Chapter 1

Abnormal Behaviour in Historical

Context
Understanding Psychopathology
 Consider these questions first: What is a psychological
disorder? What’s not?
 How do we [general public] describe
people with a mental illness?
 As lazy, crazy, dumb?
 As weak in character?
 As dangerous?
 As hopeless?
 A psychological disorder is defined as a 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 is a Psychological Disorder?

 The three criteria in the definition should be

considered.
1. Psychological Dysfunction
 Psychological dysfunction refers to a
breakdown in cognitive, emotional or
behavioural functioning.
 For example, if you are out on a date,
and you experience severe fear all evening and
just want to go home, even though there is nothing to
be afraid of, and the severe fear happens on every
date, your emotions are not functioning properly.
What is a Psychological Disorder?

 Where to draw the line between normal & abnormal

dysfunction is often difficult.
 For this reason, these problems are often considered to
be on a continuum or a dimension rather than being
categories that are either present or absent.
 Just having a dysfunction is not enough to meet the
criteria for a psychological disorder.
2. Culture-bound Personal Distress or Impairment
 That the behaviour must be associated with
distress to be classified as abnormal adds
an important component and
seems clear: the criterion is
satisfied if the individual is extremely
upset.
What is a Psychological Disorder?

 By itself this criterion does not define abnormal

behaviour. It is often quite normal to be
distressed—for example, if someone close to you dies.
 Furthermore, for some disorders, by definition,
suffering and distress are absent. Consider the person
who feels extremely elated and may act impulsively as
part of a manic episode.
 Thus, defining psychological disorder by distress alone
doesn’t work, although the concept of distress
contributes to a good definition.
 The concept of impairment is useful, although not
entirely satisfactory.
What is a Psychological Disorder?
 For example, many people consider themselves shy
or lazy. This doesn’t mean that they’re abnormal.
 But if you are so shy that you find it impossible to date
or even interact with people and you make every
attempt to avoid interactions even though you would
like to have friends, then your social functioning is
impaired.
 Most psychological disorders are simply extreme
expressions of otherwise normal
emotions, behaviours and cognitive
processes (for example shy versus
totally avoiding people).
What is a Psychological Disorder?

3. Response is Atypical or Not Culturally Expected

 Finally, the criterion that the response be atypical or
not culturally expected is important but also
insufficient to determine abnormality by itself.
 At times, something is considered abnormal because
it occurs infrequently; it deviates from the average.
The greater the deviation, the more abnormal it is.
 You might say that someone is abnormally short or
abnormally tall, meaning that the person’s height
deviates substantially from the average, but this
obviously isn’t a definition of disorder.
What is a Psychological Disorder?

 Another view is that your behaviour is abnormal if you

are violating social norms, even if a number of people
are sympathetic to your point of view.
 This definition is useful in considering important
cultural differences in psychological
disorders.
 For example, to enter a trance state
and believe you are possessed
reflects a psychological disorder in
most Western cultures but not in
many other societies,
where the behaviour is
accepted and expected.
What is a Psychological Disorder?

 The definition of harmful dysfunction and a related

concept that is also useful is to determine whether the
behaviour is out of the individual’s control (something
the person doesn’t want to do).
What is a Psychological Disorder?

An accepted definition:
 DSM-5 describes a psychological
disorder as behavioural, 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.
 This definition can be useful across cultures and
subcultures if we pay careful attention to what is
functional or dysfunctional (or out of control) in a given
society.
What is a Psychological Disorder?

 The best we may be able to do is to consider how the

apparent disease or disorder matches a “typical”
profile of a disorder—for example, major depression—
when most or all symptoms, that experts would agree
are part of the disorder, are present.
 We call this typical profile a prototype, and,
as described in Chapter 3, the
diagnostic criteria from
DSM-5 found throughout this book
are all prototypes.
 There is the addition of dimensional estimates
of the severity of specific disorders in
DSM-5.
What is a Psychological Disorder?

 For the anxiety disorders for example, the intensity

and frequency of anxiety within a given disorder such
as panic disorder is rated on a 0 to 4 scale where a
rating of 1 would indicate mild or occasional symptoms
and a rating of 4 would indicate continual and severe
symptoms.
The Science of Psychopathology
 Psychopathology is the scientific study of
psychological disorders.
 Within this field are specially trained professionals,
including clinical and counselling
psychologists, psychiatrists,
psychiatric social workers,
and psychiatric nurses, as
well as marriage and family
therapists and mental health counsellors.
The Scientist-Practitioner
 The most important development in the recent history
of psychopathology is the adoption of scientific
methods to learn more about the nature of
psychological disorders, their causes, and their
The Science of Psychopathology

 Many mental health professionals take a scientific

approach to their clinical work and therefore are called
scientist-practitioners.
 Mental health practitioners may function as scientist–
practitioners in one or more of three ways.
 First, they may keep up with the latest scientific
developments in their field and therefore use the most
current diagnostic and treatment procedures.
 In this sense, they are consumers of the science of
psychopathology to the advantage of their
patients.
 Second, scientist–practitioners evaluate their own
assessments or treatment procedures to see whether
they work.
The Science of Psychopathology

 They are accountable not only to their patients but

also to the government agencies and insurance
companies that pay for the treatments, so they must
demonstrate clearly that their treatments work.
 Third, scientist–practitioners might conduct research,
often in clinics or hospitals, producing new information
about disorders or their treatment.
Clinical Description

Clinical Description
 We often say that a patient “presents” with a specific
problem or set of problems, or we discuss
the presenting problem (e.g., chronic
worry, panic attacks).
 Presents is a traditional shorthand way of
indicating why the person came to the
clinic/psychologist.
 Describing the presenting problem is the first step in
determining a clinical description which represents
the unique combination of behaviours, thoughts and
feelings that make up a specific disorder.
Clinical Description

 The word clinical refers both to the types of problems

or disorders that you would find in a clinic or hospital
and to the activities connected with assessment and
treatment.
 One important function of the clinical description is to
specify what makes the disorder different from normal
behaviour or from other disorders.
 Statistical data may also be important. For example,
how many people in the population as a whole have
the disorder? This figure is called the prevalence of
the disorder.
Clinical Description

