CHAPTER 1
CHAPTER OUTLINE
I.
The concerns of abnormal psychology. Abnormal psychology seeks to describe, explain,
predict, and control those behaviors that are considered strange. In describing disorders,
psychologists develop a psychodiagnosis. Diagnosis is a useful first step in treatment but,
because of labeling, may sometimes have harmful consequences. Explanations about the
causes of abnormal behavior differ depending on the psychologist's theoretical orientation.
The prediction of future behavior is difficult; for instance, psychologists tend to overpredict
future violent behavior. Therapy is the method by which psychologists try to control
behavior. A growing number of individuals have entered clinical psychology and related
mental health professions. There are an increasing number of mental health professionals in
the United States. Clinical psychologists have Ph.D. or Psy.D. degrees and are trained to
assess and treat people with serious disorders. Counseling psychologists are trained in much
the same way as clinical psychologists, but they traditionally treat less serious problems.
Marriage and family counseling look at the family as a unit. Mental health counseling can
be licensed in 49 states and work in a number of clinical settings. Psychiatrists have medical
degrees and can prescribe medication. Psychoanalysts are trained in psychoanalytic
institutes and engage in personal analysis. Psychiatric social workers usually get a master's
degree and often work in family or community agencies. School psychologists work with
children and adolescents in school settings, assisting them with cognitive, social, and
behavioral interventions.
II. Defining abnormal behavior. The Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR) has the current definition of mental disorders. The standards include when
are behaviors significant, what are present distresses, painful symptoms and ascertaining
increased risk. The statistical criterion defines abnormality as those behaviors that are
infrequent. One problem with this standard is that it provides no consistent means for
deciding what is rare and what is undesirable. Psychologists view abnormal behavior as
deviating from what is considered normal in terms of distress, deviance, dysfunction and
dangerousness, the “4 D’s.” Distress involves both physical and psychological pain.
Deviance refers to odd behaviors, such as hallucinations (false sensory impressions) and
delusions (false beliefs). Dysfunction is exhibited when a person’s performance falls well
short of his or her potential. Dangerousness is defined by Tarasoff v. Regents of the
University of California which indicates that psychologists have “a duty to protect.”
III. Contextual and cultural limitations in defining abnormal behavior. Multicultural
perspectives recognize that all behaviors originate from a cultural context. One approach is
cultural universality, the traditional viewpoint on abnormality, which states that there are
universal symptoms and disorders. The opposite, cultural relativism, says that deviance
designations reflect cultural values. Both approaches have merit. A central theme is what
behaviors are widely considered to be abnormal given the culture and how the culture
influences the identification and treatment of abnormal behavior.
IV. The frequency and burden of mental disorders. The goals of psychiatric epidemiology
are to determine how frequent disorders are in the population, how such factors as age and
gender affect their prevalence (i.e., the percentage of people in a population who suffer from
a disorder at a given time), lifetime prevalence (i.e., the total proportion of people in the
population who have ever had a disorder in their lives), and incidence (i.e., the onset or
occurrence of a given disorder over some period of time). Another goal of epidemiology is
to determine whether and how trends are changing. Current research into the epidemiology
of mental disorders. Overall, men and women are equally likely to suffer from disorders;
however, men are more likely to have alcohol problems and women are more likely to
become depressed or anxious. Older people are vulnerable to cognitive impairments. Mental
illness ranks higher than malignant disease with respect to lost years of healthy life. Fewer
than one-third of people with disorders receive mental health services.
V. Stereotypes about the mentally disturbed. One myth is that mentally disturbed people can
be readily spotted. This is not true because there are no sharp dividing lines between
normality and abnormality and because some forms of deviance can be hidden. Another
myth is that mental disorder is always inherited. Genetics can play a role in some disorders,
but even in those disorders where genes are thought to play a role, environmental stress is a
crucial influence. Other myths are that people with mental disorders cannot be cured, that
their problems stem from a lack of willpower, that mental illness is always a deficit and
those who suffer disorders contribute nothing to society, and that they are more dangerous
than other people.
VI. Historical perspectives on abnormal behavior. How people view mental disorders is
related to the beliefs of their culture ad time. During prehistoric times, people believed in
demonology (demonic possession, sorcery, or the behest of an offended ancestral spirit).
