Family Therapy and Mental Health

1. Family Therapy and Mental Health University of Guelph Office of Open Learning

2. Course Instructor Carlton Brown, M.Sc., M.Div., RMFT 3-1216 Upper Wentworth Street, Hamilton ON L9A 4W2 Tel: 905-388-8728 Email: carl@mftsolutions.ca Slides: http://www.mftsolutions.ca/Pages/MentalHealthCourse.html (Who the hell are these guys?)(Who the hell are these guys?)

3. 3 Who I am One-Time Medical Researcher Baptist Minister Pastoral Counsellor Chaplain Emergency Psychiatry Marriage and Family Therapist Full-Time

4. Today History Family Therapy and Mental Health Models Being, Development, Illness and Assessment DSM-IV What it is, how to use it Bambi Meets Godzilla Family Therapy meets Mental Health Assignments

5. Ice Breaker Pick a card Half the cards depict psychiatric symptoms or illnesses Half the cards depict psychiatric medications Find your mate!

6. Introductions Name Background/experience in mental health What fascinates you about the field of mental health? What makes you nervous/afraid about the field of mental health?

7. 7 History of Family Therapy and Mental Health (unbiased and unabridged)

8. Historical Overview of Family Therapy and Mental Health Early psychotherapy: Sigmund Freud (1856 � 1939) - Neurologist Carl Jung (1875 - 1961) - Psychiatrist Carl Rogers (1902 � 1987) - Psychologist Medical Model Psychopathology arose from unhealthy interactions with others Treated by a private relationship (client-therapist)

9. 9 James Framo (1922 - 2001) Framo. A personal retrospective of the family therapy field: then and now. Journal of Marital and Family Therapy (1996) vol. 22 (3) pp. 289-316 Psychologist Accidentally fell in with Ivan Boszormenyi-Nagy, a psychiatrist with ideas about the healing power of relationships

10. 10 Virginia Satir Treating a young woman Mother threatened to sue Brought the mother in for therapy Framo and Boszormenyi-Nagy Treating young women with schizophrenia The parents were interfering Brought them in for therapy

11. 11 The Beginning of a Reframe Families make people ill Families can be a resource in treating members who are ill

12. 12 Serendipitous Discoveries When Families Included Symptoms make sense When one member gets well, another gets sick Families sometimes make healed members change back Psychology of intimate relationships (regression) Family rules Fathers just need to be invited

13. 13 And... Ill people are best treated by their families, not by professional caregivers

14. 14 Enormous Opposition �dangerous� to include families in treatment family jokes surreptitious meetings of family therapists

15. 15 Accidental Family Therapy John Bell mistakenly thought that John Bowlby was treating families in England. So he started treating them in the U.S.

16. 16 The Palo Alto Group Gregory Bateson, Don Jackson, Jay Haley, John Weakland (mid 1950�s) later Paul Watzlawick Haley. Why a mental health clinic should avoid family therapy. Journal of Marriage and Family Counseling (1975) vol. January pp. 3-13 Watzlawick. A review of the double bind theory. Family Process (1963) vol. 2 pp. 132-153

17. 17 Crazy Carl Whitaker Whitaker and Bumberry (1988). Dancing with the family: A symbolic-experiential approach. New York: Brunner/Mazel No walls or one-way mirrors Physical symptoms after visiting �He helped me to loosen up�

18. 18 Family Process Begun in 1962 by Don Jackson and Nathan Ackerman Family treatment books published in 1960�s Murray Bowen - studied and published his own family, and Framo followed suit Salvador Minuchin - Structural Family Therapy (1970�s) Maria Selvini-Palazzoli - Italy

19. 19 Resistance Thomas Jefferson Medical University, Community Mental Health Centre forced Framo to resign in 1973 Temple University - more accepting But even in California in the 80�s - psychology students resistant to family therapy ideas

20. 20 AAMFT American Association of Marriage and Family Counselors Journal of Marriage and Family Counseling (1975) American Association for Marriage and Family Therapy Journal of Marital and Family Therapy (1979) American Family Therapy Association (1977)

21. 21 Coming of Age (sort of) 80�s and 90�s Gurman and Kniskern Handbook of Family Therapy More women enter the field (Betty Carter, Monica McGoldrick, Lee Combrinck-Graham, Lynn Hoffman et al) AAMFT membership increases 500% Sex therapy Plethora of models

