Chapter 1: Psychopathology in Historical Context
Goals
Define psychological disorders according to the three basic criteria of psychopathology.
Describe each of the three basic categories of research in psychopathology.
Compare the three prominent historical approaches to psychopathology in terms of how they explain and treat psychological disorders.
Differentiate Freudian psychoanalysis from the humanistic and behavioral approaches according to their research and therapeutic emphases.
List the main influences on the development of psychopathology according to the integrative approach.
Notes and Definitions and Quotes and stuff From PPT oh my
1-1a What Is a Psychological Disorder?
psychological disorder: “Psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response.”
phobia: “A psychological disorder characterized by marked and persistent fear of an object or situation.”
abnormal behavior: “Psychological dysfunction within an individual that is associated with distress or impairment in functioning and a response that is not typical or culturally expected.”
What are the criteria for defining a psychological disorder?
Psychological dysfunction
Distress or impairment
Atypical response
“Psychological dysfunction refers to a breakdown in cognitive, emotional, or behavioral functioning”
It is important to distinguish abnormal behaviors from normal ones, as they exist on a spectrum
example from book: Fainting every time you see/think about blood is abnormal. Feeling queasy when you see blood is normal.
“having a dysfunction is not enough to meet the criteria for a psychological disorder”
Can’t define a disorder by distress alone. Not only is distress an unfortunate part of life, but some conditions are marked by the absence of distress.
Impairment is important. If this prevents you from functioning, it is bad
“most psychological disorders are simply extreme expressions of otherwise normal emotions, behaviors, and cognitive processes”
Like many criteria, “atypical” and “abnormal” behavior exists on a spectrum and does not alone mean there is a problem
deviating from the average in height, talent, etc. are fine
“In most cases, the more productive you are in the eyes of society, the more eccentricities society will tolerate. Therefore, “deviating from the average” doesn’t work well as a definition for problematic abnormal behavior.”
Breaking social norms: make sure you understand the cultural perspective
be careful not to misuse the understanding of “normal”. breaking social norms does not mean someone it disordered or should be put in a facility
is it in their control?
psychological disorder definition used in the DSM-5: “describes behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment.”
useful to compare to existing knowledge of known disorders (prototype)
prototype: “…’typical’ profile of a disorder—for example, major depression or schizophrenia—when most or all symptoms that experts would agree are part of the disorder are present.”
1-1b: The Science of Psychopathology
Psychopathology: “Scientific study of psychological disorders.”
“counseling psychologists tend to study and treat adjustment and vocational issues encountered by relatively healthy individuals, and clinical psychologists usually concentrate on more severe psychological disorders.”
Psychiatrists earn MD in med school, specialize is psych during 3-4 year residency
investigate disorders biologically
give treatments
“Psychiatric social workers typically earn a master’s degree in social work as they develop expertise in collecting information relevant to the social and family situation of the individual with a psychological disorder. Social workers also treat disorders, often concentrating on family problems associated with them.”
“Psychiatric nurses have advanced degrees, such as a master’s or even a Ph.D., and specialize in the care and treatment of patients with psychological disorders, usually in hospitals as part of a treatment team.”
scientist-practitioners: “Mental health professionals who are expected to apply scientific methods to their work. They must keep current in the latest research on diagnosis and treatment, they must evaluate their own methods for effectiveness, and they may generate their own research to discover new knowledge of disorders and their treatment.”
Consume, evaluate, and create science
“Such data flow from research that attempts three basic things: to describe psychological disorders, to determine their causes, and to treat them”
presenting problem: “Original complaint reported by the client to the therapist. The actual treated problem may sometimes be a modification derived from the presenting problem.”
clinical description: “Details of the combination of behaviors, thoughts, and feelings of an individual that make up a particular disorder.”
clinical description helps distinguish between abnormal and normal behavior
prevalence: “Number of people displaying a disorder in the total population at any given time (compare with incidence).”
incidence: “Number of new cases of a disorder appearing during a specific period (compare with prevalence).”
Other relevant stats: gender and age
course: “Pattern of development and change of a disorder over time.”
chronic course: last a long time
episodic course: likely to recover in a few months, possibly coming back at a later time
time-limited course: will improve without treatment with little risk of coming back
Onsets
Acute onset: begin suddenly
insidious onset: gradually over time
knowing onset and course is important for treatment
prognosis: “Predicted future development of a disorder over time.”
