AbnormalPsychology
DavidBarlow
BoardExamReviewer
Nino-MharMalana,RPm
AbnormalBehaviorinHistoricalContext
Psychologicaldisorder,apsychologicaldysfunctionwithinanindividualassociatedwithdistressor
impairmentinfunctioningandaresponsethatisnottypicalorculturallyexpected.
Psychologicaldysfunctionreferstoabreakdownincognitive,emotional,orbehavioralfunctioning.
Thatthebehaviormustbeassociatedwithdistresstobeclassifiedasabnormaladdsanimportant
componentandseemsclear:thecriterionissatisfiediftheindividualisextremelyupset.
Theconceptofimpairmentisuseful,althoughnotentirelysatisfactory.Forexample,manypeople
considerthemselvesshyorlazy.Thisdoesn’tmeanthatthey’reabnormal.Butifyouaresoshythat
youfinditimpossibletodateoreveninteractwithpeopleandyoumakeeveryattempttoavoid
interactionseventhoughyouwouldliketohavefriends,thenyoursocialfunctioningisimpaired.
Atypicalornotculturallyexpected.Attimes,somethingisconsideredabnormalbecauseitoccurs
infrequently;itdeviatesfromtheaverage.Thegreaterthedeviation,themoreabnormalitis.
ThemostwidelyaccepteddefinitionusedinDSM-5describesbehavioral,psychological,orbiological
dysfunctionsthatareunexpectedintheirculturalcontextandassociatedwithpresentdistressand
impairmentinfunctioning,orincreasedriskofsuffering,death,pain,orimpairment.
Psychopathologyisthescientificstudyofpsychologicaldisorders.
Althoughthereisagreatdealofoverlap,counselingpsychologiststendtostudyandtreatadjustment
andvocationalissuesencounteredbyrelativelyhealthyindividuals,andclinicalpsychologistsusually
concentrateonmoreseverepsychologicaldisorders.
Also,programsinprofessionalschoolsofpsychology,wherethedegreeisoftenaPsy.D.,focusonclinical
trainingandde-emphasizeoreliminateresearchtraining.Incontrast,Ph.D.programsinuniversities
integrateclinicalandresearchtraining. PsychiatristsfirstearnanM.D.degreeinmedicalschoolandthenspecializeinpsychiatryduring
residencytrainingthatlasts3to4years.Psychiatristsalsoinvestigatethenatureandcausesof
psychologicaldisorders,oftenfromabiologicalpointofview;makediagnoses;andoffertreatments.
Psychiatricsocialworkerstypicallyearnamaster’sdegreeinsocialworkastheydevelopexpertisein
collectinginformationrelevanttothesocialandfamilysituationoftheindividualwithapsychological
disorder.Socialworkersalsotreatdisorders,oftenconcentratingonfamilyproblemsassociatedwith
them.
Psychiatricnurseshaveadvanceddegrees,suchasamaster’sorevenaPh.D.,andspecializeinthecare
andtreatmentofpatientswithpsychologicaldisorders,usuallyinhospitalsaspartofatreatmentteam.
Finally,marriageandfamilytherapistsandmentalhealthcounselorstypicallyspend1–2yearsearninga
master’sdegreeandareemployedtoprovideclinicalservicesbyhospitalsorclinics,usuallyunderthe
supervisionofadoctoral-levelclinician.
Manymentalhealthprofessionalstakeascientificapproachtotheirclinicalworkandthereforeare
calledscientist-practitioners.
Howmanypeopleinthepopulationasawholehavethedisorder?Thisfigureiscalledtheprevalenceof
thedisorder.
Statisticsonhowmanynewcasesoccurduringagivenperiod,suchasayear,representtheincidenceof
thedisorder.
Mostdisordersfollowasomewhatindividualpattern,orcourse.Forexample,somedisorders,suchas
schizophrenia,followachroniccourse,meaningthattheytendtolastalongtime,sometimesalifetime.
Otherdisorders,likemooddisorders,followanepisodiccourse,inthattheindividualislikelytorecover
withinafewmonthsonlytosufferarecurrenceofthedisorderatalatertime.Thispatternmayrepeat
throughoutaperson’slife.Stillotherdisordersmayhaveatime-limitedcourse,meaningthedisorderwill
improvewithouttreatmentinarelativelyshortperiod.
Theanticipatedcourseofadisorderiscalledtheprognosis.Sowemightsay,“theprognosisisgood”,
meaningtheindividualwillprobablyrecover,or“theprognosisisguarded”,meaningtheprobable
outcomedoesn’tlookgood.
Etiology,orthestudyoforigins,hastodowithwhyadisorderbegins(whatcausesit)andincludes
biological,psychological,andsocialdimensions. HistoricalConceptionsofAbnormalBehavior
TheSupernaturalTradition
Humanshavealwayssupposedthatagentsoutsideourbodiesandenvironmentinfluenceourbehavior,
thinking,andemotions.Theseagents—whichmightbedivinities,demons,spirits,orotherphenomena
suchasmagneticfieldsorthemoonorthestars—arethedrivingforcesbehindthesupernaturalmodel.
