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
    • rest, relaxation, a change of environment, and certain herbal medicines are sometimes helpful
  • these types of theories have influenced how people acting abnormally have been regarded in the society

Ancient Theories

Abnormality

  • concept of abnormality is based form our inferences from ^^archaeological artifacts^^ -- fragments of bones, tool, artwork, and so on -- as well as from ^^ancient writings^^ about abnormal behavior
  • humans seemed to have always viewed abnormality as something needing special explanation

Driving Away Evil Spirits

  • historians speculate that even prehistoric people had ^^a concept of insanity^^, probably ^^one rooted in supernatural beliefs^^
    • a person who acted ^^oddly^^ was suspected of being possessed by evil spirits
    • typical treatment was ^^exorcism^^ (driving the evil spirits from the body of the suffering person)
    • shamans or healers would ^^recite prayers or incantations^^, try to talk the spirits out of the body or make the body an uncomfortable place for the spirits to reside (often through ^^extreme measures^^ like starving or beating the person); other times, the person thought to be possessed by evil spirits would simply be ^^killed^^
  • Trephination
    • Trephine: tool used for drilling the skull
    • ^^drill holes in the skull^^ of a person who display abnormal behavior to ^^allow the spirits to depart^^
    • some historians believe that people who were seeing or hearing things that were not real and people who were chronically sad were subjected to this form of brain surgery
    • if the person ^^survived^^ this surgery, the evil spirits would have been ^^released^^ and the person’s abnormal behavior would decline
    • other historians suggest that it was used primarily for the ^^removal of blood clots^^ caused by stone weapons during warfare and for other medical purposes

Ancient China: Balancing Yin and Yang

  • some of the earliest written sources of abnormality are ^^ancient Chinese medical texts^^
  • ^^Nei Ching (Classic of Internal Medicine)^^ was probably written around 2674 BCE by Huang Ti, the legendary third emperor of China
  • Ancient Chinese medicine was based on the ^^concept of yin and yang^^
  • the human body was said to contain a ^^positive force (yang)^^ and a ^^negative force (yin)^^, which confronted and complemented each other
    • if the two forces were in balance, the individual was healthy
    • if not, illness, including insanity, could result
  • Chinese medical philosophy also held that ^^human emotions were controlled by internal organs^^
  • when the “vital air” was flowing on one of these organs, an individual experienced a particular emotion
    • when air flowed on the heart, joy; lungs, sorrow
    • this theory encouraged people to live in an orderly and harmonious way, as as to maintain the proper movement of vital air
  • although the perspective on psychological symptoms represented by ancient texts was largely a ^^biological one^^, the ^^rise of Taoism and Buddhism^^ during the Chin and Tang dynasties (420-618 BCE) led to some ^^religious interpretations of abnormal behavior^^
  • religious theories of abnormality declined in China after this period

Ancient Egypt, Greece, and Rome: Biological Theories Dominate

  • Kahum Papyrus
    • oldest ancient writing on abnormal behavior
    • named after the ancient Egyptian city in which it was found, dates from about 1900 BCE
    • lists a number of disorder, each followed by a physician’s judgment of the cause of the disorder and the appropriate treatment
  • Hysteria
    • Greek: hystera meaning uterus
    • “A woman who loves bed; she does not rise and she does not shake it.”
    • 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
    • these days, hysteria is used to refer to physiological symptoms that probably are the result of psychological processes
    • in the Egyptian papyri, the prescribed treatment for this disorder involved the use of ^^strong-smelling substances^^ to drive the uterus back to its proper place
  • most ^^Greeks and Romans^^ saw abnormal behavior as an ^^affliction from the gods^^
    • Plato (423-347 BCE) and Socrates (469-399 BCE) argued that some forms of abnormal behavior were ^^divine^^ and could be the ^^source of great literary and prophetic gifts^^
  • Greek physicians ^^rejected supernatural explanations^^ of abnormal behaviors
  • 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, phlegm, yellow bile, and black bile^^
    • all diseases, including abnormal behavior were caused by ^^imbalances^^ in the body’s essential humors
    • classified abnormal behavior into ^^4 categories: epilepsy, mania, melancholia, and brain fever^^
  • treatments prescribed by the Greek physicians
    • intended to restore balance of the 4 humors
    • sometimes physiological and intrusive
    • ^^bleeding a patient^^ to treat disorders thought to result from an excess of blood
    • other treatments consisted of ^^rest, relaxation, a change of climate or scenery, a change of diet, or living a temperate life^^
  • some nonmedical treatments prescribed by these physicians sound remarkably like those prescribed by modern psychotherapists
    • Hippocrates believed that ^^removing a patient from a difficult family could help restore mental health^^
    • Plato argued that ^^insanity arose^^ when the rational mind was overcome by ^^impulse, passion, or appetite^^
    • sanity could be regained through a ^^discussion^^ with the individual designed to restore ^^rational control over emotions^^
  • among the Greeks of Hippocrates’ and Plato’s time
    • relatives of people considered insane were ^^encouraged to confine^^ their afflicted family members to the home
    • the state claimed ^^no responsibility^^ for insane people; it provided no asylums or institutions, other than religious temples, to house and care for them
    • the state could ^^take rights away^^ from people declared insane
    • relative could bring suit against those they considered insane people to their relatives
    • people declared insane ^^could not marry or acquire or dispose of their own property^^
    • poor people who were considered insane were simply ^^left to roam the streets^^ if they were not violent
      • if violent, they were ^^locked away^^
    • the general public greatly feared insanity of any form, and people thought to be insane often were ^^shunned or even stoned^^

