心理学与生活-第108章

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d）　A　biological　marker　is　a　“measurable　indicator　of　disease　that　
may　or　may　not　be　causal”；　that　is；　it　may　correlate　with　the　
disorder。　No　known　marker　perfectly　predicts；　or　brings　
about；　schizophrenia。　

3。　Family　Interaction　and　munication　
a）　Hope　remains　for　identification　of　an　environmental　
circumstance　that　increases　the　likelihood　of　schizophrenia　

b）　Research　does　offer　evidence　for　theoretical　position　that　
emphasizes　the　influence　of　deviations　in　parental　
munications　on　the　subsequent　development　of　
schizophrenia　

c）　Research　indicates　family　factors　do　play　a　role　in　
influencing　functioning　after　the　symptoms　appear　

V。The　Stigma　of　Mental　Illness　
A。　The　Problem　of　Stigma　
1。　Individuals　with　psychological　disorders　are　frequently　labeled　as　
deviant；　though　this　label　is　not　true　to　prevailing　realities　
2。　Stigma　is　a　mark　or　brand　of　disgrace；　in　the　context　of　psychology；　it　
is　a　set　of　negative　attitudes　about　a　person　that　sets　him　or　her　apart　
as　unacceptable”　
3。　Negative　attitudes　toward　the　psychologically　disturbed；　which　
e　from　many　sources；　bias　perceptions　of　and　actions　toward　
these　individuals　
4。　Mental　illness　can　bee　one　of　life’s　self…fulfilling　prophecies　
5。　Research　suggests　that　people　who　have　contact　with　individuals　
with　mental　illness　hold　attitudes　less　affected　by　stigma　
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DISCUSSION　QUESTIONS　

1。　What　if　a　well…controlled　study　showed　that　“crazy”　people　were　more　creative；　happier；　
and　lived　longer　than　“normal”　or　“sane”　people？　Ask　the　class　how　this　knowledge　
might　change　their　individual　therapies　of　abnormal　or　pathological　behavior。　
2。　What　if　someone　were　to　give　each　member　of　your　class　a　psychiatric　diagnostic　label　
and　offer　each　of　them　100；000　if　they　would　go　into　a　mental　hospital　ward　and　live　up　
to　their　label　for　a　month　without　being　discharged　as　either　cured　or　normal？　How　well　
do　class　members　think　they　would　do？　What　specific　acts　would　they　engage　in？　Have　
a　student　randomly　select　a　diagnostic　label　from　the　chapter　and　then　have　the　class　list　
the　specific　actions　they　would　perform　to　demonstrate　the　accuracy　of　the　diagnosis。　
What　does　“abnormal”　actually　mean？　Ask　the　class　to　give　you　an　operating　definition。　
Does　it　mean　“crazy”？　“Different”？　“Nuts”？　See　how　many　“definitions”　of　the　term　
you　can　get　and　be　ready　for　responses　you　would　never　have　imagined！　

4。　Because　of　the　deinstitutionalization　of　the　mentally　ill　that　occurred　in　the　1960s　and　the　
ensuing　lack　of　munity　health　support　for　that　population；　we　are　confronted　with　
the　probability　that　many　of　the　“homeless”　may　actually　be　schizophrenics　who　are　no　
longer　on　medication。　Does　this　seem　to　be　a　plausible　explanation　for　the　increase　in　
homeless　individuals？　
5。　Should　the　mentally　ill　be　forced　to　take　medication　if　medication　exists　that　will　
ameliorate　their　symptoms？　Schizophrenics　often　consider　the　voices　that　they　hear　gifts　
from　God。　Should　we　deprive　them　of　this　gift？　Should　they　be　“locked　up”　in　an　
institution　where　they　could　receive　sound　nutrition　and　protection　from　the　elements？　
Are　they　“better　off’　on　the　streets？　What　are　the　ethical　issues　involved　in　each　of　the　
above　situations？　
6。　How　valid　does　the　class　think　the　“preparedness　hypothesis”　is　as　an　explanation　for　
phobic　disorders？　If　we　“carry　around”　an　evolutionary　tendency　to　jump　when　startled　
（i。e。；　“to　respond　quickly　and　‘thoughtlessly’　to　once…feared　stimuli”）；　how　did　that　
tendency　actually　get　to　us？　Think　about　phobias　in　terms　of　the　collective　unconscious；　
as　espoused　by　Carl　Jung。　What　sort　of　justification　might　we　offer　for　applying　Jung’s　
hypothesis　to　the　preparedness　hypothesis？　
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CHAPTER　15：　PSYCHOLOGICAL　DISORDERS　

