Abnormal Psychology: Past and Present

Abnormal Psychology: Past and Present
Chapter 1 Slides & Handouts by Karen Clay Rhines, Ph.D.

Abnormal Psychology: Past and Present
What is abnormal psychology? The scientific study of abnormal behavior in an effort to describe, predict, explain, and change abnormal patterns of functioning Workers in the field may be: Clinical scientists Clinical practitioners Comer, Fundamentals of Abnormal Psychology, 7e

What Is Psychological Abnormality?
Many definitions have been proposed, yet none has won total acceptance Most definitions, however, have certain features in common: “The Four Ds” Deviance – Different, extreme, unusual, perhaps even bizarre Distress – Unpleasant and upsetting to the person Dysfunction – Interfering with the person’s ability to conduct daily activities in a constructive way Danger – Posing risk of harm While this definition is a useful starting point, it has key limitations Comer, Fundamentals of Abnormal Psychology, 7e

Comer, Fundamentals of Abnormal Psychology, 7e
Deviance From what? From behaviors, thoughts, and emotions that differ markedly from a society’s ideas about proper functioning From social norms Stated and unstated rules for proper conduct Examples? Judgments of abnormality vary from society to society as norms grow from a particular culture They also depend on specific circumstances Comer, Fundamentals of Abnormal Psychology, 7e

Distress According to many clinical theorists, behavior, ideas, or emotions usually have to cause distress before they can be labeled abnormal Not always the case Examples? Comer, Fundamentals of Abnormal Psychology, 7e

Dysfunction Abnormal behavior tends to be dysfunctional – it interferes with daily functioning Here again culture plays a role in the definition of abnormality Comer, Fundamentals of Abnormal Psychology, 7e

Danger Abnormal behavior may become dangerous to oneself or others Behavior may be consistently careless, hostile, or confused Although often cited as a feature of psychological abnormality, research suggests that dangerousness is the exception rather than the rule Comer, Fundamentals of Abnormal Psychology, 7e

The Elusive Nature of Abnormality
Ultimately, a society selects general criteria for defining abnormality and then uses those criteria to judge particular cases Szasz places such emphasis on society’s role that he finds the whole concept of mental illness to be invalid, a myth of sorts Deviations called “abnormal” are only “problems of living” Societies invent the concept of mental illness to better control or change people who threaten social order Comer, Fundamentals of Abnormal Psychology, 7e

Even if we assume that psychological abnormality is a valid concept, we may be unable to apply our definition consistently Examples: Diagnosis of alcohol problems in colleges Issue of abnormality versus eccentricity Comer, Fundamentals of Abnormal Psychology, 7e

In short, although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and sometimes dangerous, these criteria often are vague and subjective Few categories of abnormality are as clear-cut as they seem; most continue to be debated by clinicians Comer, Fundamentals of Abnormal Psychology, 7e

What Is Treatment? Once clinicians decide that a person is suffering from abnormality, they seek to treat it Treatment, or therapy, is a procedure designed to change abnormal behavior into more normal behavior It, too, requires careful definition Comer, Fundamentals of Abnormal Psychology, 7e

What Is Treatment? According to Jerome Frank, all forms of therapy have three essential features: A sufferer who seeks relief from the healer A trained, socially accepted healer, whose expertise is accepted by the sufferer and his or her social group A series of contacts between the healer and the sufferer, through which the healer… tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior Comer, Fundamentals of Abnormal Psychology, 7e

What Is Treatment? Despite this straightforward definition, clinical treatment is surrounded by conflict and confusion: Lack of agreement about goals or aims Lack of agreement about successful outcome Lack of agreement about failure Are clinicians seeking to cure? To teach? Are sufferers patients (ill) or clients (having difficulty)? Comer, Fundamentals of Abnormal Psychology, 7e

What Is Treatment? Despite their differences, most clinicians agree that large numbers of people need therapy of one kind or another Evidence also indicates that therapy is indeed often helpful Comer, Fundamentals of Abnormal Psychology, 7e

