1. Comer, Abnormal Psychology, 6e – Chapter 1 1 Chapter 1 Abnormal Psychology: Past and Present Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall University

2. 2Comer, Abnormal Psychology, 6e – Chapter 1 Abnormal Psychology: Past and Present What is abnormal psychology? What is abnormal psychology? The field devoted to the scientific study of abnormal behavior to describe, predict, explain, and change abnormal patterns of functioning The field devoted to the scientific study of abnormal behavior to describe, predict, explain, and change abnormal patterns of functioning Workers may be: Workers may be: Clinical scientists Clinical scientists Clinical practitioners Clinical practitioners

3. 3Comer, Abnormal Psychology, 6e – Chapter 1 What Is Psychological Abnormality? Many definitions have been proposed, yet none is universally accepted Many definitions have been proposed, yet none is universally accepted Most definitions, however, share some common features… Most definitions, however, share some common features… “The Four Ds” “The Four Ds” Deviance – Different, extreme, unusual Deviance – Different, extreme, unusual Distress – Unpleasant & upsetting Distress – Unpleasant & upsetting Dysfunction – Causes interference with life Dysfunction – Causes interference with life Danger – Poses risk of harm Danger – Poses risk of harm

4. 4Comer, Abnormal Psychology, 6e – Chapter 1 Deviance From what? From what? From behaviors, thoughts, and emotions considered normal in a specific place and time and by specific people From behaviors, thoughts, and emotions considered normal in a specific place and time and by specific people From social norms From social norms Stated and unstated rules for proper conduct in a given society or culture Stated and unstated rules for proper conduct in a given society or culture Examples? Examples? Judgments of deviance also depend on specific circumstances (i.e., social context) Judgments of deviance also depend on specific circumstances (i.e., social context)

5. 5Comer, Abnormal Psychology, 6e – Chapter 1 Distress According to many clinical guidelines, behavior must be personally distressing before it can be labeled abnormal According to many clinical guidelines, behavior must be personally distressing before it can be labeled abnormal Not always the case Not always the case Examples? Examples?

6. 6Comer, Abnormal Psychology, 6e – Chapter 1 Dysfunction Abnormal behavior tends to be dysfunctional – it interferes with daily functioning Abnormal behavior tends to be dysfunctional – it interferes with daily functioning Culture has an influence on determinations of dysfunction, as well Culture has an influence on determinations of dysfunction, as well Dysfunction alone does not necessarily indicate psychological abnormality Dysfunction alone does not necessarily indicate psychological abnormality

7. 7Comer, Abnormal Psychology, 6e – Chapter 1 Danger Abnormal behavior may become dangerous to oneself or others Abnormal behavior may become dangerous to oneself or others Behavior may be careless, hostile, or confused Behavior may be careless, hostile, or confused Although cited as a feature of psychological abnormality, being dangerous is the exception rather than the rule Although cited as a feature of psychological abnormality, being dangerous is the exception rather than the rule

8. 8Comer, Abnormal Psychology, 6e – Chapter 1 The Elusive Nature of Abnormality Ultimately, each society selects the general criteria for defining abnormality and then uses those criteria to judge particular cases Ultimately, each society selects the general criteria for defining abnormality and then uses those criteria to judge particular cases Szasz argues that, because of the influence of culture, the whole concept of mental illness is invalid Szasz argues that, because of the influence of culture, the whole concept of mental illness is invalid Deviations called “abnormal” are only “problems of living” Deviations called “abnormal” are only “problems of living” Societies use the concept of mental illness to control those who threaten social order Societies use the concept of mental illness to control those who threaten social order

9. 9Comer, Abnormal Psychology, 6e – Chapter 1 The Elusive Nature of Abnormality Even if we agree with the concept of abnormality, it is often applied inconsistently Even if we agree with the concept of abnormality, it is often applied inconsistently Examples: Examples: Diagnosis of alcohol problems in colleges Diagnosis of alcohol problems in colleges Issue of abnormality versus eccentricity Issue of abnormality versus eccentricity

10. 10Comer, Abnormal Psychology, 6e – Chapter 1 The Elusive Nature of Abnormality In short, although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and dangerous, these criteria often are vague and subjective In short, although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and dangerous, these criteria often are vague and subjective When is a pattern of behavior considered abnormal? When is a pattern of behavior considered abnormal?

