CHAPTER 1 ABNORMAL BEHAVIOUR IN HISTORICAL CONTEXT WHAT IS A PSYCHOLOGICAL DISORDER? (PP.2-3) APPROACHES TO DEFINING ABNORMAL BEHAVIOUR

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1 1 Historical Context 2 CHAPTER 1 ABNORMAL BEHAVIOUR IN HISTORICAL CONTEXT (PP. 2-31) Dysfunction Distress Supernatural Demons Poss. Definition Atypical (Culture) Biological DSM Past Bio Treat. Integrative Approach Psychological Present Scientist Practitioner Cognitive Clinical Description Cause Science Goals Greeks 19C Psychoanalytic Humanistic Behavioural Treatment Outcome WHAT IS A PSYCHOLOGICAL DISORDER? (PP.2-3) No single definition of psychological abnormality or of psychological normality (+1) Three criteria appear important (above, F1.1, +2) Psychological Dysfunction Distress or Impairment Atypical Response 3 APPROACHES TO DEFINING ABNORMAL BEHAVIOUR (PP.2-3) Inadequate Single Criteria Does infrequency define abnormality? Does suffering define abnormality? Does strangeness define abnormality? Does the behaviour itself define abnormality? Should normality serve as a guide? Many myths about qualities associated with mental illness also inadequate Lazy, dumb, Weak character Danger to self or others Hopeless situation, incurable, 4 WHAT IS A PSYCHOLOGICAL DISORDER? (P. 3-6) A Psychological Disorder is: A psychological dysfunction within an individual Breakdown in cognitive, emotional, or behavioural functioning Associated with distress or impaired functioning Difficulty performing appropriate and expected roles Not typical or culturally expected Impairment occurs in context of person s background Reaction is outside cultural norms Synonyms: Abnormal Behaviour, Mental Illness (less preferred), Psychopathology, 5 THE DIAGNOSTIC AND STATISTICAL MANUAL (DSM-IV) (P. 6) Widely used system for classifying psychological problems and disorders Contains diagnostic criteria for behaviours that Fit a pattern Cause dysfunction or subjective distress Are present for a specified duration And not otherwise explainable About to release DSM-V Other major system is WHO s ICD 6 1

2 THE PAST: HISTORICAL CONCEPTIONS (PP. 9) Major psychological disorders have existed In all cultures Across all time periods Causes (interpretations) and treatment of abnormal behaviour varied widely Across cultures Across time periods Particularly as a function of prevailing paradigms or world views Three dominant traditions include: Supernatural, Biological, and Psychological 7 Deviant behaviour as Battle of Good vs. Evil Caused by demonic possession, witchcraft, sorcery Mass hysteria (St. Vitus dance or Tartanism) and church Treatments included exorcism (right image), torture, beatings, and crude surgeries Movement of Moon and Stars as cause of deviant behaviour Paracelsus and lunacy Both Outer Force views popular during Middle Ages Few believed that abnormality was illness on par with physical disease 8 SUPERNATURAL TRADITION (PP. 9-12) BIOLOGICAL TRADITION (PP ) Hippocrates : Abnormal behaviour as physical disease Hysteria The Wander Uterus Galen extended Hippocrates work Humoral theory: black bile (melancholic), yellow bile (choleric), blood (sanguine), and phlegm (phlegmatic) Treatments remained crude Galen-Hippocrates tradition Foreshadowed modern views linking abnormality with brain chemical imbalances 9 'Sickness is not sent by the gods or taken away by them. It has a natural basis. If we can find the cause, we can find the cure.' BIOLOGICAL TRADITION IN 19 TH CENTURY (PP ) General Paresis (Syphilis) and biological link with madness 10 Associated with several unusual psychological and behavioural symptoms Pasteur (below) discovered cause: a bacterial microorganism Led to penicillin as successful treatment Bolstered view that mental illness = physical illness and should be treated as such John Grey, Dorothea Dix, and the Reformers (+1) 11 DEVELOPMENT OF 12 BIOLOGICAL TREATMENTS (PP ) Mental Illness = Physical Illness 1930 s: Biological treatments standard practice Insulin shock therapy, ECT (top), and brain surgery (i.e., lobotomy) By 1950 s several medications established Include neuroleptics such as reserpine (plant-based, right), major tranquilizers 2

3 PSYCHOLOGICAL TRADITION (PP ) Moral therapy Allow institutionalized patients to be treated as normal as possible and to encourage and reinforce social interaction Philippe Pinel and Jean-Baptiste Pussin William Tuke followed Pinel s lead in England Benjamin Rush led reforms in USA Clarence Hinks was mental health reformer and crusader in Canada Reasons for falling out of moral therapy Emergence of competing alternative psychological models 13 Rise of Moral Therapy Treat institutionalized patients as normal as possible; encourage and reinforce social interaction Philippe Pinel (right image) and Jean-Baptiste Pussin William Tuke followed Pinel s lead in England Benjamin Rush led reforms in United States Clarence Hinks was mental health reformer and crusader in Canada. Reasons for falling out of moral therapy Emergence of competing alternative psychological models THE PSYCHOLOGICAL TRADITION (PP ) 14 PSYCHOANALYTIC THEORY (PP.17-21) Freudian theory of structure and function of mind Mind s Structure (+1) Id: pleasure principle; illogical, emotional, irrational Ego: reality principle; logical and rational Superego: moral principles; keeps Id and Ego in balance Defense mechanisms When Ego loses battle with Id and Superego Displacement and denial Rationalization and reaction formation Projection, repression, and sublimation Freudian Stages of Psychosexual Development Oral, Anal, Phallic, Latency, and Genital stages 15 Freudian Theory 16 NEO-FREUDIAN DEVELOPMENTS IN PSYCHOANALYTIC THOUGHT Anna Freud and self-psychology Emphasized influence of ego in defining behaviour Melanie Klein, Otto Kernberg, and object relations theory Emphasized how children incorporate (introject) objects Examples include images, memories, and values of significant others (objects) Others developed concepts different from those of Freud Carl Jung, Alfred Adler, Karen Horney, Erich Fromm, and Erik Erickson Neo-Freudians generally de-emphasized sexual core of Freud s theory (PP.21) 17 Unearth hidden intrapsychic conflicts ( the real problems ) Therapy often long term Techniques: Free association Dream analysis Examined transference and counter-transference issues Little evidence for efficacy PSYCHOANALYTIC THERAPY (P.21-23) 18 3

