1. Chapter 1 Abnormal Behavior in Historical Context

2. Outline Understanding Psychopathology
Historical Conceptions of Abnormal Behavior
The Supernatural Tradition
The Biological Tradition
The Psychological Tradition
The Present
The Scientific Method
An Integrative Approach

3. Focus Questions How do psychologists define a psychological disorder?
What is a scientist-practitioner?
What supernatural influences were formerly believed to explain abnormal behavior?
How do psychological approaches including psychoanalysis, humanism and behaviorism explain abnormal behavior?
Note: These and the focus questions at the beginning of other instructor powerpoints correspond to focus questions found in Durand/Barlow Essentials of Abnormal Psychology, a version of this text which is somewhat shorter and simpler.

4. What is a Psychological Disorder?
Psychological dysfunction associated with distress and/or impairment in functioning
Involves a response that is not typical or culturally expected
May include cognitive, behavioral and/or emotional elements
Discussion Tip: Have students identify situations in which one can have an atypical behavior that is not harmful or distressing, or engage in harmful behaviors that are not related to dysfunction.
Example: Tattoos and other body modifications are sometimes seen as atypical, but they are not reflective of dysfunction because they don’t cause distress or interference to the individual.
Example: Occasionally yelling when frustrated, or falling asleep in class, or making a rude joke may be harmful, but they are not atypical, and they would only be considered psychological dysfunction if they were extreme and causing serious, persistent problems.

5. Distress, Impairment and Cultural Context
Distress is normal in some situations
Dysfunctional distress occurs when person is much more distressed than others would be
Impairment: Must be pervasive and/or significant
Mental disorders are often exaggerations of normal processes (e.g., extreme shyness or sadness)
Culture: Consider “normalcy” relative to behavior of others in same cultural context
Rule of thumb: Mental disorder = harmful dysfunction
Teaching Tip: Consult the local news/media for examples of abnormal behavior and/or keep an ongoing file of articles that exemplify this definition.

6. What is a Psychological Disorder?
FIGURE 1.1 The criteria defining a psychological disorder.

7. An Accepted Definition
Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning, or increased risk of suffering, death, pain, or impairment
Discussion Tip: Have students debate the validity of each of these components in isolation, in smaller combinations, or as an interactive whole.
Does (infrequency / suffering / strangeness / behavior itself) define abnormality? Should normalcy serve as a guide? Generate examples of situations in which students believe a mental illness is present but these criteria are NOT met.

8. The Science of Psychopathology
Psychopathology: Scientific study of psychological dysfunction
Mental health professionals
The Ph.D.: Clinical and counseling psychologist (trained in research and delivering treatment)
The Psy.D.: Clinical and counseling “Doctor of Psychology” (trained in delivering treatment)
M.D.: Psychiatrist
Psychiatric nurses
LICSW: Licensed clinical social worker (trained in delivering treatment)
Technology Tip: The American Psychological Association maintains a website offering information about careers in psychology (
Discussion Tip: Have students discuss the strengths and limitations of each profession.

9. The Scientist-Practitioner
Practice (treatment delivery) and research mutually influence each other
A scientist-practitioner:
Stays current with research in field
Evaluates own assessment and treatment
Conducts research
Technology Tip: Download and discuss David Shapiro’s article “Renewing the Scientist-Practitioner Model” at

10. The Scientist-Practitioner
FIGURE 1.2 Functioning as a scientist-practitioner

11. Clinical Description Begins with the presenting problem
Symptoms (e.g., chronic worry, panic attacks)
Description aims to:
Distinguish clinically significant dysfunction from common human experience
Describe prevalence and incidence of disorders
Prevalence is how many people in a population have the disorder.
Incidence is the number of new cases over a period of time (i.e., per year).