22. Pioneers of Family Therapy Palo Alto Group Jackson borrowed from biology and systems theory and created a new language of psychotherapy: Family homeostasis Symptoms have function Rules hypothesis Complementary/symmetrical Quid pro quo (couples, not gender, make the rules) Double bind Jackson was described as one of the top ten psychiatrists of his time and his death was a huge loss to the budding field of Family TherapyJackson was described as one of the top ten psychiatrists of his time and his death was a huge loss to the budding field of Family Therapy

23. Pioneers of Family Therapy Palo Alto Group Jay Haley � control is everything (M. Erickson) Symptoms must be outwitted by smart therapists Symptoms are used by the patient to gain control Therapist prescribes treatment Paradoxical prescriptions to �outwit� the patient�s resistance Jackson was described as one of the top ten psychiatrists of his time and his death was a huge loss to the budding field of Family TherapyJackson was described as one of the top ten psychiatrists of his time and his death was a huge loss to the budding field of Family Therapy

24. Pioneers of Family Therapy Palo Alto Group Benefits New language Interpersonal instead of intrapsychic Creative Risks Reduces therapy to a game of control Simplistically applied, it can do harm Implies that interactions cause illness (maybe not) Jackson was described as one of the top ten psychiatrists of his time and his death was a huge loss to the budding field of Family TherapyJackson was described as one of the top ten psychiatrists of his time and his death was a huge loss to the budding field of Family Therapy

25. From Streams to a River Arising from competing ideas: The power of the psyche (Freud) Environmental reinforcers (behaviourists) The power of the family (family therapy)

26. From Streams to a River Family Therapy as the Most Recent Big Idea Essentialist (zeal) Transitional (okay, maybe it�s not the miracle cure) Ecological (integrative?)

27. Family therapy in the 21st Century Systems still at the core �Intelligent� systems (beyond inanimate) Differential impact Causal processes Individual symptomatology Integration of family systems with early theories of psychotherapy Increasing influence of biology Lebow JL (2005) Handbook of Clinical Family Therapy, New York: John Wiley & Sons

28. 28 A Really Brief History of Mental Illness MacFarlane text, Ch 1 Early treatment of the mentally ill: families, homeless, prison Mid 1700�s - first asylums Early 1800�s - �moral treatment� (early form of cognitive therapy) Late 1800�s - mental hospitals 1952 - chlorpromazine community mental health families, homeless, prison

29. Break!

30. 30 Models of Being, Development, Illness and Assessment

31. 31 Being Biology Psychology Sociology

32. Biology (Paul Tillich: no psychology, sociology or spirituality without biology) Genes code the synthesis of all biological proteins, including neurons and neurotransmitters Individual problems are framed within the context of the past, present and future of the family one belongs toIndividual problems are framed within the context of the past, present and future of the family one belongs to

34. Acetylcholine � memory Serotonin � mood Dopamine � thinking and movement

35. All thinking, feeling and behaviour has a biological basis transmission of electrical impulses down neurons release of neurotransmitters at synapses stimulation of muscle contraction Movement Nonverbal communication (grimaces, smiles, clenched fists) Verbal communication (speech) Thinking affects biology Interaction affects thinking

36. 36 Development Everything grows In utero - growth and differentiation After birth - more growth Biological Sociological

37. Lots of Developmental Models Piaget - cognitive Kohlberg - moral Mahler - relational Erikson - relational Kegan - comprehensive

38. Piaget 0 - 2 - sensorimotor (reflexes, coordination, searching for lost objects) 2 - 5 - symbolic (magical, confused between real and imagined, confusion of perceptual appearance) 6 - 10 - concrete operations (logical manipulation of concrete objects) 11 and up - formal operations (abstract thinking, other perspective)

39. Kohlberg�s moral stages Preconventional Heteronomous morality (avoid punishment) Instrumental purpose (serve own needs) Conventional Mutual (Be a good person) Social system (Keep the system going) Postconventional Social contract (freely entered into) Universal ethics (universal moral principles)

41. Erikson Trust vs. mistrust Object permanency �first task of the ego� Sense of being �all right� Always a shadow of �paradise forfeited� Applications: Borderline Personality Disorder (object permanency) Being �all right� vs. psychodynamic theory of psychosis development Communications theory, narrative, and �it�s never too late to have a happy childhood�

42. Erikson Autonomy vs. shame and doubt Holding on, letting go Anal stage Doing well enough Shame: upright and exposed Doubt: what I have left behind (undone) Applications: OCD? Depression?

