Lesson 4: Psychosis

Lesson Objectives

            The student will learn about...

• Defining Psychosis
• Misconceptions about Psychosis
• Panic Attacks
• Paranoia
• Manic-Depression
• Schizophrenia
• Self-injurious Behaviour
• Organic Psychosis
• Alzheimer’s Disease
• Treatments: What is Working and What is not Working
• Multiple Personalities

Introduction

This lesson was created using some material from General Psychology 20, Alberta Distance Learning Centre.

Overview

In Lesson 3 you examined some of the less severe social and personality disturbances known as neurosis. Psychosis is even more challenging to treat, and if possible, to control.

What is psychosis? How does it compare with neurosis? How does a person become psychotic? Psychosis sounds very dangerous and threatening. Are there any dangers involved with these illnesses? The topic of psychosis raises a number of concerns examined in this lesson.

1 - Defining Psychosis

Psychosis is a serious pathological (abnormal) state resulting in a loss of contact with reality. A person who suffers from such a severe mental illness is called psychotic. Psychotics experience periods when they are unable to make adequate distinctions between what is real and what is not. They may develop distorted interpretations of events. Thought patterns and emotions are abnormal, which interferes with their daily functioning. Psychotics will rarely admit that their actions are abnormal or unusual. Because they are out of touch with reality, psychotics are unaware of the extent of their mental disorders and are, therefore, not alarmed by their conditions. How can we distinguish psychosis from neurosis?

Please remember that only someone with expert training in psychology can give a professional diagnosis. General characteristics of a psychotic person include

• lack of contact with reality
• extreme depression or excitement
• partial or complete withdrawal from social contacts with others
• confused ideas about people or objects
• hallucinations and/or delusions
• hostility in a minority of cases

Psychosis: Sarah's Story

What might cause people to become psychotic? There are two very different opinions on this question. First, a predisposition to some types of psychoses (plural of psychosis) may be inherited. That means a person has a “tendency” to have a certain condition, and if the right circumstances prevail, the illness will develop. It is yet unclear how strong the hereditary factor may be. Body chemistry (as determined through blood and urine samples) differs between the normal individual and the psychotic. Body chemistry also shows a variation between one psychotic and another depending on the particular disorder.

A second group of factors instrumental in the formation of psychotic conditions are environmental and social factors. Many people with mental illnesses come from very abusive home backgrounds. Chronic stress and conflicts in the child’s life, if severe enough, could lead to one or another form of psychosis.

2 - Misconceptions about Psychosis

In earlier times, psychosis was associated with sin and evil spirits. The general public still have lingering false ideas about psychosis. Many people are uninformed enough to consider it a disgrace if anyone in the family has any history of mental illness. If someone we know has a serious physical illness such as heart disease or cancer, we do not say that condition is disgraceful.

The person suffering from psychosis requires just as much care and understanding as the one with a physical illness. Punishment or rejection does not help.

Lesson 3 showed how hurtful carelessly applied labels are to a person suffering from neurosis. Labelling someone psychotic can be even more upsetting. People who are labelled psychotic are treated as psychotic and, therefore, continue to respond in psychotic ways. When the person is mislabelled psychotic, the results can be very damaging.

A stigma is a label associated with disgrace, dishonour, or shame. For example, someone serving time in jail, has a stigma. The stigma or sense of shame may also spread to the person’s family. For example, the parents are out of work, so the family is poor. Therefore, they require social assistance. That may be considered a stigma as well. Everyone in the family falls into the same negative category. Sometimes the stigma or mark of disgrace is justified because the person is truly evil or dangerous. Sometimes the person is saddled with a negative label not deserved.

From what has been said about society’s opinions about psychosis, psychological disturbances seem also to come under the cloud of a stigma. Because the misconception still exists that psychotics are evil and, therefore, deserve their situation, there is a tendency to punish those individuals more severely. The punisher does not sympathize or identify with the psychotic person. Another misconception is that the psychotic person is dangerous. A few psychotics must be guarded carefully, but many are nonviolent and calm. Most psychotics are more of a danger to themselves than they are to anyone else.

