Transcript Abnormal Behavior in Historical Context

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Chapter 1
Abnormal Behavior in
Historical Context
Myths and Misconceptions About Abnormal
Behavior
• No Single Definition of Psychological
Abnormality
• No Single Definition of Psychological
Normality
What is a Psychological Disorder?
• Psychological Dysfunction
– Breakdown in cognitive, emotional, or
behavioral functioning
• Personal Distress
– Difficulty performing appropriate and
expected roles
– Impairment is set in the context of a
person’s background
• Atypical or Not Culturally Expected Response
– Reaction is outside cultural norms
Abnormal Behavior Defined
• Working Definition
– A psychological dysfunction associated
with distress or impairment in functioning
that is not typical or culturally expected
• The Diagnostic and Statistical Manual (DSMIV-TR)
– DSM Contains Diagnostic Criteria
• The Field of Psychopathology
– The scientific study of psychological
disorders
The Science of Psychopathology
• 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
The Science of Psychopathology
(continued)
– M.S.W.’s: Psychiatric and non-psychiatric
social workers
– MN/MSN’s: Psychiatric nurses
– Lay public and community groups
• United by the Scientist-Practitioner
Framework
The Scientist-Practitioner
• Producers of Research
• Consumers of Research
• Evaluators of Their Work Using Empirical
Methods
Functioning as a Scientist-Practitioner
Fig. 1.2, p. 6
Clinical Description
• Begins with the Presenting Problem
• Description Aims to
– Distinguish clinically significant dysfunction
from common human experience
• Describe Prevalence and Incidence of
Disorders
Clinical Description (continued)
• Describe Onset of Disorders
– Acute vs. insidious onset
• Describe Course of Disorders
– Episodic, time-limited, or chronic course
• Prognosis
– Good vs. guarded
Causation, Treatment, and Outcome
• Etiology
– What contributes to the development of
psychopathology?
• Treatment Development
– How can we help alleviate psychological
suffering?
– Includes pharmacologic, psychosocial,
and/or combined treatments
Causation, Treatment, and Outcome
(continued)
• Treatment Outcome Research
– How do we know that we have helped?
– Limited in specifying actual causes of
disorders
Historical Conceptions of Abnormal
Behavior
• Major Psychological Disorders Have Existed
– In all cultures
– Across all time periods
• Causes and Treatment of Abnormal Behavior
– Varies Widely Across cultures, time
periods, world views
Historical Conceptions of Abnormal
Behavior (continued)
• Three Dominant Traditions
– Supernatural
– Biological
– Psychological
The Supernatural Tradition
• Deviant Behavior as a Battle of “Good” vs.
Evil
– Caused by demonic possession, witchcraft,
sorcery
– Treatments included exorcism, torture,
beatings, and crude surgeries
• The Moon and the Stars
– Paracelsus and lunacy
The Biological Tradition
• Hippocrates: Abnormal Behavior as a
Physical Disease
– Hysteria “The Wandering Uterus”
• Galen Extends Hippocrates Work
– Humoral theory of mental illness
– Treatments remained crude
The Biological Tradition (continued)
• Galenic-Hippocratic Tradition
– Linked abnormality with brain chemical
imbalances
– Foreshadowed modern views
The 19th Century
• General Paresis (Syphilis) and the Biological
Link With Madness
– 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
The 19th Century (continued)
• John Grey and the Reformers
– Championed biological tradition in the USA
Consequences of the Biological Tradition
• Mental Illness = Physical Illness
• Emil Kraeplin
– Diagnosis and Classification
The Psychological Tradition
• The Rise of Moral Therapy
– More humane treatment of institutionalized
patients
– Encourage and reinforced social
interaction
The Psychological Tradition (continued)
• Proponents of Moral Therapy
– Philippe Pinel and Jean-Baptiste Pussin
– Benjamin Rush – Led reforms in U.S.
– Dorothea Dix – Mental hygiene movement
– William Tuke - Followed Pinel’s lead in
England
• The Falling Out of Moral Therapy
• Emergence of Competing Alternative
Psychological Models
Psychoanalytic Theory
• Freudian Theory of the Structure and
Function of the Mind
• Structure of the Mind
– Id (pleasure principle; illogical, emotional,
irrational)
– Ego (reality principle; logical and rational)
– Superego (moral principles; keeps Id and
Ego in balance)
Psychoanalytic Theory (continued)
• Defense Mechanisms: Ego Loses the Battle
with the Id and Superego
– Displacement & denial
– Rationalization & reaction formation
– Projection, repression, and sublimation
• Psychosexual Stages of Development
– Oral, anal, phallic, latency, and genital
stages
Later Developments in Psychoanalytic
Thought
• Anna Freud and Self-Psychology
– Emphasized influence of the ego in
defining behavior
• Melanie Klein, Otto Kernberg, and Object
Relations Theory
– Emphasized how children incorporate
(introject) objects
– Objects – images, memories, and values of
significant others
Later Developments in Psychoanalytic
Thought (continued)
• The Neo-Freudians: Departures From
Freudian Thought
– De-emphasized the sexual core of Freud’s
theory
– Jung, Adler, Horney, Fromm, and Erickson
Psychoanalytic Psychotherapy: The
“Talking” Cure
• Unearth the Hidden Intrapsychic Conflicts
– “The Real Problems”
• Therapy Is Often Long Term
• Techniques
– Free Association
– Dream Analysis
• Examine Transference and CounterTransference Issues
• Little Evidence for Efficacy
Humanistic Theory
• Major Players
– Abraham Maslow and Carl Rogers
• Major Themes
– That people are basically good
– Humans strive toward self-actualization
Humanistic Theory (continued)
• Humanistic Therapy
– Therapist conveys empathy and
unconditional positive regard
– Minimal therapist interpretation
• No strong evidence that humanistic therapies
work
The Behavioral Model
• Derived from a Scientific Approach to the
Study of Psychopathology
• Classical Conditioning (Pavlov; Watson)
– Ubiquitous form of learning
– Contingency between neutral and
unconditioned stimuli
– Conditioning was extended to the
acquisition of fear
The Beginnings of Behavior Therapy
• Challenged Psychoanalysis and NonScientific Approaches
• Early Pioneers
– Joseph Wolpe – Systematic desensitization
• Operant Conditioning (Thorndike; Skinner)
– Another ubiquitous form of learning
– Voluntary behavior is controlled by
consequences
The Beginnings of Behavior Therapy
(continued)
• Learning Traditions Influenced the
Development of Behavior Therapy
– Behavior therapy tends to be time-limited
and direct
– Strong evidence supporting the efficacy of
behavior therapies
The Present: An Integrative Approach
• Psychopathology Is Multiply Determined
• Unidimensional Accounts of Psychopathology
Are Incomplete
The Present: An Integrative Approach
(continued)
• Must Consider Reciprocal Relations Between
– Biological, psychological, social, and
experiential factors
• Defining Abnormal Behavior
– Complex, multifaceted, and has evolved
• The Supernatural Tradition
– Has no place in a science of abnormal
behavior