1. Abnormal Behavior in Historical Context
Chapter 1
Abnormal Behavior in
Historical Context

2. Outline Understanding Psychopathology: The Basics
Historical perspective
The Supernatural Tradition
Roots of modern research
The Biological Tradition
The Psychological Tradition
An Integrative Approach

3. What Is a Psychological Disorder?
No single definition of psychological abnormality
No single definition of psychological normality

4. What Is a Psychological Disorder?
Psychological dysfunction
Breakdown in cognitive, emotional, or behavioral functioning
Personal distress
Difficulty performing appropriate and expected roles (e.g., school, job, relationships)
Impairment is set in the context of a person’s background
Atypical or not culturally expected response
Reaction is outside cultural norms

5. The Criteria for Defining a Psychological Disorder
FIGURE 1.1  The criteria defining a psychological disorder.

6. Abnormal Behavior Defined
An accepted definition
A psychological dysfunction associated with distress or impairment in functioning that is not typical or culturally expected
The Diagnostic and Statistical Manual (DSM-5)
DSM contains diagnostic criteria
Most recent update occurred May 2013
The field of psychopathology
The scientific study of psychological disorders

7. The Science of Psychopathology
Mental health professionals
The Ph.D.: Counseling or Clinical Psychologist
Trained in research, teaching, and treatment
The Psy.D.: Clinical Psychologist “Doctor of Psychology”
Trained in treatment
Licensed Mental Health Counselor (LMHC)
Licensed Clinical Social Worker (LICSW)
M.D.: Psychiatrist
Psychiatric Nurse

8. The Scientist-Practitioner
Practice (treatment delivery) and research mutually influence each other
Stays current with research in field
Evaluates own assessment and treatment
Conducts research

9. Mental Health Professional
FIGURE 1.2  Functioning as a scientist-practitioner.

10. Three Major Categories When Discussing Psychological Disorders
FIGURE 1.3  Three major categories make up the study and discussion of psychological disorders.

11. Clinical Description Begins with the presenting problem
Description aims to:
Distinguish clinically significant dysfunction from common human experience
Combination of behaviors, thoughts, and feelings that make up a specific disorder
Prevalence = number of people in a population who have the disorder (presently)
Incidence = number of new cases over a period of time (i.e., per year)

12. Clinical Description Sex ratio
Is there a higher proportion of males/females with the disorder?
Most disorders follow a particular pattern, or course
Chronic: disorder lasts a long time (possibly throughout one’s life)
Episodic: likely to recover in a few months, but suffer a recurrence of the disorder at a later time
Time-limited: typically improve without treatment in a relatively short period of time

13. Clinical Description Onset of disorders
Acute: disorder begins suddenly
Insidious: disorder develops gradually over an extended period of time
Prognosis = the anticipated course of a disorder over time
Good, guarded, poor

14. Causation, Treatment, and Outcome
Etiology = cause of disorder
What contributes to the development of psychopathology?
Treatment development
How can we help alleviate psychological suffering?
Includes pharmacologic, psychosocial, and/or combined treatments
Treatment outcome research
How do we know that we have helped?
Limited in specifying actual causes of disorders

15. Historical Conceptions of Abnormal Behavior
Major psychological disorders have existed in all cultures and across all time periods.
Causes and treatment of abnormal behavior vary widely across cultures, time periods, world views.

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
Caused by demonic possession, witchcraft, sorcery
Treatments included exorcism, torture, beatings, and crude surgeries

18. The Supernatural Tradition
Mass hysteria
Saint Vitus’s Dance and Tarantism
Modern mass hysteria
Emotion contagion – emotions spread
Mob psychology – people are suggestible when in high states of emotion; and in big groups of people
The moon and the stars
Paracelsus and lunacy
“lunatic” derived from Latin word for moon – Luna
Think: Astrology – horoscopes

19. The Biological Tradition
Hippocrates ( B.C.): Abnormal behavior as a physical disease
Hysteria “The Wandering Uterus” (paralysis, blindness)
Similar what are now called Somatoform Disorders
Hippocratic-Galenic Humoral Theory of Mental Illness
Blood = sanguine (cheerful, optimistic; insomnia, delirium
Black bile = melancholic (depression)
Yellow bile = choleric (hot tempered)
Phlegm = phlegmatic (apathy, sluggishness; calm under stress)
*Mental illness associated with having too much or too little of these fluids
Treated by changing environmental conditions (e.g., reducing heat) or bloodletting/vomiting
*Inaccurate, but foreshadowed modern views (i.e., chemical imbalance)