SUPPLEMENTAL　LECTURE　MATERIAL　

DSM…IV…TR：　What　Is　It？　

DSM…IV…TR　is　the　Diagnostic　and　Statistical　Manual　of　Mental　Disorders；　Text　Revision　Edition。　DSMIV…
TR　is　a　diagnostic　manual；　published　by　the　American　Psychiatric　Association　and　is　used　by　
mental　health　professionals　in　an　attempt　at　concordance　in　evaluation　and　diagnosis　of　the　
various　mental　illnesses。　If　you　have　medical　insurance　that　covers　mental　health　care；　your　
carrier　probably　predicates　its　decision　to　pay　for　your　care　on　the　DSM…IV…TR　diagnostic　criteria；　
as　reported　by　your　therapist。　

DSM…IV…TR　proposes　five　categories；　each　called　an　axis　（plural　=　axes）；　according　to　which　an　
assessment　of　the　disturbance　is　made。　Psychological　and　psychiatric　disorders　are　classified　
according　to　their　“fit”　on　these　various　axes。　This　is　a　multiaxial　classification　system。　In　order；　
these　axes　are：　

AXIS　I：　CLINICAL　DISORDERS　

Clinical　syndromes　include　the　major　affective　disorders；　psychoactive　substance…induced　mental　
disorders；　eating　disorders；　organic　mental　disorders　（e。g。；　senility；　Alzheimer’s）；　the　
schizophrenias；　adjustment　disorders；　and　depressive　disorders。　Axis　I　and　Axis　II　diagnoses　are　
often　indicated　at　the　same　time。　

AXIS　II：　PERSONALITY　DISORDERS　AND　MENTAL　RETARDATION　

Disorders　included　in　this　category　are　mental　retardation；　pervasive　developmental　disorders　
（e。g。；　autism）；　and　specific　developmental　disorders　（e。g。；　academic　skills　disorders　such　as　
developmental　writing　disorder；　developmental　arithmetic　disorder；　and　developmental　reading　
disorder）。　Specific　personality　traits　or　habitual　use　of　particular　defense　mechanisms　are　also　
indicated　here；　e。g。；　antisocial　personality　disorder。　These　disorders　all　have　the　mon　
denominator　of　having　their　onset　in　childhood　and/or　adolescence。　For　example；　a　diagnosis　of　
antisocial　personality　disorder　in　adulthood　requires　a　prior　diagnosis　of　conduct　disorder　in　
childhood。　This　conduct　disorder　usually　persists　in　a　stable　form　（without　period　of　remission　or　
exacerbation）　into　adult　life；　at　which　time　it　may　be　“upgraded”　to　antisocial　personality　
disorder。　

Although　you　will　not　always　have　an　Axis　I　and　Axis　II　disorder　at　the　same　time；　you　often　
will。　When　you　do；　you　see　the　diagnoses　indicated　as　follows：　

Axis　I：　Alcohol　Dependence　

Axis　II：　Antisocial　Personality　Disorder　（Principal　Diagnosis）　

When　an　individual　does　have　both　Axis　I　and　II　disorders；　the　“principal　diagnosis’　is　assumed　
to　be　the　Axis　I　disorder　unless　the　Axis　II　disorder　is　followed　by　the　qualifying　statement　
“Principal　Diagnosis”　indicated　in　parentheses。　

AXIS　III：　GENERAL　MEDICAL　CONDITIONS　

This　axis　permits　the　clinician　to　indicate　any　current　physical　disorder　or　condition　that　is　
relevant　to　the　understanding　or　management　of　the　case。　Sometimes　these　conditions　have　
clinical　significance　concerning　the　mental　disorder。　For　example；　a　neurological　disorder　may　be　

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strongly　related　to　a　patient’s　manifestations　of　Senile　Dementia。　

AXIS　IV：　PSYCHOSOCIAL　AND　ENVIRONMENTAL　PROBLEMS　

This　axis　provides　a　scale；　the　“Severity　of　Psychosocial　Stressors　Scale；”　that　enables　the　clinician　
to　code　the　overall　severity　of　psychosocial　stressors　that　have　occurred　in　the　client’s　life　during　
the　preceding　year　and　to　evaluate　their　contribution　to　any　of　the　following：　

。　development　of　a　new　mental　disorder　
。　recurrence　of　a　prior　mental　disorder　
。　exacerbation　of　an　already　existing　mental　disorder　
Stressors　often　play　a　precipitating　role　in　the　appearance　of　a　disorder；　but　they　may　also　be　a　
consequence　of　the　person’s　psychopathology。　A　mon　situation　is　to　have　the　Alcohol　
Dependence　of　one　partner　in　a　marriage　lead　to　marital　discord　and　eventually　divorce。　The　sum　
of　the　separation　and　subsequent　divorce　（with　all　its　attendant　traumas）　may　progress　to　the　
point　of　a　Major　Depressive　Episode。　Types　of　psychosocial　stressors　considered　for　rating　on　this　
axis　include：　

。　Conjugal　（marital　and　nonmarital）：　engagement；　marriage；　discord；　separation；　divorce；　
death　of　a　spouse　
。　Parenting：　being　a　parent；　friction　with　a　child；　illness　of　a　child　
。　Other　Interpersonal：　problems　with　one’s　friends；　neig