Transcript 5.1 Abnormal psychology_concepts of normality

Concepts of normality
IB – three groups of
disorders

 Anxiety
 have a form of irrational fear as the central disturbance.
 e.g. post-traumatic stress disorder, obsessive compulsive
disorder; panic disorder, social anxiety disorder;
generalized anxiety
 Affective
 Characterized by dysfunctional moods.
 Depression; Bipolar; Seasonal-affective-disorder;
alcohol/drug induced depression
 Eating Disorders
 Characterized by eating patterns which lead to insufficient
or excessive intake of food.
 Anorexia; bulimia.
Studying Abnormal
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 We will study one of these disorders (Anxiety, Affective or
Eating) and assess from:
 Etiology
 Biological
 Cognitive
 Sociocultural
 Symptoms
 Prevalence
 Treatment
 Biometical (drug therapy)
 Individual psychotherapy
 Group psychotherapy
 Cultural and gender variations
Pgs 136-141
Concepts of normality and
abnormality

 Who decides what is normal and what is abnormal?
 What effect does culture have on interpreting
behavior?
 How does different social settings change the
interpretation of what is normal vs abnormal?
 If treatment is dependent upon diagnosis, how does
one qualify the degree of behavior?
 Often it is a series of judgement
 Diagnostic manual
Trends in behavior
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 Intelligence and short
term memory follow
normal distributions
 Abnormality is often
defined as a “subjective”
feeling of “not normal”
 anxiety, unhappiness,
distress.
 When behavior violates
social norms or makes
others anxious??? Can
this be seen as
abnormality?
Rosenhan and Seligman (1984)
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 There are seven criteria that could be used to decide
whether a person or behavior is normal or not:
 Suffering
 Maladaptiveness
 Irrationality
 Unpredictability
 Vividness and unconventionality
 Observer discomfort
 Violation of moral or idea standards
Suffering
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 Does the person exhibit stress and discomfort?
Maladaptiveness
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 Does the person engage in behavior that make life
difficult for him rather than being helpful?
Irrationality
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 Is the person incomprehensible or unable to
communicate in a reasonable manner?
Unpredictability

 Does the person act in a ways that are unexpected by
himself or other people?
Vividness and unconventionality

 Does the person experience things that are different
from most people?
Observer discomfort

 Is the person acting in a way that is difficult to watch
or that makes other people embarrassed?
Violation of moral or idea
standards

 Does the person habitually break the accepted ethical
and moral standards of the culture?
Defining abnormality is not easy
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 Suffering, Maladaptiveness, Irrationality,
Unpredictability:
 Deals with how the person is living life
 Vividness and unconventionality
 Social judgment
 Often fail to consider the diversity in how people live
their lives
 Observer discomfort, Violation of moral or idea
standards
 Social norms
Two Approaches to defining
abnormal vs normal
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 The Mental health criteria:
 Jahoda (1985)
 The Mental illness criteria:
 Diagnostic and Statistical Manual of Mental Disorders
(American Psychiatric Association)
 Medical model
The mental health criteria

 Jahoda (1985) took a different approach – They
assessed the characteristics that we identify with normal
behavior.
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Efficient self perception
Realistic self esteem and acceptance
Voluntary control of behavior
True perception of the world
Sustaining relationships and giving affection
Self-direction and productivity
Evaluation of mental
health criteria

 Using Johoda’s criteria, how might you be perceived
in other cultures?
 How would a behavior be perceived in different eras
of time?
 Example – sexuality (pg 138)
Be a thinker
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 The DSM has classified transsexualism as a disorder.
It is called “gender identity disorder” when people
feel deep within themselves that they are the
opposite sex. Many films have portrayed the lives of
people who are transsexual.
1. Should this de described as a disorder, as
homosexuality was?
2. What are the arguments for and against
declassification?
Changing view of
abnormal behavior
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The mental illness criterion
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 Abnormal behavior is of physiological origin –
Medical model
 Neurotransmitters, hormones
 Can be treated with drug therapy
 Psychopathology – psychological illness that is
based on the observed symptoms of a patient.
Ethical concerns of the
medical model

