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Chapter 1

Abnormal Behavior in Historical Context

Abnormal Behavior : Myths and Misconceptions  Whats psychologically normal?  Whats not?  How do we describe people with mental illness?  Lazy, crazy, dumb?  Weak in character?  Dangerous?  Hopeless?

What is a Psychological Disorder?  Psychological dysfunction  Breakdown in function  Cognitive  Behavioral  Emotional  Harmful dysfunction (Wakefield)

What is a Psychological Disorder?  Distress or impairment  Individual versus others

Ex: mania

 Appropriateness to situation

Ex: death

 Degree of impairment

What is a Psychological Disorder?  Response is not typical or culturally expected  Frequency  Deviations from average  Eccentricity  Violation of social norms

How Do We Classify Psychological Disorders?  Diagnostic and Statistical Manual  DSM-IV-TR  Outlines criteria for disorders  Prototypes/typical profiles  Constant revision and modification  DSM-V

What is a Psychological Disorder?  Accepted DSM-IV-TR definition:  Behavioral, cognitive, emotional dysfunctions  Unexpected in cultural context  Personal distress  Substantial impairment in function

What is a Psychological Disorder?  New areas of interest for the DSM-V:  Reevaluating underlying concepts  Surveys of mental health professionals  Commonalities in disorders  Discerning differences in degree

The Science of Psychopathology  Study of psychological disorders  Conducted by

      Clinical and counseling psychologists (PhD, PsyD) Psychiatrists (MD) Psychiatric social workers (MSW) Psychiatric nurses (MN, MSN, PhD) Marriage and family therapists (MA, MS, MFT) Mental health counselors (MA, MS)

The Scientist-Practitioner Framework  Interaction of clinical work and science  Consumer of science

Informs practice Utilizes science Synthesizes both

 Evaluator of practice

 Creator of science

Clinical Description of Abnormality  Presenting Problem  Clinical Description  Dysfunction vs. common experience  Statistics  Prevalence  Incidence

Clinical Description of Abnormality  Course  Episodic  Time-limited  Chronic  Onset  Acute vs. insidious  Prognosis  Good vs. guarded

Age and Development in Abnormality  Age of onset may shape presentation  Developmental psychology  Developmental psychopathology  Life-span developmental psychopathology

Causation, Treatment, and Outcomes  Etiology  Cause or development of psychopathology  Treatment  Pharmacologic and/or psychosocial  Treatment Outcome Research  Have we really helped?  Does the effect reveal the cause?

Historical Conceptions of Abnormal Behavior  Major psychological disorders have existed across time and cultures  Causes and treatment of abnormal behavior varied widely, depending on context

The Supernatural Tradition  Deviance = Battle of Good vs. Evil  Etiology- devil, witchcraft, sorcery

Great Persian Empire (900 to 600 BC)  14th and 15th century Europe  Salem witch trials in US

 Treatments- exorcism, torture, and crude surgeries

The Supernatural Tradition: The Enlightened View  Stress and melancholy in the 14th century  Etiology- natural, curable phenomenon  Illness model  Still connected with sin  Treatments- humanistic  Rest, sleep, positive environment  Community-based

The Supernatural Tradition  Mass hysteria  St. Vitus dance  Tarantism  Modern examples?  Emotion contagion  Mob psychology

The Supernatural Tradition  Other Worldly Causes  Moon and stars  Paracelsus  lunacy  Modern examples?  Astrology

The Biological Tradition  Hippocrates (460-377 BC)  Father of modern Western medicine  Etiology = physical disease  Brain pathology  Head trauma  Genetics  Psychosocial factors  Stress, family  Precursor to somatoform disorders  Hysteria

The Biological Tradition  Galen (129-198 AD)  Hippocratic foundation

Galenic-Hippocratic Tradition

 Humoral theory of mental illness  Etiology = brain chemical imbalances  Treatments = Environmental regulation  Heat, dryness, moisture, cold  Bloodletting, induced vomiting

The Biological Tradition and the 19th Century  Syphilis and General Paresis  STD with psychosis-like symptoms  Delusions  Hallucinations  Etiology = bacterial microorganism  Louis Pasteurs germ theory  Biological basis for madness

The Biological Tradition and the 19th Century

 John Grey (1850s)  American proponent of the biological tradition  Etiology = always physical  Treatments = as is physically ill  Rest  Diet  Room temperature  Improved hospital conditions

The Development of Biological Treatments  Mental Illness = Physical Illness  The 1930s  Insulin shock therapy  Brain surgery  ECT  Benjamin Franklin (1750s)  Treatment for depression?

