Ch. 1 Abnormal Psychology: Past and Present

Question 1

The 4 Ds

Answer 1

DEVIANCE - Different, extreme, unusual, bizarre

DISTRESSING - Unpleasant and upsetting

DYSFUNCTIONAL - Interferes with a person’s ability to conduct daily activities in a constructive way

DANGER - Possibly dangerous either to themselves or to others Psych abnormality

Question 2

Abnormality and Context

Answer 2

There is no agreed-upon definition of ABNORMALITY but most definitions include the 4 Ds.

• Because behavior must be considered in the context in which it occurs, the concept of abnormality depends on the norms and values of the society in question.

Question 3

Treatment of Abnormality

Answer 3

TREATMENT – A procedure designed to change abnormal behavior into more normal ones.

According to Clinical Theorist, JEROME FRANK, All forms of therapy have 3 things:

1. A sufferer who seeks help from a healer
2. A trained, socially accepted healer, whose expertise is accepted by the sufferer or their social group
3. A series of contacts between the sufferer and healer (healer tries to produce a change in the patient’s emotional state, behavior, etc)

• If the situation does not meet these 3 criteria, then it isn’t considered ‘Therapy’.

Perception of Patients – helps determine how therapy is applied.

• Some clinicians view abnormality as an illness and so consider therapy a procedure that helps cure the illness.
  
  • Those who see abnormality as an illness speak of the “patient”.
• Others see abnormality as a problem in living and so try to teach more functional behavior and thought.
  
  • While those who view it as a problem in living refer to the “client.”

Question 4

Prevalence of Abnormality

Answer 4

• At any given time, as many as 30 percent of the adults and 19 percent of the children and adolescents in the United States display serious psychological disturbances and are in need of clinical treatment.

Question 5

Ancient Views and Treatments, Trephination and Demonology

Answer 5

DEMONOLOGY– Ancient Societies probably regarded abnormal behavior as the work of evil spirits.

• The belief was widespread as there was no ‘logical’ reason for abnormal behavior, which was probably quite scary and disturbing to people who had no other explanation available. Egyptians, Chinese, and Hebrew ( along with others) have written about demons.
• Treatments beginning as early as 500,000 years ago typically consisted of procedures meant to remove the evil spirits from the victim’s body.

TREPHINATION – Using stone tools to cut circles out of the skull to release demons.

Question 6

Greek and Roman Views and Treatments

Answer 6

HIPPOCRATES (460-377 B.C.) – Considered father of modern medicine.

• Saw abnormality as a disease arising from internal physical problems.
• HUMORS – According to the Greeks and Romans, were bodily chemicals that influence mental and physical functioning.
• Believed all diseases were caused by an imbalance of 4 fluids (HUMORS) that flow through the body:
  
  1. yellow bile
  2. black bile
  3. blood
  4. phlegm.
• So his treatments were focused on correcting physical pathology.
• Greek Philosophers, Plato and Aristotle agreed with Hippocrates that Abnormal Behavior had its roots in the physical body.
• With the rise of the Greek and Roman Empires and the rise of science, the old views of DEMONOLOGY fell out of favor as the reason for Abnormal Behavior.

Question 7

Europe in the Middle Ages, Tarantism, and Lycanthropy

Answer 7

RETURN of DEMONOLOGY – With the decline of Rome, demonological views and practices became popular once again.

• 500-1350 A.D power of the clergy greatly increases
• Church rejected scientific investigations and controlled all education
  
  • ​Abnormal behavior apparently increased greatly during this period.
• Religious beliefs were highly superstitious and demonological
• Deviant behavior and psychological abnormality were evidence of satan’s influence
• The cure was to rid the evil of the body through chants and prayers and if that didn’t work they tried other methods such as torture (these ‘procedures’ were led by clergy)

MASS MADNESS of DEMONOLOGY:

• TARANTISM – (also known as Saint Vitus’ dance), groups of people would suddenly start to jump, dance, and go into convulsions. All were convinced that they had been bitten and possessed by a tarantula, and they sought to cure their disorder by performing a dance called a TARANTELLA.
• LYCANTHROPY – In another form of mass madness, lycanthropy, people thought they were possessed by wolves or other animals. They acted wolflike and imagined that fur was growing all over their bodies – likely the origin of the Werewolf mythology.

