Developmental psychology.pdf

Integration of Behavior
The most disconcerting finding in this research is that this label of "schizophrenia
in remission" would have stayed with the patients, indicating that they were
or had been insane, crazy, or whatever description one prefers. This label undoubtedly
would have influenced others' reactions toward them in their later lives, had they not
used the pseudonyms, and sometimes it was significant in the ward, where normal behavior
was wrongly interpreted to coincide with the diagnostic label. All labels are
serious, but this one is especially so. The deleterious consequences of being officially
labeled insane in any society need no further comment.
One would hope instead that the early diagnosis would have been modified in
accordance with later evidence, but that did not happen. Or the original judgment in
the admissions interview might have been "diagnosis deferred," recognizing that the
symptoms were unclear (Farber, 1975). How difficult it is for the initial and powerful
influence of such a label to be overcome by a host of less conspicuous but more appropriate
cues (Hofling, 1973).
In fairness to the professionals, their use of "schizophrenia in remission" was
not indiscriminate. In practice this discharge diagnosis is relatively rare, for most patients
continue to be disturbed when they are released from the hospital. They are
encouraged or allowed to go home under outpatient care, with the use of medication,
and accompanied by family or friends. The patients are still disturbed, but being disturbed
does not necessarily mean further hospitalization. Similarly, being physically
ill does not imply that hospitalization is necessary. Both types of patients are discharged
as soon as possible, usually with the idea that recovery at home will be faster,
more pleasant, and accompanied by fewer undesirable side effects.
The expression "schizophrenia in remission" is regrettable, but it is also cautious
and unfortunately realistic in many cases. One-half of the people hospitalized for
schizophrenia require rehospitalization within two years. The rate of readmission for
schizophrenia is at least double the rate of first admissions (Gunderson, Autry, Mosher,
& Buschbaum, 1974).
Affective Disorders
The schizophrenic disorder, as we have seen, is primarily a disturbance in thinking.
Another psychotic condition, the affective disorder, is associated with emotional turmoil.
Alterations in thinking and mood are present in virtually all cases of serious maladjustment,
but inappropriate emotions are the most obvious characteristic of affective
disorders.
Bipolar Disorder The condition characterized by extreme fluctuations in feelings,
up and down, is called the bipolar disorder, meaning that the emotions swing from one
pole to the other. In the positive or manic state the individual may be extremely happy,
singing at the top of his or her voice, dancing in unrestrained fashion, and working on
enterprises that will change the world. Sometimes there is a "flight of ideas." The
individual goes off rapidly on one tangent, then another, and then another, as each idea
occurs. In the depressive state the person may lose interest in eating and other
pleasurable activities, show a loss of energy, and complain of worthlessness. Selfdestructive
acts and suicidal thoughts also may be evident.
The manic and depressive conditions may alternate in a variety of ways, but
the manic episode is usually sudden in onset, commonly the initial episode in a bipolar
disorder. The depressive reaction is characteristically more prolonged and recovery is
more gradual. Today extreme mania and depression are seldom seen in mental hospitals
because medications are used to stabilize the patient's emotional condition.