Abnormality: Past & Present
Dr Paul F Hard
Abnormality: Past & Present
Key Terms
Animism
Catharsis
effectiveness studies
efficacy studies
Hysteria
Mesmerism
moral treatment
outcome studies
Psychoanalysis
psychogenic
Wyatt vs Stickney
Bedlam
Themes & Challenges
Biological & Psychological Levels of Analysis
There are many ways in which culture and society
influence the perception of abnormality. In some
cultures and at some times, practices we now
think of as normal were considered disorders:
masturbation in nineteenth-century America was
considered a hallmark of insanity, whereas today
we recognize it to be almost universal in males
and very common in females. Conversely, the
Jerusalem Syndrome is now a clear disorder that
warrants hospitalization, whereas in biblical times
hearing divine voices and obeying their commands
was considered not only acceptable, but sacred.
Biological & Psychological Levels of
Analysis
Societal variables, like poverty, race, class, nationality, and gender have welldocumented and powerful influences on mental illness. For example:
Poor people in America have much more schizophrenia than wealthier
people (Hollingshead and Redlich, 1958).
White Americans have markedly higher rates of depression than African
Americans (Kessler et al., 1994).
Women have the clear majority of anxiety disorders, while men have the
clear majority of substance-abuse disorders (Robins et al., 1984).
Koro, a disorder in which a man fears that his penis will retract into his
abdomen and that he may die, is reported in Malaysia and other parts of
Southeast Asia, but not elsewhere (Rubin,1982).
Jamaican children have more disorders of undercontrol than overcontrol,
but American children show the reverse pattern (Lambert et al., 1992).
Anorexia and bulimia only occur in cultures (like modern urban societies)
that have a thin ideal for women, but not in cultures (like native tribal
societies) that do not have a thin ideal for women (McCarthy, 1990).
Depression in China is characterized by bodily symptoms, but depression in
America is characterized mostly by sadness and pessimism about the future
(Kleinman, 1986).
Themes & Challenges
Biological & Psychological Levels of
Analysis
Science & Practice
Development
Treatment of Choice
Early Approaches to Abnormality
Animistic origins: Possession
Physical Causes
Psychogenic Origins
Treatment of the insane
Segregating the Insane
The Growth of Humane Treatment
Defining Abnormality Today
The Elements of Abnormality
Suffering
Maladaptiveness
Irrationality
Unpredictability & Loss of Control
Rareness & Unconventionality
Observer Discomfort
Violation of Standards
Defining Abnormality Today
The Elements of Abnormality
The Family Resemblance Approach
to Defining Abnormality
Defining Abnormality Today
The Elements of Abnormality
The Family Resemblance Approach
to Defining Abnormality
The Hazards of Defining Abnormality
Society may Err
Observers Disagree
Observers & Actors Disagree
Defining Abnormality Today
The Elements of Abnormality
The Family Resemblance Approach
to Defining Abnormality
The Hazards of Defining Abnormality
The Hazards of Self-Diagnosis
What is a Mental Disorder?
Group exercise T/F
Discussion
What is a Serious Mental Illness? –
Federal Adult Definition
Persons 18 years or over who
currently, or at any time in the past
year, have had a diagnosable mental,
behavioral or emotional disorder
according to DSM criteria.
The disorder results in functional
impairment that interferes with or
limits major life activities.
What is a Serious Mental Illness? –
Federal Adult Definition
Disorders in DSM except “v” codes,
developmental disorders , and
substance abuse disorders unless
they co-occur with other serious
mental illness.
Functional impairments affect: basic
living skills, instrumental living skills,
and functioning in social, family and
vocational contexts.
Review information about Alabama’ s definition of
adults with serious mental illness.
Bio-psychosocial Considerations of
Mental Disorders
Most disorders seem to contain more
or less varying levels of biological,
psychological, and social
components.
Bio-psychosocial Considerations of
Mental Disorders
The disorder or disease of schizophrenia
may include:
 Genetic predisposition
 Biological changes in the brain
 Social and environmental stressors that
trigger the disorder
 Cognitive thought process disruption
 Emotional flatness
 Family adaptation
Bio-psychosocial Considerations of
Mental Disorders
Disorders have a wide range of
severity, even within each kind of
disorder.
The bio-psychosocial model helps
us to:
Conceptualize disorders
Understand the various contributors
to disorders
View the uniqueness of each
individual who suffers from a mental
disorder
Determine where and how to
intervene with treatment
Advantages of Using the DSM-IV
Mental health professionals use it to
communicate with one another and to discuss
their client’s problems.
Researchers use it to study and explain
mental disorders.
Therapists use it to design their treatment
program to fit their client’s problems.
Payers require it for billing/reimbursement
Risks of Diagnosis and
Classification
Can result in a view of a person as a
disorder, not a unique individual, biopsychosocially developed with a disorder.
Encourages us to forget the mental
disorder as an inner, unique experience.
Assigns a label with all of its powerful
negative influences: personally, socially,
politically. Stigma and depersonalization
can result.
Apple Exercise
How Do We Define
Dangerousness?
Dangerousness is the potential for
behaviors that cause harm to self or
others and/or the destruction of
property.
Dangerousness can be viewed as
existing on different levels (high,
moderate, low) depending on the
interplay of contributing factors:
behavior, timing, predictability and
likelihood.
What Are The Types of
Dangerousness?
Type 1: High Severity
Consequences very likely to occur
and include loss of life, limb, and/or
major property destruction.
What Are The Types of
Dangerousness?
Type 2: Moderate Severity
Consequences somewhat likely to
occur and result in harm, injury or
property destruction that is limited and
not life threatening.
What Are The Types of
Dangerousness?
Type 3: Low Severity
Consequences unlikely to occur or
result in harm, injury or property
destruction.
Richard Fields, MD.
What kinds of questions should we
consider when assessing safety
and/or dangerousness?
What is the “dangerous” behavior?
How severe are the likely
consequences?
How imminent is it?
How predictable is it?
How likely is it?
Why a Psychiatric Diagnosis?
Define clinical entities so that
clinicians have the same
understanding of the disorder, which
generally has similar:




Symptoms
Natural history: onset, prognosis, complications
Etiology: origins
Pathogenesis: course of development
• Determine treatment
For the Next 2 Weeks