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Chapter 1

TEXTBOOK Chapter 1 - Concepts of Abnormality Throughout History

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Hywel Morgan

Notes From Reading C HAPTER  1: CONCEPTS  OF  ABNORMALITY  THROUGHOUT  HISTORY   PGS. 1­22) INTRODUCTION - Two problems with defining abnormality: o Eccentric and unusual behaviour or beliefs are not necessarily abnormal according to diagnostic criteria o Behaviours that are repugnant and threatening to others, (ie. aggression and murder) are not always signs of underlying psychological disorder - PsychologicalAbnormality – behaviour, speech or thought that impairs the ability of a person to function in a way that is gradually expected of him or her, in the context where the unusual functioning occurs - Mental Illness – refers to same meaning as psychological abnormality, but implies a medical rather than a psychological cause - Psychological Disorder – Specific manifestation of this impairment of functioning - Psychopathology – The scientific study of psychological abnormality and the problems faced by people who suffer from such disorders ATTEMPTS AT DEFINING ABNORMALITY Statistical Concept - Behaviour is judged as abnormal if it occurs infrequently in the population - Relative infrequency is one defining feature of abnormality, however not all infrequent behaviours or thoughts should be judged as abnormal o Example: Sidney Crosby is abnormal in the sense that his athletic abilities are rare, but we would usually describe people like him as exceptional - It is not clear how unusual a given behaviour has to be in order to be considered abnormal o Example: The common cold is considered an illness and yet it has a lifetime prevalence of 100% Personal Distress - Many people who are considered to have a psychological disorder report being distress yet, distress is not present for all people identified as abnormal - If depression depended and persisted for several years, then suffering would be abnormal - Distress appears to be a frequent, but essential, feature of abnormality Personal Dysfunction - When behaviour is clearly maladaptive (interferes with appropriate functioning), it is typically said to be abnormal - Wakefield concluded that harmful dysfunction is the key notion o Dysfunction refers to “failures of internal mechanisms to perform naturally selected functions” - Wakefield argue that unless there are dysfunctional consequences to the individual, in that he is unable to perform a natural function, it makes little sense to call behaviour abnormal - In terms of evolutionary theory, a trait may be dysfunctional if it harms an organism’s capacity to reproduce successfully - The boundaries of normal and abnormal and what specifically constitutes “harmful dysfunction” are therefore not clear and are a matter of considerable controversy Violation of Norms - Behaviour and thoughts of many psychologically disordered individuals run counter to what we might consider appropriate - Aserious flaw in this criterion is that social norms vary over time and place - Few disorders are truly universal across different cultures Notes From Reading C HAPTER  1: CONCEPTS OF  ABNORMALITY  THROUGHOUT  H ISTORY  PGS . 1­22) o Example: Depression has high prevalence rate in Canada and US than in some other parts of the world, such as Korea - Different cultural and ethnic groups also manifest psychopathology differently and exhibit their own strategies for dealing with psychological distress - How we define abnormality is culturally relative – norms of a particular culture determine what is considered to be normal behaviour, and abnormality can be defined only in reference to these norms Diagnosis ByAn Expert - Clinical Psychologists – initially trained in general psychology and then receive graduate training in the application of this knowledge to the understanding, diagnosis, and amelioration of disorders of thinking and behaviour o Treatment methods primarily involve psychological interventions - Psychiatrists – trained in medicine prior to doing specialized training focusing on diagnosis and medical treatment that emphasize the use of pharmacological agents in managing mental disorders - Psychiatric Nurses – received formal training in nursing before completing a specialization in psychiatric problems - Psychiatric Social Workers – attend to the influence of the social environment on disordered clients - Occupational Therapists (OTs) – sometimes involved in providing mental health care and may provide a broad range of services on rehabilitation teams and focus on helping clients to improve their functional performance Summary of Definitions - To identify a person or a behaviour as abnormal, no single criterion is either necessary (must be present) or sufficient (enough on its own) - Defining specific behaviours, thoughts, and feelings as representing particular disorders, as does the Diagnostic and Statistical Manual of Mental Disorders (DSM), is useful because then we can plan the management and treatment of person displaying problems HISTORICALCONCEPTS OFABNORMALITY - Supernatural Causes – Causes beyond the understanding of ordinary mortals, such as the influence of gods, demons, or magic - Psychological dysfunction in various historical periods was thought to result from either possession by demons or witchcraft of evil people - Treatment involved ridding the mad