Age: disorders may appear different at different stages of life
“We call the study of changes in behavior over time developmental psychology, and we refer to the study of changes in abnormal behavior as developmental psychopathology”
“Study of abnormal behavior across the entire age span is referred to as life-span developmental psychopathology”
Etiology: “Cause or source of a disorder.”
biological, social, psychological
Correlation does not equal causation
“Statisticians often use the term Granger causality to describe when a series of events temporally predict another series of events”
Treatments can give us hints as to the cause of a disorder
effect <=/=> cause
pain goes away after meds …. pain wasn’t because of lack of meds
1-1c: Historical Conceptions of Abnormal Behavior
supernatural model: the belief that forces outside our body influence our emotions/behaviors
soul or psyche = mind = separate from body (Ancient Greece)
two other models: biological and psychological
1-2a: Demons and Witches
many attributed bad behaviors to the devil and witches
those with disorders were possessed
blamed for bad things in the community
religion and magic and sorcery
“Treatments included exorcism”
and other religious stuff
exorcism: “Religious ritual that attributes disordered behavior to possession by demons and seeks to treat the individual by driving the demons from the body.”
1-2b: Stress and Melancholy
“insanity was a natural phenomenon, caused by mental or emotional stress, and that it was curable … Mental depression and anxiety were recognized as illnesses…Common treatments were rest, sleep, and a healthy and happy environment. Other treatments included baths, ointments, and various potions”
“symptoms such as despair and lethargy were often identified by the church with the sin of acedia, or sloth”
people in villages took turns taking care of the insane
depression = cause of behavior … not demons
1-2c: Treatments for Possession
many believed possession/disease = punishment
victim blaming
some didn’t victim blame (good job)
exorcisms were mostly painless, but if they didn’t work… get rid of evil with torture
SNAKE PITS?!?!?!?!
1-2d: Mass Hysteria
large-scale odd behavior
1-2e: Modern Mass Hysteria
“emotion contagion, in which the experience of an emotion seems to spread to those around us”
ex: one person smells something and feels sick. people around them feel sick. there wasn’t anything there
empathy?
1-2f: The Moon and the Stars
moon and stars effects people
inspired lunatic from luna (moon)
still a strong belief (astrology)
1-3a: Hippocrates and Galen
Hippocrates and associates believed psychological disorders may be caused by: head trauma, genetics, brain pathology, disease
Later Galen adopted these ideas and took in into biology
“humoral theory of disorders. Hippocrates assumed that normal brain functioning was related to four bodily fluids or humors: blood, black bile, yellow bile, and phlegm. Blood came from the heart, black bile from the spleen, phlegm from the brain, and choler or yellow bile from the liver.”
disease = too much/too little
ex: black bile (melancholer) = depression
first examples of “chemical imbalance” concept
humors also related to Greek four basic qualities: heat, dryness, moisture, cold
regulate environment to treat humors
bloodletting with leeches, induced vomiting as well as normal stuff (bed rest, exercise, nutrition)
similar thoughts in China
wind moved through body
blockages of wind = bad
cold, dark wind = yin = bad
warm, life-sustaining wind = yang = good
acupuncture
“Hippocrates also coined the word hysteria to describe a concept he learned about from the Egyptians, who had identified what we now call the somatic symptom disorders. In these 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.”
mostly in women = because of empty womb wandering the body = the Greek word for “uterus” is hysteron
1-3b: The 19th Century
“Behavioral and cognitive symptoms of what we now know as advanced syphilis, a [STD] caused by a bacterial microorganism entering the brain, include believing that everyone is plotting against you (delusion of persecution) or that you are God (delusion of grandeur), as well as other bizarre behaviors. Although these symptoms are 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 …”
“Louis Pasteur’s germ theory of disease, developed in about 1870, facilitated the identification of the specific bacterial microorganism that caused syphilis.”
