Chapter 1
CHAPTER OUTLINE
I. The concerns of abnormal psychology. Abnormal psychology seeks to describe, explain, predict, and control those behaviors that are considered strange. In describing disorders, psychologists develop a psychodiagnosis. Diagnosis is a useful first step in treatment but, because of labeling, may sometimes have harmful consequences. Explanations about the causes of abnormal behavior differ depending on the psychologist's theoretical orientation. The prediction of future behavior is difficult; for instance, psychologists tend to overpredict future violent behavior. Therapy is the method by which psychologists try to control behavior. A growing number of individuals have entered clinical psychology and related mental health professions. There are an increasing number of mental health professionals in the United States. Clinical psychologists have Ph.D. or Psy.D. degrees and are trained to assess and treat people with serious disorders. Counseling psychologists are trained in much the same way as clinical psychologists, but they traditionally treat less serious problems. Marriage and family counseling look at the family as a unit. Mental health counseling can be licensed in 49 states and work in a number of clinical settings. Psychiatrists have medical degrees and can prescribe medication. Psychoanalysts are trained in psychoanalytic institutes and engage in personal analysis. Psychiatric social workers usually get a master's degree and often work in family or community agencies. School psychologists work with children and adolescents in school settings, assisting them with cognitive, social, and behavioral interventions.
II. Defining abnormal behavior. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) has the current definition of mental disorders. The standards include when are behaviors significant, what are present distresses, painful symptoms and ascertaining increased risk. The statistical criterion defines abnormality as those behaviors that are infrequent. One problem with this standard is that it provides no consistent means for deciding what is rare and what is undesirable. Psychologists view abnormal behavior as deviating from what is considered normal in terms of distress, deviance, dysfunction and dangerousness, the “4 D’s.” Distress involves both physical and psychological pain. Deviance refers to odd behaviors, such as hallucinations (false sensory impressions) and delusions (false beliefs). Dysfunction is exhibited when a person’s performance falls well short of his or her potential. Dangerousness is defined by Tarasoff v. Regents of the University of California which indicates that psychologists have “a duty to protect.”
III. Contextual and cultural limitations in defining abnormal behavior. Multicultural perspectives recognize that all behaviors originate from a cultural context. One approach is cultural universality, the traditional viewpoint on abnormality, which states that there are universal symptoms and disorders. The opposite, cultural relativism, says that deviance designations reflect cultural values. Both approaches have merit. A central theme is what behaviors are widely considered to be abnormal given the culture and how the culture influences the identification and treatment of abnormal behavior.
IV. The frequency and burden of mental disorders. The goals of psychiatric epidemiology are to determine how frequent disorders are in the population, how such factors as age and gender affect their prevalence (i.e., the percentage of people in a population who suffer from a disorder at a given time), lifetime prevalence (i.e., the total proportion of people in the population who have ever had a disorder in their lives), and incidence (i.e., the onset or occurrence of a given disorder over some period of time). Another goal of epidemiology is to determine whether and how trends are changing. Current research into the epidemiology of mental disorders. Overall, men and women are equally likely to suffer from disorders; however, men are more likely to have alcohol problems and women are more likely to become depressed or anxious. Older people are vulnerable to cognitive impairments. Mental illness ranks higher than malignant disease with respect to lost years of healthy life. Fewer than one-third of people with disorders receive mental health services.
V. Stereotypes about the mentally disturbed. One myth is that mentally disturbed people can be readily spotted. This is not true because there are no sharp dividing lines between normality and abnormality and because some forms of deviance can be hidden. Another myth is that mental disorder is always inherited. Genetics can play a role in some disorders, but even in those disorders where genes are thought to play a role, environmental stress is a crucial influence. Other myths are that people with mental disorders cannot be cured, that their problems stem from a lack of willpower, that mental illness is always a deficit and those who suffer disorders contribute nothing to society, and that they are more dangerous than other people.
