Transcript Psychopathology: History and Causes

Chapter 1 & 2
Abnormal Behavior in Historical
Context & The Causes of
Psychopathology
Myths and Misconceptions About Abnormal
Behavior
 Many Myths Are Associated With Mental Illness
 Lazy, crazy, dumb
 Weak in character
 Dangerous to self or others
 Mental illness is a hopeless situation
The Myth of Mental Illness
 Thomas Szasz - outspoken critic
 Abnormal Behavior = Unpleasant Behavior
 Psychiatric Dx - Tells us nothing meaningful about
person (unlike medical dxs)
 Dx. used to control people and keep
“undesirables” out of the way
Mental Illness - More than a Myth
 Most believe mental illnesses are objective,
and there is little to distinguish between
mental and physical illnesses. Research
supports this. This whole class will support
this point.
 However, Szasz raises two important points:
 (1) What impact does a society have on mental
illness?
Homosexuality, masturbation were once dxs
 (2) For a Dx to be given, let’s make sure it does
tell us something meaningful about a person
Approaches to Defining Abnormal Behavior
 No Single Definition of Psychological Abnormality
 No Single Definition of Psychological Normality
 Does Infrequency Define Abnormality?
 Does Suffering Define Abnormality?
 Does Strangeness Define Abnormality?
 Does the Behavior Itself Define Abnormality?
 Should Normality Serve as a Guide?
Toward a Definition of Abnormal Behavior
 Psychological Dysfunction
 Breakdown in cognitive,
emotional, or behavioral
functioning
 Distress or Impairment
 Difficulty performing
appropriate and expected
roles
 Impairment is set in the
context of a person’s
background
 Atypical or Unexpected
Cultural Response
 Reaction is outside
cultural norms
Why We Do This
Clinical Description (phenomenology)
 Describing the Problem
 Description Aims to
 Distinguish clinically significant dysfunction from
common human experience
 Describe Cluster of Symptoms
 Describe Epidemiology
 Prevalence/incidence
 Onset of Disorders (Acute vs. insidious)
 Course (Episodic, time-limited, or chronic course)
Why We Do This
Causation, Treatment, and Outcome
 What Factors Contribute to the
Development of Psychopathology?
 Study of etiology
 How Can We Best Improve the Lives of
People Suffering From Psychopathology?
 Study of treatment development
Who deals with Psychopathology Currently?
 Mental Health Professionals
 The Ph.D.’s: Clinical and counseling
psychologists
 The Psy.D.’s: Clinical and counseling
“Doctors of Psychology”
 M.D.’s: Psychiatrists
 M.S.W.’s: Psychiatric and non-psychiatric
social workers
 MN/MSN’s: Psychiatric nurses
 LPC: Licensed Clinical Counselors
Historical Conception and Causes of
Psychopathlogy
Historical Conceptions of Abnormal Behavior
 Major Psychological Disorders Have Existed
 In all cultures
 Across all time periods
 The Causes and Treatment of Abnormal Behavior Varied
Widely
 Across cultures
 Across time periods
 Particularly as a function of prevailing paradigms or
world views
The Past: Abnormal Behavior and the
Supernatural Tradition
 Deviant Behavior as a Battle of “Good” vs. “Evil”
 Deviant behavior was believed to be caused by
demonic possession, witchcraft, sorcery
 Mass hysteria (St. Vitus’dance or Tartanism) and
the church
 Treatments included exorcism, torture, beatings,
and crude surgeries
 Movement of the Moon and Stars as a Cause of
Deviant Behavior
 Paracelsus and lunacy
 Both “Outer Force” Views Were Popular During the
Middle Ages
 Few Believed That Abnormality Was an Illness on
Par With Physical Disease
Trephination – A Treatment in Line with the
Hypothesized Cause
The Past: Abnormal Behavior and the
Biological Tradition
 Hippocrates’: Abnormal Behavior as a Physical
Disease
 Hysteria “The Wander Uterus”
 Galen Extends Hippocrates Work
 Humoral theory of mental illness
 Treatments remained crude
 Galenic-Hippocratic Tradition
 Foreshadowed modern views linking abnormality
with brain chemical imbalances
The Past: The Biological Tradition
 Mental Illness = Physical Illness
 The 1930’s: Biological Treatments Were Standard
Practice
 Insulin shock therapy, ECT, and brain surgery
(i.e., lobotomy)
 By the 1950’s Several Medications Were Established
 Examples include neuroleptics (i.e., reserpine)
and major tranquilizers
The Past: The Biological Tradition Comes of
Age
 General Paresis (Syphilis) and the Biological Link
With Madness
 Associated with several unusual psychological
and behavioral symptoms
 Pasteur discovered the cause – A bacterial
microorganism
 Led to penicillin as a successful treatment
 Bolstered the view that mental illness = physical
illness and should be treated as such
 John Grey, Dorothea Dix, and the Reformers
The Past: Abnormal Behavior and
the Psychological Tradition
 The Rise of Moral Therapy
 The practice of allowing 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 the United States
 Reasons for the Falling Out of Moral Therapy
 Emergence of Competing Alternative Psychological
Models
The Past: Abnormal Behavior and
the Psychoanalytic Tradition
 Freudian Theory of the Structure and Function of the
Mind
 The Mind’s Structure
 Id (pleasure principle; illogical, emotional,
irrational)
 Ego (reality principle; logical and rational)
 Superego (moral principles; keeps Id and Ego in
balance)
Freud and Psychopathology
 Freudian Stages of Psychosexual Development
 Oral, anal, phallic, latency, and genital stages
 Defense Mechanisms: When the Ego Loses the
Battle with the Id and Superego
 Displacement & denial, rationalization, reaction
formation, projection, repression, and sublimation
Behavioral Perspectives