Can some of the severe forms of psychosis be cured? Perhaps many of them cannot be cured in the strictest sense, but they can be controlled with proper medication, counselling, and therapy. Approximately 70 to 80% of all mental patients can be released from institutions and satisfactorily adjust to normal life. However, their treatment must be monitored to ensure their progress toward mental health continues.

After identifying psychosis in very general terms, this lesson studies some of the specific forms of psychosis.

3 - Panic Attacks

Panic attack victims are not truly psychotic. However, panic attacks are included in the lesson on psychosis because they are intense, crippling emotional experiences that deeply alter the lives of the people affected. Panic attacks can prevent people from coping with life; they destroy people’s daily routines. Between attacks, people lead somewhat normal lives, but they are always in states of anxiety not knowing when panic may strike again.

Panic attacks result in levels of anxiety that are so intense the victim is terrified and immobilized. Panic attacks can appear at any age, but young adults are subject to them more frequently. Some people may experience a few isolated attacks that do not develop into a panic disorder that is more chronic and more serious. If the disorder is untreated, it may become very disabling for the person. The fear of a panic attack can restrict everyday activities and may even keep the person home-bound. (See Lesson 3 on Phobias. Agoraphobia may affect two or three people in the same family.)

Causes

We have hinted at some of the factors that may cause panic attacks. Physical and psychological causes of panic disorder work together. Current research supports the theory that anxiety disorders may be the result of genetics (abnormal biochemistry) or the result of faulty thinking. Studies with twins have confirmed the possibility of “genetic inheritance” of the disorder.

In general, panic attacks seem to be linked with major turning points in life that are potentially stressful. For example, getting a divorce and losing your family, becoming chronically unemployed, or finding you are unable to pursue one of your favourite interests are all major transitions. When stress lowers a person’s resistance, the underlying physical predisposition kicks in and triggers an attack. 

Some factors contributing to panic attacks are stress, diet, bad breathing habits, grief, a bad heart, unique brain chemistry, and being a perfectionist.

Symptoms

In general, panic attacks or anxiety attacks are violent experiences. People commonly report that they feel as if they are going insane. People experience the helpless feeling that the symptoms will strike repeatedly and without warning. The symptoms may occur in a wide variety of situations—they can even happen while the person is asleep.

Some of the symptoms that occur during a panic attack include the following:

• People usually experience difficulty breathing.
• People cannot think clearly. Wrong signals are sent from the brain. Clear thinking stops completely.
• Adrenaline is discharged into the system, the pupils dilate, hands and feet get cold, and there is a tendency to sweat.
• Reduced oxygen supply reaches the heart causing an increase in heart rate. People often report that they feel they are experiencing a heart attack or stroke, that they are losing their mind, or that they are on the verge of death. Blood pressure may be affected causing the person to faint.
• Because of lack of oxygen throughout the body, the person feels weak, confused, and perhaps like they are suffocating.
• Strong feelings of impending doom and paralyzing fear are usual.
• Other physiological responses are hyperventilation, tremors, confusion, fatigue, and tingling in fingers or toes.

A recent study showed that people who suffer from panic disorders are more prone to alcohol and other substance abuse. In addition, they are greater suicide risks, spend less time in satisfying hobbies, tend to be financially dependent on others, and are afraid of driving more than a short distance from home. Panic disorder often leads to other complications such as phobias and depression.

Treatments

Panic disorder is highly treatable with a variety of available therapies. However, therapies must focus on all the victim’s needs—physical, psychological, and physiological. For panic attacks to initially be misdiagnosed as something else is not unusual.

If a person suffers repeated attacks (four or more), he or she should definitely seek help. The first part of therapy is largely informational. Many people are greatly helped by simply understanding exactly what panic disorder is and how many others suffer from it. The person is advised to find a therapist in the area and ask about background experience in treating panic attacks in particular.

Relaxation techniques are useful in helping someone get through an attack. These techniques include retraining in proper breathing and positive visualization.

In some cases medications may be needed to treat panic anxiety. Anti-anxiety medications such as benzodiazephine may be prescribed as well as antidepressants. Finally, a support group can be very helpful to some people.

A famous person who has admitted to having problems with panic attacks is the singer Naomi Judd who used to make recordings and perform in concerts with her daughter, Wynonna.

