Transcript Definitions of Abnormality

Abnormality in 1
hour
Defining abnormality
Definitions of Abnormality
Defining a person or behaviour as ‘abnormal’ implies
something undesirable and requiring change Therefore,
we must be careful how we use the term
Psychologists need methods for distinguishing ‘normal’
from ‘abnormal’
Our definition of abnormality must be objective:
– It must not depend on anyone’s opinion or point of
view
– It should produce the same results whoever applies it
It must not be under- or over-inclusive
– It must not label as ‘abnormal’ or ‘normal’ behaviours
or traits that aren’t
Definitions of Abnormality
Three definitions can be asked for in the
examination:
– Deviation from social norms
– Failure to function adequately
– Deviation from ideal mental health
Deviation from Social Norms
Under this definition, a person’s thinking or behaviour is
classified as abnormal if it violates the (unwritten) rules about
what is expected or acceptable behaviour in a particular social
group.
Their behaviour may:
– Be incomprehensible to others
– Make others feel threatened or
uncomfortable
With this definition, it is necessary to consider:
– The degree to which a norm is violated, the importance of
that norm and the value attached by the social group to
different sorts of violation.
– E.g. is the violation rude, eccentric, abnormal or criminal?
Deviation from Social Norms:
evaluation
Social norms change between cultures and over time.
Consequently, so do people’s conceptions of abnormality.
– Homosexuality was regarded as a mental illness until
1973, but not any more.
Cross-cultural misunderstandings are common, and may
contribute to e.g. high diagnosis rate of schizophrenia
amongst non-white British people.
Classification of abnormality can only based on the context
in which behaviour occurs
– Same behaviour might be normal or abnormal e.g.
undressing in bathroom or classroom
– A subjective judgement is usually necessary e.g. there
may be situational factors unknown to the observer
Failure to Function Adequately
Under this definition, a person is considered abnormal if they
are unable to cope with the demands of everyday life.
They may be unable to perform the behaviours necessary for
day-to-day living e.g. self-care, hold down a job, interact
meaningfully with others, make themselves understood etc.
Rosenhan & Seligman (1989) suggest the following
characteristics:
– Suffering
– Maladaptiveness (danger to self)
– Vividness & unconventionality (stands out)
– Unpredictability & loss of control
– Irrationality/incomprehensibility
– Causes observer discomfort
– Violates moral/social standards
Failure to Function Adequately: Evaluation
Adequate functioning is defined largely by social norms and
these norms change through time and culture.
Most people fail to function adequately at some time, but
are not considered ‘abnormal’
– After a bereavement most people find it difficult to cope
normally. Ironically, they might actually be considered
more abnormal if they functioned as usual
Many people engage in behaviour that is maladaptive/
harmful or threatening to self, but we don’t class them as
abnormal
– Adrenaline sports
– Smoking, drinking alcohol
Deviation from Ideal Mental health
Under this definition, rather than defining
what is abnormal, we define what is
normal/ideal and anything that deviates
from this is regarded as abnormal
This requires us to decide on the
characteristics we consider necessary to
mental health
Deviation from Ideal Mental Health
Psychologists vary, but usual
characteristics include:
– Positive view of the self
– Capability for growth and development
– Autonomy and independence
– Accurate perception of reality
– Positive friendships and relationships
– Environmental mastery – able to meet the
varying demands of day-to-day situations
Deviation from Ideal Mental Health:
Evaluation
What is considered ideal is historically and
culturally specific (see ‘deviation from
social…’)
Jahoda’s and others’ criteria set the bar
too high.
– Strictly applied, so few people actually meet
these criteria that everyone ends up classed
as abnormal and so the concept becomes
meaningless
Four approaches to
explaining mental disorders.
Psychological approaches
Biological
approach
Psychodynamic
approach
Behavioural
approach
Cognitive
approach
For each approach you need...
Assumptions
Therapies
• Explain the
assumptions then
link to mental
disorders and give
an example.
• Describe and
evaluate the
therapies.
• Does it work?
• Is it accessible by
everyone?
• Ethical issues?
Evaluation of
the approach
• What does it
explain well?
• What doesn’t it
explain?
• Does it offer
effective
therapies?
• Does it raise any
ethical issues?
Biological approach
Assumptions:
– Abnormality is caused by physical processes.
