2 Elements of Abnormality

Psyc 162-001Abnormal Psychology

Spring, 2004

Lecture 2Abnormality --

A cultural (social, moral, religious) construct

Case Studies

• Mr. Simpson -- Under surveillance

• Jorgen -- Oslo Factory worker

• Joe College

• The Wealthy Widow

The Elements of Abnormality

Facets of the behavior we factor in to our decision about normality/abnormality:

• Is the person suffering?• Is the behavior maladaptive?• Is the behavior irrational?• Is the person in control?• Is the behavior vivid or unconventional?• Are observers affected?• Are moral rights or ideal standards violated?

Integrating the 7 Elements

• Very rarely do all 7 elements appear in any single disorder or in any single clinical patient

• Therefore, degrees of abnormality

• What combination of the elements in what measure determines abnormality?

• Taxonomies aspire to fit the Aristotelian model -- necessary & sufficient conditions

Necessary conditions of group membership

A NECESSARY condition is one in which:• A characteristic or feature must be present to

obtain membership

Consider: Are there necessary conditions for a geometric shape to be included in the group ‘square’?

Sufficient conditions of group membership

A SUFFICIENT condition is one in which:• A characteristic or feature, if present, guarantees

membership in the group

Consider: Is there a single, sufficient condition for membership to the group ‘triangle’?

Aristotle’s formulation applied to abnormality

• Consider: Are there any necessary conditions for abnormality?– That is, are there any of the 7 elements which

MUST be present for behaviors to be called ‘abnormal’?

• Consider: Are there any sufficient conditions for abnormality? – That is, are there any features of abnormality

which ALONE guarantee membership?

Is Suffering Necessary or Sufficient?

• Not Necessary:– Rarely present in Antisocial Personality

Disorder– Rarely present in manic phase of Bipolar

• Not Sufficient:– Bereavement includes suffering, but is not

considered to be abnormal and is not included as a mental disorder

Is Maladaptiveness Necessary or Sufficient?

• Not Necessary:– Certainly coded for in most cases as “significant

impairment of social or occupational functioning”, BUT what about ASPD?

• Not Sufficient:– Underachievement Disorder?– their behavior is maladaptive even as defined by

their own goals– Some aspects of Bipolar, e.g., are adaptive

Is Irrationality Necessary or Sufficient?

• Not Necessary:– In most diagnoses the patient’s thinking is

somewhat distorted BUT, in few diagnoses would we call it irrational

• Not Sufficient:– Some cases of ‘irrationality’ are called “art”

Is Loss of Control Necessary or Sufficient?

• Not Necessary:– e.g., some psychosexual disorders are due to

the inability to surrender control

• Not Sufficient:– In DSM is always loss of control + negative

outcome

Is Vividness & Unconventionality Necessary or Sufficient?

• Not Necessary:– e.g., up to 20% of females experience clinical

depression

• Not Sufficient:– e.g., what about genius?

Is Observer Discomfort Necessary or Sufficient?

• Not Necessary:– e.g., ‘solo’ disorders such as agoraphobia

• Not Sufficient:– Most often coded for in the PDs, BUT each PD

requires additional criteria– What about the work of a surgeon?

Is Violation of Moral Rights and Ideal Standards Necessary or Sufficient?

• Not Necessary:– e.g., not present in unipolar depression

• Not Sufficient:– Certainly not from a cross-cultural perspective

Wittgenstein’s Family Resemblance Model

• Wittgenstein proposed a classification system based on degree of shared characteristics

• This is the Family Resemblance Model• For each specific case/instance, the more features

possessed the more likely the case/instance belongs in the family

• This model allows for fuzzy boundaries -- borderline cases that don’t fit neatly into the model

The Elements of Abnormality -- Revisited

• Core Elements

– Suffering– Maladaptiveness– Irrationality

• Peripheral Elements– Loss of Control

– Vividness & Unconventionality

– Observer Discomfort

– Violation of Moral and Ideal Standards

Wittgenstein & Psychopathology

Suffering Maladaptiveness

IrrationalitySchizophrenia

Unipolar Depression

Bipolar+

_ +

_Specific Phobia

+

_

Historical Perspectives on Abnormality

Earliest Conceptions of Abnormality

• Ebers papyrus dates to 3000 BC– details anatomy of the brain– recognizes brain-behavior relationship– documents mental disorders– treatment -- incantations, magic, prayer