 Statistics on how many new cases occur during a given

period, such as a year, represents the incidence of the
disorder.
 Most disorders follow a somewhat individual pattern or
course (chronic vs. episodic).
 For example, some disorders, such as schizophrenia
follow a chronic course, meaning that they tend to last a
long time, sometimes a lifetime.
 Other disorders, like mood disorders
follow an episodic course, in that the
individual is likely to recover within a few
months only to suffer a recurrence of the
disorder at a later time.
Clinical Description

 Still other disorders may have a time-limited course,

meaning the disorder will improve without treatment in
a relatively short period.
 Similarly, there are differences in onset or how they
begin.
 Some disorders have an acute onset, meaning that
they begin suddenly; others develop gradually over an
extended period, which is sometimes called an
insidious onset.
 The anticipated course of a disorder is called the
prognosis.
Clinical Description, Aetiology, Treatment
and Outcome
 We might say, “the prognosis is good,” meaning the
individual will probably recover, or “the prognosis is
guarded,” meaning the probable outcome doesn’t look
good.
 Aetiology, or the study of origins, has to do
with why a disorder begins (what causes it)
and includes biological,
psychological, and social
dimensions.
 Treatment and outcome are also often
important to the study of psychological
disorders.
Clinical Description

 If a new drug or psychosocial treatment is successful

in treating a disorder, it may give us some hints about
the nature of the disorder and its causes.
Historical Conceptions of Abnormal
Behaviour
 For thousands of years, humans have tried to explain
and control problematic behaviour.
 Three major models that have guided us date back to
the beginnings of civilization.
 Humans have always supposed that agents outside our
bodies and environment influence our behaviour,
thinking, and emotions.
 These agents—which might be divinities,
demons, spirits, or other phenomena such
as magnetic fields or the moon or the stars
are the driving forces behind the
supernatural model.
Historical Conceptions of Abnormal
Behaviour
 In addition, since the era of ancient Greece, the mind
has often been called the soul or the psyche and
considered separate from the body.
 This split gave rise to two traditions of thought about
abnormal behaviour, summarized as the biological
model and the psychological model.
 These three models—the supernatural, the biological,
and the psychological—are very old but continue to be
used today.
The Supernatural Tradition
 For much of our recorded history, deviant behaviour has
been considered a reflection of the battle between good
and evil.
The Supernatural Tradition

Demons and Witches

 During the last quarter of the 14th century, society as
a whole began to believe more strongly in the
existence and power of demons and witches.
 People increasingly turned to magic and
sorcery to solve their problems.
 During these turbulent times, the bizarre
behaviour of people afflicted with
psychological disorders was seen as the
work of the devil and witches.
The Supernatural Tradition

 It followed that individuals possessed by evil spirits were

probably responsible for any misfortune experienced by
people in the local community, which inspired drastic
action against the possessed.
 Treatments included exorcism, in which various religious
rituals were performed in an effort to rid the victim of evil
spirits.
 The conviction that sorcery and witches are causes of
madness and other evils continued into the 15th century,
and evil continued to be blamed for unexplainable
behaviour, even after the founding of the United States,
as evidenced by the Salem, Massachusetts, witch trials
in the late 17th century.
The Supernatural Tradition

Stress and Melancholy

 An equally strong opinion, even during this period,
reflected the enlightened view that insanity was a
natural phenomenon, caused by mental or emotional
stress, and that it was curable.
 Mental depression and anxiety were recognized as
illnesses, although symptoms such as despair and
lethargy were often identified by the church with the
sin of acedia, or sloth.
 Common treatments were rest, sleep, and a healthy
and happy environment. Other treatments included
baths, ointments, and various potions.
The Supernatural Tradition

Mass Hysteria
 Another fascinating phenomenon is characterized by
large-scale outbreaks of bizarre behaviour.
 During the Middle Ages, they lent support to the notion
of possession by the devil.
 In Europe, whole groups of people were
simultaneously compelled to run out in the streets,
dance, shout, rave, and jump around in patterns as if
they were at a particularly wild party late at night (still
called a rave today, but with music).
 This behaviour was known by several names,
including Saint Vitus’s Dance and tarantism.
The Supernatural Tradition

Modern Mass Hysteria

 Mass hysteria may simply demonstrate
the phenomenon of emotion contagion,
in which the experience of an
emotion seems to spread to
those around.
 If someone nearby becomes frightened
or sad, chances are that for the moment you also
will feel fear or sadness.
 When this kind of experience escalates into full-blown
panic, whole communities are affected.
 People are also suggestible when they are in states of
high emotion.
The Supernatural Tradition

 Therefore, if one person identifies a “cause” of the

problem, others will probably assume that their own
reactions have the same source.
 In popular language, this shared response is sometimes
referred to as mob psychology.
The Moon and The Stars
 Paracelsus, a Swiss physician who lived from 1493 to
1541, rejected notions of possession by the devil,
suggesting instead that the movements of the moon and
stars had profound effects on people’s psychological
functioning.
The Supernatural Tradition

 Paracelsus speculated that the

gravitational effects of the moon on
bodily fluids might be a possible
cause of mental disorders.
 This influential theory inspired the word lunatic, which is
derived from the Latin word luna, meaning “moon.”
 The belief that heavenly bodies affect human behaviour
still exists, although there is no scientific evidence to
support it.
 Despite much ridicule, millions of people around the
world are convinced that their behaviour is influenced
by the stages of the moon or the positions of the stars.
The Supernatural Tradition

 This belief is most noticeable today

in followers of astrology, who hold
that their behaviour and the major
events in their lives can be
predicted by their day-to-day
relationship to the
position of the planets.
The Biological Tradition

Hippocrates (460-377 BC)

