“Identification and understanding are two concepts which are summarizing the main modalities of the clinical approach in psychopathology.” Develop.

“Identification and understanding are two concepts which are summarizing the main modalities of the clinical approach in psychopathology.” Develop. Abstract The approach of science, theory and clinical knowledge for the purpose of understanding, preventing and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development is the clinical approach in psychopathology. In clinical approach to psychopathology, there are many modalities and various procedures that should be followed to diagnose and to treat for mental disorders. “Identification” and “understanding” can be considered as the main topics or modalities talked in the clinical approach and in these two modalities all the facts mentioned in the clinical approach to psychopathology can be included and discussed. Here, I would like to give a brief introduction to the clinical approach in psychopathology and wish to analyze how “identification” and “understanding” summarize the main modalities of the clinical approach in psychopathology. Introduction When our body gets sick, the doctor checks our body to identify and understand the sickness and he or she is careful about the causes for the disease also. At last, the doctor identifies and understands the sickness and then prescribes medicine to cure the disease. There are many steps and procedures that should be followed from the diagnostic state to treatment state of a physical disease. The same procedure can be applied to cure our impaired mind also. When our mind is get sick or when we are having a mental disorder or any kind of mental impairment, the clinician who is an astute of human nature, an expert in human relations, a facilitator of growth and a resource who aids others in making crucial life choices, follows a gradual procedure from the diagnostic state to the treatment state of mental disorders (Comer, 1992). So, the branch of psychology concerned with the diagnosis and treatment of mental disorders is simply called the clinical psychology or clinical approach to psychopathology (Class note by Dr. Saulie). In psychopathology, clinical approach holds a very important place as this approach has very scientific procedures for treating for mental disorders. The term clinical comes through the French "clinique" from the Greek "kline" (a couch or bed). So clinical approach is the medical practice at the sickbed (Class note by Dr. Saulie). Mainly, clinical psychopathologists or clinicians study the normal human personality and the ways in which individuals differ from one another in their patterns of thinking, feeling, behaving, and relating to others. Some clinicians administer and interpret various kinds of psychological tests as personality tests, intelligence tests, aptitude tests etc. to diagnose possible mental disorders. To diagnose and treat for mental illnesses or disorders, according to the clinical approach it has to follow its steps, procedures or modalities. The clinical approach includes:-  Semeiology- study of signs of mental disorders  Nosology- study of classification of mental disorders  Aetiology- study of causes of mental disorders The following diagram helps to understand the modalities of the clinical approach. As it has been mentioned above, the main purpose of the clinical approach is to study, diagnose and provide treatment to mental illnesses. To succeed that goal, identification and understanding of mental disorders are very important and those two key factors or modalities of clinical psychopathology finely do this job concurrently. These two modalities do not work one after one and they include each and every step and modality mentioned in clinical psychology to psychopathology. Very important two fields of the clinical approach are the field of globality and the field of singularity. The field of globality includes theoretical knowledge and classification of mental disorders. Simply, this is formulated collecting facts as a whole or commonly and it helps the clinician to understand the common characteristics of a mental disorder. The field of singularity includes semeiology and this field focuses on one specific client’s mental characteristics. Both these two fields belong to identification and understanding modalities. The notion of identification is very important for singularity and globality modalities. To understand what the mental disorder is, the clinician should identify existing characteristics of the client (who seeks psychological help) or the symptoms of the client. This is a very hard task for the clinician. This becomes more difficult because there is no exact way or characteristic that divides the normality or abnormality. And humans are are various and the characteristics that one man shows do not match with the other person. So, this identification procedure is very complex. However, according to Adolphe Quetelet the normal man is an average person (Class note by Dr. Saulie). But, there are problems with this definition also. When considering the abnormality or psychopathology, the clinicians consider client’s statistical derivation, personal distress, maladaptiveness, flexibility etc. Standing at this main point, the clinician tries to identify the client (Class note by Dr. Saulie). The Field of Singularity: - For clinical identification, clinical investigation should be conducted. Clinical investigation is a systematic study designed to evaluate a product using human subjects, in the treatment, prevention or diagnosis of a disease or condition, as determined by the product's benefits relative to its risks (Comer, 1995). It generally follows the taking of the medical history- an account of the symptoms as experienced by the client. Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record. With the clues obtained during the history and physical examination, the clinical psychologist formulates a differential diagnosis- a list of potential causes of the symptoms. Specific diagnostic tests (or occasionally empirical therapy) generally confirm the cause or shed light on other previously overlooked causes. The diagnosis requires the specificity of the client and the theoretical knowledge. The main task of the diagnosis is to distinguish between the normality and the abnormality and for that there are different categories of diagnosis and to use those categories the clinician should have the knowledge of nosology or the classification of mental disorders. So, to do a real clinical investigation, from standpoint of clinical approach it is needed a specific clinical interview to diagnose the mental disorder and the clinical interview has two aspects- internal and external (the counseling request). The clinical interview, the core of most clinical work is used by clinicians to diagnose the symptoms of the client. According to American psychiatrist Harry Stack Sullivan, primary task of clinical interview is to “discover who the client is – that is he (clinician) must review what course of events the client has come through to be who he is, what he has in the way of background and experience” (Sullivin, 1954). The interview gathers information on current and past behavior, attitudes, emotions as well as a detailed history of the individual’s life in general and of the presenting problem. Then, the clinician determines when the specific problem first started and identifies other events that might have occurred about the same time as life stress, trauma, physical illness etc. The vlient’s verbal and non verbal contacts (reluctance, prolixity, mutism, pathology of the language) are highly considered. In addition, most clinicians gather at least some information on the client’s current and past interpersonal and social history, including family make up and on the individual’s upbringing. Information on sexual development, religious attitudes (currently and past), relevant cultural concerns and educational history are also routinely collected. In short sense, the clinical interview is supposed to gather the life chart of the client. Beyond gathering this information, clinical interviewers give special attention whatever they consider important. To organize the information obtained during an interview, many clinicians use a mental status exam and it includes appearance and behavior of the client, thought process, mood and effect, intellectual functioning, sensorium etc. (Barlon & Durand, 2005). Thus, the clinical interview and also the mental status examination are very much helpful to fulfill the identification modality of the clinical psychology as it covers very broad area of the life of the client. Very important details about the mental disorder can be gained through these two techniques. When the clinician wants to know few aspects of the client’s psychological functioning from a broader perspective, the clinician uses clinical tests as projective tests, self report inventories, psycho-physiological tests, neurological tests, intelligence tests etc. Those tests help the clinician to understand even the most subtle and sophisticated state of the mentality of the client. When the clinician has completed above mentioned steps, then he or she has the background knowledge about the mental disorder of the client. But, to certify it, the clinician conducts a clinical observation. One such observation is naturalistic observation in which clinicians observes the client in his or her everyday environments (Comer, 1992). Another one is structured observation in which the clinician creates an artificial environment and observes how the client behaves. Another observation technique that the clinician uses is self- monitoring in which client observes himself or herself. So, when considering the identification modality of the clinical approach, one can understand that it covers a very broad area of the clinical approach in psychopathology. Semeiology:- Furthermore, to study the client “the semeiology” part is also very important and it also belongs to the “identification part’ of the clinical approach. We need semeiology- the study of symptoms and natural indications by which illnesses are manifesting for identifying the client. Semeiology focuses on the signs- clinical manifestations which present a meaning (Class note by. Dr Saulie). The clinician uses three approaches to detect the syndromes of illness. The main aim of the clinical examination is to collect symptoms (perception, sign to judgment) organize them in syndromes (constellation of symptoms) and open the way to diagnosis (Class note by. Dr Saulie). The client’s knowledge about psychopathology with the help of semeiology helps to determine from what mental disorder the client is suffering. Three clusters of symptoms of semeiology runs from surface to the deep to identify the mental illness correctly. I. Macroscopic level- disorders of behavior (appearance, motor activity, language, tone of voice, speech impairments, daily behavior and antisocial behavior are studied). II. Microscopic level- disorders of present mind life (related to cognitive, affective and conative field). III. Dynamic level- disorders of personality (Disorders of personality) (class note by Dr. Saulie). When above mentioned steps as clinical interviews, mental status examination, clinical observation are conducted, the clinician comes to a decision that what mental disorder or mental illness that the client has. He or she has identified it. From here, though the identification part in the field of the singularity ends (identification modality can be seen in the field of globality also), the process is not over. The clinician has to find the causes for the mental disorder or he or she has to understand the causes for mental disorder and in the same way, he or she should consider the field of globality also. So, one can clearly understand that what a broad area is covered by the identification modality and understanding modality and how those two modalities are used by the clinician at the same time. Though there are various procedures and steps that should be followed in the clinical process, the modality of identification specially covers many parts of it. Etiology:- Through understanding the semeiology, it leads to know about the causes of mental illness, which is called etiology in clinical approach. Etiology (alternatively aetiology, aitiology) is the study of causation or origination and it is the starting point of “understanding modality” of the clinical approach to psychopathology. This word is most commonly used in medical and philosophical theories, where it is used to refer to the study of why things occur or even the reasons behind the way that things act. When considering the etiology modality (in understanding modality), the clinician has to be aware of many directions. For example, he or she must consider genetic and the biological background of the client. Some mental disorders as Schizophrenia has a close connection with the genetics. In the same way, imbalances of neurotransmitters like norepinephrine, dopamine, serotonin, GABA and hormonal imbalances in the brain can cause mental impairment. Not only that but also constitutional liabilities, brain dysfunction and neural plasticity, physical deprivation or disruption (Deprivation of basic physiological needs) may cause some metal dysfunctions. In the same way, the clinician must consider the socio-cultural factors as