e4H,I:pj;tl0Professor Paul Bloom:I am extremely pleased to introduce the fourth and final guest lecture of the semester. Professor Susan Nolen-Hoeksema. Susan is a professor in the Department of Psychology and the Director of Graduate Studies. She is well known for her work in clinical psychology and especially her research in depression, the nature and causes of people with depression, with special focus on sex differences in depression. She basically does everything someone can do. She is a noted scientist, winning many awards and publishing massive amounts of work in scientific journals. She is an award-winning teacher and has authored what, in my mind, is the very best textbook in her area. And she's a noted popular writer who has written popular and accessible books bringing the message and ideas and theories of clinical psychology to the broader public. The only other thing I'll mention before we welcome her is that she's going to teach next year her course in clinical psychology, which has a superb reputation as an extremely interesting course. If you are interested in what you hear today and you want to learn more about it, that's the course you should take. So, let's please welcome Dr. Susan Nolen-Hoeksema. [applause]
Professor Susan Nolen-Hoeksema:Thank you Paul. Can everybody hear me okay? Okay. So, what I want to do today is to give you a very brief overview of how modern clinical psychology looks at mental disorders, some of the ways we think about what constitutes a mental disorder, some of the characteristics that kind of cut across mental disorders, and then I'm going to use the case of mood disorders, that is depression and what is now called bipolar disorder, what you may know more popularly as manic-depression, as sort of examples of how we think about a particular set of disorders and some of the ways we go about researching the theories -- different theories for the disorders and some of the prominent treatments for disorders these days. Okay? So, I'm going to do both a fair amount of lecturing, and then I've got lots of video clips to show you as well. So, I'm going to be roaming around and changing venues here fairly often.心理学空间2h#@_oy$U1B
So, the first and most fundamental question in clinical psychology is, "What is abnormality?" Where do we draw the line between normal, healthy, typical behavior and what we might want to call abnormal, atypical, deviant, unhealthy, maladaptive mental problems? We tend to have an intuitive sense of what we mean by abnormality, and we'd like to believe--a lot of people who come into my course say, "Well, of course, you know, you guys have figured it out. You know where to draw the line. You have criteria. You have blood tests, right? --that tell me whether I have depression or schizophrenia or one of the things I've read about." Well, the reality is that we don't.
k0q`Y.e? z2y3w M_~&w0First of all, there is no biological test for any of the known mental disorders right now. And instead what we have is a set of behavioral criteria for how to diagnose different mental disorders. And what I mean by behavioral criteria is a set of symptoms that the person reports to you about how they feel, how they think, and a set of observations about their behavior and how typical or atypical it is. And you take the sort of set of symptoms the person shows or reports, and you match them up against the existing criteria for different mental disorders. And then it comes down to a fairly subjective judgment call about whether the person meets the criteria or not. Unfortunately, these judgment calls, because they are so subjective, can be influenced by a lot of factors. And we won't have a chance to go into these too much today, but just to highlight a few of them.心理学空间t&M?ZijC5A
The first is social norms. Whether you get labeled as having a mental disorder or a problem depends very heavily on what your social or cultural norms are. So, a woman wearing a veil in a Muslim community or culture would be seen as typical, even prescribed, behavior. Whereas a woman wearing a veil in a non-Muslim culture, especially until fairly recently, was often looked upon as very atypical or abnormal behavior.心理学空间"jdA+}Zz
The second kind of thing that gets--that influences whether something is called normal or abnormal is certain characteristics of the target person. In particular, I've highlighted here, gender. Whether you're a man or you're a woman really influences how unusual a certain behavior is. So, crying is a good example. A man crying in our culture is seen as fairly unusual, whereas a woman crying is seen as much less unusual. On the other hand, a woman beating up someone is taken as quite unusual behavior where it's less unusual for a man. So, we have gender stereotypes, gender roles for what is acceptable behavior, and our judgments as to whether something is normal or abnormal get influenced by those gender roles.心理学空间R{ xA;NZ&d[
\F7Q`,d#y(AM0And the third thing that can influence whether something is labeled abnormal or not is the context. And here I'm giving you the example of "paranoia." If you're paranoid and hyper-vigilant, looking for threat in downtown Baghdad, that's considered very adaptive behavior these days because it could prevent you from getting hurt or killed. Whereas, if you're in a quiet little farm in Central Connecticut, being extremely paranoid and believing there's someone who's going to shoot you around the corner is not considered as normal or as acceptable or adaptive behavior. So, the context in which you exhibit a particular behavior also can heavily influence whether it gets labeled by others as normal or abnormal.
