Abnormal Behavior in Historical Context Chapter 1 Abnormal Behavior in Historical Context

Myths and Misconceptions about Abnormal Behavior No single definition of psychological abnormality No single definition of psychological normality

FIGURE 1.1  The criteria defining a psychological disorder.

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 Discussion Tip: Using the Activity: Distinguishing Normal From Abnormal Behavior in the Instructor Resource Manual. Have students examine both case studies to highlight the difficulty of making quick classifications of behavior.

Abnormal Behavior Defined An accepted definition A psychological dysfunction associated with distress or impairment in functioning that is not typical or culturally expected The Diagnostic and Statistical Manual (DSM-IV-TR) DSM Contains diagnostic criteria The field of psychopathology The scientific study of psychological disorders Teaching Tip: Consult the local news/media for examples of abnormal behavior and/or keep an ongoing file of articles that exemplify this definition. Discussion Tip: Introduce students to the idea of categorical versus dimensional classification systems and have them debate about the relevance and limitations of each approach. Technology Tip: The American Psychiatric Association has created a web site to keep the public and professionals informed about the plans for DSM-V as well as the ongoing effort to enrich the research base as formal work on DSM-V begins. (http://www.dsm5.org/)

The Science of Psychopathology Mental health professionals The Ph.D.: Clinical and counseling psychologist The Psy.D.: Clinical and counseling “Doctor of Psychology” The Ed.D.: Clinical and counseling “Doctor of Education M.D.: Psychiatrist Psychiatric social worker Psychiatric nurse Family therapists

The Scientist-Practitioner Stays current with research in field Evaluates own assessment and treatment Conducts research Technology Tip: Download and discuss David Shapiro’s article “Renewing the Scientist-Practitioner Model” at http://www.shapiro.co.uk/may02shapiro.pdf

FIGURE 1.2  Functioning as a scientist-practitioner.

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 Prevalence is how many people in a population have the disorder. Incidence is the number of new cases over a period of time (i.e., per year).

Clinical Description Describe onset of disorders Acute vs. insidious onset Describe course of disorders Episodic, time-limited, or chronic course Prognosis Good vs. guarded

Causation, Treatment, and Outcome Etiology What contributes to the development of psychopathology? Treatment development How can we help alleviate psychological suffering? Includes pharmacologic, psychosocial, and/or combined treatments Technology Tip: The APA Div. 12 maintains a site devoted to empirically-supported treatments that can be found at http://www.apa.org/divisions/div12/rev_est/

Causation, Treatment, and Outcome Treatment outcome research How do we know that we have helped? Limited in specifying actual causes of disorders

Historical Conceptions of Abnormal Behavior Major psychological disorders have existed in all cultures and across all time periods. Causes and treatment of abnormal behavior vary widely across cultures, time periods, world views. Technology Tip: Visit the University of Dayton’s website for information and links about the history of psychology. (academic.udayton.edu/gregelvers/hop/welcome.asp)

Historical Conceptions of Abnormal Behavior Three dominant traditions Supernatural Biological Psychological Technology Tip: Visit the Museum of London website (http://www.museumoflondon.org.uk/archive/exhibits/bedlam/bedlam.htm) to find information on the 750-year-old story of Bethlem Royal Hospital, popularly known as 'Bedlam'.

The Supernatural Tradition Deviant behavior as a battle of “Good” vs. Evil Caused by demonic possession, witchcraft, sorcery Treatments included exorcism, torture, beatings, and crude surgeries

The Supernatural Tradition Mass hysteria Saint Vitus’s Dance and Tarantism Modern mass hysteria Emotion contagion Mob psychology The moon and the stars Paracelsus and lunacy Discussion Tip/Teaching Tip: Have students read their own horoscope for the week and discuss its applicability and the principles of construction (i.e., vague generalities, ambiguity).

The Biological Tradition Hippocrates: Abnormal behavior as a physical disease Hysteria “the wandering uterus” Galen extends Hippocrates’ work Humoral theory of mental illness Treatments remained crude Humors Sanguine: blood, cheerful and optimistic, insomnia and delirium caused by too much blood in the brain Melancholic: black bile, depressive Phlegmatic: phlegm, apathy and sluggishness Choleric: yellow bile, hot tempered

The Biological Tradition Galenic-Hippocratic tradition Linked abnormality with brain chemical imbalances Foreshadowed modern views

The 19th Century General paresis (syphilis) and the biological link with madness 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 Technology Tip: Several sites offer comprehensive information on the etiology, effects, and treatment of syphilis: www.cdc.gov/std/syphilis/

The 19th Century John P. Grey and the reformers Championed biological tradition in the U.S.

