Chapter 1 Abnormal Behavior in Historical Context

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Chapter 1Abnormal Behavior in Historical
Context
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ANNOUNCEMENTS You dont need to memorize
names or dates from chapter 1, other than those I
point out today in lecture. Textbooks
available at NJ Books. Office hours start this
Thursday from noon-1 pm in Busch 309. Exam
1 is 2 weeks from today, on Sept. 18. Study
guide will be available next week. If you
did not receive an email from me last week,
then there might be a problem with your
registration. You should follow up on this
immediately.
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Myths and Misconceptions About Abnormal Behavior

• No Single Definition of Psychological Abnormality
• No Single Definition of Psychological Normality
• Many Myths Are Associated With Mental Illness
• Lazy, crazy, dumb
• Weak in character
• Dangerous to self or others
• Mental illness is a hopeless situation

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Approaches to Defining Abnormal Behavior

• Does Infrequency Define Abnormality?
• In research, psychologists use statistics to
  determine what behaviors are in the normal range,
  and which are outside that range.
• Normal curve approximately 70 of all people
  will score within one s.d. of the mean
• Another 29 will score within two s.d.s of the
  mean
• Just 1 will score outside two s.d.s.this is
  clearly abnormal!

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Approaches to Defining Abnormal Behavior

• Does Suffering Define Abnormality?
• If someone has an unusual lifestyle but is not
  suffering - we would not go after that
  individual for treatment.
• Who do you know who lives a strange life,
• but is not distressed about it?
• Example someone I know jumps trains and lives
  a nomadic life, sometimes dumpster diving to
  obtain food and clothing.

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Approaches to Defining Abnormal Behavior

• Does Strangeness Define Abnormality?
• Someone who breaks social norms is considered
  strange however, this concept changes with time.
  
• Naked Guy, crying after 911, fashion.

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Approaches to Defining Abnormal Behavior

• Does the Behavior Itself Define Abnormality?
• Andrea Yates Britney Spears.
• The celebrity effect of Michael Jackson, Tom
  Cruise, Marv Albert.

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Approaches to Defining Abnormal Behavior

• Should Normality Serve as a Guide?
• We use the concept of normality to define
  abnormality but we sometimes ignore context,
  history, etc.

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Definition of Abnormal Behavior

• 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 persons
  background
• Atypical or Unexpected Cultural Response
• Reaction is outside cultural norms

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The Diagnostic and Statistical Manual (DSM-IV-TR)

• Widely Accepted System
• Used to classify psychological problems and
  disorders
• DSM Contains Diagnostic Criteria for Behaviors
  That
• Fit a pattern
• Cause dysfunction or subjective distress
• Are present for a specified duration
• And for behaviors that are not otherwise
  explainable (grief, medical conditions, etc.)
• Criteria - lists of symptoms necessary for each
  disorder.

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Abnormal Behavior Defined

• Definition
• A psychological dysfunction associated with
  distress or impairment in functioning that is not
  typical or culturally expected
• Labels and terminology
• Psychological disorder, psychiatric disorder,
  emotional disorder, or psychological abnormality
  are all names for the same thing.
• Mental illness is a less preferred term
• Psychopathology
• Is the scientific study of psychological disorders

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Approaches to the Scientific Study
ofPsychological Disorders

• 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
• M.S.W.s Psychiatric and non-psychiatric social
  workers
• MN/MSNs Psychiatric nurses
• The lay public and community groups

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Approaches to the Scientific Study
ofPsychological Disorders

• United by the Scientist-Practitioner Framework
• Although they offer different types of services
  and treatments, all are united by a reliance on
  science and research.
• Currently, many different types of health
  insurance require that any treatment used is
  backed up by research findings.

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The Past Historical Conceptions of Abnormal
Behavior

• Although Psychological Disorders Have Existed
• In all cultures
• Across all time periods
• Assumed Causes and Treatment of Abnormal Behavior
  Have Varied Widely
• Across cultures
• Across time periods
• Depending on prevailing paradigms or world views

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The Past Historical Conceptions of Abnormal
Behavior

• Three Dominant Traditions/Worldviews Include
• Supernatural
• Biological
• Psychological
• Not necessarily linear we tend to move
  recursively through these traditions at different
  points in time.

