Transcript Part - time MSc course Epidemiology & Statistics Module

The following lecture has been approved suitable for
University Undergraduate Students
This lecture may contain information, ideas, concepts and discursive anecdotes
that may be thought provoking and challenging
It is not intended for the content or delivery to cause offence
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thought, insight, reflection or critical evaluation
Abnormal Psychology
An Introduction
Prof. Craig Jackson
Head of Psychology
Birmingham City University
Module Overview
Weekly lecture and fortnightly seminar
Introduces main concepts, theories and debates in Abnormal
Psychology
Lectures will introduce key areas in abnormality and be followed by
seminars focusing on the assessment and treatment of psychological
disorders
Additional reading material will be provided for the seminars where
Appropriate
Recommended Course Text(s):
Bennett, P. (2005). Abnormal and Clinical Psychology – An Introductory
Textbook (2nd Ed.) Open University Press: Berkshire & New York
Carr, A. (2001). Abnormal Psychology, Psychology Press: Hove &
New York
Assessment
A 1500 word piece of coursework (50%)
Deadline: Friday 4th May 2012
Choose one of four essay questions:
1. Using empirical evidence compare and contrast different sources of
stress in the workplace, and highlight the behavioural, psychological
and physical responses of those people in stressful environments.
2. Discuss psychological, environmental or behavioural factors that may
contribute towards those individuals who engage in spree killings.
3. Using the DSM-IV-TR definition of personality disorder, describe the
psychopathology of narcissistic personality disorder and how it differs
from the layperson concept of “narcissism”.
4. Discuss approaches that describe the aetiology and causes of suicidal
behaviour within different groups in society.
Written exam (50%)
Two vignette-based questions. This exam will be seen.
Definition & Frame of Reference
Abnormal?
Normal?
Normative
Ideographic Vs Nomothetic
Statistical
Consensus
Social approval
Definition & Frame of Reference
Abnormal behaviours?
Criminal
Mad
Bad
Unethical
“Mad – Bad – Sad – Glad” Overlap
Distinguishing
Definition & Frame of Reference
At the risk of offending. . .
Different Perspectives. . .
Biological
Psychodynamic
Behavioural
Cognitive
Psychosocial
Biopsychosocial
Cultural
Alternative / New Age: No such thing as mental illness
Similarities and Differences
Similarities
Differences
Appropriate for 2010’s?
Explain Human Behaviour?
Definition & Frame of Reference
Abnormal behaviours?
Criminal
Mad
Bad
Unethical
Mad – Bad Overlap
Distinguishing
Biological
Traditional mode
l
of Disease Deve
lopment
Pathogen
Disease (pa
thology)
Modifiers
Lifestyle
Individual sus
ceptibility
Biological
(Kraepelin, 1855-1926; Tyrer & Steinberg,1998)
Imbalances of neurotransmitters & hormones
Genetic vulnerabilities
Brain dysfunction
Acetylcholine -
Alzheimer’s disease: reduced
Dopamine -
Schizophrenia: reduced
Norepinephrine -
depression: abnormal
Serotonin -
depression: reduced
Biological
Abnormal behaviour results from a physical illness
There is a discrete cause, prognosis and where mental health can be
physically treated
Modern mental health legislation is a result of the medical model
Kraepelin (1856-1926) carefully observed, described and catalogued
symptoms of patients displaying abnormal behaviour resulting in the
development of two major classification systems
Medical Model
DSM IV - TR
American Psychiatric Association (also used in the UK)
first published in 1952
DSM system is a multi-axial system allowing an individuals mental state
to be evaluated on five axes:
Axis 1: Presence or absence of clinical syndrome
Axis 2: Presence or absence of stable long-term conditions
(personality disorder/learning disability)
Axis 3: Physical health information
Axis 4: Psychosocial/Environmental Problems
Axis 5: Global level of functioning
