Introducing Psychopathology

Betty Rudd

• Publisher: SAGE Publications Ltd
• Year: 2013
• ISBN:
  9781446292907
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Introducing Psychopathology is an essential course companion for counselling, psychotherapy and counselling psychology trainees. It explains how to describe and diagnose client problems in clear, accessible language, demystifying the concept of psychopathology and revealing it as an integral aspect of training and practice. The book is entirely comprehensive in its coverage of client problems, groups, methods of assessment, up-to-date research and settings,

• covering crucial topics from assessment and diagnosis to the clinical symptoms of emotional distress, including severe or enduring disorders like schizophrenia and borderline personality disorder
• providing a framework for psychiatric diagnosis and classification and covering risk assessment in detail
• concluding with a chapter on holistic approaches and emotional wellbeing.

Case studies and exercises throughout the book make sense of the theory in real-life practice and the author?s enthusiasm for her subject makes for a uniquely engaging, readable guide to the complexities of psychopathologies.

1

Understanding Psychopathology

LEARNING OBJECTIVES FOR THIS CHAPTER

• Understand what Introducing Psychopathology is about

• Know the history behind the concept of psychopathology

• Discuss the philosophical underpinnings of psychopathology

• Have insight into the classification of mental disorders

• Realise that cultural and transcultural issues are involved in psychopathology

At the heart of counselling, psychotherapy and counselling psychology lies an understanding of mental distress. This is why knowledge of psychopathology is crucial for trainees entering these professions. Without it, they can get lost in a maze of psychobabble.

When I was a student, I wished for a book that explained mental disorders in a jargon-free, simple way. During my training, ploughing through the great third edition of the Diagnostic and Statistical Manual for Mental Disorders (APA, 1987) was a daunting task. What I needed was a simple introduction to psychopathology. I write the simply presented and jargon-free book I wish I had in the hope that it helps those who use (or will use) talking as a therapeutic ‘tool’ with their clients or patients.

Although having the ability to be a reflective practitioner is key (as I explain later in this chapter), without a breadth and depth of understanding how mental distress manifests in individuals, coupled with a knowledge from theory and research on how to facilitate these people to move in a desired direction, the therapeutic relationship is severely compromised; if indeed, it is present at all. Without such knowledge and understanding, therapists may unwittingly make matters worse. Bearing this in mind, Introducing Psychopathology specifically includes points to reflect on. There are teaching and learning features throughout and these are discussed further on.

You do not have to read this book in any particular order. Dip into it at any place. Each chapter can stand in its own right – if you want to find out about being depressed, just go to the chapter that deals with depression. Nevertheless, there is some logic to the order I have written the text. For instance, this chapter is the book’s introduction. The one that follows deals with assessing and referring, because these tasks are normally necessary during a first appointment. Then there is a focus on children before the spotlight shines on adults, and finally I consider possible future avenues. Therefore, you can read Introducing Psychopathology from cover to cover for a more comprehensive picture.

WHAT IS PSYCHOPATHOLOGY?

Psychopathology derives from two Greek words: ‘psyche’ meaning ‘soul’, and ‘pathos’ meaning ‘suffering’. Currently, ‘psychopathology’ is understood to mean the origin of mental disorders, how they develop and their symptoms. Traditionally, those suffering from mental disorders have usually been treated by the psychiatric profession, which adheres to the DSM-IV-TR (APA, 2002) or ICD-10 (WHO, 1992) for classifying mental disorders. It therefore follows that psychiatrists use the term ‘psychopathology’ more than people in other professions. Psychiatrists are medical doctors who then train in mental health and are able to treat with medication or/and in whatever psychotherapy model they have trained in.

Within psychiatry, the term ‘pathology’ refers to disease. However, viewing mental problems as a disease is a contentious point. Psychotherapists, counselling psychologists and counsellors (who specialise in mind matters and are not medics), view apparent mental dysfunction as mental distress, not necessarily related to pathology. So, the term ‘disorder’ is used, rather than ‘disease’. Other words for diagnosing distress within the mind remain: ‘symptoms’ meaning ‘signs’, ‘aetiology’ meaning ‘cause’, and ‘prognosis’ meaning ‘expected outcome’.

HISTORY AND PHILOSOPHY

Historical and philosophical factors of psychopathology can easily take up a whole volume. This section offers a psychopathology foundation, which can be built on by looking up the related resources and references listed at the end of the chapter.

Historically, the concept of psychopathology is rooted in the medical tradition. This is where the terms ‘diagnosis’, ‘symptoms’, ‘aetiology’ and ‘prognosis’ come from (Murphy, 2010). Psychiatrists categorise severe mental distress into psychopathological disorders whose symptoms they can treat with prescribed drugs, and use the word ‘patients’. Counselling psychologists, counsellors and psychotherapists favour the term ‘clients’ over ‘patients’ (because of the medical connotations of the word ‘patients’) and use talking, more than anything else, as a therapeutic ‘tool’. They also prefer the concept of ‘formulation’ instead of ‘diagnosis, symptoms, aetiology and prognosis’. Throughout this book, instead of repeating ‘counselling psychologists, counsellors and psychotherapists’, I use the word ‘therapists’, or ‘talking-cures’ to mean all three of these professions because although they may require different trainings, their overlap is substantial. But what are the historical roots of these professions?

