Abnormal Psychology - Unit 3 Notes

Introduction to Abnormal Psychology

  • There is no universally agreed-upon definition of psychopathology.
  • Factors considered include:
    • Maladaptiveness (inability to adjust).
    • Deviance (statistically uncommon behavior).
    • Functional impairment.
    • Suffering.
    • Irrationality.
    • Incomprehensibility.
    • Loss of control.
    • Underlying psychological or biological deviance.
  • Western conceptualizations often rely on a normal versus abnormal functioning dichotomy.
  • "Typical" and "atypical" are used to define normal and abnormal behavior.

Normal vs. Abnormal Behavior (Western Worldview)

  • Any behavior that is not typical or usual is considered abnormal by definition.

Diagnostic and Statistical Manual (DSM)

  • The DSM is the most common method used to clinically diagnose mental health conditions.
  • First published in 1952 by the American Psychiatric Association (APA).
  • It has become the dominant classification scheme worldwide, including South Africa.
  • Revisions:
    • DSM-I (1968)
    • DSM-II (1980)
    • DSM-III (1987)
    • DSM-IV-TR (1994)
    • DSM-V (2013), which differs slightly from DSM-IV-TR.
  • DSM-IV-TR used a multi-axial system for comprehensive evaluation across five axes.
  • DSM-V discarded the multi-axial system, listing Axes I, II, and III under one section.
  • Axes IV and V were replaced and listed as psychosocial and contextual features.
  • DSM-IV-TR introduced culture-bound syndromes to address population-specific syndromes.
  • DSM-IV-TR considered the influence of culture and identity on the manifestation of disorders.
  • DSM-V incorporates greater cultural sensitivity with culture-bound syndromes, cross-cultural variations, and cultural concepts of distress.
  • Mental disorders are recognized as culture-bound and contextual.
  • Understanding mental disorders from a cultural perspective improves identification, diagnosis, and treatment.
  • DSM-V is criticized for still largely viewing culture through Western lenses.

Cross-Cultural Perspectives

  • Psychology aims to understand human behavior to improve interactions and dealings with others.
  • Awareness of ethics (universal principles) and emics (culture-specific findings) is crucial.
  • Etic view: Outsider's perspective.
  • Emic view: Insider's perspective focusing on intrinsic cultural distinctions.
  • Cross-cultural perspective (etic approach): Seeks to understand phenomena across cultures to universalize conclusions.
  • Culture-specific perspective (emic approach): Understands mental illness within a specific cultural context.
  • A blended approach (combining etic and emic) is advocated for a comprehensive viewpoint.
  • Research by Draguns and Tanaka-Matsumi (2003) links culture and psychopathology, identifying relationships between distress and cultural features.
  • Three main theoretical positions from a cross-cultural approach:
    • Universalistic: Offers explanations independent of cultural connotations (etic).
      • Acknowledges culture but assumes behaviors/illnesses are common to all, with culture influencing development, expression, and response.
      • DSM-V and ICD10 are examples, assuming Western understanding can be applied universally.
    • Relativistic: Mental illness understood within the context of specific cultural norms.
      • DSM-V gives culture a restricted role, leading to incorrect categorization and unfair homogeneity (Kleinman & Kleinman, 1991).
      • Relativists contest the idea that pathology lies within a person (Wakefield et al., 2002).
    • Absolutist: Culture plays no role in the expression of behavior.
      • Presentation, manifestation, and implications of distress are the same regardless of culture (Eshun & Gurung, 2009).
      • Trivializes the role of culture in shaping human behavior.

African Worldview of Psychopathology

  • Promotes a culture-specific method, opposing universalistic and absolutist approaches.
  • The universalistic approach fails to acknowledge cultural differences.
  • The absolutist approach doesn't recognize culture's role in shaping behavior.
  • A relativistic approach is adopted, viewing mental illness as a broader concept understood in relation to cultural context.

Normal and Abnormal Behavior from an African Perspective

  • Based on societal and cosmological relationships.
  • Strong emphasis on respect for self, others, and nature.
  • Loss of land is a significant factor related to mental illness, leading to a loss of control and access to traditional healing systems.
  • Colonization disrupted harmony between nature and people.
  • Before colonization, behavior outside cultural norms was considered abnormal.
  • Wellbeing encompasses physical, spiritual, and social dimensions, unlike the Western focus on the individual.
  • Dysfunction is a state of collective and individual imbalance, especially regarding differences in community, and physical, and social functioning (Kwate, 2005).
  • Includes disharmonious social and spiritual relationships.
  • Disturbed relationships with the spiritual world, nature, family, and community are believed to cause ill health.
  • The cause of psychopathology is thought to exist outside of a person’s control, attributed to invisible beings like God, ancestors, and spirits.
  • Spirits of the departed can send illness and misfortune (Hammond-Tooke, 1989).
  • Abnormal behaviors such as alcoholism, drug abuse, conflicts, and women’s barrenness are attributed to external forces.
  • Ancestors play a critical role, providing guidance and healing.
  • Ancestors are referred to as baholo (Sesotho) or abantu abadala (Nguni languages).
  • They are seen as roots to which those on earth are attached.
  • Detachment from these roots causes mental-spiritual illnesses.
  • Mental illness is seen as a carrier of messages that must be decoded (Nwoye, 2015).