12. Clinical Description
FIGURE 1.3 Three major categories make up the study and discussion
of psychological disorders.

13. Clinical Description Describe onset of disorders
Acute vs. insidious onset
Describe course of disorders
Episodic, time-limited, or chronic course
Prognosis
Good vs. guarded
Consider age of onset, which may shape presentation
Terms regarding age of onset and course of disorders:
Developmental psychology the study of changes in behavior over time
Developmental psychopathology is the study of changes in abnormal behavior over time
Life-span developmental psychopathology includes not just childhood and adolescence, but adulthood and old age

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

15. Historical Conceptions of Abnormal Behavior
Major psychological disorders have existed across time and cultures
Perceived causes and treatment of abnormal behavior varied widely, depending on context
Technology Tip: Visit the University of Dayton’s website for information and links about the history of psychology (academic.udayton.edu/gregelvers/hop/welcome.asp)
Technology Tip: Visit the Museum of London website ( to find information on the 750-year-old story of Bethlem Royal Hospital, popularly known as “Bedlam.”

16. Historical Conceptions of Abnormal Behavior
Three dominant traditions have existed in the past to explain abnormal behavior
Supernatural
Biological
Psychological

17. The Supernatural Tradition
Deviant behavior as a battle of “Good” vs. “Evil”
Believed to be caused by demonic possession, witchcraft, sorcery
Treatments included exorcism, torture, religious services
NOTE: Important qualifier: Even as the “demons and witches” view prevailed, some dissenting voices suggested that psychological problems were caused by mental/emotional stress. Symptoms were then treated with rest and community care.

18. The Supernatural Tradition
“Stress and melancholy” = anxiety and depression
Competing view that coexisted with supernatural tradition: “insanity” is caused by emotional stress, not supernatural forces
Treatments: Rest, sleep, healthy environment, baths, potions
Possession
Mental illness sometimes believed to reflect possession by evil spirits
Treated by shocking/scaring out spirits (e.g., hang patient over snake pit)

19. The Supernatural Tradition
Mass hysteria
Saint Vitus’s Dance/Tarantism
Modern mass hysteria
Emotion contagion
Mob psychology
The moon and the stars
Paracelsus: Swiss physician suggested that mental health problems are affected by pull of moon and stars
Led to term “lunatic”
Saint Vitus’ Dance/Tarantism: Massive outbreak of unusual psychomotor behavior (e.g., people dancing/raving/ranting in the streets). This lent credence to the idea of demonic possession. Some speculate it was a reaction to insect bites. In the context of the present discussion, the point is that this is an example of “mass hysteria”
Teaching Tip: Search the media and news for articles or reports of events that highlight emotion contagion and/or “mob psychology” or keep an ongoing file of related articles.
Discussion Tip/Teaching Tip: Have students read their own horoscope for the week and discuss its applicability and the principles of construction (i.e., vague generalities, ambiguity).

20. The Biological Tradition
Hippocrates ( BC)
Father of modern Western medicine
Etiology of mental disorders = physical disease
Hysteria “the wandering uterus” – psychological symptoms were a result of the uterus moving around in the body
Linked abnormality with brain chemical imbalances
Foreshadowed modern views
Galen ( AD) extended Hippocrates’ work
Technology Tip: MIT hosts a site with many of the major works by Hippocrates (

21. Galenic-Hippocratic Tradition
Humoral theory of disorders: Functioning is related to having two much or too little of four key bodily fluids (humors)
Blood, phlegm, black bile, yellow bile
Example: Depression caused by too much black bile
Treated by changing environmental conditions (e.g., reducing heat) or bloodletting/vomiting
Humors
Sanguine: blood, cheerful and optimistic, insomnia and delirium caused by too much blood in the brain
Melancholic: black bile, depressive
Phlegmatic: phlegm, apathy and sluggishness
Choleric: yellow bile, hot tempered

22. The 19th 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
Technology Tip: Several sites offer comprehensive information on the etiology, effects, and treatment of syphilis:

23. The 19th Century John P. Grey and the reformers
Psychiatrist who believed mental illness had physical roots
Championed biological tradition in the U.S.
Led to reforms of hospitals to give psychiatric patients better care

24. The Development of Biological Treatments
Psychotropic medications became increasingly available in 1950s
Electric shock
Crude surgery
Insulin (discovered by accident to calm psychotic patients)
Major tranquilizers (discovered mid-20th C)
Minor tranquilizers (e.g., benzodiazepines) – commonly prescribed for anxiety today
Teaching Tip: The film One Flew Over the Cuckoo’s Nest offers insights into early psychiatric treatment, including medications, ECT, and overall hospital conditions.