Medieval Views

Middle Ages (around 400-1400 BCE)

  • often described as time of ^^backward thinking^^ dominated by an obsession with supernatural forces, yet even within Europe supernatural theories of abnormal behavior did not dominate until the late middle ages, between 11th and 15th centuries
  • before 11th century, ^^witches and witchcraft^^ were accepted as real but were considered mere ^^nuisances^^, overrated by superstitious people
  • ^^severe emotional shock and physical illness or injury^^ most often seen as the causes of bizarre behaviors
  • while laypeople probably did believe in ^^demons and curses^^ as causes of abnormal behavior, there is strong evidence that physicians and government officials attributed abnormal behavior to ^^physical causes or traumas^^

Witchcraft

  • beginning of 11th century, the power of the Catholic Church in Europe was ^^threatened by the breakdown of feudalism and by the rebellions^^
    • interpreted threats in terms of heresy and Satanism
  • the ^^Inquisition^^ was established originally to ^^rid the earth of religious heretics^^, but eventually those ^^practicing witchcraft or Satanism^^ also became the focus of hunts
    • witch hunts continued long after the Reformation, perhaps reaching their height during the ^^15th to 17th century or the “Renaissance”^^
  • accused witches sometimes confessed to speaking with the devil, flying on the backs of animals, or engaging in other unusual behaviors
    • may be experiencing ^^delusions^^ (false beliefs) or ^^hallucinations^^ (unreal perceptual experiences)
    • confessions of such experiences may have been ^^extracted through torture^^ or in exchange for a ^^stay of execution^^
  • The Deception of Dreams by Johann Weyer (1563)
    • those accused of being witches were suffering from ^^melancholy (depression) and senility^^
    • banned by the Church
    • supported by ^^Reginald Scot “Discovery of Witchcraft (1584)^^
    • These women are but diseased wretches suffering from melancholy and their words, actions, reasoning, and gestures show that sickness has affected their brains and impaired their powers of judgment.
  • Teresa of Avila
    • in the 16th century, 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 or sickness
    • argued that nuns were ^^comas enfermas or “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

  • Psychic Epidemics or “Mass Hysteria”
    • defined as a phenomenon in which ^^large numbers^^ of people engage in ^^unusual behaviors^^ that appear to have a ^^psychological origin^^
  • Tarantism
    • noted in Italy as early as the 14th century and became prominent in the 17th century
    • people suddenly developed an ^^acute pain^^, which they attributed to the ^^bite of a tarantula^^
    • jumped around and danced wildly in the streets, tearing at their clothes and beating each other with whips
    • dug holes in the earth and rolled on the ground; howled and made obscene gestures
    • interpreted dance frenzies and tarantism as the results of ^^possession by the devil^^
    • may have been ^^remnants of ancient rituals^^ performed by people worshipping the ^^Greek God Dionysus^^

The Spread of Asylums

  • 11th or 12th century, general hospitals began to include special rooms or facilities for people exhibiting abnormal behavior
    • mentally ill were housed against their will often in extremely harsh conditions
  • Hospital of Saint Mary of Bethlehem
    • one of the famous hospitals in London
    • officially became a mental hospital in 1547
    • “Bedlam”
    • at Bedlam and other mental hospitals established in 16th, 17th, and 18th centuries, patients were exhibited to the public for a fee
    • lived in filth and confinement, often chained to the wall or locked inside small boxes
    • Laws Regarding the Confinement of the Mentally Ill in Europe and the US
    • concerned with protection of the public and the ill person’s relatives
    • 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 behavior were ^^medical illnesses^^
  • although the supernatural theories of the middle ages have often been described 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 in the 18th and 19th Centuries

