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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 1 – What is abnormal behaviour? Introduction  Psychopathology – the field concerned with the nature and development of abnormal behaviours, thoughts, and feelings What is Abnormal Behaviour?  Abnormal behaviour – includes characteristics such as statistical infrequency, violation of norms, personal distress, disability or dysfunction, and unexpectedness Statistical Infrequency  Normal curve – bell-shaped curve, places majority of people in the middle and few at either extreme  Athletic ability – statistical infrequency, but not a part of abnormal psychology o Only certain infrequent behaviours (deep depression, hallucinations) fall into this domain Violation of Norms  Does behaviour violate social norms or threatens to make anxious those observing it o Anti-social behaviour of a psychopath o Obsessive-compulsive person‟s complex rituals  Make abnormality a relative concept o Too broad – criminals and prostitutes violate norms but aren‟t studied o Too narrow – highly anxious person (studied a lot), but doesn‟t violate any norms Personal Distress  Personal suffering – behaviour is abnormal if it creates great distress and torment in the person experiencing it o Counter example – psychopath (no guilt, etc.) Disability or Dysfunction  Disability – impairment in some important area of life (e.g., work or personal relationships) because of an abnormality o Counter example – transvestism (cross-dressing for sexual pleasure) which is currently a mental disorder if it distresses the person, is not necessarily a disability Unexpectedness  Distress and disability are considered abnormal when they are unexpected responses to environmental stimuli History of Psychopathology Early Demonology  Demonology – doctrine that an evil being, may dwell within a person and control his or her mind and body  Exorcism – casting out of evil spirits by ritualistic chanting or torture  Trepanning – create an opening in the skull that the demons can escape through Somatogenesis  Somatogenesis – the notion that something wrong with the physical body disturbs thought and action  Psychogenesis – belief that a disturbance has psychological origins  Hippocrates and the soma o Mania o Melancholia – prescribed tranquility, sobriety, healthy food, and abstinence o Phrenitis (brain fever) o The Biles – blood (moody), black bile (melancholy), yellow bile (irritability and anxiousness), and phlegm The Dark Ages and Demonology  Everyone looked to religion to save the mentally ill (did not happen)  Persecution of Witches o Malleus Maleficarum (the witches‟ hammer) – guide to witch hunts o Those accused of witch craft were to be tortured if they did not confess o A person‟s loss of reason was a symptom of demonic possession and that burning was the usual method of driving out the supposed demon  Witchcraft and mental illness o Later Middle Ages – mentally ill were generally considered witches o Many of the accused were not mentally ill  More sane than insane people were tried  Delusion-like confessions typically obtained during brutal torture th o 13 century onward – hospitals in major cities became more secular th No longer considered possessed o 13 century England – lunacy trials to determine a person‟s sanity  Conducted under the Crown‟s right to protect the mentally impaired, and the Crown became the guardian of the lunatic‟s estate  Orientation, memory, intellect, daily life, and habits on trial Development of Asylums th th  Confinement of the mentally ill began more frequently in the 15 /16 centuries  Asylums – refuges established for the confinement and care of the mentally ill  Bethlehem (1243) and Other Early Asylums o Bedlam (popular name for the hospital) later became a descriptive term for a place or scene of wild uproar and confusion o Viewing patients was considered entertainment o Medical treatments were often crude and painful o Benjamin Rush (1769)  Believed mental disorder caused by excess of blood in the brain – removed the blood  Many lunatics could be cured by being frightened  Moral Treatment o Moral treatment – patients had close contact with the attendants, who talked and read to them and encouraged them to engage in purposeful activity; residents led as normal lives as possible and in general took responsibility for themselves within the constraints of their disorders o York Retreat (1880-1884) – drugs were the most common treatment and included alcohol, cannabis, opium, and chloral hydrate  Fewer than one third of patients were dthcharged as improved or recovered o Moral treatment abandoned in the later part of the 19 century Asylums in Canada  Created to overcome neglect and suffering in the communities, poor houses, hospitals and jails  1714 First ones in Quebec o Cared for indigents, crippled people, and idiots o King of France paid the French Roman Catholic Church to take care of the people  Typically, asylum superintendents