 Model argues it is better to regard someone suffering a mental
disorder as sick than morally defective
 Gross (2002) cites misuse, due to diagnosing being influenced by
culture or politics. (pg 139 examples)
 Today psychiatrist use classification system, designed to be more
objective. More holistic approach which is biopsychosocial.
 Tomasz Szasz (1962)– US psychiatrist was most critical of the
concept “mental illness,” he argued that although some disorders
were associated with disease of the brain, most could be considered
as problems in living.
 Frude (1998) – there are few psychological disorders that can be
associated with organic pathology.
Are you shy?
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 Read top page 140 and discuss
Pg 140- 143
Diagnosing Psychological
Disorders

 Diagnosing is accomplished through clinical interview – a
checklist of questions
 Limitations
 Information is only as good as the patient provides and the
physician is listening
 Information exchange may be blocked if either the patient
or the clinician fails to respect the other, or if the other is not
feeling well.
 Intense anxiety or preoccupation on the part of the patient
may affect the process
 A clinicians unique style, degree of experience and the
theoretical orientation will definitely affect the interview.
Other methods used to diagnose
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 Observation
 Brain scanning (suspected schizophrenic or
Alzheimer)
 Psychological testing (ADHD, IQ, personality tests)
ABC’s of describing disorders
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 Affective symptoms
 Emotional elements, including fears, sadness, anger
 Behavioral symptoms
 Observational behavior, such as crying, physical
withdrawal, pacing.
 Cognitive symptoms
 Ways of thinking, including pessimism, personalization,
and self image
 Somatic symptoms
 Physical symptoms, facial twitching, stomach cramping,
amenorrhea.
Defining is not easy!
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 Is abnormal psychology stagnant or is it
continuously evolving?
 Does how we define abnormality change over time?
 Does “abnormality” reflect a social construct?
Validity and
Reliability of diagnosis
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 Diagnosing – the ability to identify a disease based
on symptoms using diagnostic systems, a set of
standardized templates which to base your analysis.
 Reliability – different clinicians using the same
system should get the same results.
 Validity – does the system identify a pattern of
symptoms that can be treated? (*this does not imply
identifying cause and effect).
Rosenhan (1973) revisited
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“On being sane in insane places,”
Aim – to test the reliability of psychiatric diagnosis
Method – field experiment
Procedure –
 5 men & 3 women tried to gain admission to 12 psychiatric
hospitals.
 They complained they had been hearing voices.
 Seven of them were diagnosed with schizophrenia.
 After being admitted they stated they felt fine and they
were no longer experiencing symptoms. It took an average
of 19 days before they were discharged.
Rosenhan cont.,
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 He then challenged that the institutions could not
distinguish abnormal from normal, and said they
would send in more confederates. They did not, yet
the institution claimed 41 pseudo-patients were
confederates attempting to be admitted.
 Conclusion – it was not possible to distinguish sane
and insane in psychiatric hospitals. This also raised
ethical concerns on treatment.
Diagnosing woes
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 Beck et al (1962) – the agreement on diagnosing for 153
patients between two psychiatrist was only 54%.
 Cooper et al (1972) – NY psychiatrist were twice as likely
to diagnose schizophrenia than London psychiatrist.
 DiNardo et al., (1993) assessed DSM III for anxiety
disorders:
 2 clinicians - 80% reliability on OCD, 57% reliability on
generalized anxiety disorders when assessing 267
individual
 Problem with generalized anxiety was how to interpret
how excessive a person’s worries were.
Diagnosing woes
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 Lipton and Simon (1985) – 131 patients assessed
 1st round of diagnosis
 89 schizophrenic
 2nd round of diagnosis
 Only 16 of the original 89 were diagnosed as
schizophrenic
 50 were diagnosed as mood disorder
 What problems do you see?
Influences on diagnosing
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 Attitudes and prejudice of psychiatrist
 Expectations that certain groups/gender are prone to
depression therefore you interpret as depression.
 Overpathologization – the excessive use of applying
expectations/stereotyping to create a diagnosis.
Pgs 143 - 147
Ethical considerations
in diagnosis
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 Stigmatizing – the use of labels to distinguish people as
different.
 Szasz (1974) Ideology and Insanity, argues people use labels
such as mentally ill, criminal or foreigner to socially exclude
people.
 DMS-IV has altered its approach to separate the behavior
from the individual.
 Self-fulfilling prophecy – people may begin to act as
