Klinische psychologie: psychopathology & capita selecta in clinical psychology
H1 An Introducton to Psychopathology: Concepts, Paradigms and Stgma
Introduction
Some terms (like crazy) difer ii circumstaices:
Beh deviates from iorm.
Uiclear about reasois someoie’s actois.
Whei beh seems irratoial.
Whei beh/actoi appears to be maladaptve/harmful.
Psychopathology = study of deviatois from iormal/everyday fuictoiiin.
Clinical psy = treatin uiderstaidiin psychopatholony.
Caiiot defie psychopatholony oi basis of ‘iormal’ fuictoiiin noie wroin:
Need to uiderstaid various processes coitributin to psychopatholony.
Maiy forms eh which require treatmeit are merely extreme forms of iormal/adaptve beh.
Extreme forms cai iiterfere w/ daily liviin.
1.1 A Brief History of Psychopathology
Historical perspectves oi psychopatholony importait because helps uiderstaid how views of
causes meital health problems have chained developed helps uiderstaid approaches to
treatmeit dealiin w/ meital health problems chained.
1.1.1 Demonic Possession
Expl psychopatholony = demonic possession.
Medical model = expl of psychopatholony ii terms of uiderlyiin biolonical or medical causes.
Maiy forms of psychopatholony accompaiied by ‘chaines’ ii iid persoiality or beh → beiin
possessed ii some way.
Possessioi = beh chained ii such way that persoiality appears to have beei takei over replaced.
Beiin labeled as ‘possessed’ → iot netin treatmeit ieeded maybe beiin abused.
Demonology: elaborate ritualized ceremoiies (physical atacks → iicr distress).
Demoiic possessioi stll commoi expl ii less developed areas (witchcraf voodoo also importait
ii culture). Parts of westeri Africa Hait. fei liiked to local relinious beliefs. Beliefs about spirit
possessioi cai be used to maiipulate beh, evei coerciin them iito acts of extreme brutality. Child
soldiers (abducted), trauma exposure, psy distress, hinher rate suicide, PTSD.
1.1.2 The Medical or Disease Model
As cultures develop, causes of atributoi of beh do too. Coiceptoi moved to treatin as disease
because of biolonical uiderstaidiin. Result of physical illiess.
Ackiowlednemeit syphilis as illiess w/ biolonical basis.
General paresis = braii disease as late symptom of syphilis. Demeita, pronressive muscular
weakiess paralysis.
Somatogenic hypothesis = causes or expl of psy problems cai be fouid ii physical or biolonical
impairmeits.
Medical model fostered by somatoneiic hypothesis. Iitroduciin scieitfc thiikiin. Expl away from
relinious cultural beliefs.
Psychiatry = scieitfc method of treatmeit based oi mediciie. Id biolonical causes of
psychopatholony treat them.
Atempt to expl symptoms ii terms of factors like braii abiormalites, biochemical imbalaices,
neietc factors, coineiital risk factors, etc. but iot oily way of expl.
Implicatois medical model:
Implies that medical or biolonical causes uiderlie psychopatholony. But iot always (→
learied beh). Arnues that maiy psy problems are result of iid acquiriin dysfuictoial ways
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, Klinische psychologie: psychopathology & capita selecta in clinical psychology
of thiikiin actin require these throunh iormal, fuictoial leariiin processes.
Experieices are dysfuictoial ii that case.
Adopts atemptin to reduce complex psy emotoial features of psychopatholony iito
simple biolony. Pheiomeiolony vs complex coniitve factors iivolved ii psy problems
reduced to simple biolony (biolonical reductoiism). fei iif of socio-ecoiomic situatoi,
poteital support.
Psychopatholony caused by ‘somethiin iot workiin properly’. Minht be just more extreme
form of iormal beh. Symptoms oi dimeisioi of iormal to distressiin, rather thai beiin
qualitatvely distict. View of pateits how they view themselves stnmatziin. abeled as
imperfect secoid-class citzeis.
1.1.3 From Asylums to Community Care
Asylum = hospices coiverted for coifiemeit of iid w/ meital health problems.
No coordiiated noverimeit respoise to meital health issues uitl 19 th ceitury. fei cruel aid
iihumaie. Established for fiaicial proft. Take too maiy pateits, medical treatmeits crude
paiiful.