were British-trained physicians who modelled the asylums after British structure, treatment, and admin  With the advent of asylums – provisions for the mentally ill were separate from provisions for the physically ill, indigents, and criminals  The process was segregated from the wider community – the institution and the community were two separate and distinct solitudes The Beginning of Contemporary Thought  An Early System of Classification o GRiesinger – any diagnosis of mental disorder must specify a biological cause o Kraeplin – syndrome (certain group of symptoms) to appear together regularly enough to be regarded as having an underlying physical cause  Mental illness distinct from others – has its own genesis, symptoms, course, and outcome o Two major groups of severe mental diseases  Dementia praecox (schizophrenia) – chemical imbalance  Manic-depressive psychosis (bipolar disorder) – irregularity is metabolism  Basis for the present diagnostic categories  General Paresis and Syphilis o Some degenerative changes in the brain cells associated with senile and presenile psychoses and some structural pathologies htat accompany mental retardation were identified by the mid-1800s o Since 1798 known manifestation  Steady deterioration of both physical and mental abilities, delusions of grandeur and progressive paralysis  After recognized the patients never recovered  1825 is was designated a disease – general paresis  Some patients had earlier had syphilis o 1860s-1870s Pasteur established germ theory of disease – disease is caused by infection of the body by minute organisms o In 1905 the specific micro-organism that causes syphilis was discovered  Causal link between infection and brain damage found o Somatogenesis gained credibility  Psychogenesis (late 18 and 19 ) o Mesmer and Charcot  Hysterical states – physical incapacities (blindness or paralysis) that no physical cause could be found  Mesmer thought they were based on physical issues – solved it with magnetic forces (not really)  Used hypnosis in a way  Charcot had a somatogenic point of view  Some of his students hypnotized a normal woman and her display certain hysterical symptoms tricking Charcot into believing she was actually hysterical  Puzzling o Breuer and the cathartic method  Breuer found that the relief and cure of symptoms seemed to last longer if, under hypnosis, they were able to recall the precipitating event for the symptom and if their original emotion was expressed  Cathartic method – reliving an earlier emotional catastrophe and releasing the emotional tension caused by suppressed thoughts about the event Current Attitudes Toward People with Psychological Disorders  People with psychological disorders often face negative stereotyping and stigmatization  The Public Perception o People with psychological disorders are unstable and dangerous (minus schizophrenia – small correlation) o The mentally ill cannot be cured and cannot contribute to society  Anti-Stigma Campaigns o Mental health literacy – the accurate knowledge that a person develops about mental illness and its causes and treatment o Culture of shame, secrecy and stigma Canada’s Mental Health Care System  Mental health care services are tied closely to the health care system  Canadians are better off than Americans across virtually all major health indicators (infant mortality rate, life expectancy, years free of disability, five-year survival rates for cancer and heart disease) Mental Health of Canadians: First View  What Factors are Associated with Mental Heath in Canada? o Current stress, social support, life events, education and childhood trauma were strongly and independently associated with both positive and negative mental health status o The amount of current stress was the strongest correlate of mental health status, since is was consistently positively associated with all positive indicators and negatively associated with all negative measures o Second only to current stress in importance, social support was similarly associated with a majority of the indicators o The number of childhood traumas was strongly associated with several negative indicators, including depression o The amount of formal education was strongly related to positive indictors of mental health  What is the Extent of Mental Health Problems in the People of Canada? o 20% of people in Ontario have one or more mental disorders (during a one-year period)  Many have difficulty performing their main activity, daily living, and relationships o 2% of Ontarians considered severely mentally ill  Regional Differences o Newfoundland and PEI are the happiest and least distressed o Quebec – high self-esteem and mastery but the least happiness and most distress  Treatment and Prevention o Need to place greater emphasis on community psychology and prevention  Deinstitutionalization and Other Challenges to Service Delivery o Deinstitutionalization has resulted in homeless, lack of supported housing, jailing of the