Psychopathology in Historical Context

What is a psychological disorder?

  • associated with stress and/or impairment in functioning. It doesn’t look normal to the rest of the world.

Distress, Impairment, and Cultural Context

  • Distress is normal in some situations

    • Dysfunctional distress occurs when a person is much more distressed than others would be

  • Impaired functioning: must be pervasive and/or significant

  • Culture: Consider “normalcy” relative to the behavior of others in the same cultural context

  • Accepted definition

    • Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and/or impairment in functioning, or increased risk of suffering, death, pain, or impairment

The Science of Psychopathology

  • Psychopathology is the scientific study of psychological disorders

    • A range of professionals are in this field: mental health counselors, psychologists, psychiatrists, etc.

Clinical description

  • Clinical description begins with the presenting problem

  • Symptoms (ex., chronic worry, panic attacks)

  • Description aims to distinguish clinically significant dysfunction from common human experience

  • May also describe other factors:

    • Prevalence and incidence of disorders

    • onset of disorders: acute vs. insidious onset

    • cause* of disorders: episodic, time-limited, or chronic course

    • prognosis: good vs. guarded

Causation, Treatment, and Outcome

  • Etiology

    • What contributes to the development of psychopathology?

  • Treatment development

    • How can we help alleviate psychological suffering?

    • Includes pharmacological, psychosocial, and combined treatments

Historical Conceptions of Abnormal Behavior

  • Major psychological disorders have existed across time and cultures

  • Perceived causes and treatment of abnormal behavior varied widely, depending on context

  • Three dominant traditions have existed in the past to explain abnormal behavior

    • Supernatural

    • Biological

    • Psychological

The Supernatural Tradition

  • Deviant behavior as a battle of “Good” vs. “Evil”

  • Believed to be caused by demonic possession, witchcraft, or sorcery

  • Treatments included exorcism, torture, and religious rituals

  • Competing view that coexisted with supernatural tradition: “insanity” is caused by emotional stress, not supernatural forces

    • Treatments: Rest, sleep, healthy environment, baths, potions

  • Mass hysteria

    • Saint Vitus’s Dance/Tarantism

  • Modern mass hysteria

    • Emotion contagion

    • Mob psychology

  • The moon and the stars

    • Paracelsus, a Swiss physician, suggested that mental health problems are affected by the pull of the moon and stars

The Biological Tradition

  • Hippocrates (460-377 BC)

    • Father of modern Western medicine

    • Mental disorders are understood as physical diseases

    • Linked abnormality with brain chemical imbalances

    • Foreshadowed modern views

  • Galen (129-198 AD) extended Hippocrates’ work

Hippocratic-Galen approach

  • Humoral theory of disorders: Functioning is related to having too much or too little of four key bodily fluids (humors)

    • Blood, phlegm, black bile, yellow bile

    • Example: Depression caused by too much black bile

    • The four humors align with personality traits (sanguine, melancholic, phlegmatic, and/or choleric)

    • Treated by changing environmental conditions (ex., reducing heat) or bloodletting/vomiting

    • Hysteria, “the wandering uterus” -psychological symptoms were a result of the uterus moving around in the body

Later Biological Advances

  • Late-stage syphilis and the biological link with psychological disturbance

    • Includes psychological and behavioral symptoms

    • Caused by a bacterium in the brain

    • Bolstered the view that mental illness = physical illness

  • John P. Grey and the reformers

    • A psychiatrist who believed mental illness had physical roots

    • Championed biological tradition in the U.S.

    • Led to reforms of hospitals to give psychiatric patients better care

The Development of Biological Treatments

  • Insulin shock therapy

  • electric shock

  • Crude surgery

  • Medication became increasingly available starting in the mid-20th century

    • Neuroleptics (major tranquilizers) are now called antipsychotics

    • Minor tranquilizers prescribed for anxiety and related disorders

Consequences of the Biological Tradition

  • Overall, mental illness is understood to have physical roots

  • Increased hospitalization

  • Mental illness is often seen as an “untreatable” condition

  • Improved diagnosis and classification

    • Emil Kraepelin was the father of classification

  • Increased role of sciences in psychopathology

The Psychological Tradition

  • Moral therapy

    • Treated institutionalized patients as normally as possible in a setting that encouraged and reinforced normal social interaction

    • Declined in use due to the size and composition of the institutionalized population

      • Large numbers of people were immigrating to the U.S. and, if institutionalized, were thought not to “deserve” moral therapy

      • The mental hygiene movement focused on providing care to everyone who needed it, causing a large influx of patients

Psychoanalytic Theory

  • Defense mechanisms: The ego’s attempt to manage anxiety resulting from the id/superego conflict

    • Displacement & denial

    • Rationalization & reaction formation

    • Projection, repression, and sublimation

  • Psychosexual stages of development

    • Oral, anal, phallic, latency, and genital stages

    • Theory: conflicts arise at each stage and must be resolved

Later Development in Psychoanalytic Thought

  • Ego psychology (Anna Freud): Defensive reactions of the ego determine behavior

  • Self-psychology (Heinz Kohut): focused on the formation of self-concept and the crucial attributes of the self that allow an individual to progress toward health or neurosis

  • Object relations: focused on how the images of the self seen from the points of view of those close to you make up your identity

  • Carl Jung: rejected focus on sexual drives; emphasized spiritual and religious drives; introduced the collective unconscious

  • Alfred Adler: focused on feelings of inferiority and the striving for superiority

Psychoanalytic Psychotherapy

  • Designed to reveal the nature of unconscious mental processes and conflicts through catharsis and insight

  • Techniques include free association, dream analysis, and analysis of transference

  • Very time-consuming and costly

  • Little evidence of effectiveness

  • Psychodynamic psychotherapy

    • Briefer

    • Focus on relieving suffering

Humanistic Theory

  • Abraham Maslow

    • Hierarchy of needs, beginning with our most basic physical needs and ranging upward to needs for self-actualization, love, and self-esteem

  • Carl Rogers

    • Humanistic therapy emphasizes unconditional positive regard, empathy, and the innate tendency towards growth

  • Most useful among individuals without psychological disorders who are dealing with the stresses of life

The Cognitive-Behavioral Model

  • Pavlov and classical conditioning

    • Learning in which a neutral stimulus is paired with a response until it elicits that response

  • Watson and the rise of behaviorism

    • Psychology is a purely objective experimental branch of natural science with the goals of prediction and control of behavior

  • Joseph Wolpe and behavior therapy

    • Systematic desensitization

  • B. F. Skinner and operant conditioning

    • Influenced by Watson and Thorndike (law of effect)

    • Learning in which behavior changes as a function of what follows the behavior (reinforcement)

  • The behavioral model has contributed greatly to the understanding and treatment of psychopathology

    • Incomplete and inadequate to account for what we now know about psychopathology

The Present: The Scientific Method and an Integrative Approach

  • Two crucial developments in the 1990s:

    • The increasing sophistication of scientific tools and methodology

    • The realization that no one influence—biological, behavioral, cognitive, emotional. or social—ever occurs in isolation (ex., Adolf Meyer)