WEBVTT 00:12.460 --> 00:16.010 Professor Paul Bloom: The final topic of the course 00:16.009 --> 00:18.809 is clinical psychology, also known as abnormal 00:18.811 --> 00:22.241 psychology or psychopathology, and this, for many of us, 00:22.236 --> 00:24.786 is what psychology is really about. 00:24.790 --> 00:25.930 It's about mental illness. 00:25.930 --> 00:27.550 It's about clinical psychologists. 00:27.550 --> 00:30.870 00:30.870 --> 00:34.100 And we started talking about this when Dr. 00:34.097 --> 00:38.817 Nolen-Hoeksema gave her guest lecture last week and I want to 00:38.820 --> 00:41.340 continue through this today. 00:41.340 --> 00:45.590 It is a topic of tremendous scientific importance but also a 00:45.592 --> 00:49.342 topic of great personal importance for many of us. 00:49.340 --> 00:54.020 Many of the people in this room have been mentally ill, 00:54.018 --> 00:58.348 strictly speaking, at some point in their lives. 00:58.350 --> 01:03.020 Some of you are under some sort of therapy or treatment or 01:03.017 --> 01:05.717 medical intervention right now. 01:05.719 --> 01:10.099 Some of you are on Prozac or Zoloft or Ambien or Wellbutrin 01:10.099 --> 01:13.499 or any of those other medications to deal with 01:13.498 --> 01:16.668 psychological problems you are facing. 01:16.670 --> 01:20.200 Others are also talking to psychiatrists, 01:20.198 --> 01:22.758 psychologists, social workers, 01:22.757 --> 01:24.607 and other people. 01:24.610 --> 01:29.450 Many of you who are not at this point mentally ill will become 01:29.447 --> 01:32.617 mentally ill during your stay at Yale. 01:32.620 --> 01:35.730 [laughter] And this is a difficult period 01:35.733 --> 01:40.643 in many people's lives and it's a period of people's lives where 01:40.638 --> 01:43.828 mental illness emerges in many of us. 01:43.830 --> 01:45.980 By one estimate, one half of all college 01:45.982 --> 01:49.352 graduates in the United States – and the number is very high 01:49.349 --> 01:53.539 with college graduates, highly educated people – one 01:53.540 --> 01:59.030 half of you will have some sort of mental illness in your life 01:59.030 --> 02:03.710 serious enough to require some sort of treatment. 02:03.709 --> 02:08.499 Those of you not directly affected with mental illness 02:08.504 --> 02:13.394 yourselves will no doubt experience your loved ones, 02:13.389 --> 02:16.569 your family, your friends getting some sort 02:16.573 --> 02:21.273 of illness, be it Alzheimer's or schizophrenia or depression or 02:21.272 --> 02:23.852 some sort of anxiety disorder. 02:23.849 --> 02:26.849 So the personal importance of clinical psychology, 02:26.848 --> 02:30.338 the personal importance of understanding what can go wrong 02:30.335 --> 02:34.995 and how best to treat it, simply can't be underestimated. 02:35.000 --> 02:39.220 Now, when we talk about mental disorders, the scope of this is 02:39.220 --> 02:42.220 very broad. It includes the prototypical 02:42.221 --> 02:46.951 schizophrenic which you could see on the streets of New Haven, 02:46.949 --> 02:49.779 somebody walking and gesturing and talking to themselves and 02:49.776 --> 02:50.826 sometimes screaming. 02:50.830 --> 02:55.900 It includes alcohol addiction and cocaine addiction and other 02:55.901 --> 02:59.591 addictions. It includes somebody with Down 02:59.591 --> 03:03.311 syndrome or autism, an old person losing his 03:03.306 --> 03:05.956 memory, a teenager falling into a deep 03:05.958 --> 03:09.178 depression, somebody with a severe social phobia to the 03:09.177 --> 03:11.977 extent that he or she can't leave the house. 03:11.979 --> 03:16.049 Then there are also very hard cases where it's difficult to 03:16.051 --> 03:20.051 say one way or another--that guy's photographing me as I'm 03:20.052 --> 03:22.862 talking and it's freaking me out [laughs] 03:22.860 --> 03:26.230 [laughter] in kind of a social phobia way. 03:26.229 --> 03:31.909 There's difficult cases where it's just hard to tell mental 03:31.910 --> 03:36.220 illness from just bad behavior in general. 03:36.220 --> 03:42.640 So, consider a killer without a conscience or a mobster like 03:42.636 --> 03:46.606 John Gotti. Is he mentally ill? 03:46.610 --> 03:49.500 And this is a question which is a deep one and we'll wrestle 03:49.502 --> 03:52.642 with it a little bit actually towards the end of this lecture. 03:52.639 --> 03:57.929 What about somebody who acts in a kind of unusual or zany way? 03:57.930 --> 04:01.540 This is originally supposed to be a picture of the character 04:01.538 --> 04:04.828 Kramer on "Seinfeld" but, given his unusual antics in the 04:04.831 --> 04:07.161 last few months, it could be a picture of the 04:07.161 --> 04:10.181 actor who plays him who got into all sorts of trouble. 04:10.180 --> 04:12.270 What about someone who is just kind of wacky? 04:12.270 --> 04:15.600 At what point does wackiness move into the domain of mental 04:15.596 --> 04:18.866 illness? What about unusual lifestyles 04:18.869 --> 04:21.289 such as extreme altruism? 04:21.290 --> 04:26.220 Batman devotes most of his life to helping others. 04:26.220 --> 04:30.370 He sleeps one hour a night and this hour is fraught with 04:30.365 --> 04:33.225 nightmares and then he fights crime. 04:33.230 --> 04:35.810 What about somebody, and this was a case reported in 04:35.813 --> 04:37.893 The New Yorker a few months ago, 04:37.889 --> 04:43.369 who has lots of money and a loving family and has his kidney 04:43.374 --> 04:46.074 removed to help a stranger? 04:46.069 --> 04:48.419 And he says, "I have two kidneys. 04:48.420 --> 04:50.160 It's minor pain, a minor operation. 04:50.160 --> 04:51.940 I could save someone's life." 04:51.940 --> 04:54.350 And his wife says, "You're mentally ill. 04:54.350 --> 04:57.360 That's just crazy to do that." 04:57.360 --> 04:59.180 Where do we draw the line? 04:59.180 --> 05:02.060 And so, there are these great philosophical and moral 05:02.057 --> 05:05.267 questions over the boundaries and how to think about mental 05:05.266 --> 05:08.256 illness. So, how should we think about 05:08.262 --> 05:11.082 mental illness? Well, there are some answers we 05:11.084 --> 05:12.524 could quickly dispense with. 05:12.519 --> 05:16.059 It used to be thought that severe mental illness was a 05:16.059 --> 05:18.129 result of demonic possession. 05:18.129 --> 05:21.709 If you read the Gospels, Jesus Christ wandered around a 05:21.709 --> 05:25.419 lot, met crazy people and exorcised the demons from their 05:25.420 --> 05:27.700 bodies. It was a common way of thinking 05:27.699 --> 05:30.589 about craziness. We now believe that this is not 05:30.594 --> 05:35.104 true. What about--yeah, it's not true. 05:35.100 --> 05:38.110 What about social deviants? 05:38.110 --> 05:42.840 Some people including the psychiatrist Thomas Szasz claim 05:42.838 --> 05:47.568 that when we label somebody as mentally ill this is not a 05:47.566 --> 05:49.336 medical decision. 05:49.339 --> 05:54.719 It's rather a social decision designed to ostracize people who 05:54.716 --> 05:59.916 deviate from society's norms, to ostracize them and rid them 05:59.917 --> 06:03.327 of moral agency. It's not that we disagree with 06:03.329 --> 06:05.159 them. It's not even that we see them 06:05.160 --> 06:07.930 as evil. Rather, we see them as sick and 06:07.931 --> 06:12.421 as such we don't even have to accord to them the respect that 06:12.423 --> 06:14.373 we accord to criminals. 06:14.370 --> 06:19.510 Now, this is not entirely an unreasonable view. 06:19.509 --> 06:23.549 In many countries around the world, dissidents, 06:23.546 --> 06:28.626 people who argue against the state, are often determined to 06:28.634 --> 06:32.324 be mentally ill and thrown in asylums. 06:32.319 --> 06:37.439 Blacks in the United States who tried to escape from slavery 06:37.435 --> 06:41.245 were described as having a mental illness. 06:41.250 --> 06:43.610 Why would they want to do so unless they were mentally ill? 06:43.610 --> 06:47.340 Up until 1973, to be a homosexual, 06:47.338 --> 06:53.548 to be gay, would count in the official records of how we 06:53.551 --> 06:58.411 classify illness as being mentally ill. 06:58.410 --> 07:02.370 And many people saw this, and we see this now, 07:02.365 --> 07:06.845 not so much as reflecting a sort of unbiased medical 07:06.849 --> 07:11.329 analysis but rather as reflecting biases that people 07:11.332 --> 07:13.972 have against gay people. 07:13.970 --> 07:16.970 And these are political and social and moral biases. 07:16.970 --> 07:19.540 They are not objective medical judgments. 