Question 8

Renaissance & Rise of Asylums, Gheel in Belgium

Answer 8

RENAISSANCE – Towards the end of the middle ages, DEMONOLOGY declined and medical views were becoming more accepted. Many people with psychological issues were treated as hospitals.

• The Renaissance was marked by the “Return to the Classics” referring specifically to the classics of the Ancient Greeks and Romans, so it was appropriate that the Renaissance returned treatment back to a scientific path.

JOHANN WEYER (1515-1588) – First physician to specialize in mental illness. Considered the founder of the modern study of psychopathology.

• Hospitals and monasteries were converted into ASYLUMS, A type of institution that first became popular in the sixteenth century to provide care for persons with mental disorders.
• Asylums started with good intentions but quickly became overcrowded and living conditions became poor and patients were treated horribly. Essentially, asylums became virtual prisons.

GHEEL in BELGIUM – a famous religious shrine devoted to the humane and loving treatment of people with mental disorders.

• Became the world’s first “colony” of mental patients. Gheel was the forerunner of today’s community mental health programs.

Question 9

Psychopathology

Answer 9

PSYCHOPATHOLOGY – A State that results in behaviors that are perceived as psychologically abnormal.

Question 10

Abnormal Psychology

Answer 10

The scientific study of abnormal behavior undertaken to describe, predict, explain, and change abnormal patterns of functioning.

Question 11

Deviance (One of the 4 Ds)

Answer 11

A behavior is DEVIANT if it is markedly different from a society’s ideas about proper functioning.

• Judgments about what constitutes abnormality vary from society to society. A society’s NORMS grow from its particular CULTURE.
• Behavior that breaks legal norms is considered to be criminal. Behavior, thoughts, and emotions that break norms of psychological functioning are called ABNORMAL.

Question 12

Distress (One of the 4 Ds)

Answer 12

In order for behavior or thought to be considered ABNORMAL, it must cause DISTRESS.

• If thoughts or behaviors we consider strange but do not put anyone in distress, then they are usually written off as ECCENTRIC. Why fix a behavior if it is harmless or even helpful?
  
  • Their positive feelings must cause us to hesitate before we decide that they are functioning abnormally.
• Must distress always be present before a person’s functioning can be considered abnormal? Not necessarily. Some people who function abnormally maintain a positive frame of mind personally. Thus, we must also consider if the person’s behavior creates DISTRESS in general – to others, for example.
  
  • Ex: A person who hears voices might feel empowered, but if he’s following the voice’s instruction to kill people, then there is clearly distress, even if it is not his.

Question 13

Dysfunction (One of the 4 Ds)

Answer 13

DYSFUNCTION – means that the behavior interferes with daily functioning. It so upsets, distracts, or confuses people that they cannot care for themselves properly.

Question 14

Danger (One of the 4 Ds)

Answer 14

DANGER – Perhaps the ultimate psychological dysfunction is behavior that becomes dangerous to oneself or others.

• Although danger is often cited as a feature of abnormal psychological functioning, research suggests that it is actually the exception rather than the rule.
  
  • Most people struggling with anxiety, depression, and even bizarre thinking pose no immediate danger to themselves or to anyone else.

Question 15

Thomas Szasz (1920–2012

Answer 15

THOMAS SZASZ (1920–2012) – a Clinical Theorist who placed such emphasis on society’s role that he found the whole concept of mental illness to be invalid,

• According to Szasz, the deviations that society calls abnormal are simply “problems in living,” not signs of something wrong within the person.

Question 16

Eccentric vs. Abnormal

Answer 16

The biggest difference between ECCENTRIC and ABNORMAL, both of which can seem DEVIANT, DISTRESSFUL, and DYSFUNCTIONAL, is that:

• …most professionals find no reason to intervene with an ECCENTRIC primarily because they are able to take care of themselves and pose NO DANGER to themselves or others.
  