range from 1 (persistent violence, suicidal behaviour or inability to
maintain personal hygiene to 100 (symptom free)
DSM IV – TR
Axis 1:
Cocaine-related disorders
Axis 2:
Anti-social personality disorder
Axis 3:
Exhaustion; Fatigue
Axis 4:
Drug-using partner; history of cannabis-related use; extremes stress
Axis 5:
Level of current functioning: 50
(frequent trips to A&E, instability, erratic eating behaviour, mood swings)
Non-Specific Symptoms
Psychoanalytic Model
Psychodynamic & Psychoanalytic
(Freud, 1900; Jung, 1912; Klein, 1927)
The child is father of the man
Effects of early experiences
(Oedipus complex, Electra complex, attachment)
Effects of trauma
(abuse, deprivation)
Anxiety, defence mechanisms & unresolved conflicts
(repression, denial)
Psychodynamic & Psychoanalytic
Abnormal behaviour results from underlying
unconscious conflict or psychopathology
(Wachtel & Messer, 1997)
Model based on Freud’s stages of Psychosexual
Development and the resulting conflict
between the ID, Ego and Superego
Conflict is managed (unconsciously) by
defence mechanisms (e.g. repression, denial and projection)
Mental health problems are a result of either ego anxieties (fixation
during a developmental stage) or the defence mechanisms.
Psychodynamic & Psychoanalytic
Oral Stage (18-24 months) gratification through sucking, crying or oral
exploration. Driven by the ID and therefore selfish pleasure is more
important aspect.
Anal Stage (24-48 months) gratification via anus, infant aware of impact on
others and begins to understand they are rewarded for being good and
punished for being bad. Development of the Ego.
Phallic Stage (48 months-6 years) Superego development characterised by
child’s experiences of sexual conflict (oedipal complex and penis envy).
Latency Stage (6 years-puberty onset) Sexual and aggressive urges
channelled through sport and hobbies.
Genital Stage (Puberty-Adulthood) Individual driven by sex and aggression
but these are balanced and discharged via appropriate means.
Psychodynamic & Psychoanalytic
Oral Stage:
Depression, Narcissism, Dependence
Anal Stage:
OCD, Sadomasochism
Phallic Stage:
Gender Identity Problems, Antisocial Personality
Latent Stage:
Inadequate or Excessive Self-Control
Genital Stage:
Identity Diffusion
Psychodynamic & Psychoanalytic
Positives
•Discovery of the unconscious
•Ideas of transference – learn relationship-maps and transfer onto significant
others
•Alternative to the medical model and without the need for medical
intervention - longer-term outpatient treatment.
•Linked to theory of personality
Negatives
•Freudian processes (e.g. Ego) are unconscious and cannot be tested!
•Theories based on a small group of middleclass Viennese women
•Freud’s theory constantly changed over time and without any reason
•Freud would have been classed as ‘abnormal’ by DSM!
Behavioural
Toxic exposure
Social Learning
Conditioning (secondary gains)
Labelling theory
Cognitive
(Skinner, 1953; Ellis, 1977)
Cognitive distortions
Self schemas
Attributions
Cognitive Behavioural
Abnormal behaviour is seen as a set of habits and like normal
behaviour these are habits which have been learnt through the same
processes
This approach combines behaviour modification, cognitive therapy,
classical conditioning (Watson & Rayner, 1920), operant conditioning
and systematic desensitization
This approach focuses on behavioural modification but fails to take
into account any organic factors and can sometimes be viewed as
treating mental health issues trivially.
Psychosocial
Stress
Gender
Socio-economic class
Race
Disability
Inequality
Neglect, abuse, deprivation
Family discord & breakdown
BioPsychosocial
Dominance of
th
Mainstream in
e biopsychoso
last 15 years
cial model
Hazard
Illness (well-be
ing)
Psychosocial
Factors
Attitudes
Behaviour
Quality of Life
Rise of the per
son as
a “psychologic
al
entity”
Linking Emotions with Physical Symptoms
Somatic Symptoms
Somatization
“The good physician treats the disease, but the
great physician treats the person.”