Althoughmanyhavethoughtthatthemindcaninfluencethebodyand,inturn,thebodycaninfluence
themind,mostphilosopherslookedforcausesofabnormalbehaviorinoneortheother.Thissplitgave
risetotwotraditionsofthoughtaboutabnormalbehavior,summarizedasthebiologicalmodelandthe
psychologicalmodel.
Duringthelastquarterofthe14thcentury,religiousandlayauthoritiessupportedthesepopular
superstitionsandsocietyasawholebegantobelievemorestronglyintheexistenceandpowerof
demonsandwitches.TheCatholicChurchhadsplit,andasecondcenter,completewithapope,
emergedinthesouthofFrancetocompetewithRome.Inreactiontothisschism,theRomanChurch
foughtbackagainsttheevilintheworldthatitbelievedmusthavebeenbehindthisheresy.
Duringtheseturbulenttimes,thebizarrebehaviorofpeopleafflictedwithpsychologicaldisorderswas
seenastheworkofthedevilandwitches.
Treatmentsincludedexorcism,inwhichvariousreligiousritualswereperformedinanefforttoridthe
victimofevilspirits.
Otherapproachesincludedshavingthepatternofacrossinthehairofthevictim’sheadandsecuring
suffererstoawallnearthefrontofachurchsothattheymightbenefitfromhearingMass.
Mentaldepressionandanxietywererecognizedasillnesses,althoughsymptomssuchasdespairand
lethargywereoftenidentifiedbythechurchwiththesinofacedia,orsloth.
Commontreatmentswererest,sleep,andahealthyandhappyenvironment.Othertreatmentsincluded
baths,ointments,andvariouspotions.
Inthe14thcentury,oneofthechiefadviserstothekingofFrance,abishopandphilosophernamed
NicholasOresme,alsosuggestedthatthediseaseofmelancholy(depression)wasthesourceofsome
bizarrebehavior,ratherthandemons.
Asweseeinthehandlingoftheseverepsychologicaldisorderexperiencedbylate-14th-centuryKing
CharlesVIofFrance,bothinfluenceswerestrong,sometimesalternatinginthetreatmentofthesame
case.KingCharlesVIofFrancewasunderagreatdealofstress,partlybecauseofthedivisionofthe
CatholicChurch.Avarietyofremediesandritualsofallkindsweretried,butnoneworked.High-ranking
officialsanddoctorsoftheuniversitycalledforthe“sorcerers”tobediscoveredandpunished. Withaperceivedconnectionbetweenevildeedsandsinontheonehandandpsychologicaldisorderson
theother,itislogicaltoconcludethatthesuffererislargelyresponsibleforthedisorder,whichmight
wellbeapunishmentforevildeeds.
IntheMiddleAges,ifexorcismfailed,someauthoritiesthoughtthatstepswerenecessarytomakethe
bodyuninhabitablebyevilspirits,andmanypeopleweresubjectedtoconfinement,beatings,andother
formsoftorture.
Masshysteriamaysimplydemonstratethephenomenonofemotioncontagion,inwhichtheexperience
ofanemotionseemstospreadtothosearoundus.
Paracelsus,aSwissphysicianwholivedfrom1493to1541,rejectednotionsofpossessionbythedevil,
suggestinginsteadthatthemovementsofthemoonandstarshadprofoundeffectsonpeople’s
psychologicalfunctioning.
TheRomanCatholicChurchrequiresthatallhealthcareresourcesbeexhaustedfirstbeforespiritual
solutionssuchasexorcismcanbeconsidered.
TheBiologicalTradition
TheGreekphysicianHippocratesisconsideredtobethefatherofmodernWesternmedicine.Heandhis
associatesleftabodyofworkcalledtheHippocraticCorpus,writtenbetween450and350b.c.,inwhich
theysuggestedthatpsychologicaldisorderscouldbetreatedlikeanyotherdisease.
Hippocratesconsideredthebraintobetheseatofwisdom,consciousness,intelligence,andemotion.
Therefore,disordersinvolvingthesefunctionswouldlogicallybelocatedinthebrain.
Hippocratesalsorecognizedtheimportanceofpsychologicalandinterpersonalcontributionsto
psychopathology,suchasthesometimesnegativeeffectsoffamilystress;onsomeoccasions,he
removedpatientsfromtheirfamilies.
TheRomanphysicianGalen,lateradoptedtheideasofHippocratesandhisassociatesanddeveloped
themfurther,creatingapowerfulandinfluentialschoolofthoughtwithinthebiologicaltraditionthat
extendedwellintothe19thcentury.
OneofthemoreinterestingandinfluentiallegaciesoftheHippocratic-Galenicapproachisthe
humoraltheoryofdisorders.
Hippocratesassumedthatnormalbrainfunctioningwasrelatedtofourbodilyfluidsorhumors:
blood,blackbile,yellowbile,andphlegm.
Bloodcamefromtheheart,blackbilefromthespleen,phlegmfromthebrain,andcholeroryellow
bilefromtheliver.