Consequences of the Biological Tradition Mental illness = physical illness Emil Kraepelin Diagnosis and classification

The Psychological Tradition The rise of moral therapy More humane treatment of institutionalized patients Encouraged and reinforced social interaction Technology Tip: The University of Evansville website hosts a number of works related to Greek contributions to psychology: (http://cogsci.evansville.edu/orcs/18.htm)

The Psychological Tradition Proponents of moral therapy Philippe Pinel and Jean-Baptiste Pussin Benjamin Rush – led reforms in U.S. Dorothea Dix – mental hygiene movement William Tuke – followed Pinel’s lead in England Asylum reform and the decline of moral therapy Emergence of competing alternative psychological models

Psychoanalytic Theory Freudian theory of the structure and function of the mind Unconscious Catharsis Psychoanalytic model 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) Technology Tip: Visit http://www.freud-museum.at/e/ for more information on Freud and his history.

Psychoanalytic Theory Defense mechanisms: 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

FIGURE 1.4  Freud’s structure of the mind.

Later Developments in Psychoanalytic Thought Anna Freud and self-psychology Emphasized influence of the ego in defining behavior Melanie Klein, Otto Kernberg, and object relations theory Emphasized how children incorporate (introject) objects Objects – images, memories, and values of significant others Technology Tip: Visit the following websites for more information about Anna Freud: www.ship.edu/~cgboeree/annafreud.html www.webster.edu/~woolflm/annafreud.html

Later Developments in Psychoanalytic Thought (continued) The “Neo-Freudians”: Departures from Freudian thought De-emphasized the sexual core of Freud’s theory Jung, Adler, Horney, Fromm, and Erickson

Psychoanalytic Psychotherapy: The “Talking” Cure Unearth the hidden intrapsychic conflicts “The real problems” Therapy is often long-term Techniques Free association Dream analysis Examine transference and counter-transference issues Psychodynamic psychotherapy Little evidence for efficacy

Humanistic Theory Major players Major themes Abraham Maslow and Carl Rogers Major themes People are basically good Humans strive toward self-actualization Discussion Tip: Have students provide examples of evidence of individuals demonstrating the self-actualizing tendency.

Humanistic Theory Person-centered therapy Therapist conveys empathy and unconditional positive regard Minimal therapist interpretation There is no strong evidence that humanistic therapies work.

The Behavioral Model Derived from a scientific approach to the study of psychopathology Classical conditioning (Pavlov; Watson) Ubiquitous form of learning Contingency between neutral and unconditioned stimuli Conditioning was extended to the acquisition of fear

The Beginnings of Behavior Therapy Challenged psychoanalysis and non-scientific approaches Early pioneers Joseph Wolpe – systematic desensitization Operant conditioning (Thorndike; Skinner) Reinforcement Another ubiquitous form of learning Voluntary behavior is controlled by consequences Questions: Briefly describe classical conditioning in your own words. What is meant by generalization and discrimination?

The Beginnings of Behavior Therapy Learning traditions influenced the development of behavior therapy. Behavior therapy tends to be time-limited and direct Strong evidence supporting the efficacy of behavior therapies Technology Tip /Discussion Tip: This website (http://www.guidetopsychology.com/sysden.htm) has an interesting overview of systematic desensitization presented as a “do it yourself” model. Have students check the site and then discuss how this could actually be applied and where things could potentially go wrong.

An Integrative Approach Psychopathology is multiply determined. Unidimensional accounts of psychopathology are incomplete. Discussion Tip: Use the Blind Men and the Human Elephant activity in the Instructor Resource Manual to illustrate the importance of taking an integrative, multidimensional approach and the dangers of scientific tunnel vision.

An Integrative Approach Must consider reciprocal relations among: Biological, psychological, social, and experiential factors Defining abnormal behavior Complex, multifaceted, and has evolved The supernatural tradition Has no place in a science of abnormal behavior