25. Consequences of the Biological Tradition
Overall, mental illness understood to have physical roots
Increased hospitalization
Mental illness often seen as “untreatable” condition
Improved diagnosis and classification
Emil Kraepelin was father of classification
Increased role of science in psychopathology

26. The Psychological Tradition
The rise of moral therapy
Became popular in first half of 19th century
“Moral” = referring to psychological/emotional factors
Main idea: Treat patients as normally as possible in normal environment
More humane treatment of institutionalized patients
Encouraged and reinforced social interaction

27. The Psychological Tradition
Proponents of moral therapy
Philippe Pinel and Jean-Baptiste Pussin – patients shouldn’t be restrained
Benjamin Rush – led reforms in U.S.
Dorothea Dix – mental hygiene movement
Asylum reform > more patients getting care
Moral therapy declined because more difficult with large groups of patients
Soon followed by emergence of competing alternative psychological models
“Competing alternative models” = behaviorism, psychoanalysis

28. Psychoanalytic Theory
Freudian theory of the structure and function of the mind
Unconscious
Catharsis
Psychoanalytic model sought to explain development and personality)
Structure of the mind
Id (pleasure principle; illogical, emotional, irrational)
Superego (moral principles)
Ego (rational; mediates between supergo/id)
NOTE
Psychoanalytic theory emphasizes the role of unconscious drives, such as those related to sex and power, as well as the importance of early life experience.
Catharsis = helpful release of emotion (e.g. by remembering painful memories)

29. FIGURE 1.4  Freud’s structure of the mind.

30. Psychoanalytic Theory
Defense mechanisms: Ego’s attempt to manage anxiety resulting from id/superego conflict
Displacement & denial
Rationalization & reaction formation
Projection, repression, and sublimation
Psychosexual stages of development
Oral, anal, phallic, latency, and genital stages
Theory: conflicts arise at each stage and must be resolved
Defense mechanisms: What happens when an “unacceptable” drive from the id needs to be made acceptable by the superego
Displacement – emotion ends up on a new target (e.g. kick dog when angry with boss)
Reaction formation – behave the opposite of your feelings because it is more acceptable
Projection – attribute your emotions to someone else
Sublimation – channel emotions into something productive (e.g. work out when feeling angry with partner)
Psychosexual stages: As a child grows up, focus shifts between different sources of need and pleasure. Becoming “stuck” at a certain stage is thought to lead to problematic behavior as an adult (e.g., “oral fixation”) This theory is NOT substantiated by research.

31. 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 – significant others and their images, memories, and values
Technology Tip: Visit the following websites for more information about Anna Freud:
Basic idea of OR is that children’s personalities and understanding of the world is largely influenced by their relationships with important people (e.g. parents) and what they learn from these relationships (e.g. safety)

32. Later Developments in Psychoanalytic Thought (continued)
The “Neo-Freudians”: Departures from Freudian thought
De-emphasized the sexual core of Freud’s theory
Examples:
Carl Jung emphasized the “collective unconscious”
Alfred Adler focused on feelings of inferiority, invented “inferiority complex”

33. 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
Teaching tips: “The real problems” refers to treating the root of psychological difficulties rather than their symptoms
“Psychodynamic” psychotherapy is another term you might hear. It refers to therapy that has has psychoanalytic principles, but may incorporate other therapeutic techniques and be more time limited
Transference/countertransference = patient’s views of therapist are influenced by patient’s views of important others in their life, and vice versa (e.g., respond to therapist as if you were responding to your nagging mother)
Free association = talking freely without direction, in the hope that the connections a patient makes in his/her mind will reveal meaningful parts of the unconscious
Technology Tip: Also see the following site for the American Psychoanalytic Association (

34. Psychodynamic Psychotherapy
Therapy with themes of psychoanalysis, but often shorter and more goal-directed
Emphasizes conflicts and unconscious, may work to uncover rauma and active defense mechanisms
Focus on:
Emotional expression
Avoidance and other cognitive or behavioral patterns
Past experience
Interpersonal experience
Therapeutic relationship
Wishes, dreams, fantasies

35. Psychoanalytic Psychotherapy
Major criticism: Largely unscientific and untested
Contributions
Unconscious processes have been empirically demonstrated
Emotions can be driggered by triggered by cues outside of conscious awareness
“Therapeutic alliance” is important
Defense mechanisms

36. Humanistic Theory Theoretical constructs Intrinsic human goodness
Striving for self-actualization
Person-centered therapy
Carl Rogers (1902–1987)
Hierarchy of Needs
Abraham Maslow (1908–1970)
Humans fulfill basic needs first (e.g., food, safety) before moving onto higher needs like self esteem
Technology Tip: For more information on Maslow, visit the following site:
Discussion Tip: Have students provide examples of evidence of individuals demonstrating the self-actualizing tendency.