43. Erikson Initiative vs. guilt Industry vs. inferiority Identity vs. role confusion Intimacy vs. isolation Generativity vs. stagnation Ego integrity vs. despair

44. 44 Kegan Never cited by the feminists Posited interdependence as the highest level of development

45. 45

46. 46 Further Reading Erik H. Erikson (1950), Childhood and Society. New York: W.W. Norton Robert Kegan (1982), The Evolving Self: Problem and Process in Human Development. Cambridge, Mass: Harvard University Press

47. The Family Life Cycle Individual life cycle is embedded within the family life cycle The family life cycle keeps changing lower birth rate longer life changing roles of women and men rise in single-parent families rise in unmarried families variations in sexual preference increasing egalitarianism Individual problems are framed within the context of the past, present and future of the family one belongs toIndividual problems are framed within the context of the past, present and future of the family one belongs to

49. New variation � kids that don�t leave home or leave and come back (sometimes many times)New variation � kids that don�t leave home or leave and come back (sometimes many times)

50. 50

51. 51 Illness illness |'ilnis| noun a disease or period of sickness affecting the body or mind : he died after a long illness | I've never missed a day's work through illness. disease - disorder in structure or function patient - someone who is suffering

52. 52 Medical Model of Illness The body has a normal state Something interferes with the body�s homeostasis pathogen virus, bacterium or family You treat the body to get rid of the pathogen The body returns to its normal state and you discharge the patient

53. 53 Expanded Model of Illness The body/mind/person has a normal state Something happens to disturb the normal state perhaps they are predisposed to becoming ill (diathesis) and then there is an added stress and without adequate support or resources they become overwhelmed and fall into an ill state

54. Family Life Cycle Stress is often the greatest at transition points between stages It is assumed that developmental tasks that aren�t resolved will create stress and cause further problems in the family system

55. Illness A defective gene may result in a defect in neurotransmission, causing a disorder: Decreased Acetylcholine � memory loss (dementia) Decreased Serotonin � decreased mood (depression) Increased Dopamine � delusions and hallucinations Decreased Dopamine � movement disorders (Parkinson�s Disease) Or a defective gene may not result in a defect, not causing a disorder Individual problems are framed within the context of the past, present and future of the family one belongs toIndividual problems are framed within the context of the past, present and future of the family one belongs to

56. Stress - Diathesis Diathesis = �tendency� Biological predisposition A tendency toward: Decreased Acetylcholine � memory loss (dementia) Decreased Serotonin � decreased mood (depression) Increased Dopamine � delusions and hallucinations Decreased Dopamine � movement disorders (Parkinson�s Disease) Add a stressor and a disorder may present Tendency + overwhelming stress = illness Individual problems are framed within the context of the past, present and future of the family one belongs toIndividual problems are framed within the context of the past, present and future of the family one belongs to

58. Stress, Illness and Development Stress causes development �Evolutionary truce� -> conflict -> growth to deal with change Stress also may cause illness Diathesis + stress = illness What does illness do to development?

59. Treatment Mental disorders have a biological basis and are treatable by biological interventions, and Psychotherapy is a biological intervention Changes in mood, thinking, or behaviour change neurotransmitter function Psychotherapy affects thinking, feeling and behaving Psychotherapy is a social activity that affects psychological and biological function Individual problems are framed within the context of the past, present and future of the family one belongs toIndividual problems are framed within the context of the past, present and future of the family one belongs to

60. Lunch!

61. The McMaster Modelof Family Functioning Has anyone hear of the McMaster model? Does anyone have experience using it? If so, where and when� Used in CAS for home studies for foster care placement and adoption Easy to learn, intuitive sense Will review model then look at clinical rating scales which may be useful in assessing familiesHas anyone hear of the McMaster model? Does anyone have experience using it? If so, where and when� Used in CAS for home studies for foster care placement and adoption Easy to learn, intuitive sense Will review model then look at clinical rating scales which may be useful in assessing families

62. The McMaster Model Diagnosis of families requires a conceptual model of family functioning The MMFF is one attempt to provide a schema to rate clinical observations and assist with diagnosis

