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Transcript Provided by YouTube:
00:10
Way back in 1887, a journalist named Elizabeth Cochran assumed the alias Nellie Bly and feigned
00:16
a mental illness to report on the truly awful conditions inside psychiatric hospitals in
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the US, which were known as asylums at the time. She found rotten food, cold showers,
00:27
prevalent rats, abusive nurses, and patients being tied down in her famous expose “Ten
00:33
Days in a Mad House”. What she documented had been pretty standard mental health treatment
00:38
for centuries, but her work led the charge in mental health reform.
00:42
It’s been a long battle.
00:43
Nearly a century later in 1975, American psychologist David Rosenhan published a paper called “On
00:49
Being Sane in Insane Places” detailing the experiment that he conducted on psychiatric
00:54
institutions themselves. The first part of his experiment involved sending pseudopatients
00:58
– a group of eight totally mentally sound associates, including David himself – to knock
01:03
on institution doors and falsely report that they’d been hearing voices. Once admitted,
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the fake patients abandoned their fake symptoms and behaved as they normally did, waiting
01:12
for administrators to recognize them as mentally healthy.
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Like Cochran, Rosenhan and his team learned that it’s easy to get into a mental institution,
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but it is much, much harder to get out. The participants were kept in the institution
01:24
for an average of 19 days, one of them for 52 days. They were forced to take psychotropic
01:28
medication (which they sneakily spit out) and were eventually discharged with a diagnosis
01:33
of paranoid schizophrenia in remission. Of course, being dubbed in remission isn’t exactly
01:38
the same thing as being labeled sane, and that was just one of Rosenhan’s criticisms
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of the system. It viewed mental illness as an irreversible condition, almost like a personality
01:48
trait, rather than a curable illness.
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Part two of his experiment came later when Rosenhan shared his results with a teaching
01:54
hospital and then told the staff that he’d be sending more pseudopatients their way in
01:59
the next few months, and challenged them to detect the imposters. With that in mind, out
02:03
of 193 new patients, 41 were ferreted out as likely or suspected pseudopatients. The
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thing is, Rosenhan never actually sent in any pseudopatients. In the end Rosenhan concluded
02:15
that the way people were being diagnosed with psychiatric issues often revealed less about
02:19
the patients themselves and more about their situation. Like, saying you’ve heard voices
02:24
one time might catch a doctors attention a lot more than weeks of normal behavior.
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Naturally people criticized his methods and his findings, but his experiment raised a
02:33
lot of important questions like: How do we define, diagnose, and classify mental disorders?
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At what point does sad become depressed? Or quirky become obsessive compulsive? Or energetic
02:43
become hyperactive? What are the risks and benefits of diagnostic labeling, and how does
02:47
the field keep evolving?
02:49
When people think of psychology they probably most often think about the conditions that
02:52
it’s been designed to understand, diagnose, and treat – namely psychological disorders.
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From common problems that most of us will experience at some point in our lives to the
03:01
more serious dysfunctions that require intensive care. They’re a big part of what psychology
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is here for and over the next several lessons we’re going to be looking at mental illness,
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as well as wellness. How symptoms are diagnosed and what biological and environmental causes
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may be at work. But, to grasp those ideas, we first have to find out how we came to understand
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the idea of mental health itself and build a science around studying, discussing, and
03:25
caring for it.
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In 2010, the World Health Organization reported that about 450 million people worldwide suffer
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from some kind of mental or behavioral disorder. No society is immune from them, but when I
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say psychological disorder I’m guessing some of you will conjure up all sorts of dramatic
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images like diabolical criminals from Arkham Asylum or Hollywood stereotypes of various
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eccentric, scary, or tragic figures. This roll call of one-sided stock images is part
03:50
of the problem our culture faces – the misconceptions and often destructive stigma associated with
03:55
psychological disorders.
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So, what does that term actually mean?
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Mental health clinicians think of psychological disorders as deviant, distressful, and dysfunctional
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patterns of thoughts, feelings, or behaviors. And yeah, there are a lot of sensitive and
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loaded words in there, so let’s talk about what we mean, starting with deviant.
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Sounds like I’m talking about doing things that are dicey or raunchy, but in this context
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it’s used to describe thoughts and behavior that are different from most of the rest of
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your cultural context. Of course, being different is usually wonderful. Geniuses and Olympians
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and visionaries are all deviants from the norm so it probably goes without saying that
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the standards for so-called deviant behavior change a lot across cultures and in different
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situations. For example, in a combat situation killing people is probably to be expected,
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but murder is definitely deviant criminal behavior back home in times of peace. And
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in some contexts speaking to spirits or ancestors is A-OK, but in other settings say a bar in
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Iowa City at happy hour it might not be quite acceptable.
