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Chapter 1

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York University
PSYC 3140
Joel Goldberg

Chapter One  Clifford Beers began a movement for the reform of mental health treatment, titled “The Mental Hygiene Movement” after surviving harsh treatment in a psychiatric hospital and recovering from depression, and paranoia.  Clarence Hincks founded the Canadian national Committee for Mental Hygiene with Dr. C. K. Clarke in 1918, which revolutionized mental health care with respect to diagnosis, treatment, and prevention of mental illness  Abnormal Psychology is the study of people who suffer mental, emotional, and often physical pain as a result of some form of psychological or mental disorder often referred to as psychopathology.  A survey of Canadians in 2003 found that approximately 7% (1.9 million) of people 20+ had been diagnosed with a mental illness and another 1.6 million (6%) were found to have a diagnosable mental illness that had not yet been formally diagnosed  Mental illness in Canada accounts for more than 50% of physician billings and results in more hospital bed-days than Cancer  Context or circumstances surrounding a behaviour influence whether a behaviour is viewed as abnormal.  According to some theorists deviation from cultural or societal norms is the only criterion for labelling a behaviour as abnormal  A parallel perspective argues that behaviours become defined as abnormal if they violate a culture’s gender roles, which are expectation for the behaviour of an individual based on his or her gender. i.e.: a woman crying in public vs. a man crying in public.  Other theorists focus on the unusualness of the behaviour, the discomfort of the person exhibiting the behaviour, the presence of mental illness, and the maladaptiveness of the behaviour. o Each of these views have their advantages and disadvantages  The cultural relativism perspective holds that no universal standards or rules exist for labelling behaviour as abnormal. Instead, behaviours can be abnormal only relative to cultural norms.  Cultural relativists believe that different definitions of abnormality are used across different cultures.  Opponents of cultural relativism argue that dangers arise when societal norms are allowed to dictate what is normal and abnormal. Psychiatrist Thomas Szasz noted that throughout history societies have labelled individuals and groups abnormal to justify controlling or silencing them. Example: Hitler.  Slaves could be diagnosed with drapetomania: a sickness that causes one to desire freedom, if they tried to escape.  Most psychologists these days do not take an extreme relativist view on abnormality, recognizing the dangers of completely accepting society’s definition of what is ab/normal. Sensitivity is increasing to the reality that cultural norms and gender roles strongly influence people’s feelings and actions  Unusualness is another standard used for designating behaviours as abnormal. A behaviour that is unusual, or rare, is considered abnormal; whereas, behaviours that are typical, or usual, are considered normal. This criterion has some ties to the relativist criterion, because the unusualness of any behaviour depends in part on a culture’s norms for the behaviour. i.e.: how unusual is it for a bereaved person to wail in public? Depends if they’re in Cairo or Calgary.  the unusualness criterion has two other problems: 1. Although the criterion may seem objective, someone still has to decide how rare a behaviour must be to call it abnormal. i.e.: are behaviours that are in 10% of population abnormal. Or 1%? Choosing a cut off would be subjective. 2. Many rare behaviours are positive for the individuals and for society, and most people would object to labelling them as abnormal. Example: hobbies and activities, eccentrics, the gifted.  Proponents of a discomfort criterion for abnormality suggest that behaviours should be considered abnormal only if the individual suffers discomfort and wants to be rid of the behaviours. o This contributed to how people view homosexuality; gay men and lesbians don’t see it as a discomfort. It was removed from a list of psychological disorders in 1973.  Problem with the discomfort criterion: people are not always aware of the problems their behaviours create for themselves or for others. Also, behaviours of some people cases great discomfort in others, if not in themselves  Mental illness: this criterion implies that a clear, identifiable physical process exists that differs from health and leads to specific behaviours or symptoms.  Problem: there are no biological tests available to diagnose any abnormalities. Most mental health problems are due to a number of complex biological and psychosocial factors rather than a single abnormal gene or disease process.  Example: obsessive compulsive disorder does not refer to an identifiable physical process but is found in individuals who exhibit symptoms of OCD.  