Abnormal Behavior in a Historical Context PDF

1. Abnormal Behavior in a Historical Context Learning Objectives: 1. Differentiate between theoretical perspectives and models of psychopathology 2. Outline the history of beliefs in the causes of psychological disorders 3. Identify the characteristics most commonly used today when definin...

1. Abnormal Behavior in a Historical Context Learning Objectives: 1. Differentiate between theoretical perspectives and models of psychopathology 2. Outline the history of beliefs in the causes of psychological disorders 3. Identify the characteristics most commonly used today when defining psychological disorders 4. Describe how culture and social context affect people's beliefs about psychological disorders What is a psychological disorder? 1. A breakdown or impairment of cognitive, emotional, or behavioral functioning 2. Associated with distress or impairment 3. Atypical, Abnormal, or not culturally expected 4. Beyond an individual's control While psychological disorders generally involve these factors, they are not all required in order to classify the individual as having a given psychological disorder. For instance, a person with a substance abuse problem may not perceive the distress or impairment it causes; likewise, certain substance abuse issues are culturally expected. Cognitive, Emotional, or Behavioral Impairments Occurs when the cognitive, emotional or behavioral response to a given situation is disproportionate or inaccurate to that situation. Going on a date should be fun; severe anxiety over a date is an impairment Seeing blood can be upsetting, but fainting at the sight of blood is also an impairment Personal Distress or Impairment Distress by itself is not a sign of psychological dysfunction Nor is distress necessary for something to be a dysfunction, such as a manic episode  Experiencing distress over the loss of a loved one is not an impairment However, experiencing great distress over the absence of a loved one (if they are on a trip or at the store), is a sign of impairment Likewise, shyness does not generally impair people's ability to live normal lives However, severe social anxiety to the point of avoiding social situations does Distress is a necessary component, but not an entire picture, of psychological dysfunction Atypical or Not Culturally Expected While it is important to acknowledge the atypical nature of psychological disorders, atypical in and of itself is not a useful category Atypical often refers to eccentric, and cultural differences blur the lines between what one given people consider out of the norm compared to another Social expectations of normality can also be abused Atypical in the useful sense can be regarded as an unexpected or abnormal response from an otherwise evolved function Queasiness around blood can be a defense mechanism, however fainting around blood is an extreme response Human emotions have an evolutionary purpose, however people with BPD can have exaggerated or major emotional reactions to otherwise mundane events Beyond Individual Control Conditions that are outside of an individual's conscious ability to prevent or stop Excessive abuse of a substance Ruminations Manic episodes The current accepted definition of a psychological disorder is: Behavioral, psychological, or biological dysfunctions that are unexpected in their cultural context and associated with present distress and impairment in functioning, or increased risk of suffering, death, pain, or impairment. The Science of psychopathology Who diagnoses psychological disorders? Clinical Psychologists Typically have a PhD or PsyD Researchers; conduct studies/research on causes and treatments of psychological conditions Able to assess, diagnose, and treat disorders Psychiatrists Medical doctors Specialize in psychiatry Investigate the nature + causes of psychological disorders from biological pov Makes diagnoses; offers treatments Other Related Fields Counselling Psychologists Study and treat adjustment and vocational issues encountered by individuals Psychiatric/Clinical Social Workers Collect info relevant to social + family situations of individual psychological disorders and treat them Psychiatric Nurse Specialize in care and treatment of patients with psych. disorders in hospitals or part of a treatment team Family Therapist/Mental Health Councillers Provide clinical services in hospitals and clinics In Canada, who can and can't call themselves a psychologist is determined on a provincial level. Some places require a doctorate in order to qualify, while others only require a master's degree. The Scientist-Practitioner  A philosophy surrounding psychological research that suggests mental health practitioners should be conducting themselves via the scientific method, and should be actively reviewing new information to improve their own work and the work of others. They are accountable to themselves and the government/insurance agencies that pay for treatment Aspects of a Clinical Description Presenting Problem Prevalence Incidence Course Onset Prognosis Age plays a major role in determining the clinical description, as symptoms of the same mental health condition can manifest differently in children than in adults. For instance, anxiety disorders in children can make them come across as physically ill due to the fact that they have difficulty understanding there is nothing physically wrong with them The Supernatural Tradition Prehistoric Evidence: Trephination occurred when stone tools were used to cut holes in the skull May have just been