The Development of Biological Treatments  The 1950s  Psychotropic medications  Increasingly available  Systematically developed  Neuroleptics  Reserpine and psychosis  Tranquilizers  Benzodiazepines and anxiety

The Development of Biological Treatments  The cons of medications  Unwanted physical side effects  Addiction/dependence  Effectiveness

Consequences of the Biological Tradition  Increased hospitalization  Untreatable conditions  Improved diagnosis and classification  Emil Kraepelin  Increased role of science in psychopathology

The Psychological Tradition: Ancient Contributions

 Plato, Aristotle, and Greece  Etiology  Social and environmental factors  Treatment  Reeducation via discussion  Therapeutic environments

 Similar practices in ancient Muslim countries

The Psychological Tradition  Moral Therapy  Moral = emotional or psychological  Treating patients normally  Encouraging social interaction  Focus on relationships  Individual attention  Education

The Psychological Tradition: Moral Therapy  Key figures in humanistic reform:  France  Philippe Pinel (1745 1826)  Jean-Baptiste Pussin  England  William Tuke (1732 1822)  United States  Benjamin Rush (1745 1813)  Horace Mann (1833)

Asylum Reform and the Decline of Moral Therapy

 Declines in the Mid-19th Century  Increased numbers of patients  Immigrants  Homeless  Mental Hygiene Movement  Dorothea Dix (1802-1887)  Staffing problems  Outcome = decreased treatment efficacy

The Psychoanalytic Tradition- Background  Anton Mesmer (1734 1815)  Mesmerism and hypnosis  Suggestibility  Jean Charcot (1825-1893)  Hypnosis as treatment  Mentor to Freud  Josef Breuer (1842-1925)  Furthered hypnosis treatments  Collaborator with Freud

Freuds Structure and Function of the Mind  Conscious versus unconscious:  Id  Pleasure principle  Illogical, emotional, irrational  Ego  Reality principle  Logical and rational  Superego  Moral principles  Balances Id and Ego

The Structure and Function of the Mind

Psychoanalysis - Defense Mechanisms  Ego fights to stay on top of the Id and Superego  Loss = anxiety  Coping strategies include:  Displacement  Denial  Rationalization  Reaction formation  Projection  Repression  Sublimation

Stages of Psychosexual Development

 Patterns of gratifying basic needs  Infancy to early childhood  Oral  Anal  Phallic  Latency  Genital  Conflicts at each stage must be resolved  i.e. Oedipus complex in the phallic stage  Adult personality reflects childhood experience

Later Developments in Psychoanalytic Thought

 Self-Psychology  Anna Freud (1895-1982)  Ego defines behavior  Object Relations Theory  Melanie Klein and Otto Kernberg  Children incorporation of objects  Images  Memories  Values of significant others

Later Developments in Psychoanalytic Thought  Freuds students de-emphasize sexuality  Carl Jung (1875-1961)  Collective unconscious  Enduring personality traits  Introversion vs. extroversion  Alfred Adler (1870-1937)  Birth order  Inferiority complex  Striving for superiority  Self-actualization

Later Developments in Psychoanalytic Thought  Emphasis on life-span development  Influence of society and culture on personality  Key figures:  Karen Horney (1885-1952)  Erich Fromm (1900-1980)  Erik Erickson (1902-1994)

Psychoanalytic Psychotherapy  Unearth intrapsychic conflicts  Long-term treatment model  Techniques  Free Association  Dream Analysis  Transference/Counter-Transference  Efficacy Data are Limited

Psychodynamic Psychotherapy
 Emphasizes conflicts and unconscious  Trauma and active defense mechanisms  Focus on:  Affect  Avoidance  Patterns  Past experience  Interpersonal experience  Therapeutic relationship  Wishes, dreams, fantasies

Psychoanalytic Psychotherapy
 Criticisms  Pejorative terms (i.e., neurosis)  Unscientific  Untested  Contributions  Unconscious processes  Emotions triggered by cues  Therapeutic alliance  Defense mechanisms

Humanistic Theory  Theoretical constructs  Intrinsic goodness  Striving for self-actualization  Blocked growth  Person-centered therapy  Carl Rogers (19021987)  Hierarchy of Needs  Abraham Maslow (1908-1970)

Humanistic Theory  Therapeutic process  Unconditional positive regard  Empathy  Facilitation  Non-directive approach  Outcomes  Study of therapeutic relationship  Questionable efficacy data  Severe psychopathology

The Behavioral Model  Classical Conditioning

Ivan Pavlov (1849-1936)

 Ubiquitous form of learning  Unconditioned stimulus (UCS)  Unconditioned response (UCR)  Conditioned stimulus (CS)  Conditioned response (CR)

The Behavioral Model  Classical Conditioning Concepts  Stimulus generalization  Extinction  Introspection

The Behavioral Model  Behaviorism  John B. Watson (1878 - 1958)  Scientific emphasis  Objective  Radical empiricism  Little Albert experiment

The Behavioral Model and Behavior Therapy  Mary Cover Jones  Preexisting phobia extinguished by exposure and modeling  Joseph Wolpe (1915 -1997)  Systematic desensitization  Relaxation

The Behavioral Model - Operant Conditioning  E.L. Thorndike (1874 1949)  Law of effect: consequences shape behavior  B.F. Skinner (1904 - 1990)  Behavior operates on environment  Reinforcements  Punishments  Behavior shaping

The Scientific Method and an Integrative Approach  Defining and studying psychopathology  Requires a broad approach  Multiple, interactive influences  Biological, psychological, social factors  Scientific emphasis  Neuroscience  Cognitive, behavioral sciences