1. Abnormal Psychology: Concepts of Normality

2. Concepts of normality and abnormality It is not any easy task to define what is normal and what is abnormal. Behavioral measures, such as intelligence and short-term memory tend to be normally distributed – that is, the distribution from a sample of people tends to fall within a bell-shaped curve. Being normal falls within this bell curve.

3. Concepts of normality and abnormality There are problems using statistics in this way when dealing with abnormal behavior, because some things that are statistically normal – such as obesity are not desirable or healthy behaviors – and some that are statistically rare – such as high IQ – are not dysfunctional.

4. Concepts of normality and abnormality Abnormality is sometimes defined as the subjective experience of feeling “not normal” – Example: feeling intense anxiety, unhappiness, or distress. ◦ Although experiencing distress is not always a reliable indicator of serious psychiatric problems. Example: patients with schizophrenia may be unaware of their condition.

5. Concepts of normality and abnormality One way to define abnormality is to consider when behavior violates social norms or makes other anxious. ◦ this definition is problematic. Cultural diversity affects how people view social norms: what is seen as normal is one culture may be seen as abnormal in another.

6. Concepts of normality and abnormality Rosenhan and Seligman (1984) suggested that there are seven criteria that could be used to decide whether a person or a behavior is normal or not. ◦ Suffering – does the person experience distress or discomfort? ◦ Maladaptiveness – does the person engage in behaviors that make life difficult for him or her rather than being helpful? ◦ Irrationality – is the person incomprehensible or unable to communicate in a reasonable manner?

7. Concepts of normality and abnormality ◦ Unpredictability – does the person act in ways that are unexpected by himself, herself or other people? ◦ Vividness and Unconventionality – does the person experience things that are different from most people? ◦ Observer discomfort – is this person acting in a way that is difficult to watch or that makes other people embarrassed? ◦ Violation of moral or ideal standards – does the person habitually break the accepted ethical and moral standards of the culture?

8. Concepts of normality and abnormality Rosenhan and Seligman’s Criteria: ◦ The first four criteria deal with how a person is living life. ◦ The fifth represents a social judgment because is deals with what is seen as conventional or not. ◦ The remaining criteria represent social norms.

9. The mental health criteria Jahoda (1958) attempted to establish what is abnormal by identifying the characteristics of people who are normal. She identified six characteristics of mental health. ◦ Efficient self-perception ◦ Realistic self-esteem and acceptance ◦ Voluntary control of behavior ◦ True perception of the world ◦ Sustaining relationships and giving affection ◦ Self-direction and productivity

10. Evaluation of the mental health criteria If Jahoda’s list was applied, most of us would seem, somehow abnormal. They are to a large extent values judgments. Mot people can agree on what constitutes physical health, however this is not the case with mental health.

11. An example of changing views on abnormal behavior: homosexuality Older versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) viewed homosexuality as abnormal. DSM-III (1980) declared that homosexuality is only abnormal if the individual has negative feelings about his or her sexual orientation. In the UK, homosexuality between consenting adults was illegal until the 1960s. People in society have changed and homosexuality itself is not considered abnormal.

12. There have been numerous theories identifying homosexuality as abnormal. Some researchers (eg: Bieber, 1976) claim to have identified abnormal patterns of upbringing and relationships that seem to lead to homosexuality. Homosexuality is thus said to be the result of disturbed early experiences, including poor family life (eg: for men - extremely poor father- son relationships and an overly involved mother) and poor relationships with same-sex peers. Psychoanalytic theorists suggest that these experiences caused the homosexual to be afraid of heterosexuality, so they become homosexual as a means of denying their fear of same-sex peers. Homosexuality as abnormal

13. Homosexuality as normal There has been much criticism (eg: Davidson, 1976) concerning the data used to support the "abnormality" argument. These criticisms are typically along these lines: Research shows that homosexuals do not in fact suffer from more mental illness than heterosexuals. The families of homosexuals also do not seem to differ in significant ways from those of heterosexuals. The psychological problems suffered by homosexuals may be caused instead by the prejudices and discrimination they meet. Human behavior, this argument continues, is infinitely variable. There is no rational or scientific reason to see homosexuality as abnormal; it is merely a value judgment.

