1
Definition
CHAPTER 1
ABNORMAL
BEHAVIOUR IN
HISTORICAL
CONTEXT
Present
DSM
Dysfunction
Distress
Atypical
(Culture)
Integrative
Approach
Science
Past
Scientist
Practitioner
Supernatural
Clinical
Description
Biological
Demons
Psychological
(PP. 2-31)
Bio Treat.
Poss.
19C
Goals
Cognitive
Psychoanalytic
Greeks
Behavioural
Cause
Treatment
Humanistic
Outcome
APPROACHES TO DEFINING
ABNORMAL BEHAVIOUR
3
WHAT IS A
4
(PP.2-3)
PSYCHOLOGICAL
DISORDER?
(PP.2-3)
• No single definition of psychological abnormality or
of psychological normality (+1)
• Three criteria appear important (above, F1.1, +2)
– Psychological Dysfunction
– Distress or Impairment
– Atypical Response
WHAT IS A PSYCHOLOGICAL
DISORDER?
2
Historical
Context
5
(P. 3-6)
A Psychological Disorder is:
– A psychological dysfunction within an individual
• Breakdown in cognitive, emotional, or behavioural functioning
– Associated with distress or impaired functioning
• Difficulty performing appropriate and expected roles
– Not typical or culturally expected
• Impairment occurs in context of person’s background
• Reaction is outside cultural norms
• Synonyms: Abnormal Behaviour, Mental Illness
(less preferred), Psychopathology, …
• Inadequate Single Criteria
–
–
–
–
–
Does infrequency define abnormality?
Does suffering define abnormality?
Does strangeness define abnormality?
Does the behaviour itself define abnormality?
Should normality serve as a guide?
• Many myths about qualities associated with mental illness
also inadequate
–
–
–
–
Lazy, dumb, …
Weak character
Danger to self or others
Hopeless situation, incurable, …
THE DIAGNOSTIC AND STATISTICAL
MANUAL (DSM-IV)
6
(P. 6)
• Widely used system for classifying
psychological problems and disorders
• Contains diagnostic criteria for behaviours that
– Fit a pattern
– Cause dysfunction or subjective distress
– Are present for a specified duration
– And not otherwise explainable
• About to release DSM-V
• Other major system is WHO’s ICD
1
THE PAST: HISTORICAL
CONCEPTIONS
7
– Caused by demonic possession,
witchcraft, sorcery
– Mass hysteria (St. Vitus’dance or
Tartanism) and church
– Treatments included exorcism
(right image), torture, beatings,
and crude surgeries
(PP. 9)
• Major psychological disorders have existed
– In all cultures
– Across all time periods
• Causes (interpretations) and treatment of
abnormal behaviour varied widely
8
(PP. 9-12)
– Paracelsus and lunacy
• Both “Outer Force” views
popular during Middle Ages
• Few believed that abnormality
was illness on par with
physical disease
• Three dominant traditions include:
– Supernatural, Biological, and Psychological
9
BIOLOGICAL
TRADITION IN
19TH CENTURY
(PP. 12-13)
• Hippocrates’: Abnormal behaviour as
physical disease
– Hysteria “The Wander Uterus”
• Galen extended Hippocrates work
– Humoral theory: black bile (melancholic),
yellow bile (choleric), blood (sanguine),
and phlegm (phlegmatic)
– Treatments remained crude
• Galen-Hippocrates tradition
– Foreshadowed modern views linking
abnormality with brain chemical
imbalances
SUPERNATURAL
TRADITION
• Movement of Moon and Stars
as cause of deviant behaviour
– Across cultures
– Across time periods
– Particularly as a function of prevailing paradigms or
world views
BIOLOGICAL TRADITION
• Deviant behaviour as Battle of
“Good” vs. “Evil”
(PP. 13-14)
'Sickness is not sent
by the gods or taken
away by them. It
has a natural basis.
If we can find the
cause, we can find
the cure.'
