Introduction to Psychology, 7th Edition, James W. Kalat Chapter 15: Abnormality, Therapy, and Social Issues Chapter 15 Abnormality, Therapy, and Social.

Introduction to Psychology, 7th Edition, James W. KalatChapter 15: Abnormality, Therapy, and Social Issues

Chapter 15

Abnormality, Therapy, and Social Issues


Abnormality, Therapy and Social Issues

On the surface it would appear that there is normal and abnormal behavior, and the distinction between normal and “weird” is clear to everyone.

But when we go deeper into the issue of normal versus abnormal, we start to see that behavior must be interpreted in its context. Normal is a matter of place and time as well as mental state and action.


Module 15.1

Abnormal Behavior: An Overview


Psychopathology

Most of us feel sad, anxious, or angry occasionally. Our moods change, we have or develop bad habits, and we

have “funny” beliefs. Mental health diagnoses are reserved for people with

problems that seriously interfere with their lives.


Defining Abnormal Behavior

There is probably no definition of “abnormal” that can’t be questioned. If we use the standard of “subjective feelings of distress”

than anyone who thinks they have a problem automatically qualifies.

And if someone behaves in bizarre and dangerous ways, but insists that they are A-OK, many people who are in fact suffering from mental illness could not be diagnosed and treated.



If we say that behavior that could result in suffering or death is a sign of mental illness, heroic deeds would be a bona fide symptom.

If we say that behavior that is very different from the usual is a sign of a psychological disorder, very depressed people would be diagnosed, but so would very happy people.



Cultural influences on abnormality Each era and society has had its own interpretations of

abnormal behavior. Culture-specific disorders are found all over the planet.

Demonic possession has been a common diagnosis in some societies for thousands of years.

Brain fag syndrome is a frequent complaint of West African students.

Running amok consists of episodes of indiscriminant violent behavior in young Southeast Asian men.



Cultural influences on abnormality An American example: Multiple Personality Disorder

The “split personality” syndrome, this is now referred to as dissociative identity disorder.

There is alternation between two or more personalities.

Each has its own disposition, behavior, and name, as if each were a separate person.



Cultural influences on abnormality This was a very rare disorder until the 1950’s, when a

few cases received widespread publicity. By the early 1990s there were many cases of DID

reported. Some observers began to claim that the disorder did not

exist at all. It is most likely that it was being promoted by over eager

therapists.



The biopsychosocial model The predominant view in Western cultures today uses

the biopsychosocial model to understand mental illness. Biological roots - include genetic factors, injury,

disease processes, and the like which result in abnormal brain development, damage, imbalances of neurotransmitters and hormones, all of which can result in abnormal behavior.



The biopsychosocial model Psychological roots – an individual’s life history and

experiences contribute to his or her ability to cope and degree of vulnerability to stress.

Social and cultural context – people are greatly influenced by how other people act toward them and the expectations people hold for them.


Classifying Psychological Disorders

The DSM-IV The Diagnostic and Statistical Manual of Mental

Disorders This manual has been created to establish uniform

definitions and standards for diagnosis. It is now in its fourth edition. It lists acceptable labels for all psychological

disorders. It lists symptoms and criteria for making diagnoses

and contains information on differential diagnosis – how to distinguish a particular disorder from others that are similar to it.



The DSM-IV Diagnosis is made along five axes (lists). A person can have one or more diagnoses on a given

axis, or none at all. Clinical disorders are diagnosed on Axis I. These are

disorders that involve a deterioration of functioning. Most common psychological disorders are listed on Axis

I.


Table 15.1 Some major categories of psychological disorders according to Axis I of DSM-IV.



The DSM-IV Axis II is reserved for personality disorders and

mental retardation. These are disorders that persist throughout life. A personality disorder is a maladaptive, inflexible way of

dealing with situations and people.


Table 15.2 Some major categories of psychological disorders according to Axis II of DSM-IV.



The DSM-IV Axis III is for general medical conditions that may

influence the person’s mood or behavior. Axis IV is for psychosocial and environmental

problems that may increase the person’s level of stress. Axis V is a 1-90 scale called the global assessment of

functioning. The lower the number assigned by the assessing clinician, the less likely it is that the person being diagnosed is able to function without treatment and support.



