SCHOOL OF SOCIAL WORK

VIRGINIA COMMONWEALTH UNIVERSITY

MENTAL, EMOTIONAL, AND BEHAVIORAL DISORDERS

SLWK 703

FALL, 2005

Joseph Walsh Office hours: Tuesday 11:00 – 2:00

Room 319 Raleigh Building and by appointment

828-8208 (W); 745-6365 (H) e-mail: jwalsh@atlas.vcu.edu

Students with disabilities, who may need an accommodation to participate and maximize learning in this course, should contact the instructor promptly to discuss this issue.

Students are expected to abide by the policies of the VCU Honor System. These policies are published annually in the University Resource Guide.

COURSE DESCRIPTION

SLWK 703. Semester course: 3 lecture hours, 3 credits. Pre-requisite: Concentration standing. This course reviews the classification, epidemiology, and course of a range of mental, emotional, and behavioral disorders across the life span. It emphasizes the critical analysis of existing or emerging theory, the impact of difference and diversity on the definition of dysfunction and distress, an appreciation of the “lived experience” of these disorders for clients and their families, and the practical implications of this knowledge for relationship building and treatment planning in social work practice settings today. Introduces knowledge of psychopharmacology related to social work interventions with mental, emotional, and behavioral disorders.

COURSE OBJECTIVES

At the completion of this course, the student will be able to:

1. Demonstrate familiarity with the history and state-of-the-science in the nosology of mental disorders, including knowledge of the major criticisms of labeling and contemporary diagnostic systems.

2. Be familiar with the current characteristics and epidemiology of the range of disorders in children, youth, and adults, e. g. anxiety and mood disorders, schizophrenia, personality disorders, adjustment and stress disorders, addictions, and disorders in sexual functioning, attention, impulse control, eating, and sleep.

3. Formulate a differential diagnosis based on DSM-IV using case examples, and discuss the role of self-awareness in the process.

4. Critically assess current selected biological, developmental, social, and other theories of etiology, and the research on the course, risk, and protective factors associated with specific mental, emotional, and behavioral disorders.

5. Articulate empathy and appreciation for the “lived experience” of clients and their families who cope with significant dysfunction or distress across age, gender, ethnicity, race, ability, sexual orientation, and class.

6. Discuss the implications of current knowledge about mental, emotional, and behavioral disorders for relationship building and treatment planning in contemporary social work practice.

7. Demonstrate knowledge of the role of pharmacology in the delivery of services to children, adolescents, and adults, including knowledge of the classes of medication.

TEXTS

Morrison, J. (1995). DSM-IV made easy: The clinician’s guide to diagnosis. New York: Guilford.

Sattler, D. N., Shabatay, V. & Kramer, G. P. (Eds.) (1998). Abnormal psychology in context: Voices and perspectives. Boston: Houghton Mifflin.

COURSE OUTLINE

I. Laying the foundation for a social work perspective on mental, emotional, and behavioral disorders.

Introduction to classification and diagnosis (history and controversy in the classification of psychopathology; overview of the DSM)

Overview of contemporary theories of etiology (the brain, emotional functioning, and mental disorder; social and behavioral science research on the causes and course of mental and emotional disorders)

II Introduction to psychopharmacology (brain structure and function; neurotransmitters, pharmacokinetics, pharmacodynamics; types of psychotropic medication)

III. A survey of emotional, mental, and behavioral disorders

For each topic: Description of clinical characteristics, review of expected course and related risk and protective factors, theories of etiology, analysis of relevant socio-cultural and gender issues, case discussions, reactions to written stories about the “lived experience” of clients, implications for relationship building, intervention planning, and ethical social work practice

Topics: Disorders of childhood and adolescence, anxiety disorders, mood disorders, adjustment disorders, substance-related disorders, schizophrenia and other psychotic disorders, personality disorders and disorders of impulse control, dissociative disorders, cognitive disorders, sexual disorders, somatoform disorders

COURSE FORMAT

I feel especially qualified to teach this course because I have no fewer than six different DSM-IV disorders, more than any other faculty member. Our class sessions will consist of lectures, small-group activities, videos, and discussions of the readings and homework assignments. Lectures and discussions will not cover all of the assigned readings, as I will attempt to respond to students’ needs and interests.

