Chapter 1 - Abnormal Behavior in Historical Context Flashcards
Psychological Disorder
Psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected.
Phobia
A psychological disorder characterized by marked and persistent fear of an object or situation.
[Example: blood-injection - injury phobia]
Abnormal Behavior [aka Psychological Disorder]
Three criteria:
1. Psychological Dysfunction
2. Distress or Impairment
3. Atypical or not culturally expected response
Psychological Dysfunction
Breakdown in cognitive, emotional, or behavioral functioning.
[EXAMPLE: If you are out on a date, it should be fun. But if you experience severe fear all evening and just want to go home, even though there is nothing to be afraid of, and the severe fear happens on every date, your emotions are not functioning properly.]
PROBLEM: Knowing where to draw the line between normal and abnormal dysfunction is often difficult. Often leading to these problems being considered as a continuum or dimension rather than categories that are either present or absent.
Therefore, having a dysfunction is not enough to meet the criteria for a psychological disorder.
Distress or Impairment
Distress is considered a very much important aspect of life and not likely to change. However, in cases of someone with a manic episode suffering and distress are absent.
Impairment is a case of someone who may so shy that it is nearly impossible to date or interact with people causing their social functioning to be impaired.
Atypical or Not Culturally Expected
At times, something is considered abnormal because it occurs infrequently; deviating from the average. The greater the deviation, the more abnormal it is.
Social Standard of Normal
Has been misused, for example, the practice of committing political dissidents to mental health institutions because they protest the policies of their government, which was common in Iraq before the fall of Saddam Hussein and now is occurring in Iraq. Although such dissident behavior clearly violated social norms, it should not alone be cause for commitment.
Harmful Dysfunction
A related concept that is also useful to determine whether the behavior is out of the individual’s control (something that the person doesn’t want to do)
Variants of this approach are most often used in current diagnostic practice, as outlined in the 5th edition of the Diagnostic and Statistical Manual, which contains the current listing of criteria for psychological disorders.
Most Widely Accepted Definition of Psychological Disorders
The Diagnostic and Statistical Manual of Mental Disorders describes behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning or increased risk of suffering, death, pain, or impairment.
Definition can be used across cultures and subcultures if we pay attention to what is functional or dysfunctional (or out of control) in a given society.
Psychopathology
The scientific study of psychological disorders.
Within the field are specifically trained professionals including; clinical and counseling psychologists, psychiatrists, psychiatric social workers, and psychiatric nurses, as well as marriage and family therapists and mental health counselors.
Clinical and Counseling Psychologists
Receive the Ph.D., doctor of philosophy degree (or sometimes an Ed.D., doctor of education, or Psy.D., 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.
Difference between Ph.D. and Psy.D.
Psy.D focuses on clinical training and de-emphasizes or eliminates research training.
Ph.D integrates clinical and research training.
Psychiatrists
Earn an M.D. degree in medical school and then specialize in psychiatry during residency training for about 3 to 4 years.
They investigate the nature and causes of psychological disorders from a biological point of view, making diagnoses and offering treatment. (most often prescribed drugs or other biological treatments)
Psychiatric Social Workers
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. Most often treat the disorder, often concentrating on family problems associated with them.
Psychiatric Nurses
Have advanced degrees, such as a master’s or even a Ph.D., and specialize in the care and treatment of patients with psychological disorders, usually in hospitals as part of a treatment team.
Marriage and Family Therapists and
Mental Health Counselors
Spend about 1 to 2 years earning a master’s degree and employed to provide clinical services by hospitals or clinics, usually under the supervision of a doctoral-level clinician.
Scientist-Practitioners
The scientific approach that many health professionals take in their clinical work.
Mental Health Practitioners function as scientist-practitioners in three ways:
- Keeping up with the latest scientific developments in their field using the most current diagnostic and treatment procedures
- Evaluate their assessments or treatment procedures to determine whether they work. [Being accountable not only to their patients but also to the government agencies and insurance companies paying for the treatments, so they must demonstrate whether their treatments are effective.]
- May conduct research in clinics or hospitals that produce new information about disorders or their treatment, becoming immune to the fads that plague our field, often at the expense of patients and their family.
Presenting Problem
The patient “presents” with a specific problem or set of problems. [Presents is a traditional shorthand way of indicating why the person came to the clinic.
Clinical Description
Represent the unique combination of behaviors, thoughts, and feelings that make up a specific disorder..
Specifying what makes the disorder different from normal behavior or from other disorders.(statistical data may also be relevant)
Prevalence
For example, how many people in the population as a whole have the disorder? The figure would be the prevalence of the disorder.
Incidence
For example, statistics on how many new cases occur during a given period, such as a year, represent the incidence of the disorder.
Sex Ratio
What percentage of males and females have the disorder?
