Ch 1 - Psychopathology: Past and Present (PSYC 316)

deviance, distress, dysfunction, danger

What are the “four Ds” of psychopathology?

deviance

• different, extreme, or unusual

  • a commonly cited feature of psychopathology

distressing

• unpleasant and upsetting to the person

  • a commonly cited feature of psychopathology

dysfunctional

• interfering with the person’s ability to conduct daily activities in a constructive way

  • a commonly cited feature of psychopathology

dangerous

• behavior that is consistently careless, hostile, desperate, or confused that may place that person or the people around them at risk

  • a commonly cited feature of psychopathology

norms

a society’s stated and unstated rules for proper conduct

culture

a people’s common history, values, institutions, habits, skills technology, and arts

Thomas Szasz

Who claimed that psychopathology is caused by “problems in living?”

eccentricities

unusual patterns with which others have no right to interfere

cultural humility

a process in which clinical scientists or practitioners continuously examine their own beliefs and cultural identities, explore individuals cultures and historical realities that differ from their own, seek to understand the cultural context of each person’s mental health challenges, and respond accordingly

• “abnormal” and “abnormality” have a degrading connotation

  • can be stigmatizing

Why are mental health conditions now referred to as “psychopathology” as opposed to “abnormal” like in the past?

psychopathology

• The scientific study of mental difficulties or disorders (including their explanations, causes progression, symptoms, assessment, diagnosis, and treatment)

  • also used as a synonym for the disorders or symptoms themselves

treatment

• a systematic procedure designed to change dysfunctional behavior into more functional behavior

  • also called therapy

therapy

• a systematic process for helping people overcome their psychological problems

  • consists of a client (patient), a trained therapist, and a series of contacts between them

Jerome Frank

Who came up with the three essential features of therapy?

1. A sufferer

2. A trained, socially accepted healer

3. A series of contacts between the healer and the sufferer

   1. through which the healer tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior

What are the three essential features of therapy?

• Those who see psychopathology as an illness call them “patients”

• Those who see psychopathology as a problem in living call them “clients”

Why do we call the person who receives therapy “clients” and “patients?” What is the difference?

Saw psychopathology behavior as the work of evil spirits

How did ancient societies view psychopathology?

trephination

an ancient operation in which a stone instrument was used to cut away a circular section of the skull to treat severe psychopathology (hallucinations or melancholia)

hallucinations

when people saw or heard things not actually present

melancholia

characterized by extreme sadness and immobility

to release evil spirits that were causing the symptoms

What was the purpose of trephination?

• philosophers and physicians offered different explanations

• Hippocrates’s four humors

How did the Greeks and Romans (500 B.C.E - 500 C.E) view psychopathology?

Quiet life, vegetable diet, temperance, exercise, celibacy, bleeding

How did the Greeks and Romans (500 B.C.E - 500 C.E) treat psychopathology?

• believed that mental disorders had a demonic cause

• church rejected all forms of scientific investigation and controlled education

How did the Europeans (500 - 1350 C.E.) view psychopathology?

exorcism, torture; gradually, hospitalization

How did the Europeans (500 - 1350 C.E.) view psychopathology?

• scientific knowledge increased!

• Johann Weyer was the first mental health physician

  • believed mind was as susceptible to sickness as the body

How was psychopathology viewed in 1400 - 1700 C.E.?

• care at religious shrines was precursor to community health programs

• asylums emerged (mid-16th century)

How was psychopathology treated in 1400 - 1700 C.E.?

• Care for people with mental disorders began to improve

• Philippe Pinel (France) and William Tuke (England) advocated for moral treatment

  • movement ended in US and Europe by early twentieth century

How was psychopathology viewed in the 19th century?

moral treatment

a 19th century approach to treating people with mental dysfunction that emphasized moral guidance and humane and respectful treatment

• somatogenic perspective

• psychogenic perspective

How was psychopathology viewed in the early 20th century?

psychoanalytic theory and treatment

How was psychopathology treated in the early 20th century?

humors

according to the early Greeks and Romans, bodily chemicals that influence mental and physical functioning

• an imbalance of four fluids (humors) that flowed through the body

  • yellow bile, black bile, blood, and phlegm

What did Hippocrates think caused psychopathology?

asylum

a type of institution that first became popular in the sixteenth century to provide care for persons with mental disorders
- most basically became prisons

moral treatment

a 19th century approach to treating people with mental dysfunction that emphasized moral guidance and humane and respectful treatment

moral treatment and mental hospitals

How was psychopathology treated in the 19th century?

Benjamin Rush and Dorothea Dix

Who were the people responsible for spreading moral treatment?

Benjamin Rush

father of American psychiatry

Dorothea Dix

Boston schoolteacher who made humane care a public and political concern in the United States

state hospitals

state-run public mental institutions in the US

somatogenic perspective

the view that psychopathology has physical causes

psychogenic perspective

the view that the chief causes of psychopathology are psychological

• Emil Kraepelin’s textbook

  • claimed that physical factors are responsible for mental dysfunction

• new biological discoveries

  • results were generally disappointing until effective medication was developed

What made the somatogenic perspective become popular?

Work with hypnotism

What made the psychogenic perspective become popular?