07:19.540 --> 07:24.270 Even now I've been recording every president that has been 07:24.271 --> 07:28.921 the president of the United States in my memory including 07:28.919 --> 07:33.399 Bush and particularly Clinton has been described by his 07:33.401 --> 07:37.561 opponents not merely as awful, evil, terrible, 07:37.561 --> 07:40.841 "hate his policies," but as mentally ill. 07:40.839 --> 07:43.879 Every president at some point or another, some bright, 07:43.876 --> 07:47.196 intelligent person figures to call him a psychopath and put 07:47.199 --> 07:49.089 that in Time magazine. 07:49.089 --> 07:53.329 Now, put aside whether--the extent to which these things are 07:53.331 --> 07:57.431 accurate, point being that we often use medical labels, 07:57.430 --> 08:02.460 particularly labels like "psychopath," "schizophrenic," 08:02.456 --> 08:07.756 "delusional," to ostracize and pick out people we disagree 08:07.762 --> 08:11.052 with. At the same time though, 08:11.046 --> 08:13.896 this is not entirely right. 08:13.899 --> 08:17.249 People go too far when they say there's no such thing as mental 08:17.249 --> 08:19.819 illness. Some people are mentally ill in 08:19.822 --> 08:23.562 a very real sense of "illness," in the same sense we would 08:23.558 --> 08:27.948 describe somebody as physically ill if they were to have cancer. 08:27.949 --> 08:32.289 This illness damages their functioning. 08:32.290 --> 08:33.900 They cannot function well. 08:33.899 --> 08:37.429 They do not tend to be more creative or more productive or 08:37.427 --> 08:40.467 more vivacious. Rather, for – with very few 08:40.467 --> 08:42.827 exceptions; possibly some exceptions 08:42.834 --> 08:44.704 revolving around mania as Dr. 08:44.700 --> 08:48.430 Nolen-Hoeksema discussed – with very few exceptions being 08:48.432 --> 08:52.552 mentally ill is just very bad for you in every possible way. 08:52.549 --> 08:57.949 Moreover, when people are treated, when people get better, 08:57.945 --> 09:02.105 they become more competent, happier, better able to 09:02.110 --> 09:05.380 participate in the world, and they do not choose to go 09:05.383 --> 09:09.573 back to their mental illness, suggesting that it really is 09:09.571 --> 09:11.941 illness in the serious sense. 09:11.940 --> 09:17.170 And so the modern treatment of psychological disorders treats 09:17.165 --> 09:20.905 them as disorders like medical disorders. 09:20.909 --> 09:24.899 Schizophrenia is as much a disease as is cancer and should 09:24.899 --> 09:27.139 be thought of in the same way. 09:27.139 --> 09:31.959 There's a whole field of abnormal psychology of 09:31.959 --> 09:33.949 tremendous scope. 09:33.950 --> 09:39.610 We've already discussed many mental illnesses in the context 09:39.612 --> 09:42.312 of other things. So, for instance, 09:42.305 --> 09:45.595 we talked about amnesia in the context of memory and how it 09:45.598 --> 09:47.728 works. We talked about autism in the 09:47.725 --> 09:49.335 context of social reasoning. 09:49.340 --> 09:53.670 There are many more and I'm not going to read through them. 09:53.669 --> 09:58.099 These are the major categories just for people's interest from 09:58.098 --> 10:02.158 The Diagnostic and Standard Manual. You don't have 10:02.164 --> 10:05.654 to--you're not responsible for all of these. 10:05.649 --> 10:08.189 And this is an illustration, which people might find 10:08.187 --> 10:10.817 interesting, of sex differences in these--in the major 10:10.823 --> 10:12.853 disorders. And the patterns, 10:12.847 --> 10:15.657 as you could see, are kind of neat. 10:15.659 --> 10:19.869 Women are more prone to have anxiety disorders and mood 10:19.865 --> 10:22.855 disorders. Men are much more likely to 10:22.858 --> 10:27.278 suffer from substance disorders, particularly alcoholism. 10:27.279 --> 10:30.729 Schizophrenia is sort of evenly matched but antisocial 10:30.732 --> 10:34.052 personality disorders, sometimes known as sociopathy 10:34.054 --> 10:36.794 or psychopathy, is predominantly male. 10:36.789 --> 10:39.729 And we'll turn to that a bit later. 10:39.730 --> 10:43.500 Here are the major ones which I want to review today. 10:43.500 --> 10:46.610 I'm not going to talk about mood disorders at all because 10:46.606 --> 10:50.156 this was the topic of the superb lecture we heard last week but I 10:50.155 --> 10:52.425 want to quickly review schizophrenia, 10:52.429 --> 10:55.859 the class of disorders known as anxiety disorders, 10:55.860 --> 10:59.850 the class of disorders known as dissociative disorders, 10:59.850 --> 11:03.910 and the class of disorders known as personality disorders. 11:03.909 --> 11:07.229 And these are the main psychological problems. 11:07.230 --> 11:10.910 When a psychologist or psychiatrist does his or her 11:10.914 --> 11:15.194 work, they're predominantly focused on somebody who has one 11:15.188 --> 11:16.808 of these problems. 11:16.809 --> 11:20.289 Some of them are rare but some of them such as anxiety 11:20.285 --> 11:23.625 disorders and the mood disorders are very common. 11:23.630 --> 11:30.800 11:30.799 --> 11:35.459 About 1% of the world's population suffers from 11:35.464 --> 11:41.554 schizophrenia and this is the most common reason for being in 11:41.549 --> 11:43.779 a mental hospital. 11:43.779 --> 11:47.869 And the reason for that is because of its severity, 11:47.871 --> 11:51.391 because of how terrible an illness it is. 11:51.389 --> 11:54.129 Schizophrenics have been described as the lepers of the 11:54.126 --> 11:57.116 twentieth century by people who pointed out that in the last 11:57.116 --> 12:00.156 hundred years people who are schizophrenics are just--there's 12:00.156 --> 12:01.926 no place for them in society. 12:01.930 --> 12:03.870 They're shunned. They're rejected. 12:03.870 --> 12:07.170 We have no idea how to treat them or how to help them. 12:07.169 --> 12:12.669 The roots of schizophrenia come from the terms "split" and 12:12.666 --> 12:17.966 "mind" but the idea is there is a split from reality. 12:17.970 --> 12:21.430 It's important to stress the sort of etymological point 12:21.429 --> 12:24.629 because sometimes people confuse schizophrenia with 12:24.632 --> 12:27.772 something--with split personality and they somehow 12:27.771 --> 12:32.001 think schizophrenia refers to having multiple personalities. 12:32.000 --> 12:33.770 This is incorrect. 12:33.769 --> 12:36.589 A multiple personality disorder is an entirely different 12:36.586 --> 12:39.226 disorder. It's a sort of dissociative 12:39.229 --> 12:42.359 disorder. Split personality--people with 12:42.355 --> 12:46.275 schizophrenia do not have multiple personalities. 12:46.279 --> 12:50.779 What they have is a problem with relating to reality. 12:50.779 --> 12:56.149 It's roughly equally split between the genders but it 12:56.149 --> 13:01.829 strikes men earlier and it happens between--around these 13:01.829 --> 13:06.269 ages and as you could see roughly--and, 13:06.269 --> 13:08.159 as you could see, it is the sort of thing that 13:08.162 --> 13:10.562 could make its first occurrence while you're in college or 13:10.559 --> 13:11.189 university. 13:11.190 --> 13:14.390 13:14.389 --> 13:18.289 There are five symptoms – main symptoms of schizophrenia. 13:18.289 --> 13:21.959 Four of them are the positive symptoms, meaning things that 13:21.961 --> 13:24.431 you do, that you have that's unusual. 13:24.429 --> 13:27.669 One is a negative symptom, something that you don't have, 13:27.666 --> 13:29.916 something that a schizophrenic lacks. 13:29.919 --> 13:34.019 So, just to walk through them, a hallucination is an 13:34.019 --> 13:38.199 experience, a sensory experience, that isn't real. 13:38.200 --> 13:41.830 So, the most typical hallucinations are auditory. 13:41.830 --> 13:43.740 Schizophrenics hear voices. 13:43.740 --> 13:47.100 They hear sounds, particularly people telling 13:47.104 --> 13:50.014 them to do things, that aren't real. 13:50.009 --> 13:53.059 Sometimes there are auditory--there are visual 13:53.056 --> 13:57.386 hallucinations or hallucinations of smell and taste but a typical 13:57.389 --> 13:59.419 hallucination is auditory. 13:59.419 --> 14:04.329 Sometimes the voices are seen from coming from oneself and so 14:04.330 --> 14:09.080 you could sometimes stop the hallucinations by doing things 14:09.077 --> 14:13.657 like humming or counting or holding your mouth open. 14:13.659 --> 14:17.929 And some schizophrenics will do this in an attempt to block 14:17.934 --> 14:19.854 auditory hallucinations. 14:19.850 --> 14:21.380 There are delusions. 14:21.379 --> 14:24.389 The difference between a hallucination and a delusion is 14:24.389 --> 14:27.229 a hallucination is a sensory experience that's wrong, 14:27.234 --> 14:29.154 that just didn't really happen. 14:29.149 --> 14:34.049 A delusion is a belief that isn't right. 