1. Abnormality revision PSYA2

2. Abnormality Definitions of abnormality Deviation from social norms Failure to function adequately Deviation from ideal mental health Explanations of abnormality Biological approach Cognitive approach Behavioural approach Psychodynamic approach Biological treatments for abnormality Drug therapy Electroconvulsive therapy (ECT) Psychosurgery Psychological treatments for abnormality Cognitive behavioural therapy (CBT) Systematic desensitisation Aversion therapy Psychoanalysis (includes dream analysis and free association)

3. Definitions of abnormality

4. Deviation from social norms definition Under this definition a person is considered abnormal if they deviate from the social norms within a society (or section of society).

5. Evaluation of deviation from social norms definition Easy to see if someone is abnormal – means help can be obtained quickly. What is abnormal in one context/situation may be normal in another e.g. wearing PJ’s to Tescos or in bed. Social norms may change over time e.g. attitudes towards homosexuality. Social norms vary between subcultures e.g. chavs and emos.

6. Evaluation of deviation from social norms definition Difficult to establish if someone is abnormal or just eccentric. Criminals break social norms but are not necessarily abnormal. Could be used as a form of control e.g. unmarried mother put into mental institutions. Social norms may vary between cultures.

7. Failure to function adequately definition Under this definition a person is considered abnormal if they are unable to cope with the demands of everyday life. Six criteria suggested by Rosenhan and Seligman: 1. Suffering/personal distress 2. Maladaptive behaviour – behaviour that prevents an individual from achieving major life goals 3. Vividness & unconventionality (stands out) 4. Unpredictably & loss of control 5. Irrationality/incomprehensibility – behaviour that does not appear to make sense to others 6. Causes observer discomfort 7. Violates moral/social standards

8. Evaluation of failure to function adequately definition Doesn’t condone intervention if the person is not harming themselves or others. Closest to the technique used by healthcare professionals – General Assessment of Functioning scale (GAF). Some people may have a mental disorder but still function adequately e.g. Stephen Fry, Winston Churchill. Some people may be judged as not functioning adequately but are not abnormal (e.g. travellers).

9. Evaluation of failure to function adequately definition Subjective – someone has to decide what an adequate level of functioning is (healthcare professional – could be biased). Role of context - most people do not function adequately at times (e.g. before exams) but are not abnormal. What is considered ‘adequate functioning’ may vary between cultures e.g. Western (individualist) cultures may place more value on earning money/achieving personal success than collectivist cultures.

10. Deviation from ideal mental health definition Deviation from ideal mental health – a person is considered abnormal if they do not meet the criteria needed for ideal mental health. Seven criteria suggested by Marie Jahoda: 1. Positive attitudes towards the self 2. Self actualisation of one’s potential – see next slide 3. Resistance to stress 4. Personal autonomy - independence 5. Accurate perception of reality 6. Adapting to the environment, including formation of healthy relationships

11. Self actualisation Maslow’s Hierarchy of Needs. Lower level needs must be achieved to reach higher levels. Self actualisation is the peak – the best we can be (supposedly).

12. Evaluation of deviation from ideal mental health definition Differs from other attempts at definition in that it focuses on the positive rather than the negative. Gives an ‘abnormal’ individual a set of criteria to aim towards. May not apply to all cultures e.g. collectivist cultures less likely to value personal autonomy. Very few people achieve self actualisation.

13. Evaluation of deviation from ideal mental health definition Ideal mental health is subjective – decided by healthcare professionals – possible bias. Possible benefits of stress – a moderate level of stress has been shown to be beneficial –Yerkes Dodson law, therefore it may be wrong to assume that resistance to stress is always ‘ideal.’

14. Explanations of abnormality

15. Biological approach Main assumption is that all mental disorders have an underlying physical cause.

16. Biological approach Biochemistry – e.g. low levels of the neurotransmitter serotonin are linked with depression. Infection – e.g. higher rate of SZs born in autumn/winter – thought to be linked to exposure to the flu virus in the womb. Neurology – post mortems of Alzheimer's patients show differences in brain structure. Genetics – concordance rate of 48% between MZ twins with schizophrenia. Genetic link has been investigated using twin, family and adoption studies.

17. Evaluation of the biological approach Doesn’t blame the sufferer because mental illness is considered in the same way as physical illness. The biological explanation is supported by lots of research. However, research is inconclusive – not all mental illness can be attributed to an underlying physical cause (e.g. concordance rate for schizophrenia in twins is not 100%). The biological approach is often accused of being reductionist because it reduces complex human behaviour to the level of cells and genes – does not consider psychological or social factors.

18. Evaluation of the biological approach Difficult to be sure if abnormality is the cause of differences in biochemistry/brain structure or an effect. Biological treatments do seem to be effective, which supports the theory that physical factors do play a part. Labelling someone with a mental illness (e.g. SZ) leads to stigma that a person may carry for the rest of their life. Takes control away from the sufferer – only a doctor can make them better.

19. Psychodynamic approach Main assumption is that abnormality is a result of unresolved unconscious conflicts originating from childhood experiences.

