Abnormal Psychology

Foundations and Criteria of Abnormal Behavior

• Course Assessment Focus: Material covered during lectures represents the most heavily tested content, taking priority over textbook reading. However, online textbooks remain valuable foundational resources.

• Defining Abnormal Behavior: Abnormal behavior is defined across five key dimensions:

  • Statistical Infrequency: Behaviors, characteristics, or cognitive abilities that occur rarely within the general population.

* The normal distribution curve (such as the Wechsler Intelligence Scale) illustrates statistical frequency:
  * The mean intelligence quotient (IQ) score is $100$.
  * Approximately $68\%$ of the population falls within $15$ points of the mean (IQ range of $85$ to $115$).
  * Approximately $95\%$ of the population falls within $30$ points of the mean (IQ range of $70$ to $130$).
  * Exactly $13.5\%$ of individuals fall between IQ scores of $70\text{--}85$ and $115\text{--}130$.
  * Exactly $2\%$ of individuals fall between IQ scores of $55\text{--}70$ and $130\text{--}145$.
  * Less than $2\%$ of the population scores below $55$ or above $145$.

• Violation of Norms: Behavior that defies established social norms, cultural rules, or implicit societal standards. Such behavior often threatens observers or induces anxiety in those witnessing it.

• Personal Distress: Behavior that causes significant personal suffering, internal distress, emotional torment, or subjective pain to the individual.

• Impairment, Disability, and Handicap: Distinction between functional limitations and social context:

  • Impairment: An underlying medical or psychological condition. It describes a structural or functional deficit but does not inherently imply limitations in daily life tasks or societal participation.

  • Disability: An alteration in the capacity to meet personal, social, or occupational demands as a direct result of an impairment. Disability emerges from the interaction between an individual's impairment and external environment/occupational requirements—representing the gap between what a person can do and what they want or need to do.

  • Impairment vs. Disability Distinction: An impaired individual who can meet all daily life demands is not considered disabled, despite having a diagnosed medical impairment.

  • Handicap: If an impaired person cannot accomplish a specific task despite accommodations (or if no accommodations are available), they are classified as both handicapped and disabled.

  • Illustrative Distinction: A standard headache is an impairment; a severe headache that prevents attendance at class or work becomes a disability.

• Unexpectedness: A response to environmental stressors that is unexpected, surprising, or grossly out of proportion to the situation.

  • Illustrative Scenario: Going out for drinks and waking up hungover the next morning is a normal reaction; waking up inside a dumpster is an abnormal response.

Historical Approaches to Mental Illness and Abnormality

• Early Demonology and Trepanning:

  • Historically, societies addressed individuals exhibiting signs of psychological abnormality through supernatural interpretations, including demonology, exorcisms, and trepanning.

  • Trepanning: The surgical practice of drilling holes into a person's skull. This physical trauma effectively prevented individuals from expressing abnormal behaviors because of severe physical injury.

• Dark Ages and Witch Persecution:

  • Diagnostic methods for identifying abnormality involved the systemic persecution of individuals labeled as witches.

  • Submersion and Seesaw Tests: Individuals suspected of witchcraft were subjected to dunking into water. If the person drowned and did not survive, they were declared normal; if they survived the immersion, it was concluded that they survived through magic, resulting in execution.

• Phrenology (Franz Joseph Gall, $1758\text{--}1828$):

  • Gall developed phrenology based on five central tenets:

  1. The brain is the structural organ of the mind.

  2. The mind is composed of multiple distinct, innate faculties.

  3. Because these faculties are distinct, each faculty must possess its own specific seat or organ within the brain.

  4. The size of an organ, all other factors being equal, serves as a direct measure of its functional power.

  5. The shape of the brain is determined by the development of its various localized organs. Because the skull conforms its shape to the brain, the external surface of the skull can be read as an accurate index of psychological aptitudes and behavioral tendencies.

• The History of Asylums:

  • Individuals with psychiatric disorders were historically institutionalized in dedicated facilities, often labeled as "lunatics," "insane," "incurables," or "idiots."

  • Institutional structures (e.g., "Hospital for the Insane," "Lunatic Asylum") functioned primarily as facilities for physical containment and isolation rather than therapeutic treatment.

  • Institutional conditions deteriorated to the degree that facilities charged public admission fees for visitors to view institutionalized patients as entertainment.

Neuroanatomy and Brain-Behavior Mapping Cases

• Broca's Aphasia (Paul Broca, $1861$):

  • Case Study of Patient 'Tan': Patient 'Tan' could only utter the single word "tan." Despite his severe output limitation, his spoken language comprehension was fully intact, his physical gestures were proper, and his daily actions were completely comprehensible.

