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Chapter 1

PS280 Chapter 1 - Abnormality History.docx

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Camie Condon

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Chapter 1: Abnormality throughout History INTRODUCTION  Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is most broadly accepted system for identifying particular types of disorders  International Classification of Mental and Behavioural Disorders (ICD-10) is also used.  Eccentric and unusual behaviour or beliefs aren’t necessarily abnormal according to diagnostic criteria o Although the boundary between eccentricity and abnormality isn’t always clear  Behaviours that are repugnant and threatening to others (e.g. aggression and murder) are not always signs of underlying psychological disorder  Abnormal psychology takes a look at the different forms of abnormality, how people become abnormal, and what can be done to make their functioning normal  Psychological abnormality – behaviour, speech, or thought that impairs the ability of a person to function in a way that is generally expected of him/her, in the context where the unusual functioning occurs.  Mental illness – often used to convey the same meaning as abnormal psychology, but it implies a medical rather than psychological cause.  Psychological disorder – a specific manifestation of impairment of functioning, as described by some set of criteria that have been established by a panel of experts.  Psychopathology – both the scientific study of psychological abnormality and problems faced by people who suffer from such disorders o They occur in all societies and have been apparent in history but varies across time and place ATTEMPTS AT DEFINING ABNORMALITY  The concept of abnormality changes with time and differs across cultures and subcultures  It is also possible that we cannot easily resolve these problems because the concepts are so vague Statistical Concept  According to this view, behaviour is judged as abnormal if it occurs infrequently in the population  Relative infrequency – ought to be one defining feature of abnormality  Not all infrequent behaviours or thoughts should be judged abnormal o E.g. innovative ideas are necessarily scarce or they would hardly be original, but most people wouldn’t consider the person who had such ides as displaying abnormality. o Same goes for professional athletes (prowess athletes)  More telling example concerns people who fall at extremes of intellectual spectrum o Psychologists have developed tests to measure intelligence which produce a score called IQ  Measures of IQ are standardized on large samples of people that are meant to represent every aspect of the total population  Based on statistical concept, those who score 70 or lower on IQ would meet one of the criteria for a diagnosis of mental retardation (considered abnormal)  An IQ score this low certainly indicates that a person will have considerable difficulty functioning independently in mainstream society, and will likely display inappropriate behaviours  Based on statistical concept, those who score 3- or more above the average (IQ of 130+), are not considered to be abnormal; they are admired if not envied.  A problem with this approach is that it’s not clear how unusual a given behaviour has to be in order to be considered abnormal. Personal Distress  Many people who are considered to have psychological disorder report being distressed o Yet distress isn’t present for all people identified as abnormal  An individual with an antisocial personality disorder who violates the rights of others, breaks laws, and lacks empathy and remorse isn’t distressed by their own behaviour; but, it’s the individuals in society who are distressed by this behaviour  If we mourn when someone we love dies, our response might be judged to be normal.  If our grief didn’t abate with time, and our depression deepened and persisted for years, our suffering would be described as abnormal  Distress, then appears to be a frequent, but not essential feature of abnormality Personal Dysfunction  When behaviour is clearly maladaptive (interferes with appropriate functioning), it’s typically said to be abnormal  Many of us respond with feelings of anger, vulnerability, sadness, and anxiety after knowing about tragic events (e.g. twin tower explosions), but this doesn’t mean it is abnormal behaviour.  Scanning the environment for such threats is somewhat adaptive as it serves a survival function  Wakefield  harmful dysfunction is the key notion – where dysfunctions refer to “failures of internal mechanisms to perform naturally selected functions” o Given a behaviour is disordered “requires both:  a scientific judgment that there exists a failure of designed function and  a value judgment that the design failure harms the individual o Wakefield refers to what an artefact or behaviour was originally designed to do o Unless there are dysfunctional consequences to the individual, in that he or she is unable to perform a natural function, it makes little sense to call behaviour abnormal  The boundaries between normal and abnormal and what specifically constitutes “harmful dysfunction” aren’t clear and is controversy Violation of Norms  A lot of behaviour and thoughts of many psychologically disordered individuals run counter to what we might consider inappropriate.  Some of them are so bizarre we see their behaviour as irrational, personally repulsive or against the social norm and are seen as not acceptable in society  Examples include: o A man who gets sexually aroused when he dresses in women’s clothing o Criminals also engage in behaviours that violate social norms o Lyrics for some hip hop or rap songs make many people uncomfortable  The notion of violating norms is the idea that psychologically abnormal people are unpredictable and somehow dangerous. o In fact most psychologically disordered people are harmless and rarely attempt to hurt anyone o They are also no more dangerous, or no more predictable than the rest of the population o It’s also the notion that the media expresses and portrays all killers and rapists as mad, but most actually aren’t.  It makes more sense to us if we think that such a repugnant person would be mad or insane to kill or hurt another person.  Social norms vary over time and place; 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 – the norms of a particular culture determine what is considered to be normal behaviour, and abnormality can be defined only in reference to these norms.  Society’s criteria for defining behaviour as acceptable or not are also not temporally universal; they reflect the predominant view in society, which changes over time. Diagnosis by an Expert  Clinical psychologists, initially trained in general psychology, receive graduate training in the application of this knowledge to understand, diagnose, and ameliorate disorders of thinking and behaving.  Treatment primarily involves psychological interventions of one kind or another.  