 The Greek physician Hippocrates (460–377
b.C.) is considered to be the father of
modern Western medicine.
 He and his associates suggested that
psychological disorders could be treated like
any other disease.
 They believed that psychological disorders might also be
caused by brain pathology or head trauma and could be
influenced by heredity (genetics).
 Hippocrates considered the brain to be the seat of
wisdom, consciousness, intelligence, and emotion.
The Biological Tradition
 Therefore, disorders involving these functions would
logically be located in the brain.
 Hippocrates also recognized the importance of
psychological and interpersonal contributions to
psychopathology, such as the sometimes-negative
effects of family stress; on some occasions, he removed
patients from their families.
Galen (129-198 AD)
 The Roman physician Galen later adopted the ideas of
Hippocrates and his associates and developed them
further, creating a powerful and influential school of
thought within the biological tradition that extended well
into the 19th century.
The Biological Tradition

 One of the more interesting and influential legacies of

the Hippocratic-Galenic approach is the 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.
 Physicians believed that disease resulted from too
much or too little of one of the
humors.
The Biological Tradition

 For example, too much black bile was thought to cause

melancholia (depression). In fact, the term
melancholer, which means “black bile,” is still used
today in its derivative form melancholy to refer to
aspects of depression.
 The humoral theory was, perhaps, the first example of
associating psychological disorders with a “chemical
imbalance,” an approach that is widespread today.
 The four humors were related to the Greeks’
conception of the four basic qualities: heat, dryness,
moisture, and cold. Each humor was associated with
one of these qualities.
The Biological Tradition

 Terms derived from the four humors are still sometimes

applied to personality traits.
 For example, Melancholic means depressive
(depression was thought to be caused by black bile
flooding the brain).
 A phlegmatic personality (from the humor phlegm)
indicates apathy and sluggishness but can also mean
being calm under stress.
 Excesses of one or more humors were treated by
regulating the environment to increase or decrease
heat, dryness, moisture, or cold, depending on which
humor was out of balance.
The Biological Tradition

 In addition to rest, good nutrition, and exercise, two

treatments were developed.
 In one, bleeding or bloodletting, a carefully
measured amount of blood was removed
from the body, often with leeches.
 The other was to induce vomiting; indeed, in
a well-known treatise on depression
published in 1621, Anatomy of
Melancholy, Robert Burton
recommended eating tobacco and a half-boiled
cabbage to induce vomiting.
 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
The Biological Tradition

 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.
 Because these disorders occurred primarily in women,
the Egyptians (and Hippocrates) mistakenly assumed
that they were restricted to women.
 They also presumed a cause: The empty uterus
wandered to various parts of the body in search of
conception (the Greek word for “uterus” is hysteron).
The 19th Century

Syphilis and General Paresis

 Behavioural and cognitive symptoms of
what we now know as advanced syphilis,
a sexually transmitted
disease 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 behaviours.
The 19th Century

 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, researchers recognized that a subgroup of
apparently psychotic patients deteriorated steadily,
becoming paralyzed and dying within 5 years of onset.
 This course of events contrasted with that of most
psychotic patients, who remained fairly stable.
 In 1825, the condition was designated a disease,
general paresis, because it had consistent symptoms
(presentation) and a consistent course that resulted in
death.
The 19th Century

 The relationship between general paresis and syphilis

was only gradually established.
 Louis Pasteur’s germ theory of disease,
developed in about 1870, facilitated the
identification of the specific bacterial
microorganism that caused syphilis.
 Of equal importance was the discovery of
a cure for general paresis.
 Physicians observed a surprising recovery in patients
with general paresis who had contracted malaria.
The 19th Century

 So, they deliberately injected other patients with blood

from a soldier who was ill with malaria.
 Many recovered because the high fever “burned out”
the syphilis bacteria.
 Ultimately, clinical investigators discovered that
penicillin cures syphilis, but with the malaria cure,
“madness” and associated behavioural and cognitive
symptoms for the first time were traced directly to a
curable infection.
John Grey (1850s)
 The champion of the biological tradition in the United
States was the most influential American psychiatrist of
the time, John P. Grey.
The 19th Century

 Grey’s position was that the causes of insanity were

always physical. Therefore, the mentally ill patient
should be treated as physically ill.
 The emphasis was again on rest, diet, and proper
room temperature and
ventilation, approaches used
for centuries by previous therapists in the
biological tradition.
 Under Grey’s leadership, the conditions
in hospitals greatly improved and they
became more humane, liveable
institutions.
The Development of Biological
Treatments
 Renewed interest in the biological origin of
psychological disorders led, ultimately, to greatly
increased understanding of biological contributions to
psychopathology and to the development of new
treatments.
 In the 1930s, the physical interventions of
electric shock and brain surgery were often
used.
 For example, insulin was occasionally given
to stimulate appetite in psychotic patients
who were not eating, but it also seemed to calm them
down.
The Development of Biological
Treatments
 In 1927, a Viennese physician, began using
increasingly higher dosages until, finally, patients
convulsed and became temporarily comatose.
 Some actually recovered their mental health, much to
the surprise of everybody, and their recovery was
attributed to the convulsions.
 The procedure became known as insulin shock therapy,
but it was abandoned because it was too dangerous,
often resulting in prolonged coma or even death.
The Development of Biological
Treatments
 Following suggestions on the possible benefits of
applying electric shock directly to the brain—notably,
by two Italian physicians in 1938—a surgeon in London
treated a depressed patient by sending six small
shocks directly through his brain, producing
convulsions. The patient recovered.
 Although greatly modified, shock treatment is still with
us today. It is interesting that even now we have little
knowledge of how it works.
 During the 1950s, the first effective drugs for severe
psychotic disorders were developed in a systematic
way.
The Development of Biological
Treatments
 Before that time, a number of medicinal substances,
including opium (derived from poppies), had been
used as sedatives, along with countless herbs and folk
remedies.
 With the discovery of Rauwolfia serpentine (later
renamed reserpine) and another class of drugs called
neuroleptics (major tranquilizers), for the first time
hallucinatory and delusional thought processes could
be diminished in some patients; these drugs also
controlled agitation and aggressiveness.
 Other discoveries included benzodiazepines (minor
tranquilizers), which seemed to reduce anxiety.
The Development of Biological
Treatments
 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.
 In the late 19th century, Grey and his colleagues
ironically reduced or eliminated interest in treating
mental patients, because they thought that mental
disorders were the result of some as-yet-undiscovered
brain pathology and were therefore incurable.
Consequences of the Biological
Tradition
 The only available course of action was to hospitalize
these patients.
 Emil Kraepelin (1856–1926) was the
dominant figure during this period and one
of the founding fathers of modern
psychiatry.
 Kraepelin (1913) was 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.
 Many of his descriptions of schizophrenic disorders are
still useful today.
Consequences of the Biological
Tradition
 By the end of the 1800s, a scientific approach to
psychological disorders and their classification had
begun with the search for biological causes.
 Furthermore, treatment was based on humane
principles.
The Psychological Tradition