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The Past Abnormal Behavior and the Supernatural
Tradition

• Deviant Behavior as a Battle of Good vs. Evil
• Causes included demonic possession, witchcraft,
  sorcery
• Multiple cases of a disorder Mass hysteria
• Treatments included exorcism, torture, beatings,
  crude surgeries, hanging upside down, chair
  spinning, even death.
• GOAL of these treatments was to make the evil
  spirits uncomfortable in the host so that they
  would leave the body.
• Example trephination, Mutter Museum in Phila.

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The Past Abnormal Behavior and the Supernatural
Tradition

• Example of mass hysteria in the U.S.?

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The Past Abnormal Behavior and the Supernatural
Tradition

• During the era of the Salem witch trials (1690s)
  30-50 men, women, girls and animals were executed
  for being possessed by the devil.
• The hysteria finally ended several years later
  after respected citizens were wrongly convicted
  and executed, to the dismay of the community.
• Governors wife accused, rise of intellectual
  community such as the president of Harvard openly
  criticized the trials and called for their end.

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The Past Abnormal Behavior and the Supernatural
Tradition

• What really happened?
• Most believe that the abnormal behaviors
  exhibited by people during this era were caused
  by a psychoactive psychedelic substanceergot
  poisoning.

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The Past Abnormal Behavior and the Supernatural
Tradition

• Other Worldly Causes of Deviant Behavior
• Movement of the moon and stars
• Lunacy
• Some disorders have a cyclic course, such as
  major depression, that appears to correspond with
  different lunar phases. (PMS in females)
• Middle Ages (500-1300 a.d.)
• Both outer force views (evil spirits, lunacy)
  were popular
• Few thought of abnormality as a physical disease

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The Past Abnormal Behavior and the Biological
Tradition

• Hippocrates Greek physician born 460 b.c.
• Abnormal Behavior as a Physical Disease
• Hysteria The Wandering Uterus
• More females than males have emotional disorders,
  even when reporting bias controlled.
• The uterus detached and wandered through a
  womans body, eventually moving up to the chest,
  causing many symptoms such as disease,
  psychological disorders, and eventual
  strangulation.

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The Past Abnormal Behavior and the Biological
Tradition

• Hippocrates Greek physician born 460 b.c.
• However, he also suggested that emotional
  disorders were partly genetic (true), possibly
  caused by brain pathology or head trauma (true),
  or stress (true).

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The Past Abnormal Behavior and the Biological
Tradition

• Galen Extends Hippocrates Work (129-200 a.d.)
• Humoral theory of mental illness
• First animal researcher
• Knew the importance of the brain in mental health

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The Past Abnormal Behavior and the Biological
Tradition

• Galens humors (fluids in the body)
• Blood ruddy, cheerful, optimistic
• Black bile melancholy, depressed, gloomy
• Yellow bile angry, irate, irascible
• Phlegm apathetic, stoic, numb.
• If the fluids were out of balance disorder of
  the mind
• For instance, domestic violence caused by too
  much yellow bile depression by too much black
  bile.

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The Past Abnormal Behavior and the Biological
Tradition

• Treatments remained crude - bloodletting,
• leeches, stimulating kidneys by drinking
• salt water, induced vomiting, deep breathing
  to soothe the soul, etc.
• but also involved manipulating the environment
  in an attempt to correct levels of the humors.

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The Past Abnormal Behavior and the Biological
Tradition

• Galenic-Hippocratic Tradition
• Linked abnormality with brain chemical imbalances
• Foreshadowed modern medical model of emotional
  disorders.

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The Past Abnormal Behavior andthe
Psychological Tradition

• Rise of Moral Therapy/Emphasis on Psychosocial
  Factors
• (Late 1800s)
• Overview Not moral in the usual sense of the
  word here it means emotional or
  psychological
• Normalizing treatment of mentally ill -
  emphasized the importance of a safe, low stress
  environment and social interaction.
• Foreshadowed modern behavioral treatments.