14. Get Ready for Questions!

15. One way to define abnormality is to consider when behavior violates social norms or makes other _________________.

16. anxious happy confused

17. Rosenhan and Seligman (1984) suggested that there are _______________criteria that could be used to decide whether a person or a behavior is normal or not.

18. five six seven

19. Which of the following is not a symptom of feeling abnormal? 1. anxiety 2. happiness 3. distress

20. Which of the following is not a symptom of feeling abnormal? anxiety happiness distress

21. Jahoda (1958) attempted to establish what is abnormal by identifying the characteristics of people who are normal. She identified ___________characteristics of mental health.

22. five six seven

23. The mental illness criterion The mental illness criterion is rooted in a view from the medical world that abnormal behavior is of physiological origin, this is called the medical model. Example: disordered neurotransmission causes abnormal behavior. Consequently treatment addresses the psychological problems, primarily through drug treatment. Abnormal behavior is referred to as psychopathology – psychological (or mental) illness that is based on the observed symptoms of a patient.

24. The mental illness criterion The term “mental disorder” is used in the DSM-IV published by the American Psychiatric Association. The DSM-IV is a handbook used by psychiatrists in the US to identify and classify symptoms of psychiatric disorders. This is a standardized system for diagnosis based on factors such as a person’s clinical and medical conditions. Psychological stressors and the extent to which a person’s mental state interferes with his or her daily life.

25. The mental illness criterion There are several ethical concerns about the use of the medical model to define abnormal behavior. The model argues it is better to regard someone suffering from a mental disorder as sick rather than morally defective because responsibility is removed from the patient.

26. The mental illness criterion According to Gross (2002), there have been examples of misuse of the medical model, since the criteria used for diagnosis are not objective and can be influenced by culture and politics. ◦ In the former Soviet Union political dissidents were diagnosed as schizophrenic, implying that they were not responsible for their deviant political beliefs. ◦ In the UK in the last century, women who were pregnant without being married could be admitted to an asylum.

27. The mental illness criterion Today, psychiatrists diagnose using a classification system that is supposed to be objective. The traditional medical model in psychiatry is now assumed to be reductionist, and most psychiatrists use a biophysical approach to diagnosis and treatment. However, this does not prevent a psychiatric diagnosis resulting in the patent being labeled as different, or “not normal.”

28. The mental illness criterion Tomasz Szasz is one of the most radical critics against the concept of “mental illness. “ In The Myth of Mental Illness (1962) he argued that while some neurophysiological disorders were diseases of the brain, most of the so called “mental disorders” should be considered as problems in living.

29. The mental illness criterion In Szaz’s view, even though people behave strangely and this is classified as mental illness by psychiatrists, such behaviors are not a symptom of an underlying brain disease. He also says that the concept of metal illness is not used correctly by psychiatrists. Frude (1998) argues there are relatively few psychological disorders that can be associated with identifiable organic pathology.

30. The mental illness criterion Is Szasz’s argument valid today? ◦ (Pilowsky, 2006) Neuropsychologists have in some cases, revealed a possible chemical abnormality in the brain in people suffering from schizophrenia. But brain scans haven’t yet provided an ultimate answer to Szaz’s questions.

31. Get Ready for Questions!

32. __________________ argues there are relatively few psychological disorders that can be associated with identifiable organic pathology.

33. Gross Frude Szasz

34. The term “mental disorder” is used in the ________________ published by the American Psychiatric Association.

35. DSM-I DSM-II DSM-III DSM-1V DSM-V

36. According to ______________, there have been examples of misuse of the medical model, since the criteria used for diagnosis are not objective and can be influenced by culture and politics.