How Was Abnormality Viewed and Treated in the Past?
In any given year as many as 30% of adults and 19% of children and adolescents in the U.S. display serious psychological disturbances and are in need of clinical treatment In addition, most people have difficulty coping at various times Is this the fault of modern society? Although modern pressures may contribute, they are hardly the primary cause; every society, past and present, has witnessed psychological abnormality Comer, Fundamentals of Abnormal Psychology, 7e

How Was Abnormality Viewed and Treated in the Past?
Many present-day ideas and treatments have roots in the past Comer, Fundamentals of Abnormal Psychology, 7e

Ancient Views and Treatments
Historians have concluded that ancient societies probably regarded abnormal behavior as the work of evil spirits This view may have begun as far back as the Stone Age The treatment for severe abnormality was to force the demons from the body through trephination and exorcism Comer, Fundamentals of Abnormal Psychology, 7e

Ancient skull with holes from trephination
Comer, Fundamentals of Abnormal Psychology, 7e

Greek and Roman Views and Treatments
500 B.C. to 500 A.D. Philosophers and physicians offered different explanations and treatments for abnormal behaviors Hippocrates believed and taught that illnesses had natural causes He looked to an unbalance of the four fluids, or humors To treat psychological dysfunctioning, Hippocrates sought to correct the underlying physical pathology Comer, Fundamentals of Abnormal Psychology, 7e

Europe in the Middle Ages: Demonology Returns
500 – 1350 A.D. The church rejected scientific forms of investigation, and it controlled all education Religious beliefs came to dominate all aspects of life Once again, abnormality was seen as a conflict between good and evil Abnormal behavior apparently increased greatly during this period Some of the earlier demonological treatments reemerged At the close of the Middle Ages, demonology and its methods began to lose favor again Comer, Fundamentals of Abnormal Psychology, 7e

The Renaissance and the Rise of Asylums
1400 – 1700 A.D. Demonological views of abnormality continued to decline German physician Johann Weyer believed that the mind was as susceptible to sickness as the body The care of people with mental disorders continued to improve in this atmosphere Comer, Fundamentals of Abnormal Psychology, 7e

The Renaissance and the Rise of Asylums
Across Europe, religious shrines were devoted to the humane and loving treatment of people with mental disorders One, at Gheel, became a community mental health program of sorts Unfortunately, this time also saw a rise of asylums – institutions whose primary purpose was care of the mentally ill The intention was good care, but because of overcrowding they became virtual prisons Comer, Fundamentals of Abnormal Psychology, 7e

The Nineteenth Century: Reform and Moral Treatment
As 1800 approached, the treatment of people with mental disorders began to improve once again Pinel (France) and Tuke (England) advocated moral treatment – care that emphasized moral guidance and humane and respectful techniques In the U.S., Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher) were the primary proponents of moral treatment Dix’s work led to the creation of state hospitals Comer, Fundamentals of Abnormal Psychology, 7e

The Nineteenth Century: Reform and Moral Treatment
By the end of the nineteenth century, several factors led to a reversal of the moral treatment movement: Money and staff shortages Declining recovery rates Overcrowding Emergence of prejudice By the early years of the twentieth century, the moral treatment movement had ground to a halt; long-term hospitalization became the rule once again Comer, Fundamentals of Abnormal Psychology, 7e

The Early Twentieth Century: Dual Perspectives
As the moral movement was declining in the late 1800s, two opposing perspectives emerged: The Somatogenic Perspective Abnormal functioning has physical causes The Psychogenic Perspective Abnormal functioning has psychological causes Comer, Fundamentals of Abnormal Psychology, 7e

The Early Twentieth Century: The Somatogenic Perspective
Two factors were responsible for the rebirth of this perspective: Emil Kraepelin’s textbook argued that physical factors (such as fatigue) are responsible for mental dysfunction New biological discoveries were made, such as the link between untreated syphilis and general paresis Despite the general optimism, biological approaches yielded mostly disappointing results throughout the first half of the twentieth century, when a number of effective medications were finally discovered Comer, Fundamentals of Abnormal Psychology, 7e