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The Past Abnormal Behavior andthe
Psychological Tradition

• Reasons for the Falling Out of Moral Therapy -
  too difficult to administer this level of
  individualized treatment in crowded hospitals.
• Emergence of Competing Alternative Psychological
  Models, such as the Freudian Model, which
  highlighted other psychological process that were
  not amenable to moral treatment.

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The Past Historical Conceptions of Abnormal
Behavior

• Three Dominant Traditions Include
• Supernatural - evil spirits or outer force,
  morality-based.
• Biological - physical abnormality,
  biologically-based.
• Psychological - social distress, mentally-based.
• Not necessarily linear we tend to move
  recursively through these traditions at different
  points in time.

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• Knowing what you do about our current culture,
  which tradition most closely resembles our
  current views about mental health and treatment?
• Examples from two recent newspaper
  ads/articles

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• Dr. Robert Hager M.D., appointed by GW Bush as
  the Chair of the National Committee on
  Reproductive medicine, suggests that women who
  experience PMS
• should spend more time praying and reading
  the bible. (2006).
• This is NOT science its an agenda pushed by
  various religious groups

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Most religious denominations in the U.S. have
some Form of treatment for homosexuality.
The list includes What most people dont know
is that ANYONE, including you and me, can start
a religion simply by filling out some paperwork
and submitting it to the state. This is part of
our right to religious freedom. My Uncles
religious order The Church of Karst We are then
free to compete for federal tax dollars to
develop such treatments.
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THE PUNCH LINE HOMOPHOBIA, not homosexuality,
is being Considered as a new psychiatric
disorder for the next version of DSM!!
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The Present The Scientific Method andan
Integrative Approach

• Defining Abnormal Behavior
• Is complex, multifaceted, and also has evolved
  over time as more scientific data is gathered.
• The Supernatural Tradition
• Has no place in a science of abnormal behavior.

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The Importance of Research

• Our therapies must be tested in well-controlled
  research studies otherwise we dont know if they
  work or not!

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The Importance of Research

• If we do not test our therapies in research, not
  only will we not know if they work or not, but we
  might even be making our clients emotional
  disorder worsen! We must carefully measure
  outcome to ensure that our clients have gotten
  better.
• Two examples of harmful treatments
• 1) smoking cessation program for heavy smokers
• 2) residential treatment for delinquent boys
• 3) critical incident debriefing
• 4) grief counseling

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The Importance of Research

• Just because we label something a treatment
  doesnt mean that it will be successful in
  reducing suffering.
• Psychologists who practice according to their own
  untested models are using interventions with no
  research data to back them up, and run the risk
  of causing harm.

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The Importance of Research

• Arguments against the importance of research
• (from NY Times article on website)
• Mainly that individuals and their problems
  are too complex to be fully captured in research
  studies.
• For example the problem of comorbidity, or when
  two or more disorders are present at once in the
  same individual. Or, if there is a complete lack
  of research data on an infrequent
  condition/disorder, sample of clients.

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The Importance of Research

• However, even given the shortcomings of our
  current research knowledge base, there is still a
  higher percentage of therapy clients who benefit
  from research-based treatments that those who
  receive eclectic, unresearched treatments (65
  versus 35, generally Consumer Reports, 1995).
• Insurance companies and practice guidelines are
  beginning to require that some disorders be
  treated with research-based interventions first
  and foremost.

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The Present The Scientific Method andan
Integrative Approach

• Psychopathology
• Is multiply determined - biopsychosocial
• One-dimensional models are incomplete
• Must Consider Reciprocal Relations Between
• Biological, psychological, social, and
  experiential factors
• Defining Abnormal Behavior
• Is complex, multifaceted, and also has evolved
• The Supernatural Tradition
• Has no place in a science of abnormal behavior

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Approaches to the Scientific Study
ofPsychological Disorders

• So, all mental health care workers are committed
  to science and research.
• But what makes them different?
• Refer to models.doc handout