Samenvatting
Samenvatting Psychopathology
Dit is een Engelse samenvatting van het boek Psychopathology voor het tweedejaarsvak Klinische Psychologie.
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Voorbeeld 4 van de 64 pagina's
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Voorbeeld van de inhoud
PsychopathologyPart 1: Introducing Psychopathology: Concepts, Procedures
and Practces
Chapter 1: An Introducton to Psychopathology: Concepts, Paradigms
and Stgma
Learning outcomes
When you have completed this chapter, you should be able to:
1. Discuss the pros and cons of a number of diferent approaches to defning
psychopathology.
2. Describe important developments in the history of our understanding and response
to mental health problems.
3. Describe and evaluate the nature and causes of mental health stgma.
4. Compare and contrast approaches to the explanaton of psychopathology, including
historical approaches, the medical model and psychological models.
Introducton
Psychopathology is the study of deviatons from normal or everyday psychological or
behavioral functoning. Clinical psychology is the branch of psychology responsible for
understanding and treatng psychopathology.
We cannot atempt to defne psychopathology on the basis that some ‘normal’
functoning has gone wrong. This is because (1) we are stll some way from understanding
the various processes that contribute to psychopathology, and (2) many forms of behavior
that require treatment by clinical psychologists are merely extreme forms of what we would
call ‘normal’ or ‘adaptve’ behavior.
1.1A Brief History of Psychopathology
An historical perspectve on psychopathology and ‘madness’ is important because it
helps us to understand how our views of the causes of mental health problems have
changed and developed over tme, and it also helps us to understand how approaches to
treatng and dealing with mental health problems have changed.
1.1.1 Demonic Possession
Demonic possession refers to the fact that the individual had been ‘possessed’ in
some way.
Many forms of psychopathology are accompanied by what appear to be
changes in the individual’s personality, and these changes in personality or behavior
are some of the frst symptoms that are notced. The fact that an individual’s
personality seems to have changed has historically tended people towards describing
those exhibitng symptoms of psychopathology as being ‘possessed’ in some way.
Demonology is a belief that those exhibitng symptoms of psychopathology
were possessed by bad spirits, and the only way to exorcise these bad spirits was
with elaborate ritualized ceremonies that frequently involved direct physical ataccs
on the suferer’s body in an atempt to force out the demons.
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,1.1.2 The Medical or Disease Model
The medical model is an explanaton of psychopathology in terms of underlying
biological or medical causes.
General paresis is a brain disease occurring as a late consequence of syphilis,
characterized by dementa, progressive muscular weacness and paralysis. The
somatogenic hypothesis is the hypothesis that the causes or explanatons of
psychological problems can be found in physical or biological impairments.
The medical model of psychopathology that was fostered by the somatogenic
hypothesis was an important development because it introduced scientfc thincing
into our atempts to understand psychopathology, and shifed explanatons away
from those associated with cultural and religious beliefs. Psychiatry is a scientfc
method of treatment that is based on medicine, the primary approach of which is to
identfy the biological causes of psychopathology and treat them with medicaton or
surgery.
Despite its obvious importance in developing a scientfc view of
psychopathology and providing some infuental treatments, the medical model of
psychopathology has some important implicatons for the way we conceive mental
health problems. Firstly, an obvious implicaton is that it implies that medical or
biological causes underlie psychopathology. This is by no means always the case, and
bizarre behavior can be developed by perfectly normal learning processes.
Secondly, the medical model adopts what is basically a reductonist approach
by atemptng to reduce the complex psychological and emotonal features of
psychopathology to simple biology.
Finally, these is an implicit assumpton in the medical model that
psychopathology is caused by ‘something not worcing properly’. This ‘something is
brocen and needs to be fxed’ view of psychopathology is problematc for a couple of
reasons. First, rather than refectng a dysfuncton, psychopathology might just
represent a more extreme form of normal behavior. Second, by implying that
psychopathology is caused by a normal process that is brocen, the medical model
may have an important infuence on how we view people sufering from mental
health problems and how they might view themselves.
1.1.3 From Asylums to Community Care
In previous centuries, asylums were hospices converted for the confnement of
individuals with mental health problems. Moral treatment is an approach to the
treatment of asylum inmates, developed by the Quacer movement in the UK, which
abandoned contemporary medical approaches in favor of understanding, hope,
moral responsibility, and occupatonal therapy.
Milieu therapies were the frst atempts to structure the hospital
environments for patents, which atempted to create a therapeutc community on
the ward in order to develop productvity, independence, responsibility and feelings
of self-respect. Token economy is a reward system which involves partcipants
receiving tocens for engaging in certain behaviors which at a later tme can be
exchanged for a variety of reinforcing or desired items.
1.2Defning Psychopathology
Abnormal psychology is an alternatve defniton of psychopathology, albeit with
stgmatzing connotatons relatng to not being ‘normal’.
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, Service user groups are groups of individuals who are end users of the mental health
services provided by, for example, government agencies such as the NHS.
When considering how to defne psychopathology, we must consider not only
whether a defniton is useful in the scientfc and professional sense, but also whether it
provides a defniton that will minimize the stgma experienced by suferers, and
facilitate the support they need to functon as inclusive members of society.