The Early Twentieth Century: The Psychogenic Perspective
The rise in popularity of this perspective was based on work with hypnotism: Friedrich Mesmer and hysterical disorders Sigmund Freud’ s theory of psychoanalysis Freud and his followers offered psychoanalytic treatment primarily to patients who did not require hospitalization – now known as outpatient therapy By the early 20th century, psychoanalytic theory and treatment were widely accepted Comer, Fundamentals of Abnormal Psychology, 7e

Current Trends It would hardly be accurate to say that we know live in an period of great enlightenment about or dependable treatment of mental disorders 43% of people surveyed believe that people bring mental health disorders upon themselves and 35% consider mental health disorders to be caused by sinful behavior Nevertheless, the past 50 years have brought major changes in the ways clinicians understand and treat abnormal functioning Comer, Fundamentals of Abnormal Psychology, 7e

How Are People with Severe Disturbances Cared For?
In the 1950s, researchers discovered a number of new psychotropic medications: Antipsychotic drugs Antidepressant drugs Antianxiety drugs These discoveries led to deinstitutionalization and a rise in outpatient care This change in care was not without problems Comer, Fundamentals of Abnormal Psychology, 7e

How Are People with Severe Disturbances Cared For?
Outpatient care has now become the primary mode of treatment When patients do need institutionalization, they are usually given short-term hospitalization, and then, ideally, outpatient psychotherapy and medication in community settings and residences The approach has been helpful for many patients, but too few community programs are available in the U.S.; only 40 to 60% of those with severe disturbances receive treatment of any kind Comer, Fundamentals of Abnormal Psychology, 7e

How Are People with Less Severe Disturbances Treated?
Since the 1950s, outpatient care has continued to be the preferred mode of treatment for those with moderate disturbances Although this type of care was once exclusively private psychotherapy, now most health insurance plans cover it, and it now includes various settings, as well as specialty care Comer, Fundamentals of Abnormal Psychology, 7e

How Are People with Less Severe Disturbances Treated?
Surveys suggest that nearly 1 in 6 adults in the US receives treatment for psychological disorders in the course of a year, the majority for fewer than 5 sessions Outpatient treatments are also becoming available for more and more kinds of problems. Yet another change in outpatient care has been the development of programs devoted exclusively to one kind of psychological problem Comer, Fundamentals of Abnormal Psychology, 7e

A Growing Emphasis on Preventing Disorders and Promoting Mental Health
The community mental health approach has given rise to the prevention movement Many of today’s programs are trying to: Correct the social conditions that underlie psychological problems Help individuals at risk for developing disorders Prevention programs have been further energized by the growing interest in positive psychology – the study and enhancement of positive feelings, traits, and abilities Comer, Fundamentals of Abnormal Psychology, 7e

Multicultural Psychology
In response to growing diversity in the U.S., this new area of study has emerged Multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically Comer, Fundamentals of Abnormal Psychology, 7e

The Growing Influence of Insurance Coverage
Today the dominant form of insurance coverage is the managed care program – a program in which the insurance company determines key care issues At least 75% of all privately insured persons in the U.S. are enrolled in managed care programs A key problem is that reimbursements for mental disorders tend to be lower than those for medical disorders In 2011, a federal parity law went into effect Comer, Fundamentals of Abnormal Psychology, 7e

What Are Today’s Leading Theories and Professions?
One of the most important developments in the field of abnormal psychology has been the growth of numerous theoretical perspectives, including: Psychoanalytic Biological Behavioral Cognitive Humanistic-existential Sociocultural At present, no single perspective dominates the clinical field Comer, Fundamentals of Abnormal Psychology, 7e

In addition to multiple perspectives, a variety of professionals now offer help to people with psychological problems Comer, Fundamentals of Abnormal Psychology, 7e