4 - Paranoia

Paranoia means false reasoning. Most authorities believe that the basic source of paranoia is the great sense of dissatisfaction, inferiority, and failure in meeting the goals of the parents. Delusions are a major part of paranoia.

Delusions are false beliefs—a person reaches the wrong conclusions about something. For example, a delusion would be that I believe that my neighbour is spying and plotting against me. Hallucinations are false sense perceptions—a person receives inaccurate information through the senses. For example, a hallucination would be that I see a misty figure close by me and can hear it calling my name at all hours of the day and night.

Three types of delusions may occur with paranoia

• Delusions of reference—Two people are sharing a joke by the water fountain. The paranoid person feels sure they are making fun of him or her.
• Delusions of grandeur—The person believes he is a member of the Royal Family, or she believes she is a distinguished scientist.
• Delusions of persecution—The person believes that spying devices have been inserted in his home to listen to what is said.

Symptoms

People with paranoia feel hypersensitive and feel resentful at the slightest provocation. They are defensive, domineering, humourless, and critical. Patients suffering from paranoia are usually of good intelligence and are able to express very clearly how they feel.

Treatments

No adequate treatment has been found. Some psychiatrists advocate keeping patients in the community unless their behaviour is disturbing or dangerous because confinement in a hospital may arouse further resentment and make them even more suspicious that people are “out to get them”.

5 - Manic-Depression

Lesson 3 on Neurosis discussed depression. Another type of depressive disorder is manic-depressive illness also known as bipolar depression because the person affected displays moods that are as different as day and night. Manic-depressive illness involves cycles of depression with cycles of elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual.

Causes

Studies have indicated that people with the illness have a somewhat different genetic make-up than those who do not get ill. The reverse is not true: people with that genetic make-up do not automatically have manic-depression. Studies have been done regarding the imbalance of the brain chemicals noradrenaline and serotonin, but additional factors such as a stressful environment are also involved.

Symptoms

Exaggerated mood change is the most outstanding feature of manic-depression. One psychologist has described it as the “psychosis of emotional extremes”. The behaviour of the manic-depressive persons varies with the individual. In some cases, the excitement phase predominates; for others, the depression phase is more intense. It usually starts in adult life before the age of 35.

Mania

Usually in the manic or excited phase there is a great sense of elation; the individual seems extremely pleased with himself. The manic patient resembles an intoxicated person in many ways—talkative, cheerful, and humorous one minute, then suddenly hostile and angry. Other characteristics include unrealistic highs in self-esteem, great energy increases, increased talking (cannot be interrupted), distractibility (attention moves constantly from one thing to another), thoughts of suicide, and high risktaking behaviour. Mania often affects thinking, judgment, and social behaviour in ways that cause serious problems and embarrassment. For example, a person might suddenly decide to sell his or her home and move to Hawaii when in a manic phase.

Depression

The depressed phase is very different. Thought and talk alike seem to be slowed. Sadness and self-accusation mark the general mood, and in some cases the individual must be guarded from suicide. Depression may occur in three stages of severity: mild, acute, and depressive stupor marked by immobility and speechlessness. Other characteristics include frequent complaints of illness, major changes in eating or sleeping patterns, persistent sadness, frequent crying, and low energy levels.

Treatment

Effective treatment for manic-depressive illness usually includes education of the patient and family about the illness and psychotherapy (counselling with a psychologist). Medication such as lithium and a group of drugs known as tricyclic antidepressants have been effective. ECT or electroconvulsive shock is sometimes used especially if depression is severe. In recent years, ECT has been much improved. The treatment is given in the hospital under sedation so that people receiving ECT do not feel pain. Usually after a few weeks or a few months, the manic-depressive individual makes a good recovery and is able to resume regular work. Attacks may recur in three out of four eases. But in most instances, patients or their friends notice the signs in time so that these people may be put under medical care. Recovery rate has been recorded at 90% or higher.

