ABNORMAL PSYCHOLOGY:
PAST AND
PRESENT
Clifford Beers, A mind that found
itself
Clifford Beers was
always an energetic
child, moody, with
little self-control. Still,
he was intelligent and
ambitious enough to
do well in school, and
he graduated from
college. However,
Beer’s moodiness
Alisha Brad
Psychopathology,
Maladjustment, emotional
disturbance, or mental Illness
What is Psychological
Abnormality?
The Features of four
D’s
Deviance
Distress
Dysfunction
Danger
Deviance
different,extreme, Norm
unusual, perhaps even Culture
bizarre
behavior, thoughts, and
emotions are deemed
abnormal when they
dif-er markedly from
a society's ideas
about proper specific circumstances
functioning.
Distress
unpleasant and
upsetting to the
person),
◦ Difficulty
performing
appropriate and
expected roles
◦ Impairment is set in
the context of a
person’s background
Dysfunctional
interfering with the
person's ability to
conduct daily
activities in a
constructive way
• Breakdown in cognitive,
emotional, or behavioral
functioning
Dangerous
behavior that
becomes dangerous
to oneself or others
Individuals whose
behavior is
consistently careless,
hostile, or confused
may be placing
themselves or those
around them at risk
Problem:
Not all unusual behavior is abnormal!!
(E.g., superior athletic ability, geniuses)
Violation of norms:
Abnormal behavior often violates the social
norms of a given culture.
(E.g., experiencing hallucinations, talking to
inanimate objects,)
Problem:
The violation of norms explicitly makes
abnormality a relative concept.
Criminals and prostitutes violate social
norms, but would not fall within the
context of abnormal psychology.
Personal Distress:
Behavior may be abnormal if it creates
great distress.
(E.g., people with depression experience
considerable distress.)
Problem:
Not all distressed individuals are mentally
ill & some mentally ill individuals do not
show distress (psychopaths).
Dysfunction:
Does the behavior impair an individual’s
ability to function in life (work, personal
relationships)?
(E.g., substance-use disorders)
Problem:
Some individuals with a DSM diagnosis,
live functional lives (e.g., transvestites).
Abnormal Behavior Defined
Definition
◦ A psychological dysfunction associated with
distress or impairment in functioning that is not
typical or culturally expected
Labels and terminology
◦ Psychological disorder, psychiatric disorder,
emotional disorder, or psychological abnormality
are all names for the same thing.
◦ Mental illness is a less preferred term
Psychopathology
◦ Is the scientific study of psychological disorders.
The Past: Historical Conceptions of
Abnormal Behavior
Three Dominant
Traditions/Worldviews
Include
◦ Supernatural
◦ Biological
◦ Psychological
Not necessarily linear;
we tend to move
recursively through
these traditions at
different points in time.
The Past: Abnormal Behavior and
the Supernatural Tradition
Mental illness was
thought to be the
result of supernatural
forces (angry Gods,
possession by
demons).
Scholars, theologians,
and philosophers
believed a troubled
mind was the result of
displeased Gods or
possession (Plato and
Socrates 384-322
BCE)
OtherWorldly Causes of Deviant
Behavior
◦ Movement of the moon and stars
◦ “Lunacy”
Some disorders have a cyclic course, such
as major depression, that appears to
correspond with different lunar phases.
Middle Ages (500-1300 a.d.)
◦ Both “outer force” views (evil spirits, lunacy)
were popular
◦ Few thought of abnormality as a physical
disease
Abnormal behavior
(hallucinations,
delusions, paranoia)
resulted from demonic
possession.
Treatment: drive the evil
spirits out of the body.
-stone-age: trephination
- Dark –age: exorcism-
prayers, brews, flogging,
starvation, etc.
Mental illness: witchcraft (1300s)
Hallucinations &
delusions--evidence of
witchcraft.
Most accused were not
mentally ill, but forced
to confess crimes they
didn not commit.
Treatment:
beatings/death by
hanging or burning.