37. Gross Szasz Pilowsky

38. Are you too shy? A recent trend in schools is to diagnose very shy children with “social anxiety disorder.” Young students are being diagnosed and treated. Shyness is so common among US children that 42% exhibit it. By the time they reach college, up to 51% of men and 43% of women describe themselves as shy or introverted. Psychiatrists say that at least one in eight of these people needs medical attention.

39. Are you too shy? It is debatable whether medical attention is needed. Julie Turner-Cobb says the stress hormone cortisol is consistently lower in shy children than in their more extroverted peers. This challenges the belief that shyness causes youngsters extreme stress.

40. Are you too shy? GlaxoSmithKline, the maker of Paxil, declared in the late 1990s that its antidepressant could also treat social anxiety and self-consciousness in restaurants. The public awareness campaign (“Imagine being allergic to people”) cost the drug maker $92 million in one year. Social anxiety became the third most diagnosed mental illness in the US, behind depression and alcohol. Studies put the total number of children affected at 15% - Higher than the one in eight whom psychiatrists suggested were shy enough for medical help.

41. Diagnosing psychological disorders Psychiatrists must rely on the patient's subjective description of the problem. Diagnosis is accomplished through a formal standardized clinical interview – a checklist of questions to ask each patient. After the interview, a mental heath status examination is completed, based on the clinician’s evaluation of the patient’s responses, today the clinician – often a psychiatrist – uses a standard diagnostic system.

42. Diagnosing psychological disorders Kleinmutz (1967) has noted that there are limitations to this interview process: ◦ Information exchange may be blocked if either the patient or the clinician fails to respect the other, or if the other is not feeling well. ◦ Intense anxiety or preoccupation on the part of the patient may affect the process. ◦ A clinician’s unique style, degree of experience, and the theoretical orientation will definitely affect the interview.

43. Diagnosing psychological disorders In addition to interviews, other methods can be used to assist with diagnosis. These include: ◦ Direct observation of the individual’s behavior ◦ Brain-scanning techniques such as CT and PET (especially in cases such as schizophrenia or Alzheimer’s disease.) ◦ Psychological testing, including personality and IQ tests.

44. Diagnosing psychological disorders Psychologist refer to the ABCs when describing symptoms of a disorder. ◦ Affective symptoms: emotional elements, including fear, sadness, anger. ◦ Behavioral symptoms: observational behaviors, such as crying, physical withdrawal from others, and pacing. ◦ Cognitive symptoms: ways of thinking, including pessimism, personalization, and self-image. ◦ Somatic symptoms: physical symptoms, including facial twitching, stomach cramping, and amenorrhoea (absence of menstruation)

45. Diagnosing psychological disorders The two major classification systems used by western psychiatrists today, the DSM and ICD (International Classification of Diseases), are based largely on abnormal experiences and beliefs reported by patients, as well as agreement among a number of professionals as to why the criteria should be used. This explains why the criteria in DSM is revised the views of homosexuality.

46. Get Ready for Questions!

47. Shyness is so uncommon among US children that only 42% exhibit it.

48. true false

49. ◦ What does ABCs stand for in psychology?

50. What does ABCs stand for in psychology? Affective, Biological, Cognitive, Somatic Anxiety, Behavioral, Cognitive, Somatic Affective, Behavioral, Cognitive, Somatic

51. The two major classification systems used by western psychiatrists today, the DSM and _________________, are based largely on abnormal experiences and beliefs reported by patients, as well as agreement among a number of professionals as to why the criteria should be used.

52. APA MLA ICD

53. ______________symptoms: physical symptoms, including facial twitching, stomach cramping, and amenorrhoea

54. Affective Behavioral Cognitive Somatic

55. ◦ _________________symptoms: observational behaviors, such as crying, physical withdrawal from others, and pacing.

56. ______________symptoms: physical symptoms, including facial twitching, stomach cramping, and amenorrhoea Affective Behavioral Cognitive Somatic

57. ◦ __________________symptoms: emotional elements, including fear, sadness, anger.

