Psychology: foundations, theories, and applications

Clinical Disorder

Clinical Psychology and Categorical Mental Disorders

Clinical psychology is a field constructed on the intent to treat disorders and dysfunctions and to promote mental health and stability in its subject. Therefore, it is centered on the processes of diagnosis and therapy, with the various disorders to which individuals are subject falling under a set of classifications discussed in greater detail in the following account.

Before proceeding to this examination, the account provides a brief background on the philosophical and academic development of clinical psychology which should improve the insight here provided on its impetus and primary objectives. Clinical Psychology, apart from its counterparts in the scientific and cultural communities, draws its roots to a history which, while not created in a vacuum, is more a product of its own course than of the uniform history of experimental psychology. Rising from a desire to better understand those capacities and frailties of the human mind than simply what empirical or neurological science had to offer, Ellenberger (1970) describes the clinical path of American psychological academe as one formed upon the education of its precursors but decidedly self-defined in its psychoanalytic framework and in its philosophical predisposition toward understanding the nature of and treatment path for mental disorders.

Where the psychological approaches before it were built around a core scientific ideal that experimental laboratory measurement is the key to psychological advance, the chronologically similar outset of experimental psychotherapeutics, which would eventually render clinical psychology was developed out of a host of other sciences, including physiology, neurology, psychological research, philosophy, and social ethics.

But what distinguishes it from experimental psychology does so with an ideological gapping that is unbridgeable. As Ellenberger presents it, in order to truly understand the psychological state of a mental examination subject, one "must consider the cultural and social background of the patient." (Ellenberger, 15) and though clinical psychology may not have been explicitly a reaction to its laboratory-bound predecessors' narrow scope, its theories seemed innately designed to address those elements of the mental behavior over which satisfying academic explanation had not yet been levied. As Freud and his contemporaries regarded it, such exploration had already been manifested in the classics, lauded as such for their illumination of the human condition. In the years which preceded the infusion and predominance of the laboratory in the field, thinkers and social scientists had already taken note of the human imagination, a so-called possession of mind and other personality traits which, even centuries later, could not be done justice in explication on only quantifiable terms. The desire to pick up on this work sets clinical psychology uniquely on its own route, with the emergence of consideration for the seemingly unobservable parts of the mind.

Herein, "a new model of the human mind was evolved. It was based on the duality of conscious and unconscious psychism. Later, it was modified to the form of a cluster of subpersonalities underlying the conscious personality." (Ellenberger, 111) This departure from conventional thinking would set the course for popular psychology here and forward, though such ideas would be consistently rejected by the established controlling parties of academic psychology in America. That is, of course, until they came to be said controlling parties. But in Freud's consistent applicability, especially as would be evidenced by the explosion in applied psychology thereafter, there is proof, Ellenberger seems to argue, that the elasticity of human minds interacting, as in psychoanalysis, provides the needed level of pragmatic subjectivity in handling the diversified obstacles of the mental process.

Clinical psychology focuses on the ways in which this responded to philosophical convention in equal part to its basis in science. Thus, clinical psychology is not just correlated to the academic advances of the field, but also beholden to what may be described as worthy humanist interpretations of man in intellectual history, evolving as consideration of these interpretations evolved with sociological change. Ellenberger provides the example that "whereas, in the eighteenth century, the prevailing myth was that of the "noble savage," of the vigorous, primitive man living in his forest and fighting for his freedom, there was now an inverted myth of a "corrupt civilized man," weakened and sophisticated." (Ellenberger, 282) the reflection of society has played a hand in our abilities to define ourselves.

Though the future of clinical psychology would coincide with its commercial interests particularly with respect to the use of pharmaceutical treatment, its history is one very much founded in the above implied notion that the mind is not simply a part of the body but also a far more complex embodiment of an abstract entity that constitutes the psyche. Here, the unique stratification of impulses, its impossible to replicate individualities and its vulnerability to the conceits of its origin make the human mind a thing still beyond the empirical set of considerations which have sought to pigeonhole it. Thus, clinical psychology is useful because it distributes psychological maladies within the context of encompassing mental disorders. Under the terms of the Diagnostic and Statistical Manual of Mental Disorders (DSM), we are given a set of disorders under which many individual afflictions are categorized for evaluating in a clinical setting. Accoridingly, the DSM "is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems)." (Psyweb, 1) Its dominance in the field helps to provide something of a streamlined set of practices for classification available to practitioners.