Early vaccine development? Inject them with the disease
John P. Grey
believed the cause was physical
treat the mentally ill as if they were physically ill
his hospitals were good, but became overcrowded
deinstitutionalization = good and bad
1-3c: The Development of Biological Treatments
increased treatment attempts focused on the biological
electric shock, brain surgery
insulin → convulsions (dangerous)
safe convulsions? shock the brain of the depressed… it worked??? became electroconvulsive therapy
substances, drugs oh my
opium, sedatives, herbs and folk remedies, major and minor tranquilizers, sedating drugs
“benzodiazepines (minor tranquilizers), which seemed to reduce anxiety. By the 1970s, the benzodiazepines (known by such brand names as Valium and Librium) were among the most widely prescribed drugs in the world. As drawbacks and side effects of tranquilizers became apparent, along with their limited effectiveness, prescriptions decreased somewhat…”
1-3d: Consequences of the Biological Tradition
Grey’s hospitals and believes discouraged medication
disorders were because of brain pathology = uncurable = hospital
Emil Kraepelin
“one of the first to distinguish among various psychological disorders, seeing that each may have a different age of onset and time course, with somewhat different clusters of presenting symptoms, and probably a different cause”
1-4a: Moral Therapy
Plato: social and cultural influences + learning environment = impact on behavior
reeducate people
also Aristotle
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.”
“The term moral actually referred more to emotional or psychological factors rather than to a code of conduct”
treat patients normal in a positive setting which reinforced/encouraged normal behaviors and interactions
Patient housing with relaxing environments:
“Greek Asclepiad Temples of the 6th century B.C. housed the chronically ill…”
Middle East Muslim countries
Philippe Pinel and Jean-Baptiste Pussin : Parisian hospital La Bicêtre
humane treatments
William Tuke followed lead in England
“Benjamin Rush (1745–1813), often considered the founder of U.S. psychiatry, introduced moral therapy in his early work at Pennsylvania Hospital”
Asylums were like prisons before, but now better
Patients previously deemed incurable were treated and released
1-4b: Asylum Reform and the Decline of Moral Therapy
humane treatment declined
it worked best when < 200 patients
patient load increased after Civil War because of immigrants
“Because immigrant groups were thought not to deserve the same privileges as “native” Americans (whose ancestors had immigrated perhaps only 50 or 100 years earlier!), they were not given moral treatments even when there were sufficient hospital personnel.”
Dorothea Dix campaigned to reform treatments for insanity
she witnessed bad conditions
informed public and leaders
mental hygiene movement: “Mid-19th-century effort to improve care of the mentally disordered by informing the public of their mistreatment.”
she spread humane treatment
unfortunately, Dix’s efforts → lots more patients
“…rapid transition from moral therapy to custodial care because hospitals were inadequately staffed.”
“ A final blow to the practice of moral therapy was the decision, in the middle of the 19th century, that mental illness was caused by brain pathology and, therefore, was incurable.”
psychoanalysis: “Psychoanalytic assessment and therapy, which emphasizes exploration of, and insight into, unconscious processes and conflicts, pioneered by Sigmund Freud”
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
Franz Anton Mesmer believed “problem was caused by an undetectable fluid found in all living organisms called “animal magnetism,” which could become blocked.”
“…patients sit in a dark room around a large vat of chemicals with rods extending from it and touching them. Dressed in flowing robes, he might then identify and tap various areas of their bodies where their animal magnetism was blocked while suggesting strongly that they were being cured.”
Benjamin Franklin did double blind experiment and proved it was wrong
“…Mesmer is widely regarded as the father of hypnosis, a state in which extremely suggestible subjects sometimes appear to be in a trance.”
Jean-Martin Charcot: neurologist. showed that in some cases mesmerism/hypnosis worked
Josef Breuer also experimented with hypnosis
had patients describe problems
patients became emotional and felt better after
they rarely remembered what they said or made connections between problems and disorder
beyond awareness of patient
worked with Freud
unconscious: “Part of the psychic makeup that is outside the awareness of the person.”
catharsis: “Rapid or sudden release of emotional tension thought to be an important factor in psychoanalytic therapy.”
“…the existence of “unconscious” memories and feelings and the importance of processing emotion-filled information have been verified and reaffirmed.”
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.”
much of this has been proven wrong, but still has a strong influence
Three major facets of psychoanalytic model
“the structure of the mind and the distinct functions of personality that sometimes clash with one another”
“the defense mechanisms with which the mind defends itself from these clashes, or conflicts”
“the stages of early psychosexual development that provide grist for the mill of our inner conflicts.”