Psychiatrists, trained in medicine prior to doing specialized training in dealing with mental disorders, focuses on diagnosis and medical treatment that emphasize the use of pharmacological agents in managing mental disorders  Psychiatric nurses receive formal training in nursing before completing specialization in psychiatric problems; they manage day to day care of mentally disordered patients.  Psychiatric social workers influence the social environment on disordered clients; they help with clients in adjusting to life within their families and the community.  Occupational therapists are sometimes involved in providing mental health care; they help clients to improve their functional performance.  The DSM-IV-TR provides the operational criteria for various disorders and thereby defines abnormality.  This doesn’t clarify the criteria by which judgments are made, and an examination of the various criteria for the different disorders suggests that different aspects of the notions serve to define different disorders.  Thomas Szasz  suggested that the idea of mental disorders was invented by psychiatry to give control to its practitioners to the exclusion of other people, such as clergymen, who in the past had greater power over psychologically disordered persons.  Oscar Lewis  claimed that a culture of poverty existed in US that kept people living in poor circumstances; he suggested that poverty led to despair and helplessness, which in turn set the stage for the development of abnormal behaviour. Summary of Definitions  To identify a person or a behaviour as abnormal, no single criterion is either necessary or sufficient.  While such a notion may have some general value, it has little practical application  Most diagnosticians avoid the use of the term abnormality and simply prefer to match their clients’ symptoms to a set of criteria appearing in the latest edition of the diagnostic manual; this works effectively in practice  Defining specific behaviours, thoughts and feelings as representing particular disorders is useful because then we can plan the management and treatment of the person displaying such problems. HISTORICAL CONCEPTS OF ABNORMALITY  Erwin Ackerknect  suggested the criterion by which a person in any society is judged to be mentally ill depends on whether the affected individual is capable of some minimum of adaptation and social functioning with his/her society.  Revolutions in philosophy and science had profound effects on all aspects of society o Including a change in the way that people were seen o E.g. Darwin’s radical conceptualization of the mechanism of evolution (natural selection) had an immediate influence on a lot of areas.  Alberta passed a Sexual Sterilization Act under which individuals who were deemed “feebleminded,” “mentally deficient,” or “mentally ill” were to be involuntarily sterilized to prevent deterioration of the intellectual level of the general population  When we consider some past notions about abnormality, we might tend to scoff and treat them as absurd, but at that time their general views of those notions might have made sense and be correct to them at that time.  Earlier ideas about abnormality were accepted not only by those who made decisions about the insane, but also by many of the sufferers and their families.  A society that explains everyday events (weather, seasons, war, etc.) as a result of supernatural causes – causes beyond the understanding of ordinary mortals, such as influence of Gods, demons, or magic – will view madness similarly. o Psychological dysfunction in various historical periods was thought to result from either possession by demons or the witchcraft of evil people o Treatment involved ridding the mad person of these influences by exorcism or other magical or spiritual means o When worldly events are seen to have natural causes – causes that can be observed and examined – are mental afflictions as well, and they are treated in a way that addresses these presumed natural causes. Evidence from Prehistory  Skulls have been found with circular sections cut out of them; there are clear signs of bone regeneration around these holes with operations called trephination were done while the person was still alive. o This was done to let the evil out his struggle with schizophrenia. o The people in Koffi’s community believed that he was possessed by demons Greek and Roman Thought  Golden Age of Greece  temples of heads were soon established emphasizing natural causes for mental disorders and that developed a greater understanding of the causes and treatment of these problems.  Hippocrates was the first instance of a rejection of supernatural causes for mental illness o He didn’t distinguish mental diseases from physical diseases o He thought that all disorders had natural causes o He argued that stress could influence mental functioning and thought that dreams were important in understanding why a person was suffering from a mental disorder. o For treatment, he advocated a quiet life, a vegetarian diet, healthful exercise, and abstinence from alcohol. o From Hippocrates’ idea of bleeding when treatment failed, they then had the idea that psychological functioning resulted from disturbances of bodily fluids or humours  Both vomiting and bleeding were thought to reduce excesses of one or another of the humours o He was the first to describe what he called hysteria, now known as conversion disorder – psychologically induced blindness, deafness, or other apparent defects in perceptual or bodily processes.  Plato  placed more emphasis on socio-cultural influences on thought and behaviour o Elaborated on Hippocrates’ notions about dreams o He suggested that they served to satisfy desires because the inhibiting influences of the higher faculties were not present during sleep o He declared that mentally disturbed people who commit crimes shouldn’t be held responsible, since they couldn’t be said to understand what they had done. o He anticipated modern notions of legal insanity, which exempts afflicted people from responsibility of their crimes o For treatment, he said that in most cases, the mentally ill should be cared for at the homes of relatives, anticipating the present trend toward community care  For those who must be hospitalized, Plato said their thinking must be rationally challenged in a conversational style of therapy  Aristotle  wrote extensively on mental disorders and other aspects of psychological functioning o He accepted Hippocrates’ bodily fluids theory but denied the influence of psychological factors in the etiology of dysfunctional thinking and behaving. o He advocated the humane treatment of mental patients  Egpytians  adopted medical and psychological ideas of the Greeks o Introduced the opportunity for interesting and calming activities, healthful diets, soothing massages, and education  Methodism  it’s principle advocate being Soranus of Ephesus o Methodism regarded mental illness as a disorder that resulted either from a constriction of body tissue or from a relaxation of those tissues due to exhaustion o The head was seen as primary site of this affliction o Mania, Soranus said, resulted from overexertion, licentiousness, or alcoholism. o Soranus thought natural bloodletting (e.g. menstruation) would provide an avoidance of the disorder, and if it
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