• Psychopathology: people who suffer mental, emotional, and often physical pain; unusual

• Cultural Norms: play a large role in defining abnormality

• Cultural Relativism: the view that there are no universal standards or rules for labeling a behavior abnormal; instead, behaviors can be labeled abnormal only relative to cultural norms

• Culture and Gender

  • Culture and gender can influence the ways people express symptoms

  • Culture and gender can influence people’s willingness to admit certain types of behaviors or feelings

  • Culture and gender can influence the types of treatments deemed acceptable or helpful for people exhibiting abnormal behaviors

4 Ds of Abnormality

1. Dysfunction

   • Interfere with the person’s ability to function in daily life, to hold a job, or to form close relationships

   • Ability to function in daily life is disrupted

   • The person might be impaired

2. Distress

   • Behaviors and feelings that cause distress to the individual or to others around him

   • Emotional/physical pain; upset/suffering

   • Subjective experience

3. Deviant

   • Influenced by cultural norms

   • Highly unusual behaviors, based on social/cultural norms

4. Dangerous

   • Behaviors and feelings that are of potential harm to the individual

*NORMAL —> ABNORMAL = SPECTRUM

HISTORICAL PERSPECTIVES ON ABNORMALITY

3 TYPES OF THEORIES USED TO EXPLAIN ABNORMAL BEHAVIOR

1. Biological Theories

   • Viewed abnormal behavior as similar to physical diseases, caused by the breakdown of systems in the body

   • Cure: restoration of bodily health

2. Supernatural Theories

   • Viewed abnormal behavior as a result of divine intervention, curses, demonic possession, and personal sin

   • Cure: religious rituals, exorcisms, confessions, and atonement

3. Psychological Theories

   • Viewed abnormal behavior as a result of traumas, such as bereavement, or of chronic stress

   • Cure: rest, relaxation, a change of environment, and certain herbal medicines are sometimes helpful

• These types of theories have influenced how people are acting abnormally have been regarded in the society

Trephination

• Trephine: tool used for drilling the skull

• Drill holes in the skull of the person display abnormal behavior to allow the spirits to depart

• If the person survived this surgery, the evil spirits would have been released and the person’s abnormal behavior would decline

• Used primarily for the removal of blood clots used by stone weapons during warfare and for other medical purposes

Hysteria:

• from Greek word hystera meaning uterus

• Only occur in women and were attributed to a “wandering uterus”

• The Egyptians believed that the uterus could become dislodged and wander throughout a woman’s body, interfering with her other organs

• Prescribed Treatment: strong-smelling substances to drive the uterus back to its proper place

• Greeks and Romans saw abnormal behavior as an affliction from the gods

• Plato and Socrates argued that some forms of abnormal behavior were divine and could be the source of great literary and prophetic gifts

Hippocrates:

• Often regarded as the father of medicine

• Argued that abnormal behavior was like other diseases of the body

• The body is composed of 4 basic humors: blood, phelgm, yellow bile, and black bile

• Classified abnormal behavior into 4 categories: epilepsy (neurological disorder), mania, melancholia (specific quality of several types of depression), and brain fever (high temperature)

• Believed that removing a patient from a difficult family could help restore mental health

Treatments of Greek Physicians:

• intended to restore balance in the 4 humors

• Sometimes physiological and intrusive

  • Bleeding a patient to treat disorders thought to result from an excess of blood

• Rest, relaxation, a change of climate/scenery, a change of diet, or living a temperate life

Witchcraft

Teresa of Avila

• Spanish nun who was canonized, explained that mass hysteria that had broken out among a group of nuns was not the work of the devil but was the result of infirmities/sickness

• Argued that nuns were comas enfermas/ “as if sick”

• Sought out natural causes for the nuns’ strange behaviors and concluded that they were due to melancholy, a weak imagination, or drowsiness and sleepiness

PSYCHIC EPIDEMICS

• mass hysteria

• Defined as a phenomenon in which large numbers of people engage in unusual behaviors that appear to have a psychological origin

• Tarantism:

  • People suddenly developed an acute pain, which they attributed to the bite of a tarantula

  • Interpreted as the results of possession by the devil

  • May have been remnants of ancient rituals performed by people worshiping the Greek God Dionysus

THE SPREAD OF ASYLUMS

• Hospital of Saint Mary of Bethlehem/ “Bedlam”

  • Lived in filth and confinement, often chained to the wall/locked inside small boxes

• Laws regarding the confinement of the mentally ill in Europe and in US

  • Dalton’s 1618 “Common Law”

    • “It is lawful for the parents, kinsmen, or other friends of a man that is mad, or frantic… to take him and put him into a house, to bind or chain him, and to beat him with rods, and to do any other forcible act to reclaim, or to keep him so he shall do no hurt”

  • The First Act for Regulating Madhouses in England was passed in 1774

    • Cleaning up the deplorable conditions in hospitals and madhouses and protecting people from being unjustly jailed for insanity

    • Provided for the licensing and inspection of madhouses and required that a physician, a surgeon, or an apothecary sign a certificate before a patient could be admitted

    • Applied only to paying patients in private madhouses, however, and not to the poor people confined to workhouses

• These asylums typically were established and run by people who thought that abnormal behaviors were medical illnesses

• Although the supernatural theories of the Middle Ages have often been decried as leading to brutal treatment of people with mental illnesses, the medical theories of those times and of the next couple of centuries did not always lead to better treatment.

