Chapter 1 Flashcards
psychological disorder
, a psychological dysfunction associated with distress or impairment in functioning and a
response that is not typical or culturally expected. Before
examining exactly what this means, let’s look at one individual’s situation
phobia
Her reaction was severe,
thereby meeting the criteria for phobia, a psychological disorder characterized by marked and persistent
fear of an object or situation
A psychological disorder, or abnormal behavior, is
a psychological dysfunction that is associated with distress or
impairment in functioning and a response that is not typical or culturally expected (see l Figure 1.1). These three
criteria may seem obvious, but they were not easily arrived
at and it is worth a moment to explore what they mean
. Drawing the line between normal and abnormal dysfunction is often difficult. For this reason,
these
problems are often considered to be on a continuum rather
than either present or absent (McNally, 2011; Widiger &
Crego, 2013). This, too, is a reason why just having a dysfunction is not enough to meet the criteria for a psychological disorder
udy was clearly impaired by her phobia, but many
people with less severe reactions are not impaired. This difference again illustrates the i
e important point that most psychological disorders are extreme expressions of otherwise
normal emotions, behaviors, and cognitive processes
psychopathology
Psychopathology is the scientific study of psychological
disorders. Within this field are clinical and counseling psychologists, psychiatrists, psychiatric social workers, and
psychiatric nurses, as well as marriage and family therapists and mental health counselors. Clinical psychologists
and counseling psychologists receive the PhD degree, doctor
of philosophy (or sometimes an EdD, doctor of education, or PsyD, doctor of psychology) and follow a course of
graduate-level study lasting approximately 5 years, which
prepares them to conduct research into the causes and
treatment of psychological disorders and to diagnose, assess, and treat these disorders. Counseling psychologists
tend to study and treat adjustment and vocational issues
encountered by relatively healthy individuals, and clinical
psychologists usually concentrate on more severe psychological disorders. Psychologists with other specialty training,
such as experimental and social psychologists, investigate
the basic determinants of behavior but do not assess or
treat psychological disorders.
Psychiatric social workers and psyciatric nurses
Psychiatric social workers typically earn a master’s degree
in social work as they develop expertise in collecting information relevant to the social and family situation of the
individual with a psychological disorder. Social workers
also treat disorders, often concentrating on family problems associated with them. Psychiatric nurses have advanced degrees and specialize in the care and treatment of
patients with psychological disorders, usually in hospitals
as part of a treatment team.
=
Finally, marriage and family therapists and mental health
counselors
typically spend 1–2 years earning a master’s
degree and are employed to provide clinical services by
hospitals or clinics
scientist practictioners
Many mental health professionals take a
scientific approach to their clinical work and therefore are
called scientist–practitioners
Mental health
practitioners function as scientist–practitioners in three
ways
. First, they keep up with the latest
developments in their field and therefore use the most current diagnostic and treatment procedures. In this sense,
they are consumers of the science of psychopathology.
Second, they evaluate their own assessments or treatment
procedures to see whether they work. They are accountable not only to their patients but also to government
agencies and insurance companies that pay for the treatments, so they must demonstrate that their treatments
work. Third, scientist–practitioners conduct research that
produces new information about disorders or their treatment. Such research attempts to do three basic things: describe psychological disorders, determine their causes, and
treat them (see l Figure 1.3). These three categories compose
an organizational structure that recurs throughout this
book. A general overview of each will give you a clearer
perspective on our efforts to understand abnormalit
episodic and time-limited course
that they tend to last a long time. Other disorders, like
mood disorders (see Chapter 6), follow an episodic course,
in that the individual is likely to recover within a few
months only to suffer a recurrence of the disorder at a later
time. Still other disorders may have a time-limited course,
meaning they will improve without treatment in a relatively
short period.
prognosis
The anticipated course of a disorder is
called the prognosis. ex- If the disorder is likely to last a long
time (become chronic), however, the individual might want
to seek treatment.