  • In fact, those deemed ECCENTRIC are often high-functioning, if not reclusive individuals.
• …if there is need for intervention because the person is unable to care for themselves or poses a danger, then the behavior is likely to shift toward ABNORMAL.
• In fact, the “15 Characteristics Common to eccentrics” in a large study by Researcher David Weeks range from beneficial to benign, but none range into the negative or malevolent end of the behavioral spectrum.
  
  • 15 Characteristics of Eccentrics: nonconformity, creativity, strong curiosity, idealism, extreme interests and hobbies, lifelong awareness of being different, high intelligence, outspokenness, noncompetitiveness, unusual eating and living habits, disinterest in others’ opinions or company, mischievous sense of humor, nonmarriage, eldest or only child, and poor spelling skills.
• Whereas the unusual behavior of persons with mental disorders is thrust upon them and usually causes them suffering, eccentricity is chosen freely and provides pleasure. In short, “Eccentrics know they’re different and glory in it”
• In fact, Weeks found that eccentrics in his study actually had fewer emotional problems than individuals in the general population.

Question 18

Johann Weyer (1515 - 1588)

Answer 18

JOHANN WEYER (1515-1588) – First physician to specialize in mental illness. Considered the founder of the modern study of psychopathology.

• Also began the first ASYLUMS, I think.

Question 19

19th Century: Moral Treatment with Pinel and Tuke

Answer 19

La Bicêtre – an asylum in Paris for male patients, was the first site of asylum reform. In 1793, during the French Revolution, PHILIPPE PINEL (1745–1826) was named the chief physician there.

• He argued that the patients were sick people whose illnesses should be treated with sympathy and kindness rather than chains and beatings.
• He allowed them to move freely about the hospital grounds; replaced the dark dungeons with sunny, airy rooms; and offered support and advice. Pinel’s approach proved remarkably successful.
• Pinel later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière.

WILLIAM TUKE (1732–1819) was bringing similar reforms to northern England. In 1796 he founded the York Retreat,

MORAL TREATMENT – The methods of Pinel and Tuke, called moral treatment because they emphasized moral guidance and humane and respectful techniques.

Question 20

Moral Treatment in America: Benjamin Rush and Dorothea Dix, and State Hospitals

Answer 20

BENJAMIN RUSH (1745–1813) – The person most responsible for the early spread of moral treatment in the United States was, an eminent physician at Pennsylvania Hospital who is now considered the father of American psychiatry. Limiting his practice to mental illness, Rush developed humane approaches to treatment.

DOROTHEA DIX (1802 - 1887) – was a Boston school-teacher who made humane care a public and political concern in the United States.

• As a result, Each state was made responsible for developing effective public mental hospitals, or STATE HOSPITALS, all of which were intended to offer moral treatment.

DECLINE of MORAL TREATMENT – By the 1850s, many issues brought the STATE HOSPITALS down to a level of basic custodial care and little healing:

• Money and staffing shortages
• Overcrowding
• Declining recovery rates
• The incorrect assumption that ALL mental patients would recover.
• Growing prejudice against people with mental disorders
• Influx of poor foreign immigrants, whom the public had little interest in helping

Question 21

Somatogenic (Kraepelin, Kraft-Ebing) vs. Psychogenic Perspectives (Breuer, Freud)

Answer 21

SOMATOGENIC PERSPECTIVE – The view that abnormal functioning has physical causes.

• EMIL KRAEPELIN (1856–1926). In 1883, Kraepelin published an influential textbook arguing that physical factors, such as fatigue, are responsible for mental dysfunction.
  
  • He developed the first modern system for classifying abnormal behaviors, listing their physical causes and discussing their expected course.
• SYPHILIS – One of the most important discoveries was that an organic disease, syphilis, led to general paresis, an irreversible disorder with both mental symptoms such as delusions of grandeur and physical ones like paralysis.
• RICHARD VON KRAFT-EBING (1840-1902) – Determined through experimentation a new understanding of general paresis, which led many researchers and practitioners to suspect that physical factors were responsible for many mental disorders, perhaps all of them.
• These discoveries led to proposals for immoral solutions such as eugenic sterilization, the elimination (through medical or other means) of the ability of individuals to reproduce.
  