Typical age of onset
Which often differs from one disorder to another
Types of courses
- Chronic course - Some disorders, such as schizophrenia, tend to last a long time, sometimes a lifetime.
- Episodic course - Some disorders, like mood disorders, are likely to recover within a few months, only to suffer a reoccurrence of the disorder at a later time. [ a pattern that may repeat itself throughout a person’s life.]
- Time-limited course - The disorder will improve without treatment or in a relatively short period with little or no risk of reoccurrence.
Differences in onset
a.) Acute onset - They begin suddenly
b.) Insidious onset - They develop gradually over an extended period.
Prognosis
The anticipated course of a disorder. “Prognosis is good,” meaning the individual will probably recover.
“Progonis is guarded,” meaning the probable outcome doesn’t look good.
Patients age (an important aspect of clinical description)
Specific psychological disorders in childhood may present differently from those in adulthood or old age.
Example: Children experiencing anxiety or panic attacks often assume that they are physically ill because they have difficulty understanding that there is nothing physically wrong. This often leads to misdiagnosis in children and they end up getting treated for a medical disorder.
Different Studies
a.) Developmental Psychology
b.) Developmental Psychopathology
c.) Life-span developmental psychopathology
Developmental Psychology
Study in changes of behavior over time
Developmental Psychopathology
Study of changes in abnormal behavior
Life-span Developmental Psychopathology
Study of abnormal behavior across the entire age span
Etiology
The study of origins having to do with why a disorder begins (what causes it) and includes biological, psychological, and social dimensions
Treatment
If a new drug or psychological treatment is successful in treating the disorder, it may give us some insight into the nature of the disorder and its causes.
Example: A drug with a known specific effect within the nervous system alleviates a certain disorder, we know that something in part of the nervous system might either be causing the disorder or helping maintain it.
Historical Conceptions of Abnormal Behavior
For thousands of years, humans have always tried to explain and control problematic behavior.However, our efforts always derived from the theories or models of behavior popular at the time.
Three major models that have guided us back to the beginning of civilization
- Supernatural model
- Biological model
- Psychological model
Supernatural model
The model is that supposed agents outside our bodies and environment influence our behavior. These agents might be divinities, demons, spirits, or other phenomena such as magnetic fields, the moon, or stars.
Soul or the Psyche
Referred to the mind being separate from the body since the era of ancient Greece
Biological model & Psychological model
Thought that the mind can influence the body and, in turn, the body can influence the mind. Most philosophers looked for causes of abnormal behavior in one or the other. This spilt gave rise to the two traditions of thought of abnormal behavior as either being biological or psychological.
Supernatural Tradition
For much of recorded history, deviant behavior has been considered a reflection of the battle of good and evil.
Demons and Witches
During the last quarter of the 14th century, the Catholic church split into two with another center in South France competing with the Catholic church of Rome. In reaction to this split, the Roman Church fought hard against evil in the world.
People increasingly turned to magic and sorcery to solve their problems. During these times, the bizarre behavior of people afflicted with psychological disorders was seen as the work of the devil and witches.
Treatments during the last quarter of the 14th century
a.) Exorcisms - various religious rituals were performed in an effort to rid the victim of evil spirits.
b.) Shaving the pattern of a cross in the hair of the victim’s head
c.) securing sufferers to a wall near the front of a church so that they might benefit from hearing Mass.
Led to the witch trials of the late 17th century, which resulted in 20 women being hung to death
Stress and Melancholy
During the 14th and 15th century there was an enlightened view that insanity was a natural phenomenon caused by mental and emotional stress and that it was curable.
Mental depression and anxiety ware recognized as illnesses, however the symptoms were identified by churches with the sin of acedia or sloth.
Odd treatments for possession
a.) Hanging people over a pit full of poisonous snakes
b.) The hypothesized therapeutic element of shock
c.) Hydrotherapy where patients were had applications of ice cold water
Mass Hysteria
Fascinating Phenomenon characterized by large-scale outbreaks of bizarre behavior.
Puzzled historians and mental health practitioners were leading support to the notion of possession by the devil during the Middle Ages.
Examples of Mass Hysteria
a.) Saint Vitus’s Dance (aka tarantism) in Europe whole groups of people simultaneously compelled to run, dance, shout, rave, and jump around in patterns all through the streets. Two attempted reasons were; possession or reaction to insect bites
b.) Local school reported 17 students and 4 teachers having dizziness, headaches, nausea, and stomach pain for no apparent reason that all stemmed from one student reporting a smell and crying in pain.
Emotion Contagion
The experience of an emotion seems to spread to those around creating a mass hysteria. If someone nearby becomes frightened or sad, chances are that, for the moment, you also will feel fear or sadness.
Mob Psychology
When emotion contagion escalates into full blown panic attacks affecting the whole community. When emotions are in a high state and one person identifies a “cause’ for the problem, others will probably assume that their own reactions have the same source.
