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Chapter 16

Chapter 16: Psychopathology

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Schizophrenia

The Psychopathology chapter has a great deal to say about mental illness, but what about mental health? One might suppose that health is just the absence of illness: Someone who's healthy is simply someone who's not depressed, not anxious, and so on. Many psychologists are questioning this view, however, and suggesting that there are features of mental health that are different from the mere absence of illness.

In this activity you meet Harold, who has been diagnosed with schizophrenia, and have the opportunity to review pertinent facts from his case history. As you learned in Chapter 16, schizophrenia is characterized by disordered thought and attention, social withdrawal, disruption of emotional responses, and in many cases, the construction of a private world accompanied by delusions and hallucinations. Subcategories of schizophrenia include the paranoid, catatonic, and disorganized subtypes.

In light of the factors contained within the case history, and in light of your impressions of Harold in the video, do you think the diagnosis is correct? What signs or symptoms support the diagnosis? Are there symptoms you might expect in someone with schizophrenia, but which Harold does not have? (Bear in mind that every case of schizophrenia is different, and many cases do not match perfectly the "text-book description.") If Harold does lack some of the expected symptoms, are the remaining symptoms central enough in his case to justify the diagnosis? Thinking through these issues will help you to appreciate some of the complexities associated with clinicial diagnosis! Finally, based on the materials in the chapter, what is your prognosis for this case?

Case History

Harold was born in Ohio in 1950. His childhood was generally normal, although he often had difficulty paying attention, and his teachers believed that he was hyperactive. Harold also had great difficulty maintaining friendships.

As Harold got older, he became emotionally unstable, vacillating rapidly between sadness and glee, seemingly without cause. Harold's attention problems persisted during high school, and classmates tended to shy away from him. Harold believes that a lot of his social problems were the result of the fact that he was a very poor athlete. "I was never able to play sports with the other boys. I was always a klutz."

After a year in college, Harold dropped out and spent the next few years wandering throughout the Midwest, working at a variety of part-time jobs and maintaining few friendships.

Harold enlisted in the army in 1971 where he hoped to work with strategic weapons. When he was denied security clearance, presumably because he failed the psychological tests, Harold became discouraged, and went AWOL. He was eventually court marshaled and dishonorably discharged. For the next several years, Harold again worked in a long succession of temporary jobs.

At the age of 27, Harold explains that he suffered a dramatic breakdown. He withdrew from society, and over the next few years, his condition deteriorated. "I was afraid to seek therapy," Harold explains, "and basically I spent the next 10 years in bed." He frequently heard voices from within his own head, and these voices would continually condemn him. He also claims that he never slept a single minute during this entire span.

In 1987, Harold finally entered an outpatient clinic where he was diagnosed as suffering from schizophrenia. He was placed on antipsychotic medications, but suffered from side effects, and chose to stop taking medication. After a significant psychotic relapse, Harold was placed on haloperidol (trade name Haldol) and he has remained on this medication for more than 10 years. Haldol has reduced Harold's symptoms, but he still sometimes hears voices, and he can often be seen talking to himself as he walks alone on the street. Harold maintains far fetched notions such as the belief that he has had a "bioelectric medical machine" surgically implanted into his brain. He also believes that the voices he hears are the results of RF waves in the atmosphere that nations use to control their weapon systems. He is often frustrated that his doctors do not take these concerns seriously.

To the best of his knowledge, Harold is the first person in his family to be diagnosed as suffering from schizophrenia. However, he does remember two uncles and a cousin who were always considered "very strange." Harold is an intelligent man, and he is well versed about current events.

Harold someday hopes to be cured of his schizophrenia, and he states that his goals are to get off of social security, to become a productive member of society, and to develop meaningful social relationships.

Do You Have A Healthy Disposition?

This survey-based activity explores one of the important factors in determining a person's health risk: their degree of overall optimism.

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