Psychiatry/Psychiatrist

Psychiatry

Psychiatrists treat patients privately and in hospital settings through a combination of psychotherapy and medication. There are about 41,000 practicing psychiatrists in the United States. Their training consists of four years of medical school, followed by one year of internship and at least three years of psychiatric residency.

Psychiatrists may receive certification from the American Board of Psychiatry and Neurology (ABPN), which requires two years of clinical experience beyond residency and the successful completion of a written and an oral test. Unlike a medical license, board certification is not legally required in order to practice psychiatry.

Psychiatrists may practice general psychiatry or choose a specialty, such as child psychiatry, geriatric psychiatry, treatment of substance abuse, forensic (legal) psychiatry, emergency psychiatry, mental retardation, community psychiatry, or public health. Some focus their research and clinical work primarily on psychoactive medication, in which case they are referred to as psychopharmacologists.

Psychoactive Drugs

Psychoactive Drugs

The role of psychoactive drugs, also called psychotherapeutic agents or psychotropic drugs, in the treatment of mental illness is dependent on the disorder for which they are prescribed. In cases where mental illness is considered biological in nature, such as with a diagnosis of bipolar disorder or schizophrenia, pharmaceutical therapy with psychotherapeutic drugs is recommended as a primary method of treatment.

In other cases, such as in personality disorder or dissociative disorder, psychoactive medications are usually considered a secondary, companion treatment (or adjunct) to a type of psychotherapy, such as cognitive-behavioral therapy.

In these situations, medication is used to provide temporary symptom relief while the patient works on the issues leading to his illness with a therapist or other mental health professional.

Psychoanalysis

Psychoanalysis

Developed in Vienna, Austria, by Sigmund Freud (1856-1939), psychoanalysis is based on an approach in which the therapist helps the patient better understand him- or herself through examination of the deep personal feelings, relationships, and events that have shaped motivations and behavior.

Freud developed his theories during the end of the 19th and the early part of the 20th centuries in Vienna, Austria, where he was a practicing physician specializing in neurological disorders. Freud’s interest originated in his medical practice when he encountered patients who were clearly suffering physical symptoms for which he could find no organic, or biological, cause.

Freud’s first attempt to get at the psychological cause of these patients’ pain was through hypnosis, which he studied in Paris in 1885. He found the results to be less than he’d hoped, however, and soon borrowed from a Viennese contemporary the idea of getting a patient to simply talk about his or her problems.

Psychological Abstracts

Psychological Abstracts

Founded in 1927, Psychological Abstracts contains nonevaluative summary abstracts of literature in the field of psychology and related disciplines, which are grouped into 22 major classification categories. It includes summaries of technical reports as well as journal articles and books.

Each edition is collected into a cumulative volume every six months, with an index listing both the volume’s contents and the national and international journals in which the abstracted literature appear. These journals are cited within the volume by codes listed in each monthly issue.

A table of contents near the beginning of each issue guides readers to broad general areas that they may wish to investigate, while the subject indexes in the cumulative volumes refers them to articles on a particular topic.

Psychological Disorder

Psychological Disorder

While psychological disorders are generally signaled by some form of abnormal behavior or thought process, abnormality can be difficult to define, especially since it varies from culture to culture. Psychologists have several standard approaches to defining abnormality for diagnostic purposes.

One is the statistical approach, which evaluates behavior by determining how closely it conforms to or deviates from that of the majority of people. Behavior may also be evaluated by whether it conforms to social rules and cultural norms, an approach that avoids condemning nonconformists as abnormal for behavior that, while unusual, may not violate social standards and may even be valued in their culture.

Yet another way to gauge the normality of behavior is by whether it is adaptive or maladaptive—and to what extent it interferes with the conduct of everyday life. In some situations, psychologists may also evaluate normality solely on the basis of whether or not a person is made unhappy or uncomfortable by his or her own behavior.

Psychology/Psychologist

Psychology

As psychology has grown and changed throughout its history, it has been defined in numerous ways. As early as 400 B.C., the ancient Greeks philosophized about the relationship of personality characteristics to physiological traits. Since then, philosophers have proposed theories to explain human behavior. In the late 1800s the emergence of scientific method gave the study of psychology a new focus.

