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 Psychology Disorder v. Mental illness Many Myths Are Associated With Mental Illness Lazy, crazy, dumb Weak in character Dangerous to self or others Mental illness is a hopeless situation

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

Definition of Abnormal Behavior (cont.) Figure 1.1 The criteria defining a psychological disorder

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-5) DSM Contains Diagnostic Criteria plus Subtypes and Specifiers Psychopathology is the Scientific Study of Psychological Disorders

DSM - 5 Definition - 2013 A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotional regulation or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally appropriate response to a common stress or loss, such as death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between individuals and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. DSM-5, p. 20.

The Science of Psychopathology Mental Health Professionals The Ph.D.: Clinical, counseling, and school psychologists The Psy.D.: Clinical, counseling, and school psychologists “Doctors of Psychology” M.D.’s: Psychiatrists (medications) Child or Adult Board Certified – extra training M.S.W.’s: Psychiatric and non-psychiatric social workers MN/MSN’s: Psychiatric nurses LPC - Licensed Mental Health/Professional Counselor United by the Scientist-Practitioner Framework

Psychology Training Models Boulder Model – 1948 Ph.D. – Scientist –Practitioner (4-5+ years of training) Producers of Research Consumers of Research Evaluators of Their Work Using Empirical Methods Teachers/Faculty Vail Model - 1973 Psy.D. – Professional Practitioner (4-5+ years of training) Practice focus Consumer of research Empirical validated methods

Dimensions of the Scientist-Practitioner Model (cont.) Figure 1.2 Functioning as a scientist-practitioner

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 Other features (e.g. age, developmental stage, ethnicity, race) Add: Subtypes and Specifiers – DSM 5

Causation, Treatment, and Outcome What Factors Contribute to the Development of Psychopathology? Study of etiology 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 - “Evidence Based Treatment” 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 Tradition Mental Illness = Physical Illness, such as “nerves” or “chemical imbalance”

The Psychological Tradition The Rise of Moral Therapy Involved more humane treatment of institutionalized patients Encourage and reinforced social interaction Proponents of Moral Therapy Dorothea Dix Philippe Pinel and Jean-Baptiste Pussin William Tuke followed Pinel’s lead in England Reasons for the Falling Out of Moral Therapy Emergence of Competing Alternative Psychological Models

Psychoanalytic Theory Freudian Theory of the Structure and Function of the Mind 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 and the Psychoanalytic Tradition (cont.) Figure 1.4 Freud’s structure of the mind

Later Developments in Psychoanalytic Thought Anna Freud and Self-Psychology Emphasized the influence of the ego in defining behavior Melanie Klein, Otto Kernberg, and Object Relations Theory Emphasized how children incorporate (introject) objects Examples include images, memories, and values of significant others (objects) The Neo-Freudians: Departures From Freudian Thought Carl Jung, Alfred Adler, Karen Horney, Erich Fromm, and Erik Erickson De-emphasized the sexual core of Freud’s theory

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

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

Behavioral-Cognitive Albert Ellis – Rational Emotive Behavior Therapy – RET/REBT – 1950’s - It is what we think that causes us to be disturbed Albert Bandura – Social Learning Theory – 1960 (vicarious learning) & Social Modeling Aaron (Tim) Beck MD – Cognitive Therapy (1960 & 70); David Burns, MD - Cognitive distortions Arnold Lazarus – Multimodal Therapy – 1970’s – 7 domains to address in assessment and treatment BASIC- ID; Behavior, Affect, Sensation, Imagery, Cognitive, Interpersonal, and Drug (physical)

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

Warning Signs – 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 and 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

Warning Signs – Younger Children Changes in school performance Poor grades despite strong efforts Excessive worry or anxiety ( i.e. refusal to go to bed/school) Hyperactivity – excessive Persistent nightmares Persistent disobedience or aggression Frequent temper tantrums

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