5.1 Abnormal Psychology Concepts of normality

Discuss the extent to which biological, cognitive and sociocultural factors influence abnormal behavior

Evaluate psychological research relevant to study of abnormal behavior

IB – three groups of disorders Anxiety have a form of irrational fear as the central disturbance. e.g. post-traumatic stress disorder, obsessive compulsive disorder; panic disorder, social anxiety disorder; generalized anxiety Affective Characterized by dysfunctional moods. Depression; Bipolar; Seasonal-affective-disorder; alcohol/drug induced depression Eating Disorders Characterized by eating patterns which lead to insufficient or excessive intake of food. Anorexia; bulimia.

Studying Abnormal We will study one of these disorders (Anxiety, Affective or Eating) and assess from: Etiology Biological Cognitive Sociocultural Symptoms Prevalence Treatment Biometical (drug therapy) Individual psychotherapy Group psychotherapy Cultural and gender variations

Discuss the concepts of normality and abnormality Pgs 136-141

Concepts of normality and abnormality Who decides what is normal and what is abnormal? What effect does culture have on interpreting behavior? How does different social settings change the interpretation of what is normal vs abnormal? If treatment is dependent upon diagnosis, how does one qualify the degree of behavior? Often it is a series of judgement Diagnostic manual

Trends in behavior Intelligence and short term memory follow normal distributions Abnormality is often defined as a “subjective” feeling of “not normal” anxiety, unhappiness, distress. When behavior violates social norms or makes others anxious??? Can this be seen as abnormality?

Rosenhan and Seligman (1984) There are seven criteria that could be used to decide whether a person or behavior is normal or not: Suffering Maladaptiveness Irrationality Unpredictability Vividness and unconventionality Observer discomfort Violation of moral or idea standards

Suffering Does the person exhibit stress and discomfort?

Maladaptiveness Does the person engage in behavior that make life difficult for him rather than being helpful?

Irrationality Is the person incomprehensible or unable to communicate in a reasonable manner?

Unpredictability Does the person act in a ways that are unexpected by himself or other people?

Vividness and unconventionality Does the person experience things that are different from most people?

Observer discomfort Is the person acting in a way that is difficult to watch or that makes other people embarrassed?

Violation of moral or idea standards Does the person habitually break the accepted ethical and moral standards of the culture?

Defining abnormality is not easy Suffering, Maladaptiveness, Irrationality, Unpredictability: Deals with how the person is living life Vividness and unconventionality Social judgment Often fail to consider the diversity in how people live their lives Observer discomfort, Violation of moral or idea standards Social norms

Two Approaches to defining abnormal vs normal The Mental health criteria: Jahoda (1985) The Mental illness criteria: Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association) Medical model

The mental health criteria Jahoda (1985) took a different approach – They assessed the characteristics that we identify with normal behavior. 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

Evaluation of mental health criteria Using Johoda’s criteria, how might you be perceived in other cultures? How would a behavior be perceived in different eras of time? Example – sexuality (pg 138)

Be a thinker The DSM has classified transsexualism as a disorder. It is called “gender identity disorder” when people feel deep within themselves that they are the opposite sex. Many films have portrayed the lives of people who are transsexual. 1. Should this de described as a disorder, as homosexuality was? 2. What are the arguments for and against declassification?

Changing view of abnormal behavior

The mental illness criterion Abnormal behavior is of physiological origin – Medical model Neurotransmitters, hormones Can be treated with drug therapy Psychopathology – psychological illness that is based on the observed symptoms of a patient.

Ethical concerns of the medical model Model argues it is better to regard someone suffering a mental disorder as sick than morally defective Gross (2002) cites misuse, due to diagnosing being influenced by culture or politics. (pg 139 examples) Today psychiatrist use classification system, designed to be more objective. More holistic approach which is biopsychosocial. Tomasz Szasz (1962)– US psychiatrist was most critical of the concept “mental illness,” he argued that although some disorders were associated with disease of the brain, most could be considered as problems in living. Frude (1998) – there are few psychological disorders that can be associated with organic pathology.

Are you shy? Read top page 140 and discuss

Discuss validity and reliability of diagnosis Pg 140- 143

Diagnosing Psychological Disorders Diagnosing is accomplished through clinical interview – a checklist of questions Limitations Information is only as good as the patient provides and the physician is listening 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 clinicians unique style, degree of experience and the theoretical orientation will definitely affect the interview.

