1. PSY 301 INTRODUCTION to PSYCHOPATHOLOGY Dr. İlkiz Altınoğlu Dikmeer Fall 2014 © 2012 John Wiley & Sons, Inc. All rights reserved.

2. PowerPoint  Lecture Notes Presentation Chapter 1 Introduction and Historical Review Abnormal Psychology, Twelfth Edition by Ann M. Kring, Sheri L. Johnson, Gerald C. Davison, & John M. Neale & John M. Neale Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.

3. Chapter Outline Chapter 1: Introduction and Historical Review I. Introduction to the Study of Mental Disorders II. History of Psychopathology III. The Evolution of Contemporary Thought IV. The Mental Health Professions © 2012 John Wiley & Sons, Inc. All rights reserved.

4. Psychopathology Study of the nature, development, and treatment of psychological disorders Challenges to the study of psychopathology: – Maintain objectivity – Avoid preconceived notions – Reduce stigma © 2012 John Wiley & Sons, Inc. All rights reserved.

5. Figure 1.1: Four Characteristics of Stigma © 2012 John Wiley & Sons, Inc. All rights reserved.

6. Defining Mental Disorder Personal Distress – Emotional pain and suffering Helplessness and hopelessness of depression Disability – Impairment in a key area (e.g., work, relationships) Chronic substance abuse results in job loss Violation of Social Norms – Makes others uncomfortable or causes problems Antisocial behavior of the psychopath Dysfunction – Wakefield's Harmful Dysfunction: failure of internal mechanisms in the mind to function properly © 2012 John Wiley & Sons, Inc. All rights reserved.

7. Figure 1.2: Key Characteristics in the Definition of Mental Disorder © 2012 John Wiley & Sons, Inc. All rights reserved.

8. History of Psychopathology Early Demonology – Possession by evil beings or spirits Exorcism Early Biological Explanations – Hippocrates (5 th century BC) Mental disturbances have natural (not supernatural) causes (problems with the brain) – Three categories of mental disorders: mania, melancholia, & phrenitis (brain fever) – Normal brain functioning depended on balance of four humors: blood, black bile, yellow bile, & phlegm © 2012 John Wiley & Sons, Inc. All rights reserved.

9. History of Psychopathology: Dark Ages Dark Ages (2 nd century AD) – Galen: last great physician of classical era – Al-Razi (9 th cent): facility in Baghdad, early practice of psychotherapy – Monks cared and prayed for mentally ill – Return to the belief in supernatural causes of mental disorders. Witches (13 th century AD) – Torture sometimes led to bizarre delusional sounding confessions, e.g., concourse with demons. Initially, historians concluded many of the accused were mentally ill. Further research found little support for this conclusion. © 2012 John Wiley & Sons, Inc. All rights reserved.

10. History of Psychopathology: Lunacy Trials Lunacy Trials – Trials held to determine sanity (orientation, memory, intellect, daily life and habits) Began in 13 th century England – Municipal authorities assumed responsibility for care of mentally ill – Lunacy attributes insanity to misalignment of moon (“luna”) and stars © 2012 John Wiley & Sons, Inc. All rights reserved.

11. History of Psychopathology: Asylums Asylums (15 th century AD) – Establishments for the confinement and care of mentally ill. Leprosariums were converted into asylums. – Priory of St. Mary of Bethlehem (founded in 1243) One of the first mental institutions The wealthy paid to gape at the insane Origin of the term bedlam (wild uproar or confusion) – Treatment non-existent or harmful at asylums Benjamin Rush recommended drawing copious amounts of blood, to relieve brain pressure which causes mental disorder. © 2012 John Wiley & Sons, Inc. All rights reserved.

12. History of Psychopathology: Pinel’s Reforms and Moral Treatment Philippe Pinel (1745-1826) – Pioneered humanitarian treatment at LaBicetre – Chains were removed, rooms replaced dungeons. Moral Treatment – Small, privately funded, humanitarian mental hospitals Friends Asylum (1817) Patients engaged in purposeful, calming activities (e.g., gardening) Talked with attendants © 2012 John Wiley & Sons, Inc. All rights reserved.