One final key development in the study and treatment of mental disorders has been a growing appreciation of the need for effective research Clinical researchers have tried to determine which concepts best explain and predict abnormal behavior, which treatments are most effective, and what kinds of changes may be required Comer, Fundamentals of Abnormal Psychology, 7e

What Do Clinical Researchers Do?
Research is the systematic search for facts through the use of careful observations and investigations It is the key to accuracy in all fields but it is particularly important in the field of abnormal psychology Comer, Fundamentals of Abnormal Psychology, 7e

Clinical researchers face certain challenges that make their work very difficult: Measuring unconscious motives Assessing private thoughts Monitoring mood changes Calculating human potential Clinical researchers must consider different cultural backgrounds, races, and genders of the people they study They must always ensure that the rights of their research participants, both human and animal, are not violated Comer, Fundamentals of Abnormal Psychology, 7e

Clinical researchers try to discover universal laws, or principles, of abnormal psychological functioning: Search for nomothetic understanding General or universal laws or truths Do not typically assess, diagnose, or treat individual clients Rely on the scientific method to pinpoint relationships between variables Use three methods of investigation to form and test hypotheses and to draw broad conclusions… Comer, Fundamentals of Abnormal Psychology, 7e

The Case Study Provides a detailed, interpretative description of a person’s life and psychological problems Can be a source of new ideas about behavior Freud’s theories based mainly on case studies May offer tentative support for a theory May challenge a theory’s assumptions May inspire new therapeutic techniques May offer opportunities to study unusual problems Comer, Fundamentals of Abnormal Psychology, 7e

The Case Study Has limitations: Is reported by biased observers Relies on subjective evidence Provides little basis for generalization These limitations are addressed by the two other methods of investigation… Comer, Fundamentals of Abnormal Psychology, 7e

The Correlational Method and The Experimental Method
Do not offer richness of detail Do allow researchers to draw broad conclusions Preferred method of clinical investigation Typically involve observing many individuals Researchers apply procedures uniformly Studies can be replicated Researchers use statistical tests to analyze results Comer, Fundamentals of Abnormal Psychology, 7e

The Correlational Method
Correlation is the degree to which events or characteristics vary with each other The correlational method is a research procedure used to determine the “co-relationship” between variables Comer, Fundamentals of Abnormal Psychology, 7e

Most Investigated Correlational Questions in Clinical Research
Are stress and onset of mental disorders related? Is culture (or gender or race) generally linked to mental disorders? Are income and mental disorders related? Are social skills tied to mental disorders? Is social support tied to mental disorders? Are family conflict and mental disorders related? Is treatment responsiveness tied to culture? Which symptoms of a disorder disappear altogether? How common is a disorder in a particular population? Comer, Fundamentals of Abnormal Psychology, 7e

Describing a Correlation
When variable change the same way, their correlation is said to have a positive direction In a negative correlation, the value of one variable increases as the value of the other variable decreases Variables also may be unrelated, meaning there is no consistent relationship between them Comer, Fundamentals of Abnormal Psychology, 7e

The magnitude (strength) of a correlation is also important High magnitude = variables which vary closely together Low magnitude = variables which do not vary as closely together Comer, Fundamentals of Abnormal Psychology, 7e

Direction and magnitude of a correlation are often calculated numerically This statistic is the “correlation coefficient” The correlation coefficient can vary from (perfect positive correlation) to (perfect negative correlation) Sign (+ or -) indicates direction Number indicates magnitude 0.00 = no consistent relationship Most correlations found in psychological research fall far short of “perfect” Comer, Fundamentals of Abnormal Psychology, 7e

When Can Correlations Be Trusted?
Correlations can be trusted based on a statistical analysis of probability In essence, they ask how likely it is that the study's particular findings have occurred by chance. Comer, Fundamentals of Abnormal Psychology, 7e

What Are the Merits of the Correlational Method?
Advantages of the correlational method: Because researchers measure their variables, observe many participants, and apply statistical analyses, they can generalize findings Can repeat (replicate) studies on other samples Difficulties with correlational studies: Results describe but do not explain a relationship Results say nothing about causation Comer, Fundamentals of Abnormal Psychology, 7e