  • Autopsy Findings: Post-mortem brain examination revealed a localized lesion (scarring) in the inferior left frontal lobe, a region designated as Broca's Area.

  • Clinical Features of Broca's Aphasia:

  • A brain-based language disorder characterized by preserved language comprehension alongside severely impaired language production.

  • Expressive abilities vary based on lesion extent (some individuals can produce several words).

  • Expressive deficits extend to all motor-language outputs: patients cannot write sentences or use sign language, as the entire expressive language output network is compromised.

• Wernicke's Aphasia (Karl Wernicke, $1876$):

  • Lesion Localization: Damage located within the medial temporal lobe.

  • Clinical Features:

  • Characterized by fluid, effortless speech production that lacks semantic meaning or coherent messaging (fluent, nonsensical speech).

  • Receptive language skills (comprehension) are severely impaired, rendering the individual unable to understand spoken or written language.

• Executive Dysfunction (Dr. John Harlow, $1848$ & Phineas Gage):

  • Trauma Case: An iron tamping rod passed entirely through Phineas Gage's mouth and skull. Dr. Harlow treated the physical injury, allowing Gage to return to physical labor.

  • Behavioral and Personality Transformation: Coworkers noted that "Gage was no longer Gage." Prior to the injury, he was diligent, reliable, and dependable; post-injury, he became an ill-mannered, unreliable liar.

  • Frontal Lobe Functionality: Demonstrates that the frontal lobes govern personality, behavioral regulation, prosocial conduct, adherence to societal norms, and interpersonal functioning.

  • Executive Functioning: The frontal lobe controls all processes underlying goal-directed behavior, including long-term planning, task organization, cognitive set-shifting, and complex problem-solving.

The Development of Clinical Neuropsychology and Diagnostic Evaluation

• World War II and Biological Neuropsychology:

  • Wartime brain trauma catalyzed the emergence of modern neuropsychology.

  • Norman Geschwind: Neurologist who advanced the biological understanding of psychological abnormality by mapping precise locations of physical head trauma in soldiers and correlating lesion locations with systematic cognitive test performance.

• Boston V.A. Clock Drawing Test:

  • Diagnostic assessment requiring patients to draw a clock face with hands set to the specific time of "$10$ minutes to $5$" ($4:50$).

• Visual Neglect: A condition where visual acuity and ocular anatomy are fully intact, but contralateral processing deficits (e.g., right hemisphere lesion causing left-side spatial neglect) disrupt visual reception and spatial representation. This condition indicates structural impairment located within the parietal lobe.

  • Signal Detection Theory in Neuroimaging:

• Evaluates the diagnostic validity of neuroimaging findings by comparing imaging results against true clinical diagnoses:

• True Positive: Abnormal/positive imaging result where imaging correctly detects a condition that is clinically present.

• False Positive: Abnormal/positive imaging result where imaging suggests a pathology that is clinically absent.

• False Negative: Typical/negative imaging result where imaging fails to detect a condition or impairment that is clinically present.

• True Negative: Typical/negative imaging result where both imaging findings and clinical evaluations show typical presentation.

Historical Lessons and Modern Frameworks in Abnormal Psychology

• Core Takeaways from Historical Lessons:

  1. Cycles of persecution, neglect, and humanitarian reform in the treatment of individuals with mental illness have occurred repeatedly across history, regardless of the specific helping agency involved.

  2. Historical eras characterized by cruel treatment and persecution of individuals displaying psychological disorders have consistently alternated with periods of humanitarian reform and compassionate care.

  3. Standard contemporary interventions may be viewed by future generations as cruel and inhumane, just as current practice looks back on historical interventions with revulsion.

  4. Modern humanitarian and structural reforms remain vulnerable to reversal during periods of adverse economic, political, or social stability.

  5. Conceptual understanding of abnormal behavior swings cyclically over time. Abnormal psychology is most effectively comprehended through an integrative, multi-perspective approach.

• Multidisciplinary Model of Clinical Psychology:

  • Biological, psychological, and social factors interact continuously to produce overall mental health outcomes:

• Biological Domain: Encompasses physical health status, physical disabilities, and genetic vulnerabilities.

• Psychological Domain: Encompasses coping skills, social skills, self-esteem, intelligence quotient (IQ), and temperament.

• Social Domain: Encompasses peer relationships, family circumstances, and school/educational environments.

• Intersecting Domains: Complex clinical outcomes arise at the intersection of these domains, including substance/drug effects, family relationships, and systemic trauma.