I expect you to attend each class session and be prepared to discuss the weekly topics and readings, perhaps incorporating material from your field placements, work, and life experiences. If you cannot attend a class, please inform me in advance if possible.

You may meet with me outside the classroom during my office hours or other mutually arranged times, to:

1. Ask questions about the course material or assignments

2. Review graded work

3. Get suggestions for further reading

4. Discuss other topics related to the course or to the social work profession in general

5. Talk informally about the future of popular music

ASSIGNMENTS AND EVALUATION

Required of everyone:

1. Attendance and participation (10%)

2. Two article reviews and presentations (Ungraded)

3. Two Formal Client Assessments (30% total)

Options (30% each; choose any two):

1. Biopsychosocial Perspective paper

2. Book report

3. Comparison of two DSM-IV disorders

Papers can be turned in early, but no later than the class period of their due dates unless I approve an extension. Late papers may be lowered by up to one letter grade per week.

All papers must be typed, double-spaced, with one-inch margins, 12-point type, and APA reference style.

The course grading scale is based on ten percentage points, so that 90-100% = A, 80-89.9% = B, 70-79.9% = C, 60-69.9% = D, and below 60% is failing.

CLASS ATTENDANCE AND PARTICIPATION

(10% of course grade)

Through regular class attendance and participation you assume responsibility for helping to create a shared learning environment for all students. Your participation is further encouraged because social workers typically function in agencies as team members. We need to develop the ability to defend our perspectives, and challenge those of others, in a spirit of collaborative learning. Your attendance and level of class participation will be taken into account when I award the final grade. No student who misses more than five classes can receive a passing grade for the course.

RESEARCH ARTICLE SUMMARY

(Required but not graded, scheduled throughout the semester)

On two occasions you must search the recent (2004-2006) academic literature and find an empirical article on a mental disorder in relation to any of the following topics: Etiology, co-morbidity of the disorder with others, assessment, risk and protective factors, or intervention. Your two articles should cover disorders from different chapters of the DSM. Each summary only needs to be 1.5 –2.5 pages long.

Organize your summary as follows:

Author, year, title, journal

Purpose of the study

Question or hypothesis

Instruments used

Results

Strengths and limitations of the study

In addition to the written summary, you must briefly present (2-3 minutes) the information to the class when that disorder (or type of disorder) is covered.

TWO FORMAL CLIENT ASSESSMENTS

(5-6 pages long, due October 4 and November 8)

For this assignment option you must complete a DSM assessment on a client you have worked with, preferably at your current field agency. Address the following points in your assessment:

1. The client’s presenting situation and relevant history (including biological, psychological, social, and spiritual factors, as appropriate) as pertains to the DSM-based assessment and diagnosis. I suggest using sub-headings in this section. (1.5 pages, 15% of grade)

2. A tentative differential diagnosis, using all five axes of DSM-IV. Include the reasons for your decisions on each axis (1 page, 25%)

3. Describe any additional information about the client that might help you to make a more valid diagnosis (1/2 page, 10%)

4. Present 3-5 relevant risk and protective factors for the client with regard to the primary diagnosis (or diagnoses) (1/2 to 1 page, 20%)

5. Compose an intervention plan (with 2-3 goals and objectives) based on the diagnosis and risk and resilience assessment (1/2 to 1 page, 15%)

6. Critique the diagnosis. That is, from a social work perspective, indicate whether the 5-Axis diagnosis is “sufficient” for understanding the client (1/2 page, 10%)

The remaining 5% of the grade will be based on the quality of the writing and presentation.