6 - Schizophrenia

Schizophrenia involves a serious brain malfunction that greatly disturbs feelings, perceptions, and rational thoughts. It is the most common of the major mental illnesses. It carries a strong social stigma. Schizophrenia occurs in 1% of the general population, but children with one schizophrenic parent have ten times more of a chance of developing the mental condition. Approximately one-third will have only one episode during a lifetime (acute schizophrenia), about one-third will have recurring episodes but will be relatively normal in between, and one-third will have symptoms for a lifetime (chronic schizophrenia). Often schizophrenic symptoms appear in young men and women between 15 and 30 years of age. When something happens to “normal” people, they respond with appropriate emotions.

When a person develops schizophrenia, a certain behaviour does not result in the appropriate emotional response. Anhedonia, or the inability to experience pleasure, is also common with this condition.

True schizophrenia is a condition that evolves gradually over an extended period of time. Distorted thought and behaviour patterns become entrenched, making a return to good mental health very difficult. The first stage of schizophrenia or period of breakdown is very disturbing to the individual. Confusion, anxiety, and panic are the individual’s reactions to the strange things that seem to happen at the onset of schizophrenia. In the second stage, the schizophrenic has grown accustomed to the symptoms. By the third stage, the condition has worsened to the “burned out” phase. Sometimes the individual becomes apathetic and responds to life’s situations in very basic, simple terms.

Causes

Schizophrenia is not caused by childhood experiences or by poor parenting. Most researchers believe that both a biological predisposition and environmental factors interact to determine who becomes schizophrenic. Some scientists believe that a chemical imbalance in the body may be a factor in some cases of schizophrenia. The control centre of the brain, which acts like a switchboard for incoming data, malfunctions. 

Heredity may be responsible in that the person inherits a predisposition to schizophrenia. Schizophrenia may develop when stress from environmental situations combines with the heredity component. Stress can trigger or worsen the symptoms when the illness is already present.

Symptoms

Personality changes are a major factor in recognizing schizophrenia. A loss of feeling or emotions is accompanied by a lack of interest and motivation. Changes occur in thought patterns as the person drifts away from reality. Thinking may be coloured by delusions and false beliefs. Schrizophrenics often believe their thoughts are being controlled by someone or even broadcast to others through a TV set, for example. People with schizophrenia often “hear voices in their heads”. Sometimes the voices are threatening. Sensations are distorted. Sometimes they feel nothing—not even real pain. They mistrust most people including those with whom they have close ties, and they lack feelings of empathy toward others.

Identifying early warning signs can ensure family and friends get early treatment for the individual. Social withdrawal is a key symptom. Other symptoms include

• deterioration of personal hygiene
• excessive fatigue or the inability to sleep
• flat emotions or inability to express emotions appropriate for the situation
• flat, emotionless gaze (described as reptilelike)
• unexpected hostility
• unusual sensitivity to stimuli (noise and light)
• sensitivity to being touched by others
• “racing” thoughts
• bizarre behaviour and irrational statements

Schizophrenia has many different categories each with its own symptoms. With paranoid schizophrenia, delusions are prominent. Hebephrenic schizophrenia is characterized by intellectual disorganization, silliness, and absurd ideas.

Treatments

Because schizophrenic behaviour is unpredictable, the individual is often required to be hospitalized for treatment. Such precautions ensure protection for both the individual and for those around them. Patients who have improved sufficiently after treatment are able to return to the community, but they may still show some signs of disturbance. Assistance from family and friends is important for schizophrenics. When this is lacking, often they fail to take medication, fail to find steady employment, and become one of the many homeless “street-people” in our society. Schizophrenia is the second highest type of mental illness for suicide risks. There is no cure. Schizophrenia has been treated primarily with antipsychotic medications that sufferers must take for the rest of their lives.

A crisis is the time when the person experiences a severe break with reality. If you are with a schizophrenic person during a crisis episode, follow these hints to calm the person and allow him/her to focus on you and be cooperative. Decrease all distractions such as a TV set being on. Speak slowly and clearly. Repeat the message until the person understands. Get the person to a hospital as quickly as possible so medical treatment can be administered.