20. Psychodynamic approach Fixation at one or more of the psychosexual stages of development – oral, anal, phallic, latent, genital e.g. fixation at oral stage could lead to eating disorders. An imbalance between the 3 parts of the mind – id, ego and superego – e.g. if superego is too strong, the person may suffer anxiety disorders. Overuse of ego defence mechanisms – denial, repression, reaction formation, etc. e.g. overuse of denial could lead to a break from reality (schizophrenia).

21. Evaluation of the psychodynamic approach Hugely influential – many psychodynamic terms are in everyday use and Freud was the first to suggest ‘talking therapy’ – the basis for modern counselling. Doesn’t consider the role of adult experiences in abnormality e.g. divorce, bereavement, etc. Based on case studies – may not be generalisable to general population. Blames parents for mental illness – consequences of their child rearing practices e.g. potty training.

22. Evaluation of the psychodynamic approach Case studies use retrospective self report data – P’s may not be truthful/may not remember accurately. Criticised as being unscientific because much of the theory is impossible to measure (not observable). Often accused of being deterministic because it suggests that we have no control over our adult life – it is predetermined by childhood experiences.

23. Behavioural (learning) approach Main assumption is that all mental abnormality is a result of one or more types of learning.

24. Behavioural approach Classical conditioning - learning by association e.g. phobias – Little Albert Operant conditioning – learning by reinforcement (positive and/or negative) – e.g. extra attention given after bereavement may encourage continuation of the behaviour until it develops into depression. Negative reinforcement – school phobia could develop because person avoids anxiety by staying at home Social learning theory – learning by observation of others (more likely if others receive positive outcomes for their behaviour) – e.g. eating disorders from observation of fashion models

25. Evaluation of the behavioural approach Doesn’t label those with a mental illness – just views it as maladaptive behaviour that can be unlearned in the same way it was learned – therefore little or no stigma. Takes a positive approach – if behaviour is not damaging to self or others then it is not abnormal – led to the failure to function adequately definition. Has lead to practical treatments that do seem to be effective, particularly when combined with a cognitive element – e.g. CBT – this lends support to the behavioural explanation.

26. Evaluation of the behavioural approach Reductionist – reduces complex human behaviour to the level of simple behaviour – doesn’t consider biological or social factors Doesn’t consider the underlying causes of abnormality. Psychologists from other approaches (e.g. psychodynamic) suggest that the behaviour is only the tip of the iceberg and if underlying causes are not dealt with, symptoms could return or reappear in another manner (symptom substitution)

27. The cognitive approach Main assumption is that mental abnormality is a result of negative/irrational thought processes. It is not the event that causes the problem, but the way that the person thinks about the event.

28. The cognitive approach Albert Ellis suggested several types of irrational cognitions can lead to abnormality (particularly depression and anxiety): Polarised thinking – viewing the world in ‘black and white’ – e.g. if I am not the best at everything I am a failure Over generalisation – seeing random events as a pattern – e.g. things always go wrong for me Musterbation – believing I must/should/ought do or be something – involves setting unrealistic standards for yourself which lead to inevitable failure Catastrophising – believing that events are worse than they really are, or always expecting the worst possible outcome

29. The cognitive approach Beck’s cognitive triad is one explanation for the development of depression – negative views about the self lead to negative views of others and negative views of the future. Everyone thinks that I am useless I will always be useless I am useless

30. Evaluation of the cognitive approach Research (e.g. Gustafson) has found that many people with depression and anxiety do have irrational and negative thought patterns. Treatments based on the cognitive approach (CBT) are effective – supports the role of faulty cognitions in abnormality. Doesn’t consider how or why a person has developed faulty thinking – could be childhood trauma, biological explanation, etc.

31. Evaluation of the cognitive approach Cause or effect? It may be that faulty thinking is a consequence of a mental condition, rather than the cause. Lays blame on the individual because it suggests it is their fault that they think this way – this could make them feel worse. Beck viewed depression as an indulgent of self defeating thoughts. Some people do have difficult lives so their negative thinking may be realistic and reasonable.

32. Biological treatments for abnormality

33. Electroconvulsive therapy Used as a last resort for severe depression. Was used as treatment for SZ in past, but not now. Patient is given a general anaesthetic and muscle relaxant. Electrodes are applied to the temples and electric current (70-130 volts) is given for no more than half a second – this causes a seizure (fit) which lasts for up to a minute. Usually a course of 6-12 treatments, given 2-3 times a week. It is still unclear who ECT works but it is thought to increase the number of neurotransmitters available in the brain (e.g. serotonin and dopamine). Over 11, 000 patients received ECT in 1999.

34. Evaluation of ECT Effectiveness – does seem to be effective, with 50-70% of patients showing an improvement after treatment. Relapse – However, research shows that 60% of patients will become depressed again within a year. Former side effects – In the past, ECT could lead to broken bones due to the intensity of the convulsions, but this is no longer a problem due to the muscle relaxant now given prior to treatment.