BOOK REPORT

(6 pages, due October 25 or before)

Choose a book that is either a biographical autobiographical, or fictional account of a person who has (or has had) a mental, emotional, or behavioral disorder. Examples of books are listed at the end of the syllabus, but you may also select another book for this assignment as long as I approve it. After reading the book, write a 6-page paper including:

1. A summary of the person’s life, or as much of it is covered in the book, specifying the portion that featured the disorder (2 pages, 10% of grade).

2. A five-axis DSM-IV diagnosis of the person, based on any period in his or her life after the onset of the disorder. You must include supporting evidence for your designations on each axis (1.5 pages, 30%).

3. A list of five risk and five protective factors that the person experienced in any period of his or her life. Each set of factors can be drawn from the same or different periods of time (1.5 – 2 pages, 30%).

4. A summary statement of what you learned about the disorder, based on the subject’s experience, that is relevant to social work’s conceptualization of it (1 – 1.5 pages, 20%).

The remaining 10% of the grade will be based on the quality of the paper’s presentation.

THE CONCEPT OF "DISORDER" IN SOCIAL WORK PRACTICE

(6 pages, due December 6 or before)

Social workers are required to use the DSM in many agencies and must therefore, at least to some extent, work within the perspective of the medical model in conceptualizing problem behaviors, cognitions, and moods. This may be inconsistent with the values of our profession, which conceptualizes problems from a holistic perspective. This assignment provides you with an opportunity to explore alternative ways that human problems can be conceptualized. The assignment involves the following steps:

1. Develop your own definition of “disorder” (perhaps using a different term) from a social work perspective. This will require you to consider how the concept (perhaps using related terms such as illness, deviance, disease, and others) is used in various fields such as social work, psychology, sociology, and medicine (20% of grade).

2. Select two mental, emotional, or behavioral disorders from the DSM-IV, one of which would be considered a disorder by your definition, and another that would not. The disorders should be from different chapters of the DSM and may not include the adjustment disorders or V-codes. Support the rationale for your selections (40% of grade).

3. Describe 1-2 administrative, cultural, social policy, or political reasons that your "non-disorder" is considered to be a "disorder" in our society at this time (15% of grade).

4. Conclude with a short statement about some specific criteria that should be used to determine whether a behavior or condition should be characterized as a disorder (15% of grade).

The remaining 10% of the grade will be based on the quality of the paper’s presentation.

A BIOPSYCHOSOCIAL PERSPECTIVE

ON AN EMOTIONAL, MENTAL, OR BEHAVIORAL DISORDER

(5-7 pages, due December 6 or before)

The purpose of this assignment is to help you increase your knowledge of the range of biological, psychological, social, and perhaps spiritual risk and protective factors for a disorder in which you are interested. These factors may pertain to the onset of the disorder, its course, or both.

1. Introduction (one page)

Choose any emotional, mental, or behavioral disorder in which you are interested. Briefly state the reason for your interest. Present several reasons why its existence presents a significant challenge for the social work profession. (20% of the grade)

2. A Biopsychosocial Perspective (2-3 pages)

Formulate a social work perspective for understanding the disorder. Address the bio-psycho-social (and perhaps spiritual) components of the disorder, with the specific influences of each component. (I suggest that you organize this section with subheadings.) Is one aspect of the framework more etiologically prominent than the others? (30%)

Consider how the manifestation of the disorder may be affected by such factors as one’s gender, race, ethnicity, age, socioeconomic status, sexual orientation, or disability (if applicable).

3. Risk and Protective Factors

Review the recent literature (the last five years) for the risk and protective factors associated with the etiology and course of that disorder in any age group you choose. Try to avoid factors that involve professional intervention or psychotropic medication. (25%)

3. Summary (up to one page)

What unique perspectives can social work bring to intervention with the disorder, and to how the larger society perceives the disorder? (15%)

The remaining 10% of the grade is based on the paper’s organization and quality of writing.

You need to include at least six citations (journal articles or books).

WEEKLY CLASS SCHEDULE

(Important note: I reserve the right to make changes in the course calendar.

Any changes will be announced in advance in the classroom.)

August 30 Course Introduction: What is a “Disorder”, Anyway?