4 HUMANISTIC THEORY (PP ) Carl Rogers, Abraham Maslow, and Fritz Perls Major Theme People are basically good Humans strive toward selfactualization Treatment Therapist conveys empathy and unconditional positive regard Minimal therapist interpretation No strong evidence that humanistic therapies work 19 BEHAVIOURAL MODEL (PP.23-25) Derived from scientific approach to study of psychopathology 20 Classical Conditioning: Ivan Pavlov (left image), John B. Watson Ubiquitous form of learning Conditioning involves correlation between neutral stimuli and unconditioned stimuli (+1) Extended to acquisition of fear (Albert +1) Operant Conditioning: Edward Thorndike, B. F. Skinner Another ubiquitous form of learning Most voluntary behaviour controlled by consequences that follow behavior Reinforcement and Punishment Both traditions greatly influenced development of behaviour therapy CLASSICAL CONDITIONING OPERANT CONDITIONING Video BEGINNINGS OF BEHAVIOUR THERAPY (PP ) Reactionary movement against psychoanalysis and non-scientific approaches Early Pioneers Joseph Wolpe: Systematic desensitization For treatment of phobias (e.g., snakes) Arnold Lazarus: Multi-modal behaviour therapy Hans Eysenck: Conditioning therapy Aaron Beck: Cognitive therapy Albert Bandura: Social learning or cognitive-behaviour therapy Stanley Rachman: an original founder of behaviour therapy Behaviour therapy tends to be time-limited and direct Strong evidence supporting efficacy of behaviour therapy 23 COGNITIVE PSYCHOLOGY (NOT IN TEXT) Reaction to behaviorist denial of role for mental processes, BUT believed in scientific study rather than subjective approaches (e.g., introspection) Adoption of Information Processing Model (+1) and later Connectionist / Neural Network models (e.g., early Freud model & Lang model for phobia +2) Number of cognitive processes hypothesized to contribute to psychopathology Selective Attention: people with certain psychological disorders more sensitive to stimuli related to their disorder (e.g., depressed people more attuned to depressive stimuli +3) 24 4

5 INFORMATION PROCESSING MODEL Freud connectionist model Lang (1979) Reaction Time (ms) Sad Unhappy Crying Dog Table Knife Depression Words Non- Depressed Words 27 PRESENT: SCIENTIFIC METHOD AND AN INTEGRATIVE APPROACH (PP. 27) Psychopathology multiply determined One-dimensional accounts incomplete Must consider reciprocal relations between Biological, Psychological, Social, and Experiential factors Defining abnormal behaviour is also complex, and multifaceted, and has evolved Supernatural tradition has no place in science of abnormal behaviour Many practitioners and laypeople treat people with psychological disorders (+1 +2) 28 Diverse people deal with clients / patients Psychologists Ph.D. s: Clinical and counseling psychologists Psy.D. s: Clinical and counseling Doctors of Psychology In Canada, regulation of profession of psychologist is under jurisdiction of provinces and territories. Other Mental Health Professionals and Lay Practitioners M.D. s: Psychiatrists M.S.W. s: Psychiatric and non-psychiatric social workers MN/MSN s: Psychiatric nurses Lay public and community groups Number of some practitioners in Canada (+1) 29 Mental Health Professionals MD PhD PsyD MA 30 5

6 DIMENSIONS OF SCIENTIST- PRACTITIONER MODEL (P. 7-8) Psychologists (somewhat) united by Scientist- Practitioner Framework Three Dimensions Producers of research Consumers of research Evaluate their work using Empirical methods 31 SCIENTIST-PRACTITIONERS (PP. 7-8) Three Major Goals of Psychological Research 32 Begin with presenting problem Distinguish clinically significant dysfunction from common human experiences Describe Incidence and Prevalence of disorders Describe onset of disorders Acute vs. Insidious onset Describe course of disorders Episodic, Time-limited, or Chronic course CLINICAL DESCRIPTION (PP. 8) 33 CAUSATION, TREATMENT, AND OUTCOME IN PSYCHOPATHOLOGY Etiology or Causation: What factors contribute to development of psychopathology? Treatment: How to best improve lives of people suffering from psychopathology? Treatment development: includes Pharmacologic, Psychosocial, and / or Combined treatments Outcome: How do we know that we have alleviated psychological suffering? Evaluate efficacy (effectiveness) of treatments Challenging because of many confounding factors (PP. 8) 34 6