– Psychological disorders are illnesses or
diseases affecting the nervous system
– Abnormal behaviour, thinking and emotion are
caused by biological dysfunctions
– Understanding mental illness involves
understanding what went wrong with the brain
Biological causes of
abnormality
Brain damage
• . Alzheimer’s
disease is caused
by degeneration of
neurones.
Chemical
imbalances
• Low level of
serotonin
(neurotransmitter)
is associated with
depression.
Infections
Genes
• Clive wearing
suffered from viral
encephalitis which
damaged his
hippocampus as a
result he could not
form new
memories.
• Could code for
abnormality in the
structure and
functioning of the
brain i.e.
schizophrenia
shows a genetic
pattern of
inheritance.
Biological approach: evaluation
Uses scientific techniques to find evidence such
as objective measurements like brain scans and
blood tests so evidence is valid.
Schizophrenia shows a genetic pattern of
inheritance but environmental factors are also
involved as the concordance rate in MZ twins is
only 46% (should be 100% if it was only genetic).
The changes observed in schizophrenics
(enlarged ventricles) could be the effect rather
than the cause of the disorder as the brain is a
plastic organ which changes depending on the
way we use it.
More evaluation
It does not take into account the early childhood
experience which according to the psychodynamic
approach could cause unconscious conflicts
between the Id, the ego and superego which could
cause abnormal behaviour in later life.
The therapies proposed by the approach (drugs
and ECT) are effective but they are not a cure,
they only control the symptoms.
It does not blame the patient but it disempowers
them as they take a passive role in the treatment
i.e. just take the medication prescribed by the
professionals.
Therapies: ECT
Electro-convulsive therapy:
Patient is relaxed with a sedative.
Electrodes are attached to the temple.
A voltage of 70 – 130 volts is passed
through the brain for half a second.
This produces a convulsion for 1 minute.
Patient awakes and remembers nothing.
2 – 3 sessions a week for 3 – 4 weeks.
Evaluating ECT
Johnson stated that 11,000 procedures were carried
out in the UK in 1999.
Can be useful in suppressing depressive symptoms
for up to one year. It is not known how it works.
Can cause temporary memory loss and emotional
side effects such as withdrawal and flatness.
Does not deal with the problem and symptoms
return usually after one year.
Can cause death (4 in 100 000).
Patients cannot give informed consent as they are in
a distressed and confused state, given only when all
other treatments have failed.
Therapies: Drugs
Antidepressants: i.e. Prozac, act
by stopping the reuptake of the
serotonin in the synaptic gap.
Antipsychotic drugs: Block the
dopamine receptors (dopamine is
a neurotransmitter which is raised
in schizophrenia).
Drugs: evaluation
Can be very effective and allow people to
lead a normal life but they do not cure the
disorder they only control the symptoms so
when the drugs are stopped the symptoms
reappear.
They do not work for all patients,
antipsychotic drugs work only for 50-60% of
schizophrenic patients.
They can have serious side-effects i.e.
antidepressants can be very addictive.
More evaluation..
They target the biological changes but do
not change life circumstances, cognitive
biases and daily stressors which might
trigger mental disorders such as
depression.
They are a fairly cheap treatment and can
act fairly quickly; they can be used to
control the symptoms enough to allow the
patient to start psychological therapies
such as CBT or psychoanalysis.
Psychodynamic approach: Assumptions: The
tripartite structure of personality
The earliest part of the human personality
THE ID = the biological part
(instincts & drives)
Present at birth
Motivated by the pleasure principle
The second part of the human
personality to develop
THE EGO (the ‘self’) 1 - 3 years
Motivated by the reality
principle
The third part of the human
personality to develop
THE SUPEREGO (the moral part)
3 - 5 years
Motivated by the morality principle
The Unconscious
The conscious. The small
amount of mental activity
we know about.
Thoughts
Perceptions
The preconscious. Things
we could be aware of if we
wanted or tried.
The unconscious. Things
we are unaware of and can
not become aware of.
Memories
Stored knowledge
Bad
Worse
Really Bad
Fears
Unacceptable sexual desires
Violent motives
Irrational wishes
Immoral urges
Selfish needs
Shameful experiences
Traumatic experiences
Explanation of abnormal behaviour
According to the psychodynamic approach
abnormality is caused by unconscious conflicts
between the Id, the superego and the ego. A
consequence of these conflicts is anxiety. In order
to protect itself against this the ego uses defence
mechanisms i.e. repression, displacement, denial.