20. The 19th Century
General paresis (syphilis) and the biological link with madness
Several unusual psychological and behavioral symptoms – delusional/psychotic
Pasteur discovered the cause – a bacterial microorganism
Led to penicillin as a successful treatment
Bolstered the view that mental illness = physical illness

21. 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

22. Early Biological Treatments
Electric shock
Crude surgery (e.g., frontal lobotomies)
Insulin (discovered by accident to calm psychotic patients)
Major tranquilizers (discovered mid-20th C) – first true antipsychotics; many negative side effects (e.g., Thorazine, Haldol)
Minor tranquilizers – typically the category of benzodiazepines; commonly prescribed for anxiety today (e.g., Xanax, Valium)

23. Consequences of the Biological Tradition
Mental illness = physical illness
Emil Kraepelin: Classification of disorders
Emphasized that different disorders have unique age of onset, symptoms, and causes

24. 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

25. The Psychological Tradition
Proponents of moral therapy
Philippe Pinel and Jean-Baptiste Pussin – patients should not be restrained (1700s)
Benjamin Rush – led reforms in U.S. (1700s)
Asylum reform = more patients receiving care
Dorothea Dix – mental hygiene movement (1800s)
Further improved standards of care, BUT significant increase in number of patients eventually resulted in decline of moral therapy (too many to care for)
Soon followed by emergence of competing alternative psychological models

26. Are Treatments Better Today?
“Wilderness Programs” with “tough love”
“Scared Straight”
Teen Boot Camps
*“Breaking down” and “building up” does not work
Continued debate on electroshock therapy (ECT)
DARE

27. Psychoanalytic Theory
Freudian theory of the structure and function of the mind
Unconscious
Catharsis
Psychoanalytic model
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)

28. Psychoanalytic Theory
FIGURE 1.4  Freud’s structure of the mind.

29. Psychoanalytic Theory
Defense mechanisms – ego’s attempt to manage anxiety resulting from id/superego conflict
Repression, Displacement, Denial, Rationalization, Reaction Formation, Projection, and Sublimation
If ineffective then neuroses result (i.e., anxiety)
Psychosexual stages of development
Oral, anal, phallic, latency, and genital stages

30. 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 research evidence for efficacy

31. Humanistic Theory Major players Major themes
Abraham Maslow and Carl Rogers
Major themes
People are basically good
Humans strive toward self-actualization
Hierarchy of needs (Maslow)
Unconditional positive regard (Rogers)

32. 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

33. The Behavioral Model
Derived from a scientific approach to the study of psychopathology
Classical conditioning (Pavlov; Watson – “Little Albert”)
Ubiquitous form of learning
People learn associations between neutral stimuli and stimuli that already have meaning (unconditioned stimuli)
Conditioning was extended to the acquisition of fear

34. The Beginnings of Behavior Therapy
Challenged psychoanalysis and non-scientific approaches
Early pioneers
Joseph Wolpe – systematic desensitization
Operant conditioning (Thorndike; Skinner)
Reinforcement
Another ubiquitous form of learning
Voluntary behavior is controlled by consequences

35. The Beginnings of Behavior Therapy
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
Eventually leads to development of Cognitive-Behavioral Therapy (CBT)
The most effective treatment approach for most disorders/problems

36. An Integrative Approach
Psychopathology is multiply determined
Unidimensional accounts of psychopathology are incomplete

37. An Integrative Approach
Must consider reciprocal relations among:
Biological, psychological, social, and experiential factors
Defining abnormal behavior
Complex, multifaceted, and has evolved
Science of psychopathology is evolving
The supernatural tradition no longer has a place in a science of abnormal behavior
Ongoing research informs our understanding

38. FYI

39. Warning Signs for Psychological Disorders in Young Children
Changes in school performance
Poor grades despite strong efforts
Excessive worry or anxiety (i.e. refusing to go to bed or school)
Hyperactivity
Persistent nightmares
Persistent disobedience or aggression
Frequent temper tantrums

40. Warning Signs for Psychological Disorders in Adolescents
Substance abuse
Inability to cope with problems and daily activities
Change in sleeping and/or eating habits
Excessive complaints of physical ailments
Defiance of authority, truancy, theft, and/or vandalism
Intense fear of weight gain
Prolonged negative mood, accompanied by poor appetite or thoughts of death
Frequent outbursts of anger

41. Warning Signs for Psychological Disorders in Adults
Confused thinking
Prolonged depression (sadness or irritability)
Feelings of extreme highs and lows
Excessive fears, worries and anxieties
Social withdrawal
Dramatic changes in eating or sleeping habits
Strong feelings of anger
Delusions or hallucinations
Growing inability to cope with daily problems and activities
Suicidal thoughts
Denial of obvious problems
Numerous unexplained physical ailments
Substance abuse