Chapter 1 Abnormal Psychology Vocabulary
What is Psychological Abnormality?
Abnormality is typically described using the four features often referred to as the four Ds: deviance, distress, dysfunction, and danger. These features help clinicians identify patterns of thoughts, feelings, and behaviors that are unusual or problematic. The four Ds are:
Deviance: behaving or thinking in ways that are markedly different from the norms of a given culture or society. Deviance is relative to the cultural context and can change over time.
Distress: experiences that are unpleasant or upsetting to the person, though distress alone does not guarantee abnormality (some people with unusual functioning may not feel distressed).
Dysfunction: interference with daily functioning, such as difficulties in self-care, work, or social interactions.
Danger: behavior that poses risk of harm to oneself or others; though danger is often cited, it is the exception rather than the rule for most mental health concerns.
Abnormality must be understood within the context of society's norms and values; norms are both stated and unstated rules for proper conduct that are influenced by culture, history, technology, and institutions.
Amira and Alberto are used as case examples to illustrate how distress, dysfunction, deviance, and danger can present in real life and how context matters.
The concept of abnormality remains elusive and is debated among clinical theorists; some have argued that deviations are merely problems in living rather than signs of internal illness (e.g., Sass’s view). Others emphasize underlying illness or disorder and consider context and coping as part of the picture.
The Four Ds in Practice (with examples)
Deviance: Amira’s and Alberto’s thoughts/behaviors differ from social norms; for example, Amira’s extreme distress and beliefs, or Alberto’s command-voiced experiences and global paranoia.
Distress: Amira experiences hopelessness, sleep disturbance, and anxiety; Alberto experiences confusion and fear. Some people, like the icebreakers, may not feel distress even when functioning unusually.
Dysfunction: Amira’s daily functioning is strained (sleep difficulties, mood disturbance, worries about her children); Alberto quits his job, isolates, stocks weapons, and withdraws from social life.
Danger: Alberto’s safety and others’ safety may be at risk due to firearms and environmental risks; however, danger is not always present even with severe distress or dysfunction.
Treatment (Therapy) and Its Definition
Treatment, or therapy, is a systematic procedure designed to change abnormal behavior into more normal functioning.
Jerome Frank’s three essential features of therapy:
A sufferer who seeks relief from a healer
A trained, socially accepted healer whose expertise is accepted by the sufferer and the sufferer’s social group
A series of contacts between healer and sufferer aimed at producing changes in emotional state, attitudes, and behavior
Case of Bill illustrates that many factors (friends’ advice, job changes, diet/exercise) can contribute to improvement, but these may not be formal therapy; real therapy involves structured, systematic procedures.
Historical Perspectives on Abnormality and Treatment
Prehistoric/Ancient views:
Abnormal behavior attributed to evil spirits or supernatural forces; treatment focused on driving out demons (trephination in the Stone Age; exorcism rituals).
Trephination: ancient skull-opening procedure thought to release evil spirits (evidence from skulls showing circular openings).
Greek and Roman views:
Hippocrates argued for natural causes of illness, including brain pathology and humoral imbalances (yellow bile, black bile, blood, phlegm).
Treatments aimed at correcting bodily imbalances (e.g., quiet life, diet, exercise, bleeding) rather than attributing symptoms to demons.
The Middle Ages (demonology returns):
Collapse of scientific inquiry; church dominance; mental illness viewed as Satan’s influence; demonological explanations dominate.
Mass madness outbreaks (tyrantism/Saint Vitus dance, tarantism) and witchcraft fears lead to exorcisms and sometimes torture.
The Renaissance and the rise of asylums:
Humanely treating the mentally ill re-emerged through shrines and charitable care (e.g., Gil, Belgium) and the modern concept of psychopathology begins to form.
Weyer (16th century) is often considered founder of modern studies of psychopathology; care slowly improved but was uneven.
The nineteenth century: reform and moral treatment
Pinel (France) and the movement toward humane, moral treatment: removal from chains, better living conditions, more humane atmosphere; many patients improved and were released.
York Retreat (England) by William Tuke; rest, talk, prayer, and work; fosters humane care.
Dorothea Dix (U.S.) championed public and political reform, leading to laws and state hospitals; moral treatment spread.
Moral treatment emphasized humane guidance, productive work, companionship, and education about problems.