14:34.049 --> 14:37.779 It's a belief that you shouldn't be having. 14:37.779 --> 14:41.349 Now, again, the question of what counts as a delusion and 14:41.350 --> 14:44.730 what counts as accuracy can be a controversial one. 14:44.730 --> 14:47.270 Richard Dawkins titled his recent book The God 14:47.274 --> 14:50.404 Delusion, describing this mass delusion that many people 14:50.401 --> 14:53.691 have that they believe there's a supernatural being who created 14:53.687 --> 14:56.017 the universe and who is watching them. 14:56.019 --> 14:59.319 Some people find that offensive, to call it a delusion 14:59.320 --> 15:01.750 and people will have different views. 15:01.750 --> 15:07.490 The delusions schizophrenics have tend to be pretty clearly 15:07.488 --> 15:11.558 weird and wrong. They often tend to believe they 15:11.563 --> 15:12.973 are famous people. 15:12.970 --> 15:16.370 Many schizophrenics have a religious bent and believe that 15:16.368 --> 15:17.798 they are Jesus Christ. 15:17.799 --> 15:21.929 In 1959, there was a Michigan hospital that had three Jesus 15:21.933 --> 15:25.143 Christs in it and they would meet and talk. 15:25.139 --> 15:31.179 One theme of delusions is what's called "ideas of 15:31.175 --> 15:34.815 reference." And ideas of reference are you 15:34.823 --> 15:38.853 think that there's all sorts of things happening that revolve 15:38.850 --> 15:41.560 around you. You hear people whispering and 15:41.558 --> 15:43.738 you think they're talking about you. 15:43.740 --> 15:47.120 You pick up the newspaper and you believe that there's coded 15:47.118 --> 15:49.808 messages in it that are directed towards you. 15:49.809 --> 15:54.159 You might believe that there is some sort of omnipotent, 15:54.157 --> 15:58.027 powerful force conspiring against you or trying to 15:58.030 --> 16:01.350 manipulate you like aliens or the FBI, 16:01.350 --> 16:03.230 the CIA, the government. 16:03.230 --> 16:06.500 You might believe that they have some sort of evil plan in 16:06.499 --> 16:10.499 mind for you. There is disorganized speech. 16:10.500 --> 16:12.970 Some schizophrenics babble. 16:12.970 --> 16:14.990 They talk and it's nonsense. 16:14.990 --> 16:17.430 If you listen to a schizophrenic on the street, 16:17.432 --> 16:20.302 sometimes what they're saying makes no sense at all, 16:20.299 --> 16:22.899 not merely that they're conveying ideas that are 16:22.901 --> 16:24.951 unreasonable but it's just garbled, 16:24.950 --> 16:25.980 it's just a mess. 16:25.980 --> 16:29.800 And sometimes there is disorganized behavior too, 16:29.799 --> 16:31.549 odd motor movements. 16:31.549 --> 16:35.279 And the most extreme cases of this are motor movements 16:35.279 --> 16:39.079 described as "catatonic" where the person doesn't move, 16:39.078 --> 16:41.328 often freezes in a position. 16:41.330 --> 16:44.080 Those are all positive symptoms. 16:44.080 --> 16:48.070 A major negative symptom in schizophrenia is absence of 16:48.065 --> 16:51.825 normal thought or affect, affect meaning emotion. 16:51.830 --> 16:54.710 So some schizophrenics might just not talk. 16:54.710 --> 16:57.430 They might have very low emotional responses. 16:57.429 --> 17:02.139 They might not care about anything. 17:02.139 --> 17:05.019 The basic psychological misfunction--oh, 17:05.019 --> 17:05.609 sorry. 17:05.610 --> 17:10.480 17:10.480 --> 17:14.820 There are different subtypes of schizophrenia. 17:14.819 --> 17:17.959 There are five major subtypes but I'm going to focus on the 17:17.962 --> 17:20.292 three major ones, the three most interesting 17:20.292 --> 17:22.402 ones. The first one is paranoid 17:22.404 --> 17:25.584 schizophrenia. So, paranoid schizophrenics 17:25.581 --> 17:30.311 believe that others are spying and plotting against them. 17:30.309 --> 17:32.759 And they often have delusions of grandeur. 17:32.759 --> 17:36.109 They often believe that other people are jealous of them. 17:36.109 --> 17:38.399 They might believe they have supernatural powers. 17:38.400 --> 17:42.580 They might believe that they're God or a messiah. 17:42.579 --> 17:46.819 The catatonic schizophrenics are unresponsive to their 17:46.819 --> 17:51.619 surroundings and often they'll just repeat what people say to 17:51.619 --> 17:53.489 them, they won't generate their own 17:53.492 --> 17:54.732 speech. And finally, 17:54.725 --> 17:59.525 the disorganized schizophrenics are maybe what you most think of 17:59.532 --> 18:02.892 when you think of somebody who is insane. 18:02.890 --> 18:05.080 They make no sense. 18:05.079 --> 18:07.609 They have delusions and hallucinations. 18:07.610 --> 18:10.700 They babble. They--their actions--they could 18:10.698 --> 18:12.678 be dangerous. They could be perceived as 18:12.680 --> 18:14.630 dangerous. They're unable to help 18:14.625 --> 18:17.095 themselves. They're unable to do anything 18:17.099 --> 18:18.019 in their lives. 18:18.020 --> 18:21.300 18:21.299 --> 18:25.359 It's hard to pin down exactly what's at root of all of these 18:25.363 --> 18:29.013 problems but a very general summary is that there is a 18:29.014 --> 18:32.944 problem – an inability to put together your thoughts and 18:32.940 --> 18:37.000 perceptions, to sequence them and coordinate 18:36.995 --> 18:41.895 them, to impose a logical structure and a reasonable, 18:41.900 --> 18:47.470 realistic temporal sequence on your experience. 18:47.470 --> 18:51.170 This is the core thing going wrong but what happens as a 18:51.170 --> 18:54.270 result of this is you lose contact with others, 18:54.265 --> 18:56.145 you lose social contact. 18:56.150 --> 19:00.960 Losing social contact means you don't get much reality checking. 19:00.960 --> 19:03.970 If I start acting weird and nobody cares, 19:03.972 --> 19:06.912 I could just get weirder and weirder, 19:06.910 --> 19:09.800 while if I'm in a good social group of people who care about 19:09.798 --> 19:12.538 me often the situation could be brought under control. 19:12.539 --> 19:15.379 So, schizophrenia is sort of a vicious circle where you have 19:15.377 --> 19:16.577 this cognitive problem. 19:16.579 --> 19:19.619 Then you have problems losing contact with others, 19:19.621 --> 19:22.601 exaggerating the cognitive problem, and so on. 19:22.599 --> 19:27.089 A lot of people have studied the genetics of schizophrenia. 19:27.089 --> 19:30.589 It's clear enough that there is a powerful genetic component. 19:30.589 --> 19:35.879 I could--you can tell how much at risk somebody is for becoming 19:35.884 --> 19:40.504 schizophrenic based on the schizophrenia and illness of 19:40.495 --> 19:42.625 their family members. 19:42.630 --> 19:45.170 In particular, if you have an identical twin 19:45.166 --> 19:48.056 who's schizophrenic, your odds are about a half of 19:48.056 --> 19:50.176 becoming schizophrenic yourself. 19:50.180 --> 19:53.270 At the same time, and we dealt with this as well 19:53.265 --> 19:56.675 when we talked about issues of sexual orientation, 19:56.680 --> 20:01.270 the fact that identical twins the odds are only 50% means 20:01.269 --> 20:05.449 there has to be an environmental component to it. 20:05.450 --> 20:08.310 If it was entirely genetic, it would be 100%. 20:08.309 --> 20:12.419 And so one claim--one way of looking at it is your genes make 20:12.417 --> 20:16.527 you vulnerable to schizophrenia but whether or not you become 20:16.525 --> 20:20.765 schizophrenic depends on what happens in your environment. 20:20.769 --> 20:23.299 You're sensitive to certain triggers. 20:23.299 --> 20:26.309 Some triggers might happen early. 20:26.309 --> 20:30.349 There is some evidence that schizophrenia is associated with 20:30.346 --> 20:32.806 trauma even at the point of birth. 20:32.809 --> 20:37.329 And there's some other evidence that schizophrenia is linked to 20:37.333 --> 20:38.723 viral infections. 20:38.720 --> 20:41.770 As an example, there are more schizophrenics 20:41.774 --> 20:45.334 born in the winter, subtle--a subtle difference but 20:45.325 --> 20:49.365 there seems to be a reliable effect of more schizophrenics 20:49.374 --> 20:51.154 born in the winter. 20:51.150 --> 20:53.380 More people get sick in the winter. 20:53.380 --> 20:57.510 At times when there's been some sort of epidemic or some sort of 20:57.514 --> 21:00.994 plague, this seems to cause a jump in the frequency of 21:00.992 --> 21:03.422 schizophrenics born at that time. 21:03.420 --> 21:07.880 There's some recent research that ties schizophrenia to the 21:07.878 --> 21:12.408 possibility of toxoplasmosis, which is a disorder carried by 21:12.413 --> 21:14.993 cat feces. The experiment basically 21:14.994 --> 21:18.634 involved asking the parents of schizophrenics one question: 21:18.630 --> 21:21.640 "Did you own a cat when your child was born?" 21:21.640 --> 21:25.250 And if the answer was "yes," it seemed to correspond to a bit 21:25.248 --> 21:28.018 higher odds for schizophrenic families than for 21:28.015 --> 21:29.875 non-schizophrenic families. 