African Epistemologies in Relation to Mental Disorders

  • Takes a holistic view of wellbeing, with minimal distinction between physical and mental functioning.
  • Strong belief in the unity of spirit, mind, and matter.
  • Physical and psychosocial systems are interconnected.
  • Social factors play a major role in the causation, maintenance, or cure of abnormality.
  • Mental disorders are believed to occur with a particular intention, and the causes can be identified (Beuster, 1997).
  • Disorders are grouped into umkhuhlane (diseases/infections caused by natural factors) and ukufa kwabantu (disorders caused by supernatural factors or the ancestors).
  • Disorders are "diseases of the African people," associated with African views on health and disease.
  • Explained by animistic theories attributing disorders to the dissatisfaction or anger of spirits, gods, or ancestors.
  • Ukuthwasa refers to a “creative illness” following a calling by ancestral spirits or a religious conversion experience (Murdock et al., 1980, cited in Vilakazi, 1997).
  • Badimo (Sesotho) or amadlozi (isiZulu) are the living spirits of the deceased.
  • Ancestors preserve honor, traditions, and good name and protect against evil.
  • They act as intermediaries between people and God (Ngubane, 1977).
  • Ancestors punish their kin when disappointed or angered, serving as a warning to amend behavior.
  • They also cause suffering if important rituals and customs are neglected.
  • Extensive birth, initiation, marriage, and death rites must be performed (Beuster, 1997).
  • Neglecting rites leads to disapproval through ill health, misfortune, or death (Gumede, 1990).
  • Ancestors require appeasement through offerings and need to be informed of family developments.
  • Ignoring demands leads to withdrawal of protection and physical/mental disorders.
  • Ancestral spirits and God decide whether to cure someone (Gumede, 1990).
  • Malicious people (witches/sorcerers) can cause mental disorders via supernatural means.
  • Explained by magical theories attributing disorders to malice and jealousy, causing injury through sorcery and witchcraft.
  • Idliso/sejeso refers to poisoning attributed to sorcery.
  • Based on the concept of umntu/motho, which is earthed by spiritual forces and guided by cultural prescripts.
  • Every human being has relatives and experiences nature.
  • As the Basotho say, motho ke motho ka batho (I am because we are).
  • Priority is given to interpersonal relations.

Ubuntu Concept

  • Umntu ngumtu ngabantu (Nguni) and Muthu ndi muthu nga vhathu (Tshivenda) mean “I am because we are, and since we are, therefore I am”.
  • The community is responsible for wellbeing.
  • Conflicts in interrelationships, killing sacred animals, or cutting down sacred trees may cause health problems.
  • A psychologically unhealthy person lives in disharmony with nature.
  • Ill health manifests in physical disease or psychological-mental illness, as well as a breakdown in social and spiritual mechanisms.
  • Humans, supernatural entities, and ancestral spirits are seen as agents of disease.
  • Adultery, cheating, cruelty, or offense can lead to phobias or diseases.
  • A widow failing to carry out cultural prescriptions (mourning clothes, avoiding contact with men) may suffer from mashwa.
  • Mashwa is a general label for disorders with bodily manifestations and psychological etiology.

Interconnectedness of Worlds

  • Conceptualizes psychopathology from collectiveness, sameness, and commonality.
  • Ensures survival for the tribe and unity with nature.
  • During pandemics, people could not perform death-related cultural practices, tampering with traditional grieving processes and making it difficult for families to find closure.

