1

1

CHAPTER 1ABNORMAL

BEHAVIOUR IN HISTORICAL

CONTEXT(PP. 2-31)

2Historical Context

Definition

Distress

DysfunctionDSM

Science

Scientist Practitioner

Treatment

Outcome

Cause

Clinical Description

Goals

Past

Present

Supernatural

Biological

Psychological

Integrative Approach

Psycho-analytic

Humanistic

Behavioural

Demons

Greeks

19C

Bio Treat.Poss.

Atypical(Culture)

Cognitive

3

WHAT IS A

PSYCHOLOGICAL

DISORDER? (PP.2-3)

• No single definition of psychological abnormality or of psychological normality (+1)

• Three criteria appear important (above, F1.1, +2)

– Psychological Dysfunction

– Distress or Impairment

– Atypical Response

4APPROACHES TO DEFINING

ABNORMAL BEHAVIOUR(PP.2-3)

• Inadequate Single Criteria

– Does infrequency define abnormality?

– Does suffering define abnormality?

– Does strangeness define abnormality?

– Does the behaviour itself define abnormality?

– Should normality serve as a guide?

• Many myths about qualities associated with mental illness also inadequate

– Lazy, dumb, …

– Weak character

– Danger to self or others

– Hopeless situation, incurable, …

5

A Psychological Disorder is:– A psychological dysfunction within an individual

• Breakdown in cognitive, emotional, or behavioural functioning

– Associated with distress or impaired functioning• Difficulty performing appropriate and expected roles

– Not typical or culturally expected• Impairment occurs in context of person’s background

• Reaction is outside cultural norms

• Synonyms: Abnormal Behaviour, Mental Illness (less preferred), Psychopathology, …

WHAT IS A PSYCHOLOGICAL DISORDER? (P. 3-6)

6

• Widely used system for classifying psychological problems and disorders

• Contains diagnostic criteria for behaviours that – Fit a pattern– Cause dysfunction or subjective distress– Are present for a specified duration– And not otherwise explainable

• About to release DSM-V

• Other major system is WHO’s ICD

THE DIAGNOSTIC AND STATISTICAL MANUAL (DSM-IV) (P. 6)

2

7

• Major psychological disorders have existed – In all cultures – Across all time periods

• Causes (interpretations) and treatment of abnormal behaviour varied widely– Across cultures– Across time periods– Particularly as a function of prevailing paradigms or

world views• Three dominant traditions include:

– Supernatural, Biological, and Psychological

THE PAST: HISTORICAL CONCEPTIONS (PP. 9)

8SUPERNATURAL

TRADITION(PP. 9-12)

• Deviant behaviour as Battle of “Good” vs. “Evil”– Caused by demonic possession,

witchcraft, sorcery

– Mass hysteria (St. Vitus’dance or Tartanism) and church

– Treatments included exorcism (right image), torture, beatings, and crude surgeries

• Movement of Moon and Stars as cause of deviant behaviour– Paracelsus and lunacy

• Both “Outer Force” views popular during Middle Ages

• Few believed that abnormality was illness on par with physical disease

9BIOLOGICAL TRADITION(PP. 12-13)

• Hippocrates’: Abnormal behaviour as

physical disease

– Hysteria “The Wander Uterus”

• Galen extended Hippocrates work

– Humoral theory: black bile (melancholic),

yellow bile (choleric), blood (sanguine),

and phlegm (phlegmatic)

– Treatments remained crude

• Galen-Hippocrates tradition

– Foreshadowed modern views linking

abnormality with brain chemical

imbalances

'Sickness is not sent by the gods or taken away by them. It has a natural basis. If we can find the cause, we can find the cure.'