Special Forms of Correlational Research
There are two special forms of correlational study: Epidemiological studies Reveal the incidence and prevalence of a disorder in a particular population Incidence = number of new cases that emerge in a given period Prevalence = total number of cases in a given period Longitudinal studies Researchers observe the same individuals on many occasions over a long period Comer, Fundamentals of Abnormal Psychology, 7e

The Experimental Method
An experiment is a research procedure in which a variable is manipulated and the manipulation’s effect on another variable is observed Manipulated variable = independent variable Variable being observed = dependent variable Allows researchers to ask questions such as: Does a particular therapy relieve the symptoms of a particular disorder?” Questions about causal relationships can only be answered by an experiment Comer, Fundamentals of Abnormal Psychology, 7e

Most Investigated Causal Questions in Clinical Research
Does factor X cause a disorder? Is cause A more influential than cause B? How does family communication and structure affect family members? How does a disorder affect the quality of a person’s life? Does treatment X alleviate a disorder? Is treatment X more helpful than no treatment at all? Is treatment A more helpful than treatment B? Why does treatment X work? Can an intervention prevent abnormal functioning? Comer, Fundamentals of Abnormal Psychology, 7e

The Experimental Method
Statistics and research design are very important Researchers must try to eliminate all confounds – variables other than the independent variable that may also be affecting the dependent variable Three features are included in experiments to guard against confounds: A control group Random assignment Blind design Comer, Fundamentals of Abnormal Psychology, 7e

The Control Group A control group is a group of research participants who are not exposed to the independent variable, but whose experience is similar to that of the experimental group By comparing the two groups, researchers can better determine the effect of the independent variable Comer, Fundamentals of Abnormal Psychology, 7e

Random Assignment Researchers must also watch out for differences in the makeup of the experimental and control groups To do so, researchers use random assignment – any selection procedure that ensures that every participant in the experiment is as likely to be placed in one group as another Examples: coin flip; picking names out of a hat Comer, Fundamentals of Abnormal Psychology, 7e

Blind Design A final confound problem is bias To avoid bias by the participant, experimenters employ a “blind design,” in which participants are kept from knowing which assigned group (experimental or control) they are in One strategy for this is providing a placebo – something that simulates real therapy but has none of its key ingredients To avoid bias by the experimenter, experimenters employ a “double-blind design,” in which the experimenters and the participants are kept from knowing which condition of the study participants are in Often used in medication trials Comer, Fundamentals of Abnormal Psychology, 7e

Alternative Experimental Designs
It is not easy to devise an experiment that is both well controlled and enlightening Clinical researchers often must settle for designs that are less than ideal and include: Quasi-experimental designs Natural experiments Analogue experiments Single-subject experiments Comer, Fundamentals of Abnormal Psychology, 7e

In quasi-experimental, or mixed, designs, investigators do not randomly assign participants to groups, but make use of groups that already exist Example: Children with a history of child abuse To address the problem of confounds, researchers use matched control groups These groups are “matched” to the experimental group based on demographic and other variables Comer, Fundamentals of Abnormal Psychology, 7e

In natural experiments, nature manipulates the independent variable and the experimenter observes the effects Example: Psychological impact of flooding Comer, Fundamentals of Abnormal Psychology, 7e

Analogue experiments allow investigators to freely manipulate independent variables while avoiding ethical and practical limitations They induce laboratory subjects to behave in ways that seem to resemble real life Example: Animal subjects Comer, Fundamentals of Abnormal Psychology, 7e

In a single-subject experiment, a single participant is observed both before and after manipulation of an independent variable An example is the ABAB, or reversal, design Comer, Fundamentals of Abnormal Psychology, 7e

In an ABAB (reversal) design, a participant’s reactions are measured during a baseline period (A), after the introduction of the independent variable (B), after the removal of the independent variable (A), and after reintroduction of the independent variable (B) Comer, Fundamentals of Abnormal Psychology, 7e

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