PSY 3410 Chapter 1
Understanding Psychology
Scientist-practitioners: mental health professionals who are expected to apply scientific methods to their work. Must keep current in the latest research on diagnosis and treatment, evaluate their own methods for effectiveness, and may generate their own research
Mental health practitioners may function as scientist-practitioners in one or more of 3 ways:
(1) may keep up with the latest scientific developments in their field, and therefore use the most current diagnostic and treatment procedures
(2) evaluate their own assessments or treatment procedures to see whether they work
(3) conducting research that produces new information about disorders or their treatment
Presenting problem: the original complaint reported by the client to the therapist. Shorthand = presents, which indicates why the person came to the clinic
Clinical description: details of the combination of behaviors, thoughts, and feelings of an individual that make up a particular disorder
Clinical refers both to the types of problems or disorders that you would find in a clinic/hospital and to the activities connected with assessment and treatment
Important function: to specify what makes the disorder different from normal behavior or from other disorders
Prevalence: number of people displaying a disorder in the total population at any given time
Incidence: number of new cases of a disorder appearing during a specific period
Sex ratio: what percentage of men and women have the disorder
Course: pattern of development and change of a disorder over time
Most disorders follow a somewhat individual pattern
Chronic course: tend to last a long time, sometimes lifetimes; ex: schizophrenia
Episodic course: the individual is likely to recover within a few months, only to shudder a recurrence of the disorder at a later time, may repeat throughout person’s life. Ex: mood disorders
Time-limited course: disorder will improve without treatment in a relatively short period with little or no risk of recurrence
Onset difference
Acute onset: begin suddenly
Insidious onset: develop gradually over an extended period
Prognosis: anticipated course of a disorder/ predicted future development of a disorder over time
Age may be important part of the clinical description because specific psychological disorders occurring in childhood may present differently from the same disorder in adulthood or old age
Developmental psychology: the study of changes in behavior over time
Developmental psychopathology: the study of changes in abnormal behavior
Life-span developmental psychopathology: study of abnormal behavior across the entire age span
Etiology: cause or source of a disorder; the study of origins (what causes it)
Includes biological, psychological, and social dimensions
Correlation does not imply causality
Granger causality: used to describe when a series of events temporarily predict another series of events
Treatments can give some hints about the nature of the disorder and its causes
Historical conceptions of abnormal behaviors
3 major models:
Supernatural model: agents outside our body and environment influence our behavior, thinking, and emotions, such as divinities, demons, spirits, or other phenomena such as magnetic fields or the moon or stars
14th-15th century, people with psychological disorders seen as the work of the devil and witches; believed to have been possessed by evil spirits
Treatments: exorcism, shaving the pattern of the cross in the hair of the victims head and securing sufferers to a wall near the front of a church so that they might benefit from hearing mass
Mind called the soul or the psyche- considered separate from the body
Mental depression and anxiety recognized as illnesses, however, symptoms such as despair and lethargy identified by the church with the sin of acedia (sloth)
Treatment: rest sleep, and a healthy and happy environment, others included baths, ointments, and various potions.