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But, to be classified as a disorder, that deviant behavior needs to cause that person
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or others around them distress, which just means a subjective feeling that something
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is really wrong. In turn, distress can lead to truly harmful dysfunction – when a person’s
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ability to work and live is clearly, often measurably, impaired.
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So that’s today’s definition but it took a long time for the Western world to come up
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with a way of thinking about psychological disorders that was rooted in science and investigative
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inquiry. It wasn’t until around the 18th and 19th centuries that we really started to put
05:23
forth the notion that mental health issues might be about a sickness in the mind. For
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example, by the 1800s doctors finally caught on to the fact that advanced syphilis could
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manifest in serious neurological problems like dementia, and irritability, and various
05:37
mental disorders. So eventually a lot of so-called mental patients were removed from asylums
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to full medical hospitals where all of their symptoms could be treated.
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This “a-ha” moment is just one instance of how perspectives on mental health began to
05:50
shift towards what is called the Medical Model of Psychological Disorder. The Medical Model
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champions the notion that psychological disorders have physiological causes that can be diagnosed
06:00
on the basis of symptoms, and treated, and sometimes even cured. That way of thinking
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about mental health was an important step forward, at least at first. It took us past
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the old days of simply locking people up when they didn’t seem quite right to others.
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But even if it was an improvement, the medical model was seen by some in the field as kind
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of narrow and outdated. Most contemporary psychologists prefer to view mental health
06:20
more comprehensively through what is called the Biopsychological Approach. You’ve heard
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us say over and over again that everything psychological is simultaneously biological
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and that truism is particularly useful here. The Biopsychological view takes that holistic
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perspective, accounting for a whole number of things clearly physiological and not in
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order to understand what’s happening to us, what might be going wrong, and how it can
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be treated.
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It takes into account psychological influences for sure like stress and trauma and memories,
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but also biological factors like genetics and brain chemistry, and social-cultural influences
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like all the expectations wrapped up in how a culture defines normal behavior. So by considering
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the whole host of nature and nurture influences, we can take a broader view of mental health,
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realizing that some disorders can be cured while others can be coped with, and still
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others may end up not being disorders at all once our culture accepts them.
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But another important part of handling disorders with scientific rigor is attempting to standardize
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and measure them. How we talk about them, how we diagnose them, and how we treat them.
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So the field has literally come up with a manual that shows you how to do that. But
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it is not without it’s flaws. It’s called the American Psychiatric Association’s Diagnostic
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and Statistical Manual of Mental Disorders; or, DSM-5 because it’s currently in its fifth
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edition. And it is used by practically everybody: clinicians obviously, but also by insurance
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and drug companies, and policy makers, and the whole legal system.
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The first edition came out in 1952, and this newest version was released in 2013. What’s
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particularly interesting about it is that it’s designed to be a work in progress…
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forever. Each new edition incorporates changes based on the latest research but also how
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our understanding of mental health and behavior evolves over time. For example, believe it
08:01
or not the first two editions actually classified homosexuality as a pathology, basically a
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disease. The 1973 third edition eliminated that designation, reflecting changing attitudes
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and a developing understanding of sexual orientation. And just by looking at the changes between
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the edition used today and the previous version released in the year 2000, you can get a picture
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not only of how quickly things change but also how classification can affect diagnosis
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– for better or worse – and also what the risks are of classifying psychological disorders
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in the first place.
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For instance, the new edition reflects our growing understanding of the symptoms of Post
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Traumatic Stress Disorder, and it changed the name of Childhood Bipolar Disorder to
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Disruptive Mood Dysregulation Disorder because kids were being over-diagnosed and over-treated
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for bipolar disorder when the condition that they had didn’t actually fit that description.
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And totally new diagnoses are being explored as well, like Gambling Addiction and what’s
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called Internet Gaming Disorder, showing that new disorders continue to arise with changing times.
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But the DSM is not perfect, even though we’ve come a long way since the Rosenhan experiment,
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critics still worry about how the DSM might inadvertently promote the over- or mis-diagnosis
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and treatment of certain behaviors. Others echo Rosenhan’s concerns that by slapping
09:12
patients with labels we’re making them vulnerable to judgments and preconceptions that’ll affect
09:17
how others will perceive and treat them.
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In the end, it’s just important to keep in mind that definitions are powerful and things
09:23
can get tricky pretty fast in the world of mental health.
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Today you learned about how we define psychological disorders, and looked at medical and biopsychological
09:30
perspectives on mental illness. We talked about how professionals use the DSM to diagnose
09:35
disorders and how it’s constantly evolving to incorporate new thinking. Thanks for watching,
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especially to all of you who are Subbable subscribers who make Crash Course possible.
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To find out how you can become a supporter, just go to subbable.com.
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This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant
09:50
is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins, the script supervisor
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is Michael Aranda, who is also our sound designer. And the graphics team is Thought Cafe.
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This post was previously published on YouTube.
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Photo credit: Screenshot from video.