mentally ill, failure to achieve an ideal of community-focused care for people with mental disorders, lack of home care, insufficient intensive case management, etc. o The average length of stay for those admitted to general hospitals dropped by more than half in 5 years o Patients in Manitoba and New Brunswick reported the longest avg stay but Nunavut the shortest (3 days) o Majority of admissions were men between 25 and 40 years, and more than half were diagnosed with more than one psychiatric disorder o Mood disorders were the most common psychiatric disorders leading to hospital treatment o Continuous pressure to get patients admitted, treated, and out o Need better community based  Delivery of Psychotherapy o Evidence-based treatments are being promoted o Concern about cost-effectiveness has caused the limited use of classical analysis and long-term psychotherapy o Common errors in cognitive-behavioural therapy (issues with evidence-based treatments being implemented ineffectively)  Help-Seeking and Perceived Need for Help o Mismatch between needs and care received o Gender differences in the use of outpatient mental health services for mood disorders, anxiety disorders, substance-use disorders, and anti-social behaviours  Promotional campaigns should be aimed toward men o Perceived need for treatment but not receiving treatment was associated with higher levels of distress, disability, and suicide ideation o Need to target the young – 50% of adolescents and young adults with depression and suicidality do not access any mental health services o High SES 1.6 times more likely to use psychiatric services  Outreach programs needed that target low-income, working individuals who have not completed high school  Community Psychology and Prevention o Community psychology – psychologists seek out problems, or even potential problems o Focus is on prevention o Need for programs that promote the psychological, social, and physical well-being of all people in Canada  Cost of Mental Health Problems o Costs to society  Personal misery  Disruption of family life  Lower quality of life  Loss of productivity o Work days lost in 1 month due to mental disorders (1.8 million in Ontario) o Total mental health care spending is about 5% of total health care spending – below most other comparable countries o It costs a lot – productivity, insurance, health care, etc. The Future  The Romanow Report o Recommended mental health be made a priority within the system o More home care and covering the costs of drugs to a certain extent o Not actually implemented  The Senate Committee Final Report o Proposed a new committee on behalf of those with mental illness with the mission of  Facilitating, enabling, and supporting of a national approach to mental health issues  To be a catalyst for reform of mental health policies and improvements in service delivery  Educate all Canadians about mental health  Diminish stigma and discrimination o Create a fund to cover transition costs and to speed up the process of developing community based mental health service delivery  Focused on affordable housing and supports  Mental Health Literacy o Most Canadians see mental health as a medical problem o Many Canadians are cautious about the use of psychiatric medication o Canadians prefer a holistic treatment approach but are largely unaware of the range of available treatment options o About 90% of Canadians believe that anyone can suffer from a mental disorder o Common mental problems, such as anxiety or depression, are viewed as more likely caused by psychosocial factors whereas mental illness such as schizophrenia are viewed as more serious and more likely caused by biomedical factors Canadians might not seek help even if available because of shame and stigma, especially for serious Chapter 2: Current Paradigms and the Role of Cultural Factors The Role of Paradigms  Subjective factors as well as limitations in our perspective on the universe enter into the conduct of scientific inquiry  Paradigm – conceptual framework or approach within which the scientist works o Set of basic assumptions that outline the particular universe of scientific inquiry  Meaning given to data may depend on a paradigm  Current thinking about abnormal psychology tends to be multi-faceted with multiple paradigms The Biological Paradigm  Biological paradigm – mental disorders are caused by aberrant biological process o Referred to as the medical or disease model  Some biological process is disrupted or not functioning normally in „illnesses‟  Dominant paradigm from late 1800s to mid-1900s o Hall (1900) used gynecological procedures to treat “insanity” in women in BC Contemporary Approaches to the Biological Paradigm  Behaviour Genetics o Study of individual differences in behaviour that are attributable in part to differences in genetic makeup  Genotype – unobservable genetic constitution  Phenotype – observable, behavioural characteristics  Are the behavioural aspects – i.e. the