VI. Historical perspectives on abnormal behavior. How people view mental disorders is related to the beliefs of their culture ad time. During prehistoric times, people believed in demonology (demonic possession, sorcery, or the behest of an offended ancestral spirit). Treatments included trephining (chipping open the skull so the evil spirit could escape) and exorcism (prayers, noisemaking, even starvation to drive out spirits). Naturalistic explanations during the Greco-Roman era, relied heavily on observations and explanations attributing disorders to organic factors such as brain pathology. Reversion to supernatural explanations in the Middle Ages. during the Dark Ages, the Catholic Church dominated all thought and reverted to supernatural explanations for mental disorders. In the 13th century, whole populations were sometimes affected by such forms of mass madness as tarantism (a dance mania) and lycanthropy (in which people believed themselves to be wolves). Witchcraft became a common explanation for abnormal behavior in the 15th-17th centuries, when the Catholic Church was under attack. Some mentally ill people were considered witches and received brutal punishment, but most accused witches were probably sane. The Malleus Maleficarum (Witch’s Hammer) is published. The rise of humanism (the Renaissance) took place in the 14th – 16th centuries, stressing human welfare and rejecting the supernatural aspects of witchcraft. Johann Weyer asserted that people who had been thought to be witches were actually mentally disturbed. The reform movement (18th and 19th centuries) led to the moral treatment movement; it began in France (Philippe Pinel) and England (William Tuke). In America (Benjamin Rush), mental patients were also treated more humanely. Dorothea Dix pushed for the improvement of care for individuals with mental disorders and for the building of mental hospitals. Clifford Beers exposed the cruel treatment he and other patients experienced in mental institutions. Generally, treatment for the mentally ill has improved in this century.
VII. Causes: Early viewpoints. From Hippocrates’ day to our own, organic explanations of abnormality have existed. During the late 1800s, there was a strong increase in this biological viewpoint, which was supported by the discovery that general paresis had an organic cause. Emil Kraepelin observed that certain symptoms occur in clusters, called syndromes, with each syndrome having a unique cause. Kraepelin classified the mental illnesses on the basis of organic causes. The psychological viewpoint is an alternative view that suggests emotions can cause mental disorders. Anton Mesmer used trances (mesmerism) to treat people with hysteria, sometimes successfully. Although he was declared a fraud, these treatments underscored the power of suggestion for curing disorder. Mesmerism and Hypnotism was studied and used by several French physicians (Liebeault, Bernheim, and Charcot) to treat hysteria during the late 1800s, this was called the Nancy School. Breuer found that reliving past experiences through catharsis removed symptoms, too. Sigmund Freud built upon this foundation. A dichotomous approach, behaviorism, was firmly rooted in laboratory research and stressed the importance of directly observable behaviors and the conditions of stimuli that evoked, reinforced, and extinguished them.
VIII. Contemporary trends in abnormal psychology. Twentieth-century views of abnormality have been influenced by the introduction of psychiatric drugs in the drug revolution of the1950s, which led to a great reduction in patients residing in mental institutions (deinstitutionalization). Psychologists have initiated legislative efforts to gain prescription privileges to treat individuals with mental disorders Medical providers (psychiatrists) are opposed to non-medical personnel having prescription privileges, and not all psychologists support psychologists’ expansion into the psychopharmacological realm, fearing that psychologists will lose their own professional identity. Managed health care, which attempts to contain costs by increasing the oversight of treatment by outside reviewers and by requiring treatment professionals to justify their therapies, may alter the types of care provided. Appreciation for research: professionals in abnormal psychology value research on both the biological and psychological bases of behavior for understanding and treating mental disorders. Diversity and multicultural psychology: Changes in the racial and ethnic diversity of the United States have helped create a new field called multicultural psychology. Racial, cultural, age, and gender differences in apparent mental disorders may be explained in terms of social conditioning (e.g., stereotyping), cultural values that are taught, and sociopolitical influences such as prejudice, which prompt healthy coping mechanisms that may be seen as symptoms. Bias in diagnosis is another explanation for differences in minority mental health.
IX. Implications Increasingly, professionals value a multi-path approach, which acknowledges that biological, psychological, and social factors combine to explain most disorders.