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Introduction
Chapter 1-3
Note to the reader:
I had already begun to edit chapter 1-3 before the lecturer informed me that ONLY the
slides had to be studied for the introduction. I left in the extra material, but you’re
welcome to skip to page 5 where the prescribed work begins.
Psychopathology
Psychological disorder: A psychological dysfunction associated with distress
or impairment in functioning that is not a typical or culturally expected
response.
Phobia: Psychological disorder characterised by marked and persistent fear of
an object or situation.
Abnormal behaviour: A psychological dysfunction within an individual that
is associated with distress or impairment in funtioning and a response that is not
typical or culturally expected.
Psyche: Mind or soul
Pathology: Sickness/illness.
Aetiology: Study of origination or causation.
Criteria defining a psychological disorder
1. Psychological dysfunction
Thwasa: Hearing voices is known to traditional healers as a state of thwasa.
This is supposed to be a calling by the ancestors to become a traditional healer.
Ukuthwasa: Only a minority of the above will eventually become qualified
healers. They are then known as ukuthwasa survivors.
Ukuphambana: If initiate does not graduate and recover from thwasa, they are
re-diagnosed as suffering from madness.
Madness as described above, is a psychological dysfunction characterised by a
breakdown in cognitive, emotional or behavioural functioning.
2. Culture-bound Personal Distress or Impairment
Defining psychological disorder by distress alone does not work. In some
cultures, Thwasa is seen as normal, even though distressing. Culture plays an
important role.
Even if considered normal by the sufferer, fainting spells (often connected to
Thwasa) can be considered a hindrance and lead to impairment in social
functioning.
Most psychological disorders are simply extreme expressions of otherwise
normal emotions, behaviours and cognitive processes, and are guided by world
views.
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3. Atypical or Not Culturally expected
Robert Sapolsky is a neuroscientist who worked closely with the Masai.
After a woman (who heard voices) in the village killed a goat with her hands,
Sapolsky asked the Masai why they thought she was crazy. Killing goats
was normal and so was hearing voices if you were in trance.
He was told that only men killed goats and that “she heard voices at the
wrong times.”
Normal and abnormal is subjective in different cultures. Jerome Wakefield
used the shorthand definition of ‘harmful dysfunction’ instead.
It is also useful to determine whether behaviour is out of the person’s
control.
The most widely accepted definition in DSM-5 describes behavioural.
psychological or biological dysfunctions that are unexpected in their
cultural context and associated with present distress and impairment in
functioning, or increased risk of suffering, death, pain or impairment.
Prototype: How disease or disorder matches ‘typical’ profile of a disorder,
when most or all symptoms of the latter are present.
DSM-5 and DSM-IV-TR are prototypes. The difference between these is
the addition of dimensional estimates of severity of specific disorders in
DSM-5.
Psychological disorders in South Africa
Moral therapy1
First half of 19th century
Strong psychosocial approach
Moral refers to emotional or psychological factors, NOT code of conduct
Treating institutionalised patients as normally as possible in a setting that
encouraged and reinforced normal social interaction
Relationships were carefully nurtured
Restraint and seclusion eliminated
History
Principles date back to Plato and beyond
Greek Asclepiad (6th Century BCE) temples housed chronically ill (including
psychological disorders) Patients well cared for, massaged, given soothing
music
Muslim countries in Middle East had similar practices
MT as a system originated with French psychiatrist Philippe Pinel & associate
Jean-Baptiste Pussin who was superintendent of Parisian hospital La Bicêtre
Pussin instituted reforms by removing all chains used to restrain patients and
using humane and psychological interventions.
1
Psychosocial approach in nineteenth century that involved treating patients as normally as possible in
normal environments.
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Pinel arrived in 1791 and was persuaded by Pussin to go along with changes.
He did, first at La Bicêtre, then at woman’s hospital Salpêtrière, where Pussin
was invited to join him
William Tuke (1732-1822) followed Pinel’s lead in England.
Benjamin Rush (1745-1813) considered as founder of US psychiatry.
Introduced MT at Pennsylvania Hospital. MT became treatment of choice in
leading hospitals.
Asylums appeared (16th century) and were like prisons. MT in Europe and USA
made asylums habitable and therapeutic.
Horace Mann (1833) chairperson of board of trustees of Worcester State
Hospital, reported on patients who had been given up as incurable, some
viciously assaultive and others torn off new clothes given to them. After MT,
majority were cured and released to their families.
Humanistic theory
Jung and Adler’s philosophies inspired HT.
Self-actualising: People strive to achieve their highest potential in all areas of
functioning against difficult life experiences.
Abraham Maslow created hierarchy of needs. Most basic physical need is food
and sex, in between is social and ranging upwards is self-actualisation, love and
self-esteem. He believed we could not progress upwards if lower levels not
satisfied.
Carl Rogers, most influential humanist. Created client-centred therapy, now
known as person-centred therapy2. Therapist takes passive role, making as few
interpretations as possible. Client is not bothered by threat to the self.
Unconditional positive regard: Complete acceptance of most of the client’s
feelings and actions without judgement or condemnation.
Empathy: Sympathetic understanding of individual’s view of the world.
Hoped for result is that client will be straightforward and honest with
themselves and access their innate tendencies for growth.
Believed relationships were most positive influence in facilitating human
growth.
Maslow noted that humanism found better application among people without
psychological disorders.
Behavioural model
Explanation of human behaviour, including dysfunction, based on principles of
learning and adaptation derived from experimental psychology.
Ivan Pavlov (physiologist) invented study of classical conditioning3. (Dogs
salivating before presentation of food).
2
Therapy method in which client, rather than counsellor, primarily directs the course of discussion,
seeking self-discovery and self-responsibility.
3
An event that automatically elicits a response is paired with another stimulus event that does not.
After repeated pairings, the neutral stimulus becomes a conditioned stimulus that by itself can elicit the
desired response.
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Stimulus generalisation: Strength of response to similar object or people is
usually a function of how similar these objects or people are. Response therefore
generalises to similar stimuli.
Unconditioned stimulus: Food
Unconditioned response: Salivation
Conditioned stimulus: Bell/footsteps
Conditioned response: Salivation without presence of food
Extinction: Presentation of conditioned stimulus without unconditioned
stimulus for long enough period will eventually eliminate conditioned response.
Edward Titchener emphasised study of introspection4.
Aetiology
Provides a framework for understanding symptoms and making decisions
regarding diagnosis and treatment.
Due to the complex and dynamic nature of disorders, aetiology does not provide
direct answers about causes.
No aetiological model is better than others.
Biomedical perspectives
The biomedical model claims that all mental illnesses have a biological cause.
Factors like social pressures, type of parenting, or other environmental factors
seen as secondary in the precipitation of mental disorders.
Biological abnormalities are understood to occur in four different areas:
1. Genetic predisposition
2. Abnormal functioning of neurotransmitters
3. Endocrine dysregulation
4. Structural abnormalities in the brain
Psychological perspectives
Psychodynamic approaches, derived from Freud’s theory of psychoanalysis.
Behavior is largely influenced by internal forces that exist outside
consciousness.
Psychological disorders emerge from conflict between the id, the ego, and the
superego & deficiencies in the ego.
Defence mechanisms are used to ward off excessive psychological pain.
Contemporary approaches include the work of:
• Melanie Klein – object relations
• John Bowlby – attachment theory
• Heinz Kohut –self psychology
• Donald Winnicott – the independents
• Intersubjective psychoanalysis and relational psychoanalysis
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Early, non-scientific approach to the study of psychology involving systematic attempts to report
thoughts and feelings that specific stimuli evoked.
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