they think they are expected to.
 Scheff (1966) argues labeling could increase symptoms
 Doherty (1975) those who reject the mental illness label tend
to improve quicker.
Ethics cont.,
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 Prejudice and discrimination – scheme processing
 Langer and Abelson (1974) : video of younger man
telling older man about his job experience. (see
interpretations pg 143)
 Racial/ethic bias: Jenkins-Hall and Sacco (1991)
 Evaluation of African American and European
American Women in depressed and non-depressed
setting (pg 143)
 Conformational bias: clinicians assume there must
be a disorder is the patient is there to see them.
Rosenhan?????
Ethics cont.,
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 Powerless and depersonalization:
 Lack of rights, constructive activity, choice, privacy, as
well as frequent verbal abuse and even physical abuse
by attendants.
Cultural considerations
in diagnosis
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 Culture-bound syndromes – disorders that appear
to be culturally specific.
 Although many disorders are universal some are
culture-bound specific
 Examples: shehjing shuairuo (neurasthenia) accounts
for more than 50% of psychiatric outpatients in China.
This disorder is listed in the Chinese Classification of
Mental Disorders (CCMD-2) but not in the DSM-IV
used in western society.
neurasthenia
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 Diagnostic criteria for neurasthenia include:
 Persistent and distressing symptoms of exhaustion after minor mental or
physical effort including general feeling of malaise, combined with a
mixed state of excitement and depression.
Accompanied by one or more of these symptoms: muscular aches and
pains, dizziness, tension headache, sleep disturbance, inability to relax and
irritability.
Inability to recover through rest, relaxation or enjoyment.
Disturbed and restless, unrefreshing sleep, often troubled with dreams.
Duration of over three months.
Does not occur in the presence of organic mental disorders, affective
disorder, panic or generalized anxiety disorder.
American Psychiatric Association
(APA)
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 APA currently recognizes culture-bound syndromes by
including separate listing in the appendix os DSM-IV (1994).
 Depression is common in western culture but appears to be
absent in Asian cultures.
 Asian people tend to live with extended family and have greater
social support.
 Asian doctors report that depression is equally common among
Asians, but that Asians only consult their doctor for physical
problems, rarely emotional distress.
 May seek help for physical symptoms associated with depression
(fatigue, appetite disturbance, sleep disruption) but not mood issue.
How accurate are the
comparisons?
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 Reporting bias may limit the validity of the data obtained
in cross culture comparisons, as data figures are typically
based on hospitalization.
 Low admission rates may reflect
 cultural beliefs about mental health issues.
 Availability of mental health care for minority groups
 Cohen (1988) in India the mentally ill are cursed and
looked down on
 Rack (1982) in China mental illness carries great stigma,
thus only those who are severely psychotic are identified.
Culture and depression
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 Marsella (2003) argues
 individualistic cultures expression of depression is
affective, (emotional).
 In these cultures feelings of loneliness and isolation
dominate.
 In more collectivist societies, somatic (physiological)
symptoms such as headaches are dominant.
 The source of the stress and the tools for coping are
different for each culture. Thus diagnosing is
challenging as is treatment.
Culture and diagnosis
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 Culture blindness - the problem of identifying
symptoms of a psychological disorder if hey are not the
norm in the clinicians own culture
 Cochrane and Sashidharan (1995) : normality behavior
assumptions are based upon white population; any
deviation reveals racial or cultural pthology
 Rack (1982) if a minority of different ethnicity exhibits a
trait that would be considered abnormal in white culture,
it is assumed to be abnormal in the other culture – this
may not be true (example: hearing voices of a loved one
as part of a funeral passage).
Apply your knowledge
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 Read the passage pg 147 describing Anne and
answer the following questions:
1. Do you think this person’s behavior is normal?
2. Do you think it is dysfunctional?
3. Why or why not?
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 Prepare a list of 3 Abnormal behaviors (http://www.mentalhealth.com/)
 Identify the Biological, Cognitive and sociocultural
factors that influence the abnormal behavior.
 Prepare summary: Discuss the extent to which
biological, cognitive and sociocultural factors
influence abnormal behavior.
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 Select three psychological research studies on
abnormal behavior and clearly identify the strengths
and limitations.