21:29.880 --> 21:37.090 A different sort of trigger is stressful family environments. 21:37.089 --> 21:40.809 Schizophrenics seem to really have more stressful family 21:40.805 --> 21:43.435 environments than non-schizophrenics. 21:43.440 --> 21:47.530 Now, we have to be careful about this. 21:47.529 --> 21:50.459 We have to bring--we have to return to the sort of 21:50.457 --> 21:53.917 methodological cautions we had in mind when we talked about 21:53.922 --> 21:56.672 individual difference research in general. 21:56.670 --> 22:00.460 Remember we talked about the worst study in the world and one 22:00.455 --> 22:04.295 of the features of this was it was failing to pull apart cause 22:04.303 --> 22:06.903 and effect. It might be that having a 22:06.897 --> 22:10.387 difficult family environment ups your odds of becoming 22:10.389 --> 22:12.529 schizophrenic. On the other hand, 22:12.529 --> 22:15.129 it might also be that schizophrenic children or 22:15.134 --> 22:18.194 children who will become schizophrenic are difficult to 22:18.192 --> 22:21.592 deal with in certain ways causing a family environment. 22:21.589 --> 22:25.279 So, it's not clear whether the effect is from difficult family 22:25.278 --> 22:27.758 environment to later schizophrenia or from 22:27.756 --> 22:30.776 schizophrenia to difficult family environment. 22:30.779 --> 22:34.649 There used to be a very popular theory of schizophrenia, 22:34.645 --> 22:38.085 which is that it was caused by excess dopamine. 22:38.089 --> 22:40.869 Dopamine, you'll remember, is a neurotransmitter. 22:40.869 --> 22:44.779 And there is some reason to take this seriously. 22:44.779 --> 22:49.599 Drugs that reduce dopamine provide some help in reducing 22:49.596 --> 22:53.756 symptoms. And if I give you a drug that 22:53.755 --> 23:00.145 shoots up your dopamine that will turn you into a temporary 23:00.146 --> 23:03.406 schizophrenic. You get what's called 23:03.405 --> 23:07.165 "amphetamine psychosis" and it'd give you--it can give you 23:07.165 --> 23:10.145 schizophrenic-like symptoms, hallucinations, 23:10.145 --> 23:12.075 delusions, that sort of thing. 23:12.079 --> 23:15.799 This--There might be something to this theory but we know now 23:15.802 --> 23:18.782 it can't be complete for at least two reasons. 23:18.779 --> 23:22.379 First, it doesn't explain the negative symptoms. 23:22.380 --> 23:27.670 It explains hallucinations and delusions and so on but it 23:27.674 --> 23:32.314 doesn't explain the loss of affect, the quietness, 23:32.308 --> 23:36.208 the stillness. Also, there seemed to be some 23:36.206 --> 23:40.296 sort of structural brain differences involving enlarged 23:40.297 --> 23:44.057 cerebral ventricles, involving reduced frontal lobe 23:44.056 --> 23:48.086 activity, suggesting that the problem with schizophrenia is a 23:48.089 --> 23:51.449 lot more complicated than others might have it, 23:51.450 --> 23:53.660 than the dopamine theory would have it. 23:53.660 --> 23:57.150 I'll end with a mystery. 23:57.150 --> 24:00.420 And this mystery is discussed nicely in the Gray textbook. 24:00.420 --> 24:04.710 The symptoms of schizophrenia, the prevalence of 24:04.713 --> 24:08.833 schizophrenics, is similar wherever you go but 24:08.825 --> 24:14.215 less industrialized countries have a better rate of recovery 24:14.215 --> 24:19.235 from schizophrenia than industrialized countries. 24:19.240 --> 24:20.620 And nobody really knows why. 24:20.619 --> 24:22.639 I listed here three possibilities. 24:22.640 --> 24:25.690 One is that the families that were--that--in a less 24:25.685 --> 24:29.215 industrialized country there's more latitude and so there's 24:29.218 --> 24:31.288 less critical- less criticism. 24:31.289 --> 24:33.619 There's less use of antipsychotic medication. 24:33.619 --> 24:37.329 Antipsychotic medications help with the symptoms but they might 24:37.332 --> 24:38.712 also impair recovery. 24:38.710 --> 24:41.230 And finally, if you think of schizophrenia 24:41.232 --> 24:44.742 as a transient disorder, maybe that will in some sense, 24:44.740 --> 24:46.750 in some way, make that more likely to 24:46.746 --> 24:47.746 actually happen. 24:47.750 --> 24:52.360 24:52.359 --> 24:55.479 The second sort of disorder I want to talk about, 24:55.475 --> 24:58.845 much more common than the 1% that's schizophrenia, 24:58.849 --> 25:02.059 is the classic disorders known as "anxiety disorders." 25:02.060 --> 25:09.070 25:09.069 --> 25:13.219 The primary disturbance in anxiety disorders is anxiety; 25:13.220 --> 25:14.560 you have a lot of anxiety. 25:14.559 --> 25:21.089 It's persistent, either anxiety or maladaptive 25:21.087 --> 25:25.437 behaviors to reduce anxiety. 25:25.440 --> 25:28.240 Now, everybody experiences anxiety. 25:28.240 --> 25:30.690 If you didn't experience anxiety, you'd be a very strange 25:30.689 --> 25:33.619 person and you probably wouldn't function very well in the world, 25:33.619 --> 25:37.489 but you have an anxiety disorder when you experience too 25:37.494 --> 25:41.694 much of it, it's uncontrollable, it's unreasonable and it messes 25:41.694 --> 25:43.984 up your life. And there's quite a few anxiety 25:43.978 --> 25:46.088 disorders. The simplest one is this 25:46.087 --> 25:50.057 generalized anxiety disorders where--and this is about one in 25:50.056 --> 25:53.826 twenty people will get it at some point in their lives and 25:53.827 --> 25:55.677 you worry all the time. 25:55.680 --> 25:56.800 You're just very anxious. 25:56.799 --> 26:00.139 You're just worried all the time and it could be paralyzing. 26:00.140 --> 26:03.550 It could give you physical symptoms like headaches, 26:03.553 --> 26:05.673 stomachaches, muscle tension and 26:05.669 --> 26:08.929 irritability. There is some evidence that 26:08.926 --> 26:12.956 generalized anxiety disorder has a genetic component, 26:12.964 --> 26:16.774 that it's somehow related to major depression. 26:16.769 --> 26:21.939 And it does seem to have its possible roots in some sort of 26:21.944 --> 26:23.644 childhood trauma. 26:23.640 --> 26:28.380 And so the model some people give for this is when you are 26:28.380 --> 26:32.040 young something really bad happens to you. 26:32.040 --> 26:34.350 This makes you hyper-vigilant. 26:34.349 --> 26:37.839 You don't trust the world, bad things could always happen 26:37.842 --> 26:39.092 around the corner. 26:39.089 --> 26:42.749 And because you're hyper-vigilant you are more 26:42.745 --> 26:46.965 prone to develop generalized anxiety disorder after a 26:46.969 --> 26:48.999 difficult life event. 26:49.000 --> 26:52.460 A second sort of anxiety disorder, which we already 26:52.455 --> 26:56.185 discussed in class are phobias and phobias are intense, 26:56.188 --> 26:57.638 irrational fears. 26:57.640 --> 27:00.820 They could focus on objects, events, and social settings. 27:00.819 --> 27:03.249 Here's a nice diagram of different phobia, 27:03.250 --> 27:06.040 different things, and their proportion of people 27:06.037 --> 27:07.517 who are afraid of it. 27:07.519 --> 27:11.109 And the point of this diagram isn't with the details. 27:11.109 --> 27:14.229 It's really--It's rather to give you a feeling for the fact 27:14.228 --> 27:17.558 that some things most everybody is afraid of or a lot of people 27:17.561 --> 27:20.251 are afraid of and some things not many at all. 27:20.250 --> 27:23.980 The big phobic object we know from previous lectures is 27:23.978 --> 27:26.258 snakes. About 40% of the population say 27:26.264 --> 27:27.664 they're afraid of snakes. 27:27.660 --> 27:29.940 How many people here are afraid of snakes? 27:29.940 --> 27:35.610 Okay. And then there's a really 27:35.609 --> 27:37.489 terrifying thing, mice. 27:37.490 --> 27:40.010 How many people are afraid of mice? 27:40.009 --> 27:42.329 Mice are the worst things in the world. 27:42.329 --> 27:45.269 [laughter] And then cats and if you're 27:45.265 --> 27:48.355 afraid of cats that's really unusual. 27:48.359 --> 27:50.599 Not many people are afraid of cats. 27:50.599 --> 27:54.119 There is a classical conditioning model of phobias, 27:54.123 --> 27:58.283 which we are all familiar with, but we are all familiar with 27:58.282 --> 28:00.892 why it is not a very good theory. 28:00.890 --> 28:04.590 A lot of people who are afraid of snakes have never had a bad 28:04.588 --> 28:06.128 experience with snakes. 