Chapter 1: Looking at abnormality
Psychopathology is the study of (people with) mental disorders, this includes mental,
emotional and physical pain.
In modern times, mental diseases are not seen as diseases with a common pathology that
can be identified in all people with that disorder. A mental disorder is a collection of
problems in thinking, cognition, emotional responding/regulation and in social behavior. It is
also possible that biological factors are associated with these problems.
Defining abnormal behavior is difficult because every culture has different norms for
behavior, and for what is acceptable behavior in different situations, and also for gender-
roles. Cultural relativism states that there are no universal standards or rules for labeling a
behavior as abnormal; instead, behaviors can be labeled as abnormal only relative to cultural
norms. This view honors the different cultures. However, opponents of this view state that it
could be dangerous when cultural norms can dictate what is normal or abnormal, think of
Hitler saying that Jews are abnormal and used this as a justification for the Holocaust.
- Culture and gender can influence the way people express symptoms.
- Culture and gender can influence people’s willingness to admit to certain types of
behavior and feelings.
- Culture and gender can influence the types of treatments that are seen as acceptable
or helpful for people that show abnormal behavior.
Modern judgements of abnormality often explain it using the four D’s: dysfuntion, distress,
deviance and dangerousness.
- Dysfunctional: when behaviors, thoughts and feelings interfere with the person’s
ability to function in daily life.
- Distress: when behaviors and feelings that cause distress to the individual/others,
they are more likely to be seen as abnormal.
- Deviant: behaviors that are highly deviant, like hearing voices when no one is
around, leads to judgements of abnormality.
- Dangerousness: behaviors and feelings, such as suicidal gestures, that are of
potential harm to the individual and to others are seen as abnormal.
There are 3 theories that have been used to explain abnormal behavior
- Biological theories: view abnormal behavior as similar to physical diseases; they are
caused by a breakdown of systems in the body. The cure is restoration of bodily
health.
- Supernatural theories: view abnormal behavior as a result of God’s intervention,
curses, demonic possession etc. To cure this, religious rituals and exorcisms must
take place.
- Psychological theories: view abnormal behavior as a result of traumas, like chronic
stress. Change of environment, rest and relaxation can be helpful.
It seems that humans have always viewed abnormality as something that needed a special
explanation. Prehistoric people probably had a concept of insanity, rooted in supernatural
beliefs. A typical treatment in this time was exorcism to drive the evil spirits from the
,person. Another treatment is called trephination: drilling holes in the skull of a person that
shows abnormal behavior, using a trephine.
Some of the earliest written sources about abnormality are from ancient China. It was based
on the concept of yin and yang. Yang = positive force. Yin = negative force. These 2
confronted and complemented each other, if they were balanced, the person was healthy.
The Chinese also said that human emotions were controlled by the internal organs; when
vital air was flowing on one of these organs, the individual experienced a particular emotion.
E.g.: when air flowed on the heart, a person felt joy. Evil winds and ghosts were therefore
blamed for abnormal behavior.
Other writings on abnormality were found in Egypt and Mesopotamia. These listed a number
of disorders with their cause and treatment. The Greeks and Romans took over these views.
They saw abnormality as an affliction from the gods, but Greek physicians rejected these
supernatural views. Hippocrates, seen as the father of medicine, said that abnormal
behavior was like the other diseases. According to him, the body was composed of 4 basic
humors: blood, phlegm, yellow bile and black bile. All diseases were caused by imbalances of
these 4 fluids. Based on observation, Hippocrates classified abnormal behavior into 4
categories: epilepsy, mania, melancholia and brain fever. Treatments ranged from
physiological to resting to talking therapy. In general, the public feared insanity of any form.
Psychic epidemics are defined as a phenomenon in which large numbers of people engage in
unusual behavior that appear to have a psychological origin. An example is dance frenzies
that broke out over a 4-month period in 1374 in Germany where monks danced themselves
to death. A similar phenomenon is tarantism: noted in the 14th century in Italy: people
suddenly developed acute pain that they believed came from the bite of a tarantula, they
jumped and danced and beat each other.
We no longer see these epidemics as caused be evil possessions. We know now that the
social context can affect our own perceptions of or bodies.
In the 11th/12th century, hospitals began to make special rooms for people with abnormal
behavior. However, the circumstances were not good; the patients were often chained to
the walls or locked inside small boxes. The hospitals were usually run by people that thought
abnormal behaviors were medical illness, which did not lead to a better treatment than
before.
The 18th and 19th century are known as the mental hygiene movement. This new treatment
was based on the view that people developed problems because they had been separated
from nature and were imposed by rapid social changes. Prescribed treatment was rest and
relaxation in a calm place. A leader of this movement with moral treatment was Philippe
Pinel, and his approach was very successful. Many more people followed, and this lead to
the fact that the moral treatment movement grew too fast: the capacity was too small and
therefore, not everyone could get an equal treatment.
In the early 20th century, there were many advances in the scientific study of disorders. Basic
knowledge about anatomy, physiology, neurology and chemistry of the body increased. They
laid the focus on biological causes of abnormality. Griesinger stated that all disorders can be
explained in terms of brain pathology. Kreaeplin followed this and developed a scheme for
classifying symptoms into discrete disorders. One of the most important discoveries was
general paresis: a disease that leads to paralysis, insanity and eventually death. The cause of
this disease was syphilis.
