiety, distress, powerlessness, frustration etc.

Cognitive - Intrusive, negative thoughts may be exaggerated - the individual sees the thought as actually representing a threat. He/she may come to fear their own thoughts and try to diffuse them by engaging in ritualistic/repetative actions that they associate with neutralising the negative thought. 

General Ways of Treating OCD:

The type of treatment for OCD will be dependent on the extent to which it affects the individual. Examples include:

• Cognitive behavioural therapy (CBT)
• Medication treatment
• Exposure and response preventation (ERP)
• A combination of all of the above.

This approach sees mental disorders as being caused by some underlying abnormal physiology.

In the early 19th century, people began to realise that mental symptoms could follow a physical disease (e.g. syphilis), and so underlying biological causes were examined.

Physical/Biological Causes of Mental Disorders:

Brain Damage - The structure of the brain may be altered in some way, e.g. due to infection or injury. General paresis (a type of dementia common in  the 19th century) was found to be caused by the syphilis bacterium attacking the nervous system.

Biochemistry - Imbalances of neurotransmitters can lead to mental disorders. In schizophrenia, there is an excess of the neurotransmitter dopamine, and in depression there is a lack of the neurotransmitter serotonin. Hormones are also implicated in mental disorders, e.g. the hormone cortisol is often elevated in stressed individuals.

Genes - Some mental disorders have a strong genetic basis. If one family member has the disorder, others are at greater risk of developing it. The closer the genetic relationship, the higher the risk.

Biological Approach - Evaluation:

+) This approach may be able to pinpoint the brain damage or neurotransmitter associated with a particular disorder.

-) However, it can't always determine the cause.

-) Studies have shown that other factors and environmental triggers such as losing a job or a breakdown of a relationship can also reduce serotonin levels. 

• This has even been shown experimentally by Watson et al (1988) using monkeys. When isolated from their group, they tended to show a marked reduction in blood levels of serotonin.

For this reason, a diathesis-stress model is often used to explain mental illness. This involves a genetic predisposition (diathesis) and an environmental trigger (stress), which interact to produce the disorder;

Genetic:

• Family and twin studies suggest that family members who suffer with OCD may have a predisposition to the condition.
• However, causes could be attributable to social rather than biological influences.
• Children whose parents suffer from OCD, if experienced by the child itself, are often different in terms of the symptoms exhibited.
• Feng et al (2007) suggested that a lack of the gene Sapap3, associated with the ability to plan and process, is implicated in OCD.

Biochemistry:

• Studies have found that lower levels/deficiency in the neurotransmitter serotonin were found in people who suffer from OCD.
• Pigott et al suggested that drugs that increased the levels of serotonin reduced ODC levels (however research in relation to this is varied).

Neuroanatomy/Brain Structure:

The Orbital-Frontal Cortex (OFC) - Associated with decision-making, judgement and the moderation of behaviour.

The Caudate Nucleus - Filters signals sent by the OFC.

The Basal Ganglia - Associated with pattern recognition, emotion and memory.

• In sufferers of OCD, the Caudate Nucleus is damaged or malfunctioning, resuting in signals being overloaded, causing heightened level of anxiety and compulsion.

• Abnormalities in the Pre-Frontal Cotext can result in a predisposition to OCD.

One way to address this is to disconnect the Pre-Frontal Cortex from the Basal Ganglia (psycho-surgery).

Drug treatments interact with chemicals in the brain to create a balance. They are effective at alleviating symptoms relatively quickly, and is a type of treatment which people feel comfortable and familiar with.

The 3 main types of drugs are:

1) Anti-anxieties - Increase the action on an inhibitory neurotransmitter, GABA, which quitens the nervous system and brings out muscle relaxation.

Examples: Benzodiazepines such as Librium and Valium.

2) Anti-depressants - Block the re-uptake of serotonin at the synapse, making it more available. Increasing serotonin levels improves mood.

Examples: Selective serotonin re-uptake inhibitors (SSRI's).

3) Anti-psychotics - Block dopamine (D2) receptors, reducing levels of dopamine.

Examples: Phenothiazine's such as Chlorpromazine. Clozapine is now often used, as it has fewer side effects than Chloropromazine and works on a wider range of neurotransmitters.

Drug Treatments - Evaluation:

-) Many of the drugs used to treat psychological disorders have serious & unpleasant side effects.

-) The long-term use of Chlorpromazine to treat schizophrenia leads to a movement disorder similar to Parkinson's. Clozapine lowers the white blood cell count and thus reduces the effectiveness of the immune system.

-) Treatment for schizophrenia is on-going and there is no cure. Patients must continue to take the medication, or they'll suffer a relapse, even though serious side effects often deter patients from continuing treatments, especially once they begin to feel well.