People with insanity, and those with physical deformities or disabilities were moved from house to house in medieval villages with neighbors taking turns caring for them
Biological model
Psychological model
Treatments for possession
Not always connected with sin, may be seen as involuntary and the possessed as blameless
In middle ages, if failed, some authorities took steps that they thought necessary to make the body uninhabitable by evil spirits through torture
Hanging people over a pit of poisonous snakes to scare the evil spirits out of the body
Mass hysteria: groups of people were compelled simultaneously to run out in streets, dance, shout, rave, and jump around as if they were at a wild party; one guess as to the cause was reaction to insect bites
May demonstrate the phenomenon of emotion contagion- the experience of an emotion seems to spread to those around us
Mob psychology: shared response of one person identifying a “cause” of the problem and others assuming their own reactions have the same source
Paracelsus: suggested that the movements of the moon and stars had profound effects on people's psychological functioning
Suspected that the gravitational effects of the moon on bodily fluids might be a possible cause of mental disorders
Inspired the word lunatic
The biological tradition
Hippocrates- considered the father of modern western medicine
Hippocratic Corpus, suggested that psychological disorders could be treated like any other disease
Believed that psychological disorders might also be caused by brain pathology or head trauma and could be influenced by hereditary (genetics)
Galen- adopted ideas of hippocrates and developed them further
Hippocratic-galenic approach led to the humoral theory of disorders
First example of associating psychological disorders with a “chemical imbalance”
Hippocrates assumed that normal brain functioning was related to 4 bodily fluids or humors:
Blood
Heart
Sanguine: describes someone who is ruddy in complexion, cheerful and optimistic
Black bile
Spleen
Melancholic: depressive
Yellow bile
Liver
Choleric: a hot tempered person
Phlegm
Brain
Phlegmatic: indicates apathy and sluggishness but can also mean being calm under stress
Physicians believed that disease resulted from too much or too little of one of the humors
Treated by regulating the environment to increase/decrease heat, dryness, moisture, or cold, depending on which humor was out of balance
2 other treatments:
Bleeding or bloodletting- a careful amount of blood was removed from the body, often with leeches
Inducing vomiting
Hippocrates also coined hysteria, what we now call the somatic symptoms disorders
The physical symptoms appear to be the result of a medical problem for which no physical cause can be found, such as paralysis and some kinds of blindness
Primarily occurred in women
Biological tradition reinvigorated in the 19th century by 2 factors: (1) the discovery of the nature and cause of syphilis and (2) strong support from the well-respected American psychiatrist John P. Grey
Syphilis
Behavioral and cognitive symptoms (of advanced syphilis- a sexually transmitted disease causd by a bacterial microorganism entering the brain) included believing that everyone is plotting against you (delusion of persecution) or that you are God (delusion of grandeur), as well as other bizarre behaviors
Symptoms similar to those of psychosis- psychological disorders characterized in part by beliefs that are not based in reality (delusions), perceptions that are not based in reality (hallucinations) or both
General paresis- psychotic patients deteriorating steadily, becoming paralyzed and dying within 5 years of onset; Louis Pasteu’s germ theory of disease facilitated the identification of the specific bacterial microorganism that causes syphilis
Cure for general paresis
physicians deliberately injected patients with malaria, those who survived this burned out the syphilis bacteria because of the high fever
“Madness” and associated behavioral and cognitive symptoms for the first time were traced directly to a curable infection
Penicillin cures syphilis
John P. Grey
Believed that the causes of insanity were always physical, therefore, mentally ill patients should be treated as physically ill. Emphasis on rest, diet, and proper room temperature and ventilation
Hospital conditions greatly improved, but became so large and impersonal that individual attention was not possible
The development of biological treatments
1930s:
Physical interventions of electric shock and brain surgery
Insulin shock therapy (1927)
Benjamin franklin discovered that a mild and modest electric shock to the head produced a brief convulsion and memory loss (amnesia) but did little harm (1750s)
1950s:
Drug treatment
First effective drugs for severe psychotic disorders developed systematically
Before 1950s, medicinal substances had been used as sedatives
Rauwolfia serpentine, or reserpine, and neuroleptics (major tranquilizers)- hallucinatory and delusional thought process diminished; these drugs controlled agitation and aggressiveness
Benzodiazepines (minor tranquilizers), such as Valium and Librium, used to reduce anxiety
Consequences of the biological tradition
Grey and colleagues reduced/eliminated interest in treating mental patients because they thought that mental disorders were the result of some as-yet-undiscovered brain pathology and therefore incurable
Interest centered on diagnosis, legal questions concerning the responsibility of patients for their actions during periods of insanity, and the study of brain pathology, instead of treatment
Emil Kraepelin (1856-1926):
Dominant figure during this period and one of the founding fathers of modern psychiatry
Influential in advocating the major ideas of biological tradition, but was little involved in treatment
One of the first to distinguish among various psychological disorders, seeing that each may have a different age or onset and time course, with somewhat different clusters of presenting symptoms, and a different cause
End of 1800s:
Treatment based on humane principles
The most unfortunate drawback was that active intervention and treatment were all but eliminated in some settings, despite the availability of some effective approaches
The Psychological Tradition
Psychosocial treatment: treatment practices that focus on social and cultural factors (such as family experience), as well as psychological influences. These approaches include cognitive, behavioral, and interpersonal methods
Moral therapy: psychosocial approach in the 19th century that involved treating patients as normally as possible in normal environments
Reinforced normal social interaction
Principles date back to plato and beyond
Originated from french psychiatrist Philippe Pinel (1745-1826) and his associate Jean-Baptiste Pussin (1746-1811) who was the superintendent of the Parisian hospital La Bicetre
Pussin removed all chains used to restrain patients and instituted humane and positive psychological interventions
Benjamin Rush- considered the founder of U.S. psychiatry; introduced moral therapy at Pennsylvania Hospital and it became leading treatment choice
Rise of moral therapy made asylums habitable and even therapeutic
Asylum reform and the decline of moral therapy
Humane treatment declined after mid-19th century
Widely recognized that moral therapy worked best when the number of patients in an institution was 200 or fewer, but the number of patients increased after the civil war due to the waves of immigrants.
