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Lecture 2

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University of Guelph
PSYC 3390
Mary Manson

Pages 2-27 (Chapter 1) and 29-59 (Chapter 2) Pages 2-27 What Do We Mean by Abnormal Behaviour? - No one element of abnormality is sufficient in defining or determining abnormality; the greater similarity between behaviour and elements of abnormality, the more likely it is that the person is abnormal or mentally disordered in some way - Elements of Abnormality o Suffering – neither sufficient nor necessary to consider something as abnormal o Maladaptiveness – interferes with well-being and with ability to enjoy work and relationships (e.g. anorexic person restricts intake of food to the point of hospitalization) o Deviancy o Violation of the Standards of Society – when people fail to follow conventional social and moral rules o Social Discomfort – when some violates social rule (e.g. sitting next to someone on an empty bus) o Irrationality and Unpredictability Why Do We Need to Classify Mental Disorders? - At the most fundamental level, classification systems provide nomenclature (a naming system) and enable us to structure info in a helpful way - Organizing info into classification system allows us to study different disorders that we classify and learn more about both causes and treatments What Are the Disadvantages of Classification? - Classification provides info in a shorthand form, which could lead to loss of info - There can also be some stigma (or disgrace) attached to receiving a psychiatric diagnosis - Stereotyping – automatic beliefs that people have about other people based on knowing one thing (often trivial) about them (e.g. people who where glasses are smarter than people who don‟t) - A persons self-concept may be directly affected by being given a diagnosis of a specific form of mental illness - Important to remember that diagnostic classification systems DO NOT classify people, but the disorders that people have o A Symptom – single indicator of a problem. Can involve affect, behaviour, or cognition o A Syndrome – group or cluster of symptoms that all occur together The DSM-IV Definition of Mental Disorder - Contains gold thandard for defining various types of mental disorders - Currently in 4 edition - Definition of mental disorder = a clinically significant behavioural or psychological syndrome or pattern, associated with distress or disability (i.e. impairment in one or more important areas of functioning), not simply a predictable and culturally sanctioned response to a particular event (e.g. death of a loved one), considered to reflect behaviour, psychological, or biological dysfunction in the individual - DSM attempts to be atheoretical – does not refer to causes of mental disorder - Definition still has problem – “clinically significant”? How much distress or disability? - Jerome Wakefield – proposed idea of mental disorder as “harmful dysfunction”. His definition – mental disorder is a mental condition that causes significant distress or disability, is not merely an expectable response to a particular event, and is a manifestation of a mental dysfunction o Acknowledges role played by social values, and tries to use scientific theory - As our understanding of different disorders changes and as our thinking evolves, so too will the DSM and its definition of mental disorder How Does Culture Affect What is Considered Abnormal? - Within given culture, there are many shared beliefs and behaviours that are widely accepted and that form part of customary practice (e.g. many Christians avoid number 13, Japanese avoid number 4, etc.) - Variation in ways different cultures describe psychological distress o No term for “mental illness” or “mental disorder” in Inuktitut (variety of Inuit languages), though there are words to describe particular syndromes and symptoms associated with mental illness - Culture can shape clinical presentation of disorders o E.g. In Chine, those suffering from depression focus on physical concerns (fatigue, headaches, etc.) rather than saying they feel sad or down o Little is known about cultural aspects of abnormal psychology Culture-Specific Disorders - Certain forms of psychopathology seem to be highly culture-specific – they are found only in certain areas of the world and appear to be highly linked to culturally bound concerns o taijin kyofusho – syndrome is a form of anxiety disorder, quite prevalent in Japan. Involves marked fear that one‟s body, body parts, or body functions may offend/embarrass others or make them feel uncomfortable. Often afraid of blushing, or fear upsetting others by their gaze facial expression, or body odour o Latino-Caribbean and Latin-Mediterranean – ataque de nervios – often triggered by stressful event like divorce or loss of loved one. Symptoms include crying, trembling, uncontrollable screaming, and out of control feeling. Person may become physically or verbally aggressive. Once ataque is over, person may return to normal and have no memory of what happened - Abnormal behaviour is behaviour that deviates from norms of society in which it is enacted - Certain unconventional actions and behaviours are almost universally considered to be the product of mental disorder How Common are Mental Disorders? - Depression affects women more than men (2:1 ratio), which suggests that gender is important factor to consider in understanding depression. o Among Jews – genders affected about