Samenvatting van hoofdstukken 1 tot en met 15 van het boek Fundamentals of Abnormal Psychology, nodig voor het vak Psychopathologie aan de universiteit van Tilburg
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Fundamentals of Abnormal Psychology
Chapter 1: Abnormal Psychology: Past and Present
Abnormal psychology: scientific study of abnormal behavior undertaken to describe, predict, explain
and change abnormal patterns of functioning. Clinical scientists are the workers in this field that gather
information. Knowledge is used by clinical practitioners, whose role is to detect, assess and treat
abnormal patterns of functioning.
No definition of abnormality has been totally accepted, but most have the four Ds in common:
1. Deviance: different, extreme, unusual or bizarre. Abnormal behavior, thoughts and emotions
are those that differ markedly from a society’s ideas about proper conduct.
a. Norms: stated and unstated rules for proper conduct. Behavior that breaks legal norms
is criminal. Behavior, thoughts and emotions that break norms of psychological
functioning are abnormal. A societies norms grow from its culture: people’s common
history, values, institutions, habits, skills, technology and arts.
b. Depends on specific circumstances.
2. Distress: unpleasant and upsetting to person. For it to be abnormal people should experience
distress. But some people who function abnormally maintain a positive frame of mind.
3. Dysfunction: interfering with person’s ability to conduct daily activities in a constructive way.
4. Danger: behavior becomes dangerous to oneself or others. Most struggling with anxiety,
depression and bizarre thinking pose no immediate danger to themselves or to anyone else.
Treatment/therapy: procedure designed to change abnormal behavior into more normal behavior.
Three essential features:
1. A sufferer who seeks relief from healer
2. A trained, socially accepted healer, whose expertise is accepted by sufferer and social group.
3. A series of contacts between healer and sufferer through which the healer tries to produce
certain changes in the sufferer’s emotional state, attitudes and behavior.
Some clinicians see abnormality as an illness and therapy a procedure that helps cure it. Others see
abnormality as a problem in living and therapists’ ads teachers of more functional behavior and thought.
In prehistoric societies people believed that all events around and within them resulted from the actions
of magical, sometimes sinister, beings who controlled the world.
Trephination: ancient operation in which a stone instrument was used to cut away a circular section of
the skull to treat severe abnormal behavior (e.g. hallucinations). The purpose was to release the evil
spirits that were supposedly causing the problem.
Later societies pointed to possession by demons. The treatment was often exorcism.
According to Hippocrates illnesses had natural causes. Abnormal behavior is a disease arising from
internal physical problems. A form of brain pathology was the culprit and resulted from an imbalance of
fluids (humors) flowing through body: yellow bile, black bile, blood and phlegm. To treat psychological
dysfunction the underlying physical pathology had to be corrected (e.g. diet of vegetables, quiet life).
Middle ages: demonological views and practices became popular again. Abnormal behavior increased
greatly. There were outbreaks of mass madness, where large numbers of people shared absurd false
believes and imagined sights or sounds. Exorcisms were used. At the end medical views gained favor
once again and many people with psychological disturbances received treatment in medical hospitals.
Renaissance: demonological views of abnormality continued to decline. Care improved. But
improvements faded, and hospitals and monasteries converted into asylums (type of institutions to
provide care for persons with mental disorders) and most asylums became virtual prisons.
19th century: Pinel (France) argued that patients were sick people whose illnesses should be treated
with sympathy and kindness rather than chains and beatings. Approach proved remarkably successful.
Tuke (England) brought similar reforms. The methods of Pinel and Tuke are moral treatment, because
they emphasized moral guidance and humane and respectful techniques.
Rush (American) developed human approaches to treatment.
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,At the end of the 19th century several factors led to a reversal of moral treatment movement:
1. Speed with which the movement had spread. This led to severe money and stagging shortages,
recovery rates declined and overcrowding in the hospitals.
2. Assumptions that all patients could be treated with humanity and dignity.
3. Emergence of a new wave of prejudice against people with mental disorders.
Two opposing perspectives emerged:
- Somatogenic perspective: view that abnormal psychological functioning has physical causes.
Similar to Hippocrates. Two factors for rebirth:
o Work of Kraepelin: argued in his book that physical factors are responsible for mental
dysfunction and developed the first modern system for classifying abnormal behaviors.
o New biological discoveries (e.g. organic disease, syphilis, led to general paralysis).
- Psychogenic perspective: view that chief causes of abnormal functioning are psychological.