Patients in hospitals increased to 1000-2000, but immigrants were not given moral treatment even when there was sufficient hospital personnel as they were thought not to deserve it
A second reason may be due to Dorothea Dix's mental hygiene movement, which was an effort to improve care of the mentally disordered by informing the public of their mistreatment. Her efforts made humane treatment more widely available, which led to a substantial increase in the number of mental patients.
Hospitals were inadequetely staffed
Final reason: in the middle of the 19th century, decided that mental illness was caused by brain pathology and therefore incurable
Psychological tradition reemerged in 20th century
First major approach: psychoanalysis
Psychoanalytic assessment and therapy, which emphasizes exploration of, and insight into, unconscious processes and conflicts, pioneered by Sigmund Frued
Based on Sigmund Frued’s theory of the structure of the mind and the role of unconscious processes in determining behavior
Second approach was behaviorism
Explanation of human behavior, including dysfunction, based on principles of learning and adaptation derived from experimental psychology
John B. Watson, Ivan Pavlov, and B.F. Skinner
Focuses on how learning and adaptation affect the development of psychopathology
Psychoanalytic Theory
Franz Anton Mesmer
Suggested to patients that their problems were caused by an undetectable fluid found in all living organisms called “animal magnetism”, which could become blocked. He would tap various areas of patients bodies where their animal magnetism was blocked while suggesting that they were cured
Widely regarded as the father of hypnosis- a state in which extremely suggestible subjects sometimes appear to be in a trance
Josef Breuer
While patients were in a highly suggestible state of hypnosis, asked them to describe their problems, conflicts, and fears in as much detail as possible. 2 phenomena occurred:
Patients often became extremely emotional as they talked and felt quite relieved and improved after emerging from the hypnotic state
Seldom would they have gained an understanding of the relationship between their emotional problems and their psychological disorder. Difficult or impossible for them to recall some details they had described under hypnosis- material seemed beyond their awareness
Breuer and Freud believed they “discovered” the unconscious mind, part of the psychic makeup that is outside the awareness of the person, and its apparent influence on the production of psychological disorders
One of the most important developments in history of psychopathology
Second close discovery was catharsis, the rapid or sudden release of emotional tension thought to be an important factor in psychoanalytic therapy
Psychoanalytic model: complex and comprehensive theory originally advanced by Sigmund Freud that seeks to account for the development and structure of personality, as well as the origin of abnormal behavior, based primarily on inferred inner entities and forces
3 major facets:
(1) the structure of the mind and the distinct functions of personality that sometimes clash with one another
(2) the defense mechanisms with which the mind defends itself from these clashes, or conflicts
(3) the stages of early psychosexual development that provide grist for the mill of our inner conflicts
The structure of the mind
3 major parts or functions:
The id
Source of our strong sexual and aggressive feelings or energies
The unconscious physical entity present at birth representing basic sexual and aggressive drives
The “animal” within
The energy or drive is the libido
Thanatos- the death instinct
Operates according to the pleasure principle, an overriding goal of maximizing pleasure and eliminating any associated tension or conflicts
Often conflicts with social rules and regulations
Processes information through the primary process, which is emotional, irrational, illogical, filled with fantasies, and preoccupied with sex, aggression, selfishness, and envy
The ego
The physical entity responsible for finding realistic and practical ways to satisfy id drives
Operates according to the reality principle
Cognitive operations or thinking are characterized by logic and reason, referred to as the secondary process
Role is to mediate conflict between id and the superego
The executive or manager
The superego
The physical entity representing the internalized moral principles of parents and society
The conscience
Represents the moral principles instilled in us by parents and culture
Purpose is to counteract the potentially dangerous aggressive and sexual drives of id
Almost entirely unconscious
Intrapsychic conflict: the struggles among the id, ego, and superego
If ego mediates successfully, higher intellectual and creative pursuits in life
If ego mediates unsuccessfully, id or superego takes over, conflict overtakes and psychological disorders develop
Defense mechanisms
Defense mechanisms: common patterns of behavior, often adaptive coping styles when they occur in moderation, observed in response to particular situations. These are thought to be unconscious processes originating in the ego
unconscious protective processes that keep primitive emotions associated with conflicts in check so that the ego can continue its coordinating function.
