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Psychology 314 Summary
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PSYCHOPATHOLOGYChapter 1
A bno r ma l B eh avi our in Historic al Co n te xt
What is psychopathology?
In simple terms, psychopathology is the the scientific study of psychological dysfunction. Psychopathology is
also called abnormal psychology. It is the study of mental disorders/mental health conditions and unusual or
maladaptive behaviours. Psychopathology refers to the behavioural or cognitive manifestations of these
disorders. That is, the behaviours you would find in a person suffering from a specific mental disorder.
Psychopathology looks at the underpinnings of these mental disorders, the ideology (how the disorder was
developed), the progressions (over time), symptomatology (symptoms you would see in a person with this
condition), actual diagnosis (and diagnostic criteria), as well as the treatment for that diagnosis.
What is a Psychological Disorder?
People experience different emotions and behavioural changes at one time or another, so at which point can
we say that a person is suffering from a psychological disorder?
Psychological dysfunction is associated with distress and/or impairment in functioning. When someone is
experiencing any kind of behavioural or cognitive changes and this causes a person distress/impairs their
functioning, then we can regard it as a possible psychological dysfunction (which could be part of a
psychological disorder). Any behavioural or cognitive changes that involve a response that is not typical or
culturally expected may also indicate a possible psychological dysfunction (ex: in some cultures hearing or
seeing ancestors is seen as part of the culture. In this case, a person hearing voices in their head would not be
categorised as abnormal behaviour because it is not atypical in that culture).
Distress, Impairment and Cultural Context
In countries like South Africa, for example, where there a number of different cultures present, it is very
important to properly assess these factors. In summary, to recognise a psychological dysfunction, we need to
look at a person’s behavioural or cognitive changes and ask:
- Is it causing the person distress?
Distress is normal in some situations (ex: being followed on an empty street). Dysfunctional distress
occurs when person is much more distressed than others would be in that similar situation (ex:
extreme fear of attending a party that your friends are all excited for).
- Is it impairing their functioning?
Impairment to functioning must be pervasive and/or significant. The changes seen in this person
must be noticeable and pervasive in order for it to considered dysfunctional. Mental disorders are
often exaggerations of normal processes (e.g. extreme shyness or sadness). For example, it is normal
for some people to be shy and take time to warm up to others. On the other hand, shyness is possibly
dysfunctional when it prevents a person from interacting with others/doing so causes them extreme
fear.
- Does it involve an atypical response? Are these changes culturally expected/typical of that culture?
One has to consider what is the norm of that culture, and whether the person has an atypical response
relative to that culture. You can then consider 'normalcy' relative to behaviour of others in same
cultural context. The rule of thumb is that it is a harmful dysfunction that will translate into a mental
health condition.
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,An accepted definition of a psychological disorder is then: Behavioural, psychological or biological
dysfunctions that are unexpected in their cultural context and associated with present distress and/or
impairment in functioning or increased risk of suffering, death, pain or impairment.
Studying Psychological Disorders: Clinical Description
In hospitals and clinics, we often say that a patient “presents” with a specific problem or set of problems or
we discuss the presenting problem. This is the original complaint that is recorded verbatim. The presenting
problem guides you in your investigation. From this, you can recognize their symptoms (e.g. chronic worry,
panic attacks). You can then look at the clinical description.
The clinical description aims to distinguish clinically significant dysfunction from common human
experience. Clinically significant dysfunction, here, refers to dysfunction that completely changes the way a
person behaves, responds to things, and manages themselves. The clinical description also describes the
prevalence (how many people in a population have the disorder) and incidence (number of new cases of the
disorder over a period of time) of disorders.
When looking at psychological disorders, there are three major characters to keep in mind.
1. The clinical description
2. Causation (aetiology) — aetiology refers to the causation of the particular diagnosis you are working
with (ex: if a person has major depressive disorder, what are the factors that caused it?). Aetiology
includes biological descriptions, genetic descriptions, psychosocial factors, etc.
3. Treatment and outcome — once we have the description and have figured out what the aetiology is, we
are then able to come up with a treatment plan and determine what the outcome would be.
Part of the clinical description will include:
- Type of onset of disorders: whether it appeared suddenly (acute onset) or gradually over time (insidious
onset).