28:06.130 --> 28:09.760 Moreover, a lot of people who have had bad experiences with 28:09.758 --> 28:13.318 things like car crashes and being electrocuted on a socket 28:13.323 --> 28:16.543 or a shooting, seeing a gun during a shooting, 28:16.541 --> 28:18.161 do not develop phobias. 28:18.160 --> 28:21.800 This lead--gives rise to a much more plausible theory known as 28:21.799 --> 28:25.339 the "preparedness theory," which says that we have evolved 28:25.341 --> 28:27.821 to be sensitive to certain phobic objects, 28:27.816 --> 28:31.736 objects that were dangerous to us in our evolutionary history. 28:31.740 --> 28:35.700 And we're prone to develop phobic responses to this. 28:35.700 --> 28:40.510 The final anxiety disorder is obsessive-compulsive disorder. 28:40.509 --> 28:46.009 Obsessions are irrational disturbing thoughts that intrude 28:46.010 --> 28:48.520 into your consciousness. 28:48.519 --> 28:53.569 This is--hits about two to three percent of the population 28:53.567 --> 28:58.787 and it leads to compulsions, repetitive actions performed to 28:58.791 --> 29:01.361 alleviate the obsessions. 29:01.359 --> 29:03.639 For instance, you might be obsessed with the 29:03.644 --> 29:05.824 idea of being dirty, your hands are dirty, 29:05.823 --> 29:09.173 you're filthy. That might lead to compulsive 29:09.168 --> 29:12.488 washing. You might believe that God is 29:12.492 --> 29:17.392 angry at you and that might lead to compulsive prayer. 29:17.390 --> 29:21.240 Cleanliness and religion are common themes of 29:21.240 --> 29:24.040 obsessive-compulsive disorder. 29:24.039 --> 29:27.279 You often know, rationally, that these are 29:27.275 --> 29:32.005 unreasonable behaviors but you can't help yourself from doing 29:32.009 --> 29:34.669 them. Sometimes I get the worry that 29:34.671 --> 29:38.511 I left my door unlocked and I run back and checked it--check 29:38.509 --> 29:40.829 it. But I feel it's a little bit of 29:40.832 --> 29:44.702 OCD coming on because I know I locked it, but did I really lock 29:44.696 --> 29:46.576 it? And then you get--now I'm 29:46.579 --> 29:48.329 worried if I locked my door. 29:48.330 --> 29:51.600 Checking and washing. 29:51.599 --> 29:54.779 Checking is what I'm talking about here- most common 29:54.781 --> 29:58.091 compulsions, and it seems to have a neuropsychological 29:58.086 --> 30:00.386 phenomena. At least it's related to 30:00.387 --> 30:03.417 heightened neural activity in the caudate nucleus. 30:03.420 --> 30:07.580 What's interesting is you might think obsessive-compulsive 30:07.584 --> 30:10.364 disorder is a very sort of Freudian, 30:10.359 --> 30:14.819 psychoanalytic sort of disorder but actually it's treated quite 30:14.816 --> 30:18.006 well with drugs, drugs that affect the serotonin 30:18.010 --> 30:19.360 level. Serotonin, being a 30:19.360 --> 30:21.560 neurotransmitter, can often do good work for 30:21.560 --> 30:23.300 obsessive-compulsive disorders. 30:23.299 --> 30:25.799 So, if you develop a disorder, an OCD problem, 30:25.802 --> 30:29.252 you might find yourself being cured simply with medications. 30:29.250 --> 30:36.530 30:36.529 --> 30:39.879 We've talked about schizophrenia and anxiety 30:39.884 --> 30:43.004 disorders. Any questions or thoughts so 30:43.000 --> 30:44.240 far? Yes. 30:44.240 --> 30:46.330 Student: What's the difference between OCD and 30:46.327 --> 30:47.647 Tourette's or are they [inaudible] 30:47.652 --> 30:49.822 Professor Paul Bloom: It's a good question. 30:49.819 --> 30:52.239 The question was the relationship between OCD and 30:52.243 --> 30:54.963 Tourette's. Tourette's is--I don't know 30:54.959 --> 30:59.229 much about it but it's a very specific neurophysiological 30:59.231 --> 31:04.191 syndrome that doesn't have--you don't have obsessive thoughts. 31:04.190 --> 31:08.780 What it leads to is involuntary tics and tremors and sometimes 31:08.776 --> 31:12.156 sort of shouted obscenities or taboo words. 31:12.160 --> 31:15.610 And it seems to be very specific to that while OCD is 31:15.611 --> 31:19.731 much broader and involves both behaviors but also the behaviors 31:19.726 --> 31:22.046 are in the service of thoughts. 31:22.049 --> 31:23.979 That's one way of thinking about the difference. 31:23.980 --> 31:26.760 Yes. Student: Can individuals 31:26.760 --> 31:30.110 have multiple disorders like be bipolar and schizophrenic? 31:30.109 --> 31:32.649 Professor Paul Bloom: Yes. 31:32.650 --> 31:34.980 The question is can individuals have multiple disorders? 31:34.980 --> 31:39.320 Absolutely, and in fact some disorders are "comorbid." 31:39.319 --> 31:42.279 And that's just a fancy way of saying they often go together. 31:42.279 --> 31:44.829 So, if you have a severe depression for instance, 31:44.831 --> 31:47.651 which is a mood disorder, you may also have an anxiety 31:47.648 --> 31:49.508 disorder. So yes, having one 31:49.506 --> 31:53.326 unfortunately doesn't immunize you against having another. 31:53.330 --> 31:56.120 Yes. Student: Where does 31:56.119 --> 31:59.839 superstition [inaudible] Professor Paul Bloom: 31:59.838 --> 32:02.698 The question was about superstitions. 32:02.700 --> 32:06.810 I think--it's an interesting question which I have never 32:06.806 --> 32:08.296 thought of before. 32:08.299 --> 32:11.269 I think it depends on the severity of superstitions. 32:11.269 --> 32:15.229 So, if you just have a superstition saying "Step on a 32:15.226 --> 32:17.886 crack, break your mother's back," 32:17.890 --> 32:19.940 which has never been scientifically proven, 32:19.943 --> 32:21.803 [laughter] but suppose you--and then so 32:21.801 --> 32:24.621 you're just kind of "Oh, I kind of--I just kind of--" or 32:24.624 --> 32:26.834 it's bad luck to break a mirror and that's it, 32:26.829 --> 32:29.289 you just have it and it doesn't make a big deal to you, 32:29.289 --> 32:31.679 that's harmless. On the other hand, 32:31.682 --> 32:37.012 if your superstition is such that you develop weird rituals; 32:37.009 --> 32:40.179 you might have to carefully walk so you don't step on any 32:40.179 --> 32:43.409 other--on any cracks or you might have to do--or if you do 32:43.405 --> 32:46.685 you might have to go back and start your whole walk to work 32:46.687 --> 32:49.617 over again. When it gets to that level it 32:49.623 --> 32:51.123 could creep into OCD. 32:51.119 --> 32:55.379 And often obsessive-compulsive disorders have a religious or a 32:55.377 --> 32:59.767 magical manifestation where you believe there are certain things 32:59.774 --> 33:04.034 you must do or terrible things will happen and in that way you 33:04.032 --> 33:08.362 could view them as extreme and build from superstitions, 33:08.359 --> 33:13.389 but simple superstitions don't tend to be of that type. 33:13.390 --> 33:16.530 Yes, in back. Student: [inaudible] 33:16.529 --> 33:20.729 Professor Paul Bloom: The question is "are people with 33:20.730 --> 33:22.690 schizophrenia dangerous?" 33:22.690 --> 33:27.060 As a rule statistically, it tends not to be the case. 33:27.059 --> 33:30.889 They tend to be more likely victims than harmful. 33:30.890 --> 33:33.130 They tend to be fairly helpless. 33:33.130 --> 33:35.900 You can have a case where a schizophrenic might harm 33:35.902 --> 33:38.212 somebody. A paranoid schizophrenic, 33:38.211 --> 33:40.951 for instance, might develop a delusion to 33:40.950 --> 33:44.990 harm somebody and so there are definitely such cases but for 33:44.989 --> 33:49.269 the most part, again, they are more victims 33:49.270 --> 33:52.280 than oppressors. They're more--they're very 33:52.284 --> 33:55.024 vulnerable because they aren't capable of dealing with other 33:55.016 --> 33:57.476 people. They often aren't capable of 33:57.479 --> 33:59.049 defending themselves. 33:59.050 --> 34:01.980 One more. Yes. 34:01.980 --> 34:05.050 Student: How permanent are the effects of the 34:05.047 --> 34:06.707 medications? Professor Paul Bloom: 34:06.706 --> 34:08.076 The question is, "How permanent is the effect of 34:08.076 --> 34:10.986 the medication?" Do you mean for schizophrenia? 34:10.989 --> 34:13.169 Student: Do they have to stay on the medication for 34:13.171 --> 34:14.661 [inaudible] Professor Paul Bloom: 34:14.663 --> 34:16.373 Yes. In general, I think. 34:16.370 --> 34:18.670 I can't think of any exceptions. 34:18.670 --> 34:22.400 The effects of medication are temporary. 