We call the study of changes in behavior over time
developmental psychology, and we refer to the study of
changes in abnormal behavior as developmental psychopathology. Because we change throughout our lives, researchers study development in adolescents, adults, and
older adults as well as in children. Study of abnormal behavior across the entire age span is referred to as life-span
developmental psychopathology
etiology
Etiology, or the study of origins, has to do with why a disorder begins and includes biological, psychological, and
social dimensions.
why are there no sepearate chapters on different treatment approaches
More recently, as our science has advanced, we have developed specific effective treatments that do not always adhere neatly to one theoretical approach or another but that have
grown out of a deeper understanding of the disorder in
question. (pg 37)
It followed that individuals “possessed” by evil spirits were
probably responsible for
any misfortune experienced by
people in the local community, which inspired drastic action against the possessed. Treatments included exorcism,
in which various religious rituals were performed to rid the
victim of evil spirits. Other approaches included shaving
the pattern of a cross in the hair of the victim’s head and
securing sufferers to a wall near the front of a church so
that they might benefit from hearing Mass
In the 14th century, one of the chief advisers to the king
of France, Nicholas Oresme, suggested that m
melancholy
(depression) was the source of some bizarre behavior,
rather than demons. Oresme pointed out that much of the
evidence for the existence of sorcery and witchcraft, particularly among those considered insane, was obtained
from people who were tortured and who, quite understandably, confessed to anything.
Another fascinating phenomenon is characterized by largescale outbreaks of bizarre behavior. During the Middle
Ages, they lent support to the notion of possession. In
Europe
whole groups of people were simultaneously compelled to run out in the streets, dance, shout, rave, and
jump around in patterns as if they were at a particularly
wild party (still called a rave today, but with music). This
behavior was known by several names, including Saint
Vitus’s Dance and tarantism. Several reasons were offered
in addition to possession. One reasonable guess was reaction to insect bites. Another possibility was what we now
call mass hysteria. Consider the following example
mass hysteria
a girl at a school complained of a smell causing unpleasant physical symptoms and a bunch of kids and teachers all had the same symptoms but the hospital found nothing to be wrong with them.
emotion contagion
Mass hysteria may simply demonstrate the phenomenon
of emotion contagion, in which the experience of an emotion
seems to spread to those around us (Hatfield, Cacioppo, &
Rapson, 1994; Wang, 2006). If someone nearby becomes
frightened or sad, chances are that, for the moment, you
also will feel fear or sadness. When this kind of experience
escalates into full-blown panic, whole communities are affected
People are also suggestible when
they
are in states of high emotion. Therefore, if one person identifies a “cause” of the problem, others will probably assume
that their own reactions have the same source. In popular
language, this shared response is sometimes referred to as
mob psychology
full moon (see pg 40 for more)
Despite
much ridicule, millions of people around the world are convinced that their behaviors are influenced by the stages of
the moon or the positions of the stars. This belief is most
noticeable today in followers of astrology, who hold that
their behavior and the major events in their lives can be
predicted by their day-to-day relationship to the position of
the planets. No serious evidence has ever confirmed such a
connection, however
women and hysteria, pg 40
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hippocrates
The Greek physician Hippocrates (460–377 b.c.) is considered to be the father of modern Western medicine. In a
body of work called the Hippocratic Corpus, written between 450 and 350 b.c. (Maher & Maher, 1985a), he and
others suggested that psychological disorders could be
treated like any other disease.
One of the more influential legacies of the
Hippocratic–Galenic approach is the humoral theory of disorders. H
Hippocrates assumed that normal brain functioning
was related to four bodily fluids or humors: blood, black
bile, yellow bile, and phlegm. Blood came from the heart,
black bile from the spleen, phlegm from the brain, and choler or yellow bile from the liver. Physicians believed that
disease resulted from too much or too little of one of the
humors; for example, too much black bile was thought to
cause melancholia (depression). In fact, the term melancholy, from melancholer, which means “black bile,” is still
used to refer to aspects of depression. The humoral theory
was, perhaps, the first example of associating psychological
disorders with a “chemical imbalance,” an approach that is
widespread today
explain the humoral theory
The four humors were related to the Greeks’ conception
of the four basic qualities: heat, dryness, moisture, and
cold. Each humor was associated with one of these qualities. Terms derived from the four humors are still sometimes
applied to personality traits. For example, sanguine (literal
meaning “red, like blood”) describes someone who is ruddy
in complvexion, presumably from copious blood flowing through the body, and cheerful and optimistic, although insomnia and delirium were thought to be caused by excessive
blood in the brain. Melancholic means depressive (depression was thought to be caused by black bile flooding the
brain). A phlegmatic personality (from the humor phlegm)
indicates apathy and sluggishness but can also mean being
calm under stress. A choleric person (from yellow bile or
choler) is hot tempered
Excess humors were treated by
regulating the environment to increase or decrease heat, dryness, moisture, or
cold, depending on which humor was out of balance.
In ancient China and throughout Asia, a similar idea existed. But rather than “humors,” the Chinese focused on
the movement of air or “wind” throughout the body.