58. Affective Behavioral Cognitive Somatic

59. Validity and reliability of diagnosis The classification system used to identify abnormal behaviors is descriptive and does not identify any specific causes for disorders. It is difficult to make a valid diagnosis for psychiatric disorders because there are no objective physical signs of such disorders.

60. Validity and reliability of diagnosis Reliability: this is high when psychiatrists agree on a patient’s diagnosis when using the same diagnostic system. This is also known as inter-rater reliability. Validity: this is the extent to which the diagnosis is accurate. This is much more difficult to assess in psychological disorders, for example because some symptoms appear in different disorders.

61. Validity and reliability of diagnosis Rosenhan (1973) tested the validity of psychiatric diagnosis. The study is considered an important and influential criticism of psychiatric diagnosis.

62. Validity and reliability of diagnosis Rosenhan's study was done in two parts. The first part involved the use of healthy associates or "pseudopatients" who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders.

63. Validity and reliability of diagnosis After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations. Hospital staff failed to detect a single pseudopatient, and instead believed that all of the pseudopatients exhibited symptoms of ongoing mental illness. Several were confined for months. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release.

64. Validity and reliability of diagnosis The second part involved asking staff at a psychiatric hospital to detect non-existent "fake" patients. No fake patients were sent, yet the staff falsely identified large numbers of ordinary patients as impostors.

65. Validity and reliability of diagnosis The study concluded, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals" and also illustrated the dangers of dehumanization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.

66. Validity and reliability of diagnosis The Rosenhan study illustrates the concerns about reliability in diagnosis of psychiatric illness. The diagnostic classification systems have been accused of being unreliable. Using the same diagnostic manual, two psychiatrists could easily diagnose the same patient with two different disorders.

67. Validity and reliability of diagnosis Beck et. al (1962) found that agreement on diagnosis for 153 patients between two psychiatrists was only 54%. Cooper et. Al (1972) found that New York psychiatrists were twice as likely to diagnose schizophrenia than London psychiatrists, who in turn were twice as likely to diagnose mania or depression when shown the same videotaped clinical interviews.

68. Validity and reliability of diagnosis Di Nardo (1993) studied reliability of the DSM-III for anxiety disorders. Two clinicians separately diagnosed 267 individuals seeking treatment for anxiety and stress disorders. They found high reliability for obsessive compulsive disorder (.80), but very low reliability for assessing generalized anxiety disorder, (.57), mainly due to problems with interpreting how excessive a person worries were.

69. Validity and reliability of diagnosis Lipton and Simon (1985) randomly selected 131 patients in New York and conducted various assessment procedures to arrive at a diagnosis for each person. This diagnosis was then compared with the original diagnoses. Of the original 89 diagnoses of schizophrenia, only 16 received the same diagnosis on re-evaluation; 50 were diagnosed with a mood disorder, even though only 15 had been diagnosed with a mood disorder.

70. Validity and reliability of diagnosis If the same diagnosis has a 50:50 chance of leading to the same or different treatment, this suggests a serious lack of validity, probably due to bias in diagnosis. Since diagnostic classification systems are not 100% objective, the diagnosis may be influenced by the attitudes and prejudices of the psychiatrist.

71. Validity and reliability of diagnosis Clinicians may expect certain groups of patients to be more prone to depression, and therefore more likely to interpret symptoms as related to depression even though the same symptoms would be interpreted as something else of they were presented by a different person. When this occurs consistently it is called overcategorization.

72. Ethical considerations in diagnosis Szasz in Ideology and Insanity (1974) argued that people use labels such as mentally ill, criminal, or foreigner in order to socially exclude people. People who are different are stigmatized. The psychiatric diagnosis provides the patient with a new identity – for example, “schizophrenic.” Criticism raised by Szasz have influenced the classification systems: in DSM-IV it is recommended to refer to an individual with schizophrenia.