Classical conditioning

Operant conditioning

Modeling/Social Learning

Behavioral treatment interventions
The Behavioral Tradition The
Behavioral Tradition

Classical Conditioning (Pavlov; Watson)
 Learning ELICITED responses
 Pairing neutral stimuli and unconditioned stimuli
 Conditioning was extended to explain fear acquisition

Operant Conditioning (Thorndike; Skinner)
 Learning EMITTED responses
 Voluntary behavior is controlled by consequences
 Positive reinforcement
 Negative reinforcement
 Punishment

Both Learning Traditions
 Greatly influenced the development of behavior therapy
The Behavioral Tradition
 Social Learning Theory (Bandura)
 Learning through observation of modeling
 Bobo doll studies
Cognitive Perspectives

Cognitive explanations

Cognitive treatment interventions

Integrated cognitive-behavioral approaches
The Cognitive Perspective
 Expanded upon behaviorism
 Thoughts, attitudes, beliefs interact with stimuli in
the environment to produce emotion and behavior
 Attributions
 Cognitive Distortions
 Negative Automatic Thoughts
Cognitive-Behavioral Tradition
 A merging of these two traditions and the dominant
paradigm currently.
 Stimulus-response relationships are important as well
as cognitive processing
 Most empirically validated treatments stem from this
tradition
Cognitive
Processing
Stimulus
Response
Emotions
Behaviors
Biological Perspectives
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The central nervous system
 The neuron
 Neurotransmission
 The Brain
The peripheral nervous system
The endocrine system
Genetics
Division of the Nervous System
The Central Nervous System
 The Neuron
 Soma – Cell body
 Dendrites – Branches that receive messages
from other neurons
 Axon – Trunk of neuron that sends messages to
other neurons
 Axon terminals – Buds at end of axon from
which chemical messages are sent
 Synapses – Small gaps that separate neurons
 Neurons Function Electrically, but Communicate
Chemically
 Neurotransmitters are the chemical messengers
Dendrites
Diagram of a Neuron
Soma
Axon
Direction of impulse
Synapse
Axon Terminals
The Synapse & Neurotransmitters
Information from one neuron flows to
another neuron across a synapse.
The synapse is a small gap
separating 2 neurons. The synapse
consists of:
1.
a presynaptic ending that contains
neurotransmitters, mitochondria and
other cell organelles,
2.
a postsynaptic ending that contains
receptor sites for neurotransmitters
and,
3.
the synaptic cleft: a space between
the presynaptic and postsynaptic
endings.
Neurotransmitter Release
Diffusion
The neurotransmitter molecules diffuse
across the synaptic cleft where they
can bind with receptor sites on the
postsynaptic ending to influence the
electrical response in the
postsynaptic neuron. In the figure on
the left, the postsynaptic ending is a
dendrite (axodendritic synapse), but
synapses can occur on axons
(axoaxonic synapse) and cell bodies
(axosomatic synapse).
Functions of Main
Types of Neurotransmitters
Figure 2.12 Manipulating serotonin in the brain.
Functions of Main
Types of Neurotransmitters
 Neurotransmitters have two basic function
 Excitation
 Inhibition
 Main Types and Functions of Neurotransmitters