In 1879, the first psychological laboratory was opened in Leipzig, Germany, by Wilhelm Wundt (1832-1920), and soon afterwards the first experimental studies of memory were published. Wundt was instrumental in establishing psychology as the study of conscious experience, which he viewed as made up of elemental sensations.

In addition to the type of psychology practiced by Wundt—which became known as structuralism—other early schools of psychology were functionalism, which led to the development of behaviorism, and Gestalt psychology. The American Psychological Association was founded in 1892 with the goals of encouraging research, enhancing professional competence, and disseminating knowledge about the field.

Psychophysics

Psychophysics

Psychophysics originated with the research of Gustav Fechner (1801-1887), who first studied the relationship between incoming physical stimuli and the responses to them. Psychophysicists have generally used two approaches in studying our sensitivity to stimuli around us: measuring the absolute threshold or discovering the difference threshold.

In studying the absolute threshold using the method of constant stimuli, an experimenter will, for example, produce an extremely faint tone which the listener cannot hear, then gradually increase the intensity until the person can just hear it; on the next trial, the experimenter will play a sound that is clearly heard, then reduce its intensity until the listener can no longer hear it.

Thresholds can also be ascertained through the method of constant stimuli. In this approach, stimuli of varying intensity are randomly presented. Although an observer’s measured threshold will change depending on methodology, this technique gives an estimate of an individual’s sensitivity.

Psychosexual Stages

Psychosexual Stages

Austrian psychotherapist Sigmund Freud described personality development during childhood in terms of stages based on shifts in the primary location of sexual impulses. During each stage libidinal pleasure is derived from a particular area of the body—called an erogenous zone—and the activities centered in that area. If the problems and conflicts of a particular stage are not adequately resolved, the child—and, later, the adult—may remain fixated at that stage.

A fixation consists of a conscious or unconscious preoccupation with an area of the body (such as the mouth in a compulsive eater), as well as certain personality traits. Freud believed that some degree of fixation is present in everyone and that it is an important determinant of personality.

During the three pregenital stages that occur in a child’s first five years, sexuality is narcissistic: it is directed toward the child’s own body as a source of pleasure rather than outward. In the oral stage, which occupies approximately the first year of life, pleasurable impulses are concentrated in the area of the mouth and lips, the infant’s source of nourishment.

Psychosis

Psychosis

Psychosis may appear as a symptom of a number of mental disorders, including mood and personality disorders, schizophrenia, delusional disorder, and substance abuse. It is also the defining feature of the psychotic disorders (i.e., brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a general medical condition, and substance-induced psychotic disorder).

Patients suffering from psychosis are unable to distinguish the real from the unreal. They experience hallucinations and/or delusions that they believe are real, and they typically behave in an inappropriate and confused manner.

Causes and Symptoms

Psychosis may be caused by a number of biological and social factors, depending on the disorder underlying the symptom. Trauma and stress can induce a short-term psychosis known as brief psychotic disorder. This psychotic episode, which lasts a month or less, can be brought on by the stress of major life-changing events (e.g., death of a close friend or family member, natural disaster, traumatic event), and can occur in patients with no prior history of mental illness.

Psychosomatic Disorders

Psychosomatic Disorders

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSMIV) classifies psychosomatic illnesses under “Psychological Factors Affecting Physical Conditions.” Physicians have been aware that people’s mental and emotional states influence their physical well-being since the time of Hippocrates.

In the twentieth century, the discoveries of psychologists have shed new light on how the mind and body interact to produce health or illness. Sigmund Freud introduced the idea that unconscious thoughts can be converted into physical symptoms (conversion reaction).

The formal study of psychosomatic illnesses began in Europe in the 1920s, and by 1939, the journal Psychosomatic Medicine had been founded in the United States. Eventually, sophisticated laboratory experiments replaced clinical observation as the primary method of studying psychosomatic illness.

Psychotherapy

Psychotherapy

Psychoanalysis,the first modern form of psychotherapy, was called the “talking cure,” and the many varieties of therapy practiced today are still characterized by their common dependence on a verbal exchange between the counselor or therapist and the person seeking help.

The therapeutic interaction is characterized by mutual trust, with the goal of helping individuals change destructive or unhealthy behaviors, thoughts, and emotions. It is common for experienced therapists to combine several different approaches or techniques. The most common approaches are discussed below.