Other methods used to diagnose Observation Brain scanning (suspected schizophrenic or Alzheimer) Psychological testing (ADHD, IQ, personality tests)

ABC’s of describing disorders Affective symptoms Emotional elements, including fears, sadness, anger Behavioral symptoms Observational behavior, such as crying, physical withdrawal, pacing. Cognitive symptoms Ways of thinking, including pessimism, personalization, and self image Somatic symptoms Physical symptoms, facial twitching, stomach cramping, amenorrhea.

Defining is not easy! Is abnormal psychology stagnant or is it continuously evolving? Does how we define abnormality change over time? Does “abnormality” reflect a social construct?

Validity and Reliability of diagnosis Diagnosing – the ability to identify a disease based on symptoms using diagnostic systems, a set of standardized templates which to base your analysis. Reliability – different clinicians using the same system should get the same results. Validity – does the system identify a pattern of symptoms that can be treated? (*this does not imply identifying cause and effect).

Rosenhan (1973) revisited “On being sane in insane places,” Aim – to test the reliability of psychiatric diagnosis Method – field experiment Procedure – 5 men & 3 women tried to gain admission to 12 psychiatric hospitals. They complained they had been hearing voices. Seven of them were diagnosed with schizophrenia. After being admitted they stated they felt fine and they were no longer experiencing symptoms. It took an average of 19 days before they were discharged.

Rosenhan cont., He then challenged that the institutions could not distinguish abnormal from normal, and said they would send in more confederates. They did not, yet the institution claimed 41 pseudo-patients were confederates attempting to be admitted. Conclusion – it was not possible to distinguish sane and insane in psychiatric hospitals. This also raised ethical concerns on treatment.

Diagnosing woes Beck et al (1962) – the agreement on diagnosing for 153 patients between two psychiatrist was only 54%. Cooper et al (1972) – NY psychiatrist were twice as likely to diagnose schizophrenia than London psychiatrist. DiNardo et al., (1993) assessed DSM III for anxiety disorders: 2 clinicians - 80% reliability on OCD, 57% reliability on generalized anxiety disorders when assessing 267 individual Problem with generalized anxiety was how to interpret how excessive a person’s worries were.

Diagnosing woes What problems do you see? Lipton and Simon (1985) – 131 patients assessed 1st round of diagnosis 89 schizophrenic 2nd round of diagnosis Only 16 of the original 89 were diagnosed as schizophrenic 50 were diagnosed as mood disorder What problems do you see?

Influences on diagnosing Attitudes and prejudice of psychiatrist Expectations that certain groups/gender are prone to depression therefore you interpret as depression. Overpathologization – the excessive use of applying expectations/stereotyping to create a diagnosis.

Discuss cultural and ethical considerations in diagnosis Pgs 143 - 147

Ethical considerations in diagnosis Stigmatizing – the use of labels to distinguish people as different. Szasz (1974) Ideology and Insanity, argues people use labels such as mentally ill, criminal or foreigner to socially exclude people. DMS-IV has altered its approach to separate the behavior from the individual. Self-fulfilling prophecy – people may begin to act as they think they are expected to. Scheff (1966) argues labeling could increase symptoms Doherty (1975) those who reject the mental illness label tend to improve quicker.

Ethics cont., Prejudice and discrimination – scheme processing Langer and Abelson (1974) : video of younger man telling older man about his job experience. (see interpretations pg 143) Racial/ethic bias: Jenkins-Hall and Sacco (1991) Evaluation of African American and European American Women in depressed and non-depressed setting (pg 143) Conformational bias: clinicians assume there must be a disorder is the patient is there to see them. Rosenhan?????

Ethics cont., Powerless and depersonalization: Lack of rights, constructive activity, choice, privacy, as well as frequent verbal abuse and even physical abuse by attendants.