11. 11Comer, Abnormal Psychology, 6e – Chapter 1 What Is Treatment? Once abnormality is determined, clinicians attempt to treat it Once abnormality is determined, clinicians attempt to treat it Treatment (or therapy) is a procedure designed to change abnormal behavior into more normal behavior Treatment (or therapy) is a procedure designed to change abnormal behavior into more normal behavior It, too, requires careful definition… It, too, requires careful definition…

12. 12Comer, Abnormal Psychology, 6e – Chapter 1 What Is Treatment? According to Jerome Frank, all forms of therapy have three essential features: According to Jerome Frank, all forms of therapy have three essential features: 1. A sufferer who hopes the healer can provide relief 2. A trained, socially acceptable healer, whose expertise is accepted by the sufferer and his or her social group 3. A series of contacts between the healer and the sufferer, through which the healer tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior

13. 13Comer, Abnormal Psychology, 6e – Chapter 1 What Is Treatment? Despite the clarity of the definition, clinical therapy is surrounded by confusion and conflict: Despite the clarity of the definition, clinical therapy is surrounded by confusion and conflict: Lack of agreement about goals or aims Lack of agreement about goals or aims Lack of agreement about successful outcomes Lack of agreement about successful outcomes Lack of agreement about failure Lack of agreement about failure Are clinicians seeking to cure? To teach? Are clinicians seeking to cure? To teach? Are sufferers patients (ill) or clients (having difficulty)? Are sufferers patients (ill) or clients (having difficulty)?

14. 14Comer, Abnormal Psychology, 6e – Chapter 1 What Is Treatment? Despite these disagreements, most clinicians agree that large numbers of people need therapy Despite these disagreements, most clinicians agree that large numbers of people need therapy And research indicates that therapy often is helpful And research indicates that therapy often is helpful

15. 15Comer, Abnormal Psychology, 6e – Chapter 1 How Was Abnormality Viewed and Treated in the Past? In any given year in the US, 30% of adults and 19% of children display serious psychological disturbances and are in need of treatment In any given year in the US, 30% of adults and 19% of children display serious psychological disturbances and are in need of treatment In addition, most people have difficulty coping at various times in their lives In addition, most people have difficulty coping at various times in their lives Is this the fault of modern society? Is this the fault of modern society? Not entirely; historical records demonstrate that every society has witnessed psychological abnormality and had its own form of treatment… Not entirely; historical records demonstrate that every society has witnessed psychological abnormality and had its own form of treatment…

16. 16Comer, Abnormal Psychology, 6e – Chapter 1 How Was Abnormality Viewed and Treated in the Past? Much of today’s thinking about abnormal psychology is built on past approaches and ideas, rather than being a rejection of these ideas Much of today’s thinking about abnormal psychology is built on past approaches and ideas, rather than being a rejection of these ideas Theories and themes about abnormal psychology occur again and again; progress has not been a steady movement forward Theories and themes about abnormal psychology occur again and again; progress has not been a steady movement forward

17. 17Comer, Abnormal Psychology, 6e – Chapter 1 Ancient Views and Treatment Most of our knowledge of prehistoric societies has been acquired indirectly, is based on inferences from archaeological findings, and is limited Most of our knowledge of prehistoric societies has been acquired indirectly, is based on inferences from archaeological findings, and is limited Most historians believe that prehistoric societies regarded abnormal behavior as the work of evil spirits Most historians believe that prehistoric societies regarded abnormal behavior as the work of evil spirits May have begun as far back as the Stone Age May have begun as far back as the Stone Age The cure for abnormality was to force the demons from the body through trephination and exorcism The cure for abnormality was to force the demons from the body through trephination and exorcism

18. Ancient skull with holes from trephination

19. 19Comer, Abnormal Psychology, 6e – Chapter 1 Greek and Roman Views and Treatments 500 B.C. to A.D. 500 A.D. 500 B.C. to A.D. 500 A.D. Many psychological disorders were identified Many psychological disorders were identified Hippocrates believed that abnormality was a disease arising from internal physical problems Hippocrates believed that abnormality was a disease arising from internal physical problems He looked to an unbalance of the four humors He looked to an unbalance of the four humors His suggested treatment that attempted to “rebalance” His suggested treatment that attempted to “rebalance”

20. 20Comer, Abnormal Psychology, 6e – Chapter 1 Europe in the Middle Ages: Demonology Returns A.D. 500 – 1350 A.D. 500 – 1350 With the rise of clergy came the downplay of science With the rise of clergy came the downplay of science Abnormality was again seen as a conflict between good & evil Abnormality was again seen as a conflict between good & evil The incidence of abnormality increased dramatically as outbreaks of mass madness occurred The incidence of abnormality increased dramatically as outbreaks of mass madness occurred Earlier (largely discarded) treatments such as exorcism re- emerged Earlier (largely discarded) treatments such as exorcism re- emerged At the close of the Middle Ages, demonology began to lose favor again At the close of the Middle Ages, demonology began to lose favor again