illness  Made up of environment/experience combined with genotype o Family method – if a predisposition for a mental disorder can be inherited, a study of the family should reveal a relationship between the number of shared genes and the prevalence of the disorder in relatives  Index cases (probands) – collection of sample individuals who bear the diagnosis in question  Schizophrenia – 10% of first degree relatives (share 50% genes) are diagnosed with schizophrenia compared to 1% in the general population o Twin method – monozygotic and dizygotic twins are measured  To the extent that a predisposition for a mental disorder can be inherited, concordance (similar diagnostically) for the disorder should be greater in the MZ twins  Equal environment assumption – the pairs have equivalent numbers of stressful life experiences o Adoptees method – children with abnormal disorders who were adopted and reared apart from their parents  Molecular Genetics o Turning on and off specific genes, etc. o Linkage analysis – collect information from affected individuals and their relatives and study the inheritance pattern of characteristics whose genetics are fully understood (genetic markers)  If occurrence of a form of psychopathology among relatives goes along with the occurrence of another characteristic whose genetics are known it is concluded that the gene predisposing individuals to the psychopathology is on the same chromosome and in a similar location on that chromosome as the gene controlling the other characteristic o Concern is that an exclusive focus on genetic factors promotes the notion that illness and mental illness are predetermined  Gene-environment interactions  Neuroscience and Biochemistry in the Nervous System o Norepinephrine (NT of SyNS) is involved in producing states of high arousal and thus may be involved in anxiety disorders o Serotonin (depression) and dopamine (schizophrenia), GABA (anxiety disorders) o Puberty  ↓ serotonin and ↑ dopamine in certain cortical areas  Increase secretion of gonadal hormones  Contributes to increase risk for psychpathology during adolescence o Neuroreceptors can be too numerous or easily excitable as well causing problems  Delusions and hallucinations of schizophrenia may result from an overabundance of dopamine receptors  Biological Approaches to Treatment o Drugs can act efficiently and often provide symptomatic improvement relatively quickly o Attempt to make inferences about the functioning of the nervous system or to see actual structure and functioning of the brain and other parts of the NS (MRI)  Antipsychotic drugs are now 1/10 the dose of just 10 years ago because of this o Contemporary workers realize that non-biological interventions can have beneficial effects  Preventing the ritualized behaviour of a person with OCD has positive effects on the brain (decreased metabolism in the right caudate nucleus)  Evaluating the Biological Paradigm o Reductionism – view that whatever is being studied can and should be reduced to its most basic elements or constituents  Reducing complex mental and emotional responses to simple biology  Be wary of this o Nervous system dysfunction can be the result of psychological or social factors  Psychological interventions can be as effective as drug treatment o Neuroscience promises to improve psychological treatments – but not make psychology completely biological The Cognitive-Behavioural Paradigm The Behavioural Perspective  The Rise of Behaviourism o Watsom (1878-1958) – behaviourism focuses on observable behaviour rather than on consciousness (learning o Classical conditioning (Pavlov) – the response (UCR) to an unconditioned stimulus (UCS) can be transferred to another stimulus (conditioned stimulus) through repeated trials creating a conditioned response (CR)  Extinction – elimination of the CR  Can instil fear – white fluffy things  Related to phobias and anxiety disorders o Operant conditioning  Law of effect – responses have consequences or contingencies  Stimuli are occasions for responses to occur if in the past they have been reinforced  Discriminative stimulus – external events that in tell an organism that if it performs a certain behaviour, a certain consequence will follow  Positive reinforcement – strengthening of a tendency to respond by providing a positive reinforce  Negative reinforcement – strengthens a response, but by the removal of an aversive event (negative reinforcers) o Modelling – learn by watching and imitating others (vicarious learning)  Children of parents with phobias or substance-abuse problems may acquire similar behaviour patterns in part through modelling  Behavioural Therapy o Attempt to change abnormal behaviour, thoughts, and feelings by applying in a clinical context the methods used and the discoveries made by experimental psychologists in their study of both normal and abnormal behaviour o Counterconditioning and exposure  Relearning achieved by eliciting a new response in the presence of a