The consensus is that behaviours and feelings that are maladaptive- that cause people to suffer distress and that prevent them from functioning in daily life- are abnormal and should be the focus of research and intervention.  The label ‘maladaptive behaviour’ is reserved for behaviours and feelings that are highly unusual or deviant.  The three components of maladaptiveness: 3D’s. dysfunction, distress, and deviance  The maladaptiveness criteria have attracted widespread support among mental health professionals, but it is viewed as subjective.  Even when the criteria is used confidently to identify a certain group of behaviours as abnormal, culture and gender can still influence the expression of those behaviours and the way those behaviours are treated.  First, culture and gender influences how likely it is that a given maladaptive will be shown. o Example: men are more likely to abuse alcohol  Second, culture and gender can influence the ways people express distress or lose touch with reality  Third, culture and gender can influence people’s willingness to admit to certain types of maladaptive behaviours  Fourth, culture and gender can influence the types of treatment that are deemed acceptable or helpful for maladaptive behaviours o Example: women may be more willing than men to seek help.  Another approach to defining abnormality is Jerome Wakefield’s notion of harmful dysfunction. o He suggested that mental disorders can be generally defines as harmful dysfunctions because they involve a harmful failure of internal mechanisms to perform their naturally selected functions. Something inside a person is not working as it should. o He clarified that not all dysfunction leads to disorders; rather, a dysfunction is a mental disorder only when the dysfunction causes some harm to the person as determines by the standards of the person’s culture. Could be personal or social harm  The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), American Psychiatric Association (APA), represents the categorical perspective that disorders are qualitatively distinct syndromes.  This approach is the one used in all systems of medical diagnosis. An alternative approach is the dimensional perspective, which views mental functioning as a continuum from normality to abnormality, with psychopathology representing exaggerations of normal functioning  A dimensional system classifies clinical representations based on the “qualification of attributes rather than assignment to categories”  Instead of studying abnormality, some clinical psychologists have begun to study happiness. Rather, they want to help people achieve high levels of functioning or what they call full functioning.  This is referred to as positive psychology- the study of positive emotion, character and institutions as well as the study of conditions and processes that contribute to the flourishing or optimal functioning of people, groups, and institutions.  The underlying premise of positive psychology is that a complete science and practice of psychology should include a framework for both addressing suffering and harnessing happiness.  A diathesis-stress model views disorders as being made up of two parts. o Diathesis: is a vulnerability or predisposition to developing a mental disorder, and it is thought to be a necessary component in the development of a disorder o Stress: is the trigger. A mental disorder occurs when an individual with a vulnerability experiences a stressful live event  Individuals with a higher diathesis may need only a small amount of stress to activate a disorder. Example: genetic vulnerability in serotonin transporter gene is more likely to develop depression following a stressor.  Three types of theories of the causes of abnormal behaviour 1. Biological theories: abnormal behaviour is caused by a breakdown of systems in the body.  Cure: restoration of body to good health 2. Supernatural theories: result of divine intervention, curses, and demonic possessions.  Cure: exorcisms, rituals, confessions, atonement. 3. Psychological theories: result of traumas, stress  Cure: rest, relaxation, a change of environment and certain herbal medicines  These three causes determined how a person was regarded in society.  Our understanding of prehistoric understanding of abnormality comes from fragments of bones and artwork  Demons and ghosts were causes of abnormal behaviour, exorcisms were common. Same with killing the ‘possessed’  Some drilled holes in skills to allow spirits to depart. This was called trephination; the tool was a trephine.  Some historians suggested that this was done to remove blood clots  Ancient Chinese medicine based on Yin (negative force) and Yang (positive force); if the two forces were in balance, individual was healthy. Excited insanity was the result of excessive Yang.  Another Chinese medicine theory: human emotions were controlled by internal organs, when the ‘vital air’ was flowing in an organ you felt the associated emotions. There was also a belief in evil wind
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