a mental illness to report on the truly awful conditions inside psychiatric hospitals in

the US, which were known as asylums at the time. She found rotten food, cold showers,

prevalent rats, abusive nurses, and patients being tied down in her famous expose "Ten

Days in a Mad House". What she documented had been pretty standard mental health treatment

for centuries, but her work led the charge in mental health reform.

It's been a long battle.

Nearly a century later in 1975, American psychologist David Rosenhan published a paper called "On

Being Sane in Insane Places" detailing the experiment that he conducted on psychiatric

institutions themselves. The first part of his experiment involved sending pseudopatients

- a group of eight totally mentally sound associates, including David himself - to knock

on institution doors and falsely report that they'd been hearing voices. Once admitted,

the fake patients abandoned their fake symptoms and behaved as they normally did, waiting

for administrators to recognize them as mentally healthy.

Like Cochran, Rosenhan and his team learned that it's easy to get into a mental institution,

but it is much, much harder to get out. The participants were kept in the institution

for an average of 19 days, one of them for 52 days. They were forced to take psychotropic

medication (which they sneakily spit out) and were eventually discharged with a diagnosis

of paranoid schizophrenia in remission. Of course, being dubbed in remission isn't exactly

the same thing as being labeled sane, and that was just one of Rosenhan's criticisms

of the system. It viewed mental illness as an irreversible condition, almost like a personality

trait, rather than a curable illness.

Part two of his experiment came later when Rosenhan shared his results with a teaching

hospital and then told the staff that he'd be sending more pseudopatients their way in

the next few months, and challenged them to detect the imposters. With that in mind, out

of 193 new patients, 41 were ferreted out as likely or suspected pseudopatients. The

thing is, Rosenhan never actually sent in any pseudopatients. In the end Rosenhan concluded

that the way people were being diagnosed with psychiatric issues often revealed less about

the patients themselves and more about their situation. Like, saying you've heard voices

one time might catch a doctors attention a lot more than weeks of normal behavior.

Naturally people criticized his methods and his findings, but his experiment raised a

lot of important questions like: How do we define, diagnose, and classify mental disorders?

At what point does sad become depressed? Or quirky become obsessive compulsive? Or energetic

become hyperactive? What are the risks and benefits of diagnostic labeling, and how does

the field keep evolving?

When people think of psychology they probably most often think about the conditions that

it's been designed to understand, diagnose, and treat - namely psychological disorders.

From common problems that most of us will experience at some point in our lives to the

more serious dysfunctions that require intensive care. They're a big part of what psychology

is here for and over the next several lessons we're going to be looking at mental illness,

as well as wellness. How symptoms are diagnosed and what biological and environmental causes

may be at work. But, to grasp those ideas, we first have to find out how we came to understand

the idea of mental health itself and build a science around studying, discussing, and

caring for it.

In 2010, the World Health Organization reported that about 450 million people worldwide suffer

from some kind of mental or behavioral disorder. No society is immune from them, but when I

say psychological disorder I'm guessing some of you will conjure up all sorts of dramatic

images like diabolical criminals from Arkham Asylum or Hollywood stereotypes of various

eccentric, scary, or tragic figures. This roll call of one-sided stock images is part

of the problem our culture faces - the misconceptions and often destructive stigma associated with

psychological disorders.

So, what does that term actually mean?

Mental health clinicians think of psychological disorders as deviant, distressful, and dysfunctional

patterns of thoughts, feelings, or behaviors. And yeah, there are a lot of sensitive and

loaded words in there, so let's talk about what we mean, starting with deviant.

Sounds like I'm talking about doing things that are dicey or raunchy, but in this context

it's used to describe thoughts and behavior that are different from most of the rest of

your cultural context. Of course, being different is usually wonderful. Geniuses and Olympians

and visionaries are all deviants from the norm so it probably goes without saying that

the standards for so-called deviant behavior change a lot across cultures and in different

situations. For example, in a combat situation killing people is probably to be expected,

but murder is definitely deviant criminal behavior back home in times of peace. And

in some contexts speaking to spirits or ancestors is A-OK, but in other settings say a bar in

Iowa City at happy hour it might not be quite acceptable.

But, to be classified as a disorder, that deviant behavior needs to cause that person

or others around them distress, which just means a subjective feeling that something

is really wrong. In turn, distress can lead to truly harmful dysfunction - when a person's

ability to work and live is clearly, often measurably, impaired.