particular stimulus  Fear of rabbits cured by feeding him in the presence of a rabbit o Moved the animal closer each time o Fear was replaced by stronger positive feelings by eating  Systematic desensitization – state or response antagonistic to anxiety is substituted for anxiety as the person is exposed gradually to stronger and stronger doses of what he or she fears  It is a form of cognitive intervention that specifically changes the expectancy of harm  Aversive conditioning – stimulus attractive to the client is paired with an unpleasant event in the hope of endowing it with negative properties  Drinker – smells alcohol while given a drug that makes you puke o Operant conditioning as an intervention  Problems treated with this method include autism, learning disabilities, mental retardation, bedwetting, aggression, hyperactivity, tantrums, and social withdrawal  Same learning conditions and processes that created maladaptive behaviour can also be used to change maladaptive behaviour  The Cognitive Perspective o Cognition – groups together the mental processes of perceiving, recognizing, conceiving, judging and reasoning o Cognitive paradigm – focus on how people structure their experiences, make sense of them, and relate their current experiences to past ones that have been stored in memory o The basics of cognitive theory  Past knowledge imposes a perceptual funnel on the experience  Schema – accumulated knowledge  If information does not fit the schema – the schema is altered or the information is to fit the schema o Beck‟s Cognitive Therapy  Depressed mood is caused by distortions in the way people perceive life experiences  CT tries to persuade clients to change their opinions of themselves and the way they interpret life events  Automatic miss-processing of information instead of self-directed hostility o Rational-Emotive Behaviour Therapy  Sustained emotional reactions are caused by internal sentences that people repeat to themselves and these self- statements reflect sometimes unspoken assumptions (irrational beliefs) about what is necessary to lead a meaningful life  REBT – goal is to eliminate self-defeating beliefs through a rational examination of them  Anxious – I must win the love of everyone  Perfection in everything, etc.  Clinical implementation of REBT  Therapist presents basic theory of REBT so that the client can understand and accept it  Once a client verbalizes a different belief in therapy, it must be made a part of everyday thinking o Cognitive Behavioural Therapy  Attention is paid to private events – thoughts, perceptions, judgements, self-statements, and unconscious assumptions – and manipulate these processes in their attempts to understand and modify overt and covert disturbed behaviour  Cognitive restructuring – changing a pattern of thought that is presumed to be causing a disturbed emotion or behaviour  Meichenbaum‟s cognitive-behaviour modification  Integrative approach focusing on narrative organization of experience (how it is constructed)  The cognitive-behaviour integrated approach  Depending on the disorder there is a different amount of emphasis on cognitive versus behavioural factors  Evaluating the cognitive-behavioural paradigm  The schema is abstact and not always well defined  Cognitive explanations do not always explain much  Thoughts are given causal status – i.e. they cause other aspects of the disorder  Cognitive and behavioural factors can be important foci of intervention The Psychoanalytic Paradigm  Psychopathology results from unconscious conflicts in the individual Classical Psychoanalytic Theory  Structure of the mind o Id – present at birth and is the part of the mind that accounts for all the energy needed to run the psyche  Basic urges for food, water, elimination, warmth, affection, and sex  Libido – psychic energy  Pleasure principle – seeks immediate gratification and operates accordingly  Id strives to eliminate tension  Primary process thinking – generating images (fantasies) of what is desired  Way to eliminate tension o Ego – primarily conscious and begins to develop during the first 6 month, it deals with reality  Secondary process thinking – planning and decision making  Reality principle – mediates demands of reality and the immediate gratification desired by the id o Superego – operates as the conscience (develops throughout childhood) o Psychodynamics – the interplay between the 3 structures of the mind  Neurotic anxiety o Objective (realistic) anxiety – real danger is happening o Neurotic anxiety – feeling of fear that is not connected to reality or to any real threat (through the id) o Moral anxiety – impulses of the superego punish an individual for not meeting expectations and satisfying the perfection principle (superego)  Defence mechanisms: coping with anxiety o Objective anxiety can be handled by removing or avoiding the danger in the external world or by dealing with it rationally o D
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