21. 21Comer, Abnormal Psychology, 6e – Chapter 1 The Renaissance and the Rise of Asylums A.D. 1400 – 1700 A.D. 1400 – 1700 German physician Johann Weyer believed that the mind was as susceptible to sickness as the body German physician Johann Weyer believed that the mind was as susceptible to sickness as the body Weyer is considered the founder of modern study of psychopathology Weyer is considered the founder of modern study of psychopathology Patient care improved as demonological views declined Patient care improved as demonological views declined

22. 22Comer, Abnormal Psychology, 6e – Chapter 1 The Renaissance and the Rise of Asylums Shrines devoted to loving care of the mentally ill were established and one, at Gheel, became a community mental health program of sorts Shrines devoted to loving care of the mentally ill were established and one, at Gheel, became a community mental health program of sorts This time also saw a rise of asylums – institutions whose primary purpose was care of the mentally ill This time also saw a rise of asylums – institutions whose primary purpose was care of the mentally ill The intention was good care, but because of overcrowding they became virtual prisons The intention was good care, but because of overcrowding they became virtual prisons

23. 23Comer, Abnormal Psychology, 6e – Chapter 1 The Nineteenth Century: Reform and Moral Treatment As 1800 approached, asylums were reformed into places of care As 1800 approached, asylums were reformed into places of care Pinel (France) and Tuke (England) advocated moral treatment – care that emphasized humane and respectful treatment Pinel (France) and Tuke (England) advocated moral treatment – care that emphasized humane and respectful treatment In the US, Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher) were the primary proponents of moral treatment In the US, Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher) were the primary proponents of moral treatment

24. 24Comer, Abnormal Psychology, 6e – Chapter 1 The Nineteenth Century: Reform and Moral Treatment By the end of the nineteenth century, there was a reversal of the moral treatment movement because of several factors: By the end of the nineteenth century, there was a reversal of the moral treatment movement because of several factors: Money and staff shortages Money and staff shortages Declining recovery rates Declining recovery rates Lack of more effective treatment for severely mentally ill Lack of more effective treatment for severely mentally ill Long-term hospitalization became the rule once again Long-term hospitalization became the rule once again

25. 25Comer, Abnormal Psychology, 6e – Chapter 1 The Early Twentieth Century: Dual Perspectives As the moral movement was declining in the late 1800s, two opposing perspectives emerged: As the moral movement was declining in the late 1800s, two opposing perspectives emerged: The Somatogenic Perspective The Somatogenic Perspective Abnormal functioning has physical causes Abnormal functioning has physical causes The Psychogenic Perspective The Psychogenic Perspective Abnormal functioning has psychological causes Abnormal functioning has psychological causes

26. 26Comer, Abnormal Psychology, 6e – Chapter 1 The Early Twentieth Century: The Somatogenic Perspective Two factors responsible for rebirth of this perspective: Two factors responsible for rebirth of this perspective: Emil Kraepelin’s textbook argued that physical factors (like fatigue) are responsible for mental dysfunction Emil Kraepelin’s textbook argued that physical factors (like fatigue) are responsible for mental dysfunction Several biological discoveries were made, such as the link between untreated syphilis & general paresis Several biological discoveries were made, such as the link between untreated syphilis & general paresis This approach, while creating optimism, lead to few positive results until the 1950s, when a number of effective medications were discovered This approach, while creating optimism, lead to few positive results until the 1950s, when a number of effective medications were discovered

27. 27Comer, Abnormal Psychology, 6e – Chapter 1 The Early Twentieth Century: The Psychogenic Perspective Rise in popularity of this perspective was based on work with hypnotism: Rise in popularity of this perspective was based on work with hypnotism: Friedrich Mesmer and hysterical disorders Friedrich Mesmer and hysterical disorders Sigmund Freud: father of psychoanalysis Sigmund Freud: father of psychoanalysis Unconscious processes at the root of abnormality Unconscious processes at the root of abnormality The psychoanalytic approach had little effect on the treatment of severely disturbed patients in mental hospitals The psychoanalytic approach had little effect on the treatment of severely disturbed patients in mental hospitals

28. 28Comer, Abnormal Psychology, 6e – Chapter 1 Current Trends Have we come a long way? Have we come a long way? 43% of people interviewed believe that people bring mental health disorders upon themselves 43% of people interviewed believe that people bring mental health disorders upon themselves 35% consider mental health disorders to be caused by sinful behavior 35% consider mental health disorders to be caused by sinful behavior However, the past 50 years have brought major changes in the ways clinicians understand and treat abnormal functioning However, the past 50 years have brought major changes in the ways clinicians understand and treat abnormal functioning

29. 29Comer, Abnormal Psychology, 6e – Chapter 1 How Are People with Severe Disturbances Treated? 1950s – Psychotropic medications discovered 1950s – Psychotropic medications discovered Antipsychotics Antipsychotics Antidepressants Antidepressants Anxiolytics (antianxiety drugs) Anxiolytics (antianxiety drugs) These discoveries led to deinstitutionalization and a rise in outpatient care These discoveries led to deinstitutionalization and a rise in outpatient care This change in care was not without problems This change in care was not without problems