Unexplained mental disorders were caused by blockages of wind or the presence of cold, dark wind (yin) as opposed to warm, life-sustaining wind (yang). Treatment involved restoring proper flow of wind through various methods, including acupuncture.
somatic symptom disorders
Hippocrates also coined
the word hysteria to describe a concept he learned
about from the Egyptians,
who had identified what we
now call the somatic symptom disorders. In these disorders, symptoms, such as
paralysis and some kinds
of blindness, appear to be
the result of a problem for which no physical cause can be found, Because these disorders occurred primarily in women, the Egyptians (and
Hippocrates) mistakenly assumed that they were restricted
to women
They also presumed a cause:
The empty uterus
wandered to various parts of the body in search of conception (the Greek word for “uterus” is hysteron). Numerous
physical symptoms reflected the location of the wandering
uterus. The prescribed cure might be marriage or, occasionally, fumigation of the vagina to lure the uterus back to
its natural location (Alexander & Selesnick, 1966). Knowledge of physiology eventually disproved the wandering
uterus theory; however, the tendency to stigmatize dramatic women as hysterical continued into the 1970s. As
you will learn in Chapter 5, somatic symptom disorders are
not limited to one sex.
cures for some disease- pg 42
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insulin shock therapy
In 1927, a Viennese physician, Manfred Sakel,
began using increasingly higher dosages until, finally, patients convulsed and became temporarily comatose (Sakel,
1958). Some actually recovered their mental health, much
to the surprise of everybody, and their recovery was attributed to the convulsions. The procedure became known as
insulin shock therapy, but it was abandoned because it was
too dangerous, often resulting in prolonged coma or death.
Other methods of producing convulsions had to be found.
electroconvulsive therapy
Following suggestions
on the possible benefits of applying electric shock directly
to the brain—notably, by two Italian physicians, Ugo Cerletti and Lucio Bini, in 1938—a surgeon in London treated
a depressed patient by sending six small shocks directly
through his brain, producing convulsions (Hunt, 1980). The
patient recovered. Although greatly modified, shock treatment is still used. The controversial modern uses of electroconvulsive therapy are described in Chapter 6
In the late 19th century, Grey and his colleagues ironically
reduced or eliminated interest in treating mental patients,
because they thought mental disorders were the result of
some as-yet-undiscovered brain pathology and were therefore incurable. The only available course of action was to
hospitalize these patients. Around the turn of the century,
some nurses documented clinical success in treating mental
patients but were prevented from treating others for fear of
raising hopes of a cure among family members. In place
of treatment, interest centered on diagnosis and the study
of brain pathology itself
Emil Kraepelin (1856–1926) was the dominant figure during this period. He was influential in
advocating the
major ideas of the biological tradition, but he was little
involved in treatment. His lasting contribution was in the
area of diagnosis and classification. Kraepelin (1913) was
one of the first to distinguish among various psychological disorders, seeing that each may have a different age of
onset, different symptoms, and probably a different cause.
psychosocial treatment
The best
treatment was to reeducate the individual through rational
discussion so that the power of reason would predominate
(Maher & Maher, 1985a). This was a precursor to modern
psychosocial treatment approaches to the causation of
psychopathology, which focus not only on psychological
factors but also on social and cultural ones as well.
moral therapy
During the first half of the 19th century, a psychosocial approach to mental disorders called moral therapy became
influential. The term moral actually referred more to emotional or psychological factors rather than to a code of conduct. Its tenets included treating institutionalized patients
as normally as possible in a setting that encouraged normal
social interaction (Bockoven, 1963). Relationships were
carefully nurtured. Individual attention emphasized positive
consequences for appropriate interactions and behavior,
and restraint and seclusion were eliminated
As with the biological tradition, the principles of moral
therapy date back to Plato and beyond. For example,
the
Greek Asclepiad Temples of the 6th century b.c. housed the
chronically ill, including those with psychological disorders. Here, patients were well cared for, massaged, and
provided with soothing music. S
what happened to moral therapy after the mid 19th century
Unfortunately, after the mid-19th century, humane treatment declined. It was widely recognized that moral therapy
worked best when the number of patients in an institution
was 200 or fewer, allowing for a great deal of individual
attention. But after the Civil War, enormous waves of
immigrants arrived in the United States, and patient loads
in hospitals increased to 1,000 or 2,000, and even more.
Because immigrant groups were thought not to deserve the
same privileges as native-born Americans (whose ancestors
had immigrated perhaps only 50 or 100 years earlier!), they
were not given moral treatments even when there were
sufficient hospital personnel.
what was the name of dorothea dix work
Having worked in various institutions, she had
firsthand knowledge of the deplorable conditions imposed on patients with insanity, and she made it her life’s
work to inform the American public and their leaders of
these abuses. Her work became known as the mental
hygiene movement
what problems happened as a result of her work.