Psychodynamic approach

Freudian psychoanalysis places emphasis on uncovering unconscious motivations and breaking down defenses. Therapy sessions may be scheduled once or even twice a week for a year or more. This type of therapy is appropriate when internal conflicts contribute significantly to a personís problems. (For more information, see entry on Psychoanalysis).

Psychotic Disorders

Psychotic Disorders

Formerly, all psychological disorders were considered either psychotic or neurotic. Psychotic disorders were those that rendered patients unable to function normally in their daily lives and left them “out of touch with reality.”

They were associated with impaired memory, language, and speech and an inability to think rationally. Neurotic disorders, by comparison, were characterized chiefly by anxiety; any impairment of functioning was primarily social. Psychotic conditions were attributed to physiological causes, neurotic conditions to psychosocial ones.

Other distinguishing features associated primarily with psychotic disorders were hospitalization and treatment by biological methods—medication and electroconvulsive therapy. With the development of new types of psychoactive drugs in the 1950s and 1960s, medication became a common form of therapy for anxiety, depression, and other problems categorized as neurotic.

electroconvulsive therapy

”Psychotic” and “neurotic” are no longer employed as major categories in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) . Instead, disorders that formerly belonged to either one category or the other appear side by side in Axis I of the manual under the heading “Clinical Syndromes.” The term “psychotic” still appears in DSMIV, most prominently in the categorization “Schizophrenia and Other Psychotic Disorders.”

The disorders in this section have as their defining feature symptoms considered psychotic, which in this context can refer to delusions, hallucinations, and other positive symptoms of schizophrenia, such as confused speech and catatonia. In other parts of DSM-IV, “psychotic” is also used to describe aspects of a disorder even when they are not its defining feature, as in “Major Depressive Disorder with Psychotic Features.”

hallucinations

Puberty

Puberty

The word puberty is derived from the Latin pubertas, which means adulthood. Puberty is initiated by hormonal changes triggered by a part of the brain called the hypothalamus, which stimulates the pituitary gland, which in turn activates other glands as well.

These changes begin about a year before any of their results are visible. Both the male reproductive hormone testosterone and female hormone estrogen are present in children of both sexes. However, their balance changes at puberty, with girls producing relatively more estrogen and boys producing more testosterone.

Most experts suggest that parents begin short and casual discussions about puberty with their children by the age of seven or eight. Offering the child reading materials about puberty can impart information to the young person without the awkwardness that may characterize the parent-child conversations. Parents can then offer their children opportunities to ask questions or to discuss any aspects of puberty and sexuality that may arise from their reading.

Ethel Dench Puffer

Ethel Dench Puffer

Ethel Dench Puffer was born in Framingham, Massachusetts, the eldest of four daughters. Her family was of native New England stock and highly educated by the standard of the era. After graduating from Smith College in 1891 at the age of 19 and teaching high school for one year in New Hampshire, Puffer returned to Smith as an instructor of mathematics, where she taught for the next three years while developing a keen interest in psychology.

In 1895, Puffer traveled to Germany to study aesthetics under Hugo Münsterberg (1863-1916), then a professor of psychology at the University of Freiberg. On the strength of her research, she was awarded a fellowship for graduate study by the Association of Collegiate Alumnae.

Enrolling in Radcliffe College in 1897 and working again under Münsterberg at Harvard University, she earned a certificate stating she had completed work equivalent to that of a doctoral candidate for the Harvard Ph.D.

Punishment

Punishment

Punishment is defined as the administration of aversive stimulus to reduce or eliminate unwanted behavior. It can be either physical or nonphysical. Punishment differs from negative reinforcement in that the latter increases the frequency of behavior by removing a negative event.

Punishment can be as simple as giving electric shocks to lab rats to prevent them from touching a lever or as complex—and controversial—as placing criminals in jail for breaking the law. The use and effectiveness of corporal punishment have also been debated by psychologists, parents, teachers, and religious leaders for many years.

Research studies have found that punishment is effective in suppressing or eliminating unwanted behavior. But in order for punishment to be effective it must happen immediately after the behavior, be severe, and occur every time the behavior occurs. Detractors of the use of punishment have pointed out that, outside the laboratory setting, it is almost impossible to consistently administer punishment in this manner.