  • Mental Hygiene Movement
    • the 18th and 19th centuries saw the growth of a more ^^humane treatment^^ of people with mental health problems
    • new treatment was based on the psychological view that people ^^developed problems^^ because they had become ^^separated from nature^^ and has ^^succumbed to the stresses^^ imposed by the rapid social changes of the period
  • Moral Treatment
    • movement’s leader was ^^Philippe Pinel (1745-1826)^^
    • French physician who took charge of ^^La Bicetre in 1793^^
    • argued “to detain maniacs in constant seclusion and to load them with chains; to leave them defenseless, to the brutality of underlings… in a word, to rule them with a rod of iron… is a system of super intendencies, more distinguished for its ^^convenience^^ than for its humanity or success”
    • believed that many forms of abnormality could be cured by ^^restoring patients’ dignity and tranquility^^
  • Philippe Pinel
    • 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 Salpetriere, a mental hospital for female patients in Paris
  • Quaker William Tuke (1732-1822)
    • opened an asylum in England in 1796 called ^^“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 (1802-1887)
    • one of the most militant crusaders for moral treatment of the insane
    • retired ^^school teacher^^ living in Boston
    • visited a jail on a cold Sunday morning in 1841 to teach a Sunday school class to women inmates
    • discovered the negligence and brutality that characterized the treatment of poor people exhibiting abnormal behavior, many of whom were simply warehoused in jails
    • 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
    • helped establish more than 30 mental institutions
    • run according to ^^humanitarian perspectives^^
  • as more asylums were built and more people went into them, the capacity of the asylums to recruit mental health professionals and to maintain a humane, individual approach to each patient declined
  • effective treatments for most major mental health problems were not developed until well into the 20th century

The Emergence of Modern Perspectives

The Beginnings of Modern Biological Perspectives

  • increasing focus on biological causes of abnormality
  • Wilhelm Griesinger (1817-1868)
    • German psychiatrist
    • in 1845, published ^^“The Pathology and Therapy of Psychic Disorders”^^
    • a systematic argument that all psychological disorders can be explained in terms or ^^brain pathology^^
  • Emil Kraepelin (1856-1926)
    • one of Griesinger’s followers
    • in 1883, published a text emphasizing the importance of brain pathology in psychological disorders
    • developed a scheme for classifying symptoms into discrete disorders that is the basis for our modern classification systems
    • having a good classification system gives investigators a common set of levels of disorders as well as a set of criteria for distinguishing between them, contributing immensely to the advancement of the scientific study of the disorders
  • General Paresis
    • one of the most important discoveries under pinning modern biological theories of abnormality
    • a disease that leads to ^^paralysis, insanity, and eventually death^^
    • the discovery of ^^syphilis^^ is the cause of one form of insanity lent great weight to the idea that biological factors can cause abnormal behaviors
  • modern biological theories of the psychological disorders have focused on the ^^role of genetics, structural and functional abnormalities in the brain, and biochemical imbalances^^

The Psychoanalytic Perspective

  • Franz Anton Mesmer (1734-1815)
    • Austrian physician
    • believed that people have a ^^magnetic fluid^^ in the body that must be distributed in a particular pattern in order to maintain health
    • the distance of magnetic fluid in 1 person could be ^^influenced by the magnetic forces of other people^^, as well as by the ^^alignments of the planets^^
    • much of Mesmer’s treatment were the ^^hysterical disorders^^, in which people lose functioning or feeling in some part of the body for no apparent physiological 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^^”
      • Mesmer’s patients appeared very suggestible, and the mere suggestion that their ailments would disappear seemed enough to make them actually disappear
  • Jean Charcot (1825-1893)
    • head of La Salpetriere Hospital in Paris and the leading neurologist of time
    • argued that ^^hysteria was caused by degeneration in the brain^^
  • Hipplyte-Marie Berheim (1840-1919) and Ambroise-Auguste Liebault (1823-1904)
    • showed that they could induce the symptoms of hysteria, such as paralysis in an arm of the loss of feeling in a leg, by suggesting these symptoms to patients who were hypnotized; could also remove symptoms under hypnosis
  • Charcot was so impressed by the evidence that hysteria psychological roots that he became a leading researcher of the psychological causes of abnormal behavior
  • Sigmund Freud (1856-1939)
    • Viennese neurologist who went to study with Charcot in 1885
    • much of the mental life of an individual remains ^^hidden from consciousness^^
  • Pierre Janet (1859-1947)
    • 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 (1842-1925)
    • 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
  • ^^Breuer and Freud^^ collaborated on “^^On the Physcial Mechanisms of Hysterical Phenomena^^” in 1893
    • laid out their discoveries about ^^hypnosis, the unconscious, and the therapeutic value of catharsis^^
    • proved to be a ^^foundation stone^^ in the development of psychoanalysis, the study of the unconscious