MORAL TREATMENT:

• Philippe Pinel

  • Leader of Moral Treatment movement

  • Ordered that patients be allowed to walk freely around the asylum

  • Provided with clean and sunny rooms, comfortable sleeping quarters and good food

  • Nurses and professional therapists were trained to work with the patients to help them regain their sense of tranquility and engage in planned social activities

  • His approach was remarkably successful

    • Patients are able to control their behavior and reengage in life

    • Some could be released from the asylum

    • Successfully reformed La Salpatriere, a mental hospital for female patients in Paris

• Quaker William Tuke

  • “The Retreat”

  • Direct response to the brutal treatment he saw being delivered at other facilities to people with abnormal behavior

  • Treatment was designed to restore patients’ self-restraint by treating them with respect and dignity and encouraging them to exercise self-control

• Dorothea Dix

  • One of the most militant crusaders for moral treatment of the insane

  • Led to the passage of laws and appropriations to fund the cleanup of mental hospitals and the training of mental health professionals dedicated to the moral treatment of patients

THE EMERGENCE OF MODERN PERSPECTIVES

Wilhelm Griesinger

• “The Pathology and Therapy of Psychic Disorders”

  • A systematic argument that all psychological disorders can be explained in terms of brain pathology

Emil Kraepelin

• Developed a scheme for classifying symptoms into discrete disorders that is the basis for our modern classification systems

General Paresis

• a disease that leads to paralysis, insanity, and eventually death

THE PSYCHOANALYTIC PERSPECTIVE

Franz Anton Mesmer

• believed that people have a magnetic fluid in the body that must be distributed in a particular pattern in order to maintain health

• Much of his treatments were the hysterical disorders, in which people lose functioning/feeling in some part of the body for no apparent reason

• Mesmerism

  • The “cures” Mesmer effected in his psychiatric patients were attributed to the trancelike state that Mesmer seemed to induce in his patients

  • Later labeled as “hypnosis”

    • Patients appeared very suggestible and the mere suggestion that their ailments would disappear seemed enough to make them actually disappear

Jean Charcot

• argued that hysteria was caused by degeneration in the brain

Hippolyte-Marie Berheim and Ambroise-Auguste Liebault

• showed that they could induce symptoms of hysteria, such as paralysis in an arm/the loss of feeling in a leg, by suggesting these symptoms to patients who were hypnotized; could also remove symptoms under hypnosis

Sigmund Freud

• much of the mental life of an individual remains hidden from consciousness

Pierre Janet

• investigating multiple personality disorder, in which people appear to have multiple, distinct personalities, each of which operates independently of the others, often not knowing the others exist

Josef Breuer

• discovered that encouraging patients to talk about their problems while under hypnosis led to a great upwelling and release of emotion, which eventually was called “catharsis”

  • Discussion was less censored than conscious discussion, allowing the therapist to elicit important psychological material more easily

THE ROOTS OF BEHAVIORISM

Ivan Pavlov

• Classical Conditioning: discovered that dogs could be conditioned to salivate when presented with stimuli other than food if the food was paired with these other stimuli

John Watson

• rejected psychoanalytic and biological theories of abnormal behaviors and explained them entirely on the basis of the individual’s history of conditioning

E.L. Thorndike and B.F. Skinner

• studying how the consequences of behaviors shape their likelihood of recurrence

• Operant/Instrumental Conditioning: argued that behaviors followed by positive consequences are more likely to be repeated than behaviors followed by negative consequences

Behaviorism

• the study of the impact of reinforcements and punishments on behavior

THE COGNITIVE REVOLUTION

Albert Bandura

• Argued that people’s beliefs about their ability to execute the behaviors necessary to control important events— self-efficacy beliefs — are crucial in determining people’s well-being

Albert Ellis

• Rational-emotive Therapy

  • A theory for emotional problems based on this theory

  • Required the therapists to challenge, sometimes harshly, their patient’s irrational belief systems

  • Became very popular and moved psychology into the study of the thought processes behind serious emotional problems

Aaron Beck

• focused on the irrational thoughts of people with psychological problems

• Cognitive Therapy: become one of the most widely used therapies for many disorders

MODERN MENTAL HEALTH CARE

Deinstitutionalization

• Patient’s Rights Movement

  • Argued that mental patients can recover more fully/live more satisfying lives if they are integrated into the community, with the support of community based treatment facilities— deinstitutionalization

• Community Mental Health Movement

  • “Bold new approach” to mental health care

  • Attempted to provide coordinated mental health services to people in community mental health care centers

• Community Mental Health Centers

  • Often include teams of social workers, therapists, and physicians who coordinate care

• Halfway Houses

  • Offer people with long-term mental health problems the opportunity to live in a structured, supportive environment as they try to reestablish working relationships and ties to family and friends

• Day Treatment Centers

  • Allow people to obtain treatment during the day, along with occupational and rehabilitative therapies, but live at home at night

• Many of the goals were never fully reached

MANAGED CARE

• a collection of methods for coordinating care that ranges from simple monitoring to total control over what care can be provided and paid for

PROFESSIONALS WITHIN ABNORMAL PSYCHOLOGY

Psychiatrists

• have an MD degree and have received specialized training in the treatment of psychological problems

• Can prescribe medications for the treatment of these problems and have been trained to conduct psychotherapies as well

Clinical Psychologist

• Typically have a PhD in psychology, with a specialization in treating and researching psychological problems

• Can conduct psychotherapy, but in most states they do not currently prescribe medications

Marriage and Family Therapist

• specialize in helping families, couples, and children overcome problems that are interfering with their well-being

Clinical Social Workers

• have a master’s degree in social work and often focus on helping people with psychological problems overcome social conditions that are contributing to their problems

Licensed Mental Health Counselors

• individuals who have graduate training in counseling beyond the bachelor’s degree in counseling but have not obtained a PhD