10

BIOLOGICAL

TRADITION IN

19TH CENTURY(PP. 13-14)

• General Paresis (Syphilis) and

biological link with madness

– Associated with several unusual

psychological and behavioural

symptoms

– Pasteur (below) discovered cause:

a bacterial microorganism

– Led to penicillin as successful

treatment

– Bolstered view that mental illness

= physical illness and should be

treated as such

• John Grey, Dorothea Dix, and the

Reformers (+1)

11 12DEVELOPMENT OF

BIOLOGICAL TREATMENTS(PP. 14-15)

• Mental Illness = Physical Illness

• 1930’s: Biological treatments

standard practice

– Insulin shock therapy, ECT (top),

and brain surgery (i.e., lobotomy)

• By 1950’s several medications

established

– Include neuroleptics such as

reserpine (plant-based, right),

major tranquilizers

3

13

• Moral therapy– Allow 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 USA– Clarence Hinks was mental health reformer and crusader

in Canada• Reasons for falling out of moral therapy

– Emergence of competing alternative psychological models

PSYCHOLOGICAL TRADITION (PP. 15-17)

14THE

PSYCHOLOGICAL

TRADITION(PP. 15-17)

• Rise of Moral Therapy

– Treat institutionalized patients as normal as possible; encourage and reinforce social interaction

– Philippe Pinel (right image) and Jean-Baptiste Pussin

– William Tuke followed Pinel’s lead in England

– Benjamin Rush led reforms in United States

– Clarence Hinks was mental health reformer and crusader in Canada.

• Reasons for falling out of moral therapy

– Emergence of competing alternative psychological models

15PSYCHOANALYTIC THEORY(PP.17-21)

• Freudian theory of structure and function of mind

• Mind’s Structure (+1)

– Id: pleasure principle; illogical, emotional, irrational

– Ego: reality principle; logical and rational

– Superego: moral principles; keeps Id and Ego in balance

• Defense mechanisms• When Ego loses battle with Id and Superego

– Displacement and denial

– Rationalization and reaction formation

– Projection, repression, and sublimation

• Freudian Stages of Psychosexual Development

– Oral, Anal, Phallic, Latency, and Genital stages

16Freudian Theory

17NEO-FREUDIAN DEVELOPMENTS

IN PSYCHOANALYTIC THOUGHT(PP.21)

• Anna Freud and self-psychology

– Emphasized influence of ego in defining behaviour

• Melanie Klein, Otto Kernberg, and object relations theory

– Emphasized how children incorporate (introject) objects

– Examples include images, memories, and values of significant

others (objects)

• Others developed concepts different from those of Freud

– Carl Jung, Alfred Adler, Karen Horney, Erich Fromm, and Erik

Erickson

• Neo-Freudians generally de-emphasized sexual core of Freud’s theory

18

PSYCHOANALYTIC

THERAPY(P.21-23)

• Unearth hidden

intrapsychic conflicts (“the

real problems”)

• Therapy often long term

• Techniques:

– Free association

– Dream analysis

• Examined transference and

counter-transference

issues

• Little evidence for efficacy

4

19HUMANISTIC THEORY(PP. 21-22)

• Carl Rogers, Abraham Maslow,

and Fritz Perls

• Major Theme

– People are basically good

– Humans strive toward self-

actualization

• Treatment

– Therapist conveys empathy

and unconditional positive

regard

– Minimal therapist

interpretation

• No strong evidence that

humanistic therapies work

20BEHAVIOURAL

MODEL(PP.23-25)

• Derived from scientific approach to study of psychopathology

• Classical Conditioning: Ivan Pavlov (left image), John B. Watson

– Ubiquitous form of learning

– Conditioning involves correlation between neutral stimuli and unconditioned stimuli (+1)

– Extended to acquisition of fear (Albert +1)

• Operant Conditioning: Edward Thorndike, B. F. Skinner

– Another ubiquitous form of learning

– Most voluntary behaviourcontrolled by consequences that follow behavior

– Reinforcement and Punishment

• Both traditions greatly influenced development of behaviour therapy

21

CLASSICAL

CONDITIONING

Video

22

OPERANT

CONDITIONING

23BEGINNINGS OF BEHAVIOUR THERAPY(PP. 25-27)