1.2.1 Deviaton from the Statstcal Norm
We can use statstcal defnitons to decide whether an actvity or a psychological
atribute deviates substantally from the statistical norm (the mean, average, or
model example of a behavior). However, there are at least two important problems
with using deviatons from statstcal norms as indicatons of psychopathology. Firstly,
sometmes a beter approach would be to evaluate the specifc needs of individuals
with deviaton from the norm in a way that allows us to suggest strategies, services
and supports that will optmize individual functoning. Secondly, substantal deviaton
from the norm does not necessarily imply psychopathology because individuals with
high scores are also statstcally rare.
1.2.2 Deviaton from Social and Politcal Norms
We assume that socially normal and acceptable behaviors have evolved to represent
adaptve ways of behaving, and that anyone who deviates from these norms is
exhibitng psychopathology. However, it is very difcult to use deviaton from social
norms as a way of defning psychopathology.
First, diferent cultures ofen difer signifcantly in what they consider to be
socially normal and acceptable. Second, it is difcult to use cultural norms to defne
psychopathology because cultural factors seem to signifcantly afect how
psychopathology manifests itself. (1) social and cultural factors will afect the
vulnerability of an individual to causal factors; (2) culture can produce ‘culture-
bound’ symptoms of psychopathology which seem confned to specifc cultures and
can infuence how stress, anxiety and depression manifest themselves (examples are
Ataque de Nervios (a form of panic disorder found in Latnos from the Caribbean)
and Seizisman (a state of psychological paralysis found in the Haitan community));
and (3) society or culture can infuence the course of psychopathology.
1.2.3 Maladaptve Behavior and Harmful Dysfuncton
It is ofen temptng to defne psychopathology in terms of whether it renders the
individual incapable of adaptng to what most of us would consider normal daily
living. The problem with defning psychopathology solely in terms of maladaptve
behavior is apparent when we discuss forms of behavior that we might call
maladaptve, but we would not necessarily want to label as psychopathology.
A similar approach is to assume that mental health problems can be defned
as harmful dysfunction: the assumpton that psychopathology is defned by the
‘dysfuncton’ of a normal process that has the consequence of being in some way
harmful.
1.2.4 Distress and Disability
It is clearly the case that many individuals with severe symptoms of psychopathology
do sufer considerable personal distress. Defning psychopathology in terms of the
degree of distress and impairment expressed by the suferer is useful in a number of
ways. Firstly, it allows people to judge their own ‘normality’ rather than subjectng
them to judgments about their ‘normality’ made by others in society. Secondly,
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, defning psychopathology in terms of the degree of distress and impairment
experienced can be independent of the type of lifestyle chosen by the individual.
However, this defniton too has difcultes. Firstly, this approach does not
provide any standards by which we should judge behavior itself. Finally,
psychopathology classifcaton schemes do include so-called ‘disorders’ in which
diagnosis does not require that the suferer necessarily reports any personal distress
or impairment.
1.3Explanatory Approaches to Psychopathology
Despite the fact that symptoms of mental health problems seemed bafing to many
people, there was stll a strong desire to understand psychopathology, to describe its
causes, and, as a consequence, to develop efectve interventons.
1.3.1 Biological Models
Genetcs and neuroscience are two of the most important biological paradigms
through which researchers atempt to understand psychopathology. The discipline of
genetcs provides us with a variety of techniques that allow an assessment of
whether psychopathology symptoms are inherited or not, and neuroscience
techniques allow us to determine whether psychopathology symptoms are
associated with abnormalites or diferences in brain or central nervous system
functoning.
1.3.1.1 Genetcs
Genetics is the study of heredity and the variaton of inherited characteristcs.
The way in which genetcs might infuence psychopathology can be studied in a
variety of ways:
1. Concordance studies are studies designed to investgate the probability with
which family members or relatves will develop a psychological disorder
depending on how closely they are related – or, more specifcally, how much
genetc material they have in common.
2. Twin studies are studies in which researchers have compared the probability
with which monozygotc (MZ) and dizygotc (DZ) twins both develop
symptoms indicatve of a psychopathology in order to assess genetc
contributons to that psychopathology.
3. Because both families and twins are licely to share similar environments as
well as genes, interpretaton of family and twin studies can be difcult.
However, many of these difcultes of interpretaton can be overcome by
studying the offspringp of MZ and DZ twins rather than the twins themselves.
The diathesis-stress model is a model that suggests a mental health problem
develops because of an interacton between a genetc predispositon and our
interactons with the environment. Heritability is a measure of the degree to
which symptoms can be accounted for by genetc factors.
Molecular genetics is a genetc approach that seecs to identfy individual
genes that may be involved in transmitng psychopathology symptoms. Genetic
linkage analysis is a method of identfying individual genes by comparing the
inheritance of characteristcs for which gene locaton is cnown with the
inheritance of psychopathology symptoms.
Epigenetics is the study of changes in organisms caused by modifcaton or
gene expression rather than alteraton of the genetc code.
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