In the field of clinical psychology we have a number of different ways, kind of heuristics that we use to label things as abnormal or unhealthy or troubling. And three of these characteristics are what we often call the three Ds: distress, dysfunction, and deviance. So, behaviors that cause the individual or others significant distress often get labeled as abnormal or unhealthy. Depression is a prime example, as we'll see when we talk about the characteristics of it. It's a miserable state of being; you're unhappy, you're sad, you may even feel so badly you want to kill yourself. And that very, very high level of distress is part of the reason why it's labeled as a mental disorder. Other mental disorders don't cause the individual distress, but they may cause other people distress.
T"CZ"\^(pr0So, one example of this is something called "antisocial personality disorder," where the individual has no regard for the rights of other people, has no hesitation to steal or--steal from or hurt other people, has no empathy or sympathy for other people's feelings and so can inflict a lot of harm on other people and has absolutely no distress over this whatsoever. But this behavior causes other people distress, and that's one of the reasons why that's labeled an abnormal behavior or a mental health problem.
The second general criterion is "dysfunction." If a set of behaviors prevents the person from functioning in daily life, then it might be labeled as abnormal or might end up being labeled as a mental health problem. Again, depression is a good example. People who are depressed often become completely non-functional. They can't get up and go to class; they can't go to work; they can't interact with their friends; they withdraw and become totally isolated socially. So, they might lose their job; they might flunk out of school. And this complete decline in functioning is one of the major reasons that we consider depression one of the most debilitating disorders.心理学空间 e nYxFL(C&?
And then finally, "deviance," the behaviors or feelings are highly unusual. This is probably the most controversial of the three because it weighs, it is so heavily influenced by the social norms. What's deviant in one culture is not deviant in another culture. But if a set of behaviors is completely unacceptable to a culture, highly unusual, they're more likely to end up getting labeled as abnormal.心理学空间!Dju"^sof&N
Acw'k%zR!_-e0Okay. So, how do we pull this all together? Well, these days the manual for making diagnoses in clinical psychology and psychiatry in the United States is called theDiagnostic and Statistical Manualor theDSM, and it's in its fourth revision. It's been around since the, I believe the '50s, and the early editions in the '50s and '60s were highly subjective and based on Freudian theory. But since 1980 there's been real effort to make the criteria much more objective, to make the set of behaviors or observations that are required to diagnose someone be things that are observable, that you can see in other people that they can report on reliably, and that one clinician and another clinician will agree upon. So, theDSM gives lists of symptoms with the required symptoms for a diagnosis, the number of symptoms that have to be present, and the notions of deviation, dysfunction and distress are built into these criteria. And I'm going to give you a couple of examples of these criteria when we talk about the specific types of mood disorder.心理学空间.|#ep}3{$@?6N,`gc
"S TyN#cA U0So as I said, I'm going to use mood disorders as kind of a case example here of how we go about diagnosing and understanding psychopathology, but I also just want to impart some information because mood disorders are one of the most common problems that people face. As many as one in four women will have an episode of serious depression at some time in her life, and about 13% of men will have an episode of serious depression in their lives. So, these are extremely common kinds of problems that people experience, particularly at your age. The college years are one of the peak times of onset, first onset, of depression in particular. And also, for bipolar disorder, or manic-depression, the late adolescent, early 20s are the peak onset times for these disorders as well.心理学空间O:wt2VBG;x|o7G
So, the mood disorders divide into what's called unipolar depression disorders, which is depression only and then bipolar disorders where the person cycles between depression and mania. And here are theDSMcriteria for major depression, one of the most severe forms of depression. And as I said, theDSMsets up these relatively observable criteria and how many you have to have and what absolutely has to be present in order to get the diagnosis. So, the first criterion in theDSMfor major depression is that the individual has to either show sadness or a diminished interest or pleasure in their usual activities, which is referred to as anhedonia. So, you have to have one or the other of these to sort of pass the first criterion. So, you might say that you feel sad and blue and just--or actually say you feel depressed. Some people feel those feelings very strongly. Other people don't really feel so sad or blue, but what they'll say is that nothing interests them anymore. It's like the emotion has been sucked out of their life altogether. They don't have any fun doing the activities they used to do before. They don't want to hang with their friends. They just--they don't care about eating. Just nothing feels right, feels good, anymore.心理学空间.Z@qT9lY^Ju!t#x V
KA2dy9_.[.[%f0And then the individual has to have four of the--at least four of the following symptoms in addition to sadness or anhedonia. First, they can show significant weight or appetite change. So, you may completely lose your interest in eating and lose a lot of weight, or some people go on eating binges. I had a very good friend who was depressed for about a year, and she gained fifty pounds because she would just eat. She would binge eat, especially at night.