Abnormal Psychology Module 1.1 PDF

MODULE 1.1—DEFINITION AND HISTORY ABNORMAL PSYCHOLOGY BS PSYCHOLOGY | DOC. ROMAINE MAGBOO | FIRST SEM AY 2024-2025 UNDERSTANDING PSYCHOPATHOLOGY abnormal behavior—it is - The terms “mental disord...

MODULE 1.1—DEFINITION AND HISTORY ABNORMAL PSYCHOLOGY BS PSYCHOLOGY | DOC. ROMAINE MAGBOO | FIRST SEM AY 2024-2025 UNDERSTANDING PSYCHOPATHOLOGY abnormal behavior—it is - The terms “mental disorder,” “mental quite normal to be illness,” and “psychopathology” are often distressed used interchangeably by those in psychology - Some disorders, by and related fields; all refer to the study of definition, suffering and unusual or abnormal behaviors. distress are absent - A mental health condition that has a negative - Defining psychological effect on the way an individual thinks, feels, disorder by distress and behaves. alone doesn’t work, - A behavior is considered abnormal if it occurs although concepts of rarely or infrequently in the general distress contribute to a population. good definition - Psychological Disorder or Problematic - Impairment—concept is Abnormal Behavior—it is a psychological useful, though not entirely dysfunction within an individual that is satisfactory (if normal associated with distress or impairment in functioning becomes functioning and a response that is not typical impaired) or culturally expected. - Most psychological - No one criterion has yet been developed that disorders are simply fully defines a psychological disorder. extreme expressions of otherwise normal emotions, behaviors, and cognitive processes ATYPICAL OR - Important but also NOT insufficient to determine CULTURALLY if a disorder is present by EXPECTED itself - Example: talented/ eccentric—people that are far from the average behavior, but few would CRITERIA be considered disorder - The more productive you PSYCHOLOGICAL - Breakdown in cognitive, are in the eyes of society; DYSFUNCTION emotional, or behavioral the more eccentricities functioning society will tolerate. - Example: experience - “Deviating from the severe fear all evening average” doesn’t work when on a date or your well as a definition for emotions are not problematic abnormal functioning properly behavior - View that your behavior is DISTRESS OR - Criterion is satisfied if the disordered if you are IMPAIRMENT individual is extremely violating social norms, upset even if a number of - Does not necessarily people are sympathetic to define problematic your point of view. SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 1 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH - The tests that measure one’s deviation are - This definition is useful in developed from within a particular cultural considering important framework. cultural differences in - There is not an objective, scientific psychological disorders definition of “obsessive-compulsive - Harmful disorder,” there is only the definition Dysfunction—behavior is that the researchers developing the out of individual’s control measure have (and someone else may not agree with it). ACCEPTED DEFINITION - When viewing behavior, both sides of the - DSM-5 describes behavioral, psychological, normal curve would be considered or biological dysfunctions that are “abnormal.” unexpected in their cultural context and - Both someone with very high and very associated with present distress and low general anxiety would be impairment in functioning, or increased risk considered abnormal. of suffering, death, pain, or impairment. - In the real world, though, it is usually - Prototype—“typical” profile of a disorder only one tail of the curve that is - Patient may have only had some viewed as problematic or abnormal. features/symptoms of the disorder (a - Most people, however, would only minimum number) and still meet the consider the person with an extremely criteria for the disorder because his/her low IQ of 70 to have a mental disorder symptoms is close to the prototype instead of a high IQ of 130, even if they both deviate by 15. OTHER DEFINITIONS/PERSPECTIVES SOCIAL DEVIANCE PERSPECTIVE MENTAL DISORDERS AS STATISTICAL DEVIANCE - Behavior is deemed abnormal if it deviates - The statistical deviance perspective defines greatly from the accepted social standards, abnormal behavior by comparing an values, and norms of an individual’s culture. individual’s behavior to the frequency of - A population may have accepted standards occurrence of the same behavior in the general that the majority of the culture does not population. actually meet. - A behavior is considered abnormal if it occurs - An example of this would be using rarely or infrequently in the general alcohol and tobacco prior to the legal population. age of use, which would be considered - This lends itself very well to measurement, as unlawful and socially unacceptable, yet researchers and clinicians can administer major surveys show that over 75% of objective assessments to clients and get high school seniors have consumed accurate measurements of just how far their alcohol. depression, anxiety, hyperactivity, and so on - There is little to no objective validity, due to are from the norm, making it seen as highly individuals and groups even within the same scientific. culture having different ideas of what is socially - Who determines how far from the norm is too acceptable. far from the norm? - What is acceptable at one point in time can - Researchers and clinicians make that become unacceptable with the passage of decision. time, or vice versa. - Behaviors are considered “abnormal” if - Until 1973, for example, homosexuality they occur in less than 5% of the was classified as a diagnosable mental population (1.645 standard disorder by the American Psychiatric deviations from the mean), but this is Association. an entirely arbitrary cutoff. - Finally, the different morals and standards of disparate cultural groups would mean that SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 2 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH what was normal in one country or region - In this model, then, mental disorders would be considered abnormal in another. are