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

Outline Understanding Psychopathology: The Basics Historical perspective The Supernatural Tradition Roots of modern research The Biological Tradition The Psychological Tradition An Integrative Approach

What Is a Psychological Disorder? 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 (e.g., school, job, relationships) Impairment is set in the context of a person’s background Atypical or not culturally expected response Reaction is outside cultural norms

The Criteria for Defining a Psychological Disorder FIGURE 1.1  The criteria defining a psychological disorder.

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-5) DSM contains diagnostic criteria Most recent update occurred May 2013 The field of psychopathology The scientific study of psychological disorders

The Science of Psychopathology Mental health professionals The Ph.D.: Counseling or Clinical Psychologist Trained in research, teaching, and treatment The Psy.D.: Clinical Psychologist “Doctor of Psychology” Trained in treatment Licensed Mental Health Counselor (LMHC) Licensed Clinical Social Worker (LICSW) M.D.: Psychiatrist Psychiatric Nurse

The Scientist-Practitioner Practice (treatment delivery) and research mutually influence each other Stays current with research in field Evaluates own assessment and treatment Conducts research

Mental Health Professional FIGURE 1.2  Functioning as a scientist-practitioner.

Three Major Categories When Discussing Psychological Disorders 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 Combination of behaviors, thoughts, and feelings that make up a specific disorder Prevalence = number of people in a population who have the disorder (presently) Incidence = number of new cases over a period of time (i.e., per year)

Clinical Description Sex ratio Is there a higher proportion of males/females with the disorder? Most disorders follow a particular pattern, or course Chronic: disorder lasts a long time (possibly throughout one’s life) Episodic: likely to recover in a few months, but suffer a recurrence of the disorder at a later time Time-limited: typically improve without treatment in a relatively short period of time

Clinical Description Onset of disorders Acute: disorder begins suddenly Insidious: disorder develops gradually over an extended period of time Prognosis = the anticipated course of a disorder over time Good, guarded, poor

Causation, Treatment, and Outcome Etiology = cause of disorder What contributes to the development of psychopathology? Treatment development How can we help alleviate psychological suffering? Includes pharmacologic, psychosocial, and/or combined treatments 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.

Historical Conceptions of Abnormal Behavior Three dominant traditions have existed in the past to explain abnormal behavior Supernatural Biological Psychological

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 – emotions spread Mob psychology – people are suggestible when in high states of emotion; and in big groups of people The moon and the stars Paracelsus and lunacy “lunatic” derived from Latin word for moon – Luna Think: Astrology – horoscopes

The Biological Tradition Hippocrates (460-377 B.C.): Abnormal behavior as a physical disease Hysteria “The Wandering Uterus” (paralysis, blindness) Similar what are now called Somatoform Disorders Hippocratic-Galenic Humoral Theory of Mental Illness Blood = sanguine (cheerful, optimistic; insomnia, delirium Black bile = melancholic (depression) Yellow bile = choleric (hot tempered) Phlegm = phlegmatic (apathy, sluggishness; calm under stress) *Mental illness associated with having too much or too little of these fluids Treated by changing environmental conditions (e.g., reducing heat) or bloodletting/vomiting *Inaccurate, but foreshadowed modern views (i.e., chemical imbalance)

The 19th Century General paresis (syphilis) and the biological link with madness Several unusual psychological and behavioral symptoms – delusional/psychotic Pasteur discovered the cause – a bacterial microorganism Led to penicillin as a successful treatment Bolstered the view that mental illness = physical illness

The 19th Century John P. Grey and the reformers Psychiatrist who believed mental illness had physical roots Championed biological tradition in the U.S. Led to reforms of hospitals to give psychiatric patients better care

Early Biological Treatments Electric shock Crude surgery (e.g., frontal lobotomies) Insulin (discovered by accident to calm psychotic patients) Major tranquilizers (discovered mid-20th C) – first true antipsychotics; many negative side effects (e.g., Thorazine, Haldol) Minor tranquilizers – typically the category of benzodiazepines; commonly prescribed for anxiety today (e.g., Xanax, Valium)

Consequences of the Biological Tradition Mental illness = physical illness Emil Kraepelin: Classification of disorders Emphasized that different disorders have unique age of onset, symptoms, and causes

The Psychological Tradition The rise of moral therapy Became popular in first half of 19th century “Moral” = referring to psychological/emotional factors Main idea: Treat patients as normally as possible in normal environment More humane treatment of institutionalized patients Encouraged and reinforced social interaction

The Psychological Tradition Proponents of moral therapy Philippe Pinel and Jean-Baptiste Pussin – patients should not be restrained (1700s) Benjamin Rush – led reforms in U.S. (1700s) Asylum reform = more patients receiving care Dorothea Dix – mental hygiene movement (1800s) Further improved standards of care, BUT significant increase in number of patients eventually resulted in decline of moral therapy (too many to care for) Soon followed by emergence of competing alternative psychological models

Are Treatments Better Today? “Wilderness Programs” with “tough love” “Scared Straight” Teen Boot Camps *“Breaking down” and “building up” does not work Continued debate on electroshock therapy (ECT) DARE

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)

Psychoanalytic Theory FIGURE 1.4  Freud’s structure of the mind.

Psychoanalytic Theory Defense mechanisms – ego’s attempt to manage anxiety resulting from id/superego conflict Repression, Displacement, Denial, Rationalization, Reaction Formation, Projection, and Sublimation If ineffective then neuroses result (i.e., anxiety) Psychosexual stages of development Oral, anal, phallic, latency, and genital stages

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 Little research 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 Hierarchy of needs (Maslow) Unconditional positive regard (Rogers)

Humanistic Theory Person-centered therapy Therapist conveys empathy and unconditional positive regard Minimal therapist interpretation No strong evidence that purely humanistic therapies work to treat mental disorders More effective for people dealing with normal life stress, not suffering from psychopathology

The Behavioral Model Derived from a scientific approach to the study of psychopathology Classical conditioning (Pavlov; Watson – “Little Albert”) Ubiquitous form of learning People learn associations between neutral stimuli and stimuli that already have meaning (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

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 Eventually leads to development of Cognitive-Behavioral Therapy (CBT) The most effective treatment approach for most disorders/problems

An Integrative Approach Psychopathology is multiply determined Unidimensional accounts of psychopathology are incomplete

An Integrative Approach Must consider reciprocal relations among: Biological, psychological, social, and experiential factors Defining abnormal behavior Complex, multifaceted, and has evolved Science of psychopathology is evolving The supernatural tradition no longer has a place in a science of abnormal behavior Ongoing research informs our understanding

FYI

Warning Signs for Psychological Disorders in Young Children Changes in school performance Poor grades despite strong efforts Excessive worry or anxiety (i.e. refusing to go to bed or school) Hyperactivity Persistent nightmares Persistent disobedience or aggression Frequent temper tantrums

Warning Signs for Psychological Disorders in Adolescents Substance abuse Inability to cope with problems and daily activities Change in sleeping and/or eating habits Excessive complaints of physical ailments Defiance of authority, truancy, theft, and/or vandalism Intense fear of weight gain Prolonged negative mood, accompanied by poor appetite or thoughts of death Frequent outbursts of anger

Warning Signs for Psychological Disorders in Adults Confused thinking Prolonged depression (sadness or irritability) Feelings of extreme highs and lows Excessive fears, worries and anxieties Social withdrawal Dramatic changes in eating or sleeping habits Strong feelings of anger Delusions or hallucinations Growing inability to cope with daily problems and activities Suicidal thoughts Denial of obvious problems Numerous unexplained physical ailments Substance abuse