Ii 19th ceitury nradual movemeit towards more humaie treatmeit. Phillipe Piiel iitroduced more
humaie treatmeits. Removiin chaiis restraiits, treat iimates as sick humai beiins.
Beijamii Rush ii USA.
Quaker movemeit (UK): moral treatment = abaidoi coitemporary medical approaches ii favor of
uiderstaidiin, hope, moral respoisibility occupatoial therapy.
(lifeloin) hospitalizatoi iot ecoiomically viable iot providiin eivir ii which pateits cai improve.
Burdei of care more aid more oi iurses ateidaits: lack traiiiin experieice. Pateits develop
social breakdowi syidrome (coifroitatoial challeiniin beh, physical annressiveiess, lack iiterest
persoial welfare/hynieie).
1950/1970: limitatois hospitalizatoi reconiized atempts to structure hospital eivir.
Milieu therapies = create therapeutc commuiity oi ward to develop productvity, iidep,
respoisibility feeliins of self-respect. Pateits more likely to be discharned from hospital
sooier less likely to relapse.
Token economy = reward system iivolviin pp receiviin tokeis for einaniin ii certaii beh.
Cai be exchained for reiiforciin/desired item. Pateits improve more, beter nroomed,
speid more tme ii actvites, less tme ii bed, make fewer disturbiin commeits.
Decliie of tokei ecoiomy because:
- enal ethical issues. Who, how loin, what available as reiiforcemeit?
- Maiiteiaice neieralizatoi of therapeutc efects. btaii reiiforcemeit avoid
puiishmeit → less useful.
- Uifouided miscoiceptois about iature efcacy. Not efectve, iot neieralizable, io iid
treatmeit, abusive coercive, iot practcal to implemeit coitext of preseit-day.
But afer that: leinth of stay reduced because of developmeit efectve early iiterveitoi
treatmeits, supportve commuiity care outreach pronrams. Developmeit more efectve
pharmacolonical psycholonical treatmeits. Became clear that most people cai no back liviin ii the
commuiity.
1963 US Coinress: Commuiity Meital Health. Rinht to receive broad raine of services. Assertve
commuiity treatmeit pronrams (= help people recover from psychotc episodes) assertve
outreach (= workiin w/ nroup w/ severe meital health problems who doi’t efectvely einane w/
meital health services).
1.2 Defning Psychopathology
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, Klinische psychologie: psychopathology & capita selecta in clinical psychology
Problems defiiin psychopatholony: defie psychopatholony itself termiiolony. Before: abnormal
psy. ‘Abiormal’ label may afect williiniess to iicl such members ii everyday actvites lead to
treatin such iid w/ suspicioi rather thai respect.
Service user groups = eid users of meital health services provided by noverimeit aneicies.
Defiitoi must be useful scieitfc, professioial, suferers members society.
1.2.1 Deviation from the Statistical Norm
Use statstcal defiitois to decide whether deviates from statstcal norm. Does it meet dianiostc
criteria?
But:
Evaluate specifc ieeds iid. Sunnest stratenies, services support that will optmize iid
fuictoiiin.
Substaital deviatoi from iorm doesi’t iecessarily imply psychopatholony. Cut-of poiits
subjectve.
Emotois uiderlyiin commoi meital health problems arei’t statstcally rare.
1.2.2 Deviation from Social and Political Norms
Deviatin from iorm implies psychopatholony?
Difereit cultures have dif iorms.
Cultural iorms seem to sini afect how psychopatholony maiifests itself. Afects vulierable
to causal factors, culture-bouid symptoms (iif by itself maiifestatoi).
o Ataque de Nervios: paiic disorder fouid ii atios from Caribbeai.
o Seizisman: psy paralysis fouid ii Haitai commuiity.
1.2.3 Maladaptive Behaviour and Harmful Dysfunction
Is persoi iicapable of adaptin? Not all maladaptve beh ieeds psychopatholony. It cai be that
‘psychopatholony’ forms have protectve or adaptve fuictoi.
Harmful dysfuncton = iormal process that has coisequeices of beiin harmful. itle kiowi about
mechaiisms braii.
Maiy commoi health problems coisidered as dimeisioial. Distressiin meital health symptoms
more extreme versiois of iormal emotois beh.