Unfortunately, an unforeseen
consequence of Dix’s efforts was a substantial increase in the
number of mental patients. This influx led to a rapid transition from moral therapy to custodial care. Dix reformed our
asylums and inspired the construction of new institutions
here and abroad. But even her tireless efforts could not ensure sufficient staffing to allow the individual attention
necessary to moral therapy.
A final blow to the practice
of moral therapy was the
decision, in the middle of
the 19th century, that mental illness was caused by
brain pathology and, therefore, was incurable.
psychoanalysis and behaviorism
based on sigmund freuds theory of the structure of the mind and the role of unconscious processes in determining behavior. The second was behaviorism, associated with John B.
Watson, Ivan Pavlov, and B. F. Skinner, which focuses
on how learning and adaptation affect the development
of psychopathology
mesmers treatments on pg 45- look at them, its a lot to write.
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While his patients were
in the highly suggestible state of hypnosis, Breuer asked
them to describe their problems, conflicts, and fears. Breuer
observed two important phenomena during this process.
First, patients often became extremely emotional as they
talked and felt relieved and improved after emerging from
the hypnotic state. Second, seldom would they have gained
an understanding of the relationship between their emotional problems and their psychological disorder. In fact, it
was difficult or impossible for them to recall some details
they had described under hypnosis. In other words, the
material seemed to be beyond the awareness of the patient.
With this observation, Breuer and Freud had “discovered”
the unconscious mind and its apparent influence on the
production of psychological disorders.
catharsis pg 45
They also discovered that it is therapeutic to recall and
relive emotional trauma that has been made unconscious
and to release the accompanying tension. This release of
emotional material became known as catharsis. A fuller
understanding of the relationship between current emotions and earlier events is referred to as insight. As you shall
see throughout this book, the existence of “unconscious”
memories and feelings and the importance of processing
emotion-filled information have been verified.
psychoanalytic model
Freud expanded these basic observations into the psychoanalytic model, the most comprehensive theory yet constructed on the development and
structure of our personalities. He also speculated on
where this development could go wrong and produce
psychological disorders. Although many of Freud’s
views changed over time, the basic principles of mental functioning that he originally proposed remained
constant through his writings and are still applied by
psychoanalysts today
ID
The id is the source of our strong
sexual and aggressive feelings or energies. It is, basically, the
animal within us; if totally unchecked, it would make us all
rapists or killers.
libido
The energy or drive within the id is the libido.
Even today, some people explain low sex drive as an absence
of libido. A
thanatos
A less important source of energy is the death instinct, or thanatos.
these two basic drives, toward life and fulfillment on the one hand and death and destruction on the
other,
are continually in opposition.
good definitions on page 46
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Id
The id operates according to the pleasure principle, with
a goal of maximizing pleasure and eliminating any associated tension or conflicts. The goal of pleasure, which is
particularly prominent in childhood, often conflicts with
social rules. The id has its own characteristic way of processing information; referred to as the primary process,
this type of thinking is emotional, irrational, illogical,
filled with fantasies, and preoccupied with sex, aggression,
selfishness, and envy
ego
The part
of our mind that ensures that we act realistically is called the
ego, and it operates according to the reality principle instead
of the pleasure principle. The cognitive operations or thinking styles of the ego are characterized by logic and reason
and are referred to as the secondary process, as opposed to
the illogical and irrational primary process of the id
superego
The third important structure within the mind, the superego, or what we might call conscience, represents the moral principles instilled in us by our parents and our culture. It is the voice within us that nags at us when we know we’re doing something wrong. Because the purpose of the superego is to counteract the potentially dangerous aggressive and sexual drives of the id, the basis for conflict is apparent
what is the role of the ego
The role of the ego is to
mediate conflict between
the id and the superego. The
ego is often referred to as
the executive or manager of our minds. If it mediates successfully, we
can go on to higher intellectual and creative pursuits. If it is unsuccessful, and
the id or superego becomes too strong,
conflict will overtake us and psychological
disorders will develop.
intrapsychic conflicts
Because these conflicts are all within the mind, they are referred to as intrapsychic conflicts. Freud
believed that the id and the superego are
almost entirely unconscious. We are fully
aware only of the secondary processes
of the ego, which is a relatively small part
of the mind.