So that's today's definition but it took a long time for the Western world to come up

with a way of thinking about psychological disorders that was rooted in science and investigative

inquiry. It wasn't until around the 18th and 19th centuries that we really started to put

forth the notion that mental health issues might be about a sickness in the mind. For

example, by the 1800s doctors finally caught on to the fact that advanced syphilis could

manifest in serious neurological problems like dementia, and irritability, and various

mental disorders. So eventually a lot of so-called mental patients were removed from asylums

to full medical hospitals where all of their symptoms could be treated.

This "a-ha" moment is just one instance of how perspectives on mental health began to

shift towards what is called the Medical Model of Psychological Disorder. The Medical Model

champions the notion that psychological disorders have physiological causes that can be diagnosed

on the basis of symptoms, and treated, and sometimes even cured. That way of thinking

about mental health was an important step forward, at least at first. It took us past

the old days of simply locking people up when they didn't seem quite right to others.

But even if it was an improvement, the medical model was seen by some in the field as kind

of narrow and outdated. Most contemporary psychologists prefer to view mental health

more comprehensively through what is called the Biopsychological Approach. You've heard

us say over and over again that everything psychological is simultaneously biological

and that truism is particularly useful here. The Biopsychological view takes that holistic

perspective, accounting for a whole number of things clearly physiological and not in

order to understand what's happening to us, what might be going wrong, and how it can

be treated.

It takes into account psychological influences for sure like stress and trauma and memories,

but also biological factors like genetics and brain chemistry, and social-cultural influences

like all the expectations wrapped up in how a culture defines normal behavior. So by considering

the whole host of nature and nurture influences, we can take a broader view of mental health,

realizing that some disorders can be cured while others can be coped with, and still

others may end up not being disorders at all once our culture accepts them.

But another important part of handling disorders with scientific rigor is attempting to standardize

and measure them. How we talk about them, how we diagnose them, and how we treat them.

So the field has literally come up with a manual that shows you how to do that. But

it is not without it's flaws. It's called the American Psychiatric Association's Diagnostic

and Statistical Manual of Mental Disorders; or, DSM-5 because it's currently in its fifth

edition. And it is used by practically everybody: clinicians obviously, but also by insurance

and drug companies, and policy makers, and the whole legal system.

The first edition came out in 1952, and this newest version was released in 2013. What's

particularly interesting about it is that it's designed to be a work in progress...

forever. Each new edition incorporates changes based on the latest research but also how

our understanding of mental health and behavior evolves over time. For example, believe it

or not the first two editions actually classified homosexuality as a pathology, basically a

disease. The 1973 third edition eliminated that designation, reflecting changing attitudes

and a developing understanding of sexual orientation. And just by looking at the changes between

the edition used today and the previous version released in the year 2000, you can get a picture

not only of how quickly things change but also how classification can affect diagnosis

- for better or worse - and also what the risks are of classifying psychological disorders

in the first place.

For instance, the new edition reflects our growing understanding of the symptoms of Post

Traumatic Stress Disorder, and it changed the name of Childhood Bipolar Disorder to

Disruptive Mood Dysregulation Disorder because kids were being over-diagnosed and over-treated

for bipolar disorder when the condition that they had didn't actually fit that description.

And totally new diagnoses are being explored as well, like Gambling Addiction and what's

called Internet Gaming Disorder, showing that new disorders continue to arise with changing times.

But the DSM is not perfect, even though we've come a long way since the Rosenhan experiment,

critics still worry about how the DSM might inadvertently promote the over- or mis-diagnosis

and treatment of certain behaviors. Others echo Rosenhan's concerns that by slapping

patients with labels we're making them vulnerable to judgments and preconceptions that'll affect

how others will perceive and treat them.

In the end, it's just important to keep in mind that definitions are powerful and things

can get tricky pretty fast in the world of mental health.

Today you learned about how we define psychological disorders, and looked at medical and biopsychological

perspectives on mental illness. We talked about how professionals use the DSM to diagnose

disorders and how it's constantly evolving to incorporate new thinking. Thanks for watching,

especially to all of you who are Subbable subscribers who make Crash Course possible.

To find out how you can become a supporter, just go to subbable.com.

This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant

is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins, the script supervisor

is Michael Aranda, who is also our sound designer. And the graphics team is Thought Cafe.