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PSYCHOPATHOLOGY - a term clinical psychologists use as a synonym for abnormal behaviour.
ABNORMAL PSYCHOLOGY - the scientific study whose objectives are to describe, explain, predict, and modify behaviours that are considered strange or unusual
1) Describing Abnormal Behaviour
Understanding a particular case of abnormal behaviour begins with systematic observations by an attentive professional.
These observations, usually paired with the results of the person’s psychological history, become the raw material for a PSYCHODIAGNOSIS.
PSYCHODIAGNOSIS - an attempt to describe, assess, and systematically draw inferences about an individual’s psychological disorder.
2) Explaining Abnormal Behaviour
To explain abnormal behaviour, the psychologist first identifies possible causes for the described behaviour.
This information, in turn, bears heavily on the program of treatment chosen.
Depending on your viewpoint, some explanations may appear more valid than others.
No one explanation is sufficient to explain the complexity of the human condition; normal and abnormal behaviours result from a combination of factors.
3) Predicting Abnormal Behaviour If a therapist can correctly identify the source of
a client’s difficulty, he or she should be able to predict the kinds of problems the client will face during therapy and the symptoms the client will display.
4) Modifying Abnormal Behaviour
Abnormal behaviour may be modified through THERAPY, which is a program of systematic intervention designed to improve a client’s behavioural, affective (emotional), and/or cognitive state.
Psychologists focus first on understanding the cause of abnormal behaviour and from there plan treatment.
Just as there are many ways to explain abnormal behaviours, there are many possible ways to conduct therapy and many professional helpers offering their services.
Along with the demand for mental health treatment, the numbers and types of qualified helping professionals have grown.
In the past, mental health services were offered primarily by psychiatrists, psychologists, and psychiatric social workers. The list of service providers has expanded rapidly.
TYPES OF MENTAL HEALTHPROFESSIONALS
Clinical Psychologist Counseling Psychologist School Psychologist Psychiatrist Psychoanalyst Clinical Social Worker Psychiatric Nurse Occupational Therapist Pastoral Counselor Community Mental Health
Worker Alcohol- or Drug-Abuse
Counselor
DETERMINING ABNORMALITY Implicit in our discussion is the one overriding concern of
abnormal psychology: ABNORMAL BEHAVIOR itself.
What exactly is abnormal behaviour, and how do psychologists define a mental disorder?
The Diagnostic and Statistical Manual of Mental Disorders (DSM), the most widely used classification system of mental disorders, defines abnormal behaviour as:
“a behavioural or psychological syndrome or pattern that reflects an underlying psychobiological dysfunction, that is associated with distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) and is not merely an expectable response to common stressors or losses.” (www.dsm5.org)
Clinically significan
t disturban
ce in behavior,
emotiona
l regulatio
n, or cognitive function
Associated with
distress or
disability
Biological,
psychological, or developmental
dysfunction in
individual
MENTALDISORDER
The DSM – 5 Definition
This definition is quite broad and raises many questions. 1. when is a syndrome or pattern of behaviour significant
enough to have meaning?2. what constitutes “present distress” and “painful
symptoms”?3. what criteria do we use in ascertaining an underlying
psychobiological dysfunction and not merely an expectable response to common stressors?
Despite problems in defining abnormal behaviour, practitioners tend to agree that it represents behaviour that departs from some norm and that harms the affected individual or others.
Nearly all definitions of abnormal behaviour use some form of statistical average to gauge deviations from normative standards.
THE ELEMENTS OF ABNORMALITY
Elem
ents
of
abno
rmal
ity
inclu
de:
Suffering
Maladaptiveness
Deviancy
Violation of the Standards of Society
Social Discomfort
Irrationality and Unpredictability
Dangerousness
If people suffer or experience psychological pain we are inclined to consider this as indicative of abnormality. Depressed people clearly suffer, as do people with anxiety disorders.
But what of the patient who is manic and whose mood is one of elation? He or she may not be suffering. In fact, many such patients dislike taking medications because they do not want to lose their manic “highs.”
You may have a test tomorrow and be suffering with worry. But we would hardly label your suffering abnormal.
Although suffering is an element of abnormality in many cases, it is neither a sufficient condition (all that is needed) nor even a necessary condition (a feature that all cases of abnormality must show) for us to consider something as abnormal.