Models That Explain Abnormal Behavior

  • Colonial disruptions cause energy imbalances that lead to illness.
  • Colonization resulted in cultural misorientation.
  • Societal changes caused misalignment.
  • Altered ways of life force people to exist in dissonance.
  • People resort to unhealthy behaviors to numb feelings of misalignment.
  • Colonization distorted relationships with bodies and communities.
  • Bodies were portrayed as sources of labor and symbols of everything bad.
  • Relationships became individualistic.
  • Materialistic approach to objects was adopted (Manganyi, 1973).
  • Under normal conditions, people relate to objects based on attractiveness and utility value.
  • Being robbed of dignity, self-respect, and spirituality distorts the sense of being-in-the-world-with-objects.
  • Validation occurs in terms of (external) possessions.
  • Evaluation of material wealth indicates assimilation of Western values and denial of historical factors (Akbar, 1981).
  • “Anti-self-attitude” is displayed by individuals seeking approval from the white population.
  • Their behavior is influenced by this desire, and standards are based on what is acceptable by white society.
  • Self-destructiveness entails engaging in self-defeating activities due to frustrations of oppression (Akbar, 1981).
  • Substance abuse and criminal activities are associated with self-destructiveness.
  • Colonial dehumanization results in a distorted understanding of what is fundamentally wrong.
  • Illnesses are perceived superficially, treating symptoms instead of dealing with the source.
  • African cosmology is founded on the total healing of the environment, not just symptoms.
Healing: Ukuva/Ho Utlwa
  • Illness is a consequence of disharmony between the body and the psyche.
  • Healing focuses on realigning the person to his/her whole self.
  • Realignment centers on ukuva/ho utlwa, which means ‘to hear’ or ‘to feel’, with a focus on feelings (maikutlo/imizwa).
  • Africans encourage people to ukuzimamela (isiXhosa) or o aimamela (Sesotho), which means taking time to listen to oneself.
  • A diagnostic activity and an illustration that African Psychology is embedded in culture.
  • A healthy person is expected to be in conversation with his/her psyche/soul.
  • When someone is not well, they say andiziva kakuhle/ha ke ikutlwe hantle, meaning something has interrupted the connection.
  • Healing involves returning a person to the state of ukuziva kakuhle, which means hearing oneself again.
  • The body is simply the physical part of the spirit, since ukumila is essence immersing itself with flesh.
  • Realignment necessitates the involvement of the family and ancestors.
  • Each clan carries its own medicine, dispensed through unique rituals.
  • Diviners are consulted when beyond family comprehension.
  • Ukuva/ho utlwa describes various senses such as taste, hearing, and physical sensation.
  • African cosmology requires one to be in touch with the inner conversation of the psyche/soul.

Choice Between Health Care Systems

  • Members of South African black communities face a choice between Western and traditional health care systems.
  • Urbanisation and industrialisation have brought about a rational and individualised lifestyle.
  • This contrasts with group-oriented, traditional lifestyle (Vilakazi, 1997).
  • Dramatic change results in uncertainty and conflict.
  • Deficiencies in the modern health care system lead people to turn to traditional healers.
  • The Western approach is disease-oriented, focusing on symptoms and individual decisions.
  • The traditional approach is socially oriented in its interpretation of health and illness, requiring consensus.
  • In a multicultural society, therapists face the challenge of working with people from diverse cultural backgrounds.
  • Mainstream psychology is based on Western philosophy.
  • How would a Western-trained therapist treat a client who believes problems are due to spirit possession, requires a traditional healer, and needs a ritual and journey into the spirit world?
  • The African population may exhibit depressed states via general physical complaints (Draguns and Tanaka-Matsumi, 2003).
  • Depression is often reported as physical complaints rather than psychological representations (Trujillo, 2008).
  • Discussing emotional trauma is perceived as threatening.
  • Somatic complaints appear less threatening because they are related to the outer self (Draguns & Tanaka-Matsumi, 2003).
Concept of Empathy
  • Empathy is the ability to understand and share the feelings of others.
  • Mirroring behaviors encourage sharing and generosity.
  • Ukuvelana encompasses the reciprocal.
  • Therapist must become umntu (that person).
  • The healing relationship is non-hierarchical, and the therapist is on a constant frequency of humility.

Misconceptions About Illness and African Healing

  • Colonial demonisation and distortions have resulted in misconceptions.
  • Belief in “angry ancestors” punishing kin is a myth.
  • Commodification of indigenous healing has led to people spending vast sums appeasing “angry ancestors”.
  • Caution is needed regarding information on indigenous healing practices.
  • Individuals are carriers of culture, influenced by beliefs, customs, and symbolism (Schlebusch et al., 1990).
  • All individuals exist within their own cultural context.
  • Culture acts as a filter when perceiving and interpreting events.
  • All cultures experience psychopathology (Draguns & Tanaka-Matsumi, 2003).
  • Understanding culture is critical for accurate diagnoses and psychiatric treatment.
  • Psychopathology and culture are intertwined (Sam & Moreira, 2012).
  • People gain insight into how to build systems to process and integrate psychological suffering as a result of culture.