Aaron Mesmer

Who created hypnotism?

psychoanalysis

either the theory or the treatment of psychopathology that emphasizes unconscious psychological forces as the cause of psychological dysfunction

psychotropic medications

drugs that mainly affect the brain and reduce many symptoms of mental dysfunction

• psychotropic medications (discovered in 1950s)

  • antipsychotic drugs

  • antidepressant drugs

  • antianxiety (anxiolytic) drugs

• led to deinstitutionalization

  • more outpatient care

  • community mental health approach

• METHODS AREN’T WIDELY SPREAD/ACCESSIBLE TO EVERYONE

  • people are only hospitalized until imminent crisis passes, then released

    • no long-lasting recovery

  • correctional facilities have become a front line for mental health care

• growing emphasis on prevention

In recent decades/current times, how are people with severe pathologies cared for?

antipsychotic drugs

help reduce extremely confused and distorted thinking

antidepressant drugs

lift the mood of depressed people

antianxiety drugs

reduce tension and worry

deinstitutionalization

the practice of releasing paients from public mental hospitals; begun in the 1960s with the release of hundreds of thousands of patients

mostly private psychotherapy and counseling services from self-employed therapists

How were people with less severe pathologies treated before 1950?

• outpatient care is primary mode of treatment

  • less expensive outpatient settings

• treatment for more kinds of pathologies

  • programs devoted exclusively to specific pathologies

How are people with less severe pathologies treated today?

private psychotherapy

an arrangement in which a person directly pays a therapist for counseling services

positive psychology

the study and enhancement of positive feelings, traits, and abilities

multicultural psychology

the field that seeks to understand how the varied histories, opportunities, and barriers experienced by people of different races, ethnicities, genders, sexual orientation, abilities, languages, and of such factors affect behavior, emotion, and thought

intersectionality

a multicultural framework that examines how each individual’s memberships in multiple cultural groups and social identities—including race, ethnicity, socioeconomic class, gender, and sexual orientation—combine to shape their particular experiences, opportunities, outlook, and functioning

managed care programs

programs in which the insurance company determines such key issues as which therapists its clients may choose, the cost of sessions, and the number of sessions for which a client may be reimbursed

• reimbursements for mental health services tend to be lower than those for medical disorders

• often shortened, less effective therapy

What are the problems with managed care programs?

telemental health

the use of remote technologies, such as long-distance videoconferencing, to deliver mental health services without the therapist being physically present

clinical researchers

people who try to discover broad laws, or principles, of mental dysfunction and challenges

• search for nomothetic understanding

nomothetic

general

clinical practitioners

people who search for an idiographic understanding of psychopathology

idiographic

individualistic

scientific method

the process of systematically gathering and evaluating information, through careful observations, to understand a phenomenon

variable

any characteristic or event that can vary, whether from time to time, from place to place, or from person to person

case study

detailed account of a person’s life and psychological problems

• biased observers

• reliance on subjective evidence

  • low internal validity (inside the study)

• little basis for generalization

  • low external validity (outside the study)

What are the limitations of a case study?

correlation

the degree to which events or characteristics vary along with each other

correlational method

a research procedure used to determine how much events or characteristics vary along with each other

positive correlation

variables change the same way (r value in direction of +1)

negative correlation

value of one variable increases as the value of the other variable decreases (r value in the direction of -1)

unrelated correlation

no consistent relationship (r value closer to 0)

magnitude

strength of a correlation

correlation coefficient

a statistical term that describes the direction and magnitude of a correlation

• Have ability to generalize to broader population

  • lots of participants, allow for statistical analysis

• Easily replicable

What are the pros of the correlational method?

independent variable

manipulated variable

dependent variable

variable being observed

experiment

a research procedure in which a variable is manipulated and the effect of that manipulation on another variable is observed

confound

in an experiment, a variable other than the independent variable that is also acting on the dependent variable

• control group

• random assignment

• masked design

What 3 features must be included in experiments to guard against confounds?

statistical significance

indicates whether improvement occurred because of treatment

clinical significance

indicates whether the amount of improvement is meaningful in the individual’s life

control group

in an experiment, a group of participans who are not exposed to the independent variable

experimental group

in an experiment, the participants who are exposed to the independent variable under investigation

random assignment

any selection procedure that ensures that every participant in the experiment is as likely to be placed in one group as in the other

masked (blind) design

individuals kept unaware of their assigned group

double-masked design

participants and researcher are both kept unaware of their assigned group

matched designs

a research design that matches the experimental participants with control participants who are similar on key characteristics

natural experiments

an experiment in which nature, rather than an experimenter, manipulates an independent variable

analogue experiments

a research method in which the experimenter produces pathological-like behavior in laboratory participants adn then conducts experiments on the participants

longitudinal study

a study that observes the same participants on many occasions over a long period of time

epidemiological study

a study that measures the incidence and prevalence of a problem, such as a disorder, in a given population

incidence

the number of newcases of a disorder occurring in a population over a specific period of time

prevalence

the total number of cases of a disorder occurring in a population over a specific period of time

qualitative methods

natural and unfiltered research methods intended to seek out each participant’s direct perspective—gathering information that is offered in the participant’s own words

mixed-methods research

a research tradition that combines, or mixes, both quantitative and qualitative approaches within the same research project

community-based participatory research

a research tradition that has members of an affected community work collaboratively with academically trained researchers at all stages of the research process