The primary purpose of the DSM is to provide practitioners with a reference point for evaluation of observable symptoms in patients. The provision of symptoms affiliated to specific disorders in the DSM makes it instrument of the utmost importance in attempting to narrow down conditions due for treatment. Accordingly, "for each disorder included in the DSM, a set of diagnostic criteria that indicate what symptoms must be present (and for how long) in order to qualify for a diagnosis (called inclusion criteria) as well as those symptoms that must not be present (called exclusion criteria) in order for an individual to qualify for a particular diagnosis." (Psyweb, 1)

Anxiety Disorders:

Anxiety Disorders are perhaps the most common of those disorders falling under the clinical umbrella. These can impact individuals with otherwise functional and healthy lives or can be debilitating to the extent of disrupting one's ability to work or socialize normally. The variance of possible forms for this disorder includes Panic Attacks, Social Anxiety, Post Traumatic Stress Disorder and a wide variety of Phobias or irrational fears. According to Rowney et al., though anxiety can be a normal and natural response to certain external stimuli, it "can become a pathologic disorder when it is excessive and uncontrollable, requires no specific external stimulus, and manifests with a wide range of physical and affective symptoms as well as changes in behavior and cognition.' ( Rowney et al., 1)

An example of this is the Panic Disorder in which individuals may suffer from an unpredictable vulnerability to panic attacks. These are described as a loss of control, a shortness of breath, dizziness and in intense sense of indefinable fear. Indications are that there is a direct reciprocity between the experience of these symptoms and the emotional trauma affiliated therewith. Accordingly, the National Institute of Mental Health defines this as "fear of one's own unexplained physical symptoms is also a symptom of panic disorder. People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death. They can't predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack." (NIMH2, 1) the purpose of clinical psychology is to attempt to trace this condition to a root in the unconsciousness that might be triggering the irrational or undue response to such stimuli.

In the case of some disorders however, where some event has clearly triggered a pathological emotional response in the subject, the clinical approach is devoted to treatment. Post Traumatic Stress Disorder is one such Anxiety Disorder, which is demonstrative of the manner in which specific personal experiences can create a psychological conflict in the subject. Here, a condition commonly associated with such experiences as those found in war, for example, is evidence of the need for a clinical approach which is best suited to exploring the experiential rather than physiological causes of the condition. Here, we can see that certain inhospitable conditions can be held responsible for the presence of the disorder. The experiences which are encountered by soldiers engaged in direct combat are perilous, chaotic and contrary to the rules and parameters which protect us in our daily lives. An absence of order and the intensely heightened threat of injury or fatality require soldiers to shed many of the assumptions and securities of civilian life as a means to survival. But for many who succeed in forging the protective behaviors and mentalities necessary to endure the unspeakable horrors of war, the return to civilian life can bring with it a haunting incapacity to return to the disposition of civil society. This leaves many veterans prone to the condition known as Post-Traumatic Stress Disorder (PTSD). This may be characterized as "an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat." (NIMH, 1) in the particular case of this discussion, military combat is a cause of PTSD that can have devastating long-term outcomes. Indeed, "studies estimate that as many as 500,000 troops serving in Iraq and Afghanistan will suffer from some form of psychological injury, with PTSD being the most common." (Eliscu, 58) the outcomes of this condition will run a wide range of symptoms that impact the ability of individuals to cope with the pressures of everyday life, to relate to those who have not experienced the traumas of war, and heightened propensities toward violence, toward crime, toward alcoholism, toward substance abuse and toward depression. Such is to say that the real and tangible outcomes of this condition suggest a detectable sociological problem potentially afflicting in some degree an entire class of Americans.

Dissociative Disorders:

The discussion above on PTSD reveals a correlation between specific traumatic experiences and the development of pathogenic emotional responses. In some instances, clinicians must attempt to delve into memory which has been obscured by psychoses or what clinical psychology refers to as Dissociative Disorder. Repression is often the most attractive label to apply to those suffering the long-term emotional repercussions of vaguely recalled or completely forgotten trauma, but this might be a flawed approach to treatment of an emotional condition.

According to the study by Gleaves et al. (2004) "amnesia and/or subsequent recovery of memories have been found to be relatively common in studies of clinical populations that experienced childhood sexual and physical abuse." (Gleaves, 4) This is indicative of the long-standing relationship between trauma such as sexual abuse during childhood and psychological conflicts later in life. There are a broad range of resolutions or evasive tactics which individuals might employ to contend with the presence of such experiences in their past. And there is an illustrated pattern wherein memories of such occurrences may be obscured over time. It has been even further argued by advocates of the repression theory that individuals subjected to recurrent abuse may adapt dissociative skills to contend with untenable emotional conditions, thus obscuring such experiences within the adult psyche. Thus, most clinicians believe that repetition of traumatic atrocities is likely to increase the presence and cosmetic pervasion of dissociative tendencies. Habitual sexual abuse is in particular a matter in which victims may be vulnerable to developing the coping mechanisms that banish such experiences to the periphery of the consciousness. Clinicians have consistently engaged in semantic discourse over the parameters by which the Dissociative Disorder is more or less likely under such a condition.

However, through a review of the clinical history and the semantic debate over the relationship between trauma -- especially sexual abuse -- during childhood and the surfacing of psychologically distressing consequences in adulthood, it is evident that the diagnosis of repression is often misapplied. "The term 'dissociative." As applied to these disorders, is better construed as a descriptive label (referring to loss of conscious access to memory) than any pathological process instigated by trauma." (Kilstrom, 36)

Though it is regarded in popular psychology as a relatively common route to evading traumatic experiences, dissociative repression is actually not as easy to assign to subjects as it has appeared. Though there is enough case history to illustrate that memory repression is a phenomenon which does occur under the conditions above mentioned, investigative research on the topic illuminates the proclivity by clinicians and mental health physicians to incorrectly employ it as a catch-all term for characterization of the psychological conflicts incited in a person by forgotten experiences.