13. History of Psychopathology: Dorothea Dix Dorothea Dix (1802-1887) – Crusader for prisoners and mentally ill – Urged improvement of institutions – Worked to establish 32 new, public hospitals – Unfortunately, small staffs at these new public hospitals could not provide necessary individual attention – Hospitals administered by physicians, who were more interested in biological rather than psychological aspects of mental illness © 2012 John Wiley & Sons, Inc. All rights reserved.

14. The Evolution of Contemporary Thought : Biological Approaches General paresis and Syphilis – Degenerative disorder with psychological symptoms (delusions of grandeur) and physical symptoms (progressive paralysis) – By mid-1800’s, it was known that general paresis and syphilis occurred together in some patients – In 1905, biological cause of syphilis found – Since general paresis had biological cause, other mental illness might also Biological causes of psychopathology gained credibility © 2012 John Wiley & Sons, Inc. All rights reserved.

15. The Evolution of Contemporary Thought : Genetics Galton’s (1822-1911) work lead to notion that mental illness can be inherited – Nature (genetics) and nurture (environment) – Eugenics Promotion of enforced sterilization (restricting the ability of people to have children) to eliminate undesirable characteristics from the population Many state laws required mentally ill to be sterilized By 1945, more than 45 000 people with mental illness were forcibly sterilized. © 2012 John Wiley & Sons, Inc. All rights reserved.

16. Early Biological Treatments Insulin-coma therapy – Sakel ( 1930’s)  for schizophrenia, serious health risks (e.g., irreversible coma and death) Electroconvulsive Therapy (ECT) – Cerletti and Bini (1938) – Induce epileptic seizures with electric shock – Still being used esp. for severe depression Prefrontal lobotomy – Moniz (1935) – A surgical procedure that destroys the connection tracts of frontal lobe to the other areas of brain. – Often used to control violent behaviors; led to listlessness, apathy, and loss of cognitive abilities © 2012 John Wiley & Sons, Inc. All rights reserved.

17. The Evolution of Contemporary Thought: Psychological Approaches Mesmer (1734-1815) – Treated patients with hysteria using “animal magnetism” – Early practitioner of hypnosis Charcot (1825-1893) – His support legitimizes hypnosis as treatment for hysteria Breuer (1842-1925) – Used hypnosis to facilitate catharsis in Anna O. – Cathartic Method Release of emotional tension triggered by reliving and talking about event © 2012 John Wiley & Sons, Inc. All rights reserved.

18. Freud Breuer and Freud (1856-1939) jointly publish, “Studies in Hysteria” in 1895, which serves as the basis for Freud’s theory. Freudian or Psychoanalytic theory – Human behavior determined by unconscious forces. – Psychopathology results from conflicts among these unconscious forces. © 2012 John Wiley & Sons, Inc. All rights reserved.

19. Freud’s Structures of the Mind Id – Unconscious – Pleasure principle Immediate gratification – Libido Energy of ID Ego – Primarily conscious – Reality principle Attempt to satisfy ID’s demands within reality’s constraints Superego – The conscience – Develops as we incorporate parental and society values © 2012 John Wiley & Sons, Inc. All rights reserved.

20. Defense Mechanisms Id, Ego, & Superego continually in conflict – Conflict generates anxiety – Ego generates strategies to protect itself from anxiety Defense mechanisms Psychological maneuvers used to manage stress & anxiety © 2012 John Wiley & Sons, Inc. All rights reserved.

21. Table 1.2: Selected Defense Mechanisms © 2012 John Wiley & Sons, Inc. All rights reserved.

22. Psychoanalytic Therapy Goals of Psychoanalytic Therapy or Psychoanalysis – Understand early-childhood experiences, particularly key (parental) relationships – Understand patterns in current relationships Psychoanalytic Techniques – Free Association – Analysis of Transference – Interpretation © 2012 John Wiley & Sons, Inc. All rights reserved.