Anxiety alerts the ego to set defense mechanisms
Displacement: transfers a feeling about or a response to an object that causes discomfort onto another, usually less threatening, object or person
Denial: refuses to acknowledge some aspect of objective reality or subjective experience that is apparent to others
Projection: falsely attributes own unacceptable feelings, impulses, or thoughts to another individual or object
Rationalization: conceals the true motivations for actions, thoughts, or feelings through elaborate reassuring or self-serving but incorrect explanations
Reaction formation: substitutes behavior, thoughts, or feelings that are the direct opposite of unacceptable ones
Repression: blocks disturbing wishes, thoughts, or experiences from conscious awareness
Sublimation: directs potentially maladaptive feelings or impulses into socially acceptable behavior
More severe internal conflicts can trigger self-defeating defensive processes or symptoms
Phobic and obsessive symptoms common
Psychosexual stages of development
The sequence of phases a person passes through during development. Each stage is named for the location on the body where id gratification is maximal at that time. Begins during infancy and early childhood
Stages: oral, anal, phallic, latency, and genital - each represent distinctive patterns of gratifying our basic needs and satisfying our drive for physical pleasure
Freud hypothesized- if an individual did not receive the appropriate gratification during a specific stage or if one left a strong impression, or fixation, the individuals personality would reflect that stage throughout their adult life
Freud also thought that all young boys think of their mothers sexually
Castration anxiety: the fear in young boys that they will be genitally mutilated because of their lust for their mothers
Oedipus complex: the battle of the lustful impulses on the one hand and castration anxiety on the other that creates internal conflict, or intrapsychic
Electra complex: the counterpart for girls, where they want to possess their fathers and replace their mother
Penis envy- girls desiring a penis to be more like father and brother
Nonpsychotic psychological disorders freud called neuroses, or neurotic disorders
Later developments in psychoanalytic thought
Anna Freud
Ego psychology: derived from psychoanalysis, emphasizes the role of the ego in development and attributes psychological disorders to failure of the ego to manage impulses and internal conflicts; also known as self-psychology
Heinz Kohut
Focused on a theory of the formation of self-concept and the crucial attributes of the self that allow an individual to progress toward health, or to develop neurosis- psychological disorder thought to result from unconscious conflicts and the anxiety they cause
This psychoanalytic approach became known as self-psychology
Object relations: the study of how children incorporate the memories and values of people who are close and important to them
Object refers to the important people; introjection is the process of incorporation
Object relations theory- you tend to see the world through the eyes of the person incorporated into your self
Carl Jung
Collective unconsciousness: accumulated wisdom of a culture collected and remembered across generations
Suggested spiritual and religious drives
Emphasized the importance of enduring personality traits such as introversion and extroversion
Alfred Adler
Inferiority complex
Focused on feelings of inferiority and the striving for superiority
Erik Erikson
Theory of development across the lifespan
Psychoanalytic psychotherapy
Free association: psychoanalytic therapy technique intended to explore threatening material repressed into the unconscious. The patient is instructed to say whatever comes to mind without censoring
Dream analysis: psychoanalytic therapy method in which dream contents are examined as symbolic of id impulses and intrapsychic conflict
Psychoanalyst: therapist who practices psychoanalysis after earning either an M.D. or a Ph.D. degree and receiving additional specialized postdoctoral training
Transference: psychoanalytic concept suggesting that clients may seek to relate to the therapist as they do to important authority figures, particularly their parents
Countertransference: therapists project some of their own personal issue and feelings, usually positive, onto the patient
Psychodynamic psychotherapy: contemporary version of psychoanalysis that still emphasizes unconscious processes and conflicts but is briefer and more focused on specific problems
Used by many therapists
7 tactics:
(1) a focus on affect and the expression of patients emotions
(2) an exploration of patients attempts to avoid topics or engage in activities that hinder the progress of therapy
(3) the identification of patterns in patients actions, thoughts, feelings, experiences, and relationships