By mid-to-late 19th century, overcrowding and staffing shortages, plus the belief that all patients could be cured with humane care, contributed to a decline of moral treatment.
The early twentieth century: somatogenic vs psychogenic perspectives
Somatogenic: abnormal behavior caused by biological factors.
Psychogenic: abnormal behavior caused by psychological factors; Freud’s psychoanalysis becomes influential.
Emil Kraepelin began modern Biological Psychiatry, identified two distinct disorders manic depression and dementia praecox.
Recent decades and current trends
The 1950s saw the advent of psychotropic medications (antipsychotics, antidepressants, antianxiety drugs) that affect the brain and reduce symptoms.
Deinstitutionalization: large-scale discharge from public mental hospitals; outpatient care becomes primary; community care expands but remains under-resourced.
Community mental health approach emphasizes care in community settings; aims to prevent relapse and support integration, but gaps remain in providing adequate services.
Outpatient care becomes dominant for both severe and mild problems; private psychotherapy expands with insurance coverage; specialized programs (suicide prevention, eating disorders, phobia clinics, etc.) develop.
Prevention and positive psychology: shifting focus toward preventing disorders and promoting mental health.
Multicultural psychology: integrating cultural context into assessment and treatment; awareness of demographic changes (in the U.S., rising minority populations).
Insurance coverage and parity: debates over insurance coverage for mental health equal to physical health; parity laws improve access but gaps remain; managed care controls provider networks, costs, and treatment duration.
Technology and mental health: growing influence of online information, teletherapy, and new ethical considerations (not deeply described in transcript, but referenced as a current trend).
Key Figures, Theories, and Professions Today
Competing theoretical perspectives coexist today; no single dominant view as in the psychoanalytic era. Major schools:
Biological
Cognitive-behavioral
Humanistic-existential
Sociocultural
Developmental psychopathology
Before the 1950s, psychotherapy was primarily the domain of psychiatrists; post-World War II saw expansion to psychologists, social workers, counselors, psychiatric nurses, marriage and family therapists, and others.
Professions and typical credentials (examples from the transcript):
Psychiatrists (MD)
Psychologists (PhD, PsyD, EdD)
Social workers (MSW, DSW)
Counselors (various master’s degrees)
Other roles: clinical, counseling, school psychologists; psychiatric nurses; marriage/family therapists; clinical social workers.
Notable data points (examples of the changing landscape):
Historically higher female participation in psychology-related fields over time; current data show a high percentage of women in graduate programs and many specialties.
The growth of specialized outpatient programs (suicide prevention, eating disorders, phobia clinics, etc.).
The field emphasizes empirical research to understand, predict, and treat abnormal behavior; acknowledges progress as well as ongoing controversies and gaps.
Societal Context, Culture, and Ethics
Culture shapes what is considered abnormal: norms vary across societies and over time; what is deviant in one culture may be typical in another.
Ethical implications include stigma, access to care, and balancing respect for cultural differences with the need for effective treatment.
The growing role of positive psychology and prevention reflects a shift from solely addressing pathology to promoting well-being and resilience.
The impact of insurance: parity laws intended to equalize mental and physical health coverage, but real-world coverage lags and can restrict access to care; managed care introduces constraints that can affect the quality and duration of therapy.
The importance of community care: while it has value, many communities lack sufficient resources to provide adequate ongoing support, particularly for severe disturbances.
Current Data and Trends (Selected Numerical Highlights)
Inpatient public mental hospitals (U.S.) in 1955: 600{,}000 patients; today: about 38{,}075 daily in public facilities (private facilities also exist).
Historical inpatient census (selected years):
1950: 520{,}000
1955: 570{,}000
1960: 540{,}000
1970: 370{,}000
1980: 140{,}000
1990: 105{,}000
2010: 50{,}000
2020: 80{,}000
Percent of Americans with private health insurance: 67%
Parity laws and ACA: 2008 parity law; 2014 ACA designated mental health care as an essential health benefit; improvements but not complete equality.
Costs and utilization:
Managed care typically limits provider choice and sets preapproval requirements and session limits; concerns include shorter or less effective treatment when cost-driven.
UnitedHealth case (2019) cited discrimination in covering only enough mental health treatment to stabilize conditions, not treat underlying problems.