effects of urban or rural dwelling, gender and minority status on state of mind, system factors as family systems and biopsycho-social factors like holistic causal model etc. when understanding the causes for psychopathology. In short, he or she should have a clear knowledge about the different approaches to psychopathology and genetic and social background of the client and the present knowledge about what is going around the client. The Field of Globality:- In the diagnostic processes of the clinical approach to psychopathology, the field of singularity is not enough and it is needed the global knowledge to diagnose the mental illness which are to be treated through therapy. Most notably, psychiatrists and clinical psychologists are particularly interested in this area and may either be involved in clinical treatment of mental illness or research into the origin, development and manifestations of such states or often, both. The field of globality enables the clinician to understand the common characteristic of the mental illnesses. As the clinician has a common knowledge about the characteristics about the mental disorder, when the client describes and exhibits those characteristics, he or she can get a rough idea of the mental illness. So, in the field of globality, the two modalities identification and understanding are included. Before diagnosing a psychological disorder, the clinician must study the themes, also known as abnormalities, within psychological disorders. The most prominent themes consist of deviance, distress, dysfunction and danger. These themes are known as the 4 D's, which define abnormality. This term deviance describes the idea that specific thoughts, behaviors and emotions are considered deviate when they are unacceptable or not common in society while the term distress accounts for negative feelings by the individual with the disorder. The client may feel deeply troubled and affected by their illness. Dysfunction means maladaptive behavior that impairs the client’s ability to perform normal daily functions such as getting ready for work in the morning or driving a car and the term danger involves dangerous or violent behavior directed at the individual or others in the environment. In order to determine whether someone has a psychological disorder or illness, all four D's must be present in combination with other factors. Nosology:- (from the Greek νόσος, nosos, "disease" + λόγος "logos") is the “diagnosis stage’’ being based on the knowledge of the diagnostic criteria in psychiatry (class note by Dr.sulie). Simply it means the “classification system” of mental disorders. A nosologist understands how the classification is underpinned. The nosology which belongs to especially to the identification modality, but also has connection to the understanding modality of the clinical approach is very important. Mental disorders can be classified by etiology (cause), pathogenesis (mechanism by which the disease is caused) or by symptom(s). Alternatively, diseases may be classified according to the organ system involved, though this is often complicated since many mental disorders affect more than one organ. The classification of mental disorders:- There are currently two widely established systems for classifying mental disorders—Chapter V of the International Classification of Diseases (ICD-10) produced by the World Health Organization (WHO) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Psychiatric Association (APA). Both list categories of disorders thought to be distinct types and have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable although significant differences remain. The other manuals of psychological disorders also present various details about the mental disorders. The clinician can easily diagnose the mental disorders if he or she has a sound knowledge about those manuals of mental disorders. When all above mentioned procedures are completed, the clinician identifying and understanding the mental disorder, he or she provides psychotherapy; treatments of mental illness. Psychotherapy may be performed by practitioners with a number of different qualifications including psychiatry, clinical psychology, clinical social work, counseling psychology, mental health counseling, clinical or psychiatric social work, marriage and family therapy, rehabilitation counseling, music therapy, occupational therapy, psychiatric nursing, psychoanalytic therapy etc. If the client needs physical medication, those services are also supplied. Till the client recovers from the mental disorder treatments are supplied by the clinician accordingly. When considering all above mentioned facts, it is clear that the clinical approach in psychopathology is a broad area consisting of many modalities. Though there are various modalities, procedures and steps, the two main modalities of identification and understanding cover all the other modalities and in the same way, by those two modalities each and every concept, procedure or modality discussed in the clinical approach is included and discussed. These two modalities explain the clinical approach concurrently and not separately. In short, only the two modalities of identification and understanding of the clinical approach in psychopathology can be introduced as the clinical approach. Conclusion The Branch of psychology concerned with the diagnosis and treatment of mental disorders is the clinical approach in psychopathology. In this approach many modalities, procedures and steps are talked. But, all the modalities, procedures and steps included in this approach can be easily analyzed and talked in two modalities of identification and understanding. In short, those two modalities have summarized concurrently all the other modalities, procedures and steps included in the clinical approach in psychopathology. References Barlow, H. D & Durand V. M. (2005). Abnormal psychology: an integrative Approach (4th ed.). Belmont: Thomson Wadsworth. Carson, R. C., Butcher, & J. N., Mineka, S., (2000), Abnormal psychology and modern life (11th ed.) India: Pearson Education. Comer, R. J., (1995). Abnormal psychology (2nd ed.). USA: W. H. Freeman and Company. Halgin, R. P. & Whitbourne, S. K., (2000). Abnormal psychology (3rd ed.) USA: Mcgraw- Hill Higher Education. Psychopathology (no date). Retrieved February 24, 2012 from http://en.wikipedia.org/wiki/ Psychopathology. Rosenhan, D.V. & Seligman M. E. (1984). Abnormal psychology. New York: W. W. Norton and Company. Saulie, J., Abnormal psychology class note. Schwartz, S., (1993). Classical studies in Abnormal psychology. London : Mayfield Publishing Company. Sharrf, R. S., (2004). Theories of psychotherapy and counseling, (4th ed.). USA: Thomson Wadsworth.