defense mechanisms
The ego fights a continual battle to stay on top of the warring
id and superego. Occasionally, their conflicts produce anxiety. The anxiety alerts the ego to marshal defense mechanisms, unconscious protective processes that keep emotions
associated with conflicts in check so that the ego can continue
to function. Although Freud first conceptualized defense
mechanisms, it was his daughter, Anna Freud, who developed the ideas more fully
More severe internal conflicts that produce a lot of anxiety or other emotions can trigger self-defeating defensive
processes or symptoms like what
Phobic and obsessive symptoms
are especially common self-defeating defensive reactions
that, according to Freud, reflect an inadequate attempt to
deal with such conflicts. Phobic symptoms typically incorporate elements of the conflict. For example, a dog phobia
may be connected to an infantile fear of castration; that is,
a man’s internal conflict involves a fear of being attacked
and castrated, a fear that is consciously expressed as a fear
of being attacked and bitten by a dog, even if he knows the
dog is harmless
psychosexual stages of development
Freud also theorized that during infancy and early childhood we pass through a number of psychosexual stages of
development. The stages—oral, anal, phallic, latency, and
genital—represent distinctive patterns of gratifying our basic
needs and satisfying our drive for physical pleasure.
oral
For
example, the oral stage (birth to about age 2) is characterized by a focus on the need for food. In the act of sucking,
necessary for feeding, the lips, tongue, and mouth become
the focus of libidinal drives and, therefore, the principal
source of pleasure. Freud hypothesized that if we did not
receive appropriate gratification during a specific stage or if
a specific stage left a particularly strong impression (which
he termed fixation), an individual’s personality would reflect the stage throughout adult life. For example, fixation
at the oral stage might result in excessive thumb sucking
and emphasis on oral stimulation through eating, chewing
pencils, or biting fingernails. Adult personality characteristics theoretically associated with oral fixation include dependency and passivity or, in reaction to these tendencies,
rebelliousness and cynicism
phallic stage
girls like their dads and boys like their moms
castration anxiety
Furthermore, strong fears develop that the father may punish that lust by removing the
son’s penis—thus, the phenomenon of castration anxiety.
neuroses
In Freud’s view, all nonpsychotic psychological disorders
resulted from unconscious conflicts, the anxiety that resulted from those conflicts, and the implementation of defense
mechanisms. Freud called such disorders neuroses, or
neurotic disorders.
Anna Freud (1895–1982), Freud’s daughter, concentrated
on how defense mechanisms determine behavior. In doing
so, she was the first proponent of the modern field of ego
psychology. According to Anna Freud,
, the individual slowly
accumulates adaptational capacities, skills in reality testing,
and defenses. Abnormal behavior develops when the ego is
deficient in regulating such functions as controlling impulses or in marshaling appropriate defenses to internal
conflicts.
. In another modification of Freud’s theories, Heinz
Kohut (1913–1981) focused on
the formation of self-concept
and the attributes of the self that allow an individual to
progress toward health, or conversely, to develop neurosis.
This psychoanalytic approach became known as selfpsychology (Kohut, 1977)
object relations
A related area is object relations—the study of how
children incorporate the images, the memories, and sometimes the values of a person to whom they were (or are)
emotionally attached. Object in this sense refers to these
important people, and the process of incorporation is
called introjection.
free association
Freud developed techniques of free association, in which
patients are instructed to say whatever comes to mind. Free
association is intended to reveal emotionally charged material that may be repressed because it is too painful or
threatening to bring into consciousness.
dream analysis
Freud’s patients
lay on a couch, and he sat behind them so that they would
not be distracted. Other techniques include dream analysis
(still quite popular), in which the therapist interprets the
content of dreams, supposedly reflecting the primary-process thinking of the id, and relates the dreams to symbolic
aspects of unconscious conflicts
psychodynamic psychotherapy
Psychoanalysis is still practiced, but many psychotherapists employ a loosely related set of approaches referred to as
psychodynamic psychotherapy. Although conflicts and unconscious processes are still emphasized, and efforts are
made to identify trauma and defense mechanisms, therapists
use a mixture of tactics, including (1) a focus on affect and
the expression of patients’ emotions; (2) an exploration of
patients’ attempts to avoid topics or hinder the progress of
therapy; (3) the identification of patterns in patients’ actions,
thoughts, feelings, experiences, and relationships; (4) an emphasis on past experiences; (5) a focus on interpersonal experiences; (6) an emphasis on the therapeutic relationship; and
(7) an exploration of patients’ wishes, dreams, or fantasies
bf skinner and reinforcement- pg 53
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