1. In an hour!
Abnormality

2. Definitions of abnormality

3. Deviation from Social Norms
Norms are the way that the majority are expected to behave in society.
Those that do not think or act the same as others in society break the norms, and are therefore deemed abnormal.
The definition is based on the fact that abnormal behaviour is ‘vivid and unpredictable, violating moral and ideal standards’ (Rosenhan and Seligman, 1987)
Change over time: social norms change as social attitudes change.
For example the wearing of trousers by women.
Human rights abuse: this definition has been used to abuse human rights, for example, the term ‘mental illness’ is a form of social control.
Cultural relativism: social norms vary within and between cultures. Sometimes it is difficult to tell what is actually abnormal

4. Failure to Function Adequately
Failing to function adequately = not being able to cope with day-to-day activities.
Maladaptive behaviour
Personal distress
Irrational behaviour
Peoples’ behaviour is considered abnormal when it begins to cause torment or distress.
Unpredictable behaviour
Observer discomfort
Violation of moral and ideal standards
The more of these key terms you experience, the more abnormal you are...
Cultural relativism:
Day-to-day tasks are set by the culture in which you live.
Applying these criteria to people outside of our culture increases rates of abnormality.
This explains why non-white, non-middle class individuals often diagnosed as mentally ill.
Someone needs to decide if someone else is failing to function adequately, or not managing day-to-day tasks. This might be the patient who realises they are distressed. Other times this is a doctor who notices that someone is not coping well
Maladaptive behaviour
Behaviour that stops you achieving your goals
Personal distress
E.g. experiencing depression or anxiety would cause distress to the individual
Unpredictable behaviour
Behaviour you would not expect in a set of circumstances
Violation of moral and ideal standards
Any behaviour that doesn’t fit with society’s standards
Observer discomfort
Any behaviour which causes distress in others (e.g. family or friends)
Irrational behaviour
Any behaviour without a rational explanation

5. Deviation from Ideal Mental Health
This definition is the only one which outlines ‘normality’.
Marie Jahoda (1958) outlined 6 criteria necessary for ideal mental health; the more you have, the more normal you are.
She compared mental health to physical health in terms of the criteria needed to withstand illness.
These criteria are…
Having a high self esteem
Self-attitudes
Reaching your full capability
Self-actualisation
Being able to cope with stress
Integration
Being independent
Autonomy
Not being too optimistic or pessimistic
Accurate perception of reality
Being able to problem solve, love and adjust
Mastery of the environment
Is mental health the same as physical health? If we use these criteria to detect mental illness in the same way as physical illness, then we are likely to make misdiagnoses.
Not everyone can achieve all the criteria
Cultural relativism: Criteria for ideal mental health are culture-bound. This means that they match the Western cultures, but cannot apply to everyone.

6. Biological approaches to psychopathology
Abnormal behaviours result from physical problems and should be treated medically.
Mental illness is of a similar nature to physical illness – both are characterised by a particular set of symptoms, which will match up with a diagnosis of a particular condition. The condition can then be treated appropriately.
Just as physical illnesses are caused by disease producing germs, genetic factors, biochemical imbalances, or changes to the nervous system, it is assumed that this is also true for mental illnesses.
Genetics
Passed from parent to child. We study identical twins to find a concordance rate (low for phobias, higher for schizophrenia)
Biochemistry
Genes tell the body how to function (e.g. neurotransmitters)High levels of serotonin lead to anxiety, low levels lead to depression. We need a balance to be healthy.
Neuroanatomy
Genes determine the structure of the brain. Research has shown enlarged ventricles (open spaces) in the brain of schizophrenics
Viruses
Viruses can also lead to abnormal behaviour, e.g. Torrey (2001) found flu in pregnancy is linked to schizophrenia. Clive Wearing is another example.

7. Limitations of the biological approach
No 100% concordance rates. Gottesman and Shields (1976) reviewed 5 twin studies looking at schizophrenia. MZ twins = 50% so schizophrenia is not a result of genetic inheritance. Maybe we inherit a susceptibility and exposure to life conditions could lead to the disorder (diathesis-stress model).
Does excess dopamine cause schizophrenia, or does schizophrenia cause low dopamine?
Schizophrenia is associated with excess dopamine. However some schizophrenics actually have lower levels in some brain levels. Maybe there are simultaneous low and high levels.
In the 18th century the medical model lead to a more humane form of treatment (before this demons were blamed). Now the illness was seen as potentially treatable. Some say that the medical model is inhumane. Szasz (1972) said that not all mental illnesses have a physical basis, and should not be thought of in the same way. He suggests that mental illness was invented as a form of social control.