If these defence mechanisms are unsuccessful
this anxiety seep through to the conscious mind
and creates mental disorders such as phobias.
These conflicts originate mainly in early childhood
while the child goes through the psychosexual
stages of development.
Schizophrenia is explained as a
regression to the oral stage when the ego
(which operates on the reality principle) is
developing and the Id is dominant. The
weak ego explains the lack of grasp of
reality in schizophrenics.
Anorexia is explained by repressing fear of
sexual activities, by not eating the girls aim
at retaining their child physic thus avoiding
sexualisation.
Evaluation
This theory is almost impossible to test scientifically and the support
for the theory consist mainly of case studies carried out on upperclass Austrian women, the sample does not represent the wider
population therefore the results cannot be generalised. They are not
replicable so the results are not reliable. They are high in ecological
validity the patients were real people in a real therapeutic situations.
The interpretation of the data was done by Freud so it might have
been biased.
This theory was the first theory which took into account the
childhood experiences as a possible cause of mental disorders.
This approach was the first to propose a “talking” cure which
changed the way mental patients were treated.
It does not explain the biological factors such as enlarged ventricles
in schizophrenics but they could be the effect rather than the cause
of the disorder as the brain is a plastic organ which changes
depending on the way we use it.
Therapy
Psychoanalysis: its aim is to bring the unconscious
conflicts to the conscious mind where they can be dealt
with.
It uses two main strategies
1. Free association: Client is asked to talk about anything
that comes to mind and the therapist writes this down
and then later analysis the content to reveal repressed
desires. The client is made aware of this to then
overcome them.
2. Dream analysis: Client is asked to talk about dreams
(manifest content) the therapist then interprets the
hidden meaning (latent content) and makes client aware
of this so they can overcome repressed issues
Evaluation
Uses retrospective data (from childhood), this can
be inaccurate because people might have forgotten
and it can be distorted by schemas.
It may take a long time; sometimes years so is not
appropriate in cases when urgent intervention is
required (i.e. suicidal patients).
It is very expensive and rarely available in its original
form on the NHS, this limits access.
People with mental disorders such as schizophrenia
might not have the necessary insight to take part in
the treatment.
Can be very unethical to bring up repressed
memories as they can be painful.
Behavioural approach
Assumptions:
Abnormal behaviour like any other behaviour is learned from the
environment.
Behaviour can be learned in 3 ways:
1. Classical conditioning: learning by association i.e. phobia UCS: bite
UCR: fear NS: dog, pairing dog and bite, dog becomes the CS, CR:
fear (phobia: the dog elicits the fear response).
2. Operant conditioning: learning by consequences i.e. depression. A
person displays depressed behaviour others shows sympathy
(positive reinforcement) and are likely to let them off their normal
duties (negative reinforcement) so the behaviour will be repeated
as it has been reinforced.
3. Social learning: learning by imitation i.e. anorexia. Young girls see
very thin models being praised and getting attention and money
(reinforcements) they try to get as thin as these models to get the
same reinforcements.
Classical conditioning: Learning a phobia
Rat: NS
Noise: UCS)
BANG
Pairing
Fear: UCR
Rat: NS
Noise: UCS)
BANG
Fear: UCR
After conditioning
Rat: CS
Fear: CR
Evaluation of the behavioural
approach
This approach can offer satisfactory explanations for
some disorders such as phobias and eating disorders.
However many people have phobias of objects they
have never met (i.e. snakes) these cannot be explained
by classical conditioning. These could be due to
evolution.
It does not explain the biological factors such as
enlarged ventricles in schizophrenics but they could be
the effect rather than the cause of the disorder as the
brain is a plastic organ which changes depending on the
way we use it.
More evaluation....
It does not take into account the early childhood
experience which according to the psychodynamic
approach could cause unconscious conflicts between the
Id, the ego and superego which could cause abnormal
behaviour in later life.
Treatments based on the behavioural approach such as
systematic desensitisation can be very effective for
disorders such as phobias.
It does not take into account cognitive factors such as
cognitive biases i.e. even when severely underweighted,
anorexic see themselves as overweight.