  • 1927 – The U.S. Supreme Court ruled that eugenic sterilization was constitutional.
• Not until the 1950s, when a number of effective medications were finally discovered, did the somatogenic perspective truly begin to pay off for patients.

PSYCHOGENIC PERSPECTIVE – The view that the chief causes of abnormal functioning are psychological.

• Gained popularity only AFTER Hypnotism demonstrated its potential.
• Friedrich Anton Mesmer (1734–1815) – was able to put people in a trancelike mental state with extreme suggestibility, a treatment called MESMERISM.

JOSEF BREUER (1842–1925) of Vienna. Breuer, a physician, discovered that his patients sometimes awoke free of hysterical symptoms after speaking candidly under hypnosis about past upsetting events.

• Breuer was joined in his work by another Viennese physician, SIGMUND FREUD (1856–1939), which eventually led him to develop the theory of PSYCHOANALYSIS, which holds that many forms of abnormal and normal psychological functioning are PSYCHOGENIC.
  
  • In particular, Freud believed that unconscious psychological processes are at the root of such functioning.
  • Freud and his followers offered psychoanalytic treatment to patients in their offices for sessions of approximately an hour—a format now known as OUTPATIENT THERAPY.

Question 22

Ignorant Society Regarding Mental Disorders

Answer 22

Surveys have found that:

• 43% think that people bring mental disorders on themselves
• 31% consider such disorders to be a sign of personal weakness
• 35% believe the disorders are caused by sinful behavior

Question 23

Psychotropic Medication

Answer 23

PSYCHOTROPIC DRUGS – drugs that primarily affect the brain and reduce many symptoms of mental dysfunction. They included:

• Antipsychotic drugs, which correct extremely confused and distorted thinking.
• Antidepressant drugs, which lift the mood of depressed people.
• Antianxiety drugs, which reduce tension and worry.

Question 24

Deinstitutionalization, Outpatient Care, and the Community Mental Health Approach

Answer 24

DEINSTITUTIONALIZATION – the process of removing the mentally ill from institutions.

• Since the discovery of PSYCHOTROPIC medications, mental health professionals have followed a policy of deinstitutionalization, releasing hundreds of thousands of patients from public mental hospitals.
• In 1955, close to 600,000 people were confined in public mental institutions across the United States. Today the daily patient population in the same kinds of hospitals is around 42,000.
• OUTPATIENT CARE has now become the primary mode of treatment for people with severe psychological disturbances as well as for those with more moderate problems.
  
  • When severely disturbed people do need institutionalization these days, they are usually hospitalized for a short period of time. Ideally, they are then provided with outpatient psychotherapy and medication in community programs and residences
• COMMUNITY MENTAL HEALTH APPROACH – The current emphasis on community care for people with severe psychological disturbances
  
  • The approach has been helpful for many patients, but too few community programs are available.
  • As a result, hundreds of thousands of persons with severe disturbances fail to make lasting recoveries.
  • After release from the hospital, they at best receive minimal care and often wind up living in decrepit rooming houses or on the streets.
  • Around 140,000 people with such disturbances are homeless on any given day; another 440,000 are inmates of jails and prisons

Question 25

Treatment of Less Severe Disturbances

Answer 25

Since the 1950s, OUTPATIENT CARE has continued to be the preferred mode of treatment for people with moderate psychological disturbances.

• Outpatient care usually takes the form of PRIVATE PSYCHOTHERAPY and addresses everything from ANXIETY and DEPRESSION to “PROBLEMS of LIVING” like difficulties dealing with marriage, family, peers, school, etc.
  
  • Around 60% of people with psychological disorders in the United States receive treatment in the course of a year.
  • At least 20% of clients enter therapy because of milder problems in living.
  • Another change in outpatient care since the 1950s has been the development of programs devoted exclusively to specific psychological problems.
    