34:22.400 --> 34:25.350 Now, that doesn't mean if you have a bout of OCD or depression 34:25.348 --> 34:27.908 you have to be on medication the rest of your life. 34:27.909 --> 34:29.979 What could happen is, for instance, 34:29.981 --> 34:33.581 somebody--if you had a mild depression, go on something like 34:33.576 --> 34:36.896 Prozac or Wellbutrin, use that time to kind of get 34:36.896 --> 34:39.396 your life back together, cheer up a bit, 34:39.398 --> 34:43.118 and then when they go off the medication they are fine. 34:43.119 --> 34:46.809 But as Professor Nolen-Hoeksema pointed out, unless they've 34:46.813 --> 34:50.633 developed coping skills they're likely to relapse and get the 34:50.633 --> 34:53.243 problem again. So, the physical effects of 34:53.239 --> 34:56.589 medication are always temporary, particularly with anybody with 34:56.591 --> 34:59.321 schizophrenia, but they can often help people 34:59.318 --> 35:02.028 get out of a problem, anxiety or depression. 35:02.030 --> 35:05.260 Okay. Dissociative disorders. 35:05.260 --> 35:11.190 I'll show you a movie clip and then we'll go back and talk a 35:11.189 --> 35:13.399 little bit about it. 35:13.400 --> 35:20.820 Let me ask you a question that might seem somewhat uncaring. 35:20.820 --> 35:22.380 How many of you think he's faking? 35:22.380 --> 35:25.810 35:25.809 --> 35:30.479 How many of you [laughter] are confident there are many 35:30.477 --> 35:35.747 people living inside his head as--in the way it's depicted? 35:35.750 --> 35:39.300 Okay. How many of you are unsure? 35:39.300 --> 35:41.190 How many of you have two minds? 35:41.190 --> 35:45.200 There is one part of you struggling-- [laughter] 35:45.201 --> 35:48.531 It's--let's go--we'll go back to him. 35:48.530 --> 35:52.890 Dissociative disorder are disorders involving 35:52.885 --> 35:56.685 dissociation. And what people mean by that is 35:56.688 --> 35:59.378 literally a dissociation of memory; 35:59.380 --> 36:05.200 that is, you become somehow unaware, separated from some 36:05.200 --> 36:11.450 part of your identity or history and you're unable to recall 36:11.445 --> 36:18.005 those parts of your identity and history except sometimes under 36:18.006 --> 36:20.966 special circumstances. 36:20.969 --> 36:25.099 Now, some degree of dissociation is normal. 36:25.099 --> 36:28.969 There is--I will--I have here in, actually, 36:28.967 --> 36:31.637 Dr. Nolen-Hoeksema's excellent 36:31.637 --> 36:36.697 abnormal psychology textbook a checklist of dissociative 36:36.702 --> 36:42.412 experiences many of which normal people have: "Not sure whether 36:42.411 --> 36:47.661 one has done something or only thought about it." 36:47.660 --> 36:49.920 Anybody ever have that? 36:49.920 --> 36:54.560 Common. "So involved in the fantasy 36:54.562 --> 36:57.382 that it seems real." 36:57.380 --> 37:02.490 [laughter] "Feeling as though one's body 37:02.489 --> 37:05.109 is not one's own." 37:05.110 --> 37:10.170 I will also add that experiments with pharmaceuticals 37:10.170 --> 37:14.550 can often lead to dissociative experiences. 37:14.550 --> 37:17.900 [laughter] "Driving a car and realizing 37:17.901 --> 37:21.871 that one doesn't remember part of the trip. 37:21.869 --> 37:25.989 Talking out loud to oneself when alone." 37:25.990 --> 37:29.350 Okay. "Not recognizing one's 37:29.346 --> 37:31.396 reflection in a mirror." 37:31.400 --> 37:36.140 Okay. That's not very common 37:36.138 --> 37:39.738 [laughter] but it is--it's within the 37:39.736 --> 37:45.626 normal range but then you get more severe cases and there is 37:45.632 --> 37:50.532 three different types: dissociative amnesia, 37:50.530 --> 37:54.070 dissociative fugue, and dissociative identity 37:54.065 --> 37:57.245 disorder. Dissociative amnesia is 37:57.252 --> 38:02.362 illustrated in a story of a woman who sees something 38:02.359 --> 38:08.369 terrible and as a result her memory of that experience was no 38:08.367 --> 38:10.667 longer accessible. 38:10.670 --> 38:15.570 It's often known as "psychogenic amnesia." 38:15.570 --> 38:19.480 The only thing wrong in here is you have memory loss. 38:19.480 --> 38:24.500 And sometimes it's a selective memory loss but sometimes it 38:24.501 --> 38:27.781 could be global. It's as in these movies cases 38:27.776 --> 38:31.086 where you lose your memory because something terrible has 38:31.090 --> 38:34.290 happened and you would get it back later but you have a 38:34.286 --> 38:36.176 temporary loss of identity. 38:36.179 --> 38:39.379 The idea is that something so terrible has happened you 38:39.383 --> 38:42.533 separate yourself from your previous identity and your 38:42.527 --> 38:45.857 memory. Over half of people charged 38:45.859 --> 38:52.309 with homicide claim to have some degree of dissociative amnesia. 38:52.309 --> 38:56.489 The problem here is that many, many, many of those cases 38:56.488 --> 39:00.738 involve alcohol and drugs, which can lead to some sort of 39:00.742 --> 39:02.492 alcoholic blackout. 39:02.490 --> 39:04.910 Also, people could be lying. 39:04.909 --> 39:07.999 If you're charged with murder, it's often a reasonable thing 39:08.001 --> 39:10.151 to say, "I don't remember any of this," 39:10.150 --> 39:14.340 to just kind of--and--as a way to distance yourself from it. 39:14.340 --> 39:19.480 Dissociative fugue is kind of weird and interesting. 39:19.480 --> 39:22.840 The guy's wife leaves him for another man. 39:22.840 --> 39:26.500 Six months later he was discovered tending bar in Miami 39:26.498 --> 39:28.868 Beach and calling himself Martin. 39:28.869 --> 39:33.249 And he totally wiped out his past memory and developed a new 39:33.252 --> 39:36.342 identity. This is also known as 39:36.335 --> 39:38.595 "psychogenic fugue." 39:38.599 --> 39:42.539 So, it's global amnesia but there's also identity 39:42.540 --> 39:44.970 replacement. You leave home, 39:44.967 --> 39:49.987 you develop a new identity, and it's called a fugue state. 39:49.989 --> 39:53.179 This is my favorite mental disorder. 39:53.179 --> 39:55.679 If I had to get a serious mental disorder, 39:55.678 --> 39:58.418 I would get this because I'd get to travel. 39:58.420 --> 40:02.050 When it wears off your old identity comes back and your new 40:02.048 --> 40:03.548 identity is forgotten. 40:03.550 --> 40:08.760 Then there's dissociative identity disorder and this is a 40:08.755 --> 40:14.235 story of this woman who goes back and forth from her regular 40:14.239 --> 40:20.559 personality to a personality of Donna who is only six years old. 40:20.560 --> 40:25.810 40:25.809 --> 40:29.319 This was originally known as ""multiple personality disorder" 40:29.320 --> 40:32.710 and the idea is you have two or more distinct people in one 40:32.713 --> 40:35.553 head. It is--there are--It is a rare 40:35.552 --> 40:40.022 and controversial disorder but it includes some very famous 40:40.023 --> 40:44.193 cases and has been illustrated in many movies and books 40:44.185 --> 40:48.725 including the wonderful movie Primal Fear where--Ed 40:48.733 --> 40:52.673 Norton's first big movie, highly recommend it. 40:52.670 --> 40:55.130 And it's been tried as a criminal defense. 40:55.130 --> 40:59.820 The Hillside Strangler claimed to be two people but he was 40:59.818 --> 41:02.448 still convicted, both of them. 41:02.449 --> 41:08.099 It typically starts early, the pattern of dissociation. 41:08.100 --> 41:09.630 Mostly it's women. 41:09.630 --> 41:13.900 And mostly, it involves some sort of recollection of torture 41:13.897 --> 41:17.037 or sexual abuse. Also, and to get back to your 41:17.035 --> 41:21.015 question, can you have more than one mental disorder at the same 41:21.023 --> 41:23.013 time, people with dissociative 41:23.012 --> 41:26.912 disorder often show symptoms of posttraumatic stress disorder or 41:26.905 --> 41:30.695 PTSD. What causes it? 41:30.699 --> 41:35.969 Well, it is often argued to be the cause--caused by severe 41:35.965 --> 41:39.655 abuse, often sexual or physical abuse. 41:39.659 --> 41:43.119 The problem is most people who get abused don't develop 41:43.117 --> 41:45.227 dissociative identity disorder. 41:45.230 --> 41:50.230 And one idea is that it's abuse plus some sort of genetic or 41:50.226 --> 41:54.796 biological predisposition to dissociate and in fact, 41:54.800 --> 41:57.920 people with dissociative identity disorder seem to be 41:57.920 --> 41:59.060 very susceptible. 41:59.059 --> 42:01.599 They're easier to hypnotize than other people. 42:01.599 --> 42:05.559 And so it might begin as sort of a self--an act of 42:05.557 --> 42:08.887 self-hypnosis. You put yourself in a hypnotic 42:08.891 --> 42:12.701 trance to cope with some terrible situation and you begin 42:12.702 --> 42:16.652 to develop new and separate and distinct personalities. 42:16.650 --> 42:20.110 Now, of the many things I'm going to talk to you, 42:20.105 --> 42:23.335 I've talked--spoken about, some have been very 42:23.344 --> 42:26.414 controversial. One issue of controversy which 42:26.406 --> 42:29.646 we talked about was the existence in nature of so-called 42:29.646 --> 42:31.056 "repressed memories." 