Plato, Aristotle, and Greece

 Plato thought that the two causes of maladaptive
behaviour were the social and cultural influences in
one’s life and the learning that took place in that
environment.
 If something was wrong in the environment, such as
abusive parents, one’s impulses and emotions would
overcome reason.
 The best treatment was to re-educate the individual
through rational discussion so that the power of reason
would predominate.
The Psychological Tradition

 This was very much a precursor to modern

psychosocial treatment approaches to the causation
of psychopathology, which focus not only on
psychological factors but also on social and cultural
ones as well.
 Other well-known early philosophers, including Aristotle,
also emphasized the influence of the social environment
and early learning on later psychopathology.
 These philosophers wrote about the importance of
fantasies, dreams, and cognitions and thus anticipated,
to some extent, later developments in psychoanalytic
thought and cognitive science.
The Psychological Tradition & Moral
Therapy
 They also advocated humane and responsible care
for individuals with psychological disturbances.
Moral Therapy
 During the first half of the 19th century, a strong
psychosocial approach to mental disorders called
moral therapy became influential.
 The term moral actually referred more to emotional
or psychological factors rather than to a code of
conduct.
Moral Therapy

 Its basic tenets included treating

institutionalized patients as normally
as possible in a setting that encouraged and
reinforced normal social interaction, thus providing
them with many opportunities for
appropriate social and interpersonal
contact.
 Asylums had appeared in the 16th century, but they
were more like prisons than hospitals.
 It was the rise of moral therapy in Europe and the
United States that made asylums habitable and even
therapeutic.
Moral Therapy

Key Figures in the Humanistic Reform were:

 In France
 Philippe Pinel (1745 – 1826)
 Jean-Baptiste Pussin
 In England
 William Tuke (1732 – 1822)
 In the United States
 Benjamin Rush (1745 – 1813)
 Horace Mann (1833)
Asylum Reform and the Decline of Moral
Therapy
 After the mid-19th century, humane treatment declined
because of a convergence of factors.
 First, it was widely recognized that moral therapy
worked best when the number of patients in an
institution was 200 or fewer, allowing for a great deal of
individual attention.
 After the Civil War, enormous waves of immigrants
arrived in the United States, yielding their own
populations of mentally ill.
 Patient loads in existing hospitals increased to 1000 or
2000, and even more.
Asylum Reform and the Decline of
Moral Therapy
 Because immigrant groups were thought not to
deserve the same privileges as “native” Americans,
they were not given moral treatments even when there
were sufficient hospital personnel.
 A second reason for the decline of moral
therapy has an unlikely source. The great
crusader Dorothea Dix (1802–
1887) campaigned endlessly
for reform in the
treatment of insanity.
 She had first-hand knowledge of the deplorable
conditions imposed on patients with insanity, and she
made it her life’s work to inform the American public
and their leaders of these abuses.
Asylum Reform and the Decline of Moral
Therapy
 Her work became known as the mental hygiene
movement.
 In addition to improving the standards of care, Dix
worked hard to make sure that everyone who needed
care received it, including the homeless.
 Through her efforts, humane treatment became more
widely available in U.S. institutions.
 Unfortunately, an unforeseen consequence of Dix’s
heroic efforts was a substantial increase in the number
of mental patients.
 This influx led to a rapid transition from moral therapy
to custodial care because hospitals were inadequately
staffed.
Asylum Reform and the Decline of
Moral Therapy
 Dix reformed our asylums and single-handedly
inspired the construction of numerous new institutions
in the U.S. and abroad.
 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.
 The psychological tradition lay dormant for a time, only
to re-emerge in several different schools of thought in
the 20th century.
Asylum Reform and the Decline of
Moral Therapy
 The first major approach was psychoanalysis, based
on Sigmund Freud’s (1856–1939) elaborate theory of
the structure of the mind and the role of unconscious
processes in determining behaviour.
 The second was behaviourism, associated with John
B. Watson, Ivan Pavlov, and B.F. Skinner, which
focuses on how learning and adaptation affect the
development of psychopathology.
Psychoanalytic Theory

 Franz Anton Mesmer (1734–1815) had

hypnotized his patients.
 Mesmer suggested to his patients that their
problem was caused by an
undetectable fluid found in all
living organisms called “animal magnetism,”
which could become blocked.
 He identified and tapped various areas of their bodies
where their animal
magnetism was blocked while suggesting strongly
that they were being cured.
 Mesmer is widely regarded as the father of hypnosis,
a state in which extremely suggestible subjects
sometimes appear to be in a trance.
Psychoanalytic Theory

 Many distinguished scientists and physicians were

interested in Mesmer’s powerful methods of
suggestion.
 One of the best known, Jean-Martin Charcot (1825 –
1893), was head of the Salpétrière Hospital in Paris.
 A distinguished neurologist, Charcot demonstrated
that some techniques of mesmerism were effective
with a number of psychological disorders, and he did
much to legitimize the practice of hypnosis.
 Significantly, in 1885 a young man named Sigmund
Freud came from Vienna to study with Charcot.
Psychoanalytic Theory