63. The McMaster Model Started in 1962 with the Family Categories Schema of Epstein, Sigal & Rakoff - study of 110 non-clinical families Revised several times to current presentation and tested thoroughly for reliability and validity Provides full spectrum of ratings from health to pathology

64. Assumptions Underlying the MMFF The parts of the family are interrelated One part of the family cannot be understood in isolation from the rest of the system Family functioning cannot be fully understood by simply understanding each of the parts The development of the MMFF is grounded in some basic assumptions of systems theoryThe development of the MMFF is grounded in some basic assumptions of systems theory

65. Assumptions (cont�d) A family�s structure and organization are important factors determining the behaviour of family members 5) Transactional patterns of the family system are among the most important variables that shape the behaviour of family members Note the emphasis on transactional patterns � a piece emphasized in family therapy that was downplayed or sometimes ignored in psychotherapyNote the emphasis on transactional patterns � a piece emphasized in family therapy that was downplayed or sometimes ignored in psychotherapy

66. Six Dimensions of Family Functioning Problem Solving Communication Role Functioning Affective Responsiveness Affective Involvement Behaviour Control Excellent summary of these in Table 4.1 (pp. 142-143) of the chapter from WalshExcellent summary of these in Table 4.1 (pp. 142-143) of the chapter from Walsh

67. Problem Solving Refers to a family�s ability to resolve problems to a level that maintains effective family functioning Problems are divided into instrumental ($, food, clothing, housing, etc.) and affective (emotional issues) Families that have difficulty coping with instrumental problems almost always struggle with affective problems while the reverse is not necessarily true � could struggle with affective problems and be fine with instrumental onesFamilies that have difficulty coping with instrumental problems almost always struggle with affective problems while the reverse is not necessarily true � could struggle with affective problems and be fine with instrumental ones

68. Problem Solving Seven steps to problem solving: Identify the problem Communicate it to the right people Develop a set of solutions Decide on one solution Carry out the action required Monitor to ensure action is carried out Evaluate the effectiveness It is believed that healthier families: complete most if not all the steps and have fewer unresolved problems It may be hard to tell that healthy families have worked through all seven steps because they may not be able to describe the process they use since it appears second nature It is easier to identify families that have difficulty with the steps The lower the functioning, the less steps completed in the problem solving process A normal family may have some unresolved problems but they do not interfere with effective family functioning (e.g. parents disagree on how to discipline a child but remain a �united front� in front of the children) Only the most effective families evaluate the problem solving process Difficulties with instrumental problems lead to lower rating than difficulty with only affective problemsIt is believed that healthier families: complete most if not all the steps and have fewer unresolved problems It may be hard to tell that healthy families have worked through all seven steps because they may not be able to describe the process they use since it appears second nature It is easier to identify families that have difficulty with the steps The lower the functioning, the less steps completed in the problem solving process A normal family may have some unresolved problems but they do not interfere with effective family functioning (e.g. parents disagree on how to discipline a child but remain a �united front� in front of the children) Only the most effective families evaluate the problem solving process Difficulties with instrumental problems lead to lower rating than difficulty with only affective problems

69. Communication Defined as the exchange of information between family members Also divided into instrumental and affective areas Assessed on two dimensions: Clear vs. masked Direct vs. indirect Focused more on verbal communication than non-verbal Clear vs. masked = is the message clear or is it camouflaged, muddied or vague Direct vs. indirect = is the message directed to the appropriate person (e.g. triangles, detouring, not speaking to someone, etc.) One criticism of the MMFF could be it�s focus on verbal communication. It does so because it�s attempting to describe objective criteria and there is too much room for subjective interpretation in trying to describe and analyse non-verbal communication. The MMFF is used in a lot of research and they needed it to have specific criteria in order to produce high reliability and validity. Discrepancies between verbal and non-verbal communication can be captured as �masked� or under another area such as roles or affective responsiveness The level of health or pathology in parents� communication should be weighed more heavily than that of children The lower the level of communication functioning in a single member, dyad, or triad, the lower the overall rating The greater the number of family members at a lower level of health/pathology in the communication area, the lower the overall rating of the family Clear vs. masked = is the message clear or is it camouflaged, muddied or vague Direct vs. indirect = is the message directed to the appropriate person (e.g. triangles, detouring, not speaking to someone, etc.) One criticism of the MMFF could be it�s focus on verbal communication. It does so because it�s attempting to describe objective criteria and there is too much room for subjective interpretation in trying to describe and analyse non-verbal communication. The MMFF is used in a lot of research and they needed it to have specific criteria in order to produce high reliability and validity. Discrepancies between verbal and non-verbal communication can be captured as �masked� or under another area such as roles or affective responsiveness The level of health or pathology in parents� communication should be weighed more heavily than that of children The lower the level of communication functioning in a single member, dyad, or triad, the lower the overall rating The greater the number of family members at a lower level of health/pathology in the communication area, the lower the overall rating of the family