SUFFERING
Maladaptive behavior is often an indicator of abnormality. The person with anorexia may restrict her intake of food to the point
where she becomes so emaciated that she needs to be hospitalized. The person with depression may withdraw from friends and family
and may be unable to work for weeks or months. Maladaptive behavior interferes with our wellbeing and with our
ability to enjoy our work and our relationships. However, not all disorders involve maladaptive behavior. Consider
the con artist and the contract killer, both of whom have antisocial personality disorder.
The first may be able glibly to talk people out of their life savings, the second to take someone’s life in return for payment.
Is this behaviour maladaptive? Not for them!, because it is the way in which they make their
respective livings. We consider them abnormal, however, because their behaviour is
maladaptive for and toward society.
MALADAPTIVE
The word abnormal literally means “away from the normal.” But simply considering statistically rare behavior to be abnormal does
not provide us with a solution to our problem of defining abnormality. Genius is statistically rare - however, we do not consider people with
such uncommon talents to be abnormal in any way. Also, just because something is statistically common doesn’t make it
normal - the common cold is certainly very common, but it is regarded as an illness nonetheless.
On the other hand, mental retardation (which is statistically rare and represents a deviation from normal) is considered to reflect abnormality.
This tells us that in defining abnormality we make value judgments - If something is statistically rare and undesirable (as is severely diminished intellectual functioning), we are more likely to consider it abnormal than something that is statistically rare and highly desirable (such as genius) or something that is undesirable but statistically common (such as rudeness).
STATISTICAL DEVIANCY
All cultures have rules. Some of these are formalized as laws. Others form the norms and moral standards that we are taught to
follow. Although many social rules are arbitrary to some extent, when
people fail to follow the conventional social and moral rules of their cultural group we may consider their behaviour abnormal.
Of course, much depends on the magnitude of the violation and on how commonly the rule is violated by others.
A behaviour is most likely to be viewed as abnormal when it violates the standards of society and is statistically deviant or rare.
In contrast, most of us have parked illegally at some point. This failure to follow the rules is so statistically common that we tend not to think of it as abnormal.
VIOLATION OF THE STANDARDS OF SOCIETY
When someone violates a social rule, those around him or her may experience a sense of discomfort or unease.
Imagine that you are sitting in an almost empty movie theatre. There are rows and rows of unoccupied seats. Then someone comes in and sits down right next to you. How do you feel?
In a similar vein, how do you feel when someone you met only 4 minutes ago begins to chat about her suicide attempt?
SOCIAL DISCOMFORT
We expect people to behave in certain ways. Although a little unconventionality may add some spice to life, there is a point at which we are likely to consider a given unorthodox behaviour abnormal.
If a person sitting next to you suddenly began to scream and yell obscenities at nothing, you would probably regard that behaviour as abnormal. It would be unpredictable, and it would make no sense to you.
The disordered speech and the disorganized behaviour of patients with schizophrenia are often irrational.
Such behaviours are also a hallmark of the manic phases of bipolar disorder.
Perhaps the most important factor, however, is our evaluation of whether the person can control his or her behaviour.
IRRATIONALITY and UNPREDICTABILITY
It seems quite reasonable to think that someone who is a danger to him- or herself or to another person must be psychologically abnormal.
Indeed, therapists are required to hospitalize suicidal clients or contact the police (as well as the person who is the target of the threat) if they have a client who makes an explicit threat to harm another person.
But, as with all of the other elements of abnormality, if we rely only on dangerousness as our sole feature of abnormality, we will run into problems.
Is a soldier in combat mentally ill? What about someone who is an extremely bad driver? Both of these people may be a danger to others. Yet we would not consider them to be mentally ill.
Why not?
DANGEROUSNESS
And why is someone who engages in extreme sports or who has a dangerous hobby (such as free diving, race car driving or keeping poisonous snakes as pets) not immediately regarded as mentally ill?
Just because we may be a danger to ourselves or to others does not mean we are mentally ill.
Conversely, we cannot assume that someone diagnosed with a mental disorder must be dangerous.
Although mentally ill people do commit serious crimes, serious crimes are also committed every day by people who have no signs of mental disorder.