Therapies
As the assumption of the behavioural
approach is that abnormal behaviour is
learned, the aim of the therapies it
proposes is to “unlearn” the abnormal
behaviour and replace it by a normal
behaviour.
Systematic desensitisation aims at
“unlearning” the association between the
phobic abject and fear to replace it by a
new association between the object and a
state of relaxation.
Systematic desensitisation
It is a step by step
approach
The client learns relaxation
techniques
The client works out a hierarchy of
fear from the least frightening to the
most frightening
Fur
Paw
Mouth
Dog
The client works
through the hierarchy
learning to use
relaxation techniques
in the presence of the
feared object
Evaluation
It can be very effective in the treatment of some phobias (6090% for spider phobias) but it does not seem so effective with
social phobias or phobias of objects or situations which relate
to evolution.
Once the phobia is improved it may be replace by another
phobia or another form of anxiety disorder which suggests
that phobias might have a deeper psychological cause.
It is an expensive treatment as it is carried out by a qualified
clinical psychologist so it is not accessible to everybody.
It requires 6-8 sessions for moderate phobias, more for strong
phobias so it requires commitment from the patient.
It does not address psychological factors for example the
psychodynamic approach argues that phobias are due to an
unconscious conflict and the phobic object is a symbol of the
real object of fear.
Basic assumptions
Emotional problems can be attributed
directly to distortions (maladaptive thoughts) in our
thinking processes.
These maladaptive thoughts usually take
place automatically and without full
awareness.
Examples of Cognitive Biases that
may be used by people with
Depression
Cognitive Bias
Explanation
Minimisation
The bias towards minimising success in
life.
Maximisation
The bias towards maximising the
importance of even trivial failures.
Selective Abstraction
A bias towards focusing on only the
negative aspects of life and ignoring
the wider picture
All or nothing Thinking
A tendency to see life in terms of black
and white and ignoring the middle
ground; you are a success or a failure,
rather than not good at some things
but OK at others.
Ellis’s ABC Model
Activating events (A) have consequences
(C) which are affected
by
beliefs
It is not the
event
which (B).
creates the problem, it is
the way you think about it
An example...
Sally and Clive split
up
Beliefs
Rational thoughts
“we were not compatible”
Activating
event
Irrational thoughts
“It’s my fault, nobody can ever
love me, all my relationships will
fail”
Consequences
Desirable emotions
“ I am sad but next time it
will work out”
Desirable behaviour
“ I have learned from this,
Lets go out”
Undesirable emotions
“ I feel so guilty, I am
unlovable”
Undesirable behaviour
“ I’ll never have another
relationship. It hurts too
much”
Evaluating the cognitive approach
as an explanation of abnormality
It does not take into account biological factors
such as enlarged ventricles in schizophrenics
(but...)or genetic factors.
It suggests that it is the patient who is at fault
rather than the situation in which they are.
A disorder such as depression can change
the way we think so the faulty thinking might
be the effect rather than the cause of the
disorder
More evaluation
It does not account for the cause of the
faulty thinking (i.e. early childhood
experiences)
Some irrational beliefs are quite realistic
(Alloy & Abrahmson, 1979)
There is clear evidence for cognitive
biases and dysfunctional thinking and
beliefs in disorders such as depression
and anxiety disorders.
Let summarise....
Negative
schemata about
the self, the world
and the future
So what should the therapist
target?
Cognitive
bias
Rational-Emotive-Behaviour Therapy
(a form of CBT)
Helps the patient identify the maladaptive thoughts
and the consequences of thinking in this way
disputes the beliefs and tries to show
The therapist disputes
that they are not true i.e. the client does not always
fail in all relationships
The client and the therapist set goals to think in a
more adaptive way i.e. focus on the client’s success
and trying to build on those.
The treatment focuses on the present situation,
looking back to the past only when it can be useful i.e.
to learn from it
Logical disputing:
Does it make sense?
Empirical
disputing:
Is it consistent with
reality?
Pragmatic
disputing:
Is this belief/attitude
helpful in the client’s life?
Evaluation of the REBT
Suitable for treating a wide range of mental disorder
Gives the individual responsibility for their treatment
Less time consuming than psychoanalysis but how does
it compare with the biological approach therapies?
Evidence to support CBT use for depression
Is it accessible to everyone?
Ethics?