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d） A biological marker is a “measurable indicator of disease that
may or may not be causal”； that is； it may correlate with the
disorder。 No known marker perfectly predicts； or brings
about； schizophrenia。
3。 Family Interaction and munication
a） Hope remains for identification of an environmental
circumstance that increases the likelihood of schizophrenia
b） Research does offer evidence for theoretical position that
emphasizes the influence of deviations in parental
munications on the subsequent development of
schizophrenia
c） Research indicates family factors do play a role in
influencing functioning after the symptoms appear
V。The Stigma of Mental Illness
A。 The Problem of Stigma
1。 Individuals with psychological disorders are frequently labeled as
deviant； though this label is not true to prevailing realities
2。 Stigma is a mark or brand of disgrace； in the context of psychology； it
is a set of negative attitudes about a person that sets him or her apart
as unacceptable”
3。 Negative attitudes toward the psychologically disturbed； which
e from many sources； bias perceptions of and actions toward
these individuals
4。 Mental illness can bee one of life’s self…fulfilling prophecies
5。 Research suggests that people who have contact with individuals
with mental illness hold attitudes less affected by stigma
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PSYCHOLOGY AND LIFE
DISCUSSION QUESTIONS
1。 What if a well…controlled study showed that “crazy” people were more creative； happier；
and lived longer than “normal” or “sane” people？ Ask the class how this knowledge
might change their individual therapies of abnormal or pathological behavior。
2。 What if someone were to give each member of your class a psychiatric diagnostic label
and offer each of them 100；000 if they would go into a mental hospital ward and live up
to their label for a month without being discharged as either cured or normal？ How well
do class members think they would do？ What specific acts would they engage in？ Have
a student randomly select a diagnostic label from the chapter and then have the class list
the specific actions they would perform to demonstrate the accuracy of the diagnosis。
What does “abnormal” actually mean？ Ask the class to give you an operating definition。
Does it mean “crazy”？ “Different”？ “Nuts”？ See how many “definitions” of the term
you can get and be ready for responses you would never have imagined！
4。 Because of the deinstitutionalization of the mentally ill that occurred in the 1960s and the
ensuing lack of munity health support for that population； we are confronted with
the probability that many of the “homeless” may actually be schizophrenics who are no
longer on medication。 Does this seem to be a plausible explanation for the increase in
homeless individuals？
5。 Should the mentally ill be forced to take medication if medication exists that will
ameliorate their symptoms？ Schizophrenics often consider the voices that they hear gifts
from God。 Should we deprive them of this gift？ Should they be “locked up” in an
institution where they could receive sound nutrition and protection from the elements？
Are they “better off’ on the streets？ What are the ethical issues involved in each of the
above situations？
6。 How valid does the class think the “preparedness hypothesis” is as an explanation for
phobic disorders？ If we “carry around” an evolutionary tendency to jump when startled
（i。e。； “to respond quickly and ‘thoughtlessly’ to once…feared stimuli”）； how did that
tendency actually get to us？ Think about phobias in terms of the collective unconscious；
as espoused by Carl Jung。 What sort of justification might we offer for applying Jung’s
hypothesis to the preparedness hypothesis？
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CHAPTER 15： PSYCHOLOGICAL DISORDERS
SUPPLEMENTAL LECTURE MATERIAL
DSM…IV…TR： What Is It？
DSM…IV…TR is the Diagnostic and Statistical Manual of Mental Disorders； Text Revision Edition。 DSMIV…
TR is a diagnostic manual； published by the American Psychiatric Association and is used by
mental health professionals in an attempt at concordance in evaluation and diagnosis of the
various mental illnesses。 If you have medical insurance that covers mental health care； your
carrier probably predicates its decision to pay for your care on the DSM…IV…TR diagnostic criteria；
as reported by your therapist。
DSM…IV…TR proposes five categories； each called an axis （plural = axes）； according to which an
assessment of the disturbance is made。 Psychological and psychiatric disorders are classified
according to their “fit” on these various axes。 This is a multiaxial classification system。 In order；
these axes are：
AXIS I： CLINICAL DISORDERS
Clinical syndromes include the major affective disorders； psychoactive substance…induced mental
disorders； eating disorders； organic mental disorders （e。g。； senility； Alzheimer’s）； the
schizophrenias； adjustment disorders； and depressive disorders。 Axis I and Axis II diagnoses are
often indicated at the same time。
AXIS II： PERSONALITY DISORDERS AND MENTAL RETARDATION
Disorders included in this category are mental retardation； pervasive developmental disorders
（e。g。； autism）； and specific developmental disorders （e。g。； academic skills disorders such as
developmental writing disorder； developmental arithmetic disorder； and developmental reading
disorder）。 Specific personality traits or habitual use of particular defense mechanisms are also
indicated here； e。g。； antisocial personality disorder。 These disorders all have the mon
denominator of having their onset in childhood and/or adolescence。 For example； a diagnosis of
antisocial personality disorder in adulthood requires a prior diagnosis of conduct disorder in
childhood。 This conduct disorder usually persists in a stable form （without period of remission or
exacerbation） into adult life； at which time it may be “upgraded” to antisocial personality
disorder。
Although you will not always have an Axis I and Axis II disorder at the same time； you often
will。 When you do； you see the diagnoses indicated as follows：
Axis I： Alcohol Dependence
Axis II： Antisocial Personality Disorder （Principal Diagnosis）
When an individual does have both Axis I and II disorders； the “principal diagnosis’ is assumed
to be the Axis I disorder unless the Axis II disorder is followed by the qualifying statement
“Principal Diagnosis” indicated in parentheses。
AXIS III： GENERAL MEDICAL CONDITIONS
This axis permits the clinician to indicate any current physical disorder or condition that is
relevant to the understanding or management of the case。 Sometimes these conditions have
clinical significance concerning the mental disorder。 For example； a neurological disorder may be
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strongly related to a patient’s manifestations of Senile Dementia。
AXIS IV： PSYCHOSOCIAL AND ENVIRONMENTAL PROBLEMS
This axis provides a scale； the “Severity of Psychosocial Stressors Scale；” that enables the clinician
to code the overall severity of psychosocial stressors that have occurred in the client’s life during
the preceding year and to evaluate their contribution to any of the following：
。 development of a new mental disorder
。 recurrence of a prior mental disorder
。 exacerbation of an already existing mental disorder
Stressors often play a precipitating role in the appearance of a disorder； but they may also be a
consequence of the person’s psychopathology。 A mon situation is to have the Alcohol
Dependence of one partner in a marriage lead to marital discord and eventually divorce。 The sum
of the separation and subsequent divorce （with all its attendant traumas） may progress to the
point of a Major Depressive Episode。 Types of psychosocial stressors considered for rating on this
axis include：
。 Conjugal （marital and nonmarital）： engagement； marriage； discord； separation； divorce；
death of a spouse
。 Parenting： being a parent； friction with a child； illness of a child
。 Other Interpersonal： problems with one’s friends； neig