 After returning from France, Freud teamed up with

Josef Breuer (1842–1925), who
had experimented with a
somewhat different
hypnotic procedure.
 While his patients were in the highly
suggestible state of hypnosis,
Breuer asked them to describe their problems,
conflicts, and fears in as much detail as they could.
 Breuer observed two extremely important phenomena
during this process. First, patients often became
extremely emotional as they talked and felt quite
relieved and improved after emerging from the
hypnotic state.
Psychoanalytic Theory

 Second, seldom would they have gained an

understanding of the relationship between their
emotional problems and their psychological disorder.
 In fact, it was difficult or impossible for them to recall
some details they had described under hypnosis. In
other words, the material seemed to be beyond the
awareness of the patient.
 With this observation, Breuer and Freud had
“discovered” the unconscious mind and its apparent
influence on the production of psychological disorders.
 This is one of the most important developments in the
history of psychopathology and, indeed, of psychology
as a whole.
Psychoanalytic Theory

 A close second was their discovery that it is therapeutic

to recall and relive emotional trauma that has been
made unconscious and to release the accompanying
tension.
 This release of emotional material became known as
catharsis.
 A fuller understanding of the relationship between
current emotions and earlier events is referred to as
insight.
 Freud and Breuer’s theories were based on case
observations, some of which were made in
a surprisingly systematic way for
those times.
Psychoanalytic Theory

 An excellent example is Breuer’s classic

description of his treatment of “hysterical”
symptoms in Anna O. in 1895.
 Freud took these basic observations and
expanded them into the psychoanalytic model,
the most comprehensive theory yet constructed on the
development and structure of our personalities.
 He also speculated on where this development could
go wrong and produce psychological disorders.
The Structure of the Mind
 The mind, according to Freud, has three major parts or
functions: the id, the ego, and the superego.
Psychoanalytic Theory

 The id is the source of our strong sexual

and aggressive feelings or energies.
 It is, basically, the animal within us; if
totally unchecked, it would make us all
rapists or killers.
 The energy or drive within the id is the libido.
 A less important source of energy, not as well
conceptualized by Freud, is the death instinct, or
thanatos.
 These two basic drives, toward life and fulfilment on
the one hand and death and destruction on the other,
are continually in opposition.
Psychoanalytic Theory

 The id operates according to the pleasure principle,

with an overriding goal of maximizing pleasure and
eliminating any associated tension or conflicts.
 The id has its own characteristic way of processing
information; referred to as the primary process, this
type of thinking is emotional, irrational, illogical, filled
with fantasies, and preoccupied with sex, aggression,
selfishness, and envy.
 But only a few months into life, we know we must adapt
our basic demands to the real world. In other words,
we must find ways to meet our basic needs without
offending everyone around us.
Psychoanalytic Theory

 Put yet another way, we must act realistically.

 The part of our mind that ensures that we act
realistically is called the ego, and it operates according
to the reality principle instead of the pleasure principle.
 The cognitive operations or thinking styles of the ego
are characterized by logic and reason and are referred
to as the secondary process, as opposed to the illogical
and irrational primary process of the id.
 The third important structure within the mind, the
superego, or what we might call conscience,
represents the moral principles instilled in us by our
parents and our culture.
Psychoanalytic Theory

 It is the voice within us that nags at us when we know

we’re doing something wrong.
 Because the purpose of the superego is to counteract
the potentially dangerous aggressive and sexual drives
of the id, the basis for conflict is readily apparent.
 The role of the ego is to mediate conflict between the id
and the superego, juggling their demands with the
realities of the world.
 The ego is often referred to as the executive or
manager of our minds.
 If it mediates successfully, we can go on to the higher
intellectual and creative pursuits of life.
Psychoanalytic Theory

 If it is unsuccessful, and the id or superego becomes

too strong, conflict will overtake us and psychological
disorders will develop.
 Because these conflicts are all within the mind, they
are referred to as intrapsychic conflicts.
 Freud believed that the id and the superego are almost
entirely unconscious.
 We are fully aware only of the secondary processes of
the ego, which is a relatively small part of the mind.
Psychoanalytic Theory
Psychoanalytic Theory

Defence Mechanisms
 The ego fights a continual battle to stay on top of the
warring id and superego. Occasionally, their conflicts
produce anxiety that threatens to overwhelm the ego.
 The anxiety is a signal that alerts the ego to marshal
defence mechanisms, unconscious protective
processes that keep primitive emotions associated
with conflicts in check so that the ego can continue its
coordinating function.
 We all use defence mechanisms at times—they are
sometimes adaptive and at other times maladaptive.
 Examples of defence mechanisms are (APA, 2000):
Psychoanalytic Theory

 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.
Psychoanalytic Theory

 Reaction formation: Substitutes behaviour, 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 behaviour.
Psychosexual Stages of Development
 Freud also theorized that during infancy and early
childhood we pass through a number of psychosexual
stages of development that have a profound and
lasting impact.
Psychoanalytic Theory

 The stages—oral, anal, phallic, latency, and genital

— represent distinctive patterns of gratifying our basic
needs and satisfying our drive for physical pleasure.
 For example, the oral stage, typically extending for
approximately 2 years from birth, is characterized by a
central focus on the need for food.
 In the act of sucking, necessary for feeding, the lips,
tongue, and mouth become the focus of libidinal drives
and, therefore, the principal source of pleasure.
Psychoanalytic Theory

 Freud hypothesized that if we did not receive

appropriate gratification during a specific stage or if a
specific stage left a particularly strong impression
(which he termed fixation), an individual’s personality
would reflect the stage throughout adult life.
 For example, 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.
Psychoanalytic Theory

 One of the more controversial and frequently

mentioned psychosexual conflicts occurs during the
phallic stage (from age 3 to age 5 or 6), which is
characterized by early genital self-stimulation.
 This conflict is the subject of the Greek tragedy
Oedipus Rex, in which Oedipus is fated to kill his father
and, unknowingly, to marry his mother.
 Freud asserted that all young boys relive this fantasy
when genital self-stimulation is accompanied by
images of sexual interactions with their mothers.
Psychoanalytic Theory