42:31.059 --> 42:34.189 This is another very controversial case related to 42:34.190 --> 42:35.980 the repressed memory case. 42:35.980 --> 42:39.860 In a recent poll, less than one quarter of 42:39.856 --> 42:45.336 psychiatrists believe there is such a thing as dissociative 42:45.340 --> 42:47.420 identity disorder. 42:47.420 --> 42:48.680 Why would you doubt that? 42:48.679 --> 42:50.969 Well, there are some curious statistics. 42:50.969 --> 42:55.329 Between 1930 and 1960, there were two cases in the 42:55.334 --> 42:57.664 United States. In the 1980s, 42:57.663 --> 42:59.403 there were 20,000 cases. 42:59.400 --> 43:02.910 You cannot go elsewhere from the United States and find 43:02.912 --> 43:05.842 people with dissociative identity disorder. 43:05.840 --> 43:07.970 It seems to be an American phenomena. 43:07.970 --> 43:10.580 And it varies by therapists. 43:10.579 --> 43:13.369 Some therapists, indeed some hospitals, 43:13.373 --> 43:17.863 some medical units go decades without ever seeing anybody that 43:17.858 --> 43:21.238 approaches dissociative identity disorder. 43:21.239 --> 43:24.189 Other therapists, virtually every patient they 43:24.190 --> 43:26.420 have has multiple personalities. 43:26.420 --> 43:31.760 One worry based on these facts is dissociative identity 43:31.755 --> 43:36.315 disorder is in a sense real, that Richard really does 43:36.324 --> 43:39.944 believe he's moving from personality to personality but 43:39.936 --> 43:43.276 he didn't come in to therapy with that problem. 43:43.280 --> 43:45.980 Rather, his therapist gave it to him. 43:45.980 --> 43:49.430 The claim is that it's the result of suggestion by the 43:49.429 --> 43:51.139 therapist. The therapists, 43:51.135 --> 43:54.215 and they're typically good people who wish to help, 43:54.218 --> 43:57.978 but the therapists might be in the grips of a theory involving 43:57.980 --> 44:01.060 repression and multiple personalities and different 44:01.063 --> 44:05.083 selves and encourage, either tacitly or overtly, 44:05.079 --> 44:10.009 their patients to develop these separate personalities. 44:10.010 --> 44:13.320 Related to this, it's not clear to what extent 44:13.315 --> 44:17.795 dissociative identity disorder is an extreme version of normal 44:17.796 --> 44:21.936 psychopathology--sorry, of normal psychology. 44:21.940 --> 44:26.270 So people, from the philosopher Dan Dennett to the psychologist 44:26.267 --> 44:29.127 Judith Harris, have pointed out that we're 44:29.129 --> 44:32.269 different selves in different situations. 44:32.269 --> 44:35.989 We can consciously play act the different selves but we could 44:35.987 --> 44:39.707 also just shift personalities depending on whether we're with 44:39.705 --> 44:42.675 our friends or our family or with strangers. 44:42.679 --> 44:45.609 The claim is that dissociative identity disorder, 44:45.610 --> 44:49.200 however dramatic it looks, might merely be an extended 44:49.196 --> 44:53.296 version of this where people as well are to some extent play 44:53.296 --> 44:56.976 acting to make their therapists and doctors happy. 44:56.980 --> 45:00.200 45:00.199 --> 45:06.399 Any questions about dissociative identity disorder? 45:06.400 --> 45:09.930 Yes. Student: [inaudible] 45:09.929 --> 45:13.089 Professor Paul Bloom: Yes. 45:13.090 --> 45:15.530 Dissociative amnesia--the question involves the 45:15.527 --> 45:18.067 relationship between dissociative amnesia and the 45:18.072 --> 45:21.042 retrograde and anterograde amnesia discussed before. 45:21.039 --> 45:23.879 Those other amnesias are the result of brain damage. 45:23.880 --> 45:28.060 They tend to be if not permanent long lasting and 45:28.056 --> 45:30.536 severe. Dissociative amnesia is 45:30.537 --> 45:34.737 apparently caused by specific life events and can often be 45:34.744 --> 45:36.224 very short-lived. 45:36.219 --> 45:39.099 They're, of course, all brain events but in the 45:39.096 --> 45:42.096 crude sense the dissociative amnesia is more of a 45:42.098 --> 45:46.038 psychological happening than the other sorts of amnesias that we 45:46.039 --> 45:49.849 talked about involving Korsakoff syndrome and the patient "HM" 45:49.854 --> 45:50.984 and so on. 45:50.980 --> 45:56.940 45:56.940 --> 45:59.680 Other questions. Yes, in back. 45:59.679 --> 46:08.529 Student: [inaudible] Professor Paul Bloom: 46:08.525 --> 46:11.195 Yes. What happened in 1960--There 46:11.196 --> 46:12.656 was a very famous case. 46:12.659 --> 46:15.279 I think the case was the case of Sybil. 46:15.280 --> 46:17.090 Does anybody know? 46:17.090 --> 46:19.890 The teaching fellows are nodding but there was a very 46:19.890 --> 46:23.070 famous case which I think was of Sybil which was made into a 46:23.068 --> 46:26.138 movie and discussed and had a huge influence on people and 46:26.139 --> 46:28.939 then they started to believe that it was real. 46:28.940 --> 46:32.540 46:32.539 --> 46:36.929 There is a type--The fourth and final type of disorder is 46:36.933 --> 46:41.723 something which is not actually discussed in the Gray textbook 46:41.718 --> 46:45.168 but it has to do with personality and this is 46:45.170 --> 46:49.960 interesting because it probably extends to some extent to many 46:49.955 --> 46:53.795 of these people--the people in this room. 46:53.800 --> 46:55.880 Personality, as you remember, 46:55.883 --> 47:00.573 is your way of dealing with the world, in particular the way you 47:00.572 --> 47:03.402 have of dealing with other people. 47:03.400 --> 47:07.440 The notion of personality disorders is that some 47:07.436 --> 47:12.066 personalities are so bad that they veer off into mental 47:12.074 --> 47:16.544 illness so one personality disorder is a narcissistic 47:16.541 --> 47:18.861 personality disorder. 47:18.860 --> 47:22.590 Everyone likes to talk about themselves and thinks they're 47:22.589 --> 47:26.309 terrific to some extent, some people to a little bit too 47:26.314 --> 47:30.494 much, but if it's really extreme they could talk--they--you could 47:30.493 --> 47:34.153 get labeled with a narcissistic personality disorder. 47:34.150 --> 47:39.050 You might have an avoidant personality disorder, 47:39.048 --> 47:42.798 dependent, histrionic, borderline. 47:42.800 --> 47:44.650 Borderline is really bad. 47:44.650 --> 47:48.070 When people describe you as a borderline personality disorder, 47:48.065 --> 47:50.525 that just means you're just awful to be with, 47:50.530 --> 47:51.930 you're kind of awful. 47:51.929 --> 47:54.249 [laughter] There is the paranoid 47:54.251 --> 47:58.221 personality disorder which is not that you're paranoid 47:58.221 --> 48:01.231 schizophrenic, very clearly no signs of 48:01.231 --> 48:03.451 schizophrenia, no hallucinations, 48:03.446 --> 48:04.896 nothing like that. 48:04.900 --> 48:06.480 You are just paranoid. 48:06.480 --> 48:09.140 You're just--to a greater extent than normal, 48:09.143 --> 48:12.663 you think other people are against you and plotting against 48:12.655 --> 48:14.695 you. The most interesting 48:14.696 --> 48:19.366 personality disorders in my mind have to do with violence and 48:19.365 --> 48:24.025 crime and they have to do in particular with something called 48:24.034 --> 48:27.074 "antisocial personality disorder." 48:27.070 --> 48:32.980 Now, most murderers are not mentally ill in a medical sense. 48:32.980 --> 48:36.050 They're not mentally ill according to how clinicians 48:36.054 --> 48:37.264 categorize things. 48:37.260 --> 48:41.400 To some extent, most people who kill are just 48:41.400 --> 48:45.540 normal people being driven by normal desires, 48:45.540 --> 48:50.340 rage, jealousy, hate, just taken to an extreme. 48:50.340 --> 48:55.160 Even mass murderers do not as a rule appear to be substantively 48:55.163 --> 48:58.823 different from a psychological point of view. 48:58.820 --> 49:03.370 In every society--and honestly, I wrote the lecture on this 49:03.368 --> 49:07.098 quite a while ago but, given the recent events, 49:07.099 --> 49:11.569 they stand as a perfectly good example of what I'm going to 49:11.570 --> 49:14.190 say. In every society there is a 49:14.189 --> 49:17.959 notion of somebody who has been deeply humiliated, 49:17.964 --> 49:21.204 usually male, and he's been humiliated over 49:21.199 --> 49:24.239 and over again. He sees himself as losing 49:24.235 --> 49:27.635 status and losing status and losing status and he tries to 49:27.643 --> 49:31.203 get it all back, to gain face with one act of 49:31.202 --> 49:36.572 terrible violence where he takes his revenge over everybody and 49:36.568 --> 49:39.768 then is known as--and as a result, 49:39.769 --> 49:43.029 even though he might die, he probably will die, 49:43.034 --> 49:46.874 makes his way to a level of social status he would have 49:46.866 --> 49:48.566 never gotten before. 