Indeed, research suggests that in people with mental illness, dangerousness is more the exception than it is the rule (Corrigan & Watson, 2005).
What Do We Mean by Abnormality?
ABNO
RMALIT
Y
There is no consensus
definitio
n
There
are som
e clea
r ele
ments of abnormality
Points to remember!No one element is sufficient to
define or determine abnormality
Definition of deviant changes as society changes
THE ELEMENTS OF ABNORMALITY
FOUR major means of judging psychopathology include DISTRESS, DEVIANCE (bizarreness), DYSFUNCTION (inefficiency in behavioural, affective, and/or cognitive domains), and DANGEROUSNESS.
Most people who seek the help of therapists are suffering psychological distress that may show up physically and/or psychologically.
In the psychological realm, distress is manifested in extreme or prolonged emotional reactions such as anxiety and depression.
Of course, it is normal for a person to feel depressed after suffering a loss or a disappointment.
But if the reaction is so intense, exaggerated, and prolonged that it interferes with the person’s capacity to function adequately, it is likely to be considered abnormal.
DISTRESS
Deviance is most closely related to using a statistical average.
Statistical criteria equate normality with those behaviours that occur most frequently in the population.
Abnormality is therefore defined in terms of those behaviours that occur least frequently.
Bizarre or unusual behaviour is an abnormal deviation from an accepted standard of behaviour (such as an antisocial act) or a false perception of reality (such as a hallucination or delusion).
This criterion can be extremely subjective; it depends on the individual being diagnosed, on the diagnostician, and on the particular cultural context.
DEVIANCE
In everyday life, people are expected to fulfil various roles.
Emotional problems sometimes interfere with the performance of these roles, and the resulting role dysfunction may be used as an indicator of abnormality.
Thus one way to assess dysfunction is to compare an individual’s performance with the requirements of a role.
Another related way to assess dysfunction is to compare an individual’s performance with his or her potential.
DYSFUNCTION
Dangerousness Predicting the dangerousness of clients to
themselves and others has become an inescapable part of clinical practice.
Therapists to assess the dangerousness of clients (to themselves and others) and to protect any intended victim.
Psychologists have attempted to devise risk-assessment procedures and to ascertain what actions a therapist must take to comply with “a duty to protect.”
DANGEROUSNESS
MULTICULTURAL LIMITATIONS IN DETERMINING ABNORMALITY
Perhaps one of the strongest criticisms of abnormality definitions comes from the multicultural perspective.
If deviations from the majority are considered abnormal, then many
ethnic and racial minorities who show strong cultural differences from the majority could be classified as abnormal.
When we use a statistical definition, the dominant or most influential group generally determines what constitutes normality and abnormality.
Multiculturalists contend that all behaviors, whether normal or abnormal, originate from a cultural context.
Psychologists are increasingly recognizing that this is an inescapable conclusion and that culture plays a major role in our understanding of human behaviour.
What is Culture? CULTURE is the configuration of shared learned behaviour
that is transmitted from one generation to another by members of a particular group; the components of culture include the values, beliefs, and attitudes embedded in a group’s worldview and symbolized by artifacts, roles, expectations, and institutions (Sue & Sue, 2008a).
Three important points should be emphasized:
1. Culture is not synonymous with race or ethnic group. Jewish, Polish, Irish, and Italian Americans represent diverse ethnic groups whose individual members may share a common racial classification. Yet their cultural contexts may differ substantially from one another. Likewise, an Irish American and an Italian American, despite their different ethnic heritages, may share the same cultural context.
2. Every society or group that shares and transmits behaviours to its members possesses a culture.
3. Culture is a powerful determinant of worldviews (Sue & Sue, 2008a). It affects how normal and abnormal behaviors are defined and how disorders encountered by members of that culture are treated.
These three points give rise to a major problem: one group’s definition of mental illness may not be shared by another.
This contradicts the traditional view of abnormal psychology, which is based on cultural universality—the assumption that there exists a fixed set of mental disorders whose obvious manifestations cut across cultures
The belief that a disorder such as depression is similar in origin, process, and manifestation in all societies and, therefore, no modifications in diagnosis and treatment need be made; Western concepts of normality and abnormality can be considered universal and equally applicable across cultures
In contrast to the traditional view of cultural universality, the principle of cultural relativism emphasizes that lifestyles, cultural values, and worldviews affect the expression and determination of behaviour, thus underscoring the importance of culture and diversity in the manifestation of abnormal symptoms.