31. 31Comer, Abnormal Psychology, 6e – Chapter 1 How Are People with Severe Disturbances Treated? Outpatient care is now the primary mode of treatment Outpatient care is now the primary mode of treatment When patients need greater care, they are usually given short-term hospitalizations or outpatient psychotherapy and medication in community settings When patients need greater care, they are usually given short-term hospitalizations or outpatient psychotherapy and medication in community settings Unfortunately, there are too few community programs available; only 40% of those with severe disturbances receive treatment of any kind Unfortunately, there are too few community programs available; only 40% of those with severe disturbances receive treatment of any kind

32. 32Comer, Abnormal Psychology, 6e – Chapter 1 How Are People with Less Severe Disturbances Treated? Since the 1950s, there has been an increase in outpatient care Since the 1950s, there has been an increase in outpatient care Although this type of care was once exclusively private psychotherapy, it now includes various settings, as well as specialty care Although this type of care was once exclusively private psychotherapy, it now includes various settings, as well as specialty care In any given year, 1 in 5 adults receive some type of mental health care In any given year, 1 in 5 adults receive some type of mental health care

33. 33Comer, Abnormal Psychology, 6e – Chapter 1 A Growing Emphasis on Preventing Disorders and Promoting Mental Health The community mental health approach has given rise to the prevention movement The community mental health approach has given rise to the prevention movement Many of today’s programs are trying to: Many of today’s programs are trying to: Correct the social conditions associated with psychological problems Correct the social conditions associated with psychological problems Identify and help those at risk for developing disorders Identify and help those at risk for developing disorders Prevention programs have also been energized by the rise of positive psychology – the study and promotion of positive feelings, traits, and abilities Prevention programs have also been energized by the rise of positive psychology – the study and promotion of positive feelings, traits, and abilities

34. 34Comer, Abnormal Psychology, 6e – Chapter 1 Multicultural Psychology In response to the growing diversity in the U.S., this new area of study has emerged In response to the growing diversity in the U.S., this new area of study has emerged Multicultural psychologists seek to understand how culture, race, ethnicity, and gender affect behavior and thought, and how people of different cultures, races, and genders may differ psychologically Multicultural psychologists seek to understand how culture, race, ethnicity, and gender affect behavior and thought, and how people of different cultures, races, and genders may differ psychologically Two areas of focus for clinicians: Two areas of focus for clinicians: Greater sensitivity to cultural issues Greater sensitivity to cultural issues Inclusion of cultural morals and models in treatment Inclusion of cultural morals and models in treatment

35. 35Comer, Abnormal Psychology, 6e – Chapter 1 The Growing Influence of Insurance Companies Today the dominant form of insurance coverage is the managed care program – a program in which the insurance company determines key care issues Today the dominant form of insurance coverage is the managed care program – a program in which the insurance company determines key care issues Approximately 75% of all privately insured persons in the U.S. are enrolled in managed care programs Approximately 75% of all privately insured persons in the U.S. are enrolled in managed care programs At issue are the duration of therapy, the push for medication treatment, and the relatively low rates of reimbursement for care At issue are the duration of therapy, the push for medication treatment, and the relatively low rates of reimbursement for care

36. 36Comer, Abnormal Psychology, 6e – Chapter 1 What Are Today’s Leading Theories and Professions? One important development in the field of abnormal psychology is the growth of theoretical perspectives, including: One important development in the field of abnormal psychology is the growth of theoretical perspectives, including: Psychoanalytic Psychoanalytic Biological Biological Behavioral Behavioral Cognitive Cognitive Humanistic-existential Humanistic-existential Sociocultural Sociocultural No single perspective dominates No single perspective dominates

37. 37Comer, Abnormal Psychology, 6e – Chapter 1 What Are Today’s Leading Theories and Professions? In addition to multiple perspectives, there also are a variety of professionals now available to offer help to people with psychological problems In addition to multiple perspectives, there also are a variety of professionals now available to offer help to people with psychological problems

39. 39Comer, Abnormal Psychology, 6e – Chapter 1 What Are Today’s Leading Theories and Professions? One final development in the study and treatment of mental disorders is a growing appreciation for effective research One final development in the study and treatment of mental disorders is a growing appreciation for effective research Clinical researchers attempt to examine which concepts and theories best explain and predict abnormal behavior, which treatments are most effective, and what kinds of changes may be required Clinical researchers attempt to examine which concepts and theories best explain and predict abnormal behavior, which treatments are most effective, and what kinds of changes may be required