Complete the Schizophrenia Disorder quiz

7 - Self-injurious Behaviour

Self-injurious behaviour is included in the lesson on psychosis because it is an extreme way to cope with psychological/emotional problems. Self-injurious behaviour refers to any deliberate behaviour that can cause tissue damage such as open wounds, bruises, and redness without the conscious intent to commit suicide. Other names may also be used such as self-mutilation or slashing. Three times more women than men engage in selfinjury. Often this behaviour begins during late childhood and early adolescence. Certain personality factors may be involved: inability to express emotional needs, rapid mood swings, inability to tolerate intense feelings, and having a perfectionist approach to required tasks.

There are three major types of self-injury:

• Major self-mutilation — the most extreme and uncommon kind; a great deal of tissue is destroyed
• Stereotypic self-mutilation — fixed or rhythmic pattern such as repeated headbanging
• Superficial or moderate self-mutilation — relatively little tissue is damaged. Injury may occur by cutting the skin with razors, skin carving, burning, interference with wound healing, needle sticking, self-punching, or scratching. Self-injury can become addictive; some people have difficulty giving up the practice.

Causes

People who self-mutilate often have a history of violence and/or sexual abuse in their past that they have not told anyone about. They may be drug or alcohol abusers or have parents who were heavily involved in alcoholism. They may be devastated by the loss of a parent through death or divorce.

Self-injury is anger turned inward. The common element that triggers self-injury is anxiety from overwhelming psychological distress—intense anger, guilt, frustration, or self-hatred. To direct anger at themselves rather than at their abusers feels safer and more controlled. Besides release of tension, self-injury converts unbearable emotional pain into manageable physical pain. One psychologist proposed the theory that children who are not nurtured and protected fail to learn to protect themselves.

Symptoms

Slashing involves using something sharp like a razor, knife, or broken glass to cut the skin, usually the arms. It is fairly common in prisons. Women and girls are most likely to slash, especially if they are survivors of sexual abuse. The physical pain seems to reduce the emotional pain the women are feeling.

Moderate self-injury can be a symptom of many disorders including post-traumatic stress disorder, multiple personality disorder, eating disorders, substance abuse, and clinical depression. The person has a repeated impulse to destroy or alter body tissue. Tension increases immediately before, and a sense of relief follows the act of self-harm. No association occurs between the self-harm act and actual suicide.

Treatment

If you are prone to self-injury, stay away from the materials that are usually used for self-injury. Remind yourself about long-term consequences such as scars. Stay away from drugs and alcohol. Stay in the company of others. Find new ways to cope with your feelings—such as mediation, exercise, and healthy hobbies. Learn to nurture yourself. When you are very angry, engage in vigorous physical activity. Visit a therapist to help express your anger and make changes in your life. Most people who self-harm have problems with low self-esteem and are disgusted by their own selfinjury behaviour. There are more socially acceptable forms of self-mutilation such as piercing the ears, nose, naval skin, and other body parts.

If you are a friend of someone who self-injures, do not shame the person. Understand that he or she is under a lot of stress and give your support. Stay with the person until the impulse to self-injure passes. Encourage him or her not be alone.

8 - Organic Psychosis

Organic psychosis is any behavioural disorder attributed to damage or disease in the body that seriously affects one’s mental state. Senile psychosis is the term for the psychological disorder associated with the organic brain damage that occurs in old age. The term senility is applied to the general deterioration that may occur with brain damage due to hardening of the walls of the arteries that results in a decreased circulation of blood in the brain. Alzheimer’s Disease (senile psychosis) is studied in more detail in the next part of this lesson.

Alcohol Psychosis

Alcohol Psychosis is form of organic psychosis that has its origin in excessive alcohol use over long periods of time. Alcoholism is one of the most serious forms of addiction. Heavy drinking sometimes causes deterioration of physical health with damage to the liver and brain cells. Psychological functioning is disrupted as well because concentration, memory, and judgment frequently suffer. Alcohol is a depressant, not a stimulant. The chronic alcohol user is less alert, responds slowly, and is less dependable.

9 - Alzheimer’s Disease

Most often, Alzheimer’s affects people 60 and over, but it has also been known to strike people in their early 40s and 50s. About 300,000 Canadians are afflicted. Dementia is a decline in intellectual ability severe enough to interfere with a person’s daily routine. It can have many causes. Alzheimer’s is the most common disorder. Other conditions that produce dementia are strokes, Huntington’s chorea, Parkinson’s disease, depression, drug interactions, stress (due to serious health problems or death of a spouse, for example), thyroid problems, and vitamin deficiencies (B-12). Memory loss and changes in mood and behaviour are early signs of dementia. Early and accurate diagnosis is essential to determine the cause of the dementia.