equally, but not necessarily true for other religious groups Prevalence and Incidence - Epidemiology – study of distribution of diseases, disorders, or health-related behaviours in a given population. Mental health epidemiology – study of distribution of mental disorders o Determining frequencies of mental disorders - Prevalence – number of active cases in population during any given period of time, figures typically expressed as % o Point prevalence – estimated proportion of actual, active cases of the disorder in a given population at any instant in time  Conduct study to count number of people who suffering from major depression on January 1 of next year. Anyone who suffered during November and December but recovered by January 1 would not be included in figure, same as if someone‟s depression begun on January 2 o One-year prevalence – count everyone who suffered from depression at any time during the whole year, figure would be higher as it covers a longer time, would also include those who had recovered before point prevalence and people whose disorders didn‟t begin until after o Lifetime prevalence – Estimate of how many people had suffered from particular disorder at any time in their lives (even if now recovered) - Incidence – number of new cases that occur over a given period of time (typically 1 year), usually lower than prevalence figure because they exclude already existing cases Prevalence Estimates for Mental Disorders - Comorbidity – describe the presence of 2+ disorders in the same person, especially high in people with a disorder that was rated as serious on a scale of severity also had 2+ additional disorders (e.g. person who drinks excessively may also be depressed and have an anxiety disorder) Treatment - In a recent study of over 1000 young Canadians (ages 15-24) found that only 25% of those with mental health problems had sought help - There are also differences across disorders with respect to treatment-seeking patterns o % of Ontario residents who received treatment within a year of developing a problem were 52.6% for panic disorder, but only 6.5% for phobias and 4.2% for addictive disorders - Barriers to seeking treatment include difficulty accessing mental health services (long wait lists, etc.), attitudes about seeking help (trying to solve it on your own) - Immigrant groups less likely to seek help than those born in Canada - Treatment mainly done by family physician, instead of mental health specialist, and mostly outpatient - Outpatient treatment requires patients to visit mental health facility/practitioner - Hospitalization and inpatient care are preferred for people who need intensive treatment than can be provided on outpatient basis The Mental Health “Team” - Professionals collect info from several perspectives and sources (family members, friends, school officials), and any mental health professionals and social agencies with which the patient may have had contact - Each of these people then meet to process and integrate all available info, arrive at consensus diagnosis, and plan the initial phase of treatment Research Approaches in Abnormal Psychology Sources of Information - Case Study – studies of specific individuals whom were described in great detail, information only relevant to individual being described and may be flawed o Kraeplin and Bleuler – provide us with detailed accounts of patients whom would be easily recognized as suffering from disorders like schizophrenia and manic depression o Alzheimer – described patient with unusual clinical picture that subsequently became Alzheimer‟s disease o Freud – founder of psychoanalysis, published many clinical cases describing what we recognize now as phobia and OCD - Direct Observation – Observers count how many times children who are classified as being aggressive, hit, bite, push, punch or kick other children they play with. Tells us something that we want to know using a variable that is relevant to our interests - Self-Report Data – data from participants themselves. Can sometimes be misleading – because some people sometimes purposely lie, misinterpret the question or want to seem favourable (or unfavourable), self-report data cannot always be regarded as highly accurate and helpful - Developing ways to study behaviours, moods, and cognitions that have long been considered inaccessible (e.g. brain-imaging to study people‟s brains at work – blood flow to various parts of brain during memory tasks) o Transcranial Magnetic Stimulation (TMS) – stimulate underlying brain tissue, collect behavioural data Forming Hypotheses about Behaviour - Hypotheses efforts to explain, predict, or explore something  BEHAVIOUR - Case studies can be helpful in developing hypotheses] - Hypotheses frequently determine therapeutic approaches used to treat particular clinical problem o Someone who washes their hands 60-100 times/day (OCD) and does damage to skin and underlying tissue  If we believe this behaviour is result of problems in certain neural circuits, we may try to find which are dysfunctional in hopes of correcting them  If the behaviour is viewed as a symbolic cleaning of sinful and unacceptable thoughts, we might try to unearth and address sources of person‟s concern with morals and scruples  If we see hand washing as merely product of unfortunate conditioning or learning, we might try to extinguish problematic behaviour o Working hypotheses about causes of different disorders shape what kinds of approaches we adopt both when