 These fantasies, in turn, are accompanied by strong

feelings of envy and perhaps anger toward their fathers,
with whom they identify but whose place they wish to
take.
 Furthermore, strong fears develop that the
father may punish that lust by removing the
son’s penis—thus, the phenomenon of
castration anxiety.
 This fear helps the boy keep his lustful impulses toward
his mother in check.
 The battle of the lustful impulses on the one hand and
castration anxiety on the other creates a conflict that is
internal, or intrapsychic, called the Oedipus complex.
Psychoanalytic Theory

 The phallic stage passes uneventfully only if several

things happen.
 First, the child must resolve his ambivalent relationship
with his parents and reconcile the simultaneous anger
and love he has for his father.
 If this happens, he may go on to channel his libidinal
impulses into heterosexual relationships while
retaining harmless affection for his mother.
 The counterpart conflict in girls, called the Electra
complex, is even more controversial.
 Freud viewed the young girl as wanting to replace her
mother and possess her father.
Psychoanalytic Theory

 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.
 In Freud’s view, all nonpsychotic psychological
disorders resulted from underlying unconscious
conflicts, the anxiety that resulted from those conflicts,
and the implementation of ego defence mechanisms.
Psychoanalytic Theory

 Freud called such disorders neuroses, or neurotic

disorders, from an old term referring to disorders of the
nervous system.
Psychoanalytic Theory

Later Developments in Psychoanalytic Thought

 Freud’s original psychoanalytic theories have been
greatly modified and developed in a number of different
directions, mostly by his students or followers.
 Some theorists simply took one component of
psychoanalytic theory and developed it more fully.
 Others broke with Freud and went in entirely new
directions.
 Anna Freud (1895–1982), Freud’s daughter,
concentrated on the way in which the defensive
reactions of the ego determine our behaviour.
 In so doing, she was the first proponent of the modern
field of ego psychology.
Psychoanalytic Theory

 According to Anna Freud, the individual slowly

accumulates adaptational capacities, skill in reality
testing, and defences.
 Abnormal behaviour develops when the ego is
deficient in regulating such functions as delaying and
controlling impulses or in marshalling appropriate
normal defences to strong internal conflicts.
 In another somewhat later modification of Freud’s
theories, Heinz Kohut (1913–1981) 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 conversely, to develop
neurosis.
Psychoanalytic Theory

 This psychoanalytic approach became known as self-

psychology.
 A related area that is quite popular today is referred to
as object relations. Object relations is the study of
how children incorporate the images, the memories,
and sometimes the values of a person who was
important to them and to whom they were (or are)
emotionally attached.
 Object in this sense refers to these important people,
and the process of incorporation is called introjection.
 Introjected objects can become an integrated part of
the ego or may assume conflicting roles in determining
the identity, or self.
Psychoanalytic Theory

 According to object relations theory, you tend to see

the world through the eyes of the person incorporated
into your self.
 Object relations theorists focus on how these disparate
images come together to make up a person’s identity
and on the conflicts that may emerge.
 Carl Jung (1875–1961) and Alfred Adler
(1870–1937) were students of Freud who
came to reject his ideas and form their
own schools of thought.
 Jung, rejecting many of the sexual aspects
of Freud’s theory, introduced the concept of the
collective unconscious.
Psychoanalytic Theory

 The collective unconscious is a wisdom

accumulated by society and culture that is stored
deep in individual memories and passed down from
generation to generation.
 Jung also suggested that spiritual and religious drives
are as much a part of human nature as are sexual
drives; this emphasis and the idea of the collective
unconscious continue to draw the attention of
mystics.
 Jung emphasized the importance of enduring
personality traits such as introversion (the tendency to
be shy and withdrawn) and extroversion (the tendency
to be friendly and outgoing).
Psychoanalytic Theory

 Adler focused on feelings of inferiority

and the striving for superiority; he
created the term inferiority complex.
 Unlike Freud, both Jung and Adler
also believed that the basic quality of human nature
is positive and that there is a strong drive toward self-
actualization (realizing one’s full potential).
 Jung and Adler believed that by removing barriers to
both internal and external growth the individual would
improve and flourish.
 Others took psychoanalytical theorizing in different
directions, emphasizing development over the life span
and the influence of culture and society on personality.
Psychoanalytic Theory

 Karen Horney (1885–1952) and Erich Fromm (1900–

1980) are associated with these ideas, but the best-
known theorist is Erik Erikson (1902–1994).
 Erikson’s greatest contribution was
his theory of development across the
life span, in which he described in
some detail the crises and conflicts
that accompany eight
specific stages.
 For example, in the last of these
stages, the mature age, beginning about age 65,
individuals review their lives
and attempt to make sense of them, experiencing both
satisfaction at having completed some lifelong goals and
Psychoanalytic Theory

Psychoanalytic Psychotherapy
 Many techniques of psychoanalytic psychotherapy, or
psychoanalysis, are designed to reveal
the nature of unconscious mental processes and
conflicts through catharsis and insight.
 Freud developed techniques of free association, in
which patients are instructed to say whatever comes to
mind without the usual socially required censoring.
 Free association is intended to reveal emotionally
charged material that may be repressed because it is
too painful or threatening to bring into consciousness.
Psychoanalytic Theory

 Freud’s patients lay on a couch, and

he sat behind them so that they would
not be distracted.
 This is how the couch became the
symbol of psychotherapy.
 Other techniques include dream analysis
(still quite popular today), in which the
therapist interprets the content of dreams,
supposedly reflecting the primary-
process thinking of the id, and
systematically relates the
dreams to symbolic aspects of unconscious conflicts.
Psychoanalytic Theory

 The relationship between the therapist, called the

psychoanalyst, and the patient is important.
 In the context of this relationship as it evolves, the
therapist may discover the nature of the patient’s
intrapsychic conflict.
 This is because, in a phenomenon called transference,
patients come to relate to the therapist much as they
did to important figures in their childhood, particularly
their parents.
 Patients who resent the therapist but can verbalize no
good reason for it may be re-enacting childhood
resentment toward a parent.
Psychoanalytic Theory