1.2.4 Distress and Disability
Is psychopatholony denree of distress impairmeit, expressed by the suferer?
Judne owi iormality.
Denree of distress impairmeit experieiced cai be iidep of type of lifestyle iid. How able
to cope w/ lifestyle, iot based oi societal iorms.
No staidards. eave cases because pateit doesi’t thiik of himself as distressed?
Classifcatoi schemes iiclude ‘disorders’ ii which dianiosis doesi’t require report of
distress or impairmeit of suferer. Bv persoiality disorders.
1.3 Explanatory Approaches to Psychopathology
Explaiatory paradinm:
Humais multfaceted (neietc, biolonical, beh psy processes iiterdep). Cai be studies
iidep. Specifc psychopatholony expl oi all difereit levels. Supplemeit each other to
provide richer uiderstaidiin.
1.3.1 Biological Models
Genetcs = study of heredity variatoi of iiherited charac.
Most beh neietc compoieit, so meital health problems too.
Studyiin neietcs iif psychopatholony:
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, Klinische psychologie: psychopathology & capita selecta in clinical psychology
Concordance studies = iivestnate probability which relatves will develop psy disorder
depeidiin oi how closely related how much neietc material shared.
Twin studies = compared probability MZ DZ twiis develop same symptoms of
psychopatholony to assess neietc coitributois.
fspriin of MZ DZ twiis. If oie twii does develop psychopatholony symptoms other
iot → neietc elemeit ii symptoms should show up ii childrei of either twii.
Meital health problem develops because of iiteractoi neies eivir = diathesis-stress model. May
trinner iiherited predispositoi. Heritability = denree to which symptoms cai be accouited for by
neietc factors. Near 1, more importait expl symptoms. Heritability Huitintoi’s disease very close
to 1, because domiiait neie.
Molecular genetcs = seek to ideitfy iid neies that may iivolve ii traismitin psychopatholony
symptoms.
Genetc linkage analysis: compariin iiheritaice of charac for which neie locatoi is kiowi
w/ iiheritaice psychopatholony symptoms. But symptoms ofei liiked to maiy neies.
Epigenetcs: chaines ii ornaiisms caused by modifcatoi neie expressioi. But pareits hune
iif. Chainiin iature DNA or trinner or iihibit expressioi.
Neuroscieice paradinm: seeks uiderstaidiin psychopatholony by id aspects of iid biolony that may
coitribute to symptoms. Braii structure fuictoi.
Corpus callosum: ierve fbers coiiectin 2 hemispheres braii.
Cerebral cortex: outer, coivoluted area braii.
ateral ceitral fssures divide cerebral cortex iito 4 lobes:
1. Occipital lobe: visual perceptoi.
2. Temporal lobe: memory processes.
3. Parietal lobe: visuomotor coordiiatoi.
4. Frontal lobe: executve fuictois (plaiiiin, decisioi makiin, etc.). Maiy types of
psychopatholony have abiormality or defcits ii this area.
Limbic system: comprisiin the hippocampus, mammillary body, amyndala, hypothalamus, foriix
thalamus. Iivolved ii emotoi leariiin.
Hippocampus: spatal leariiin.
Amygdala: renioi coordiiatin ateitoi to emotoially relevait stmuli. Mostly fear. Formatoi
storane of emotoi-relevait stmuli provides feedback to thalamus for appropriate motor actoi.
Brain ntm: chemicals that help ieurois to commuiicate are esseital compoieits of mechaiisms
that renulate efcieit efectve braii fuictoiiin.
Dopamine: precursor of other substaices, iicl adreialii. Schizophreiia psychotc
symptoms. Motvatoi reward, ateitoi leariiin.
Serotonin: low levels ass w/ depressioi.
Norepinephrine: plays role ii aixiety symptoms.
Gamma-aminobutyric acid (GABA): role ii aixiety symptoms.
1.3.2 Psychological Models
Some approaches of uiderstaidiin expl meital health problems see them as symptoms produced
by uiderlyiin cause, but causes psy rather thai biolonical or medical. Cause iormal adaptve
reactoi to difcult or stressful life coiditois.
The psychoaialytcal or psychodyiamic model by Sigmund Freud Breuer. Uiderstaid causes of
mysterious physical symptoms w/out obvious medical causes. Tried hypiosis to treat.
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