we study disorders and when we try to treat them Sampling and Generalization - Sampling – a group of people are representative of a much larger group of individuals (i.e. population) - The more representative our sample is, the better able we are to generalize, to the larger group, the findings derived from our work with the sample Criterion and Comparison Groups - Comparison group – also known as control group – group of people who do not exhibit the disorder being studied but who are comparable in al other major respects to the criterion group o Typically psychologically healthy or “normal” - Criterion group – people with the disorder Studying the World As It Is: Observational Research Designs - Observational research – does not involve any manipulation of variables. Researcher selects groups of interest and then compares groups on a variety of different characteristics - Correlational studies – may not be able to pin down causal relationships, can be powerful and rich source of inference, often suggest causal hypotheses Retrospective vs. Prospective Strategies - Prospective – method that often focuses on individuals who have higher-than-average likelihood of becoming psychologically disordered before abnormal behaviour is observed - Retrospective – Method of trying to uncover the probable causes of abnormal behaviour by looking backward from the present Manipulating Variables: The Experimental Method in Abnormal Psychology - Positive correlation – vary together in a direct, corresponding manner (i.e. as x increases, y increases) - Negative correlation – as x increases, y decreases Studying the Efficacy of Therapy - If a treated group shows significantly more improvement than the untreated group, we can have confidence in the treatment‟s efficacy - In treatment research, it is important that the 2 groups (treated and untreated) be as comparable as possible except for the presence or absence of the proposed active treatment o Patients typically randomly assigned to either condition - In some cases, alternative research design may be called for, in which 2 or more treatments are compared in different equivalent groups (standard treatment comparison study) Single-Case Experimental Designs - In experimental research, participants assessed at baseline and then randomly assigned to different groups (e.g. treatment and control condition). After experiment or treatment is completed, data collected from 2 different groups then compared - Single-Case Research Designs – same subject studied over time. Behaviour or performance at one point in time can then be compared to behaviour or performance at later time, after specific intervention/treatment introduced o ABAB design – letters refer to phases of intervention  1A – baseline condition – collect data from subject  1B – introduce treatment, perhaps behaviour changes in some way  2A – withdraw treatment and see what happens  2B – get behaviour to change again and observe what happens Animal Research - Analogue studies – studies in which a researcher attempts to emulate the conditions hypothesized as leading to abnormality - Lab experiments with dogs had shown that, when subjected to repeated experiences of painful, unpredictable, and inescapable electric shock, the dogs lost their ability to learn a simple escape response to avoid future shock – they just sat and endured the pain o Transferred to human depression – reaction to uncontrollable stressful events where one‟s behaviour has no effect on one‟s environment, leading person to become helpless, passive, and depressed o “Learned helplessness theory of depression” Pages 29-59 Historical Views of Abnormal Behaviour Demonology, Gods and Magic - Chinese, Egyptians, Hebrews and Greeks often attribute abnormal behaviours to a demon or god who had taken possession of a person - “Possession” was assumed to involve good or evil spirits usually depended on the affected individual‟s symptoms o If speech/behaviour appeared to have religious or mystical significant = good spirit, people often treated with awe and respect o If person became excited or overactive and engaged in behaviour contrary to religious teaching = bad spirit - Primary type of treatment for demonic possession was exorcism, included various techniques for casing evil spirit out of affected person – typically included magic, prayer, incantation, noisemaking, and use of horrible-tasting concoctions made from sheep‟s dung and wine Hippocrates‟ Early Medical Concepts - Hippocrates – “father of modern medicine”, denied that deities and demons intervened in development of illnesses and insisted that mental disorders had natural causes and appropriate treatments - Believed that brain was central organ of intellectual activity, mental disorders due to brain pathology - Emphasized importance of heredity and predisposition, pointed out injuries to head could cause sensory and motor disorders - Classified all mental disorders into 3 categories – mania, melancholia, phrenitis - 4 elements of material world (ear, water, air, fire), had attributes to dryness, cold, heat, and moistness. – Combined to form 4 essential fluids or body – blood (sanguis), phlegm, bile (choler), black bile (melancholer) - Considered dreams important in understanding patient‟s personality - Believed that hysteria (appearance of illness in absence of organic pathology) was restricted to women and caused by uterus wandering to other parts of the
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