WHAT IS MENTAL DISORDER?
Distinguishing "normal" from "abnormal" is no simple task. Three classic symptoms suggest severe mental disorder: hallucinations, delusions, and extreme affective disturbances. Hallucinations are false sensory experiences, such as hearing nonexistent voices. Delusions are extreme disorders of thinking that involve persistent false beliefs. If you think you are the President of the United States (and you are not), you have a symptom of psychopathology. Similarly, those whose affect (emotion) is, for no apparent reason, depressed, anxious, or manic–or those who seems to have no emotional response at all–have yet other signs of mental disorder. Beyond such signs of distress, the experts do not always agree, however. What is abnormal and what is not becomes a judgment call, a judgment made more difficult because no sharp boundary separates normal from abnormal thought and behavior. The medical model takes a "disease" view, while psychology sees mental disorder as an interaction of biological, cognitive, social, and other environmental factors. Evolving Concepts of Mental Disorder
In the ancient world, people assumed that supernatural powers were everywhere, accounting for good fortune, disease, and disaster–even for the rise and fall of nations. In about 400 BC, the Greek physician Hippocrates may have taken humanity’s first step toward a scientific view of mental disturbance when he declared that abnormal behavior has physical causes. He taught his disciples to interpret the symptoms of psychopathology as an imbalance among four body fluids called "humors": blood, phlegm (mucus), black bile, and yellow bile. Those with an excess of black bile, for example, were inclined to melancholy or depression, while those who had an abundance of blood were sanguine, or warmhearted. With this revolutionary idea, Hippocrates incorporated mental disorder into medicine, and his view influenced educated people in the Western world until the end of the Roman Empire. Then, in the Middle Ages, superstition eclipsed the Hippocratic model of mental disorder. Under the influence of the Church, physicians and clergy reverted to the old ways of explaining abnormality in terms of demons and witchcraft. Even today some people hold the ancient ideas about spirit possession, witchcraft, and mental disturbance. THE MEDICAL MODEL In the latter part of the 18th century, the "illness" view that originated with Hippocrates reemerged with the rise of science. The resulting medical model held that mental disorders are diseases of the mind that, like ordinary physical diseases, have objective causes and require specific treatments. The new view of mental illness brought sweeping reforms that were implemented in "asylums" for the "insane." In this supportive atmosphere, many patients actually improved –even thrived–on rest, contemplation, and simple but useful work. Modern psychologists think that the medical model has its own weaknesses. They point out that the assumption of "illness" leads to a doctor-knows-best approach in which the therapist takes all the responsibility for diagnosing the illness and prescribing treatment. The patient becomes a passive recipient of medication and advice, rather than an active treatment participant learning how to manage his or her thoughts and behaviors. PSYCHOLOGICAL MODELS What do psychologists have to offer in place of the medical model? The psychological alternative gives equal footing to cognitive, environmental, and biological explanations. Like the medical model, this psychological perspective emerged most clearly at the end of the 18th century, helped along by the flamboyant work of Franz Anton Mesmer (1734–1815). Mesmer believed (incorrectly) that many disorders were caused by disruptions in the flow of a mysterious force that he called animal magnetism. He unveiled several new techniques to study animal magnetism, including one originally called mesmerism, which we now call hypnosis....
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