Ancient Greece

Medical and talking-cure roots are embedded in the soil of ancient Greek philosophy. Indeed, the philosophy of the western world is rooted in ancient Greece, from which the mould of western-world thinking was wrought, influencing the way in which the west is. Therefore it follows that the source of my views grows from this mould, which shapes my world and consequently this book, because I was born, raised and live in the west. If I visit a non-western country, the cross-cultural differences may be too great for me to comprehend. I might think that I understand someone whose philosophical ‘template’ is embedded within a non-western philosophy, but I may, in my relative ignorance, misunderstand that person. For this reason, the philosophy focused on here relates to the western world. Nevertheless, as therapists in multicultural settings, we need to be aware of a client’s culture and adapt appropriately.

It is possible to trace two fine philosophical threads stemming from the ancient Greek philosophers Plato and Aristotle (Plato’s student) to the present day. The threads start together as one, with Plato.

The Platonic philosophical thread

Plato taught that humans comprise mind, body and spirit, that the latter is eternal and that there are universal truths outside of time and space, such as honesty and respect. Modern Rogerian counselling, with its basic values of honesty (congruence), compassion (empathy) and respect (unconditional positive regard) – neither judging nor psychopathologising – resonate with Plato’s philosophy (Rogers, 1961, 1980). According to Plato, if mind, body and spirit are out of balance in individuals, distress or imbalance is created within them (for more on Plato, see Nails, 2006). This philosophical thread weaves its way into the seventeenth century.

Spinoza

Plato’s philosophy influenced Spinoza, who was a seventeenth-century Jewish lens grinder, born in Holland. He stated that the notion of spirit, or God, is central and integral for the body and the mind and, like Plato, believed in an everlasting God. Spinoza philosophised that since our bodies and minds are part of the same divine essence of God, they must not contradict each other. His notion was that distress was not plausible with a harmonious body and mind, and upheld Plato’s philosophy of honesty and respect (for more about Spinoza, see LeBuffe, 2010). This fine philosophical thread continued to weave its way, reaching the eighteenth century. At this time, in the UK, conditions for those with mental disorders were inhumane. Inmates in ‘madhouses’ such as Bedlam (also known as Bethlem and Bethlehem) were referred to as ‘mad’, ‘insane’ or ‘lunatics’. They were locked up, practically all were naked, force-fed, iron-fettered and lived in disgusting conditions. But there came a change.

Madness cured

In 1700, a man named David Irish claimed to cure madness by offering mental asylum inmates warmth, nutritious food and drink, positive attention, comfort and care rather than having them manacled and living in filth (for more on Irish, see Hunter and Macalpine 1963). Underlying such humane acts is the assumption that all people deserve a basic amount of nurturing. Tension arose between the two philosophical threads, with purported mind-doctors ‘pathologising’ madness on the one hand and the move towards a more humane way of treating those in mental asylums on the other (Appignanesi, 2010). Indeed, the modern notion of formulation can be seen as having its genesis in the eighteenth century with the ideas of a great philosopher, Rousseau, who recognised that his formative years related to his ‘nerves’.

Rousseau

During the eighteenth century, the thinking of Rousseau and the Romantic Movement exploded into the western world like a popping champagne cork. This movement aspired to merge reason with emotion and introduced the notion of the relationship between child and parent being important for sanity. It was Rousseau who reflected that adults suffer from mental distress (nerves) due to pain inflicted during their formative years. He claimed that human inequality is behind individual mental distress. His degeneration theory states that the people who have nothing to lose go back to their primitive and low brutish state, whereas those who can fulfil their potential are enabled to move towards gaining the ideal of perfection (for more on Rousseau see, for example, Farrel, 2006). Contemporary author Gerhardt expresses a similar idea. She illustrates how it is that the countries with the most inequality also have the most mental distress when compared with those with less inequality; she draws on a substantial amount of research findings that back up her theory (2010). This view adds to the tension between an approach to mental health using a medical model (with its focus on pathology) and one advocating talking-cures (which favour formulations).

Hegel

As history marched from the eighteenth to the nineteenth century, another great philosopher emerged, Hegel, who was immensely influenced by Rousseau’s ideas. According to Hegel, philosophy is the best and absolute form of knowledge, derived dialectically, bringing together knowledge and experience (for more on Hegel see, for example, Stern, 2002). Talking therapies blossom from this stem. He was the forerunner of the existential school of psychotherapy, prizing the individual’s experience and endeavouring to make sense of life; the very idea of psychopathology is anathema to this school and its philosophy.

Twentieth and twenty-first centuries

Existentialism eventually developed into Husserl’s phenomenology (for more on Husserl see, for example, Smith, 2007), central to which is the describing of phenomena as they are experienced, rather than interpreting or theorising. It does not make a comfortable bedfellow with psychopathology. What is comfortable for phenomenologists is viewing the relationship...