70. Role Functioning Family roles are defined as the repetitive patterns of behaviour by which family members fulfill family functions Five areas of function: 1) Provision of resources 2) Nurturance and support 3) Adult sexual gratification 4) Personal development 5) Maintenance and management of the system 1 includes money, food, clothing and shelter 2 includes comfort, warmth, reassurance and emotional support 3 includes mutual satisfaction with sexual relationship 4 includes developing skills for personal achievement 5 includes a variety of functions: decision making, boundaries, behavioural control, household finance, health-related functions1 includes money, food, clothing and shelter 2 includes comfort, warmth, reassurance and emotional support 3 includes mutual satisfaction with sexual relationship 4 includes developing skills for personal achievement 5 includes a variety of functions: decision making, boundaries, behavioural control, household finance, health-related functions

71. Role Functioning Two other aspects of role functioning: Role allocation � how roles are assigned and distributed (e.g. appropriate/inappropriate, implicit/explicit, autocratic/democratic, shared among all members) Role accountability � making sure that functions are fulfilled; reinforces commitment and effectiveness Healthy families assign roles in a reasonable fashion, roles are age appropriate and encourage personal development Necessary functions are fulfilled and there are clear lines of accountability Effective families share roles which allows for flexibility Imagine how this applies to families with a ill member � what might happen? Healthy families assign roles in a reasonable fashion, roles are age appropriate and encourage personal development Necessary functions are fulfilled and there are clear lines of accountability Effective families share roles which allows for flexibility Imagine how this applies to families with a ill member � what might happen?

72. Affective Responsiveness Defined as the ability to respond to a given stimulus with the appropriate quality and quantity of feelings Two aspects to consider: Responding with a full range of feelings Does the response match the stimulus and/or context Think of response as being measured on an arc, with too little on one end, just enough in the middle, and too much on the other endThink of response as being measured on an arc, with too little on one end, just enough in the middle, and too much on the other end

73. Affective Responsiveness Distinguish between welfare emotions and emergency emotions Welfare emotions include: affection, warmth, tenderness, support, love, consolation, happiness, and joy Emergency emotions include: Anger, fear, sadness, disappointment, and depression Healthy families are able to express a full range of emotions, and experience appropriate emotions in a given context with reasonable intensity and duration Consider cultural variability in expression In healthy families, inappropriate displays of affect are not disruptive to family functioningHealthy families are able to express a full range of emotions, and experience appropriate emotions in a given context with reasonable intensity and duration Consider cultural variability in expression In healthy families, inappropriate displays of affect are not disruptive to family functioning

74. Affective Involvement Defined as the extent to which the family shows interest in and values the particular activities and interests of individual family members Ranges from a complete lack of involvement to extreme involvement Keep in mind the individual life cycle and the family life cycle as this area is discussed re. what is normal ie. adolescenceKeep in mind the individual life cycle and the family life cycle as this area is discussed re. what is normal ie. adolescence

75. Affective Involvement Six types of involvement: Lack of involvement Involvement devoid of feelings Narcissistic involvement Empathic involvement Over-involvement Symbiotic involvement 2 some interest, primarily intellectual 3 interest only to the degree that it reflects the self eg. Searching for Bobby Fisher; social psychology concept BIRGing � basking in reflected glory See also Dwight (Robert De Niro) in This Boys Life re. scouting 4 seen as optimal, involved for the sake of others 5 excessive interest in one another 6 an extreme and pathological involvement in others, lack of differentiation 4 is the best; followed by 2, 3 or 5; 1 and 6 are the worst (most disturbed)2 some interest, primarily intellectual 3 interest only to the degree that it reflects the self eg. Searching for Bobby Fisher; social psychology concept BIRGing � basking in reflected glory See also Dwight (Robert De Niro) in This Boys Life re. scouting 4 seen as optimal, involved for the sake of others 5 excessive interest in one another 6 an extreme and pathological involvement in others, lack of differentiation 4 is the best; followed by 2, 3 or 5; 1 and 6 are the worst (most disturbed)