23. Table 1.3: Major Techniques of Psychoanalysis © 2012 John Wiley & Sons, Inc. All rights reserved.

24. Phallic Stage Child’s pleasure focuses on genitals Latency Stage Child represses sexual interest and develops social and intellectual skills Anal Stage Child’s pleasure focuses on anus Genital Stage A time of sexual reawakening; source of sexual pleasure becomes someone outside of the family Oral Stage Infant’s pleasure centers on mouth Freudian Stages 6 yrs to puberty Birth to 1½ yrs 1½ to 3 yrs Puberty onward 3 to 6 years

26. Neo-Freudians Jung (1875-1961) – Analytical psychology – Collective unconscious – Archetypes – Catalogued personality characteristics Extraversion vs. Introversion Adler (1870-1937) – Individual psychology Fulfillment derived from working for the social good © 2012 John Wiley & Sons, Inc. All rights reserved.

27. Continuing Influences of Freud and His Followers Childhood experiences help shape adult personality  less emphasis on psychosexual stages but more on parent-child interactions. There are unconscious influences on behavior  but not a repository of id instincts The causes and purposes of human behavior are not always obvious  finding hidden meanings in behavior. © 2012 John Wiley & Sons, Inc. All rights reserved.

28. The Evolution of Contemporary Thought: Rise of Behaviorism John Watson (1878-1958) Behaviorism – Focus on observable behavior – Emphasis on learning rather than thinking or innate tendencies Three types of learning: – Classical Conditioning – Operant Conditioning – Modeling © 2012 John Wiley & Sons, Inc. All rights reserved.

29. Classical Conditioning Discovered by Pavlov (1849-1936) – Unconditioned Stimulus (UCS) Meat powder (automatically elicits salivation) – Unconditioned Response (UR) Salivation (automatic response to meat powder) – Neutral Stimulus (NS) Initial ringing of bell (does not automatically elicit salivation) – Conditioned Stimulus (CS) After pairing the NS and the UCS, the NS becomes a CS (bell now automatically elicits salivation) – Conditioned Response (CR) Salivation (automatic response to bell) – Extinction CS (bell) not followed by UCS (meat powder) causes gradual disappearance of CR (salivation) © 2012 John Wiley & Sons, Inc. All rights reserved.

30. Figure 1.3: The process of classical conditioning © 2012 John Wiley & Sons, Inc. All rights reserved.

31. Operant Conditioning E. Thorndike (1874-1949) – Learning through consequences – Law of Effect Behavior that is followed by satisfying consequences will be repeated; behavior that is followed by unpleasant consequences will be discouraged B.F. Skinner (1904-1990) – Principle of Reinforcement Positive reinforcement – Behaviors followed by pleasant stimuli are strengthened Negative reinforcement – Behaviors that terminate a negative stimulus are strengthened © 2012 John Wiley & Sons, Inc. All rights reserved.

32. Modeling Learning by watching and imitating others’ behaviors – Can occur without reinforcement Bandura & Menlove (1968) – Modeling reduced children’s fear of dogs © 2012 John Wiley & Sons, Inc. All rights reserved.

33. Behavior Therapy (1950’s) Behavior Therapy or Behavior Modification – Systematic Desensitization Used to treat phobias and anxiety Combines deep muscle relaxation and gradual exposure to the feared condition or object Starts with minimal anxiety producing condition and gradually progresses to most feared – Intermittent Reinforcement Rewarding a behavior only occasionally more effective than continious schedules of reinforcement © 2012 John Wiley & Sons, Inc. All rights reserved.

34. Importance of Cognitions Limitations of Behavior Therapy – How we think or appraise a situation influences our feelings and behaviors Cognitive Therapy – Emphasize how people think about themselves and their experiences can be a major determinant of psychopathology – Focus on understanding maladaptive thoughts – Change cognitions to change feelings and behaviors Ellis (1913-2007) – REBT (Rational-Emotive Behavior Therapy) © 2012 John Wiley & Sons, Inc. All rights reserved.

35. Mental Health Professions Psychologists – Clinical or Counseling – Ph. D. or Psy. D. Psychiatrists – M.D.’s can prescribe psychotropic medications Psychiatric Nurses and Psychiatric Nurses Practitioners – Nurse Practitioners can prescribe psychotropic medications Social Workers – M.S.W. – Not trained in psychological assessment Master’s Level Therapists & Counselors – MFT’s (Marriage and Family Therapists) © 2012 John Wiley & Sons, Inc. All rights reserved.

36. COPYRIGHT Copyright 2012 by John Wiley & Sons, New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. © 2012 John Wiley & Sons, Inc. All rights reserved.