“The mind, according to Freud, has three major parts or functions: the id, the ego, and the superego”
id: “In psychoanalysis, the unconscious psychical entity present at birth representing basic sexual and aggressive drives.”
animal within; bad if left unchecked
libido: energy and drive
thanatos: death instinct
drives in constant opposition
illogical, emotional, irrational thinking (primary process)
driven by pleasure principle: “…overriding goal of maximizing pleasure and eliminating any associated tension or conflicts.”
ego: “In psychoanalysis, the psychical entity responsible for finding realistic and practical ways to satisfy id drives.”
mediator
logical, rational thinking (secondary process)
driven by reality principle
superego: “In psychoanalysis, the psychical entity representing the internalized moral principles of parents and society.”
conscience
driven by moral principles
“The role of the ego is to mediate conflict between the id and the superego, juggling their demands with the realities of the world.”
intrapsychic conflicts: “In psychoanalysis, the struggles among the id, ego, and superego.”
we are only aware of the ego
defense mechanisms: “Common patterns of behavior, often adaptive coping styles when they occur in moderation, observed in response to particular situations. In psychoanalysis, these are thought to be unconscious processes originating in the ego.”
sometimes adaptive, sometimes maladaptive
phobic and obsessive symptoms
Denial: Refuses to acknowledge some aspect of objective reality or subjective experience that is apparent to others
Displacement: Transfers a feeling about or a response to an object that causes discomfort onto another, usually less threatening, object or person
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
“…reduction in unadaptive defense mechanisms, and strengthening of adaptive mechanisms such as humor and sublimation, correlated with psychological health. Thus, the concept of defense mechanisms—coping styles, in contemporary terminology—continues to be important to the study of psychopathology.”
psychosexual stages of development: “In psychoanalysis, 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.”
oral: 0 - 2 years
food, sucking, lips, tongue, and mouth = sources of pleasure
lack of … gratification = problems in adulthood
“…fixation at the oral stage might result in excessive thumb sucking and emphasis on oral stimulation through eating, chewing pencils, or biting fingernails. Adult personality characteristics theoretically associated with oral fixation include dependency and passivity or, in reaction to these tendencies, rebelliousness and cynicism.”
anal
phallic: 3 - 5/6 years
characterized by early genital self-stimulation
Oedipus complex in boys
kill dad, get with mom
castration anxiety: “In psychoanalysis, the fear in young boys that they will be mutilated genitally because of their lust for their mothers.”
Electra complex and penis envy in girls
“Freud viewed the young girl as wanting to replace her mother and possess her father. Central to this possession is the girl’s desire for a penis, so as to be more like her father and brothers—hence the term penis envy. According to Freud, the conflict is successfully resolved when females develop healthy heterosexual relationships and look forward to having a baby, which he viewed as a healthy substitute for having a penis.”
latency
genital
Freud believed disorders results from underlying unconscious conflicts
called “neuroses, or neurotic disorders, from an old term referring to disorders of the nervous system.”
ego psychology: “Derived from psychoanalysis, this theory 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.” - developed by Anna Freud
self-psychology: “Derived from psychoanalysis, this theory 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 ego psychology.” - developed by Heinz Kohut?
Heinz Kohut focused on neurosis: “Obsolete psychodynamic term for psychological disorder thought to result from unconscious conflicts and the anxiety they cause. Plural is neuroses.”
object relations: “Modern development in psychodynamic theory involving the study of how children incorporate the memories and values of people who are close and important to them.”
“Object in this sense refers to these important people, and the process of incorporation is called introjection.”
may internalize conflicting things
collective unconscious: “Accumulated wisdom of a culture collected and remembered across generations, a psychodynamic concept introduced by Carl Jung.”
“spiritual and religious drives are as much a part of human nature as are sexual drives…”
emphasized traits like introversion and extraversion
Alfred Adler - inferiority complex
Psychoanalytic Psychotherapy
Designed to reveal the nature of unconscious mental processes and conflicts through catharsis and insight
catharsis: “Rapid or sudden release of emotional tension thought to be an important factor in psychoanalytic therapy.”
Techniques include free association, dream analysis, and analysis of transference
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 conflicts.”
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 issues and feelings, usually positive, onto the patient.”
Very time consuming and costly
4 - 5 times a week for 2 - 5 years
Little evidence of effectiveness
focus on underlying conflict rather than symptoms and disorders
symptom substitution: when you get rid of symptoms, but new ones pop up because you didn’t deal with the unconscious conflict
psychoanalyst: “Therapist who practices psychoanalysis after earning either an M.D. or a Ph.D. degree and receiving additional specialized postdoctoral training.”
psychodynamic psychotherapy: “Contemporary version of psychoanalysis that still emphasizes unconscious processes and conflicts but is briefer and more focused on specific problems.”