Qualitative Methods

Qualitative Methods

Research psychologists can collect two kinds of information: quantitative data and qualitative data. Quantitative data are often represented numerically in the form of means, percentages, or frequency counts. Such data are often referred to as “measurement” data, referring to the fact that we often like to measure the amount or extent of some behavior, trait, or disposition.

For example, shyness, test anxiety, and depression can all be appraised by means of paper-and-pencil tests which yield numerical scores representing the extent of shyness, anxiety, etc. that resides in the individual taking the test.

A psychologist interested in the relationship between test anxiety and grade point average would collect the appropriate quantitative information on each of these two variables and conduct statistical tests that would reveal the strength (or absence) of the relationship.

Race and Intelligence

Race and Intelligence

Throughout human history, people have tended to divide each other into groups. Most often, physical characteristics are used to distinguish between groups, and the groups are called races. Some people have long believed that many characteristics about a person could be determined by simply looking at the person’s race.

Intelligence is one trait that has been studied in an attempt to correlate it to racial groups. In fact, at present the best evidence does not strongly support the idea that the people of any race are more or less intelligent than those of any other race. In addition, intelligence testing is an imperfect science. Traditional tests are skewed to favor certain segments of society.

Genes and intelligence: a clear verdict

Saying that intelligence is partly genetic—programmed in the genes and inherited from one generation to the next—is vastly different than saying that genes underlie any racial differences. To give a classic example, scatter two identical groups of seed on a rich and a barren, dry plot of land. Within the rich plot, genetics will determine any difference in seed growth. But environment will cause most of the difference between the two plots.

Racism

Racism

Racism is most commonly used to describe the belief that members of one’s own race are superior physically, mentally, culturally, and morally to members of other races. Racist beliefs provide the foundation for extending special rights, privileges, and opportunities to the race that is believed to be superior, and to withholding rights, privileges, and opportunities from the races believed to be inferior.

No scientific evidence supports racist claims, although racism exists in all countries and cultures. The definition of racism has evolved to describe prejudice against a group of people based on the belief that human groups are unequal genetically, and that members of some racial groups are thus inferior.

Sociologists distinguish between individual racism, a term describing attitudes and beliefs of individuals, and institutional racism, which denotes governmental and organizational policies that restrict minority groups or demean them by the application of stereotypes. While such policies are being corrected to eliminate institutional racism, individual racism nonetheless persists.

Otto Rank

Otto Rank

Otto Rank was Sigmund Freud’s closest collaborator for 20 years. Later, he strongly influenced the development of psychotherapy in the United States. He was the first psychoanalyst to examine mother-child relationships, including separation anxiety.

He also was one of the first to practice a briefer form of psychotherapy, called “active therapy.” His work, in contrast to orthodox Freudian psychology, emphasized free will, relationships, and creativity. Many of Rank’s ideas, including the importance of the ego, consciousness, and the present, have become mainstays of psychoanalytic theory.

Born in Vienna, Austria, in 1884, Otto Rosenfeld changed his name to Otto Rank as an adolescent. It was one of his first acts of “self-creation.” The second son of Simon Rosenfeld, a jeweler, and Karoline Fleischner, the family could only afford a higher education for one son. Rank attended trade school, despite recurring bouts of rheumatic fever, and became a locksmith, while his brother studied law. In 1904, Rank suffered a suicidal depression, after which he experienced a spiritual rebirth.

Rape

Rape

Rape is essentially an act of power and dominance. Although an estimated 15 to 40 percent of American women are victims of rape or attempted rape, men are raped as well. Women are more likely to be raped by someone they know; between 50 and 70 percent of all rapes occur within the context of a romantic relationship, and more than half the time the assault takes place in the victim’s home.

Rape is one of the most underreported crimes in the United States, due to the victim’s fear of embarrassment, humiliation, or retaliation by the rapist. Estimates of the percentage of rapes reported to authorities range from 10 to 50 percent. Because of the difficulty of obtaining a conviction, about two percent of all rapists are convicted, and most serve approximately half of their original sentence.

A survey conducted in 1987 found that 57 percent of women who have been raped develop post-traumatic stress disorder. These women may lose their appetite, become easily startled, and suffer from headaches, sleep disorders, or fatigue. Many women have difficulty maintaining a normal life following a rape, and may repress the experience for an extended period before they are able to talk about it.