used as a way of removing bone splinters or blood clots Abnormal behavior was thought to be a sign of demonic possession Still believed by some cultures today 14th - 15th Century Demons and witches believed to be the cause of psychological disorders Abnormality was considered a divine punishment for abhorrent behavior The individual was held responsible for their disorder  Treatment plans included: Hanging people over snake pits Cold water baths Exorcism The goal was to make the body uninhabitable by the evil spirits Occasionally these treatments actually worked Contrasting Explanation: Stress and Melancholy Some believed that disorders came as the result of natural issues like stress Insanity is a natural phenomenon caused by mental or emotional stress Depression was recognized (by some) as a mental health condition (despair, lethargy) Treatable with rest, sleep, happiness, potions, baths, etc King Charles VI of France was thought by his contemporaries to be mad; initial treatments involved moving him out to the country, and providing him with plenty of leisure and relaxation activities, which improved his health. However, when his original physician died, the next physicians reverted back to beliefs about sorcery, and would accuse anybody who rejected their practices of being sorcerers. The king's condition did not continue to improve. The Moon and Stars Paracelsus suggested that the moon and stars had an effect on psychological functioning Lunatic -- derived from luna The Biological Tradition Greek + Roman Thought Hippocrates Physician -- father of medicine Psychological disorders could be treated just like any other disease Caused by brain pathology or head trauma; influenced by heredity  Recognized the importance of psychological and interpersonal connections such as stress or family structures Humoral Theory (Hippocrates and Galen) Brain function was related to the four bodily fluids Blood Black bile Yellow bile Phlegm Too much of a specific fluid could cause problems, such as black bile causing melancholia Excess of one bodily fluid was treated by regulating the environment (temperature, humidity, etc), as well as blood-letting and induced vomiting Hysteria Physical symptoms with no organic cause such as paralysis or blindness Found primarily in women Hippocrates coined the term hysteria: "Wandering uterus" Precscribed cures include: Marriage Fumigation of the vagina to lure the uterus back to its natural location 19th Century A subgroup of people with psychosis experienced Believing everyone is plotting against you Believing you are god Unusual behaviors These individuals tended to deteriorate steadily, become paralyzed, and die within 5 years Designated a disease: General Paresis (modern known as syphilis) Injecting blood with malaria caused a high fever that burned out the syphilis bacteria  While penicillin would later be used to treat syphilis more effectively, malaria was strong proof that madness and its associated symptoms could both have biological causes, and be treated Development of Biological Treatments: Shock Therapy Insulin injections could induce coma, which seemed to improve symptoms of schizophrenia Produced convulsions -- perhaps this was an active feature Electroconvulsive therapy (ECT) -- delivering shock to a patient's skull Initially used and effective for treating schizophrenia Most effectively used for major depression (and is still used as treatment today) Development of Biological treatments New drugs including neuroleptics (major tranquilizers), and benzodiazepines (minor tranquilizers) Diminish hallucinations and delusions, and reduce anxiety These treatments were often discovered by accident Emil Kraeplin Published a textbook in 1853 published a textbook that attempted to classify mental health conditions Groups of symptoms tended to occur together. These were dubbed Syndromes Disorders had distinct features, differed in age of onset and course Suspected disorders had different causes (though these were all biological) Predessecor to the DSM-5 and ICD-10 Psychological Tradition Plato pioneered the Precursor to the Psychological Tradition Cause of maladaptive behavior were social and cultural influences in a person's life  Treatment involved rational discussion to re-educate and so that reason would predominate Plato and other early philosophers advocated for humane and responsible care A precursor to modern psychosocial approaches Moral Therapy Originated with French psychiatrist Phillippe Pinel Moral meaning "emotional" or "psychological" Treated institutionalized patients as normally as possible, provided opportunities for social contact Was different from treatment methods of the time, which often saw rampant abuse Asulyms became more habitable and therepuetic Decline of Moral Therapy Dorothea Dix's Mental Hygiene Movement Advocated for patients with mental illness Humane treatment became more widely available in North America Led to increase in number of patients This movement backfired as it caused custodial care to decline due to lack of staff Mental institutions quickly reverted back to their pre-moral therapy days as a result of lack of resources By the mid-19th century believed that mental illness was caused by brain pathology, and therefor was incurable Psychoanalaytic Theory Anton Mesmer Believed that animal magnetism, and invisible fluid in the body, could cause psychological disorders by becoming blocked Benjamin Franklin put this to the test using a double-blind test involving magnetic and non-magnetic water  His conclusion was that animal magnetism