76. Behaviour Control Defined as the pattern a family adopts for handling behaviour in three areas: Physically dangerous situations Meeting and expressing psychobiological needs (e.g. eating, sleeping, toileting, etc.) Interpersonal socializing behaviour both between people in the family and between family members and outsiders

77. Behaviour Control Four styles of behaviour control: Rigid � little room for negotiation Flexible � reasonable, with room for negotiation Laissez-faire � no standards Chaotic � unpredictable, shifts between other styles without predictability Descending in effectiveness from 2 to 1 to 3 to 4 In effective families, there may be small inconsistencies but they do not affect family functioning Focus on consistency and flexibilityDescending in effectiveness from 2 to 1 to 3 to 4 In effective families, there may be small inconsistencies but they do not affect family functioning Focus on consistency and flexibility

78. 78 Case Study watch the clip use the rating scale to assess this family

79. Break

80. Classification of Disease ICD-9 ICD-9-CM DSM-IV DSM-IV-TR

81. Classification of Disease World Health Organization ICD-9 International Classification of Diseases, 9th revision Mortality data only (ICD-9 is for dead people) ICD-9-CM International Classification of Diseases, 9th revision, clinical modification Based on ICD-9 Official coding for illnesses in the United States

82. Implications Disease Classification is internationally agreed upon It also forms the basis for billing from governments and third parties

83. Classification of Mental Disorders Based on ICD-9-CM Called Diagnostic and Statistical Manual of Mental Disorders (DSM) Current edition is the Fourth Edition, published in 1994 (DSM-IV) A text revision was published in 2000 (DSM-IV-TR)

84. Definition of a Mental Disorder �clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.�

85. Mental Disorder, continued Must not be expectable and culturally sanctioned response to a particular event (e.g. death of loved one) Must be a current manifestation of dysfunction Deviant behaviour and conflicts with society are not included unless the deviance or conflict is a symptom of individual dysfunction, as above

86. Mental Disorder, continued The DSM-IV classifies disorders, not people Not a �schizophrenic� but �an individual with Schizophrenia (295)� Not an �alcoholic� but �an individual with Alcohol Dependence (303.90)�

87. How Diagnoses are Arranged Five Axes Axis I Clinical Disorders Other Conditions That May Be a Focus of Clinical Attention (V-Codes) Axis II Personality Disorders Mental Retardation

88. How Diagnoses are Arranged Five Axes Axis III General Medical Conditions Axis IV Psychosocial and Environmental Problems (V-Codes, also coded on Axis I if a primary concern) Axis V Global Assessment of Functioning (GAF)

89. 89 Mental Health Problems schizophrenia bipolar disorder antisocial personality disoder borderline personality disorder narcissistic personality disorder histrionic personality disorder dependent personality disorder

90. 90 More Mental Health Problems obsessive-compulsive disorder PANIC disorder phobias social anxiety obsessive-compulsive disorder obsessive-compulsive disorder post traumatic stress disorder generalized anxiety disorder

91. 91 Even More Mental Health Problems Depression Aging Brain Injury Substance Abuse Women and mental health Children, adolescents and mental health (ADHD, ODD, CD)

92. 92

93. 93 Discussion What is family therapy? What is mental illness? How might family therapy help mental illness?

94. 94 Assignments In Class Presentation (30%) 22 minutes groups one-page handout In Class Quiz (10%) Friday, November 5th Final Paper (60%) Friday, November 26th

95. 95 In Class Presentations Schizophrenia and Other Psychotic Disorders Bipolar Disorder up Friday September 24 Personality Disorders up Friday October 1 Anxiety Disorders up Friday October 22 Depression and Special Topics up Friday November 5

96. Charades

97. Next Class Friday September 24 Schizophrenia and other psychotic disorders Bipolar affective disorder Two student presentations Read MacFarlane chapters 3 and 8 Read Carlson and Sperry Chapter 4 Read Marsh and Lefley 2003 Relax and Have Fun!