37. Humanistic Theory Person-centered therapy
Therapist conveys empathy and unconditional positive regard
Minimal therapist interpretation
No strong evidence that purely humanistic therapies work to treat mental disorders
More effective for people dealing with normal life stress, not suffering from psychopathology
NOTE: Despite the lack of evidence for purely humanistic therapies, humanistic principles and techniques ARE found in most evidence-based therapies, such as positive regard for the patient, focusing on values (e.g. to build motivation at beginning of treatment) and validating patient’s contributions

38. The Behavioral Model
Derived from a scientific approach to the study of psychopathology
Classical conditioning (Pavlov; Watson)
Ubiquitous form of learning
People learn associations between neutral stimuli and stimuli that already have meaning (unconditioned stimuli)
Conditioning explains the acquisition of some fears
Example of classical conditioning. If you eat spoiled tuna salad and then vomit, you will develop an association between the taste of tuna salad (previously a neutral stimulus) and the sensation of nausea. Next time you taste tuna salad, you feel nauseous.

39. The Behavioral Model Classical conditioning – concepts
Stimulus generalization
Start to respond in the same way to similar stimuli. E.g., a child taught to fear the color red (because it is paired with a loud, scary noise) may also fear the color orange
Extinction
When the conditioned stimulus is repeatedly presented without the unconditioned stimulus, the association is weakened
Example of extinction. If you eat a food that makes you sick, but then you eat it more times and it does not make you sick, the association between food = illness will be weakened.
Question:
Can you think of any of your behaviors that might have developed through classical conditioning?

40. The Behavioral Model John B. Watson (1878–1958)
Believed that psychology should be as scientific and objective as possible
“Little Albert” experiment: Baby Albert was taught to fear a white rat when it was repeatedly paired with a loud noise (classsical conditioning)
Mary Cover Jones
One of the first to treat phobias with exposure and extinction of learned association

41. The Behavioral Model - Operant Conditioning
E.L. Thorndike (1874–1949)
Law of effect: Behavior will repeated more often if it is followed by good consequences and less often if it is followed by bad consequences
B.F. Skinner (1904–1990)
Behavior “operates” on environment and is managed by consequences (rewards and punishments)
Behavior “shaping”: New behavior can be learned by reinforcing successive approximations
Operant conditioning: People learn to repeat or decrease behaviors based on the consequences that follow them. E.g., If a child gets a cookie every time she cries, she will learn that crying has a desired consequence and will cry more often.

42. The Beginnings of Behavior Therapy
Behavior therapy: Creating new associations by practicing new behavioral habits, and/or reinforcing useful behaviors with positive consequences
Behavior therapy tends to be time-limited and direct
Strong evidence supporting the efficacy of behavior therapies
Example: Joseph Wolpe (1915–1997)
Systematic desensitization: Individuals gradually exposed to fears (usually through imagination) while practicing relaxation exercises
NOTE: Inform students that behavior therapy will be discussed in greater detail during Chapter 5, Anxiety Disorders. This group of disorders is most effectively treated with therapy that has a strong behavioral component.
Technology Tip /Discussion Tip: This website ( has an interesting overview of systematic desensitization presented as a “do it yourself” model. Have students check the site and then discuss how this could actually be applied and where things could potentially go wrong.

43. The Present: The Scientific Method and an Integrative Approach
Defining and studying psychopathology
Requires a broad approach
Multiple, interactive influences
Biological, psychological, social factors
Scientific emphasis continues to be very important
The supernatural tradition no longer has a place in a science of abnormal behavior
Advances in neuroscience and cognitive and behavioral science will add to our knowledge