-) Some anti-depressants also have dangerous side effects. Patients taking MAOI's must be cautious as to what they eat as many foods can cause severe reactions.

-) The long-term use of tricyclic anti-depressants has been associated with heart problems.

+) SSRI's (modern anti-depressants) have fewer side effects and are considered safer than older anti-depressants. However, they have sometimes been linked to suicide.

-) There's ethical issues involved, as very ill people might not be able to give informed consent.

Psychosurgery aims to disconnect the thinking/planning part of the brain (frontal lobes) from the emotional parts (the amygdala).

Moniz (1935) performed the first attempt at human psychosurgery, when he performed the first pre-frontal lobotomy - a surgery severing the connection between the pre-frontal cortex and the rest of the brain.

He deemed the procedure a success, even though 6% of patients didn't survive the operation.

Freeman (1942) was impressed by Moniz, so he invented the 'ice-pick lobotomy', even though he had no surgical background himself. His technique involved tapping an ice-pick though an unconscious patient's eye socket and wiggling it around to destroy pre-frontal tissue.

From 1936-1950's, lobotomies were used thoughtout the USA, ultimately on around 40,000-50,000 patients.

Nowadays, psychosurgery is used as a last resort, using modern surgical techniques.

Psychosurgery - Evaluation:

-) Psychosurgery is now very rare, so it is hard to judge its effectiveness.

+) Beck & Cowley (1990) said it has been beneficial in alleviating the symptoms of severe anxiety disorders and OCD.

-) There are major ethical issues as damage is irreversible and the changes to the personality are upredictable. Patients may be too ill to understand the implications of the treatment and therefore can't give informed consent.

Sakel (1956) was treating a schizophrenic patient who was also a diabetic. He was accidentally given an overdose of insulin, which gave him a seizure. After the seizure, his schizophrenic symptoms seemed to have improved. This led to the development of inducing seizures/convulsions to treat schizophrenia and depression. Gradually, passing an electric current across the brain became the preferred method to inducing such seizures, and so ECT was created by Cerletti (1940).

Sakel (1956) made the observation and developed inducing seizures as treatment.

Cerletti (1940) developed this observation and treatment into the creation of ECT.

In the early days, ECT was dangerous as the convulsion was powerful and made the patient flail around (often breaking bones) and often led to disorientation and memory loss. Nowadays, muscle-relaxants are used and the shock (70V-130V) is applied unilaterlly for half a second to minimise memory loss.

Today, in the UK, ECT is only used for the most severe forms of depression where other treatments have failed. However, how ECT actually works is still a mystery.

ECT - Evaluation:

+) ECT is often quicker than drugs or psychological therapies; the effects are immediate.

+) It is an effective, short-term treatment for depression.

-) Sackheim (1988) however, found that 60-70% of patients improved but a large proportion became depressed again the following year.

-) Requires consent or a second opinion before it can be administered, and the Mental Health Act (2007) now states that a patient can refuse ECT unless its use is necassary to save a life or prevent serious deterioration in the person's condition.

-) ECT is criticised on ethical grounds. There are fears it may have been used (especially in the early days) to punish or control patients in mental hospitals (as highlighted in the novel 'One Flew over the Cuckoo's Nest' by Ken Kesey).

-) Breggin (1979) found that brain damage occurs in animals who were given ECT.

Freud set about looking for underlying, unconscious causes for mental disorders in the 20th century, as at this time, medicine could offer little explanation.

He believed that we are all born with raw animal instincts, such as the drive for sex, food, and aggression, which have to be tamed to allow us to live in society.

He thought that during childhood, we go through a series of stages where we must deal with conflict between our instincts and pressures to conform to the rules of society.

Eventually, we learn to control these instincts and pressures to conform to society.

However, at times, unresolved conflic which has been pushed down in the unconscious can resurface and cause mental disorders.

He developed what he called a 'talking cure' (psychoanalysis) during which unresolved conflicts could be uncovered and dealt with, allowing the person to 'move on'.

Psychodynamic Approach - Evaluation:

+) It tries to find the underlying causes for behavour rather than just treating symptoms.

+) It focuses on the individual. Rather than just seeing a patient as a list of symptoms, it tries to understand the patient's own unique experiences.

+) It still has a vast influence today and is widely recognised as one of the most influential theories of the 20th century.

+) It created greater sympathy for people with mental disorders.

-) It's impossible to test scientifically and isn't based on scientific evidence.

-) It's deterministic, in that it sees behaviour as being determined by instincts which the patient has no control over.

-) It deals with the past rather than the here and now.

-) It's culture-specific in that it may only apple to sexually-repressed Victorian women (Freud's patients in the 20th century).

-) It's not appropriate for disorders such as schizophrenia.