8. Psychological approaches to psychopathology (psychodynamic)
Finally, early childhood experiences can lead to abnormality. Freud believed that early loss or abuse could lead to depression.
Abnormal behaviour could be due to the id (the innate ‘pleasure’ principle) seeking immediate satisfaction.
Abnormal behaviour could be due to the overuse of ego defence mechanisms. The superego (moral principle) develops at age 5 and is in conflict with the id. The ego (reality principle) tries to help the individual cope with the demands of daily life and uses mechanisms such as repression, denial, or regression.
Abnormal behaviour could be due to fixation at one of the stages of development (e.g. anal stage = OCD, or oral stage = eating disorders).

9. Limitations of the psychodynamic approach
The model has an over-emphasis on childhood influences and ignores everyday problems in adult life.
It is difficult to validate the theory – it cannot be scientifically tested.
It is difficult to find evidence for the id, ego, and superego; after all, they are in the unconscious.
The model is ‘unfalsifiable’; if an analyst uncovers something from childhood, this is said to have an influence on adult life. However, if no such childhood event is uncovered, then the child has been traumatised by the event and it remains hidden!
The model is dominated by case studies and these are unscientific.
Evidence collected by therapists is subjective and biased.
Freud’s patients were mainly Viennese, middle-class women – can the findings be generalised?
There is an over-emphasis on sexual factors being the influence of abnormal behaviour. Now social relationships are seen as important, perhaps inadequate social relationships can cause sexual problems.
Individuals are not to blame for their behaviour, parents are!

10. Psychological approaches to psychopathology (behavioural)
Classical conditioning
Learning through association
A NS is paired with an UCS resulting in a CR. Phobias could be learned due to previous association with fear or anxiety. E.g. Little Albert
Operant conditioning
Learning through rewards and punishment
A maladaptive behaviour is rewarded (e.g. not eating results in compliments) and the behaviour continues.
Social learning theory
Learning through imitation of role models
Seeing others rewarded leads to imitation. E.g. Anxiety tends to run in families.
All behaviour is learned whether it is normal or abnormal.
The emphasis of this approach is on the environment and it ignores the role of biology or of any internal thoughts or feelings.
The learning can take one of three forms:

11. Limitations of the behavioural approach
The approach is limited.
The approach ignores the role of biology.
Research is based on animal learning.
The approach ignores the role of cognition; it only focuses on the symptoms and not the cause of abnormal behaviour.
The problem with these theories is that many people do not know the source of their phobia, and it is supposed to be traumatising in some way.
Seligman (1970) provided an explanation of why people rarely mention phobias of fast moving objects like cars, suggesting that basic anxieties are hard-wired into our brains from ancestors. Therefore we are prepared for small and fast moving animals, but not cars.
Behavioural therapies are effective, but not long-lasting. Symptoms are just the tip of the iceberg and we are not treating the cause, symptoms resurface (symptom substitution). Maybe the symptoms are behavioural but the cause is not.

12. Psychological approaches to psychopathology (cognitive)
The cognitive approach believes that abnormality stems from faulty cognitions about others, our world and us.
This faulty thinking may be through cognitive deficiencies (lack of planning) or cognitive distortions (processing information inaccurately).
These cognitions cause distortions in the way we see things; Ellis suggested it is through irrational thinking.

13. Limitations of the cognitive approach
Situational factors of the abnormal behaviour may be ignored because the cognitive model assumes the individual’s thinking to be of fault.
The disorder is thought to be in the patient’s mind rather than due to the individual’s environment.
Biological factors are ignored.
The individual is blamed for their faulty thinking.
It is not clear what comes first, the illness or the thinking. Do thoughts and beliefs cause disturbance, or does the mental disorder cause the faulty thinking?
Faulty thinking may be a vulnerability factor for abnormality. People with maladaptive cognitive processes are at a greater risk of developing mental disorders.
Alloy and Abrahmson (1979) suggest that depressive people tend to see things as they really are (rather than normal people seeing the world through rose-tinted glasses)
Depressed people give more accurate estimates of the likelihood of a disaster than ‘normal controls’ and call this the ‘sadder but wiser’ effect

14. Biological therapies (drugs)

15. Biological therapies (ECT)
Electrodes are placed on the temple of the non-dominant side of the brain and on the forehead.
Patients are injected to make them unconscious and given a muscle relaxing agent, patients are given oxygen due to their inability to breathe.
Electric current of 0.6 amps (lasting half a second) is passed through the brain, this current produces a seizure lasting about a minute.
ECT is given 3 times a week for 3-15 sessions.
Not sure why it works.
ECT causes changes to the brain but we’re not sure how.