 Acetylcholine
 Dopamine
 Norepinephrine and beta blockers
 Serotonin (5HT)
 Endorphins
 Gamma aminobutyric acid (GABA) and benzodiazepines
Cholinergic system (Acetylcholine)
ACETYLCHOLINE (ACh)
Acetylcholine (ACh) is a neurotransmitter substance
that is found both in the CNS and in the PNS.
In the PNS it is the NT released at synapses on
skeletal muscle and is also found in the ganglia of the
autonomic nervous system.
In the brain it appears to be involved in learning and
memory and in sleeping and dreaming.
Dopaminergic system (Dopamine)
DOPAMINE (DA)
Dopamine (DA) is an inhibitory neurotransmitter
It is implicated in movement, attention and learning.
Dopamine excess may be involved in
Schizophrenia.
Most importantly it is involved in the “reward system
of the brain.”
Noradrenergic system (Norepinephrine)
NORADRENALINE (NA)
Noradrenalin (NA) is not synthesised in the cell body
but the dopamine synthesised there is converted into
NA inside the synaptic vessicles.
Like ACh, NA is found in the autonomic nervous
system. Here it has an excitatory role.
In the brain, NA is inhibitory and is primarily involved in
control of alertness and wakefulness.
The release of NA from the neuron is more
complicated than for other neurotransmitters.
NA stimulates the release of Adrenalin (a hormone)
from the adrenal medulla.
Serotonergic system (Serotonin)
SEROTONIN
At most synapses Serotonin (5-HT) is an
inhibitory neurotransmitter.
It plays a role in the regulation of mood,
producing sedation or relaxation.
It also has a role in the control of eating, sleep
and arousal. In addition, it can regulate pain.
Endorphins
 Generally inhibitory
 Modulate the experience of pain
 Involved in feelings of euphoria and reward
GABA
 Most prevalent inhibitory neurotransmitter in the brain
 Implicated in relaxation/antianxiety
 Many drugs target this system
The Brain
Forebrain
Midbrain
Hindbrain
Telencephalon Diencephalon Mesencephalon Metencephalon Myelencephalon
Divisions of the Brain
A review of this method of dividing the brain.
Forebrain
Midbrain
Hindbrain
Telencephalon Diencephalon Mesencephalon Metencephalon Myelencephalon
Cerebral Cortex
Basal Ganglia
Hippocampus
Amygdala
Thalamus
Hypothalamus
Tectum
Tegmentum
Pons
Cerebellum
Medulla
Cerebral Cortex
Anatomical Divisions- 4 lobes
The average human brain weighs about 1,400 grams (3 lb). The brain
can be divided down the middle lengthwise into two halves called
the cerebral hemispheres. Each hemisphere of the cerebral cortex
is divided into four lobes …
Although most people have the same patterns of gyri and sulci on
the cerebral cortex, no two brains are exactly alike.
Neuroscience and the Brain Structure
 Lobes of Cerebral Cortex
 Frontal – Thinking and reasoning abilities, memory
 Parietal – Touch recognition
 Occipital – Integrates visual input
 Temporal – Recognition of sights and sounds and
long-term memory storage
 Limbic System-”emotion center”
 Thalamus – Receives and integrates sensory
information
 Hypothalamus – Eating, drinking, aggression, sexual
activity
Major Structures of the Brain
Division of the Nervous System
Figure 2.7b Major Structures of the Brain.
Neuroscience: Peripheral Nervous and
Endocrine Systems
