Professor Paul Bloom: The final topic of the course is clinical psychology, also known as abnormal psychology or psychopathology, and this, for many of us, is what psychology is really about. It's about mental illness. It's about clinical psychologists. And we started talking about this when Dr. Nolen-Hoeksema gave her guest lecture last week and I want to continue through this today. It is a topic of tremendous scientific importance but also a topic of great personal importance for many of us. Many of the people in this room have been mentally ill, strictly speaking, at some point in their lives. Some of you are under some sort of therapy or treatment or medical intervention right now. Some of you are on Prozac or Zoloft or Ambien or Wellbutrin or any of those other medications to deal with psychological problems you are facing. Others are also talking to psychiatrists, psychologists, social workers, and other people.
0r n;YJ:\0Many of you who are not at this point mentally ill will become mentally ill during your stay at Yale. [laughter] And this is a difficult period in many people's lives and it's a period of people's lives where mental illness emerges in many of us. By one estimate, one half of all college graduates in the United States – and the number is very high with college graduates, highly educated people – one half of you will have some sort of mental illness in your life serious enough to require some sort of treatment. Those of you not directly affected with mental illness yourselves will no doubt experience your loved ones, your family, your friends getting some sort of illness, be it Alzheimer's or schizophrenia or depression or some sort of anxiety disorder. So the personal importance of clinical psychology, the personal importance of understanding what can go wrong and how best to treat it, simply can't be underestimated.心理学空间tE:E1Cn o.m
Now, when we talk about mental disorders, the scope of this is very broad. It includes the prototypical schizophrenic which you could see on the streets of New Haven, somebody walking and gesturing and talking to themselves and sometimes screaming. It includes alcohol addiction and cocaine addiction and other addictions. It includes somebody with Down syndrome or autism, an old person losing his memory, a teenager falling into a deep depression, somebody with a severe social phobia to the extent that he or she can't leave the house. Then there are also very hard cases where it's difficult to say one way or another--that guy's photographing me as I'm talking and it's freaking me out [laughs] [laughter] in kind of a social phobia way. There's difficult cases where it's just hard to tell mental illness from just [laughter as Professor Bloom waves goodbye to the photographer] bad behavior in general. So, consider a killer without a conscience or a mobster like John Gotti. Is he mentally ill? And this is a question which is a deep one and we'll wrestle with it a little bit actually towards the end of this lecture.
R*Wvzdx0What about somebody who acts in a kind of unusual or zany way? This is originally supposed to be a picture of the character Kramer on "Seinfeld" but, given his unusual antics in the last few months, it could be a picture of the actor who plays him who got into all sorts of trouble. What about someone who is just kind of wacky? At what point does wackiness move into the domain of mental illness? What about unusual lifestyles such as extreme altruism? Batman devotes most of his life to helping others. He sleeps one hour a night and this hour is fraught with nightmares and then he fights crime. What about somebody, and this was a case reported inThe New Yorkera few months ago, who has lots of money and a loving family and has his kidney removed to help a stranger? And he says, "I have two kidneys. It's minor pain, a minor operation. I could save someone's life." And his wife says, "You're mentally ill. That's just crazy to do that." Where do we draw the line? And so, there are these great philosophical and moral questions over the boundaries and how to think about mental illness.心理学空间5h\;W"Z _&Go
So, how should we think about mental illness? Well, there are some answers we could quickly dispense with. It used to be thought that severe mental illness was a result of demonic possession. If you read the Gospels, Jesus Christ wandered around a lot, met crazy people and exorcised the demons from their bodies. It was a common way of thinking about craziness. We now believe that this is not true. What about--yeah, it's not true. What about social deviants? Some people including the psychiatrist Thomas Szasz claim that when we label somebody as mentally ill this is not a medical decision. It's rather a social decision designed to ostracize people who deviate from society's norms, to ostracize them and rid them of moral agency. It's not that we disagree with them. It's not even that we see them as evil. Rather, we see them as sick and as such we don't even have to accord to them the respect that we accord to criminals.
A;O~ JNk*z0Now, this is not entirely an unreasonable view. In many countries around the world, dissidents, people who argue against the state, are often determined to be mentally ill and thrown in asylums. Blacks in the United States who tried to escape from slavery were described as having a mental illness. Why would they want to do so unless they were mentally ill? Up until 1973, to be a homosexual, to be gay, would count in the official records of how we classify illness as being mentally ill. And many people saw this, and we see this now, not so much as reflecting a sort of unbiased medical analysis but rather as reflecting biases that people have against gay people. And these are political and social and moral biases. They are not objective medical judgments. Even now I've been recording every president that has been the president of the United States in my memory including Bush and particularly Clinton has been described by his opponents not merely as awful, evil, terrible, "hate his policies," but as mentally ill. Every president at some point or another, some bright, intelligent person figures to call him a psychopath and put that inTimemagazine. Now, put aside whether--the extent to which these things are accurate, point being that we often use medical labels, particularly labels like "psychopath," "schizophrenic," "delusional," to ostracize and pick out people we disagree with.
6I4LvoNd,?0At the same time though, this is not entirely right. People go too far when they say there's no such thing as mental illness. Some people are mentally ill in a very real sense of "illness," in the same sense we would describe somebody as physically ill if they were to have cancer. This illness damages their functioning. They cannot function well. They do not tend to be more creative or more productive or more vivacious. Rather, for – with very few exceptions; possibly some exceptions revolving around mania as Dr. Nolen-Hoeksema discussed – with very few exceptions being mentally ill is just very bad for you in every possible way. Moreover, when people are treated, when people get better, they become more competent, happier, better able to participate in the world, and they do not choose to go back to their mental illness, suggesting that it really is illness in the serious sense. And so the modern treatment of psychological disorders treats them as disorders like medical disorders. Schizophrenia is as much a disease as is cancer and should be thought of in the same way.心理学空间+PFm]Pw
zq.G\&P;C8J0There's a whole field of abnormal psychology of tremendous scope. We've already discussed many mental illnesses in the context of other things. So, for instance, we talked about amnesia in the context of memory and how it works. We talked about autism in the context of social reasoning. There are many more and I'm not going to read through them. These are the major categories just for people's interest fromThe Diagnostic and Standard Manual.You don't have to--you're not responsible for all of these. And this is an illustration, which people might find interesting, of sex differences in these--in the major disorders. And the patterns, as you could see, are kind of neat. Women are more prone to have anxiety disorders and mood disorders. Men are much more likely to suffer from substance disorders, particularly alcoholism. Schizophrenia is sort of evenly matched but antisocial personality disorders, sometimes known as sociopathy or psychopathy, is predominantly male. And we'll turn to that a bit later.
%v Y%C)d!sz0Here are the major ones which I want to review today. I'm not going to talk about mood disorders at all because this was the topic of the superb lecture we heard last week but I want to quickly review schizophrenia, the class of disorders known as anxiety disorders, the class of disorders known as dissociative disorders, and the class of disorders known as personality disorders. And these are the main psychological problems. When a psychologist or psychiatrist does his or her work, they're predominantly focused on somebody who has one of these problems. Some of them are rare but some of them such as anxiety disorders and the mood disorders are very common.