THE FREQUENCY AND BURDEN OF MENTAL DISORDERS
PSYCHIATRIC EPIDEMIOLOGY, the study of the prevalence of mental illness in a society, provides insights into factors that contribute to the occurrence of specific mental disorders.
The PREVALENCE of a disorder indicates the percentage of people in a population who suffer from a disorder at a given point in time; lifetime prevalence refers to the percentage of people in the population who have had a disorder at some point in their life.
INCIDENCE refers to the onset or occurrence of a given disorder over some period of time.
From this information, we can find out how frequently or infrequently various disturbances occur in the population.
We can also consider how the prevalence of disorders varies by ethnicity, gender, and age and whether current mental health practices are effective.
Prevalence and Incidence
Epidemiology • Study of distribution of diseases, disorders, or health-
related behaviors in a given population
Prevalence Number of active cases in population during any given period of time
Typically expressed as percentagesDifferent types of prevalence estimates
Prevalence and Incidence
Incidence Number of new cases in population over given period of time
Incidence figures are typically lower than prevalence figures
Prevalence and Incidence
Lifetime prevalence Most prevalent category
Most common individual disorders Comorbidity
Prevalence Estimates for Mental Disorder
HISTORICAL PERSPECTIVES ON ABNORMAL BEHAVIOUR
Prehistoric societies some half a million years ago did not distinguish sharply between mental and physical disorders.
Abnormal behaviors, from simple headaches to convulsive attacks, were attributed to evil spirits that inhabited or controlled the afflicted person’s body.
According to historians, these ancient peoples attributed many forms of illness to demonic possession, sorcery, or the behest of an offended ancestral spirit.
PREHISTORIC AND ANCIENT BELIEFS
Within this system of belief, called demonology, the victim was usually held at least partly responsible for the misfortune.
• It has been suggested that Stone Age cave dwellers may have treated behaviour disorders with a surgical method called trephining, in which part of the skull was chipped away to provide an opening through which the evil spirit could escape.
• People may have believed that when the evil spirit left, the person would return to his or her normal state
Another treatment method used by the early Greeks, Chinese, Hebrews, and Egyptians was exorcism.
In an exorcism, elaborate prayers, noises, emetics (drugs that induce vomiting), and extreme measures such as flogging and starvation were used to cast evil spirits out of an afflicted person’s body.
• With the flowering of Greek civilization and its continuation into the era of Roman rule (500 b.c.–a.d. 500), naturalistic explanations gradually became distinct from supernatural ones.
• Early thinkers, such as Hippocrates (460–370 b.c.), a physician who is often called the father of medicine, actively questioned prevailing superstitious beliefs and proposed much more rational and scientific explanations for mental disorders.
• Naturalistic explanations relied heavily on observations—the foundation of the scientific method.
NATURALISTIC EXPLAINATIONS (Greco – Roman Thought)
• These explanations negated the intervention of demons in the development of abnormality and instead stressed organic causes.
• Fortunately, the treatment they prescribed for mental disorders tended to be more humane than previous treatments.
• Hippocrates believed that, because the brain was the central organ of intellectual activity, deviant behavior was caused by brain pathology—that is, a dysfunction or disease of the brain.
• He also considered heredity and environment important factors in psychopathology.
• He classified mental illnesses into three categories—mania, melancholia, and phrenitis (brain fever)—and for each category, he gave detailed clinical descriptions of disorders such as paranoia, alcoholic delirium, and epilepsy.
• People came to believe that many illnesses were the result of supernatural forces, although they had natural causes.
• In many cases, the mentally ill were treated gently and with compassion in monasteries and at shrines, where they were prayed over and allowed to rest.
• In other cases, treatment could be quite brutal, especially if illnesses were believed to be God’s wrath.
• Because illness was then perceived to be punishment for sin, the sick person was assumed to be guilty of wrongdoing, and relief could come only through atonement or repentance.
REVERSION TO SUPERNATURAL EXPLAINATIONS (THE MIDDLE AGES) :
The Dark Ages (5th – 20th Centuries)
• During this period, treatment of the mentally ill sometimes consisted of torturous exorcistic procedures seen as appropriate to combat Satan and eject him from the possessed person’s body.