Psychic Epidemics
A phenomenon in which large numbers
of people engage in unusual behavior that
appear to have a psychological origin.---
Mass Madness
Dance frenzies or manias ( Germany)----
Saint Vitus dance
Tarantism---pain caused bite of a
tarantula-----worshipping the Greek GOD
Dionysus
Lycanthropy- a condition in which people
believed themselves to be possessed by
wolves and imitated their behavior.
Paracelsus, a Swiss physician who lived
during the 16th century, introduced the idea
that the movement of the moon and stars
affected people's psychological functioning;
this theory inspired the use of the word
lunatic (Latin word for moon, luna) to
describe those who exhibited behavioral
disorders. Many of his views still persist
today.
The Past: Abnormal Behavior and the
Biological Tradition
Hippocrates: Greek physician born 460 b.c.
Abnormal Behavior as a Physical Disease
◦ Hysteria: “The Wandering Uterus”
◦ More females than males have emotional
disorders, even when reporting bias controlled.
◦ The uterus detached and wandered through a
woman’s body, eventually moving up to the
chest, causing many symptoms such as disease,
psychological disorders, and eventual
strangulation.
The Past: Abnormal Behavior and the
Biological Tradition
Hippocrates: Greek physician born 460
b.c.
However, he also suggested that
emotional disorders were partly genetic
(true), possibly caused by brain pathology
or head trauma (true), or stress (true).
The view that deviant behavior occurs
because of disease in the body is called
“Somatogenesis.”
Hippocrates
Father of medicine
Thought cognitive functioning could be
restored by balancing the four humors in
body: blood (sanguis), black bile
( melancholic), yellow bile (choleric), &
phlegm ( phlegmatic).
The Past: Abnormal Behavior and the
Biological Tradition
Galen Extends Hippocrates Work (129-
200 a.d.)
◦ Humoral theory of mental illness
◦ First animal researcher
◦ Knew the importance of the brain in mental
health
The Past: Abnormal Behavior and the
Biological Tradition
Galen’s ‘humors’ (fluids in the body):
Blood: ruddy, cheerful, optimistic
Black bile: melancholy, depressed, gloomy
Yellow bile: angry, irate, irascible
Phlegm: apathetic, stoic, numb.
If the fluids were out of balance: disorder of the mind
For instance, domestic violence caused by too much
yellow bile; depression by too much black bile.
The Past: Abnormal Behavior and the
Biological Tradition
Treatments remained crude - bloodletting,
leeches, stimulating kidneys by drinking
salt water, induced vomiting, deep breathing to
‘soothe the soul,’ etc.
but also involved manipulating the
environment in an attempt to correct levels
of the humors.
The Past: Abnormal Behavior and
the Psychological Tradition
Rise of Moral Therapy/Emphasis on Psychosocial
Factors
(Late 1800’s)
◦ Overview – Not moral in the usual sense of the word;
here it means ‘emotional’ or ‘psychological’
◦ Normalizing treatment of mentally ill - emphasized the
importance of a safe, low stress environment and social
interaction.
◦ Foreshadowed modern behavioral treatments.
The Past: Abnormal Behavior and
the Psychological Tradition
Reasons for the Falling Out of Moral
Therapy - too difficult to administer this
level of individualized treatment in
crowded hospitals.
Emergence of Competing Alternative
Psychological Models, such as the
Freudian Model, which highlighted other
psychological process that were not
amenable to moral treatment.
Mentally ill housed in asylums (1500s+)
After crusades, mentally ill were confined to
asylums.
Asylums (originally leprosariums), were converted
after crusades when leprosy was on a decline.
Most famous: St. Mary’s of Bethlehem in London
(founded in 1243). Called “Bedlam.”
Deplorable conditions- little food, little patient care,
blood letting practices, & spread of diseases.
Asylums became “attraction.”
Bethlehem- became hot tourist spot,
where people gawked at London’s
mentally ill.