The Roots of Behaviorism

  • Ivan Pavlov (1849-1936)
    • Russian physiologist
    • developed methods and theories for understanding behavior in terms of stimuli and responses rather than in terms of the internal workings of the unconscious mind
    • 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 (1878-1958)
    • Pavlov inspired him
    • study important human behaviors, such as phobias, in terms of classical conditioning
    • 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 (1874-1949) and B.F. Skinner (1904-1990)
    • studying how the consequences of behaviors shape their likelihood of recurrence
    • argued that behaviors followed by ^^positive consequences^^ are more likely to be ^^repeated^^ than are behaviors followed by negative consequences -- ^^operant or instrumental conditioning^^
  • Behaviorism
    • the study of the impact of reinforcements and punishments on behavior
    • has had a profound an impact on psychology and on our common knowledge of psychology as has psychoanalytic theory
    • have led to many of the effective physiological treatments for disorders

The Cognitive Revolution

  • Study of Cognitions: thought processes that influence behavior and emotion
  • Albert Bandura
    • a clinical psychologist trained in behaviorism who has contributed a great deal to the application of behaviorism to psychopathology
    • 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
    • argued that people prone to psychological disorders are plagued by ^^irrational negative assumptions about themselves and the world^^
    • developed a theory for emotional problems based on his theory -- ^^rational-emotive theory^^
    • ^^controversial^^ because it required 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 ^^irrational thoughts of people with psychological problems^^
    • ^^Beck’s Cognitive Theory^^ has become one of the most widely used therapies for many disorders

Modern Mental Health Care

Deinstitutionalization

  • Patient’s Rights Movement
    • a large and vocal movement in 1960
    • argued that mental patients can recover more fully or live more satisfying lives if they are ^^integrated into the community^^, with the support of ^^community-based treatment facilities -- deinstitutionalization^^
  • Community Mental Health Movement
    • officially launched in 1963 in US by President John Kennedy as a “^^bold new approach^^” to mental health care
    • attempted to provide coordinated mental health services to people in community mental health centers
  • Community Mental Health Centers
    • often include teams of social workers, therapists, and physicians who coordinate core
  • 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^^
  • Although deinstitutionalization began with laudatory goals, many of these goals were never fully reached, leaving many people who formerly would have been institutionalized in mental hospitals no better off.
    • People with acute problems that require hospitalization may go to inpatient wards of general hospitals or specialized psychiatric hospitals but after acute problems subside, they are often released back to their community treatment center rather than remaining for the long term in a psychiatric hospital
    • In recent years, the financial strains on local, state, and federal governments have led to the closing of many community mental health centers.
    • When released from mental institutions
    • some began living in nursing homes and other types of group homes with little mental health treatment
    • some with their families who were ill-equipped to handle serious mental illness
    • some began living on the streets ( 4 out of 5 of all long-term homeless adults in the US and Europe have a major mental disorder, a severe substance use disorder or both.)
    • many may end up in jail (2/3 had experienced some form of diagnosable mental disorder in their lifetime)

Managed Care

  • 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
    • the goals are to coordinate services for an existing medical problem and to prevent future medical problems
    • often, health care providers are given a set amount of money per member (patient) per month and then must determine how best to serve each patient
    • managed care can solve some of the problems created by deinstitutionalization
    • instead of leaving it up to people with a serious psychological problem, or their families, to find appropriate care, the primary provider might find this care and ensure that patients have access to it
    • theoretically, managed care can have tremendous benefits for people with long-term, serious mental health problems
    • mental heath care often is not covered fully by health insurance
    • many people do not have any health insurances
    • mental health services are expensive, because mental health problems are sometimes chronic, mental health treatment can take a long time

Professions within Abnormal Psychology

  • Psychiatrists
    • have an MD degree and have received specialized training in the treatment of psychological problems
    • can prescribe medication 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
  • Psychiatric Nurse
    • have a degree in nursing, with a specialization in the treatment of people with severe psychological problems
    • often work on inpatient psychiatric wards in hospitals, delivering medical care and certain forms of psychotherapy
    • in some states, they have privileges to write prescriptions for psychotherapeutic drugs