Part Ⅰ Background and methods 1
1 Introduction 3
Modern concepts of abnormality 3
Historical overview 5
Somatogenic and psychogenic perspectives 7
Care in the community 8
Issues of diagnosis 9
The medical model 9
Alternatives to the medical model 15
The aetiology of mental health problems 17
Genetic models 18
Biological models 21
Psychological models 21
Socio-cultural models 24
Systemic models 25
Biopsychosocial models 26
Diathesis-stress model 27
Chapter summary 27
For discussion 28
Further reading 29
2 The psychological perspective 30
The psychoanalytic approach 30
Freud 30
Freud's contemporaries and descendants 35
The practice of psychoanalysis 36
Behavioural approaches 38
Classical conditioning 38
Operant conditioning 39
Combining classical and operant conditioning 40
Behaviour therapy 40
Cognitive approaches 44
Alternative models of the emotions 46
Cognitive behavioural therapy 47
Humanistic approaches 52
Models of the individual and neurosis 53
Humanistic therapy 55
How effective are the therapies? 58
Meta-analyses 58
Therapist-client relationship 59
Chapter summary 59
For discussion 60
Further reading 60
3 Biological explanations and treatments 61
The behavioural anatomy of the brain 61
Hindbrain,midbrain and forebrain 61
Cerebrum 62
The synapse 65
The neurotransmitters 66
The autonomic nervous system 67
Drug therapies 69
Treating depression 69
Treating anxiety 72
Treating schizophrenia 73
Adherence to drug treatments 75
Electroconvulsive therapy 76
Use of ECT 77
The ECT controversy 77
Psychosurgery 79
Availability of psychosurgery 80
Post-operative effects 80
Chapter summary 82
For discussion 83
Further reading 83
4 Moving beyond the individual 84
Family models of mental health disorders 84
Systemic therapy 85
Structural family therapy 86
Strategic family therapy 88
How effective is systemic therapy? 90
Psychosocial explanations of mental health problems 92
Socio-economic status 92
Gender differences 94
Minority status 96
Preventing mental health problems 98
Health promotion 98
Therapeutic interventions 99
Using the media 100
Public education 100
Organizational interventions 101
Chapter summary 102
For discussion 103
Further reading 103
5 The process of therapy 104
Assessment issues 105
Standardized interview schedules 106
Symptom-specific measures 107
General measure 107
Other measures 107
Working through the problem 108
Ending therapy 110
Who benefits most from therapy? 111
Client characteristics 111
Client responses 113
What makes a good therapist? 113
Therapist experience 114
Therapist training 115
Gender and ethnicity 115
Within-therapy factors 116
Treatment acceptability 116
Therapist competence 116
The therapeutic alliance 117
Self-disclosure 118
Specific techniques 118
Factors beyond the therapy situation 119
Chapter summary 120
For discussion 121
Further reading 121
PartⅡ Specific issues 123
6 Schizophrenia 125
The nature of schizophrenia 126
Personal experiences 126
DSM diagnostic criteria for schizophrenia 128
Alternative view of the symptoms 128
Deconstructing schizophrenia 129
Aetiology of schizophrenia 130
Genetic factors 130
Biological mechanisms 133
Substance abuse 136
Psychosocial factors 136
A psychobiological model 138
Psychological models 139
Treatment of schizophrenia 142
Antipsychotic medication 142
ECT 144
Psychological approaches 144
Chapter summary 147
For discussion 148
Further reading 149
7 Anxiety disorders 150
Generalized anxiety disorder 150
Aetiology of generalized anxiety disorder 151
Treatment of generalized anxiety disorder 155
Panic disorder 158
Aetiology of panic disorder 158
Treatment of panic disorder 163
Obsessive-compulsive disorder 165
Obsessions 165
Compulsions 166
Aetiology of obsessive-compulsive disorder 167
Treatment of obsessive-compulsive disorder 170
Chapter summary 173
For discussion 175
Further reading 175
8 Mood disorders 176
Major depression 176
Aetiology of major depression 177
Treatment of major depression 183
Suicide 186
Aetiology of suicide 187
Treatment of attempted suicide 189
Seasonal affective disorder 190
Aetiology of seasonal affective disorder 191
Treatment of seasonal affective disorder 193
Bipolar disorder 193
Aetiology of bipolar disorder 194
Treatment of bipolar disorder 197
Chapter summary 198
For discussion 199
Further reading 200
9 Trauma-related conditions 201
Post-traumatic stress disorder 201
Aetiology of post-traumatic stress disorder 204
Treatment of post-traumatic stress disorder 207
Recovered memory 210
Explanations of recovered memory 211
Evidence of recovered memory 212
Dissociative identity disorder 216
Aetiology of dissociative identity disorder 217
Treatment of dissociative identity disorder 223
Chapter summary 225
For discussion 226
Further reading 226
10 Sexual disorders 228
Sexual dysfunctions 228
Erectile dysfunction 229
Aetiology of erectile dysfunction 229
Treatment of erectile dysfunction 230
Vaginismus 232
Aetiology of vaginismus 232
Treatment of vaginismus 233
The paraphilias 233
Paedophilia 234
Aetiology of paedophilia 235
Treatment of paedophilia 237
Transvestic fetishism 242
Aetiology of transvestic fetishism 244
Treatment of transvestic fetishism 245
Gender identity disorder 246
Aetiology of gender identity disorder 247
Treatment of gender identity disorder 248
Chapter summary 252
For discussion 253
Further reading 253
11 Personality disorders 255
Personality disorders 255
A dimensional view challenging DSM 257
A cognitive model 258
Borderline personality disorder 260
Aetiology of borderline personality disorder 261
Treatment of borderline personality disorder 262
Antisocial personality and psychopathy 269
Aetiology of antisocial personality and psychopathy 270
Treatment of antisocial personality 274
Treatment of psychopathy 275
Chapter summary 279
For discussion 280
Further reading 280
12 Eating disorders 281
Anorexia nervosa 281
Bulimia nervosa 283
Aetiology of anorexia and bulimia 284
Interventions in anorexia 292
Interventions in bulimia 298
Chapter summary 300
For discussion 301
Further reading 302
13 Developmental disorders 303
Learning difficulties 303
Aetiology of learning difficulties 305
Social interventions in learning difficulties 307
Psychological interventions in learning difficulties 310
Autism 312
Core limitations of autism 313
Aetiology of autism 315
Treatment of autism 318
Attention-deficit/hyperactivity disorder 321
Diagnostic versus categorical understandings of ADHD 322
Aetiology of attention-deficit/hyperactivity disorder 323
Treatment of attention-deficit/hyperactivity disorder 325
Working with adults who have ADHD 328
Chapter summary 329
For discussion 331
Further reading 331
14 Neurological disorders 332
Alzheimer's disease 332
Aetiology of Alzheimer's disease 334
Treatment of Alzheimer's disease 337
Head injury 341
Cognitive rehabilitation following head injury 343
Multiple sclerosis 345
Aetiology of multiple sclerosis 348
Psychological sequelae of multiple sclerosis 349
Treatment of multiple sclerosis 351
Chapter summary 353
For discussion 353
Further reading 354
15 Addictions 355
Drugs and drug dependence 355
Excess alcohol consumption 357
Aetiology of excess alcohol consumption 359
Interventions in excess alcohol consumption 362
Heroin use 366
Aetiology of heroin use 367
Treatment of heroin use 370
Pathological gambling 374
Aetiology of pathological gambling 375
Treatment of pathological gambling 378
Chapter summary 379
For discussion 381
Further reading 381
Glossary 382
References 386
Index 425