Differential diagnosis As in medicine, diverse mental health disorders often

have similar or overlapping symptoms. Psychologists and psychiatrists are trained to make

differential diagnoses. They look at all the disorders with similar symptoms

that listed in the DSM-IV as well as disorders that are purely medical but affect mood and behavior.

They either rule these disorders out or revise their original diagnosis based on the information they have gathered.



Criticisms of DSM-IV The distinction between normal and abnormal can seem

arbitrary at times (5 months of a problem is not a disorder, but 6 months is).

Are criminal behaviors (child molesting) really a sign of mental illness, or some other serious problem?



Criticisms of DSM-IV Is it an adjustment to a life stressor, or is it a mental

illness? Statistics on prevalence of disorders are uncertain and

at times seem inflated. To what extent is the situation the problem, rather than

the person?


Figure 15.1 According to one extensive survey, about half the people in the United States will suffer at least one psychological disorder at some time. (The figures for the individual conditions do not add up to the total percentage for “any disorder” because some people have more than one disorder.) However, the exact percentages depend on where one draws the dividing line between “normal” and “abnormal.” (Based on data of Kessler et al., 1994


Psychological Disorders

There is a stigma associated with receiving a mental health diagnosis.

Yet it is possible that as many as 50% of the population has a diagnosable mental illness at some time in their lives (according to the standards of the DSM-IV).

If this is true, it is evidence that people with psychological disorders are not very different from the rest of us. In fact, maybe we are those people.


Module 15.2

Psychotherapy: An Overview


Psychotherapy

Psychotherapy is a treatment of psychological disorders by methods that include an ongoing relationship between a trained therapist and a client.

Psychotherapy is utilized for a wide variety of disorders.


Psychotherapy

Psychotherapy is sought by or prescribed for a diverse range of clients, from those with very serious emotional disturbance, to the “worried well” and those who are basically well but wish to function more effectively.

There are many techniques of psychotherapy, but all of them seem to depend in large part on the client’s motivation to improve.


Schools of Psychotherapy

Psychoanalysis The psychodynamic therapies are based on the theories

of Sigmund Freud. These methods try to relate personality to the

interplay of conflicting forces in the person. The individual may be unaware of some of these

forces and motives. Psychoanalysis is the oldest “talk” therapy. It

attempts to bring unconscious thoughts and emotions to awareness, and help people understand their own thoughts and actions.



Psychoanalysis The psychodynamic therapies

Psychoanalysis uses free association and transference to bring unconscious material to consciousness.

This in turn produces catharsis, the release of pent-up emotions associated with unconscious thoughts and memories.




In free association, the client thinks about a symptom or problem and then says everything that comes to mind related to it.

This process is supposed to uncover hidden thoughts and feelings.




Transference refers to the client’s experience of feelings previously associated with a parent or other important figure that are “transferred” to the therapist.

Psychoanalysts and other psychodynamic therapists make active interpretations of the client’s statements.

If a client disagrees with the therapist’s interpretations, they may label this as resistance, a continued repression that interferes with therapy.



Behavior therapy Behaviorists believe that human behavior is learned and

can be unlearned. Behavioral therapy is based on this principle.

Treatment begins with specific behavioral goals, such as “stay in seat for entire class period” or “spend a maximum of X dollars a week.”

The treatment plan entails how the client will learn to behave in ways that will help him or her achieve the goals.


Figure 15.4 A child can be trained not to wet the bed by using classical conditioning techniques. At first, the sensation of a full bladder (the CS) produces no response, and the child wets the bed. This causes a vibration or other alarm (the UCS), and the child wakes up (the UCR). By associating the sensation of a full bladder with a vibration, the child soon begins waking up to the sensation of a full bladder alone and will not wet the bed.



Therapies that focus on thoughts and beliefs Some therapies focus on what is in the client’s mind right

now instead of on thoughts and feelings from the past. Cognitive therapy seeks to improve people’s

functioning by changing how they think and what they believe about situations.

Rational-emotive therapy assumes that thoughts precede emotions, and that unpleasant feelings are a result of irrational thoughts.



