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Chapter 1: looking at abnormality
Psychopathology (study of abnormal psychology): study of people who suffer mental, emotional and often
physical pain
Defining abnormality
Mental illness
A common belief is that behaviors/thoughts/feelings are pathological/abnormal when they are symptoms of
a mental illness. This implies a disease process. To date, no biological test is available to diagnose any type
of abnormality. Mental disorders: collection of problems in thinking/cognition, emotional responding and
social behavior. It is still possible that biological factors are involved with these problems.
Cultural norms
The context/circumstances surrounding a behavior influences whether it is viewed as abnormal. Cultural
norms play a large role. Gender-role expectations can also influence the labeling of behavior. Cultural
relativism: there are no universal standards/rules for labeling behavior abnormal, but behaviors can only be
labeled abnormal relative to cultural norms. Throughout history, labeling has been used to justify
controlling/silencing abnormal people.
Influences of culture and gender on expression of abnormal behavior and the way it is treated:
The way people express symptoms
Willingness to admit to certain types of behaviors/feelings
Types of treatments deemed acceptable/helpful
The four d’s of abnormality
The four d’s are dysfunction, distress, deviance and dangerousness. Dysfunctional:
behaviors/thoughts/feelings interfere with ability to function in daily life, hold a job or form close
relationships. Distress: behaviors and feelings that cause this are likely to be considered abnormal.
Deviance: lead to judgements of abnormality (hearing voices etc.). Dangerousness: behaviors/feelings that
are of potential harm, such as suicidal gestures or aggression. Together the four d’s make up the definition
of what is abnormal or maladaptive.
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,Historical perspectives on abnormality
Biological theories: abnormal behavior is similar to physical diseases. Supernatural theories: abnormal
behavior is a result of divine intervention, curses, demonic possession and personal sin. Psychological
theories: abnormal behavior as result of traumas or chronic stress.
Ancient theories
Driving away evil spirits
According to supernatural theories, treatment was exorcism: driving evil spirits from the body. Stone Age
and Middle Ages: drill holes in the skull so that spirits could depart = trephination, executed with a
trephine.
Ancient China: balancing Yin and Yang
Human body was said to contain a positive force (yang) and negative force (yin). When they are in balance,
you are healthy. When not, illness and insanity could be the result. The belief that human emotions were
controlled by internal organs was also held. With the rise of Taoism and Buddhism religious interpretations
arised.
Ancient Egypt, Greece and Rome: biological theories dominate
Writings on abnormal behavior were found in the papyri of Egypt and Mesopotamia (Kahun Papyrus). This
lists a number of disorders, followed by judgement of the cause and appropriate treatment. Egyptians
believed that the uterus could become dislodged, interfering with other organs (hysteria).
Greeks and Romans saw abnormal behavior as affliction from the gods. Hippocrates: body is composed of
four basic humors, namely blood, phlegm, yellow bile and black bile. Diseases are caused by imbalances in
these humors. He classified abnormal behavior in four categories: epilepsy, mania, melancholia and brain
fever.
Treatments by Greek: sometimes physiological and intrusive, sometimes rest/relaxation/change of climate
or scenery/change of diet/change of lifestyle. The state claimed responsibility for insane people, but they
could also take rights away from them.
Medieval views
Severe emotional shock and physical illness or injury were seen as causes of bizarre behavior.
Witchcraft
Some psychiatric historians think that ‘witches’ must have been mentally ill. They sometimes admitted to
strange things, but these confessions may have been extracted through torture etc. Johann Weyer and
Reginald Scot wrote that they thought that the accused may suffer from melancholy and senility.
Most writings of the medieval/Renaissance times/witch hunt periods distinguish between people who were
mad and witches.
Psychic epidemics
Psychic epidemics: phenomenon in which many people engage in unusual behaviors that appear to have a
psychological origin. Tarantism was noted in Italy. People developed acute pain, attributed to bite of a
tarantula. They jumped and danced, tearing at their clothes and beating each other. Many people then
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,believed it was due to possession by the devil. Psychologists try to understand them through research of the
influence of others on an individual’s self-perceptions.
The spread of asylums
In the 12th century, people already took some responsibility for housing and caring for the mentally ill.
However, they were little more than inmates, housed against their will often in extremely harsh conditions
in hospitals such as Bedlam.
The first act for Regulating Madhouses in England was passed in 1774 to clean up the conditions and
protecting people from being unjustly jailed. It applied only to paying patients. Asylums were typically
established by people thinking that abnormal behaviors were medial illnesses.
