Chapter 1Abnormal Behavior in Historical Context

Myths and Misconceptions About Abnormal Behavior

• No Single Definition of Psychological Abnormality

• No Single Definition of Psychological Normality

What is a Psychological Disorder?

• Psychological Dysfunction

– Breakdown in cognitive, emotional, or behavioral functioning

• Personal Distress

– Difficulty performing appropriate and expected roles

– Impairment is set in the context of a person’s background

• Atypical or Not Culturally Expected Response

– Reaction is outside cultural norms

Figure 1.1

The criteria defining a psychological disorder

Definition of Abnormal Behavior (cont.)

Abnormal Behavior Defined

• A Psychological Dysfunction Associated With Distress or Impairment in Functioning That is not a Typical or Culturally Expected Response

• The Diagnostic and Statistical Manual (DSM-IV)

– DSM Contains Diagnostic Criteria

• Psychopathology is the Scientific Study of Psychological Disorders

The Science of Psychopathology

• Mental Health Professionals

– Ph.D. : Clinical and counseling psychologists

– Psy.D: Clinical and counseling “Doctors of Psychology”

– M.D. : Psychiatrists

– M.S.W. : Psychiatric and non-psychiatric social workers

– MN/MSN: Psychiatric nurses

• United by the Scientist-Practitioner Framework

Figure 1.2

Functioning as a scientist-practitioner

Dimensions of the Scientist-Practitioner Model

Dimensions of the Scientist-Practitioner Model (cont.)

Figure 1.3

Three major categories make up the study and discussion of psychological disorders.

Clinical Description

• Begins with the Presenting Problem

• Description Aims to

– Distinguish clinically significant dysfunction from common human experience

• Describe Prevalence and Incidence of Disorders

• Describe Onset of Disorders

– Acute vs. insidious onset

• Describe Course of Disorders

– Episodic, time-limited, or chronic course

Causation, Treatment, and Outcome

• What Factors Contribute to the Development of Psychopathology?

– Study of etiology: biopsychosocial model

• How Can We Best Improve the Lives of People Suffering From Psychopathology?

– Study of treatment development

– Includes pharmacologic, psychosocial, and/or combined treatments

• How Do We Know That We Have Alleviated Psychological Suffering?

– Study of treatment outcome

– Limited in specifying actual causes of disorders

Historical Conceptions of Abnormal Behavior

• Major Psychological Disorders Have Existed

– In all cultures

– Across all time periods

• The Causes and Treatment of Abnormal Behavior Varied Widely

– Across cultures

– Across time periods

– As particularly as a function of prevailing paradigms or world views

• Three Dominant Traditions Include: Supernatural, Biological, and Psychological

The Supernatural Tradition

• Deviant Behavior as a Battle of “Good” vs. Evil

– Deviant behavior was believed to be caused by demonic possession, witchcraft, sorcery

– Treatments included exorcism, torture, beatings, and crude surgeries

• The Moon and the Stars

– Paracelsus and lunacy

The Biological Tradition

• Hippocrates: Abnormal Behavior as a Physical Disease

– Hysteria “The Wander Uterus”

• Galen Extends Hippocrates Work

– Treatments remained crude

• Galenic-Hippocratic Tradition

– Foreshadowed modern views linking abnormality with brain chemical imbalances

The 19th Century

• General Paresis (Syphilis) and the Biological Link With Madness

– Associated with several unusual psychological and behavioral symptoms

– Pasteur discovered the cause – A bacterial microorganism

– Led to penicillin as a successful treatment

– Bolstered the view that mental illness = physical illness and should be treated as such

• John Grey and the Reformers

• Consequences of the biological movement:

– Mental Illness = Physical Illness

The Psychological Tradition

• The Rise of Moral Therapy

– Involved more humane treatment of institutionalized patients

– Encouraged and reinforced social interaction

• Reasons for the Falling Out of Moral Therapy

– Population of mentally ill increased rapidly with immigration

– Labor/resource intensive

• Emergence of Competing Alternative Psychological Models

Psychoanalytic Theory

• Freudian Theory

• The Structure of the Mind

– Id (pleasure principle; illogical, emotional, irrational)

– Ego (reality principle; logical and rational)

– Superego (moral principles; keeps Id and Ego in balance)

• Defense Mechanisms: When the Ego Loses the Battle with the Id and Superego

– Displacement & denial

– Rationalization & reaction formation

– Projection, repression, and sublimation

• Psychosexual Stages of Development

– Oral, anal, phallic, latency, and genital stages

The Past: Abnormal Behavior andthe Psychoanalytic Tradition (cont.)

Figure 1.4Freud’s structure of the mind

Psychoanalytic Psychotherapy: The “Talking” Cure

• Unearth the hidden intrapsychic conflicts (“The Real Problems”)

• Therapy is often long-term

• Techniques include free association and dream analysis

• Examine transference and counter-transference issues

• Little evidence for efficacy

Humanistic Theory

• Abraham Maslow and Carl Rogers

• Major Themes

– That people are basically good

– Humans strive toward self-actualization

• Humanistic Therapy

– Therapist conveys empathy and unconditional positive regard

– Minimal therapist interpretation

The Behavioral Model

• Derived from a scientific approach to the study of psychopathology

• Ivan Pavlov, John B. Watson, and Classical Conditioning

– Classical conditioning is a ubiquitous form of learning

– Conditioning involves a contingency between neutral and unconditioned stimuli

– Conditioning was extended to the acquisition of fear and other emotional responses

The Beginnings of Behavior Therapy

• Reactionary movement against psychoanalysis and non-scientific Approaches

• Early Pioneers

– Joseph Wolpe – Systematic desensitization

• Edward Thorndike, B. F. Skinner, and Operant Conditioning

– Another ubiquitous form of learning

– Most voluntary behavior is controlled by the consequences that follow behavior

• Learning traditions greatly influenced the development of behavior therapy

– Behavior therapy tends to be time-limited and direct

– Strong evidence supporting the efficacy of behavior therapies

The Present: An Integrative Approach

• Psychopathology Is multiply determined

• Unidimensional accounts of psychopathology are incomplete

• Must consider reciprocal relations between

– Biological, psychological, social, and experiential factors

• Defining abnormal behavior is also complex, multifaceted, and has evolved

• The supernatural tradition has no place in a science of abnormal behavior