• Reflects etiological view dating back 30,000 years

Spirit possession as etiology

• Site of function -- possession of the head

• animus possession versus evil spirit versus angry god

• Treatment was a logical corollary to the etiological model

– Trephining

Trephining

Biblical references to abnormality

• Ancient Hebrews -- madness as the retraction of God’s protection

• New Testament -- Jesus cures a man with an “unclean spirit” (Mark 5:1-13)

• Treatment options:– magic, prayer, noisemaking– purgatives including potions of wine and sheep

dung– starving, flogging

The Greek Reformation

• Athens under Pericles (461-429 BC)– Ancient Greek priests supplement exorcism

with alternative strategies• kindness, suggestion, recreational measures

(plays, riding, walking, harmonious music)– patients slept in temples of the god Asclepius to

capture dreams which point to treatment• reminiscent of anyone?

– Note: same etiological formulation, different treatment model

Harmonious music -- mechanisms of change

• McGill study: subjective experience of harmonious music correlated with:– activation of dorsomedial

midbrain and R thalamus

– suppression of R amygdala

– enhanced affect, reward & punishment centers

Blood & Zatorre (2001)

Hippocratres -- first biological formulation

• Revolutionary concepts– defied demonology

– advocated biological causes and biological treatments

– mental disorders = brain pathology

– heredity & predisposition

– clinical observation & taxonomy

• Ironically without knowledge of anatomy

460-377 BC

Hippocratic Taxonomy

• 4 humors from the 4 elements

– blood fire

– phlegm water

– black bile earth

– yellow bile air

• treatments concepts follow:

– melancholia - sobriety, vegetable diet, celibacy, exercise short of fatigue, bleeding

• some indications of theory of mind-body nexus

– tranquil life, removal of patients from family

Expansion of Hippocratic Typology

• Galen -- Greek practicing in Rome

• Human autopsies still banned - studied animal anatomy

• Expanded 4 humors to theory of personality and disorder– misled as to psychological cause for

centuries

• Contributions– experimental approach to diagnosis

– ‘bodily health can be affected by the suffering of the psyche’

•Fall of Roman Empire at end of C5th

•‘Dark Ages’ for Abnormal Psychology with death of Galen in A.D. 200

Abnormality through the Middle Ages(500 - 1500 A.D.)

• Reversion to etiological models based on demonic possession

• Fueled by emerging trend of ‘mass madness’– Tarantism - early C13th, Italy

– Saint Vitus’s Dance - Germany and rest of Europe

– Lycanthropy• 1541 case tragic example of the misinterpretation of

somatic delusions

• Mass hysteria peaked during C14th & C15th– consider the events of this time

St. Catherine - canonized for exorcisms

Witchcraft as Insanity

• Church doctrine on demonology and witchcraft culminated in publication of Malleus Maleficarum in 1486

• Condoned and encouraged ritualized torture of an estimated 1 million people across next 3 centuries

• What proportion of these were psychotic?– “intercourse with the devil” (Zilboorg interpretation,

1941)

– Schoeneman - “the typical accused witch was not a mentally ill person but an impoverished woman with a sharp tongue and a bad temper.” - 1984

Avicenna -- the protector

• Author of ‘The Canon of Medicine”

• The “prince of physicians”• Kept alive the concept of

abnormality due to physical and psychical disorder

• Advocated creative, humane treatment

C. 980-1037

The Era of Asylums - (1547-1792)

• 1547 - Henry VIII officially creates asylum at monastery of St. Mary of Bethlehem

• Origin of term ‘bedlam’:– “bedlam beggars, who, with roaring voices, sometime

with lunatic bans, sometime with prayers, enforce their charity” (King Lear, II. iii)

• Mexico 1566, Paris 1641, Moscow 1764, ‘Lunatics’ Tower in Vienna 1784

Humanitarian Reform

• Phillipe Pinel - 1792– received grudging approval of Revolutionary

Committee to remove chains– destroyed dungeons & created light & airy

rooms

• Benjamin Rush– continued the trend in US– established Pennsylvania Hospital in 1783

Rushian innovations

Phillipe Pinel -- A Final Note