Causes

Alzheimer’s Disease is characterized by the progressive degeneration of brain cells. Cause of the disease is not known, but heredity and environmental toxins are suspected. Only 5 to 10% of the Alzheimer’s Disease cases are believed to be caused by purely genetic factors. Groups of nerve endings in the outer layer of the brain degenerate and disrupt the passage of electrochemical signals between cells. Brain shrinkage occurs because many nerve cells have been destroyed.

Symptoms

In the initial stages, the individual experiencing Alzheimer’s Disease exhibits minor symptoms often attributed to other illnesses. One of the most dominant symptoms is a progressive deterioration of memory, judgment, and concentration. Mental powers such as reasoning and verbal skills are affected as well as physical coordination. A spouse or a friend may notice changes in spending habits, neglect of nutrition, sanitation, grooming, home care, or unusual mood swings or increased alcohol consumption. Gradually the individual becomes more forgetful. As memory loss increases, changes also appear in personality, mood, and behaviour. People with dementia have short attention spans, walk around a lot, seldom sit still for long, and are often agitated.

Treatment

Providing simple memory aids may assist the Alzheimer’s patient, such as a prominent calendar, lists of daily tasks, and directions about how to use common items in the home. Understandably, people with Alzheimer’s Disease have difficulty comprehending the changes in their thinking and behaviour, which may lead to frustrations.

An experimental drug called THA to treat the disease is undergoing testing in the United States. It may help reduce memory loss and other symptoms in some patients. Currently prevention or cure is unknown.

Recently, a nurse who has been a long-term worker with the elderly discovered an unusual therapeutic idea. A life-size doll about the size of a year-old baby with a fairly realistic-looking face brought some comfort to Alzheimer’s patients. They could hold and hug the doll; it distracted them when they were restless and agitated; it provided something to talk to while they were alone; or they could talk to others about the doll. Having the doll helped them reminisce a little about their younger days

10 - Treatments: What is Working and What is not Working

Two major perspectives exist about abnormal behaviour. The main premise of the medical model is that mental disorders are diseases or illnesses arising from a malfunction inside the person. The treatment prescribed, which could be psychotherapy or drugs, is aimed at changing the patient’s behaviour and attitudes. The psychosocial model focuses on the interaction between the individual and the social environment. The self-concept is given careful consideration. Mending relationships within the patient’s social environment is the main target for treatment suggested by the psychosocial model.

Most therapists prefer the eclectic approach. It is a very open-minded and flexible approach, surveying a wide range of theories and choosing the best ideas from here and there along a broad radius of ideas. The result is an integrated type of therapy where various techniques are adapted to suit each individual case, but a large range of possible theories are explored in the process. For example, the psychobiological approach incorporates information from the biological, psychological, and social aspects that may have contributed to the behavioural disorder. It covers a range of possibilities.

Drugs are another type of physical intervention used to correct underlying chemical abnormalities. Ataractics is the term for drugs used in the treatment of mental and emotional disorders. Drug treatments seem to alleviate some of the guilt felt by both the patients and their families. The notion is that if the patient is being treated for a chemical imbalance, then no one is really responsible for “driving the person crazy”. Thus the illness is no more shameful than diabetes, epilepsy, or high blood pressure. The chemical composition of the mentally ill person’s brain does differ significantly from a normal person. Missing chemicals may be identified and, therefore, can be replaced. For example, one of the chemicals lacking in the brain of the mentally ill is adenine. An injection of malononitrile stimulates the production of adenine.

Antipsychotics are a major treatment for the nonagitated, psychotic patients. Another class of drugs widely used is benzodiazepines. The immediate goal of treatment of the acutely agitated psychotic individual is to reduce the agitation, irritability, and/or hostility to where the patient is not a physical danger to himself or herself or to others. The alleviation of hallucinations and/or delusions causing agitated behaviour is the ultimate goal. If the psychotic person is too upset to take oral medication, drugs may be administered by intramuscular injection.