 Somatic Branch of PNS
 Controls voluntary muscles and movement
 Autonomic Branch of the PNS-involuntary muscles
 Sympathetic and parasympathetic branches of the ANS
 Regulates cardiovascular system & body temperature
 Regulates the endocrine system and aids in digestion
AUTONOMIC NERVOUS SYSTEM
CONTROLS MOBILIZATION OF BODIES
RESOURCES – FIGHT/FLIGHT RESPONSE
THE EFFECTS OF ANS
 SYMPATHETIC
 INCREASE
 HR, RESPIRATION, BP, GLUCOSE
UTILIZATION
 DECREASE
 IMMUNE SYSTEM , DIGESTIVE FUNCTIONS
 PARASYMATHETIC
 RETURN TO BASELINE
 RELAXATION DIGESTION
ENDOCRINE SYSTEM
The Endocrine System and Psychopathology
 Integration of endocrine and nervous system function
 The Hypothalamic-Pituitary-Adrenalcortical Axis
(HPA axis)
 A circuit that runs through these neuroendocrine
structures that drives the fight or flight response
 This system is can become dysregulated and lead
to psychopathology
 Depression
 PTSD
The Interaction of Genetic and
Environmental Effects
 The Diathesis-Stress Model, simplistic model
 Examples include blood-injury-injection phobia and alcoholism
and probably schizophrenia (stress may be prenatal, not always
stressful life event, crit periods)
 Reciprocal Gene-Environment Model, Genes interact with
environment born with predisposition or personality for risk
taking – influences (does not cause) choice of boyfriend so
more break-ups more break-ups lead to higher level of
depression for people with certain genetic make-up
 stressful life events may be greater in people with
depression …. Not just coincidental…may be because
genetic loading may influence things like mate selection or
procrastination that influence stress load
Cultural, Social, and Interpersonal
Factors in Psychopathology
 Cultural Factors
 Influence form and expression of behavior
 Gender Effects
 Exerts a strong and puzzling effect on psychopathology
 Family Effects
 Family System Approaches
 Social Effects on Health and Behavior
 Frequency and quality are important
 Related to mortality, disease, and psychopathology
 Stigma of Psychopathology
 Culturally, socially, and interpersonally situated
One-Dimensional vs. Multidimensional Models
 One-Dimensional Models
 Explaining behavior in terms of a single cause
 Problem – Other information is often ignored,
 Multidimensional Models
 Interdisciplinary, eclectic, and integrative
 What were once traditions are now
integrated factors of causality
 “System” of influences that cause and maintain
suffering
 Uses information from several sources
 Abnormal behavior as multiply determined
Multidimensional Models of Abnormal Behavior
Overview
 Biological Factors
 Genetics (diathesis?)
 Physiology (endocrine function)
 Neurobiology (transmitter dysregulation/cell death)
 Behavioral Factors (coping)
 Cognitive Factors (attributional style)
 Social Factors (support of friends, family)
 Developmental Factors (developmental insults)
 Each of these factors may be weighted more than another
for a particular person experiencing psychopathology
Genetics
Biological
Psychological
Structure and Function
of Systems
Cognitive and
Behavioral Function
CONTEXT
Environmental
Stimuli
Behavioral
Response
Emotional
Response
Cognitive
Response