Eating Disorders:

A basic understanding of the subject identifies eating disorders as psychological diseases. Eating disorders such as anorexia and bulimia have replaced, for many emotionally vulnerable young individuals, sound nutritional and physiological patterns of behaviors as a means to weight loss. "A person with anorexia nervosa, often called anorexia, has an intense fear of gaining weight. Someone with anorexia thinks about food a lot and limits the food she or he eats, even though she or he is too thin. Anorexia is more than just a problem with food. it's a way of using food or starving oneself to feel more in control of life and to ease tension, anger, and anxiety." (1, DHHS) 1

Simply stated, the presence of an eating disorder relating to the stifling of one's dietary needs is generally reflective of some discontent with one's self or one's life. Often, an eating disorder such as anorexia, which the U.S. Department of Health & Human Services identifies as considerably more of a threat to women, will be attached to a host of other mental health symptoms. Among them, an individual may additionally suffer from depression, self-esteem or body image issues or an array of potential symptoms relating to identity and self-perception. There may additionally be present in the familial or childhood background of such an individual a history or an incident of trauma which may consciously or unconsciously relate to the pattern of negative health behaviors. This matter of trauma in one's personal history reflects the nature reflects this recurrent theme in the discussion on clinical psychology.

In many individuals who are driven to afflict themselves through such physically and emotionally devastating behaviors, there is evidence of some internalized shame or self loathing which does again call into relevance the possible impact of some childhood or formative trauma. In addition or alternative to experiencing serious emotional shortcomings in establishing stable and healthy interpersonal relationships, the way that the afflicted individual relates to his or her self is likely to be negatively impacted. As Kaufman (1989) would argue, shame had long been a subject ignored by researchers and clinicians due to its obscurity and its association to the taboos of childhood sexuality. (p. 4) However, the author contends, "the recent acceleration of addictive, abusive, and eating disorders has shifted the focus of attention. These are syndromes in which shame plays a central role, and the new and growing focus on these particular disorders has moved shame into the spotlight." (Kaufman, 1989, p. 4) the correlation in one manner or another drawn between consumption habits and a personal sense of shame turns the sufferer's attention from personal relationships to a relationship with one's health and body. To the latter, the close association between negative body image and the onset of eating disorder cycles is directly evidenced.

Mood Disorders:

Depression, Bipolar Disorder and other major depressive disorders can have a debilitating impact on the life of the sufferer. The persistent symptoms that include intense melancholy, self-destructive behavior, manic emotional inconsistency and the damaging of personal relationships can impede upon the desires or ability of the sufferer to engage in normal everyday activities.

Here, the article by Blanco et al. (2002) brings the benefits of pharmaceutical treatment as a clinical approach to bipolar depression to this discussion, considering the often severe condition as one which is generally treated by therapy, medication and, where necessary, institutionalization. The nature of its symptoms and treatment approach tends to discourage a social-cognitive approach primarily due to the combined evidence of progress made by medicating those with the condition and to the danger imminent in failing to address such conditions. Indeed, according to the article by Blanco et al., "in the last decade, a number of pharmacological agents have shown efficacy in the treatment of bipolar disorder, and several guidelines have been published to suggest appropriate clinical management." (Blanco, 1003). Without clinical treatment, patients with depression or bipolar disorder face substantial distress and impairment and have a significant risk of morbidity and mortality." (Blanco et al., 1006) the dangers of suicide, self-abuse or erratic social interaction which may be associated with bipolarity suggest that clinical therapy and course of treatment might be the only realistic approach for some such sufferers.

Schizophrenic Disorders:

Schizophrenia is one of the more challenging disorders faced by clinical psychologists. As denoted in the text by Craddock et al. (2005), even pinning down its cause can be extremely daunting for the clinical psychology. As Craddock et al. indicate, this disorder is shrouded in uncertainty based on the continuing dialogue invested in defining its causes. Today, theories promote a whole of myriad of explanations, among them, the argument that "future identification of psychosis susceptibility genes will have a major impact on our understanding of disease pathophysiology and will lead to changes in classification and the clinical practice of psychiatry." (Craddock et al., 193) This is an important part of defining clinical treatment approaches as is taking note of the experiences and perceptions of the subject. Such is denoted in the discussion by Grohol (2005) which explores the implications of this experience. Grohol denotes that, beyond concrete misinterpretations of reality, an individual experiencing schizophrenic delusions may construct exaggerated versions of reality or false scenarios that reinforce these misinterpretations. Essentially, "delusions are false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's usual cultural concepts." (Grohol, 1) Quite frequently, these delusions may take on a paranoid form, with subjects conjuring realities in which they are at the focus of some form of persecution.