Therapies that focus on thoughts and beliefs Cognitive-behavior therapy sets clear goals for

changing behavior (like a behavioral therapist). The therapist puts more emphasis on also changing the

person’s interpretation of thoughts and events (like a cognitive therapist).



Humanistic therapy Humanistic therapists believe that people naturally strive

to achieve their full potentials. The source of psychological distress is perceived

incongruence between the way an individual’s self-concept and his or her ideal image of self.

The most common humanistic therapy is person-centered (nondirective/client-centered) therapy.



Humanistic therapy Person-centered therapy

The therapist listens to the client non-judgmentally. The therapist also provides unconditional positive

regard. Unconditional positive regard is an ideal state, similar

to the regard that a loving parent has for a child. The therapist tries to be genuine, empathetic and

caring, and tries not to interpret the client’s thoughts or feelings or offer advice.


Table 15.3 Comparison of five types of psychotherapy


Concept Check:

In which type of therapy would the therapist be most likely to interpret a thought, feeling or dream?

Psychodynamic or psychoanalysis


Concept Check:

In which therapies are treatment goals stated in clear and specific terms?

Behavioral and cognitive-behavioral


Concept Check:

In which therapy is the client viewed as essentially good and wishing to achieve full potential in life?

Person-centered (humanistic)



Family systems therapy Family systems therapy treats the person in the context

of the family. The underlying assumption of family systems is that

an individual’s problems arise in a family setting. Therefore the best way to deal with them is to change

and improve family relationships and communication.



Other trends in psychotherapy Eclectic therapists do not use any single method

exclusively, but a combination of approaches. Brief therapy models are gaining in popularity. In brief or time-limited therapy, the therapist and client

agree to a certain length, number of meetings and expectations and goals for the treatment.



Other trends in psychotherapy Group therapy involves the treatment of many clients

by one or two therapists on an ongoing basis. Group therapy is less expensive and allows the clients to

help each other with advice and feedback. Self-help groups work in a similar way but there is no

therapist involved.


Psychotherapy

How effective is psychotherapy? According to some research studies, many people start

to feel better anyway without psychotherapy (spontaneous remission).

Meta-analysis of many studies of psychotherapy suggests that a majority of people do show improvements after therapy.

Keep in mind the “file-drawer” effect when considering the results of meta-analyses.


Psychotherapy

How effective is psychotherapy? A recent study by Consumer Reports of mental health

treatment and psychotherapy supported the conclusion that most mental health treatment is helpful in improving the psychological and emotional well being of clients.

No one method of therapy stands out as better than the others.


Psychotherapy

How effective is psychotherapy? Although it is a complex and tricky business to evaluate

the effectiveness of psychotherapeutic treatment, there are distinct advantages to seeking professional mental health care.

A trained clinician keeps confidentiality, uses methods with some demonstrated level of effectiveness, and can make referrals to other professionals if he or she suspects that this may be warranted (for example, if a medical problem may exist).


Psychotherapy

How effective is psychotherapy? Similarities among psychotherapeutic methods

The creation of a therapeutic alliance that offers social support for the client.

The opportunity for the client to engage in self-examination (this is not an advantage cross-culturally, though).

The opportunity to receive encouragement from the therapist on a regular basis.

There is an affirmation of the client’s desire to change and improve.


Psychotherapy

How effective is psychotherapy? Advice for potential clients

Ask the local Mental Health Association for some recommendations.

You may feel most comfortable with a therapist from a cultural background that is similar to yours.

If spirituality or religion is important to you, you may want to find a therapist who sympathizes with your beliefs.


Psychotherapy

How effective is psychotherapy? As with any other “remedy” be skeptical of

overconfidence and claims of amazing results. Expect at least some small improvement within a couple

of months of starting, and don’t be afraid to ask for your therapist’s input if this doesn’t happen.

Be an active participant in your own treatment – nobody “fixes” you, rather, you receive help in changing your own life.


Finding the Best Therapy

Research suggests that the various methods of therapy and professionals who provide services are about equally effective. There is no “best” type of therapist or best method.

