Chapter 1 Abnormal Behavior in Historical Context

Myths and Misconceptions About Abnormal Behavior No Single Definition of Psychological Abnormality No Single Definition of Psychological Normality

What is a Psychological Disorder? Psychological Dysfunction –Breakdown in cognitive, emotional, or behavioral functioning Personal Distress –Difficulty performing appropriate and expected roles –Impairment is set in the context of a person’s background Atypical or Not Culturally Expected Response –Reaction is outside cultural norms

Abnormal Behavior Defined Working Definition –A psychological dysfunction associated with distress or impairment in functioning that is not typical or culturally expected The Diagnostic and Statistical Manual (DSM- IV-TR) –DSM Contains Diagnostic Criteria The Field of Psychopathology –The scientific study of psychological disorders

The Science of Psychopathology Mental Health Professionals –The Ph.D.’s: Clinical and counseling psychologists –The Psy.D.’s: Clinical and counseling “Doctors of Psychology” –M.D.’s: Psychiatrists

The Science of Psychopathology (continued) –M.S.W.’s: Psychiatric and non-psychiatric social workers –LPC/MHSP: Licensed Professional Counselors/Mental Health Service Provider –LMFT: Licensed Marriage and Family Therapist –MN/MSN’s: Psychiatric nurses –Lay public and community groups

The Scientist-Practitioner Producers of Research Consumers of Research Evaluators of Their Work Using Empirical Methods

Fig. 1.2, p. 6 Functioning as a Scientist-Practitioner

Clinical Description Begins with the Presenting Problem Description Aims to –Distinguish clinically significant dysfunction from common human experience Describe Prevalence and Incidence of Disorders

Clinical Description (continued) Describe Onset of Disorders –Acute vs. insidious onset Describe Course of Disorders –Episodic, time-limited, or chronic course Prognosis –Good vs. guarded

Causation, Treatment, and Outcome Etiology –What contributes to the development of psychopathology? Treatment Development –How can we help alleviate psychological suffering? –Includes pharmacologic, psychosocial, and/or combined treatments

Causation, Treatment, and Outcome (continued) Treatment Outcome Research –How do we know that we have helped? –Limited in specifying actual causes of disorders

Historical Conceptions of Abnormal Behavior Major Psychological Disorders Have Existed –In all cultures –Across all time periods Causes and Treatment of Abnormal Behavior –Varies Widely Across cultures, time periods, world views

Historical Conceptions of Abnormal Behavior (continued) Three Dominant Traditions –Supernatural –Biological –Psychological

The Supernatural Tradition Deviant Behavior as a Battle of “Good” vs. Evil –Caused by demonic possession, witchcraft, sorcery –Treatments included exorcism, torture, beatings, and crude surgeries The Moon and the Stars –Paracelsus and lunacy

The Biological Tradition Hippocrates: Abnormal Behavior as a Physical Disease –Hysteria “The Wandering Uterus” Galen Extends Hippocrates Work –Humoral theory of mental illness –Treatments remained crude

The Biological Tradition (continued) Galenic-Hippocratic Tradition –Linked abnormality with brain chemical imbalances –Foreshadowed modern views

The 19 th Century General Paresis (Syphilis) and the Biological Link With Madness –Several unusual psychological and behavioral symptoms –Pasteur discovered the cause – A bacterial microorganism –Led to penicillin as a successful treatment –Bolstered the view that mental illness = physical illness

The 19 th Century (continued) John Grey and the Reformers –Championed biological tradition in the USA

Consequences of the Biological Tradition Mental Illness = Physical Illness Emil Kraeplin –Diagnosis and Classification

The Psychological Tradition The Rise of Moral Therapy –More humane treatment of institutionalized patients –Encourage and reinforced social interaction

The Psychological Tradition (continued) Proponents of Moral Therapy –Philippe Pinel and Jean-Baptiste Pussin –Benjamin Rush – Led reforms in U.S. –Dorothea Dix – Mental hygiene movement –William Tuke - Followed Pinel’s lead in England The Falling Out of Moral Therapy Emergence of Competing Alternative Psychological Models

Psychoanalytic Theory Freudian Theory of the Structure and Function of the Mind Structure of the Mind –Id (pleasure principle; illogical, emotional, irrational) –Ego (reality principle; logical and rational) –Superego (moral principles; keeps Id and Ego in balance)

Psychoanalytic Theory (continued) Defense Mechanisms: Ego Loses the Battle with the Id and Superego –Displacement & denial –Rationalization & reaction formation –Projection, repression, and sublimation Psychosexual Stages of Development –Oral, anal, phallic, latency, and genital stages

Later Developments in Psychoanalytic Thought Anna Freud and Self-Psychology –Emphasized influence of the ego in defining behavior Melanie Klein, Otto Kernberg, and Object Relations Theory –Emphasized how children incorporate (introject) objects –Objects – images, memories, and values of significant others

Later Developments in Psychoanalytic Thought (continued) The Neo-Freudians: Departures From Freudian Thought –De-emphasized the sexual core of Freud’s theory –Jung, Adler, Horney, Fromm, and Erickson

Psychoanalytic Psychotherapy: The “Talking” Cure Unearth the Hidden Intrapsychic Conflicts –“The Real Problems” Therapy Is Often Long Term Techniques –Free Association –Dream Analysis Examine Transference and Counter- Transference Issues Little Evidence for Efficacy

Humanistic Theory Major Players –Abraham Maslow and Carl Rogers Major Themes –That people are basically good –Humans strive toward self-actualization

Humanistic Theory (continued) Humanistic Therapy –Therapist conveys empathy and unconditional positive regard –Minimal therapist interpretation No strong evidence that humanistic therapies work

The Behavioral Model Derived from a Scientific Approach to the Study of Psychopathology Classical Conditioning (Pavlov; Watson) –Ubiquitous form of learning –Contingency between neutral and unconditioned stimuli –Conditioning was extended to the acquisition of fear

The Beginnings of Behavior Therapy Challenged Psychoanalysis and Non- Scientific Approaches Early Pioneers –Joseph Wolpe – Systematic desensitization Operant Conditioning (Thorndike; Skinner) –Another ubiquitous form of learning –Voluntary behavior is controlled by consequences

The Beginnings of Behavior Therapy (continued) Learning Traditions Influenced the Development of Behavior Therapy –Behavior therapy tends to be time-limited and direct –Strong evidence supporting the efficacy of behavior therapies

The Present: An Integrative Approach Psychopathology Is Multiply Determined Unidimensional Accounts of Psychopathology Are Incomplete Cognitive Behavioral Therapy (CBT) –Aaron Beck –Albert Ellis

The Present: An Integrative Approach (continued) Must Consider Reciprocal Relations Between –Biological, psychological, social, and experiential factors Defining Abnormal Behavior –Complex, multifaceted, and has evolved The Supernatural Tradition –Has no place in a science of abnormal behavior