The Moon and Stars
Swiss Physician Paracelsus suggested that the moon and stars’ movements profoundly affected people’s psychological functioning.
Speculating that the moon’s gravitational effect on bodily fluids might be a possible cause of mental disorders.
Inspiring the word “lunatic,” which is derived from the Latin word luna meaning “moon”
Belief is still followed by astrologers, however, there has been no serious evidence confirming a connection.
Humoral Theory of Disorders
Created by the Greek physician Hippocrates and Roman physician Galen (Hippocratic-Galenic approach)
Normal brain functioning related to four bodily fluids or humors:
a.) Blood - Heart c.) Yellow bile (or choler) - Liver
b.) Black bile - Spleen d.) Phlegm - Brain
The first example of associating psychological disorders with a “chemical imbalance.”
Four Basic Qualities related to the four humors
- Heat
- Dryness
- Moisture
- Cold
Excess of one or more humors was treated by regulating the environment to increase or decrease heat, dryness, moisture, or cold depending on which humor was out of balance.
Two additional treatments during King Charles VI’s reign
a.) Bleeding or bloodletting - carefully measure the amount of blood that was removed from the body often with leeches.
b.) Induced vomiting - 1621, Anatomy of Melancholy, Robert Burton recommended eating tobacco and a half-boiled cabbage to induce vomiting.
Chinese Yin and Yang
It focused on the movement of air or “wind” throughout the body and that 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 the proper flow of wind through various methods, including acupuncture.
Psychosocial Treatment
Approaches the causation of psychopathology, which focuses on psychological, social, and cultural factors.
Moral Therapy
The term moral refers to more emotional or psychological factors rather than to a code of conduct.
Treated institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction providing them with many opportunities for appropriate social and interpersonal contact.
Horace Mann at Worcester State Hospital treated 100 patients who were assaultive before treatment, and no more than 12 continued to be violent a year after beginning treatment
Mental Hygiene Movement
Schoolteacher Dorothea Dix was aware of the deplorable conditions imposed on patients with insanity, and made it her life’s work to inform the American public and their leaders of the abuse.
Psychoanalysis
Based on Sigmond Freud’s elaborate theory of the structure of the mind and the role of unconscious processes in determining behavior.
Behaviorism
John B. Watson, Ivan Pavlov, and B. F. Skinner focused on how learning and adaptation affect the development of psychopathology.
Unconscious
Discovered by Josef Breuer and Sigmund Freud and its apparent influence on the production of psychological disorders.
Catharsis
Recalling and reliving emotional trauma that has been made unconscious and releasing the accompanying tension.
Insight
The relationship between current emotions and earlier events
Psychoanalytic Model
Three Major Facets:
- The structure of the mind and the distinct functions of personality that sometimes clash with one another
- The defense mechanisms with which the mind
defends itself from these clashes or conflicts - The stages of early psychosexual development provide a grist for the mill of our inner conflicts.
Structure of the Mind 3 Major Parts (or functions)
- the id
- the ego
- the superego
id
The source of our strong sexual and aggressive feelings or energies.
Libido
The energy or drive within the id
(drives toward life and fulfillment)
Thanatos
A less important source of energy (death instinct drives toward death and destruction)
Pleasure Principle
Id operates according to this principle with an overriding goal of maximizing pleasure and eliminating any associated tension or conflicts.
Primary Focus
Id’s characteristical way of processing information is emotional, irrational, illogical, filled with fantasies, and preoccupied with sex, aggression, selfishness, and envy.
Ego
The part of the mind that ensures that we act realistically
Reality Principle
The ego operates according to this principle, which are characterized by logic and reason.
Secondary Process
The cognitive operations or thinking styles of the ego
Superego
The third important structure of th*e mind that represents your conscience
*Purpose it to counteract the potentially dangerous aggressive and sexual drives of the id.
*And mediate conflict between the id and the superego
Moral Principles
The superego operates according to this principle that has been instilled in us by our parents and our culture.
Intrapsychic Conflicts
Conflicts with the mind between the id and ego.
a.) If mediates are successful, we can go on to the higher intellectuals and pursuits in life.
b.) If unsuccessful, and the id or the ego becomes too strong, conflict will overtake us, and psychological disorders will develop.
Defense Mechanism
Unconscious protection processes that keep primitive emotions associated with conflicts in check so that the ego can continue its coordinating function signaled by anxiety.
Examples of defense mechanisms:
- Denial
- Displacement
- Projection
- Rationalization
- Reaction Formation
- Repression
- Sublimination
Denial
Refuses to acknowledge some aspect of objective reality or subjective experience that is apparent to others.
Displacement
Transfers a feeling about, or a response to, an object that causes discomfort onto another, usually less threatening, object or person.
Projection
Falsely attributes own unacceptable feelings, impulses, or thoughts to another individual or object.