Healthcare Cost Institute (2019) found inpatient mental health care out-of-pocket costs rising faster than other inpatient health care.
Happiness and positive psychology data:
About 1/3 of adults consider themselves very happy.
Happiness building blocks: genes contribute 48%, life events 40%, values 12%.
Factors in happiness: social relationships, resilience, charity, mindful living, exercise, sleep, etc. (eight components listed).
Work and happiness: top occupations with high happiness: Tech workers 90%, Clergy 67%, Firefighters 57%, Special education teachers 53%; lower happiness in restaurant kitchen workers 21%, construction 19%, garage/service attendants 13%
Social contact: daily face-to-face contact and happiness peak around 6 hours per day; at zero hours, happiness about 30%; at 1 hour, 34%; at 3 hours, 43%; at 6 hours, 53%; at 9 hours, 43%
Marriage and happiness: currently married 3.4; always single 3.2; divorced 2.9; widowed 2.9 (on a 0–4 happiness scale)
Demographics and culture:
Racial/ethnic minority groups constitute 40% of the U.S. population, expected to grow to 52% by the year 2055; this shift is driven by age structure, birth rates, and immigration.
Globalization and policy:
The rise of multiple cultures and languages in society; the need for culturally informed assessment and treatment.
Insurance parity and access remain a central policy issue across nations; ongoing debates about the adequacy and equity of coverage for mental health services.
Practical Takeaways for Study and Practice
Abnormality is best understood as a combination of four Ds within a cultural and contextual framework; no single criterion suffices.
Treatment is a systemic process with core elements: patient, healer, shared belief in the healer’s expertise, and structured interactions aimed at changing thoughts, emotions, and behaviors.
Historical perspectives reveal a shift from supernatural explanations to medical/biological and psychosocial approaches, with cycles of reform and backlash.
Current practice embraces multiple theories and professions; outpatient care and community-based approaches are central, but access and quality vary by region and policy.
Prevention and positive psychology are growing, highlighting the shift toward promoting mental health and resilience, not just treating illness.
Cultural context and insurance structures significantly affect diagnosis, treatment options, and outcomes; clinicians should consider norms, values, and systemic barriers when assessing and planning care.
Quick Reference: Terms and Concepts
Abnormality: Deviance, Distress, Dysfunction, Danger, contextualized by culture and norms.
Humors: Four bodily fluids (yellow bile, black bile, blood, phlegm) once thought to influence personality and mood.
Trephination: Ancient skull surgery to release evil spirits.
Demonology: Belief in possession by spirits as a cause of abnormal behavior; exorcism as a treatment.
Moral treatment: Nineteenth-century humane, respectful care emphasizing moral guidance, meaningful activity, and social interaction.
Deinstitutionalization: Policy shift toward outpatient care and community-based services; reduces long-term hospital confinement.
Parity laws: Legal efforts to ensure mental health treatment coverage is on par with physical health coverage.
Positive psychology: Study of positive feelings, traits, and abilities; informs prevention and well-being strategies.
Multicultural psychology: Integration of cultural context into assessment and treatment; important for diverse populations.
Connections to Earlier and Later Content
The historical arc from demonology and humors to biological and psychosocial perspectives mirrors the evolution of scientific approaches in psychology.
The shift to community-based care foreshadows the later chapters on community psychology, public policy, and ethical considerations in mental health.
Prevention and positive psychology align with broader trends in public health and social policy, emphasizing environment, resilience, and well-being.
Ethical, Philosophical, and Practical Implications
How we define abnormality affects who receives help and how they are treated; risk of stigmatization vs. protection of vulnerable individuals.
The balance between medical/biological explanations and sociocultural factors shapes treatment approaches and resource allocation.
Policy and insurance structures can enable or hinder access to care; parity and affordability remain central to effective mental health care.
The move toward prevention requires investment in social determinants of mental health (poverty, violence, education, housing) as well as individual treatment.
Professional diversity (psychiatrists, psychologists, social workers, counselors, nurses) reflects the need for a range of skills and settings to meet varied needs.
Final Note
Abnormal psychology is a dynamic field that integrates history, culture, biology, cognition, behavior, and social policy. The past informs the present, and current and future trends emphasize prevention, accessibility, cultural competence, and evidence-based practice.