“I’m just a soul whose intentions are good;

Oh Lord, please don’t let me be misunderstood”

- The Animals

September 6 The Classification and Diagnosis of Mental Disorders

(and Adjustment Disorders)

“I’m not looking to block you up,

Shock or knock or lock you up,

Analyze you, categorize you,

Finalize you or advertise you”

- Bob Dylan

Readings: Morrison – Introduction, 14

Instructor’s handout

September 13 Anxiety Disorders

“I’m having a nervous breakdown; mental shakedown;

Well my hands start to shiver; my knees start to quiver,

My whole body’s in a tither;

I’m having a nervous breakdown”

- Eddie Cochran

Readings: Morrison - 6

Sattler – 1

September 20 Mood Disorders

“Manic depression is touching my soul;

I know what I want but I just don’t know (how to go about gettin’ it);

Feeling, sweet feeling, drips from my fingers;

Manic depression is catching my soul.”

- Jimi Hendrix

Readings: Morrison - 5

Sattler – 4, 5

September 27 Psychotropic Medications

“Twenty-twenty-twenty four hours to go,

I wanna be sedated;

Nothin’ to do, nowhere to go,

I wanna be sedated”

- The Ramones

Readings: Instructor’s handout

October 4 Child and Adolescent Disorders

“Where you going with your shoes undone,

Throwing rocks, making fun of everyone?

Son you’re bound to break your mamma’s heart

Unless you change your ways”

- Randy Newman

Readings: Morrison – 16 Client Assessment #1 due

Sattler – 12 (226-241)

October 11 Eating Disorders

“They call, they call me the fat man,

‘Cause I weigh two hundred pounds;

All the girls, they love me

‘Cause I know my way around”

- Fats Domino

Readings: Morrison - 11

Sattler – 12 (241-246)

October 18 Substance-Related Disorders

“I’ve got swinging doors, a juke box, and a bar stool;

And my new home has a flashy neon sign;

Come by and see me anytime you want to.

‘Cause I’m always here at home ‘till closing time”

- Merle Haggard

Readings: Morrison - 3

Sattler – 9

October 25 Cognitive Disorders

“Been dazed and confused for so long it’s not true”

- Led Zeppelin

Readings: Morrison – 1

Sattler – 11 (202-215) Book Report due

November 1 Schizophrenia and other Psychotic Disorders

“The dream police they live inside of my head

The dream police they come to me in my bed

The dream police they come into my sleep.

Well I can’t tell lies ‘cause they’re listening to me

And when I fall asleep, bet they’re spying on me

‘Cause they’re waiting for me, they’re looking for me

Every single night they’re driving me insane,

Those men inside my brain”

- Cheap Trick

Readings: Morrison - 4

Sattler – 7

November 8 Personality Disorders

“Someone deserted you, the damage is done

Now you don't deserve to be loved by no one

Hands that would feed you when you were two

Were the same hands that beat you black and blue

You get defensive at every turn

You're overly sensitive and overly concerned

So you don't always show your sweet side”

-Lucinda Williams

Readings: Morrison - 15

Sattler – 8 Client Assessment #2 due

November 15 Sexual Disorders (and Impulse Control Disorders)

“Every breath you take, every move you make

Every bond you break, every step you take

I’ll be watching you.

Every single day, every word you say

Every game you play, every night you stay

I’ll be watching you.”

- The Police

Readings: Morrison – 10

Sattler – 10

November 22 Dissociative Disorders

“I’m looking through you; where did you go?

I thought I knew you; what did I know?

You don’t look different but you have changed.

I’m looking through you; you’re not the same.”

- The Beatles

Readings: Morrison - 9

Sattler – 2

November 29 Somatoform Disorders

“When you kiss me, when you miss me,

Hold my hand, make me understand,

I break out in a cold sweat”

- James Brown

Readings: Morrison - 7

Sattler – 3

December 6 Odds and Ends

“Odds and ends, odds and ends,

Lost time is not found again”