just extreme variations of normal psychological phenomena or problems MALADAPTIVE BEHAVIOR PERSPECTIVE that many or most of us experience. - It attempts to classify mental disorders as - The dimensional model has a very large those behaviors that are dysfunctional. amount of scientific support, particularly in - This refers to the effectiveness or the area of personality disorders. ineffectiveness of behavior in dealing with - Support has been found for dimensional challenges or accomplishing goals. models of many other disorders, though, - Typically discussed maladaptive behaviors including anxiety, depressive episodes, and include physically harmful behaviors, even psychotic disorders. behaviors that prevent the person from - Unfortunately, however, the real world often taking care of themselves, those that requires caseness or non-caseness. prevent communication with others, and - This, subsequently, creates a tension between those that interfere with social bonding and the need for categories and the lack of relationships. scientific support for them. - Adaptive behavior is hard to objectively quantify due to the fact that it is based on DSM DEFINITIONS OF MENTAL DISORDER both the situation and one’s subjective - The Diagnostic and Statistical Manual of judgment. Mental Disorders (DSM) is published by the - If a person is engaging in coercive behaviors, American Psychiatric Association and is the stealing, and lying to others, most people most widely used classification system of would say those are maladaptive behaviors mental disorders in the United States (outside (and depending on his age, qualify you for a of the U.S., both the DSM and the International diagnosis of Conduct Disorder or Antisocial Classifications of Disease, or ICD, are used). Personality Disorder), but it can be considered - It provides diagnostic criteria for almost 300 adaptive by their intentions. mental disorders. - One’s culture also plays a large role in - In the most recent edition, published in 1994, determining the adaptiveness of a behavior. the following features are considered - This perspective clashes mightily with the descriptive of a mental disorder: statistical deviance perspective, in that 1. A clinically significant behavioral or statistically deviant behaviors (e.g., an IQ psychological syndrome or pattern higher than 99% of the population) can be that occurs in an individual. highly adaptive, and that numerous 2. Is associated with present distress maladaptive behaviors (such as fear of public (e.g., a painful symptom) or disability speaking) are quite common in the population (i.e., impairment in one or more as a whole. important areas of functioning) or with a significantly increased risk of DIMENSIONAL VS. CATEGORICAL MODELS OF suffering death, pain, disability, or an MENTAL DISORDERS important loss of freedom. - In a categorical model, psychopathology is 3. Must not be merely an expectable dichotomous, either being present or not and culturally sanctioned response being present. to a particular event, for example, the - Dimensional models, on the other hand, death of a loved one. acknowledge the fact that the vast majority of 4. A manifestation of behavioral, human behavior exists on a continuum, psychological, or biological rather than the polarized view of the dysfunction in the individual. categorical model. 5. Neither deviant behavior (e.g., - What tends to be labeled as abnormal political, religious, or sexual) nor and unusual are merely the far ends of conflicts that are primarily between the this normal curve of behavior. individual and society are mental disorders unless the deviance or SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 3 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH conflict is a symptom of a dysfunction - In addition, it is again acknowledged that there in the individual. is no precise boundary between normality and - The DSM-IV goes on to state, though, that “no mental disorders and that the addition or definition adequately specifies precise deletion of a condition from the DSM should boundaries for the concept of “mental have substantial potential benefits which disorder” and that “the concept of mental outweigh potential harms. disorder (like many other concepts in medicine - While this proposed definition, and the and science) lacks a consistent operational revisions to many disorders that actually definition that covers all situations.” specify measures to determine severity and - The categorical nature of the DSM-IV is also of symptom level, are certainly an improvement concern, and the authors even state that they over the DSM-IV (which was, in turn, an recognize the actual, dimensional nature of improvement over earlier versions), there are mental disorders, but due to the need for still concerns over this definition. caseness (as described above) must operate in a categorical nature. THE SCIENCE OF PSYCHOPATHOLOGY - This, in turn, contributes to the high amount of - Psychopathology is the scientific study of diagnostic overlap, or comorbidity, present in psychological disorders. clinical populations. - Within this field are specially trained - In one of the most well-conducted studies to professionals, including clinical and counseling examine this issue, Ronald Kessler and his psychologists, psychiatrists, psychiatric social research team (2005) found that 26.2% of workers, and psychiatric nurses, as well as Americans met the criteria for a mental marriage and family therapists and mental disorder; of these, 45% met criteria for two health counselors. or more disorders. - The proposed revision, which was made CLINICAL - Receive the Ph.D., available both online at DSM5.org and in an PSYCHOLOGISTS doctor of philosophy, article by D.J. Stein and colleagues (2010), is AND degree (or sometimes an as follows. COUNSELING Ed.D., doctor of 1. A behavioral or psychological PSYCHOLOGISTS education, or Psy.D., syndrome or pattern that occurs in an doctor of psychology) individual and follow a course of 2. That reflects an underlying graduate-level study psychobiological dysfunction lasting approximately 5 3. The