Treatments included trephining (chipping open the skull so the evil spirit could escape) and
exorcism (prayers, noisemaking, even starvation to drive out spirits). Naturalistic
explanations during the Greco-Roman era, relied heavily on observations and explanations
attributing disorders to organic factors such as brain pathology. Reversion to supernatural
explanations in the Middle Ages. during the Dark Ages, the Catholic Church dominated all
thought and reverted to supernatural explanations for mental disorders. In the 13th century,
whole populations were sometimes affected by such forms of mass madness as tarantism (a
dance mania) and lycanthropy (in which people believed themselves to be wolves).
Witchcraft became a common explanation for abnormal behavior in the 15th-17th centuries,
when the Catholic Church was under attack. Some mentally ill people were considered
witches and received brutal punishment, but most accused witches were probably sane. The
Malleus Maleficarum (Witch’s Hammer) is published. The rise of humanism (the
Renaissance) took place in the 14th – 16th centuries, stressing human welfare and rejecting
the supernatural aspects of witchcraft. Johann Weyer asserted that people who had been
thought to be witches were actually mentally disturbed. The reform movement (18th and 19th
centuries) led to the moral treatment movement; it began in France (Philippe Pinel) and
England (William Tuke). In America (Benjamin Rush), mental patients were also treated
more humanely. Dorothea Dix pushed for the improvement of care for individuals with
mental disorders and for the building of mental hospitals. Clifford Beers exposed the cruel
treatment he and other patients experienced in mental institutions. Generally, treatment for
the mentally ill has improved in this century.
VII. Causes: Early viewpoints. From Hippocrates’ day to our own, organic explanations of
abnormality have existed. During the late 1800s, there was a strong increase in this
biological viewpoint, which was supported by the discovery that general paresis had an
organic cause. Emil Kraepelin observed that certain symptoms occur in clusters, called
syndromes, with each syndrome having a unique cause. Kraepelin classified the mental
illnesses on the basis of organic causes. The psychological viewpoint is an alternative view
that suggests emotions can cause mental disorders. Anton Mesmer used trances
(mesmerism) to treat people with hysteria, sometimes successfully. Although he was
declared a fraud, these treatments underscored the power of suggestion for curing disorder.
Mesmerism and Hypnotism was studied and used by several French physicians (Liebeault,
Bernheim, and Charcot) to treat hysteria during the late 1800s, this was called the Nancy
School. Breuer found that reliving past experiences through catharsis removed symptoms,
too. Sigmund Freud built upon this foundation. A dichotomous approach, behaviorism, was
firmly rooted in laboratory research and stressed the importance of directly observable
behaviors and the conditions of stimuli that evoked, reinforced, and extinguished them.
VIII. Contemporary trends in abnormal psychology. Twentieth-century views of abnormality
have been influenced by the introduction of psychiatric drugs in the drug revolution of
the1950s, which led to a great reduction in patients residing in mental institutions
(deinstitutionalization). Psychologists have initiated legislative efforts to gain prescription
privileges to treat individuals with mental disorders Medical providers (psychiatrists) are
opposed to non-medical personnel having prescription privileges, and not all psychologists
support psychologists’ expansion into the psychopharmacological realm, fearing that
psychologists will lose their own professional identity. Managed health care, which
attempts to contain costs by increasing the oversight of treatment by outside reviewers and
by requiring treatment professionals to justify their therapies, may alter the types of care
provided. Appreciation for research: professionals in abnormal psychology value research
on both the biological and psychological bases of behavior for understanding and treating
mental disorders. Diversity and multicultural psychology: Changes in the racial and ethnic
diversity of the United States have helped create a new field called multicultural
psychology. Racial, cultural, age, and gender differences in apparent mental disorders may
be explained in terms of social conditioning (e.g., stereotyping), cultural values that are
taught, and sociopolitical influences such as prejudice, which prompt healthy coping
mechanisms that may be seen as symptoms. Bias in diagnosis is another explanation for
differences in minority mental health.
IX. Implications Increasingly, professionals value a multi-path approach, which acknowledges
that biological, psychological, and social factors combine to explain most disorders.