William Osler
Cultural
Prejudice, and discrimination
Social change & uncertainty
Urban stressors – violence and homelessness
Alternative / Postmodern / New Age
Problem of medicalisation of people’s misfortunes
. . . of labelling
. . . of Iatrogenesis
. . . of diagnosis
. . . of social control
Behavioural
Medical Model (Kraepelin, 1855-1926) - also known as the
biological model, disease model or organic model (Tyrer & Steinberg,
1998)
Psychoanalytic Model (Freud, 1900; Jung, 1912; Klein, 1927)
Cognitive-Behavioural Model
(Skinner, 1953; Ellis, 1977)
Family Systems Model (Segal 1991)
Family Systems Model
Family and other social groups are interrelated and
what happens to one individual in the group will affect
another
Good interactions with other people help to prevent
mental health problems (e.g. depression) and bad ones
may increase the risk
Systemic therapy approaches aim to look at the functionality of the family in
terms of both their overall structure (Structural Family Therapy) and their
ability to adjust to the
Demands placed upon them (Strategic Family
Therapy)
The importance of the family systems model is
that it moves beyond the individual
Abnormal?
Core models (with several variations within them) attempt to offer
diagnosis, definitions and frameworks for abnormality
Each approach also attempts to ‘treat’ abnormality in their distinct way
Treating the mentally ill is problematic, not least because of the number of
approaches, cultural variations, lack of consensus and human error involved
in the prognosis and treatment of mental disorders.
Some References
Ames M. Going Postal: Rage, Murder, and Rebellion: From Reagan's Workplaces to Clinton's Columbine and
Beyond,
Bennett, P. (2005). Abnormal and Clinical Psychology – An Introductory Textbook (2nd Ed.) Open University
Press: Berkshire & New York
Butcher, J.N., et al (2008) Abnormal Psychology: concepts. Ch 2. Pearson.
Carr, A. (2001). Abnormal Psychology, Psychology Press: Hove & New York
Ellis, A. (1977). The basic clinical theory of rational-emotive therapy, in A. Ellis & R. Grieger (eds) Handbook of
Rational-Emotive Therapy. New York: Springer
Freud, S. (1900). The Interpretation of Dreams. New York: Wiley
Jung, C.G. (1912) Symbols of Transformation. New York: Bollingen, no. 5
Klein, M. (1927). The psychological principals of infant analysis, International Journal of Psychoanalysis, 8: 2537
Kraepelin, E. ([1883] 1981) Clinical Psychiatry (trans. A.R. Diefendorf). Delmar, NY: Scholar’s Facsimiles and
Reprints
Moffatt, G. Wounded Innocents and Fallen Angels: Child Abuse and Child Aggression. Westport, CT: Praeger,
2003.
Some References
Nevid, J.S., et al (2008) Abnormal Psychology in a changing world. (7th Ed.) Ch 2. Pearson.
Pantziarka, P. Lone Wolf: True Stories of Spree Killers. London: Virgin Books, 2000.
Segal, L. (1991). Brief Therapy: the MRI approach. In A. Gurman and D. Kniskern (eds ), Handbook of Family
Therapy (vol.2, pp. 17-199). New York: Brunner Mazel
Skinner, B.F. (1953). Science and Human Behaviour. New York: Macmillan
Tyrer, P. & Steinberg, D. (1998). Models of Mental Disorder: Conceptual Models in Psychiatry (3rd edn).
Chichster: Wiley
Wachtel, P. & Messer, S. (1997). Theories of Psychotherapy: Origins and Evolution. Washington, DC: APA
Watson, J.B, & Rayner, R. (1920). Conditioned emotional reaction. Journal of Experimental Psychology, 3: 1-14
Watzlawick, P., Weakland, J.H. and Fisch, R. (1974). Challenge: Principles of Problem Formulation and
Problem Resolution. New York: W.W. Norton.