Treatment- patients were drained of blood
& purposely “frightened.”
Islamic physician Avicenna
Approached treatment of mental disorders
with human practices unknown to
western medical practitioners of the time.
Moral Treatment (1790s +)
Philippe Pinel – humanitarian treatment
of mentally ill in asylums.
Patients formerly chained & shackled
were released & free to roam the
buildings.
Treatment: cannabis, opium, alcohol.
Dr.Samuel Cartwright
Dysaesthesia Aethiopis or refussal to
work for one’s master.
Thomas Szasz (1971)
Societies have labeled individuals and
groups abnormal in order to justify
controlling or silencing them.
Drapetomania- a sickness that caused the
slave to desire freedom
Adolf Hitler- justification for
Holocaust----genocide
Medical model (recent)
Mental illness– may have biological,
psychological, and/or social cause.
Treatment: drugs, psychotherapy, ECT
German physician Johann Weyer (1515-
1588),
the first physician to specialize in
mental illness, believed that the mind
was as susceptible to sickness as the
body was. He is now considered the
founder of the modern study of
psychopathology.
The care of people with mental disorders continued to improve in this
atmosphere. In England such individuals might be kept at home while
their families were aided financially by the local parish. Across Europe
religious shrines were devoted to the humane and loving treatment of
people with mental disorders. Perhaps the best known of these shrines was
at Gheel in Belgium. Beginning in the fifteenth century, people came to it
from all over the world for psychic healing. Local residents welcomed these
pilgrims into their homes, and many stayed on to form the world's first
"colony" of mental patients. Gheel was the forerunner of today's community
mental health programs, and it continues to demonstrate that people with
psychological
disorders can respond to loving care and respectful treatment (van Walsum, 2004;
Aring,
1975,1974). Many patients still live in foster homes there, interacting with other resi-
dents, until they recover.
The first asylum had been founded in
Muslim Spain in the early fifteenth
century,
but the idea did not gain full momentum
until the 1500s. In 1547, Bethlehem Hospital
was given to the city of London by
Henry VIII for the sole purpose of
confining the
mentally ill. In this asylum patients bound
in chains cried out for all to hear. Duri
William tuke/Phillipe Pinel
Dorethea Dix
Emil Kraepelin
Wilhelm Griesinger
Franz Anton Mesmer
Jean Martin Charcoat
Joseph Breur
Sigmund Freud
Learning A Habit !
Symptom- single indicator of a problem.
Syndrome-A group or cluster of
symptoms that all occur together.
Epidemiology- study of the distribution of
disease, disorders, or health-related
behaviors in a given population.
Prevalence- number of active cases in a
population during any given period of
time.
Incidence- The number of new cases that
occur over a given period of time.
Comorbidity- History of one disorder also
had two or more additional disorders.
For Treatment
Acute- short in duration
Chronic- more long lasting
CAUSES AND RISK FACTOR
FOR ABNORMAL BEHA
Among those who studied the effects of hypnotism on hysterical disorders was Josef
Breuer (1842-1925) of Vienna. This physician discovered that his patients sometimes
awoke free of hysterical symptoms after speaking candidly under hypnosis about
past
upsetting events. During the 1890s Breuer was joined in his work by another Viennese
physician, Sigmund Freud (1856-1939). As you will see in Chapter 3, Freud's work
eventually led him to develop the theory of psychoanalysis, which holds that many
forms of abnormal and normal psychological functioning are psychogenic. In particular,
he believed that unconscious psychological processes are at the root of such
functioning.
Freud also developed the technique of psychoanalysis, a form of discussion in which
clinicians help troubled people gain insight into their unconscious psychological
pro-cesses. He believed that such insight, even without hypnotic procedures, would help
the
patients overcome their psychological problems.