Moral treatment in the 18th and 19th century
There was more humane treatment, period known as the mental hygiene movement. Problems because of
separation from nature and stresses imposed by rapid social changes. Leader of the movement for moral
treatment was Philippe Pinel. He believed many forms could be cured by restoring dignity and tranquility.
His approach was successful, despite others thinking he was mad for doing it.
William Tuke opened an asylum, his treatment was designed to restore self-restraint by treating them with
respect and dignity and encouragement to exercise self-control. Dorothea Dix was one of the most militant
crusaders for moral treatment. Laws and appropriations were passed and mental institutions were
established. Because of the amount of patients, the number of them actually benefiting from it dropped.
The emergence of modern perspectives
Early 20th century advances in scientific study of disorders.
The beginnings of modern biological perspectives
Basic knowledge of anatomy, physiology, neurology and chemistry of the body increased. Wilhelm
Griesinger said that all psychological disorders can be explained in terms of brain pathology. Emil
Kraepelin developed a scheme for classifying symptoms into discrete disorders, it is the basis of our system
now. One of the most important discoveries was that of general paresis: a disease that leads to paralysis,
insanity and death. The discovery that syphilis is the cause of one form of insanity was more evidence that
biological factors can cause abnormality.
The psychoanalytic perspective
Franz Anton Mesmer believed that people have a magnetic fluid in the body that must be distributed in a
particular pattern to maintain health. His methods were known as mesmerism. He induced a trance like
state in his patients, later called hypnosis. Jean Charcot argued that hysteria was caused by degeneration of
the brain. Bernheim and Liebauld showed that they could induce symptoms of hysteria by suggesting them
to patients during hypnosis. Breuer discovered that encouraging patients to talk about their problems during
hypnosis led to a great upwelling/release of emotion, eventually called catharsis. Freud thought much of
mental life stays unconscious. Psychoanalysis: study of the unconscious.
The roots of behaviorism
Ian Pavlov developed methods and theories for understanding behavior in terms of stimuli response
instead of the unconscious mind. His method was called classical conditioning. Thorndike and Skinner
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, studied how the consequences of behavior shape the likelihood of recurrence. Behaviorism: the study of
the impact of reinforcements/punishments on behavior.
The cognitive revolution
1970s: focus shifted towards cognitions: thought processes that influence behavior and emotion. Bandura
said that self-efficacy beliefs are crucial in determining wellbeing. Self-efficacy beliefs: beliefs about
ability to execute behavior necessary to control important events. Albert Ellis said that people prone to
psychological disorders have irrational negative assumptions about themselves and the world. He
developed a theory called rational-emotive theory. The therapy of Aaron Beck focused on irrational
thoughts.
Modern mental health care
Halfway through 20th century: breakthroughs in drug treatments for some of the major forms of
abnormality.
Deinstitutionalization
Patients’ rights movement argued that patients can recover more fully/live more satisfying lives when
integrated into the community, with community based treatment facilities. This process is called
deinstitutionalization. In the US, the community mental health movement was launched, wanting to
provide coordinated mental health services to people in community mental health centers. These include
social workers, therapists and physicians Halfway houses: live in a structured, supportive environment
while reestablishing working relationships/ties to family and friends. Day treatment centers: treatment
during the day with occupational and rehabilitative therapies and at night sleeping home. The resources to
care for all mental health patients has never been adequate. Many of the goals were never fully reached,
leaving many people no better off.
Managed care
Managed care: collection of methods for coordinating care ranging from simple monitoring to full control
over what care can be provided/paid for. Goals: coordinate services for existing medical problems and
prevent future problems. Managed care can solve some of the problems caused by deinstitutionalization.
For example, the primary provider might find care and ensure access, coordinate care offered by other
providers or ensure continuity so patients don’t ‘fall through the cracks’. Mental health care is not always
covered by insurance.
Professions within abnormal psychology
Psychiatrists: MD degree, specialized training in treatment of psychological problems, can prescribe meds.
Clinical psychologists: PhD in psychology, specialization in treating/researching psychological problems,
conduct psychotherapy.
Marriage and family therapists: helping families/couples/children overcome interfering problems.
Clinical social workers: master’s degree in social work, helping people with psychological problems
overcome social conditions that contribute to the problems.
Licensed mental health counselors: graduate training in counseling beyond bachelor in counseling.
Psychiatric nurses: degree in nursing, specialization in treatment of people with psychological problems.
Chapter integration
Theories that integrate biological, psychological and social perspectives on abnormality are most useful.
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