    • Ex: suicide prevention centers, substance abuse programs, eating disorder programs, phobia clinics, and sexual dysfunction programs.

Question 26

Prevention

Answer 26

PREVENTION of psychological disorders is relatively new, with community programs trying to correct the social conditions that underlie psychological problems (poverty or violence in the community, for example).

Another recent development is a focus on an aspect of the field called POSITIVE PSYCHOLOGY – the study and promotion of:

• Positive Feelings (such as optimism and happiness)
  
  • Developed through GRATITUDE
• Positive Traits (like hard work and wisdom)
  
  • Developed through MINDFULNESS
• Group-directed Virtues, (including altruism and tolerance)
  
  • Developed through KINDNESS

Question 27

Multicultural Psychology

Answer 27

MULTICULTURAL PSYCHOLOGY – The field that examines the impact of culture, race, ethnicity, and gender on behaviors and thoughts, and focuses on how such factors may influence the origin, nature, and treatment of abnormal behavior.

Question 28

3 Methods of Clinical Investigation, Case Study, Correlational and Experimental Methods

Answer 28

Clinical researchers depend mainly on three methods of investigation:

CASE STUDY – typically a study of an individual, which allows deep insights into a specific person’s life and psychological problems.

• Benefits include:
  
  • Providing a NOMOTHETIC (relating to the study or discovery of general scientific laws) role for further inquiry.
  • May offer support for an existing theory or hypothesis.
  • May challenge an existing theory.
  • May show the value of new therapeutic techniques.
  • May offer opportunities to study unusual problems that do not occur often enough to permit a large number of observations, such as dissociative identity (multiple personalities) disorder.
• Limitations include:
  
  • Reported by biased observers
  • Relies on subjective evidence
  • Provides little basis for generalization
  • Events or treatments in one case may not be transferrable to other cases.

The limitations of Case Studies are largely addressed by two other methods: Correlational and Experimental, which offer 3 important features:

1. The researchers typically observe many individuals.
2. The researchers apply procedures uniformly and can thus replicate their investigations.
3. The researchers use statistical tests to analyze the results of their studies and determine whether broad conclusions are justified.

CORRELATIONAL METHOD – A research procedure used to determine the degree to which events or characteristics vary along with each other.

• Testing to REJECT THE NULL HYPOTHESIS (which states that the difference obtained using a sample cannot be explained by random sampling error alone) by Scientists must then decide whether the correlation they find in a given sample accurately reflects a real correlation in the general population.
• Benefits include:
  
  • Can generalize their correlations to people beyond the ones they have studied.
  • Researchers can easily repeat correlational studies using new samples of participants to check the results of earlier studies.
• Limitations include:
  
  • Although correlations allow researchers to describe the relationship between two variables, they do not explain the relationship (i.e. They do NOT explain CAUSALITY).
  • When two things are correlated, the CAUSAL input to the correlation could be one of the things that is correlated, but it could also be a third factor not currently being considered, referred to as a CONFOUNDING FACTOR.
  • Even so, correlation gives meaningful clues towards discovering causality.

EXPERIMENTAL METHOD – a research procedure in which a variable is manipulated and the manipulation’s effect on another variable is observed.

• The manipulated variable is called the INDEPENDENT VARIABLE.
• The observed variable is called the DEPENDENT VARIABLE.
• As with correlational studies, investigators who conduct experiments must do a statistical analysis on their data and find out how likely it is that the observed improvement is due to chance (i.e. Can they REJECT the NULL HYPOTHESIS and declare the findings STATISTICALLY SIGNIFICANT?)
  
  • If the true cause of changes in the dependent variable cannot be separated from other possible causes, then an experiment gives very little information.
  • Thus, experimenters must try to eliminate all CONFOUNDS from their studies—variables other than the independent variable that may also be affecting the dependent variable. To guard against CONFOUNDING VARIABLES, researchers mus include THREE important features in their experiments:
    
    1. CONTROL GROUP – a group in addition to the experimental group that does not receive the treatment in question in order to compare the effects of receiving vs. not receiving the treatment.
       