35. Current side effects – Short term memory loss is common. Former ethical issues – In the past, ECT was sometimes used to control ‘problem’ patients. Current ethical issues – Patients are usually required to give written consent for the procedure, but it is difficult to say if this consent can be fully informed, given that they are suffering from a mental conditioned. Patients can be given ECT against their will if they have been ‘sectioned’ (detained on the recommendation of 2 health care professionals). Approximately 2000 patients are given ECT without consent each year. Evaluation of ECT

36. Drug treatment Aim is to regulate the imbalance of biochemical's which are thought to be causing the abnormality. Four common categories of drugs: Anti-depressants (e.g. Prozac) - used to treat depression and eating disorders. Anti-psychotics (e.g. chlorpromazine)– commonly used to treat psychotic disorders (where patients experiences detachment from reality), such as schizophrenia. Anti-anxiety (e.g. Valium) – used to treat anxiety disorders, phobias, OCD, etc. Anti manic – used to treat bi-polar disorder (formerly called manic depression).

37. Evaluation of drug treatment Effectiveness - drug treatments do appear to be effective, and have allowed people who would have formerly been institutionalised to live more ‘normal’ lives in the community Speed of effect – begin to work more quickly than therapy, so can allow the patient to improve enough to consider other forms of therapy (e.g. CBT)

38. Evaluation of drug treatment Relapse – drugs may only treat the symptoms but not the underlying cause – e.g. a person may be depressed due to social factors. This may mean that symptoms reappear when treatment ends. Ethical issues – used in the past as a form of control, but now requires consent. However, still the issue of whether a mentally ill patient can given fully informed consent. Side effects – some drugs have side effects that may be worse than the condition they are used to treat. For example, a side effect of SZ drug treatment is tardive dyskinesia – an involuntary twitching of the facial muscles.

39. Psychological treatments for abnormality

40. Systematic desensitisation A behavioural therapy commonly used to treat phobias: Patient and therapist work together to create a hierarchy of fear provoking situations e.g. looking at photo of spider to holding one. Can use in vitro (imagined) or in vivo (real life) situations. Begin at lowest level of hierarchy – patient is taught relaxation techniques so that they can confront the situation without fear/anxiety. Reciprocal inhibition means that we cannot feel fear and relaxation at same time (two conflicting emotions). Patient is ‘cured’ when they can be relaxed as the highest level of the hierarchy.

41. Evaluation of systematic desensitisation Effectiveness in treating phobias is supported by research. In vivo techniques rely on patients imagination so may not be effective for all – research shows that in vivo techniques are more effective and longer lasting. There are quicker alternatives – such as flooding, where patient is exposed to highest level immediately – but these may cause more distress than SD. Some patients may suffer from symptom substitution – because the underlying issue has not been fully addressed, their phobia of a particular object/situation could be transferred to a different object situation.

42. Aversion therapy A behavioural treatment based on classical conditioning. Aims to rid the individual of an undesirable habit (e.g. addictions) by associating it with an unpleasant stimulus. E.g. alcoholics can be given a drug which causes nausea when alcohol is consumed.

43. Evaluation of aversion therapy Some research supports effectiveness of AV. But does not appear to be long lasting – may relapse. May allow patients to abstain from addiction long enough to try other, longer lasting therapies. Ethical issues – can the patient give fully informed consent to a possibly traumatic procedure if they are mentally ill? The therapist may also suffer distress from administering the treatment.

44. Cognitive behavioural therapy Incorporates both cognitive and behavioural theories about the causes of abnormality. Commonly used for a wide range of disorders, especially depression. Cognitive component: Therapist and client work together to identify negative and/or irrational thought patterns which may have caused abnormality. Behavioural component: Therapist sets ‘homework’ for the patient which challenges the truth of their irrational thoughts. E.g. if patients believes that they must say yes to every demand made of them because people will not like them otherwise, homework could be to say no and see what the response is – not likely to be as they expect.

45. Evaluation of CBT Useful for a wide variety of disorders e.g. depression, anxiety, phobias, etc. At least as effective as drugs for treating depression. Relatively quick and therefore inexpensive – available on the NHS. Gives the patient control over their own condition – less ethical issues than other treatments. Can be combined with other treatments for improved effectiveness – e.g. drugs.

46. Psychoanalysis A name given to psychodynamic treatments, which covers a number of different techniques. They all have the same aim – to bring unconscious conflicts into the conscious mind. Freud believed that conscious recognition of these conflicts is enough to resolve the patient’s symptoms (e.g. depression).

47. Forms of psychoanalysis Dream analysis – the patient reports their dreams to the therapist- symbols from dreams are interpreted as an indication of the unconscious, which the therapist will then discuss with the patient. Free association – patient is encouraged to talk freely about whatever comes into their head. Talking without conscious thought is believed to reveal the unconscious. Transference - the attitudes, feelings, and desires of our very early significant relationships get transferred onto the therapist. Unconscious issues with these relationships can then be addressed (e.g. resentment towards mother).

48. Evaluation of psychoanalysis Time consuming and expensive. Mixed findings on effectiveness – between 30- 60%. Research only supports effectiveness for certain disorders e.g. mild anxiety. Not effective for all – especially more severe conditions like SZ. Power lays with the therapist to interpret and analyse the patient- takes control of the condition away from the patient. Patient may become dependent on therapist due to length and nature of treatment.