Did not gain much following until studies of hypnotism demonstrated its potential. Hypnotism
is a procedure in which a person is placed in a trancelike mental state during which he becomes
extremely suggestible. It was discovered that patients sometimes awoke free of hysterical
symptoms after speaking candidly under hypnosis about past upsetting events. This led to
psychoanalysis: theory of treatment of abnormal mental functioning that emphasizes
unconscious psychological forces as the cause of psychopathology.
Psychotropic medications: discovered in 1950s. drugs that mainly affect the brain and reduce many
symptoms of mental dysfunction. They include:
- First antipsychotic drugs: correct extremely confused and distorted thinking.
- Antidepressant drugs: lift the mood of depressed people.
- Antianxiety drugs: reduce tension and worry.
Since this discovery, from the 1960s a policy of deinstitutionalization was followed: practice of
releasing hundreds of thousands patients from public mental hospitals.
Outpatient care has now become the primary mode of treatment for people with severe psychological
disturbances and those with more moderate problems.
Private psychotherapy: a person directly pays a therapist for counseling services.
Developments since 1950: today outpatient therapy is offered in a number of less expensive settings
(e.g. community mental health centers) and is becoming available for more kinds of problems. Programs
have been developed devoted exclusively to specific psychological problems (e.g. substance abuse).
The community mental health approach has given rise to prevention: interventions aimed at deterring
mental disorders before they can develop.
Positive psychology: study and enhancement of positive feelings, traits and abilities. Better
understanding of constructive functioning enables clinicians to better promote psychological wellness.
Multicultural psychology: examines impact of culture, race, ethnicity and gender on behaviors and
thought and focusses on how they may influence the origin, nature and treatment of abnormal behavior.
The dominant form of insurance now consists of managed care programs in which the insurance
company determines key issues as which therapists its clients may choose, cost of sessions and
number of sessions for which a client may be reimbursed. A key problem with insurance coverage is
that reimbursements for mental disorders tends to be lower than those for physical disorders.
Since 1950 different theories have developed, which often conflict and compete with each other:
- Biological
- Cognitive behavioral
- Humanistic-existential
- Sociocultural
- Developmental psychopathology
Technological change has had both negative and positive significant effects on the mental health field.
Telemental health: use of digital technologies to deliver mental health services without the therapist
being physically present.
Clinical researchers try to discover broad laws, or principles of abnormal psychological function. They
use the scientific method: collect and evaluate information through careful observations to understand
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, a phenomenon. The observations enable them to pinpoint and explain relationships between variables.
Clinical researchers depend mainly on three methods of investigation:
Provides individual Provides general Provides causal Statistical analysis Replicable
information information information possible
Case study Yes No No No No
Correlational method No Yes No Yes Yes
Experimental method No Yes Yes Yes Yes
1. Case study: typically focused on 1 individual. Detailed description of life and psychological
problems. Describes person’s history, present circumstances and symptoms. Useful:
a. Source of new ideas about behavior and open the way for discoveries.
b. Challenge a theory’s assumptions.
c. Show value of new therapeutic techniques.
d. Offer opportunities to study unusual problems that do not occur often enough to permit
a large number of observations.
Limitations:
a. Reported by biased observers.
b. Rely on subjective evidence.
c. Little basis for generalization.
2. Correlational method: focused at many individuals. Used to determine co-relationship
between variables. Correlation is the degree to which events or characteristics vary with each
other. The correlation coefficient can vary from +1.00 to -1.00. Advantages over case study:
a. Better generalization.
b. Easily repeat correlational studies with new samples.
However, they do not explain the relationship.
3. Experimental method: focused at many individuals. Research procedure in which variable is
manipulated (independent variable) and manipulation effect on another variable (dependent
variable) is observed. Experimenters must try to eliminate all confounds (variables other than
independent variable that act on dependent variable), three features for this:
a. Control group: group of research participants who are not exposed to the independent
variable under investigation but experience is similar to that of experimental group.
b. Random assignment: any selection procedure that ensures that every participant in
the experiment is as likely to be placed in one group as the other.
c. Masked (or blind) design: participants do not know whether they are in experimental
or control condition. If also the experimenter is unaware it is a double blind.
These methods enable scientists to form and test hypotheses and to draw conclusions.
Quasi-experimental design/mixed design: research design that fails to include key elements of a
‘pure’ experiment and/or intermixes elements of experimental and correlational studies. Less than ideal:
- Matched design: investigators do not randomly assign participants to control and experimental
groups, but instead make use of groups that already exist in the world.