Cultural considerations in diagnosis Culture-bound syndromes – disorders that appear to be culturally specific. Although many disorders are universal some are culture-bound specific Examples: shehjing shuairuo (neurasthenia) accounts for more than 50% of psychiatric outpatients in China. This disorder is listed in the Chinese Classification of Mental Disorders (CCMD-2) but not in the DSM-IV used in western society.

neurasthenia Diagnostic criteria for neurasthenia include: Persistent and distressing symptoms of exhaustion after minor mental or physical effort including general feeling of malaise, combined with a mixed state of excitement and depression. Accompanied by one or more of these symptoms: muscular aches and pains, dizziness, tension headache, sleep disturbance, inability to relax and irritability. Inability to recover through rest, relaxation or enjoyment. Disturbed and restless, unrefreshing sleep, often troubled with dreams. Duration of over three months. Does not occur in the presence of organic mental disorders, affective disorder, panic or generalized anxiety disorder. Neurasthenia and depression: a study of somatization and culture in China. Kleinman A. Abstract The author reviews conceptual and empirical issues regarding the interaction of neurasthenia, somatization and depression in Chinese culture and in the West. The historical background of neurasthenia and its current status are discussed, along with the epidemiology and phenomenology of somatization and depression. Findings are presented from a combined clinical and anthropological field study of 100 patients with neurasthenia in the Psychiatry Outpatient Clinic at the Hunan Medical College. Eighty-seven of these patients made the DSM-III criteria of Major Depressive Disorder; diagnoses of anxiety disorders were also frequent. Forty-four patients were suffering from chronic pain syndromes previously undiagnosed, and cases of culture-bound syndromes also were detected. For three-quarters of patients the social significances and uses of their illness behavior chiefly related to work. Although from the researcher's perspective 70% of patients with Major Depressive Disorder experienced substantial improvement and 87% some improvement in symptoms when treated with antidepressant medication, fewer experienced decreased help seeking, and a much smaller number perceived less social impairment and improvement in illness problems (the psychosocial accompaniment of disease including maladaptive coping and work, family and school problems). These findings are drawn on to advance medical anthropology and cultural psychiatry theory and research regarding somatization in Chinese culture, the United States and cross culturally. The author concludes that though neurasthenia can be understood in several distinctive ways, it is most clinically useful to regard it as bioculturally patterned illness experience (a special form of somatization) related to either depression and other diseases or to culturally sanctioned idioms of distress and psychosocial coping.

American Psychiatric Association (APA) APA currently recognizes culture-bound syndromes by including separate listing in the appendix os DSM-IV (1994). Depression is common in western culture but appears to be absent in Asian cultures. Asian people tend to live with extended family and have greater social support. Asian doctors report that depression is equally common among Asians, but that Asians only consult their doctor for physical problems, rarely emotional distress. May seek help for physical symptoms associated with depression (fatigue, appetite disturbance, sleep disruption) but not mood issue.

How accurate are the comparisons? Reporting bias may limit the validity of the data obtained in cross culture comparisons, as data figures are typically based on hospitalization. Low admission rates may reflect cultural beliefs about mental health issues. Availability of mental health care for minority groups Cohen (1988) in India the mentally ill are cursed and looked down on Rack (1982) in China mental illness carries great stigma, thus only those who are severely psychotic are identified.

Culture and depression Marsella (2003) argues individualistic cultures expression of depression is affective, (emotional). In these cultures feelings of loneliness and isolation dominate. In more collectivist societies, somatic (physiological) symptoms such as headaches are dominant. The source of the stress and the tools for coping are different for each culture. Thus diagnosing is challenging as is treatment.

Culture and diagnosis Culture blindness - the problem of identifying symptoms of a psychological disorder if hey are not the norm in the clinicians own culture Cochrane and Sashidharan (1995) : normality behavior assumptions are based upon white population; any deviation reveals racial or cultural pthology Rack (1982) if a minority of different ethnicity exhibits a trait that would be considered abnormal in white culture, it is assumed to be abnormal in the other culture – this may not be true (example: hearing voices of a loved one as part of a funeral passage).

Apply your knowledge Read the passage pg 147 describing Anne and answer the following questions: Do you think this person’s behavior is normal? Do you think it is dysfunctional? Why or why not?

Discuss the extent to which biological, cognitive and sociocultural factors influence abnormal behavior

Prepare a list of 3 Abnormal behaviors - (http://www. mentalhealth Identify the Biological, Cognitive and sociocultural factors that influence the abnormal behavior. Prepare summary: Discuss the extent to which biological, cognitive and sociocultural factors influence abnormal behavior.

Evaluate psychological research relevant to study of abnormal behavior

Select three psychological research studies on abnormal behavior and clearly identify the strengths and limitations.