Rationalization
Conceals the true motivations for actions, thoughts, or feelings through elaborate reassuring or self-serving but incorrect explanations
Reaction Formation
Substitute behavior, thoughts, or feelings that are the direct opposite of unacceptable ones
Repression
Blocks disturbing wishes, thoughts, or experiences from the conscious awareness
Sublimination
Directs potentially maladaptive feelings or impulses into socially acceptable behavior
Psychosexual stages of development
Freud’s theory is that during infancy and early childhood, we pass through a number of stages that have a profound, lasting impact.
- Oral
- Phallic
- Latency
- Genital
Freud hypothesized that if we did not receive appropriate gratification during a specific stage or if a specific stage left a particularly strong impression (fixation), an individual’s personality would reflect the stage throughout adult life.
Castration Anxiety
The phenomenon is that intense fears developed by a father may punish a little boy’s lust for their mother by removing the son’s penis.
Neuroses
Term Freud had used to label neurotic disorders that referred to disorders of the nervous system.
Term previously used as the psychoanalytical view of the causes of psychological disorders had been dropped from the DSM in 1980
Ego Psychology
It was developed by Freud’s daughter, Anna Freud.
The theory is that an individual slowly accumulates adaptional capacities, skills in reality testing, and defenses. Abnormal behavior develops when the ego is deficient in regulating such functions as delaying and controlling impulses or in marshaling appropriate normal defenses to strong internal conflicts.
Defense reactions of the ego determines our behavior
Self-psychology
Developed by Heinz Kohut on the formation of self-concept and the progress toward health, or conversely, the development of neurosis.
Object Relations
The study of how children incorporate the images, the memories, and sometimes the values of a person who was important to them and to whom they were (or are) emotionally attached.
Object
Refers to these important people
Introjection
The process of incorporation
Introjected objects can become an integrated part of the ego or may assume conflicting roles in determining the identity or self.
Collective Unconcious
Developed by Freud’s student Carl Jung. A theory in which wisdom accumulated by society and culture is stored deep in individual memories and passed down from generation to generation.
Emphasizing:
a.) Spiritual and religious drives are much a part of human nature as sexual drives
b.) Importance of enduring personality traits such as introversion (the tendency to be shy and withdrawn) and extroversion (the tendency to be friendly and outgoing)
Inferiority Complex
Developed by Freud’s student Alfred Adler. Focused on feelings of inferiority and the striving for superiority.
Free Association
Developed by Freud, in which patients were instructed to say whatever comes to mind without the usual socially required censoring.
(intended to be emotionally charged material that may be repressed because it is too painful or threatening to bring into consciousness.)
Dream Analysis
Therapists interpret the content of dreams, supposedly reflecting the primary-process thinking of the id, and systematically relate the dreams to symbolic aspects of unconscious conflicts.
Transference
A phenomenon where the patient comes to relate to the therapist much as they did to important figures in their childhood, particularly their parents.
Countertransference
Therapists project some of their own personal issues and feelings, usually positive, onto the patient.
Psychodynamic Psychotherapy
Conflicts and unconscious processes are emphasized. Efforts are made to identify trauma and active defense mechanisms; however, therapists use an eclectic mixture of tactics with a social and interpersonal focus.
Therapeutic Alliance
The relationship of the therapist and the patient.
Humanistic Psychology
The philosophies of Carl Jung and Alfred Adler emphasized the positive, optimistic side of human nature adopted by personality theorists.
Self-actualizing
The assumption is that all of us could reach our highest potential in all areas of functioning if only we had the freedom to grow.
Person-centered therapy (Client-centered therapy)
The therapist takes a passive role, making as few interpretations as possible.
Unconditional postive regard
The complete and almost unqualified acceptance of most of the client’s feelings and actions
Behavioral Model
Also known as:
Cognitive-behavioral model
OR
Social learning model
Brought the systematic development of more scientific approach to psychological aspects of psychopathology
Classical Conditioning
A type of learning in which a neutral stimulus is paired with a response until it elicits that response.
Extinction
Presentation of a Conditioned Stimulus (CS) like chemotherapy without the Unconditional Stimulus (UCS), like the nurse or medical equipment for a long period of time would eventually eliminate the Conditioned Response (CR) like nausea and vomiting.
Introspection
A study developed by Edward Titchener in which subjects simply reported on their inner thoughts and feelings after experiencing certain stimuli.
Systematic Desensitization (Behavior Therapy)
Individuals were gradually introduced to the objects or situations they feared so that their fear could be extinguished; that is they could test reality and see that nothing bad happened in the presence of the phobic object or scene.
Reinforcement (B.F. Skinner)
“Reward” connotes the effect of the behavior.
Shaping (B.F. Skinner)
A process of reinforcing successive approximation to a final behavior or set of behaviors
