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Chapter 1

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Western University
Psychology 2030A/B
David Vollick

Abnormal  Psychology  Chapter  One     • Psychological  Disorder:  dysfunction  within  the  individual  that  is  associated   with  distress  or  impairment  in  functioning  and  a  response  that  is  not  typical  or   culturally  accepted   • A  psychological  disorder  has  three  defining  criteria:   1. Psychological  dysfunction:  a  breakdown  in  cognitive,  emotional,  or   behavioural  functioning   2. Distress  or  impairment:  individual  is  extremely  upset   3. Atypical  response:  response  to  b  atypical  or  not  culturally  expected  is   important  but  also  insufficient  to  determine  abnormality     • Knowing  were  to  draw  the  line  between  normal  and  abnormal  dysfunction  is   often  difficult,  therefore  problems  are  often  considered  to  exist  on  a   continuum  or  as  a  dimension,  rather  than  as  categories  that  are  either  present   or  not.     • For  this  reason,  having  a  dysfunction  is  not  enough  to  meet  the  criteria  for  a   psychological  disorder.   • For  some  disorders,  suffering  and  distress  are  absent.     • Thus,  defining  psychological  disorder  by  distress  alone  doesn’t  work,  although   the  concept  of  distress  contributes  to  a  good  definition.     • The  concept  of  impairment  is  useful,  though  is  not  entirely  satisfactory.   • Something  is  considered  abnormal  if  it  deviates  from  the  average.  The  greater   the  deviation,  the  more  abnormal  it  is.     • We  accept  extreme  behaviours  from  celebrities  that  would  not  be  tolerated  in   other  members  of  the  society.   • Behaviour  is  abnormal  if  you  are  violating  social  norms,  even  if  some  people   are  sympathetic  to  your  point  of  view.  This  definition  is  useful  in  considering   important  cultural  differences  in  psychological  disorders   • Wakefield  used  the  definition  “harmful  dysfunction”.  A  concept  useful  to   determine  whether  the  behaviour  is  beyond  the  individual’s  control.   • Diagnostic  and  Statistical  Manual  contains  the  current  listing  of  criteria  for   psychological  disorders   • Definition  of  abnormal  can  be  useful  across  cultures  and  subcultures  if  we  pay   attention  to  what  is  “functional”  or  “dysfunctional”    in  a  given  society.     • It  is  not  easy  to  decide  what  represents  dysfunction  or  dyscontrol,  scholars   have  argued  that  health  professionals  will  never  be  able  to  satisfactorily  define   “disease”  or  “disorder”   • We  must  instead  consider  how  the  apparent  disease  or  disorder  matches  up  to   a  “typical”  profile  (prototpe).   • According  to  the  DSM,  the  patient  can  have  only  some  features  or  symptoms  of   the  disorder  (a  minimum  number),  but  not  all  of  them  and  still  meet  the   criteria  for  the  disorder  because  the  set  of  symptom  is  close  to  the  “prototype”   • Szasz  and  Albee  are  highly  critical  of  medical  diagnonsies  being  ued  in  the  case   of  psychological  disorders.     • Szasz  position  that  mental  illness  is  a  myth  and  that  the  practice  of  labeling   mental  illnesses  should  be  abolished.  He  argued  that  a  fundamental  difference   exists  between  the  use  of  diagnoses  for  physical  diseases  and  their  use  in   mental  illnesses.  The  former  uses  objective  criteris,  but  for  mental  illness   subjective  judgements  are  required.   • Albee  argued  that  the  biggest  mistake  was  uncritically  accepting  of  the  concept   of  “mental  disease”  and  using  the  medical  model  and  associated  diagnoses  in   conceptualizing  abnormal  behaviour.   • Improvements  to  the  definition  of  “disorder”  have  lead  to  three  questions:   1. Analyze  the  concepts  that  underlie  disorders,  evaluating  the  degree  to   which  concepts  conform  (or  don’t)  to  the  numerous  ways  we  currently   have  for  understanding  disorders   2. Survey  mental  health  professionals  worldwide  to  see  whether  any  striking   commonalities  in  the  concepts  of  mental  disorders  emerge   3. Determine  what  separates  who  meet  the  criteria  for  a  disorder  from   individuals  who  have  a  mild  form  of  the  same  problems  that  does  not   interfere  with  their  functioning     The  Science  of  Psychopathology   • Psychopathology:  the  scientific  study  of  psychological  disorders   • Ph.D.  (Doctor  of  Philosophy)  –  conduct  research  into  the  causes  and  treatment   of  psychological  disorders  and  to  diagnose,  assess,  and  treat  these  disorders   • Psy.D.  (Doctor  of  Psychology)  –  more  emphasis  on  clinical  practice  and  less  on   research  training   • In  Canada,  regulation  of  the  psychology  profession  is  under  the  jurisdiction  of   the  provinces  and  territories.     • Depending  on  the  jurisdiction,  a  psychologist  may  have  either  a  doctoral  or   master’s  degree   • Psychologists  with  other  speciality  training,  concentrate  on  investigating  the   basic  determinants  of  behaviour  but  do  not  assess  or  treat  psychological   disorders   • Councelling  psychologists  –  treat  adjustment  and  vocational  issues   encountered  by  relatively  healthy  individuals   • Clinical  Psychologists  –  concentrate  on  more  severe  psychological  disorders   than  counseling  psychologists   • Psychiatrist  (earn  M.D.)  –  investigate  the  nature  and  causes  of  psychological   disorders,  often  from  a  biological  point  of  view,  making  diagnoses,  and  offer   treatments   • Psychiatric  Social  Workers  (Masters  Degree)  –  treat  disorders,  often   concentrating  on  family  problems   • Psychiatric  Nurses  (Masters  or  Ph.D.)  –  care  and  treatment  of  patients  with   psychological  disorders   • Marriage  and  Family  Therapists  and  Mental  Health  Counselors  (Masters)  –   provide  clinical  services  in  hospitals  or  clinics,  usually  under  supervision  of   doctoral-­‐level  clinician       The  Scientist-­‐  Practitioner   • Psychopathology  is  the  adoption  of  scientific  methods  to  learn  more  about  the   nature  of  psychological  disorder,  their  causes,  and  their  treatment   • Scientist  Practitioners  function  as  such  in  one  of  three  ways:   1. Consumer  of  Science  –  keep  up  with  the  latest  scientific  developments  in   their  field,  use  the  most  current  diagnostic  and  treatment  procedures   therefore  enhancing  the  practice   2. Evaluator  of  Science  –  evaluate  their  own  assessments  or  treatment   procedures  to  see  whether  they  work,  therefore  determining  the   effectiveness  of  the  practice   3. Creator  of  Science  –  conducts  research  that  leads  to  new  procedures   useful  in  practice     Clinical  Description   • Studying  psychological  disorders  contains  three  major  categories  of  focus:   1. Clinical  Description  -­‐  represents  the  unique  combination  of  behaviours,   thoughts,  and  feelings  that  make  up  a  specific  disorder     2. Causation  (etiology)  -­‐     3. Treatment  and  Outcome  -­‐     • Presenting  Problem  –  indication  why  the  person  came  in     • One  important  function  of  clinical  description  is  to  specify  what  makes  the   disorder  different  from  normal  behaviour  or  from  other  disorders   • Prevalence  –  how  many  people  in  the  population  as  a  while  have  the  disorder?   • Incidence  –  how  many  new  cases  occur  during  a  given  period   • Most  disorders  follow  a  somewhat  individual  pattern  or  course   4. Chronic  Course:  tends  to  last  a  lifetime   5. Eipisodic  Course:  likely  recover  in  a  few  months,  only  to  have  a                                reoccurrence  later   6. Time-­‐Limited  Course:  will  improve  without  treatment  in  a  relatively                                short  period   • Disorders  have  differences  in  onset:   7. Acute  Onset:  begin  suddenly   8. Insidious  Onset:  gradually  over  an  extended  period   • Prognosis:  the  anticipated  course  of  the  disorder   • The  patients  age  might  be  a  very  important  part  of  the  clinical  description     Causation,  Treatment,  and  Outcomes   • Etiology:  why  a  disorder  begins  and  includes  biological,  psychological,  and   social  dimensions   • Treatment  is  often  important  to  the  study  of  psychological  disorders.  If  a  new   drug  or  treatment  is  successful  it  may  give  us  hints  about  the  nature  of  the   disorder  and  its  causes   • The  effect  does  NOT  necessarily  imply  the  cause     Supernatural  Tradition:  Demons  and  Witches   • One  opinion  puts  the  cause  and  treatment  of  psychological  disorders  in  the   realm  of  the  supernatural   • Society  began  to  believe  in  the  reality  and  power  of  demons  and  witches   • Roman  church  fought  back  against  the  evil  in  the  world  that  must  have  been   behind  this  heresy   • People  turned  to  magic  and  sorcery  to  solve  their  problems   • The  bizarre  behaviour  of  people  afflicted  with  psychological  disorders  was   seen  as  work  of  the  devil  and  witches   • Individuals  possessed  by  evil  spirits  ere  probably  responsible  for  any   misfortune   • Treatments  included  exorcism  and  shaving  the  patter  of  the  cross  in  the   victims  hair  and  securing  them  to  a  wall  near  the  front  of  a  church     • Conviction  of  sorcery  and  witches  causes  of  madness  and  other  evils  continued   into  the  15  century  (Salem  witch  trials)     Supernatural  Tradition:  Stress  and  Melancholy   • Insanity  was  a  natural  phenomenon,  caused  by  mental  or  emotional  stress  and   that  it  was  curable   • Mental  depression  and  anxiety  were  recognized  as  illnesses,  although   symptoms  such  as  despair  and  lethargy  were  often  identified  by  the  church   with  sin  of  acedia  or  sloth   • Treatments  were  rest,  sleep,  and  a  healthy  and  happy  environment,  baths,   ointments,  and  various  potions   • People  with  mental  illnesses  and  physical  disabilities  were  moved  from  house   to  house  in  medieval  villages,  as  neighbors  took  turns  caring  for  them   • Oresme  suggested  that  disease  of  melancholy,  rather  than  demons,  was  the   source  of  bizarre  behaviour   • Oresme  pointed  out  that  much  of  the  evidence  for  the  existence  of  sorcery  and   witchcraft  was  obtained  from  people  who  were  tortured  and  confessed  to   anything     Supernatural  Tradition:  Treatments  for  Possession   • Believed  that  a  person  was  responsible  for  his  or  her  own  disorder,  which   might  be  punishment  for  evil  deeds   • Possession  is  not  always  connected  with  sin  and  may  be  seen  as  involuntary   and  the  possessed  individual  as  blameless   • Exorcisms  sometimes  worked,  but  if  they  didn’t’  people  were  subjected  to   confinement,  beatings,  and  other  forms  of  torture   • Other  treatments  included  hanging  people  over  a  pit  full  of  poisonous  snakes   to  scare  the  evil  spirits  away  or  other  therapeutic  elements  of  shock,  including   dunkings  in  ice-­‐cold  water     Supernatural  Tradition:  The  Moon  and  the  Stars   • Paracelsus  rejected  notions  of  possession,  suggesting  instead  that  the   movement  of  the  moon  and  the  stars  had  profound  effects  on  people’s   psychological  functioning   • Inspired  by  the  word  lunatic   • Millions  of  people  are  convinced  that  their  behaviour  is  influenced  by  the   stages  of  the  moon  and  the  stars     *  Roman  Catholic  church  requires  that  all  health  care  resources  be  exhausted  before   spiritual  solutions  can  be  considered     The  Biological  Tradition:  Hippocrates  and  Galen   • Hippocrates  is  considered  the  father  of  modern  medicine   • He  suggested  that  psychological  disorders  could  be  treated  like  any  other   disease   • The  did  not  limit  their  search  for  the  causes  of  psychopathology  to  the  general   area  of  “disease”  because  they  believed  that  psychological  disorders  may  be   caused  by  brain  pathology  or  head  trauma  and  could  be  influenced  by  heredity   • He  recognized  the  importance  of  psychological  and  interpersonal  contribution   to  psychopathology   • Galen’s  approach  is  the  humoral  theory  of  disorder  (first  theory  related  to   chemical  imbalance)   • Normal  brain  function  is  elated  to  four  bodily  fluids  or  humors:  blood  (heart),   black  bile  (spleen),  yellow  bile  (liver),  and  phlegm  (brain)   • Disease  results  from  too  much  or  too  little  of  one  of  the  humors   • The  four  humors  were  related  to  the  Greek’s  conception  of  the  four  basic   qualities:  heat,  dryness,  moisture,  and  cold   • The  fours  humors  are  applied  to  personality  traits:     o Sanguine  (blood)  –  ruddy  in  complexion,  cheerful,  optimistic,  excessive   blood  caused  insomnia  and  delirium   o Melancholic  (black  bile)  –  depressive  personality   o Phlegmatic  (phlegm)  –  apathy,  sluggishness,  and  calm  under  stress   o Choleric  (yellow  bile)  –  hot  tempered   • Excesses  of  one  or  more  humors  were  treated  by  regulating  the  environment   to  increase  or  decrease  heat,  dryness,  moisture,  or  cold  depending  on  which   humor  was  out  of  balance   • Two  other  treatments  involved  bloodletting  and  vomiting   • Somatoform  Disorders  are  when  the  physical  symptoms  appear  to  be  the   result  of  an  organic  pathology  for  which  no  organic  cause  can  be  found   • Mistakenly  assumed  that  is  was  restricted  to  women  and  the  cause  was  the   wandering  uterus  for  which  the  cure  was  to  get  married  or  have  the  vagina   fumigated  to  lure  it  back  to  its  natural  location     The  Biological  Tradition:  19  Century   • Syphilis  symptoms  included  