• Prayers, curses, obscene epithets, and the sprinkling of holy water— as well as such drastic and painful “therapy” as flogging, starving, and immersion in hot water—were used to drive out the devil.
• Belief in the power of the supernatural became so prevalent and intense that it frequently affected whole populations.
• Beginning in Italy early in the thirteenth century, large numbers of people were affected by various forms of mass madness, or group hysteria, in which a great many people exhibit similar symptoms that have no apparent physical cause.
• One of the better known manifestations of this disorder was tarantism, a dance mania characterized by wild raving, jumping, dancing, and convulsions.
MASS MADNESS(13th Century)
• The hysteria was most prevalent during the height of the summer and was attributed to the sting of a tarantula.
• A victim would leap up and run out into the street or marketplace, jumping and raving, to be joined by others who believed that they had also been bitten.
Another form of mass madness was lycanthropy, a mental disorder in which victims imagine themselves to be wolves and imitate wolves’ actions.
(Motion pictures about werewolves— people who assume the physical characteristics of wolves during the full moon—are modern reflections of this delusion.)
How can these phenomena be explained? Stress and fear are often associated with outbreaks of mass hysteria.
• People whose actions were interpreted as peculiar were often suspected of witchcraft.
• It was acceptable to use torture to obtain confessions from suspected witches, and many victims confessed because they preferred death to prolonged agony.
• Thousands of innocent men, women, and even children were beheaded, burned alive, or mutilated.
WITCHCRAFT(15th - 17th Centuries)
How have explanations of abnormal behaviour changed
over time? Ancient peoples believed in demonology and attributed abnormal
behaviours to evil spirits that inhabited the victim’s body. Treatments consisted of trephining, exorcism, and bodily assaults.
Rational and scientific explanations of abnormality emerged during the Greco-Roman era. Especially influential was the thinking of Hippocrates, who believed that abnormal behaviour was due to organic, or biological, causes, such as a dysfunction or disease of the brain. Treatment became more humane.
With the collapse of the Roman Empire and the increased influence of the church and its emphasis on divine will and the hereafter, rationalist thought was suppressed and belief in the supernatural again flourished.
During the Middle Ages, famine, pestilence, and dynastic wars caused enormous social upheaval. Forms of mass madness (mass hysteria) affected groups of people.
One of the better known manifestations of this disorder was tarantism, a dance mania characterized by wild raving, jumping, dancing, and convulsions. The hysteria was most prevalent during the height of the summer and was attributed to the sting of a tarantula. A victim would leap up and run out into the street or marketplace, jumping and raving, to be joined by others who believed that they had also been bitten.
Another form of mass madness was lycanthropy, a mental disorder in which victims imagine themselves to be wolves and imitate wolves’ actions. (Motion pictures about werewolves— people who assume the physical characteristics of wolves during the full moon—are modern reflections of this delusion.)
In the fifteenth century, some of those killed in church endorsed witch hunts were people we would today call mentally ill.
People whose actions were interpreted as peculiar were often suspected of witchcraft. It was acceptable to use torture to obtain confessions from suspected witches, and many victims confessed because they preferred death to prolonged agony.
Thousands of innocent men, women, and even children were beheaded, burned alive, or mutilated.
The Rise of Humanism (Renaissance) brought a return to rational and scientific inquiry, along with a heightened interest in humanitarian methods of treating the mentally ill.
The eighteenth and nineteenth centuries were a period characterized by reform movements.
What were early viewpoints on the causes of mental
disorders? In the nineteenth and twentieth centuries, major medical
breakthroughs fostered a belief in the biological roots of mental illness.
An especially important discovery of this period was the microorganism that causes general paresis.
Scientists believed that they would eventually find organic causes for all mental disorders.
The uncovering of a relationship between hypnosis and hysteria corroborated the belief that psychological processes could produce emotional disturbances.
What are some contemporary trends in abnormal
psychology? Three major contemporary developments have had or are
having important influence in the mental health professions: 1. the multicultural psychology movement, 2. positive psychology and optimal human functioning, and 3. changes in the therapeutic landscape (drug revolution,
prescription privileges for psychologists, managed care, and evidence-based practice).
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