But no one way of doing psychotherapy is right for every client. You need to use your knowledge to “shop” for the therapist who will work best with you.


Module 15.3

Social and Legal Aspects of Treatment


Deinstitutionalization

Deinstitutionalization refers to the trend over the second part of the twentieth century of removing patients from mental hospitals.

There are alternatives to long-term inpatient care. Unfortunately, many patients were discharged without the benefit of adequate planning for their future care.


Deinstitutionalization

As a result of this lack of foresight, many former mental hospital patients are now: Homeless Placed in nursing homes Imprisoned Dead


Involuntary Commitment and Treatment

In the case of people with severe mental health problems, the right to live freely among others can come into conflict with the rights of others.

If a person’s mental state represents a serious danger to self, others or causes the individual to be completely unable to care for him or herself, serious ethical issues are raised.



There are many potential problems in the process of involuntary commitment: Not all seriously mentally ill patients realize that they are

ill. People have been committed to mental hospitals just to

be put “out of the way.” It is extremely difficult to determine which patients

should be committed.



Usually the opinion of one or more trained professionals plus court action must be obtained in order to commit a person with a mental illness.

Even after commitment, the patient is always given the right to refuse specific treatments.


Figure 15.8a People with schizophrenia who refuse drug therapy impress their physicians as being seriously disturbed. Patients who refuse drugs rate themselves as dissatisfied with their physicians and their treatments. (a) Physicians’ ratings of their patients. High scores indicate greater disturbance. Those refusing treatment showed greater indications of disturbance on most scales.


Figure 15.8b People with schizophrenia who refuse drug therapy impress their physicians as being seriously disturbed. Patients who refuse drugs rate themselves as dissatisfied with their physicians and their treatments. (a) Physicians’ ratings of their patients. High scores indicate greater disturbance. Those refusing treatment showed greater indications of disturbance on most scales.


The Duty to Protect

The Tarasoff case The Tarasoff case established that a therapist who

knows that a client has harmful intent towards an identified person or persons has a duty to break confidentiality with the client to protect the endangered person.

Judging dangerousness is not a clear-cut matter and the therapist must often weigh carefully the factors. Breach of confidentiality is a serious violation of the patient’s rights.


The Duty to Protect

The insanity defense Insanity is a legal term, not a psychological or medical

one. Its definition is more judicial than scientific. Bizarre crimes in and of themselves do not

demonstrate insanity. The most famous definition of insanity is based on the

M’Naghten rule, from 19th Century British law.


The Duty to Protect

The insanity defense The M’Naghten rule

The gist of the law states that in order to be judged insane at the time of a crime, a people must be so disordered that they cannot understand what they are doing.

Some legal authorities felt that this rule was too narrow and rigid.


The Duty to Protect

The insanity defense Under 1% of accused felons plead insanity. The insanity defense is extremely rare. These cases receive a great deal of media attention. If the person is found not guilty by reason of insanity,

they will likely be institutionalized for a very long time.


Preventing Mental Illness

Some psychologists, especially community psychologists have started to create movement towards preventing mental illness. Community psychologists focus on the needs of groups

rather than individuals. They look at various routes to circumventing mental

illness or lessening its damaging effects.



Prevention methods are aimed at stopping mental illness before it begins.

Intervention involves identifying a disorder in its early stages and relieving it.

Maintenance is taking steps to prevent an illness from becoming more serious.

“An ounce of prevention is worth a pound of cure.”

-- Old aphorism



Some steps that would help in prevention efforts: Ban use of environmental toxins Promote good prenatal care and education Promote full employment Provide high quality and affordable child care Improve educational opportunities


Concept Check:

Can you think of some other steps that would promote good mental health and improve psychological functioning overall in our society?


Mental Illness: Science and Society

The issues we have examined in this module are complex and involve scientific, social and ethical dimensions.

Even if you do not grow up to be a psychologist, as a citizen of our country it is in your best interest to be informed about the social and legal aspects of mental illness and the benefits to society of promoting good mental health.

Introduction to Psychology, 7th Edition, James W. Kalat Chapter 15: Abnormality, Therapy, and Social Issues Chapter 15 Abnormality, Therapy, and Social.

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