       • Control Group – In an experiment, a group of participants who are not exposed to the independent variable.
       • Experimental Group – In an experiment, the participants who are exposed to the independent variable under investigation.
    2. RANDOM ASSIGNMENT – A selection procedure that ensures that participants are randomly placed either in the control group or in the experimental group.
    3. MASKED DESIGN – To avoid bias, individuals are kept unaware of their assigned group.
       
       • Neither the participants nor the researcher (to prevent EXPERIMENTER BIAS or ROSENTHAL EFFECT) should know which participants are in each group – called a DOUBLE-BLIND or DOUBLE MASKED DESIGN.
  • Benefits include:
    
    • The discovery of CAUSALITY – Experiments can answer questions about causality
      
      • Ex: “Does a particular therapy relieve the symptoms of a particular disorder?”

Question 29

Alternative Research Designs: matched, natural, analogue, single-subject, longitudinal, and epidemiological

Answer 29

Clinical scientists must often settle for research designs that are less than ideal. These alternative designs are often called QUASI-EXPERIMENTAL designs, or MIXED designs—designs that fail to include key elements of a “pure” experiment or intermix elements of both experimental and correlational studies.

MATCHED DESIGN – investigators do not randomly assign participants to control and experimental groups, but instead make use of groups that already exist in the world at large.

• Ex: To study the effects of child abuse, you can’t abuse children and then see what happens. Instead, you have to choose participants who have already been subject to child abuse.
  
  • To make this comparison as valid as possible, the researchers match the experimental participants (abused children) with control participants (non-abused children) who are similar in age, sex, race, number of children in the family, type of neighborhood, or other characteristics.

NATURAL EXPERIMENT – nature itself manipulates the independent variable, while the experimenter observes the effects.

• Natural experiments must be used for studying the psychological effects of unusual and unpredictable events, such as floods, earthquakes, plane crashes, and fires.

ANALOGUE EXPERIMENT – Researchers induce laboratory participants to behave in ways that seem to resemble real life abnormal behavior and then conduct experiments on the participants in the hope of shedding light on the real-life abnormality.

• Ex: Investigator Martin Seligman in a classic body of work, has produced depressionlike symptoms in laboratory participants by repeatedly exposing them to negative events (shocks, loud noises, task failures) over which they have no control. In these “learned helplessness” analogue studies, the participants seem to give up, lose their initiative, and become sad. (suggesting to some clinicians that human depression itself may indeed be caused by loss of control over the events in one’s life).

SINGLE-SUBJECT EXPERIMENT – when investigating a disorder so rare that few participants are available, a single participant is observed both before and after the manipulation of an independent variable.

LONGITUDINAL STUDY – Investigators observe the same individuals on many occasions over a long period of time to see how they progress and evolve.

• Researchers cannot directly manipulate the independent variable or randomly assign participants to conditions in a longitudinal study, so they cannot definitively pinpoint causes.
• However, because longitudinal studies report the order of events, they do provide compelling clues about which events are more likely to be causes and which are more likely to be consequences.

EPIDEMIOLOGICAL STUDY – reveals how often a problem occurs in a particular population. More specifically, they determine the incidence and prevalence of the problem (such as a particular psychological disorder,).

• INCIDENCE is the number of new cases that emerge in a population during a given period of time.
• PREVALENCE is the total number of new cases + existing cases during a given period.

Question 30

Institutional Review Boards (IRB) and the Tuskegee Syphilis Study

Answer 30

399 African American men had syphilis went untreated by government doctors and researchers in the TUSKEGEE SYPHILIS STUDY, research conducted from 1932 to 1972, prior to the emergence of Institutional Review Boards. In this infamous study, 399 participants were not informed that they had the disease, and they continued to go untreated even after it was discovered that penicillin is an effective intervention for syphilis.

INSTITUTIONAL REVIEW BOARDS (IRB) – An ethics committee in a research facility that is empowered to protect the rights and safety of human research participants.

• Among the important participant rights that the IRB protects are the right of informed consent, an acceptable risk/benefit balance, and privacy (confidentiality or anonymity).