11
• General Paresis (Syphilis) and
10
biological link with madness
– Associated with several unusual
psychological and behavioural
symptoms
– Pasteur (below) discovered cause:
a bacterial microorganism
– Led to penicillin as successful
treatment
– Bolstered view that mental illness
= physical illness and should be
treated as such
• John Grey, Dorothea Dix, and the
Reformers (+1)
DEVELOPMENT OF
BIOLOGICAL TREATMENTS
12
(PP. 14-15)
• Mental Illness = Physical Illness
• 1930’s: Biological treatments
standard practice
– Insulin shock therapy, ECT (top),
and brain surgery (i.e., lobotomy)
• By 1950’s several medications
established
– Include neuroleptics such as
reserpine (plant-based, right),
major tranquilizers
2
PSYCHOLOGICAL TRADITION
13
(PP. 15-17)
• Moral therapy
– Allow institutionalized patients to be treated as normal as
possible and to encourage and reinforce social interaction
– Philippe Pinel and Jean-Baptiste Pussin
– William Tuke followed Pinel’s lead in England
– Benjamin Rush led reforms in USA
– Clarence Hinks was mental health reformer and crusader
in Canada
• Reasons for falling out of moral therapy
– Emergence of competing alternative psychological models
• Rise of Moral Therapy
– Treat institutionalized patients as
normal as possible; encourage
and reinforce social interaction
– Philippe Pinel (right image) and
Jean-Baptiste Pussin
– William Tuke followed Pinel’s
lead in England
– Benjamin Rush led reforms in
United States
– Clarence Hinks was mental
health reformer and crusader in
Canada.
THE
14
PSYCHOLOGICAL
TRADITION
(PP. 15-17)
• Reasons for falling out of
moral therapy
– Emergence of competing
alternative psychological models
PSYCHOANALYTIC THEORY
15
(PP.17-21)
16
Freudian Theory
• Freudian theory of structure and function of mind
• Mind’s Structure (+1)
– Id: pleasure principle; illogical, emotional, irrational
– Ego: reality principle; logical and rational
– Superego: moral principles; keeps Id and Ego in balance
• Defense mechanisms
• When Ego loses battle with Id and Superego
– Displacement and denial
– Rationalization and reaction formation
– Projection, repression, and sublimation
• Freudian Stages of Psychosexual Development
– Oral, Anal, Phallic, Latency, and Genital stages
NEO-FREUDIAN DEVELOPMENTS
IN PSYCHOANALYTIC THOUGHT
17
(PP.21)
• Anna Freud and self-psychology
– Emphasized influence of ego in defining behaviour
• Melanie Klein, Otto Kernberg, and object relations theory
– Emphasized how children incorporate (introject) objects
– Examples include images, memories, and values of significant
others (objects)
• Others developed concepts different from those of Freud
– Carl Jung, Alfred Adler, Karen Horney, Erich Fromm, and Erik
Erickson
• Neo-Freudians generally de-emphasized sexual core of Freud’s theory
• Unearth hidden
intrapsychic conflicts (“the
real problems”)
• Therapy often long term
• Techniques:
18
PSYCHOANALYTIC
THERAPY
(P.21-23)
– Free association
– Dream analysis
• Examined transference and
counter-transference
issues
• Little evidence for efficacy
3
HUMANISTIC THEORY
19
(PP. 21-22)
• Carl Rogers, Abraham Maslow,
and Fritz Perls
• Major Theme
– People are basically good
– Humans strive toward selfactualization
• Treatment
– Therapist conveys empathy
and unconditional positive
regard
– Minimal therapist
interpretation
• No strong evidence that
humanistic therapies work
BEHAVIOURAL
MODEL
(PP.23-25)
• Derived from scientific approach to
study of psychopathology
20
• Classical Conditioning: Ivan Pavlov (left
image), John B. Watson
– Ubiquitous form of learning
– Conditioning involves correlation
between neutral stimuli and
unconditioned stimuli (+1)
– Extended to acquisition of fear
(Albert +1)
• Operant Conditioning: Edward
Thorndike, B. F. Skinner
– Another ubiquitous form of
learning