Presently, the importance of nutrition in maintaining or restoring mental health is receiving wide attention. For example, megavitamin therapy has yielded some positive results. A low carbohydrate, high protein diet is supplemented by large doses of vitamins. It is not yet precisely understood how this therapy works, but findings have been very encouraging.

All of the physical treatments mentioned treat the symptoms of mental illness; they do not attempt to alter the causes except in the case of a chemical imbalance. If the treatment reduces or eliminates the symptoms, the patient can return to a more or less normal life.

Psychological Treatment of Behavioural Disorders

Psychotherapy simply means treatment for behavioural disorders through psychological means.

Group therapy offers opportunity for persons with behavioural problems to use the empathy and support of a small group to resolve their conflicts. The group leader may either provide direct guidelines or be nondirective during therapy. Thus, one therapist can give support to several people at once. The group provides a setting for people to explore their common problems in an open, uninhibited way with the realization that others have experienced a similar hardship. For group therapy to be valuable, participants must be capable of forming relationships with others and must be willing to express their feelings to the group.

When other therapies seem to fail, hypnotherapy may be used. In this approach, hypnosis is teamed with other therapeutic procedures. One common use of hypnotherapy is age regression that examines events of early childhood.

Psychoanalysis was a therapy used by Sigmund Freud to bring repressed memories and hidden conflicts into conscious awareness (Lesson 1). It is still a popular method used by a number of therapists. One of the merits of psychoanalytic therapy is abreaction or the expression of a repressed emotion. Another name for this is catharsis or the discharge of emotional tensions by verbalizing one’s feelings. For example, Sally always believed her older sister was favoured by her parents, which caused her to be bitter. Many years later she was able to talk about the pain she felt when she was ignored by her parents.

The psychoanalytic technique is best suited to a certain type of individual. Characteristics important in a patient considering psychoanalysis are above average intelligence, introspective attitude, good verbal expression, not seriously disturbed, and between 18 and 40 years of age. Patients must have fairly healthy personalities so they can understand what is going on and help with their own cure. Often psychoanalytic treatment extends over a period of several years.

Sleep deprivation has been studied for many years as a possible treatment for depression. It involves keeping people up for nearly a day or longer than normal. Sleep deprivation accelerates the response to antidepressant medication. Sleep deprivation benefits may have something to do with body rhythms. It is not a helpful therapy for people with milder forms of depression or those who are manic-depressive.

Play therapy for young children serves several purposes. It is designed to help them become aware of valid reasons for their feelings and behaviours. For children who have been emotionally abused or neglected, another purpose is to provide them with an opportunity to interact with caring, sensitive adults. Free play is often used, which means various toys are provided and the children are given the opportunity to play with them in any way they choose. Doing art work and then explaining what they have drawn and why is another way to gain valuable information from young children. Through play therapy, children may reveal information about themselves that they cannot talk about such as sexual abuse, sibling rivalry, dysfunctional family lifestyles, and damaging discipline practices.

Treatment or Abandonment?

Sometimes therapy alone is not adequate for seriously ill mental patients. Institutionalized care may be prescribed for those who present a threat to themselves or to those around them. Families of these patients may not be able to provide the indepth care and supervision they require. There are critical shortages of acute-care beds in psychiatric units of hospitals to provide care for patients with severe problems.

In recent years the philosophy relating to mentally ill people has changed. At one time these people were institutionalized indefinitely. The new change took the focus away from institutions and emphasized having these patients released to the community to continue their recovery and rehabilitation in a more “normal” situation surrounded by friends and family. However, many of these people have been abandoned by friends and family because these care-givers have found the amount of support and supervision required for the mentally ill is too demanding in addition to their own commitments. Without follow-up support such as community clinics to monitor ongoing treatment and medication, many former mental patients neglect to take their medication and to check-in for necessary medical appointments. After that happens, they usually begin experiencing the same symptoms that sent them to a mental institution in the first place. As their mental illness becomes more pronounced, these people often find themselves wandering the streets and seeking shelter whereever they can as homeless people. Others end up in the criminal justice system for crimes that have been committed when what they really need is psychiatric care. Institutional care can be reduced, but before that happens, the money must be spent to make the patients ready for the community and the community ready for the patients.