Derived from psychoanalytic approach
Focus on affect and the expression of emotions
Exploration of attempts to avoid topics or engage in activities that hinder the progress of therapy
Identification of patterns in actions, thoughts, feelings, experiences, and relationships
Emphasis on past experiences
Focus on interpersonal experiences
Emphasis on the therapeutic relationship
Exploration of wishes, dreams, or fantasies
1-4c: Humanistic Theory
person-centered therapy: “Therapy method in which the client, rather than the counselor, primarily directs the course of discussion, seeking self-discovery and self-responsibility.” - Carl Rogers
Abraham Maslow
Hierarchy of needs, beginning with our most basic physical needs and ranging upward to needs for self-actualization, love, and self-esteem
“…beginning with our most basic physical needs for food and sex and ranging upward to our needs for self-actualization, love, and self-esteem. Social needs such as friendship fall somewhere between. Maslow hypothesized that we cannot progress up the hierarchy until we have satisfied the needs at lower levels.”
Self-actualizing: “Process emphasized in humanistic psychology in which people strive to achieve their highest potential against difficult life experiences.”
Carl Rogers
Humanistic therapy emphasizing unconditional positive regard, empathy, and innate tendency towards growth
Unconditional positive regard: “Acceptance by the counselor of the client’s feelings and actions without judgment or condemnation.”
empathy
Most useful among individuals without psychological disorders who are dealing with stresses of life
humanistic psychology: philosophies based on Jung and Adler (and other personality theorists)
“…humanistic therapists believed that relationships, including the therapeutic relationship, were the single most positive influence in facilitating human growth.”
1-4d: The Cognitive-Behavioral Model
cognitive-behavioral model: “Model that 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.”
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.”
introspection: “Early, nonscientific approach to the study of psychology involving systematic attempts to report thoughts and feelings that specific stimuli evoked.”
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.”
Pavlov and classical conditioning
Learning in which a neutral stimulus is paired with a response until it elicits that response
classical conditioning: “Fundamental learning process first described by Ivan Pavlov. An event that automatically elicits a response is paired with another stimulus event that does not (a neutral stimulus). After repeated pairings, the neutral stimulus becomes a conditioned stimulus that by itself can elicit the desired response.”
stimulus generalization: similar stimuli associated with response
unconditioned stimulus (UCS) : thing that causes response naturally
unconditioned response (UCR): natural/unlearned response
conditioned stimulus (CS): new stimulus that did not previously elicit response, but now does
conditioned response (CR): same response to the new stimulus
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.”
introspection: “Early, nonscientific approach to the study of psychology involving systematic attempts to report thoughts and feelings that specific stimuli evoked.” - Edward Titchener
Watson and the rise of behaviorism
Psychology is a purely objective experimental branch of natural science with goals of prediction and control of behavior
Taught little Albert to be afraid of white furry objects (with rats)
student Mary Cover Jones thought fear could be unlearned in a similar way
Joseph Wolpe and behavior therapy
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.”
Systematic desensitization
systematic desensitization: “Behavioral therapy technique to diminish excessive fears, involving gradual exposure to the feared stimulus paired with a positive coping experience, usually relaxation.”
B. F. Skinner and operant conditioning
Learning in which behavior changes as a function of what follows the behavior (reinforcement)
Influenced by Watson and Thorndike (law of effect)
“…behavior is either strengthened (likely to be repeated more frequently) or weakened (likely to occur less frequently) depending on the consequences of that behavior”
reinforcement: “In operant conditioning, consequences for behavior that strengthen it or increase its frequency. Positive reinforcement involves the contingent delivery of a desired consequence. Negative reinforcement is the contingent escape from an aversive consequence. Unwanted behaviors may result from their reinforcement or the failure to reinforce desired behaviors.”
“…operant conditioning, a type of learning in which behavior changes as a function of what follows the behavior. Skinner observed early on that a large part of our behavior is not automatically elicited by a UCS and that we must account for this.
“…all of our behavior is governed to some degree by reinforcement, which can be arranged in an endless variety of ways, in schedules of reinforcement.”
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.”
Behavioral model has contributed greatly to the understanding and treatment of psychopathology
Incomplete and inadequate to account for what we now know about psychopathology
1-5: The Present: The Scientific Method and an Integrative Approach
Scientific methods were not often applied to the theories and treatments within a tradition
Mental health professionals tend to look at psychological disorders narrowly, from their own theoretical orientation
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