Freud and his followers applied the psychoanal
The Psychogenic Perspective The late nineteenth century also saw the emer-
gence of the psychogenic perspective, the view that the chief causes of abnormal func-
tioning are often psychological. This view, too, had a long history. The Roman statesman
and orator Cicero (106-43 D.C.) held that psychological disturbances could cause bodily
ailments, and the Greek physician Galen (c. 129-c. 200) believed that many mental disor-
ders are caused by fear, disappointment in love, and other psychological events. However,
the psychogenic perspective did not gain much of a following until studies of hypnotism
demonstrated its potential.
Hypnotism is a procedure that places people in a trancelike mental state during
which they become extremely suggestible. It was used to help treat psychological
disorders as far back as 1778, when an Austrian physician named Friedrich Anton
Mesmer (1734-1815) established a clinic in Paris. His patients suffered from
hysterical
disorders, mysterious bodily ailments that had no apparent physical basis. Mesmer had his
The Nineteenth Century:
Reform and Moral Treatment
As 1800 approached, the treatment of people with
mental disorders began to improve once again (Maher
& Maher, 2003). Historians usually point to La Bicetre
as the first site of asylum reform. In 1793, during the
French Revolution, Philippe Pinel (1745-1826) was
named the chief physician there. He argued that the
patients were sick people whose illnesses should be
treated with sympathy and kindness rather than chains
and beatings (van Walsum, 2004). He unchained the
patients and allowed them to move freely about the
hospital grounds; replaced the dark dungeons with
sunny, well-ventilated rooms; and offered support and
advice. Pinel's approach proved remarkably successful.
Many patients who had been shut away for decades
improved greatly over a short period of time and were
released. Pinel later brought similar reforms to a mental
hospital in Paris for female patients, La Salpetriere.
The Spread of Moral Treatment The methods of
Pinel and Tuke, called moral
treatment because they emphasized moral
guidance and humane and respectful tech-
niques, caught on throughout Europe and the
United States. Patients with psychological
problems were increasingly perceived as
potentially productive human beings whose
mental functioning had broken down under
stress. They were considered deserving of
individual care, including discussions of their
problems, useful activities, work, compan-
ionship, and quiet.
hip, and quiet.
The person most responsible for the early spread of moral
treatment in the United
States was Benjamin Rush (1745-1813), an eminent physician
at Pennsylvania Hospi-tal who is now considered the father of
American psychiatry. Limiting his practice to
mental illness, Rush developed innovative, humane approaches
to treatment (Whitaker,
2002). For example, he required that the hospital hire intelligent
and sensitive attendants
to work closely with patients, reading and talking to them and
taking them on regular
walks. He also suggested that it would be therapeutic for
doctors to give small gifts to
their patients now and then.
Page 41
Page 58
Theories and Treatment of
Abnormality
Biopsychosocial Approach
Biological Model
drug therapy, electroconvulsive therapy,
and neurosurgery
1950s, researchers discovered several
effective psychotropic medications
Four major psychotropic drug groups are
used in therapy: antianxiety,
antidepressant, antibipolar, and
antipsychotic drugs
Second form of biological treatment,
used primarily on depressed patients, is
electroconvulsive therapy (ECT)
Third form of biological treatment is
neurosurgery, or psychosurgery, brain
surgery for mental disorders.