 In the phenomenon of countertransference, therapists

project some of their own personal issues and
feelings, usually positive, onto the patient.
 Psychoanalysis is still practiced, particularly in some
large cities, but many psychotherapists employ a
loosely related set of approaches referred to as
psychodynamic psychotherapy.
 A major criticism of psychoanalysis is that it is
basically unscientific, relying on reports by the patient
of events that happened years ago.
Humanistic Theory
 Jung and Adler’s general philosophies were adopted in
the middle of the century by personality theorists and
became known as humanistic psychology.
 Self-actualizing was the watchword for this
movement. The underlying assumption is that all of us
could reach our highest potential, in all areas of
functioning, if only we had the freedom to grow.
 Abraham Maslow (1908–1970) was most systematic in
describing the structure of personality. He postulated a
hierarchy of needs, beginning with our most basic
physical needs for food and sex and ranging upward to
our needs for love, self-esteem and self-actualization.
Humanistic Theory

 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.
Humanistic Theory

 Carl Rogers (1902–1987) is, from the point of

view of therapy, the most influential
humanist.
 Rogers (1961) originated client-centered
therapy, later known as person-centered
therapy.
 In this approach, the therapist takes a passive
role, making as few interpretations as possible.
 The point is to give the individual a chance to develop
during the course of therapy,
unfettered by threats to the self.
 Humanist theorists have great faith in the ability of
human relations to foster this growth.
Humanistic Theory

 Unconditional positive regard, the complete and

almost unqualified acceptance of most of the client’s
feelings and actions, is critical to the humanistic
approach.
 Empathy is the sympathetic understanding of the
individual’s particular view of the world.
 The hoped-for result of person-centered therapy is that
clients will be more straight-forward and honest with
themselves and will access their innate tendencies
toward growth.
Humanistic Theory

 Rather than seeing the relationship as a means to an

end (transference), humanistic therapists believed that
relationships, including the therapeutic relationship,
were the single most positive influence in facilitating
human growth.
 Nevertheless, the humanistic model contributed
relatively little new information to the field of
psychopathology.
The Behavioural Model

The Behavioural Model

 The behavioural model, which is also known as the
cognitive-behavioural model or social learning model,
brought the systematic development of a more
scientific approach to psychological aspects of
psychopathology.
Pavlov and Classical Conditioning
 In his classic study examining why dogs salivate before
the presentation of food, physiologist Ivan Pavlov
(1849–1936), initiated the study of classical
conditioning, a type of learning in which a neutral
stimulus is paired with a response until it elicits that
response.
The Behavioural Model

 Conditioning is one way in which we acquire new

information, particularly information that is somewhat
emotional in nature.
 An example: Patients who receive chemotherapy often
experience severe nausea and, occasionally, vomiting
when they merely see the medical personnel who
administered the chemotherapy or any equipment
associated with the treatment, even on days when
their treatment is not delivered.
 This phenomenon is called stimulus generalization
because the response generalizes to similar stimuli.
The Behavioural Model

 Whether the stimulus is food, as in Pavlov’s laboratory,

or chemotherapy, the classical conditioning process
begins with a stimulus that would elicit a response in
almost anyone and requires no learning; no conditions
must be present for the response to occur.
 For these reasons, the food or chemotherapy is called
the unconditioned stimulus (UCS). The natural or
unlearned response to this stimulus—in these cases,
salivation or nausea—is called the unconditioned
response (UCR).
The Behavioural Model

 Now the learning comes in. As we have already seen,

any person or object associated with the
unconditioned stimulus (food or chemotherapy)
acquires the power to elicit the same response, but
now the response, because it was elicited by the
conditional or conditioned stimulus (CS), is termed a
conditioned response (CR).
 Thus, the nurse associated with the chemotherapy
becomes a conditioned stimulus.
 The nauseous sensation (upon seeing the nurse),
which is almost the same as that experienced during
chemotherapy, becomes the conditioned response.
The Behavioural Model

 Most learning of this type, however, requires repeated

pairing of the unconditioned stimulus (for example,
chemotherapy) and the conditioned stimulus (for
instance, nurses’ uniforms or hospital equipment).
 What Pavlov with his dogs also learned is that
presentation of the conditioned stimulus (for example,
the metronome) without the food for a long enough
period would eventually eliminate the conditioned
response to the food.
 In other words, the dog learned that the metronome no
longer meant that a meal might be on the way. This
process was called extinction.
The Behavioural Model
The Behavioural Model

Watson and the Rise of Behaviourism

 An early American psychologist, John B. Watson
(1878–1958), is considered the founder of
behaviourism.
 Watson wrote in 1913: “Psychology, as the behaviourist
views it, is a purely objective experimental branch of
natural science. Its theoretical goal is the prediction
and control of behaviour. Introspection forms no
essential part of its methods” (p. 158).
 In 1920, he and a student, Rosalie Rayner,
presented an 11-month-old boy named
Albert with a harmless fluffy white rat to
play with.
The Behavioural Model

 Albert was not afraid of the small animal and enjoyed

playing with it.
 Every time Albert reached for the rat, however, the
experimenters made a loud noise
behind him.
 After only five trials, Albert showed the first signs of
fear if the white rat came near.
 The experimenters then determined that Albert
displayed mild fear of any white furry object, even a
Santa Claus mask with a white fuzzy beard.
 Another student of Watson’s, Mary Cover Jones
(1896–1987), thought that if fear could be learned or
classically conditioned in this way, perhaps it could also
be unlearned or extinguished.
The Behavioural Model