- Natural experiment: nature itself manipulates independent variable, while experimenter
observes the effect. E.g. earthquake.
- Analogue experiment: induce laboratory participants to behave in ways that seem to resemble
real-life abnormal behavior and conduct experiments on participants in hope of shedding light
on the real life abnormality.
- Single-subject experiment: a single participant is observed and measured.
- Longitudinal study: observes same participants on many occasions over long period of time.
- Epidemiological study: measures incidence and prevalence of a problem in a population.
Institutional review board (IRB): ethics committee in a research facility that is empowered to protect
rights and safety of human research participants. Try to ensure the following rights to its participants:
- Participants enlist voluntarily
- Before enlisting, participants adequately informed about what study entails (informed consent).
- Participants can end their participation at any time.
- Benefits of the study outweigh its costs/risks.
- Participants are protected from physical and psychological harm.
- Participants have access to information about the study.
- Participants’ privacy is protected by principles such as confidentiality or anonymity.
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, Chapter 2: Models of Abnormality
Model/paradigm: set of assumptions and concepts that help scientists explain and interpret
observations. It influences what investigators observe, questions they ask, information they seek and
how they interpret this information. Several models are used.
On one end there is the biological model which sees physical processes as key human behavior. In
the middle are 3 models that focus on more psychological and personal aspects of human functioning:
- Psychodynamic model: looks at people’s unconscious internal processes and conflicts.
- Cognitive-behavioral model emphasizes behavior, ways in which it is learned and thinking
that underlies behavior.
- Humanistic-existential model stresses role of values and choices.
At far end is the socio-cultural model, which looks to social and cultural forces as keys to human
functioning. It includes:
- Family-social perspective focuses on an individual’s family and social interactions.
- Multicultural perspective: emphasizes an individual’s culture and shared beliefs, values and
history of that culture.
The biological model
Abnormal behavior is seen as an illness brought about by malfunctioning parts of the organism. They
point to problems in brain anatomy, brain chemistry and/or brain circuitry as the cause of such behavior.
The brain is made up of nerve cells (neurons) and support cells (glia). Within the brain, large groups
of neurons form distinct regions (brain structures). The neurons in each brain structure help control
important functions. Particular psychological disorders can be linked to problems in specific structures
of the brain or to problems in transmission of messages from neuron to neuron.
Information is communicated throughout the brain in the form of electrical impulses that travel from one
neuron to one or more others. An impulse is first received by a neuron’s dendrites, from there it travels
down the neuron’s axon and then it is transmitted through the nerve ending at the end of the axon to
the dendrites of other neurons. Each neuron has multiple dendrites and a single axon. The synapse
separates one neuron from the next. When an electrical impulse reaches a neuron’s ending, the nerve
ending is stimulated to release a chemical (neurotransmitter), which travels across the synaptic space
to receptors on dendrites of neighboring neurons. After binding to receptors some neurotransmitters
give a message to receiving neurons to fir, other carry an inhibitory message (i.e. stop firing).
The endocrine glands release hormones into the bloodstream.
Brain circuits: network of particular brain structures that work together, triggering each other into action
to produce a distinct kind of behavioral, cognitive or emotional reaction.
Sources of biological abnormalities:
- Genetics/genes: chromosome segments that control characteristics and traits we inherit.
- Evolution: many of the genes that contribute to abnormal functioning result from evolutionary
principles. Human reactions and genes responsible for them have survived over the course of
time because they have helped individuals to thrive and adapt. E.g. capacity to experience fear.
This perspective is controversial in clinical field and has been rejected by many theorists.
Biological treatments:
- Drug therapy: Most common, but many believe that they are overused. In the 1950s several
effective psychotropic medications, drugs that mainly affect emotions and thought
processes, were discovered. 4 groups used in therapy:
o Antianxiety drugs: (minor tranquilizers or anxiolytics) help reduce tension and anxiety.
o Antidepressant drugs: help improve the functioning of people with depression and
certain other disorders.
o Antibipolar drugs: (mood stabilizers) help steady mood of those with bipolar disorder.
o Antipsychotic drugs: help reduce confusion, hallucinations and delusions that often
accompany psychosis.
- Brain stimulation: interventions that directly or indirectly stimulate certain areas of the brain.
E.g. electroconvulsive therapy (ECT) in which a brain seizure is triggered when an electric
current passes through electrodes attached to patient’s forehead.
- Psychosurgery: brains surgery for mental disorders.
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