person of these influences by exorcism or other magical or spiritual means - Natural Causes – Causes that can be observed and examined Evidence From Prehistory - Paleoanthropologists discovered human remains from the Stone Age where skulls had circular sections cut out of them - It was concluded that these operations (called trephination) were done while the person was alive to let out spirits causing the victim to engage in severely abnormal behaviour o Maher and Maher suggested that trephination may have been intended to remove bone splinters or blood clots caused by blows to the head during warefare - Egyptian papyri from almost 4000 years ago describe supernatural explanations for various disorders and the use of magic and incantation as treatment procedures - Hunter-gatherer societies do not distinguish mental from physical disorders; both are seen as having supernatural causes Greek and Roman Thought Notes From Reading C HAPTER  1: ONCEPTS OF  ABNORMALITY  THROUGHOUT  HISTORY  PGS . 1­22) - Temples of healing were established that emphasized natural causes for mental disorders and that developed a greater understanding of the causes and treatment of these problems - Hippocrates, father of modern medicine, denied the popular belief that psychological problems were caused by the intervention of gods or demons o He did not distinguish mental diseases from physical diseases, instead he thought that all disorders had natural causes o Hippocrates argued that stress could influence mental functioning and also thought that dreams were important in understand why a person was suffering from a mental disorder o As a treatment, Hippocrates advocated a quiet life, a vegetarian diet, healthful exercise, and abstinence from alcohol and if these didn’t work, he considered induced bleeding or vomiting to be of value o Hippocrates was first to describe what he called hysteria, now known as conversion disorder: psychological induced blindness, deafness, or other apparent deficits in perceptual or bodily processes - Plato placed more emphasis on socio-cultural influences on thought and behaviour o Elaborating on Hippocrates’notions about dreams, Plato suggested that they served to satisfy desires because the inhibiting influences of the high faculties were not present during sleep o Suggested treatment responses that presaged current approaches; in most cases, the mentally ill should be cared for at the homes of relatives, anticipating the present trend toward community care o For those who must be hospitalized, he said their thinking must be rationally challenged in a conversational style of therapy that was remarkably like some forms of present-day psychotherapy - Aristotle advocated the humane treatment of mental patients o Accepted Hippocrates’bodily fluids theory and denied the influence of psychological facts in the etiology of dysfunctional thinking and behaving - Methodisn regarded mental illness as a disorder that resulted either rom a constriction of body tissue or from a relaxation of those tissues due to exhaustion - The Greeks provided the first clinical observations of disorders, and made the first attempts at classification o Treatments were primarily physical, but some psychological and social components were typically included - Galen, who continued the work of Hippocrates, thought there were two sources of mental disorder: physical and mental o Physical causes included head injuries, alcohol abuse, and menstrual disturbances, where psychological factors included stress, loss of love and fear - The Romans thought it was effective to have the patients in a comfortable environment, even thought they employed physical treatment - Galen suggested that having people talk about their problems to a sympathetic listener had value in treating the mentally disorder (the early form of psychotherapy) The Arab World - While the dark ages descended on Europe, theArabs continued the Greco-Roman traditions of investigation and humane treatment of the mentally ill - In Egypt, the gentle methods used in the temples of Saturn persisted into the Mohammedan period Notes From Reading C HAPTER  1: CONCEPTS OF  ABNORMALITY  THROUGHOUT  H ISTORY  PGS . 1­22) o These generally supportive and kindly approaches to the mentally ill continued to characterize theArab world’s approach throughout the period, during which the writings of the Greek scholars were lost to Europeans - The Quran itself reflects compassionate attitudes toward the mentally ill, and it is interesting that, despite Western assumptions to the contrary, Arab societies in general continue to hold to these admirable views and practices - InArab asylums (a place of refuge and protection), treatment followed the tradition of care, support and compassion - The Islamic physicianAvicenna’s analyses of mental disorders reflect a practical approach characterized by an emphasis on natural causes, particularly environmental and psychological factors - His treatment followed to Greco-Roman emphasis on care and compassion, but thso employed procedures not unlike early behaviour therapy methods of the 20 century Europe in the Middle Ages - Europe entered a period, approximatelyAD 500-1500, when the teachings of the Greeks and Romans were either lost or suppressed - It is often claimed that the natural theories of Greco-Roman times were replaced by supernatural ex
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