 She worked with a boy named Peter, who at 2 years,

10 months old was already quite afraid of furry objects.
 Jones decided to bring a white rabbit into the room
where Peter was playing for a short time each day.
 She also arranged for other children, whom she knew
did not fear rabbits, to be in the same room.
 She noted that Peter’s fear gradually diminished. Each
time it diminished, she brought the rabbit closer.
 Eventually Peter was touching and even playing with
the rabbit and years later the fear had not returned.
The Behavioural Model and Behaviour
Therapy
The Beginnings of Behaviour Therapy
 The implications of Jones’s research were largely
ignored, but in the late 1940s and early 1950s, Joseph
Wolpe (1915–1997), a pioneering psychiatrist from
South Africa, became dissatisfied with prevailing
psychoanalytic interpretations of psychopathology and
began looking for something else.
 He developed a variety of behavioural procedures for
treating his patients, many of whom suffered from
phobias.
 His best-known technique was termed systematic
desensitization.
The Behavioural Model and Behaviour
Therapy
 Individuals were gradually introduced
to the objects or situations they feared
so that their fear could
extinguish; that is, they
could test reality and see that
nothing bad happened in the presence
of the phobic object or scene.
 Wolpe added another element by having his patients
do something that was incompatible with fear while
they were in the presence of the dreaded object or
situation.
The Behavioural Model and Behaviour
Therapy
 Because he could not always reproduce the phobic
object in his office, Wolpe had his patients carefully
and systematically imagine the phobic scene, and the
response he chose was relaxation because it was
convenient.
 For example, Wolpe treated a young man with a
phobia of dogs by training him first to relax deeply and
then imagine he was looking at a dog across the park.
 Gradually, he could imagine the dog across the park
and remain relaxed, experiencing little or no fear.
 Wolpe then had him imagine that he was closer to the
dog.
The Behavioural Model and Behaviour
Therapy
 Eventually, the young man imagined that he was
touching the dog while maintaining a relaxed, almost
trancelike state.
 Wolpe reported great success with systematic
desensitization, one of the first wide-scale
applications of the new science of behaviourism to
psychopathology.
 Wolpe, working with fellow pioneers Hans Eysenck
and Stanley Rachman in London, called this approach
behaviour therapy.
The Behavioral Model - Operant
Conditioning
B. F. Skinner and Operant Conditioning
 B. F. Skinner (1904–1990), published The Behavior of
Organisms in 1938, in which he laid out, in a
comprehensive manner, the principles of operant
conditioning, a type of learning in which behaviour
changes as a function of what follows the behaviour.
 Skinner observed early on that a large part of our
behaviour is not automatically elicited by an
unconditioned stimulus and that we must account for
this.
 Skinner was strongly influenced by Watson’s conviction
that a science of human behaviour must be based on
observable events and relationships among those
events.
The Behavioral Model - Operant
Conditioning
 The work of psychologist Edward L. Thorndike (1874–
1949) also influenced Skinner.
 Thorndike is best known for the law of effect, which
states that behaviour is either strengthened (likely to
be repeated more frequently) or weakened (likely to
occur less frequently) depending on the consequences
of that behaviour.
 For example, if a 5-year-old boy starts shouting at the
top of his lungs in a restaurant, much to the
annoyance of the people around him, it is unlikely that
his behaviour was automatically elicited by an
unconditioned stimulus.
The Behavioural Model - Operant
Conditioning
 Also, he will be less likely to do it in the future if his
parents scold him, take him out to the car to sit for a
bit, or consistently reinforce more appropriate
behaviour.
 Skinner coined the term operant conditioning because
behaviour operates on the environment and changes it
in some way.
 For example, the boy’s behaviour affects his parents’
behaviour and probably the behaviour of other
customers. Therefore, he changes his environment.
 Skinner preferred the term reinforcement to “reward”
because it connotes the effect on the behaviour.
The Behavioral Model - Operant
Conditioning
 He pointed out that all of our behaviour is governed to
some degree by reinforcement, which can be arranged
in an endless variety of ways, in schedules of
reinforcement.
 He also believed that using punishment as a
consequence is relatively ineffective in the long run
and that the primary way to develop new behaviour is
to positively reinforce desired behaviour.
 Skinner and his disciples taught animals a variety of
tricks, including dancing, playing Ping-Pong, and
playing a toy piano.
The Behavioral Model - Operant
Conditioning
 To do this he used a procedure called shaping, a
process of reinforcing successive approximations to a
final behaviour or set of behaviours.
The Present: The Scientific Method and an
Integrative Approach
 We have just reviewed three traditions or ways of
thinking about causes of psychopathology: the
supernatural, the biological, and the psychological
(further subdivided into two major historical
components: psychoanalytic and behavioural).
 Each tradition has failed in important ways.
 In the 1990s, two developments came together as
never before to shed light on the nature of
psychopathology: (1) the increasing sophistication of
scientific tools and methodology, and (2) the
realization that no one influence—biological,
behavioural, cognitive, emotional, or social—ever
occurs in isolation.
The Present: The Scientific Method
and an Integrative Approach
 Literally, every time we think, feel, or do something, the
brain and the rest of the body are hard at work.
 Perhaps not as obvious, however, is that our thoughts,
feelings, and actions inevitably influence the function
and even the structure of the brain, sometimes
permanently.
 In other words, our behaviour, both normal and
abnormal, is the product of a continual interaction of
psychological, biological, and social influences.
 By 2000, a veritable explosion of knowledge about
psychopathology was occurring.
The Present: The Scientific Method and an
Integrative Approach
 The young fields of cognitive science and neuroscience
began to grow exponentially as we learned more about
the brain and about how we process, remember, and
use information.
 At the same time, startling new findings from
behavioural science revealed the importance of early
experience in determining later development.
 It was clear that a new model was needed that would
consider biological, psychological, and social influences
on behaviour.
 This approach to psychopathology would combine
findings from all areas with our rapidly growing
understanding of how we experience life during different
developmental periods, from infancy to old age.
References

 Barlow, D.H. & Durand, V.M. (2015), Abnormal

Psychology: An Integrative Approach (7th ed.).
Wadsworth.
 Barlow, D.H., Durand, V.M., du Plessis, L.M. & Visser, C.
(2017), Abnormal Psychology: An Integrative Approach (1st
South African ed.). Wadsworth.