(4) an emphasis on past experiences
(5) a focus on patients interpersonal experiences
(6) an emphasis on the therapeutic relationship
(7) an exploration of patients wishes, dreams, or fantasies
2 additional features:
Significantly briefer than classical psychoanalysis
Deemphasize the goal of personality reconstruction, focusing on relieving the suffering associated with psychological disorders
Humanistic theory
Jung and Adler- humanistic psychology
Self-actualizing: process emphasized in humanistic psychology in which people strive to achieve their highest potential against difficult life experiences
Abraham Maslow
Hierarchy of needs
We cannot progress up the hierarchy until we have satisfied the needs at lower levels
Carl Rogers
Most influential humanist
Originated client-centered therapy, or person-centered therapy: the client primarily directs the course of discussion, seeking self-discovery and self-responsibility
Unconditional positive regard: acceptance by the counselor of the client's feelings and actions without judgement or condemnation
Critical to humanistic approach
Humanistic therapists believed that relationships were the single most positive influence in facilitating human growth
Found its greatest application among those without psychological disorders
The cognitive-behavioral model
Combines insights from the behavioral, cognitive, and social learning models, which brought the systematic development of a more scientific approach to the psychological aspects of psychopathology
Pavlov and classical conditioning
Ivan Petrovich Pavlov initiated classical conditioning
A fundamental learning process, an event that automatically elicits a response is paired with another stimulus event that does not (a neural stimulus). After repeated pairings, the neutral stimulus becomes a conditioned stimulus that by itself can elicit the desired response
For classical conditioning to begin, the unconditioned stimulus (UCS) must be one the would elicit a response in almost anyone and requires no learning; no conditions must be present for the response to occur
The natural or unlearned response to the unconditioned stimulus is the unconditioned response (UCR)
The object/person being associated with the UCS is the conditioned stimulus (CS)
The response elicited by the CS is the conditioned response (CR)
Extinction: learning process in which a response maintained by reinforcement in operant conditioning or pairing in classical conditioning decreases when that reinforcement or pairing is removed; also the procedure of removing that reinforcement or pairing
Edward Titchener
Emphasized the study of introspection: nonscientific approach to the study of psychology involving systematic attempts to report thoughts and feelings that specific stimuli evoked
Watson and the rise of behaviorism
John B. Watson
Founder of behaviorism
Purely objective experimental branch of natural science
Goal is the prediction and control of behavior
Making a kid fear rats
Fear being classically conditioned
The beginnings of behavior therapy
Joseph Wolpe
Systematic desensitization: Behavioral therapy technique to diminish excessive fears, involving gradual exposure to the feared stimulus paired with a positive coping experience, usually relaxation.
Called this approach behavior therapy
Array of therapy methods based on the principles of behavioral and cognitive science, as well as principles of learning as applied to clinical problems. It considers specific behaviors rather than inferred conflicts as legitimate targets for change.
B.F. Skinner and operant conditioning
Operant conditioning: a type of learning in which behavior changes as a function of what follows the behavior.
Reinforcement: to “reward”
Using punishment was ineffective in the long run and that the primary way to develop new behavior is to positively reinforce desired behavior
Edward L. Thorndike
best known for the law of effect, which states that behavior is either strengthened (likely to be repeated more frequently) or weakened (likely to occur less frequently) depending on the consequences of that behavior.
Shaping: In operant conditioning, the development of a new response by reinforcing successively more similar versions of that response. Both desirable and undesirable behaviors may be learned in this manner.
The present: the scientific method and an integrative approach
1990s 2 developments
(1) the increasing sophistication of scientific tools and methodology
(2) the realization that no one influence - biological, behavioral, cognitive, emotional, or social- ever occurs in isolation
NIMH plan 4 goals
(1) to define the brain mechanisms underlying complex behaviors
(2) to examine mental illness trajectories across the lifespan
(3) to strive for prevention and cures
(4) to strengthen the public health impact of research