– Most voluntary behaviour
controlled by consequences that
follow behavior
– Reinforcement and Punishment
• Both traditions greatly influenced
development of behaviour therapy
21
22
CLASSICAL
OPERANT
CONDITIONING
CONDITIONING
Video
BEGINNINGS OF BEHAVIOUR THERAPY
(PP. 25-27)
• Reactionary movement against psychoanalysis and non-scientific
approaches
• Early Pioneers
– Joseph Wolpe: Systematic desensitization
• For treatment of phobias (e.g., snakes)
– Arnold Lazarus: Multi-modal behaviour therapy
– Hans Eysenck: Conditioning therapy
– Aaron Beck: Cognitive therapy
– Albert Bandura: Social learning or cognitive-behaviour therapy
– Stanley Rachman: an original founder of behaviour therapy
• Behaviour therapy tends to be time-limited and direct
• Strong evidence supporting efficacy of behaviour therapy
23
COGNITIVE PSYCHOLOGY
24
(NOT IN TEXT)
• Reaction to behaviorist denial of role for mental processes,
BUT believed in scientific study rather than subjective
approaches (e.g., introspection)
• Adoption of Information Processing Model (+1) and later
Connectionist / Neural Network models (e.g., early Freud
model & Lang model for phobia +2)
• Number of cognitive processes hypothesized to contribute
to psychopathology
– Selective Attention: people with certain psychological disorders
more sensitive to stimuli related to their disorder (e.g., depressed
people more attuned to depressive stimuli +3)
–…
4
INFORMATION PROCESSING MODEL
25
26
Freud
“connectionist”
model
Lang
(1979)
Reaction
Time (ms)
Sad
Dog
Unhappy Table
Crying
Knife
…
…
27
PRESENT: SCIENTIFIC METHOD AND AN
INTEGRATIVE APPROACH
28
(PP. 27)
• Psychopathology multiply determined
• One-dimensional accounts incomplete
• Must consider reciprocal relations between
Depression
Words
– Biological, Psychological, Social, and Experiential
factors
• Defining abnormal behaviour is also complex,
and multifaceted, and has evolved
• Supernatural tradition has no place in science of
abnormal behaviour
• Many practitioners and laypeople “treat” people
with psychological disorders (+1 +2)
NonDepressed
Words
Diverse people deal with clients / patients
• Psychologists
– Ph.D.’s: Clinical and counseling psychologists
– Psy.D.’s: Clinical and counseling “Doctors of Psychology”
– In Canada, regulation of profession of psychologist is under
jurisdiction of provinces and territories.
• Other Mental Health Professionals and Lay Practitioners
– M.D.’s: Psychiatrists
– M.S.W.’s: Psychiatric and non-psychiatric social workers
– MN/MSN’s: Psychiatric nurses
– Lay public and community groups
29
Mental Health Professionals
30
MD
PhD PsyD MA
• Number of some practitioners in Canada (+1)
5
DIMENSIONS OF
SCIENTISTPRACTITIONER MODEL
(P. 7-8)
31
• Psychologists
(somewhat) united
by ScientistPractitioner
Framework
• Three Dimensions
SCIENTIST-PRACTITIONERS
32
(PP. 7-8)
• Three Major Goals of Psychological Research
– Producers of
research
– Consumers of
research
– Evaluate their work
using Empirical
methods
• Begin with presenting
problem
• Distinguish clinically
significant dysfunction
from common human
experiences
• Describe Incidence and
Prevalence of disorders
• Describe onset of
disorders
– Acute vs. Insidious onset
• Describe course of
disorders
– Episodic, Time-limited, or
Chronic course
CLINICAL
DESCRIPTION
(PP. 8)
33
CAUSATION, TREATMENT, AND
OUTCOME IN PSYCHOPATHOLOGY
34
(PP. 8)
• Etiology or Causation: What factors contribute to
development of psychopathology?
• Treatment: How to best improve lives of people
suffering from psychopathology?
– Treatment development: includes Pharmacologic,
Psychosocial, and / or Combined treatments
• Outcome: How do we know that we have alleviated
psychological suffering?
– Evaluate efficacy (effectiveness) of treatments
– Challenging because of many confounding factors
6