,Mesmerism: the cures that Mesmer had for diseases, these included touching the patient
while they were sitting in a dark room with a tub filled with chemicals. This induced a trans-
like state in the patients: hypnosis. The connection between hypnosis and hysteria were
fascinating, symptoms could be removed when under hypnosis.
Psychoanalysis: the study of the unconscious. Freud was very interested in this and wrote
many books about it.
The complete opposite of the psychoanalytic theory is behaviorism: understanding behavior
in terms of stimuli and responses, thus, the study of the impact of reinforcements and
punishments on behavior. Pavlov discovered classical conditioning. Skinner discovered
operant conditioning.
In the 1970s, psychology shifted its focus to the study of cognitions: thought processes, like
attention, interpretation and beliefs, that influence behavior and emotion.
Self-efficacy beliefs: beliefs about your ability to execute the behaviors that are necessary to
control important events. These are crucial in determining people’s well-being.
Halfway 20th century, there were major breakthroughs in drug treatments. Phenothiazines in
particular; a class of drugs that reduces hallucinations and delusions. Since then, there has
been an explosion of new drug therapies.
In the 1960s, the patient’s rights movement emerged. They argued that mental patients can
recover better, this with the help of deinstitutionalization: integration into the community
and community-based treatment facilities. This movement had a massive effect on the lives
of people with serious problems. There were several types of community-based treatment
facilities:
- Community mental health centers: has teams of social workers, therapists and
physicians that coordinate care of the patients
- Halfway houses: they offer people with long-term problems the opportunity to love
in a structured and supportive environment as they try to reestablish relationships.
- Day treatment centers: allow people to obtain treatment during the day, but sleep at
home.
However, there was not enough room to help everyone, and as a result, people needed to
leave and had to go back to their old home or to the streets.
Managed care: a collection of methods for coordinating care that ranges from simple
monitoring to total control over what care can be provided and paid for. The goal is to
coordinate services and to prevent future problems. Managed care can solve from of the
problems created by deinstitutionalization.
Professions within abnormal psychology
- Psychiatrists: MD degree, prescribe medications, conduct psychotherapies
- Clinical psychologists: PhD In psychology, conduct psychotherapy
- Marriage and family therapists: helping families, couples and children
- Clinical social workers: master’s degree in social work, focus on helping people with
psychological problems overcome social conditions
- Licensed mental health counselors: graduate training in counseling, but not a PhD
- Psychiatric nurses: degree in nursing, specialized in treatment of severe
psychological problems
Each of these professions has its rewards and limitations.
, Chapter 2: Theories and treatment of abnormality
Theory: a set of ideas that provides a framework for asking questions about a phenomenon
and for gathering and interpreting information about that phenomenon.
Therapy: a treatment, usually based on a theory of a phenomenon that addresses those
factors that cause the phenomenon.
Biopsychosocial approach: recognizing that the development of psychological symptoms
often results from a combination of biological, psychological and sociocultural factors. These
factors are often called risk factors, some risk factors may lead specifically to certain types of
symptoms, but most of the create an increased risk for a number of problems. Factors that
increase risk for multiple types of problems are called transdiagnostic risk factors. Most of
the times, you need multiple triggers in order to develop problems. Only when the risk factor
and the trigger come together in the same individual; they cause the disorder; this is called
the diathesis-stress model.
Biological approach to treating and understanding abnormality
Brain dysfunction is 1 of 3 causes of abnormality on which biological approaches are often
focused. The other 2 are biochemical imbalances and genetic abnormalities. These 3 can all
influence each other.
- Brain dysfunction: when your brain doesn’t function properly, you often show
problems in psychological functioning. The brain can be divided in 3 main regions:
hindbrain that consists of (medulla: controls breathing and reflexes, pons:
attentiveness and timing of sleep, cerebellum: coordination of movement, reticular
formation), midbrain that consists of (superior and inferior colliculus: relay sensory
information and control movement, substantia nigra: crucial part of pathway that
regulates responses to rewards), and the forebrain that consists of (thalamus: directs
incoming information from receptors to the cerebrum, hypothalamus: regulates
eating, drinking and sexual behavior and is involved in processing basic emotions,
pituitary gland: most important part of endocrine system, produces different
hormones and control secretion of other glands, limbic system: regulates instinctive
behaviors, it consists of different structures: amygdala (critical in emotions like fear),
hippocampus (plays a role in memory), and the last part of the forebrain is the
cerebrum: the outer layer is called cerebral cortex which is involved in advanced
thinking processes, composed of 2 hemispheres). Brain dysfunction can result from
injury. Dysfunctions in these areas are transdiagnostic risk factors.
- Biochemical imbalances: the brain requires a number of chemicals in order to work,
these include neurotransmitters and hormones that are produced by the endocrine
system. Neurotransmitters are biochemicals that act as messengers that carry
impulses from one neuron to another. A neuron consists of a cell body and dendrites.
They receive impulses from other neurons, that impulse travels down the axon, until
it reaches the synaptic terminals, here, neurotransmitters are released. Neurons
don’t touch each other, there is a synapse/synaptic gap between them,
neurotransmitters are released in this gap and then they bind to receptors
(molecules on the membrane) of the receiving neurons. How much neurotransmitter
is released, is based on 2 processes: reuptake (when the ‘sending’ neuron reabsorbs
the neurotransmitter that it just released) and degradation (when the ‘receiving’