Antonio de Egas Moniz- lobotomy,
Psychological Approach
Psychodynamic Model
Behavioral Model
Cognitive Model
Humanistic Model
Gestalt Model
Existential Model
The Sociocultural Model:
The Family-Social and Multicultural
Perspectives
CLINICAL ASSESSMENT,
DIAGNOSIS, AND
TREATMENT
Treatment
Angela Savanti was 22 years old,
lived at home with her mother, and
was employed as a secretary in a
large insurance company. She . .. had
had passing periods of "the blues"
before, but her present feelings of
despondency were of much greater
proportion. She was troubled by a
severe depression and frequent crying
spells, which had not lessened
over the past two months. Angela
found it hard to concentrate on her
job, had great difficulty falling
asleep at night, and had a poor
appetite . ... Her depression had begun
after she and her boyfriend Jerry
broke up two months previously
Characteristics of
Assessment Tools
Clinical assessment is Standardized
used to determine how Reliability
and why a person is Validity
behaving abnormally
and how that person
may be helped. It also
enables clinicians to
evaluate people's
progress after they
have been in treatment
for a while and decide
whether the treatment
should be changed
Clinical Interview
Clinical interview is just such
a face-to-face encounter
Mental status exam (MSE) -a
set of questions and
observations that
systematically evaluate the
client's awareness, orientation
with regard to time and place,
attention span, memory,
judgment and insight,
thought content and
processes, mood, and
appearance (Palmer, Fiorito,
& Tagliareni, 2007)
Clinical Observation
Clinical Test Classification Systems
Personality ----------------------------------
Projective
Psychophysiological Tests
Neurological and
Neuropsychological Tests
A list of such Symptom-a single
categories, or indicator of a
disorders, with problem. It can
descriptions of the involve affect
symptoms and behavior or
guidelines for cognition.
assigning individuals A cluster of
to the categories is symptoms is called
known as a a syndrome
classification
system.
Syndrome
A group or cluster of symptoms that all
occur together.
Example:
Sad or depressed mood, problems
sleeping, concentration problems, weight
loss, and suicidal thinking are all
symptoms that reflect the syndrome of
depression.
Diagnostic and
DSM-IV/V Statistical Manual of
Mental
Treatment Disorders (DSM) is the
standard classification
of mental disorders used
by mental health
Age and Gender professionals in the
Considerations in United States and
Psychiatric Diagnosis contains a listing of
diagnostic criteria for
every psychiatric
Cultural and spiritual disorder recognized by
issues that can affect the U.S. healthcare
diagnosis. system.
Mental Illness Description
Psychotic
Loss of reality testing
with delusions and
hallucinations
Ex. Schizophrenia
Neurotic
No loss of reality
testing; based on
mainly intrapsychic
conflicts or life
events that cause
anxiety; symptoms
include obesession,
phobia and
compulsion
Functional
No known structural
damage or clear-cut
biological cause to
account for
impairment.
Ex. dyspepsia
Organic
Illness caused by
specific agent
producing structural
change in the brain;
usually associated
with cognitive
impairment, delirium
or dementia
Ex. Pick’s Disease
Primary
No known cause;
disease of its own kind
also called idiophatic
Ex. Pulmonary
fibrosis is the
formation or
development of excess
fibrous connective
tissue (fibrosis) in
the lungs.
Secondary
Known to be
symptomatic
manifestation of a
systematic, medical,
or cerebral disorder
Ex. Delirium resulting
from infectious brain
disease
WARNING SIGNS FOR
PSYCHOLOGICAL DISORDERS IN ADULTS
Confused thinking
Prolonged depression (sadness or irritability)
Feelings of extreme highs and lows
Excessive fears, worries, and anxieties
Social withdrawal
Dramatic changes in eating or sleeping habits
Strong feelings of anger
Delusions or hallucinations
Growing inability to cope with daily problems and activities
Suicidal thoughts
Denial of obvious problems
Numerous unexplained physical ailments
Substance abuse
WARNING SIGNS
FOR PSYCHOLOGICAL DISORDERS
IN YOUNGER CHILDREN
Changes in school performance
Poor grades despite strong efforts
Excessive worry or anxiety (i.e., refusing to go to bed or
school)
Hyperactivity
Persistent nightmares
Persistent disobedience or aggression
Frequent temper tantrums
WARNING SIGNS FOR
PSYCHOLOGICAL DISORDERS
IN OLDER CHILDREN AND PRE-ADOLESCENTS
Substance abuse
Inability to cope with problems and daily activities
Change in sleeping and/or eating habits
Excessive complaints of physical ailments
Defiance of authority, truancy, theft, and/or vandalism
Intense fear of weight gain
Prolonged negative mood, accompanied by poor appetite or
thoughts of death
Frequent outbursts of anger