49:48.570 --> 49:54.490 The American term for this used to be "going postal" and--but 49:54.489 --> 49:56.659 this is an old idea. 49:56.659 --> 50:00.689 Stone Age tribes in Papua, New Guinea, had a term for 50:00.687 --> 50:03.397 this. They call it "running amok" and 50:03.404 --> 50:06.004 this is--and every society has this. 50:06.000 --> 50:09.820 So, there's normal murderers, there's mass murderers, 50:09.819 --> 50:13.419 and then there's the interesting cases like serial 50:13.418 --> 50:16.208 killers like Dahmer or Son of Sam, 50:16.210 --> 50:20.210 Ted Bundy, John Wayne Gacy, even the imaginary Hannibal 50:20.212 --> 50:22.582 Lecter. Many of these sort of serial 50:22.578 --> 50:26.038 killers do have some sort of mental illness but the mental 50:26.036 --> 50:28.216 illnesses are all over the place. 50:28.219 --> 50:30.359 There was a guy, Jerome Brudos, 50:30.357 --> 50:34.557 who had such a severe fetish for women's feet that he killed 50:34.559 --> 50:38.689 young women and severed their feet and then kept their feet 50:38.691 --> 50:40.331 around his house. 50:40.329 --> 50:45.099 Son of Sam was pretty clearly a paranoid schizophrenic. 50:45.099 --> 50:50.009 He did his murders because a barking dog told him to. 50:50.010 --> 50:53.670 Jeffrey Dahmer is a cannibal killer and he killed people so 50:53.671 --> 50:57.591 he could eat them and then--and I asked one of my colleagues in 50:57.585 --> 51:01.055 clinical--colleagues what exactly was wrong with him and 51:01.057 --> 51:03.517 the person immediately responded, 51:03.519 --> 51:06.729 "He has a severe eating disorder." 51:06.730 --> 51:08.560 [laughter] So, it's--it was a joke. 51:08.560 --> 51:11.620 It was in very, very bad taste. 51:11.619 --> 51:14.029 [laughter] A lot of [laughter] 51:14.033 --> 51:17.863 murderers claim to have dissociative disorders, 51:17.861 --> 51:22.271 "it wasn't me who killed the guy, it was my alter ego, 51:22.271 --> 51:24.971 Fred." It's not clear how often 51:24.967 --> 51:28.787 they're telling the truth, if ever or whether this is a 51:28.785 --> 51:31.185 way of escaping responsibility. 51:31.190 --> 51:34.650 There is a mental illness--There's an extreme, 51:34.651 --> 51:38.191 specific version of a personality disorder that 51:38.189 --> 51:41.659 revolves around violence, and this is known as 51:41.656 --> 51:43.816 "antisocial personality disorder." 51:43.820 --> 51:47.220 51:47.219 --> 51:50.389 It is--it used to be called moral insanity. 51:50.389 --> 51:54.339 Now it's often called psychopathy. 51:54.340 --> 51:58.750 Some people make a distinction between psychopath and 51:58.751 --> 52:01.361 sociopath. For the purposes here others 52:01.361 --> 52:05.001 don't, and for the purposes here I'm going to blend them into one 52:04.998 --> 52:07.208 category. Then I'll use the term 52:07.207 --> 52:11.737 "psychopath." They're typically male. 52:11.739 --> 52:15.709 They are defined as selfish, callous, impulsive, 52:15.710 --> 52:18.330 they're sexually promiscuous. 52:18.329 --> 52:22.989 They seem to lack love, loyalty, normal feelings of 52:22.988 --> 52:28.228 affiliation and compassion, and they get into all sorts of 52:28.227 --> 52:32.707 trouble because they're easily bored and they seek out 52:32.711 --> 52:35.721 stimulation. Now, when you hear this, 52:35.721 --> 52:39.501 you've got to realize that this sort of person is not 52:39.496 --> 52:43.776 necessarily an unattractive person to imagine or think about 52:43.778 --> 52:47.478 or even under some circumstances to encounter. 52:47.480 --> 52:49.990 You have to avoid the temptation when you think about 52:49.990 --> 52:52.690 psychopath to think about a guy like this, to think about 52:52.694 --> 52:56.164 Hannibal Lecter. The most famous psychopath, 52:56.155 --> 53:01.695 of course, is James Bond who is a perfect psychopath in every 53:01.702 --> 53:06.142 regard as played by him also by Sean Connery. 53:06.139 --> 53:09.349 The Roger Moore and Timothy Dalton characters were not 53:09.351 --> 53:12.061 psychopaths. I could give a whole course on 53:12.058 --> 53:15.668 that. Is this an illness? 53:15.670 --> 53:19.010 Well, again, this is one of the hard cases. 53:19.010 --> 53:22.600 Psychopaths don't come in for treatment. 53:22.599 --> 53:25.269 James Bond would never go to a therapist and say, 53:25.270 --> 53:27.940 "I have a problem with promiscuity and my life of 53:27.941 --> 53:29.331 adventure. [laughter] 53:29.332 --> 53:32.702 Why is it that I don't have this need to settle down and 53:32.702 --> 53:34.972 have kids and be a one-woman man?" 53:34.969 --> 53:37.499 They don't have a problem with it. 53:37.500 --> 53:40.610 Other people often have a problem with it but it's not 53:40.613 --> 53:43.613 clear that's enough to make it a mental disorder. 53:43.610 --> 53:48.040 Also, a lot of psychopaths are reasonably successful. 53:48.039 --> 53:52.009 Now, this gets complicated because psychologists study 53:52.007 --> 53:55.977 psychopaths but the psychopaths that they study are by 53:55.975 --> 53:58.965 definition unsuccessful psychopaths. 53:58.969 --> 54:03.249 And what some people have argued is the real psychopaths, 54:03.248 --> 54:06.338 the successful ones, are the ones that run the 54:06.344 --> 54:09.684 world, that excel in every field because they are successful 54:09.683 --> 54:12.403 enough that they don't look like psychopaths. 54:12.400 --> 54:14.920 They have no conscience, no compassion, 54:14.919 --> 54:17.559 love, loyalty. They are cold-blooded and 54:17.557 --> 54:21.087 ambitious but they don't go around making this so obvious 54:21.090 --> 54:23.110 that we throw them in prison. 54:23.110 --> 54:28.600 And so, it's an interesting and subtle and complicated case. 54:28.600 --> 54:33.670 54:33.670 --> 54:37.200 The final section – and I'll start this and we'll go five 54:37.201 --> 54:40.731 minutes into this and then move--continue it next week with 54:40.733 --> 54:43.233 the final class – concerns therapy. 54:43.230 --> 54:48.720 54:48.719 --> 54:52.249 Now, the most interesting thing for us to deal with is the 54:52.251 --> 54:54.421 question of, "Does therapy work?" 54:54.420 --> 54:57.020 And there's a lot to be said about this. 54:57.019 --> 55:00.899 The history of therapy has been gruesome and unsuccessful. 55:00.900 --> 55:04.360 Again, to be mad was to be viewed as to be in league with 55:04.357 --> 55:07.937 the devil and so people with mental illnesses were tortured 55:07.937 --> 55:11.127 to death, burnt, sent out to sea and so 55:11.130 --> 55:12.860 on. In the eighteenth century they 55:12.855 --> 55:15.595 were thought of as degenerates and sent away from society. 55:15.599 --> 55:21.579 In the nineteenth century there was a brief blast of compassion 55:21.576 --> 55:27.456 where Pinel tried to have mental hospitals and then there were 55:27.455 --> 55:33.235 all sorts of--since then all sorts of medical treatments that 55:33.238 --> 55:38.348 were considerably less successful and this brief video 55:38.347 --> 55:44.417 will summarize some of the previous medical treatments. 55:44.420 --> 55:48.170 I often wonder a hundred years from now how they're going to 55:48.170 --> 55:51.790 look at our current therapies and then whether they'll see 55:51.794 --> 55:55.104 them as equally barbaric and stupid as we look at the 55:55.099 --> 55:56.879 therapies in the past. 55:56.880 --> 56:01.520 What I'll begin next lecture with is a very quick discussion 56:01.518 --> 56:05.998 of what therapies work of the ones currently available and 56:05.998 --> 56:08.198 then I'll end the class. 56:08.199 --> 56:09.829 And this will be a somewhat short class. 56:09.829 --> 56:13.309 I'll end the class with a discussion of happiness. 56:13.309 --> 56:17.109 There is an optional thing I'll add, which is your reading 56:17.107 --> 56:20.907 responses are done and you'll have the opportunity to make 56:20.905 --> 56:24.495 comments on the class in anonymous evaluations but what 56:24.502 --> 56:29.102 I'm kind of interested in is if people could send me an e-mail, 56:29.099 --> 56:32.179 and this is entirely optional, about the most interesting 56:32.177 --> 56:34.427 thing that we've covered in this class. 56:34.429 --> 56:37.569 I'm curious what people think it is and it's something which I 56:37.571 --> 56:39.941 could try to build up on for future classes. 56:39.940 --> 56:41.840 So, again, this is optional. 56:41.840 --> 56:44.550 Just give it a subject heading "Intro Psych" and send it to me 56:44.553 --> 56:47.003 if you choose to do it and I'll see you on Wednesday.