73. Ethical considerations in diagnosis Ethical concerns about labeling remain, which result from identifying someone’s behavior as abnormal, since a psychiatric diagnoses may be a label for life. Even if a patient no longer shows any symptoms, the label “disorder in remission” still remains.

74. Ethical considerations in diagnosis Scheff (1966) argued that one of the adverse effects of labels is the self-fulfilling prophecy – people may begin to act as they think they are expected to. They may internalize the role of “mentally ill patient” and this could increase in symptoms. Doherty (1975) points out that those who reject the mental illness label tend to improve more quickly than those who accept it.

75. Ethical considerations in diagnosis Langer and Abelson (1974) tested social perception of the mentally ill. They showed a videotape of a younger man telling an older man about his job experience. If the viewers were told beforehand that the man was a job applicant, he was judged to be attractive and conventional-looking, whereas if they were told that he was a patient he was described as tight, defensive, dependent, and frightened of his own aggressive impulses. This clearly demonstrates the power of schema processing.

76. Ethical considerations in diagnosis There are several types of bias that may affect the validity of a diagnosis: ◦ Racial/ethnic: The study of the 'Effect of client race and depression on evaluations by white therapists' by Jenkins-Hall and Sacco (1991) involved white therapists being asked to watch a video of a clinical interview then to evaluate the female interviewee. There were four conditions representing the possible combinations of race and depression. In one condition the woman was African American and nondepressed, in another condition she was a white American and nondepressed. In the other two conditions she was each of these races but depressed. Although the therapists rated the nondepressed African American and the white American in much the same way, their ratings of the depressed women differed in that they rated the African American woman wit more negative terms and saw her as less socially competent than the depressed white American woman.

77. Ethical considerations in diagnosis ◦ Confirmation bias:  Clinicians may tend to have expectations about the person who consults them, assuming that if the client is here, there must be some disorder to diagnose. Since their job is to diagnose abnormality, they perhaps over-react and see abnormality wherever they look. This is most clearly by Rosenhan (1973).  institutionalization refers to individuals in institutions, once admitted, all their behavior is seen as a symptom of their mental illness.

78. Ethical considerations in diagnosis Powerlessness and depersonalization: this is produced in institutions through a lack of rights, constructive activity, choice, and privacy, as well as frequent verbal and even physical abuse from attendants.

79. Ethical considerations in diagnosis Clinicians might believe that the more assessment techniques they use the more valid their interpretation will be. Kahneman and Tversky (1973) point out that this is not the case, there is not a positive correlation between the number of assessment techniques used and the accuracy of eventual diagnosis.

80. Cultural considerations in diagnosis Culture-Bound Syndromes - abnormalities thought to be culturally specific. ◦ Depression (absent in Asian societies) Reporting Bias – people tend to avoid doctors and sort it out within family. ◦ Data based on hospital admissions ◦ China—mental illness carries stigma Difference in Symptoms ◦ Affective (emotional symptoms) - individualistic ◦ Somatic (physiological symptoms) - collectivist Culture Blindness – the problem of identifying symptoms of psychological disorder if they are not the norm in the clinicians own culture.

81. Get Ready for Questions!

82. The mental illness criterion is rooted in a view from the ____________world that abnormal behavior is of physiological origin

83. The mental illness criterion is rooted in a view from the ________________world that abnormal behavior is of physiological origin psychological pseudoscience medical

84. _________________tested social perception of the mentally ill. They showed a videotape of a younger man telling an older man about his job experience.

85. Langley and Weber Lynn and McCall Langer and Abelson

86. _____________________ point out that this is not the case, there is not a positive correlation between the number of assessment techniques used and the accuracy of eventual diagnosis.

87. _________________tested social perception of the mentally ill. They showed a videotape of a younger man telling an older man about his job experience. Kahneman and Tversky Lynn and McCall Langer and Abelson

88. ______________________– people tend to avoid doctors and sort it out within family.

89. Culture-bound Difference in symptoms Reporting bias