- Course of disorders: whether it lasts for a short period of time (episodic course), lasts for a limited time
(time-limited course), or typically lasts for a long time (chronic course).
- Prognosis of the patient: whether they’ve got a good prognosis (a good chance of recovery) or a a poor/
guarded prognosis (individual is not following/committed to treatment, or lacks support).
- The age of onset: this may shape presentation of disorder/symptoms. Personality disorders, for example,
can only be diagnosed after a person is 18. Whereas schizophrenia can likely only be diagnosed later in a
persons life.
Causation, Treatment and Outcome
Causation/aetiology has to do with why a disorder began and what contributes to the development of
psychopathology. This includes biological, psychological, and social aspects. Treatment development looks at
how we can we help alleviate psychological suffering. This includes pharmacological (medication),
psychosocial (clinical psychologist interventions) and/or combined treatments.
Historical Conceptions of Abnormal Behaviour
Major psychological disorders have existed across time and cultures. The perceived causes and treatment of
abnormal behaviour varied widely, depending on the context. However, three dominant traditions have
existed in the past to explain abnormal behaviour.
1. Supernatural Tradition — these explanations relied on the idea of good vs. evil. Supernatural
explanations for mental disorders included demons and witches (exorcisms were used as treatment),
stress and melancholy, possession, mass hysteria, and the moon and the stars.
2. Biological Tradition — started with Hippocrates and carried on all the way to Western Medicine. In this
model, mental illness was seen as having physical/biological roots. The assumption was that disorders
were caused by brain pathology or head trauma, and also could be influenced by genes. For example, in
the 19th century, Syphilis was believed to be a biological cause of mental illness.
3. Psychological Tradition
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,The Psychological Tradition — Psychoanalytic theory
At the forefront of this line of thought were Plato and Aristotle who thought that the two causes of
maladaptive behavior were the social and cultural influences in one’s life and the learning that took place in
that environment. For example, if a child had abusive parents, their impulses and emotions might overcome
reason Treatment thus focused on re-educating the patient through rational discussion so that the power of
reason would predominate. Philosophers wrote about the importance of fantasies, dreams, and cognitions.
A strong psychosocial approach to mental disorders, known as moral therapy, came to rise at beginning of
the 19th century. Its basic tenets included treating institutionalized patients as normally and humanely as
possible in a setting that encouraged and reinforced normal social interaction, thus providing them with
many opportunities for appropriate social and interpersonal contact.
There were a number of proponents of moral therapy including:
▪ Philippe Pinel and Jean-Baptiste Pussin – enforced that patients should not be restrained
▪ Benjamin Rush – led reforms in USA
▪ Dorothea Dix – lead the campaigned for the reform of treatment of insanity and improved
standards of care (her work is known has become known as the mental hygiene movement).
Unfortunately, an unforeseen consequence of Dix’s efforts was a substantial increase in the number
of mental patients. This influx led to a rapid transition from moral therapy to custodial care
because hospitals were inadequately staffed.
Another psychological explanation for mental disorders is Freud’s psychoanalytic theory. Psychoanalytic
theory focuses on the structure and function of the mind. This encourages the role of unconscious drives.
Psychoanalytic theory is made up psychosexual stages of development. The theory says that at each stage
(oral, anal, phallic, latency and genital stages), a conflict will arise that must be resolved in order for the
person to develop. The psychoanalytic model sought to explain development and personality. Thus, Freud
describes the structure of the mind as having an id (pleasure principle; illogical, emotional, irrational), ego
(rational; mediates between id and superego), and superego (moral principles).
Defence mechanisms arise as the ego's attempt to manage anxiety resulting from id/superego conflict. Some
defense mechanisms are displacement, denial, rationalisation, reaction formation, projection, repression,
sublimation.
Other psychological theories includes self-psychology (emphasised influence of the ego in defining
behaviour), object relations theory (emphasised that children incorporate the images, memories, and values
of a person— referred to as object— who was important to them and to whom they were/are emotionally
attached), etc. Moreover, ’Neo-Freudians’ departed from Freudian thought and de-emphasised the sexual
core of Freud's theory. Carl Jung emphasised the 'collective unconscious.’ Similarly, Alfred Adler focused on
feelings of inferiority, introducing the concept of the 'inferiority complex’ (feelings of being inferior while
striving for superiority).
