Chapter 1 Abnormal Behavior in Historical Context

1. Chapter 1Abnormal Behavior in Historical Context

2. Myths and Misconceptions About Abnormal Behavior • No Single Definition of Psychological Abnormality • No Single Definition of Psychological Normality

3. What is a Psychological Disorder? • Psychological Dysfunction • Breakdown in cognitive, emotional, or behavioral functioning • Personal Distress • Difficulty performing appropriate and expected roles • Impairment is set in the context of a person’s background • Atypical or Not Culturally Expected Response • Reaction is outside cultural norms

4. Abnormal Behavior Defined • Working Definition • A psychological dysfunction associated with distress or impairment in functioning that is not typical or culturally expected • The Diagnostic and Statistical Manual (DSM-IV-TR) • DSM Contains Diagnostic Criteria • The Field of Psychopathology • The scientific study of psychological disorders

5. The Science of Psychopathology • Mental Health Professionals • The Ph.D.’s: Clinical and counseling psychologists • The Psy.D.’s: Clinical and counseling “Doctors of Psychology” • M.D.’s: Psychiatrists

6. The Science of Psychopathology (continued) • M.S.W.’s: Psychiatric and non-psychiatric social workers • MN/MSN’s: Psychiatric nurses • Lay public and community groups • United by the Scientist-Practitioner Framework

7. The Scientist-Practitioner • Producers of Research • Consumers of Research • Evaluators of Their Work Using Empirical Methods

8. Functioning as a Scientist-Practitioner Fig. 1.2, p. 6

9. Clinical Description • Begins with the Presenting Problem • Description Aims to • Distinguish clinically significant dysfunction from common human experience • Describe Prevalence and Incidence of Disorders

10. Clinical Description (continued) • Describe Onset of Disorders • Acute vs. insidious onset • Describe Course of Disorders • Episodic, time-limited, or chronic course • Prognosis • Good vs. guarded

11. Causation, Treatment, and Outcome • Etiology • What contributes to the development of psychopathology? • Treatment Development • How can we help alleviate psychological suffering? • Includes pharmacologic, psychosocial, and/or combined treatments

12. Causation, Treatment, and Outcome (continued) • Treatment Outcome Research • How do we know that we have helped? • Limited in specifying actual causes of disorders

13. Historical Conceptions of Abnormal Behavior • Major Psychological Disorders Have Existed • In all cultures • Across all time periods • Causes and Treatment of Abnormal Behavior • Varies Widely Across cultures, time periods, world views

14. Historical Conceptions of Abnormal Behavior (continued) • Three Dominant Traditions • Supernatural • Biological • Psychological

15. The Supernatural Tradition • Deviant Behavior as a Battle of “Good” vs. Evil • Caused by demonic possession, witchcraft, sorcery • Treatments included exorcism, torture, beatings, and crude surgeries • The Moon and the Stars • Paracelsus and lunacy

16. The Biological Tradition • Hippocrates: Abnormal Behavior as a Physical Disease • Hysteria “The Wandering Uterus” • Galen Extends Hippocrates Work • Humoral theory of mental illness • Treatments remained crude

17. The Biological Tradition (continued) • Galenic-Hippocratic Tradition • Linked abnormality with brain chemical imbalances • Foreshadowed modern views

18. The 19th Century • General Paresis (Syphilis) and the Biological Link With Madness • Several unusual psychological and behavioral symptoms • Pasteur discovered the cause – A bacterial microorganism • Led to penicillin as a successful treatment • Bolstered the view that mental illness = physical illness

19. The 19th Century (continued) • John Grey and the Reformers • Championed biological tradition in the USA

20. Consequences of the Biological Tradition • Mental Illness = Physical Illness • Emil Kraeplin • Diagnosis and Classification

21. The Psychological Tradition • The Rise of Moral Therapy • More humane treatment of institutionalized patients • Encourage and reinforced social interaction

22. The Psychological Tradition (continued) • Proponents of Moral Therapy • Philippe Pinel and Jean-Baptiste Pussin • Benjamin Rush – Led reforms in U.S. • Dorothea Dix – Mental hygiene movement • William Tuke - Followed Pinel’s lead in England • The Falling Out of Moral Therapy • Emergence of Competing Alternative Psychological Models

23. Psychoanalytic Theory • Freudian Theory of the Structure and Function of the Mind • Structure of the Mind • Id (pleasure principle; illogical, emotional, irrational) • Ego (reality principle; logical and rational) • Superego (moral principles; keeps Id and Ego in balance)

24. Psychoanalytic Theory (continued) • Defense Mechanisms: Ego Loses the Battle with the Id and Superego • Displacement & denial • Rationalization & reaction formation • Projection, repression, and sublimation • Psychosexual Stages of Development • Oral, anal, phallic, latency, and genital stages

25. Later Developments in Psychoanalytic Thought • Anna Freud and Self-Psychology • Emphasized influence of the ego in defining behavior • Melanie Klein, Otto Kernberg, and Object Relations Theory • Emphasized how children incorporate (introject) objects • Objects – images, memories, and values of significant others

26. Later Developments in Psychoanalytic Thought (continued) • The Neo-Freudians: Departures From Freudian Thought • De-emphasized the sexual core of Freud’s theory • Jung, Adler, Horney, Fromm, and Erickson

27. Psychoanalytic Psychotherapy: The “Talking” Cure • Unearth the Hidden Intrapsychic Conflicts • “The Real Problems” • Therapy Is Often Long Term • Techniques • Free Association • Dream Analysis • Examine Transference and Counter-Transference Issues • Little Evidence for Efficacy

28. Humanistic Theory • Major Players • Abraham Maslow and Carl Rogers • Major Themes • That people are basically good • Humans strive toward self-actualization

29. Humanistic Theory (continued) • Humanistic Therapy • Therapist conveys empathy and unconditional positive regard • Minimal therapist interpretation • No strong evidence that humanistic therapies work

30. The Behavioral Model • Derived from a Scientific Approach to the Study of Psychopathology • Classical Conditioning (Pavlov; Watson) • Ubiquitous form of learning • Contingency between neutral and unconditioned stimuli • Conditioning was extended to the acquisition of fear

31. The Beginnings of Behavior Therapy • Challenged Psychoanalysis and Non-Scientific Approaches • Early Pioneers • Joseph Wolpe – Systematic desensitization • Operant Conditioning (Thorndike; Skinner) • Another ubiquitous form of learning • Voluntary behavior is controlled by consequences

32. The Beginnings of Behavior Therapy (continued) • Learning Traditions Influenced the Development of Behavior Therapy • Behavior therapy tends to be time-limited and direct • Strong evidence supporting the efficacy of behavior therapies

33. The Present: An Integrative Approach • Psychopathology Is Multiply Determined • Unidimensional Accounts of Psychopathology Are Incomplete

34. The Present: An Integrative Approach (continued) • Must Consider Reciprocal Relations Between • Biological, psychological, social, and experiential factors • Defining Abnormal Behavior • Complex, multifaceted, and has evolved • The Supernatural Tradition • Has no place in a science of abnormal behavior