believing  that  everyone  is  plotting  against  you  or   that  you  are  God   • Patients  deteriorated  steadily,  becoming  paralyzed  and  dying  within  5  years  of   onset   • Condition  designated  a  disease  of  genera  paresis   • Louis  Pasteur’s  germ  theory  of  disease  facilitated  the  identification  of  the   specific  bacterial  micro-­‐organism  that  caused  syphilis   • Symptoms  of  the  disease  were  caused  by  germ  (bacterium)  that  had  invaded   the  body   • Grey’s  position  was  that  insanity  always  has  physical  symptoms  and  therefore   the  mentally  ill  could  be  treated  as  physically  ill   • Hospitals  improved  and  they  became  more  humane,  livable  institutions,  but   soon  became  so  large  and  impersonal  that  individual  attention  was  not   possible   • Deinstitutionalization,  in  which  patient  were  released  into  their  communities   had  negative  consequences  including  increasing  the  number  of  patients  with   chronic  disabilities  left  homeless  on  the  streets  of  our  cities         The  Biological  Tradition:  The  Development  of  Biological  Treatments   • In  the  1930’s,  the  physical  interventions  of  electric  shock  and  brain  surgery   were  used   • Insulin  Shock  Therapy  was  abandoned  because  it  was  too  dangerous   • Joseph  von  Meduna  concluded  that  induced  brain  seizures  might  cure   schizophrenia     • Electroconvulsive  Therapy  (ECT)  is  still  used  today   • The  first  effective  drugs  for  sever  psychotic  disorders  were  developed  by   Heinz  Lehman   • The  development  of  reserpine  and  neuroleptics,  for  the  first  time  hallucinatory   and  delusional  thought  processes  could  be  diminished  also  controlled   agitation  and  aggressiveness   • Benzodiazepines  reduced  anxiety   • The  positive  effects  of  these  drugs  on  some  patients  revitalized  both  the  search   for  biological  contributions  to  psychological  disorders  and  the  search  for  new   and  more  powerful  drugs     The  Biological  Tradition:  Consequences  of  the  Biological  Tradition   • Grey  reduced  or  eliminated  interest  in  treating  patients  with  mental  illnesses   because  they  though  mental  disorders  were  due  to  some  as  yet  discovered   brain  pathology  and  were  therefore  incurable   • In  place  of  treatment,  interest  centered  on  diagnosis,  legal  question,  and  the   study  of  brain  pathology  itself   • Kraepelin,  one  of  the  founding  fathers  of  modern  psychiatry  was  little  involved   in  treatment,  reflecting  the  belief  that  disorders  were  due  to  brain  pathology   • Kraepelin  was  one  of  the  first  to  distinguish  among  various  psychological   disorders,  seeing  that  each  may  have  a  different  age  of  onset  and  course,  with   somewhat  different  clusters  of  presenting  symptoms  and  probably  a  different   cause   The  Psychological  Tradition   • Plato  thought  that  the  two  causes  of  maladaptive  behaviour  were  the  social   and  cultural  influences  in  a  person’s  life  and  the  learning  that  took  place  in   that  environment   • Psychosocial  approaches  focus  not  only  on  psychological  factors  but  also  on   social  an  cultural  ones   • Advocated  for  human  and  responsible  care  for  people  with  psychological   disturbances     The  Psychological  Tradition:  Moral  Therapy   • Moral  Therapy  included  treating  institutionalized  patients  as  normally  as   possible  in  a  setting  that  encouraged  and  reinforced  normal  social  interaction,   thus  providing  them  with  many  opportunities  for  appropriate  social  and   interpersonal  contact   • The  principles  of  moral  therapy  originated  with  Pinel     • Moral  therapy  became  the  treatment  of  choice  in  the  leading  hospitals     • Asylums  appeared  with  the  intent  of  providing  places  of  refuge  for  the   confinement  and  care  of  people  with  mental  illnesses,  although  they  were   more  like  prisons  than  hospitals   • Sussman  noted  that  asylums  in  Canada  began  with  humane  intentions  and  the   development  of  moral  therapy  did  bring  some  relief  to  many  people  with   mental  illnesses     The  Psychological  Tradition:  Asylum  Reform  and  the  Decline  of  Moral  Therapy   • Humane  treatment  declined  because  of  increased  patient  loads     • A  second  reason  for  the  decline  of  moral  therapy  was  Dorothea  Dix   • Her  work  began  known  as  the  mental  hygiene  movement   • Dix  worked  hard  to  make  sure  that  everyone  who  needed  care  received  it,   including  the  homeless   •
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