Treatment within the psychological model began with psychoanalytic psychotherapy. Psychoanalytic
psychotherapy is designed in such a way to reveal the nature of unconscious mental processes and conflicts
through catharsis and insight. Freud developed techniques of free association, in which patients are
instructed to say whatever comes to mind without censoring. Free association is intended to reveal
emotionally charged material that may be repressed because it is too painful or threatening to bring into
consciousness. Other techniques include dream analysis, in which the therapist interprets the content of
dreams, and relates the dreams to symbolic aspects of unconscious conflicts. The goal of this stage of therapy
is to help the patient gain insight into the nature of the conflicts.
Freud also examined transference, (patients relating to the therapist much as they did to important figures in
their childhood) and countertransference (therapists project some of their own personal issues and feelings,
usually positive, onto the patient).
Psychodynamic Psychotherapy is a therapy with themes of psychoanalysis, but it is shorter and often more
goal-directed than classic psychoanalysis. It emphasises conflicts and unconscious, may work to uncover
trauma and active defence mechanisms. Psychodynamic Psychotherapy focuses on a patient’s:
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, - Emotional expression
- Avoidance and other cognitive or behavioural patterns
- Past experience
- Interpersonal experience
- Therapeutic relationship
- Wishes, dreams, fantasies
Therapist de-emphasises the role of personality reconstruction and focus instead on alleviating suffering
associated with the psychological disorder.
The Psychological Tradition — Humanistic theory
Adler believed that human nature reaches its fullest potential when we contribute to the welfare of other
individuals and to society as a whole. He believed that we all strive to reach superior levels of intellectual
and moral development. Both Jung and Adler retained many of the principles of psychodynamic thought.
Their general philosophies were adopted in the middle of the century by personality theorists and became
known as humanistic psychology.
This theory emphasized the importance of self-actualising. The underlying assumption is that all of us could
reach our highest potential, in all areas of functioning, if only we had the freedom to grow. Abraham Maslow
postulated a hierarchy of needs, beginning with our most basic physical needs for food and sex and ranging
upward to our needs for self-actualisation, love, and self-esteem. Maslow hypothesized that we cannot
progress up the hierarchy until we have satisfied the needs at lower levels.
Carl Rogers originated person-centered therapy. The point of this approach is to give the individual a chance
to develop during the course of therapy, unfettered by threats to the self. The therapist conveys empathy and
unconditional positive regard to the patient. The hoped-for result of person-centered therapy is that clients
will be more straight-forward and honest with themselves and will access their innate tendencies toward
growth.
However, the humanistic approach is more effective for people dealing with normal life stress, rather than
those suffering from psychopathology.
The Psychological Tradition — The Behavioural Model
The behavioral model, which is also known as the cognitive-behavioral model or social learning model,
brought the systematic development of a more scientific approach to psychological aspects of
psychopathology. One behavioral approach, known as classical conditioning was introduced by Pavlov. In
classical conditioning, people learn associations between neutral stimuli and stimuli that already have
meaning (unconditioned stimuli). Two important classical conditioning concepts are stimulus generalisation
and extinction.
John B. Watson believed that psychology should be as scientific and objective as possible. He conducted the
'Little Albert' experiment in which Baby Albert was taught to fear a white rat when it was repeatedly paired
with a loud noise (via classical conditioning). Later, Albert also became fearful of anything resembling the
white rat. Mary Cover Jones believed that if fear could be classical conditioned this way they might also be
able to unconditional them. She was one of the first to treat phobias with exposure and extinction of learned
association.
E.L. Thorndike developed a law of effect: Behaviour will be repeated more often if it is followed by good
consequences and less often if it is followed by bad consequences. Similarly, B.F. Skinner believed that
behaviour 'operates' on environment and is managed by consequences (rewards and punishments). Skinner
introduced the idea of behaviour ‘shaping.’ That is, the idea that new behaviour can be learned by reinforcing
successive approximations.
Behaviour therapy looks at creating new associations by practising new behavioural habits and/or reinforcing
useful behaviours with positive consequences. Behaviour therapy tends to be time-limited and direct and
there is strong evidence supporting the efficacy of behaviour therapies.
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