11 - Multiple Personalities

Multiple personality is now formally known as Dissociative Identity Disorders (DID). For this section we will still refer to it as multiple personality because that label gives a more accurate understanding of the behavioural problem. At one time it was surrounded by mystery and thought to be a very rare phenomenon. Research has shown that it is much more common than formerly believed. Up to 1% of the population may be affected in some way, which would mean it is as much of a problem as schizophrenia and depression.

Multiple personality (MPD) is a mental process that produces a lack of connection or continuity in a person’s thoughts, memories, feeling, actions, and most importantly in their sense of identity. During the period when a person is in that state, connections are not made between certain key information as it normally would be. What would cause such a dramatic upheaval to occur in a person’s thought patterns? When faced with overwhelming traumatic situations from which there is no physical escape, a child may resort to “going away” in his or her head. Most people do that to a lesser degree such as daydreaming or getting lost in a book or movie, all of which involve losing touch with conscious awareness of one’s immediate surroundings. This ability is typically used by children as an extremely effective defense against acute physical and emotional pain or anxious anticipation of that pain. This is a creative survival technique allowing the child to sever memories of the pain and pretend the trauma had not occurred. Because the dissociative escape is so effective, children become practised at doing it and may automatically use this whenever they feel threatened or anxious. It may occur in early childhood as a response to extreme, repeated physical, sexual, and/or emotional abuse especially when children are at a sensitive developmental stage usually before age nine. Because this process can produce changes in memory, people who frequently dissociate often find their sense of personal history and identity are affected.

A person diagnosed with MPD has within them two or more entities, or personality states, each with its own independent way of relating, perceiving, thinking, and remembering about themselves and their lives. Although these alternate personality states may appear to be very different, they are all manifestations of a single person.

Let’s return to Billy’s story.

Integration of all personalities into the “basic” personality is the ultimate goal of therapy for multiple personality. But some cases of multiple personality are too complex to be resolved.

People affected may experience the following general symptoms of multiple personality: depression, mood swings, suicidal tendencies, sleep disorders, panic attacks, phobias, alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms, and eating disorders. They can also experience amnesias, time loss, trances, and out-of-body experiences. Some may have a tendency toward self-persecution, even violence.

Treatment of multiple personalities holds much hope although patients often spend years living with misdiagnoses. That occurs because the symptoms are very similar to those of many other psychiatric conditions. Dissociative disorders are highly responsive to individual psychotherapy. Treatment is long-term, intensive, and invariably painful because it involves remembering and reclaiming the dissociated traumatic experiences. The objective of therapy is to integrate the whole personality that has been fragmented into many separate compartments. Fusion involves bringing all aspects of the person’s self together by communicating and remembering what each part does to get rid of the amnesia. Then the therapist works toward getting all the pieces of the personality to work together so the person can return to good mental health.

Assignment  - U3L4 Quiz Part A and B.

For each assignment, there is a part A and part B. 

• Part A - read the lesson on "Psychosis".  Answer the questions in the following document Unit 3 Lesson 4, Part A
• Unit 3 Lesson 4, Part A (PDF format)
  Do NOT submit, but maintain your answers for completing the final assignment.

• Part B - Complete part B (open book) by clicking on the following link Unit 3 Lesson 4, Part B Quiz.

Assignment Two - U3 Research Project

Click on the following link to view your U3 Research Project.

 Click here for Unit 3 Research Project in PDF format.

Click here for instructions on how to save google slides in PDF format.


Label your assignment U3_research_surname and submit it to the correct assignment folder - U3 Research

Evaluation - Click on the following link to view the complete Evaluation RUBRIC

Content should include: definition of one disorder, affects on body, characteristics, causes, people affected, treatments, images, interesting facts, and bibliography (3+ sources)

Organization – 20
Creativity/presentation – 20
Knowledge/understanding – 20
Communication/bibliography (3+ sources) – 20
Overall Effectiveness – 20

Total - 100

Lesson Review

This lesson focused on a number of very serious personality disturbances. Each one has different causes, symptoms, and treatments.