was nothing more than strong suggestion Jean Charcot Legitimized hypnosis Sigmund Freud and Joseph Breuer Employed hypnosis and had a patient talk freely about unpleasant past events that they believed caused hysteria Patients tended not to remember; led to the development of the unconscious mind Recounting the trauma/emotional memory in this way gave rise to the Cathartic method -- the idea that accessing the unconscious in this way would help heal trauma Developed psychoanalytic theory Psychoanalytic Model Developed by Sigmund Freud Unconscious forces control behavior The story of Anna O Developed hysteria following the death of her father Was systematically treated via hypnosis and talk therapy by Breuer The Structure of the mind: 1. The Id Fully unconscious -- the source of strong sexual and aggressive tendencies Maximize pleasure and eliminate tension The Ego Operates according to the reality principle Satisfies the Id within the rules and confines of society The Superego The conscience Moral principles as instilled by society Antithesis to the Id and appeases the ego Freud believed that if the Id or Ego got too strong, it would create psychological disorders Defense Mechanisms Ego uses defense mechanisms to protect the mind if conflict between ID and superego threatens to overwhelm Repression Blocks disturbing wishes, thoughts, or experiences from conscious awareness Projection Falsely attributing one's own feelings to another person (like believing a person has romantic feelings for you because you have romantic feelings for them) Denial Refusing to acknowledge some aspect of reality or subject experience that is apparent to others, like facing the fact a relationship is over Displacement Transfer of feelings from one person to another Reaction formation Substituting a disliked behavior, emotion, or thought by adhering to thoughts, emotions, or behaviors directly the opposite of them Rationalization Concealing the true motives behind behaviors, thoughts, or feelings, through elaborate reassuring or self-serving, but incorrect, explanations The Psychosexual Stages of Development Gross Freudian stuff Issues in getting through the stages can cause psychological disorders Psychoanalytic Psychotherapy Techniques Designed to reveal the nature of unconscious mental processes and conflicts Free Association The patient is instructed to say whatever comes to mind without censoring  Dream Analysis Dream contents are explored as symbolic of id impulses or intrapsychic conflicts Insight Transference Clients may seek to relate to the therapist as they do to important authority figures, particularly their parents Countertransference Done 4-5 times a week for 2-5 years Lack of evidence that it actually works Humanistic Theory A reaction to psychoanalytic theory More positive about humanity and human nature Emphasis the dignity and potential of humanity Believed that we all want to be our best selves, but have things like home lives or other issues blocking us Self-actualization occurs when we reach our highest potential This is a goal we all fundamentally strive toward Abraham Maslow and his hierarchy of needs Carl Rogers Person centered therapy: self-fulfillment is achieved through self-acceptance; being honest in interactions; trusting experience; and relying on oneself for personal evaluations More useful for people without major psychological disorders Distressing life events distort perception of self, which leads to abnormal behavior Influential in the practice and study of modern-day therapist-client relationships Unconditional positive regard Worked on understanding how psychotherapy works The Behavioral Model Pavlov and classical conditioning  Dogs associate a bell ringing with food and begin to salivate John B. Watson Considered the founder of behaviorism Psychology as a science must be restricted to study of observable features and behaviors Abnormal functioning is learned and can be unlearned Influenced by classical conditioning, all problematic functioning is the result of unfortunate conditioning experiences Still utilized today Behavior Therapy Systematic Desensitization Individuals are gradually introduced to objects or situations that are feared See that nothing bad really happened in the presence of a phobic object or scene Patients engage in something incompatible with fear such as relaxation B.F Skinner Operant Conditioning Positive vs negative reinforcement Positive vs negative punishment Classical conditioning involves associating an involuntary response to a stimulus, whereas operant conditioning associates a voluntary behavior and a consequence Both can experience Extinction The Significance of the Behavioral Model Huge impact on modern psychological practice and understanding of disorders Not sufficient enough Pure behavioral perspectives imply that environmental factors are the only cause of psychological disorders, which is untrue Fails to development across the lifespan Learning can occur indirectly or vicariously A new model of psychology is needed An Integrative Approach Developed with increasing sophistication and reliance on scientific tools and methodology Realization that no one influence occurs in isolation (be that biological, cognitive, emotional, social, etc) Psychosocial Disorders are multiply determined Multiple influences come together to develop psychological disorders Which of the following methods are still used in psychological treatment today? A. Shock Therapy B. Trephination C. Behavior Therapy D. A and C *Get through notes/readings first, then lecture