16. Evaluation of biological therapies
Drugs
ECT
Strengths
Cheap and easy to take.
Little effort needed.
WHO (2001) reported relapse to be highest when taking a placebo (55%) and lowest when drug was taken combined with family intervention (2-3%).
Antipsychotics work (66%)
Saves lives
Effective for severe depression when other techniques fail
Comer (2002) states that 60-70% of ECT patients improve after treatment
Sackheim et al (2001) found 84% of patients relapse within 6 months (i.e. not long term)
Limitations
Kirsch et al (2002) reviewed 38 antidepressant studies and found placebos to fare almost as well as real drugs.
Tackles the symptoms and not the cause.
As soon as the drug is stopped the patient returns to old state.
Side effects of drugs: SSRIs (anxiety, sexual dysfunctional, insomnia, nausea and suicidal thoughts).
1998 Donald Schell, 60, killed his wife, daughter, granddaughter and himself two days after starting SSRIs.
Patients who received ‘sham’ ECT (ECT procedure with no electric current) recovered. So maybe the attention received helps too
Side effects of ECT: memory loss, cardiovascular changes and headaches
DOH report (1999) found many suffered long term fear and anxiety

17. Psychological therapies (psychoanalysis)
Free association, client is encouraged to talk freely without any censorship of thoughts.
Dream analysis, client recalls dreams and therapist interprets the manifest content to discover the latent content.
Projective techniques, client is shown for example an inkblot and is asked what they see in the picture.

18. Evaluation of psychoanalysis
limitations
strengths
There are issues with Freud’s theory of personality, this then means that these arise in therapy too.
Freud tried to fit his theories to the individual. Modern humanistic or person-centred therapies put the client first, rather than imposing theories on them.
Therapy is very time-consuming and is unlikely to provide answers quickly.
People must be prepared to invest a lot of time and money into the therapy; they must be motivated.
They might discover some painful and unpleasant memories that had been repressed, which causes them more distress.
This type of therapy does not work for all people and for all types of disorders.
Bergin (1971) analysed patient histories and estimated that 80% benefitted from psychoanalysis. It seems that the length and intensity of the treatment leads to recovery.
Tschuschke et al (2007) carried out a long-term study of 450 patients and found the longer the treatment the better the outcome.

19. Psychological therapies (systematic desensitisation)
The subject is given training in muscle relaxation techniques.
A hierarchy of fear is drawn up; this is a list of fearful situations, real or imagined, and the subject lists them in order of least to most fearful.
The subject uses the relaxation techniques at each stage of the hierarchy; starting with the least fearful situation and progressing onto the next stage when the subject feels sufficiently able to do so.

20. Evaluation of behavioural therapies
Strengths
Limitations
Quick
Requires little effort
Can be the only treatments for some groups, e.g. those with learning difficulties
Can be self-administered with computer programmes
Very successful with phobias, 75% success rate (McGrath et al, 1990)
Capafóns et al (1998) found that SD reduced a fear of flying
The symptoms may be repressed but other symptoms may appear (symptom substitution). But Langevin (1993) claims that there is no evidence to support this claim.
Öhman et al (1975) suggest that SD may not be as effective at treating evolutionary adaptations, e.g. fear of the dark, heights etc. This is because they helped our ancestors to survive.
It may work in a lab but not in the real world.
It relies too much on the patient imagining the fearful scenario.

21. Psychological therapies (CBT)
The focus is on the ‘B’ of the ABC model to change irrational beliefs
The techniques used in cognitive-behavioural therapy include:
Challenging the clients’ thoughts and asking them to prove the accuracy of their beliefs (logical disputing)
Self-instruction or self-talking (e.g. “thought-stopping”). This is pragmatic disputing .
Teaching the client ways of acquiring coping strategies (the behavioural element of the therapy).

22. Evaluation of cognitive therapies
Strengths
Limitations
In a meta-analysis of 28 studies Engels et al (1993) found that CBT is effective for a range of disorders (OCD and social phobias).
CBT is more effective than SD or a combination of other therapies.
Not only useful for people suffering from mental disorders or phobias, but also non-clinical populations (exam anxiety).
Yoichi et al (2002) found that CBT could be administered on a computer programme. The sessions lasts 50 minutes, and is based on the A-B-C as well as homework. The homework is to get the client to think about the advantages and disadvantages of irrational beliefs. This lead to a decrease in anxiety.
Fails to address the issue beyond the irrational environment, e.g. bullying partners or jobs with critical bosses. So the environment continues to produce irrational thoughts and maladaptive behaviours.
CBT doesn’t always work.
Sometimes people do not do as they are told and out it into action.
Some do not listen to the advice of the practitioner.