• Reactionary movement against psychoanalysis and non-scientific

approaches

• Early Pioneers

– Joseph Wolpe: Systematic desensitization

• For treatment of phobias (e.g., snakes)

– Arnold Lazarus: Multi-modal behaviour therapy

– Hans Eysenck: Conditioning therapy

– Aaron Beck: Cognitive therapy

– Albert Bandura: Social learning or cognitive-behaviour therapy

– Stanley Rachman: an original founder of behaviour therapy

• Behaviour therapy tends to be time-limited and direct

• Strong evidence supporting efficacy of behaviour therapy

24COGNITIVE PSYCHOLOGY(NOT IN TEXT)

• Reaction to behaviorist denial of role for mental processes,

BUT believed in scientific study rather than subjective

approaches (e.g., introspection)

• Adoption of Information Processing Model (+1) and later

Connectionist / Neural Network models (e.g., early Freud

model & Lang model for phobia +2)

• Number of cognitive processes hypothesized to contribute

to psychopathology

– Selective Attention: people with certain psychological disorders

more sensitive to stimuli related to their disorder (e.g., depressed

people more attuned to depressive stimuli +3)

– …

5

25INFORMATION PROCESSING MODEL

26

Freud “connectionist”

model

Lang (1979)

27

Depression Words

Non-Depressed

Words

Sad DogUnhappy TableCrying Knife… …

Reaction Time (ms)

28

• Psychopathology multiply determined• One-dimensional accounts incomplete• Must consider reciprocal relations between

– Biological, Psychological, Social, and Experiential factors

• Defining abnormal behaviour is also complex, and multifaceted, and has evolved

• Supernatural tradition has no place in science of abnormal behaviour

• Many practitioners and laypeople “treat” people with psychological disorders (+1 +2)

PRESENT: SCIENTIFIC METHOD AND AN

INTEGRATIVE APPROACH(PP. 27)

29Diverse people deal with clients / patients• Psychologists

– Ph.D.’s: Clinical and counseling psychologists

– Psy.D.’s: Clinical and counseling “Doctors of Psychology”

– In Canada, regulation of profession of psychologist is under jurisdiction of provinces and territories.

• Other Mental Health Professionals and Lay Practitioners

– M.D.’s: Psychiatrists

– M.S.W.’s: Psychiatric and non-psychiatric social workers

– MN/MSN’s: Psychiatric nurses

– Lay public and community groups

• Number of some practitioners in Canada (+1)

30Mental Health Professionals

MD

PhD PsyD MA

6

31DIMENSIONS OF

SCIENTIST-

PRACTITIONER MODEL(P. 7-8)

• Psychologists

(somewhat) united

by Scientist-

Practitioner

Framework

• Three Dimensions

– Producers of

research

– Consumers of

research

– Evaluate their work

using Empirical

methods

32

• Three Major Goals of Psychological Research

SCIENTIST-PRACTITIONERS(PP. 7-8)

33• Begin with presenting

problem• Distinguish clinically

significant dysfunction from common human experiences

• Describe Incidence and Prevalence of disorders

• Describe onset of disorders– Acute vs. Insidious onset

• Describe course of disorders– Episodic, Time-limited, or

Chronic course

CLINICAL

DESCRIPTION(PP. 8)

34CAUSATION, TREATMENT, AND

OUTCOME IN PSYCHOPATHOLOGY(PP. 8)

• Etiology or Causation: What factors contribute to development of psychopathology?

• Treatment: How to best improve lives of people suffering from psychopathology?

– Treatment development: includes Pharmacologic, Psychosocial, and / or Combined treatments

• Outcome: How do we know that we have alleviated psychological suffering?

– Evaluate efficacy (effectiveness) of treatments

– Challenging because of many confounding factors