consequences of which are years, which prepares clinically significant distress (e.g., a them to conduct research painful symptom) or disability (i.e., into the causes and impairment in one or more important treatment of areas of functioning) psychological disorders 4. Must not be merely an expectable and to diagnose, assess, response to common stressors and and treat these disorders. losses (for example, the loss of a loved - Counseling one) or a culturally sanctioned psychologists tend to response to a particular event (for study and treat example, trance states in religious adjustment and rituals) vocational issues 5. That is not primarily a result of social encountered by relatively deviance or conflicts with society healthy individuals - A mental disorder should, by this definition, - Clinical psychologists have diagnostic validity, clinical utility, and usually concentrate on be differentiated from other, similar more severe disorders. psychological disorders. SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 4 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH - Also, programs in problems associated with professional schools of them. psychology, where the degree is often a Psy.D., PSYCHIATRIC - Have advanced degrees, focus on clinical training NURSES such as a master’s or and de-emphasize or even a Ph.D., and eliminate research specialize in the care and training. treatment of patients - In contrast, Ph.D. with psychological programs in universities disorders, usually in integrate clinical and hospitals as part of a research training. treatment team - Psychologists with other specialty training, such as MARRIAGE AND - Typically spend 1 to 2 experimental and social FAMILY years earning a master’s psychologists, THERAPISTS, degree and are employed concentrate on MENTAL HEALTH to provide clinical investigating the basic COUNSELORS services by hospitals or determinants of clinics, usually under the behavior but do not supervision of a assess or treat doctoral-level clinician psychological disorders. SCIENTIST-PRACTITIONERS PSYCHIATRISTS - First earn an M.D. degree - Mental health professionals take a scientific in medical school and then approach to their clinical work specialize in psychiatry during residency training that lasts 3 to 4 years. - Investigate the nature and causes of psychological disorders, often from a biological point of view; make diagnoses; and offer treatments. - Emphasize drugs or other biological treatments, although most use psychosocial treatments as well. PSYCHIATRIC - Typically earn a master’s SOCIAL degree in social work as WORKERS they develop expertise in collecting information relevant to the social and CLINICAL DESCRIPTION family situation of the - Represents the unique combination of individual with a behaviors, thoughts, and feelings that make up psychological disorder. a specific disorder. - Social workers often concentrate on family SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 5 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH PROGNOSIS - Anticipated course of LIFESPAN - Study of abnormal behavior disorder DEVELOP- across the entire age span - Good or Guarded MENTAL PSYCHO- PRESENTS - Traditional shorthand way of PATHOLOGY indicating why the person came to the clinic CAUSATION, TREATMENT, AND ETIOLOGY PREVALENCE - How many people in the OUTCOMES population, as a whole, have - Etiology—study of origins, has to do with why the disorder a disorder begins (what causes it) and includes biological, psychological, and social INCIDENCE - How many new cases occur dimensions. during a given period - If a drug or psychosocial treatment is successful in treating a disorder, it may give COURSE - Individual pattern hints on the nature and causes of a disorder - The effect does not necessarily imply the CHRONIC COURSE cause - Tend to last a long time, - The latest and most effective drug and sometimes a lifetime psychosocial treatments are described in the - Schizophrenia context of specific disorders in keeping with the integrative multidimensional EPISODIC COURSE perspective - Likely to recover within a few months only to suffer a HISTORICAL CONCEPTIONS recurrence of the disorder at - Supernatural Model—the driving forces a later time behind are these agents, which might be - Mood disorders divinities, demons, spirits, or other phenomena such as magnetic fields or the TIME-LIMITED COURSE moon or the stars - Improve without treatment - Ancient Greece—the mind has often been in a relatively short period called the soul or the psyche and considered with little or no risk of separate from the body. recurrence - Three models: - the supernatural ONSET ACUTE ONSET - the biological - Begins suddenly - the psychological INSIDIOUS ONSET THE SUPERNATURAL TRADITION - Develop gradually over an - Deviant behavior has been considered a extended period reflection of the battle between good and evil. DEVELOP- - Study of changes in - The Great Persian Empire From 900 To 600 MENTAL behavior over time B.C.—all physical and mental disorders were PSYCHOLOGY considered the work of the devil DEVELOP- - Changes in abnormal DEMONS AND WITCHES MENTAL behavior - Last Quarter Of The 14th Century—religious PSYCHO- and lay authorities supported these popular PATHOLOGY superstitions and society as a whole began to believe more strongly in the existence and power of demons and witches. SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 6 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH - Catholic Church had split were developed, including dunkings in ice-cold - Roman Church fought back against the evil in water (hydrotherapy) the world - Magic and sorcery to solve their problems. MASS HYSTERIA - Treatments included exorcism - St. Vitus’s dance, Tarantism - The conviction that sorcery and witches are - Characterized by large-scale outbreaks of causes of madness and other evils continued bizarre behavior into the 15th century, and evil continued to be blamed for unexplainable behavior, even MODERN MASS HYSTERIA after the founding of the United States, as - The phenomenon of emotion contagion, in evidenced by the Salem, Massachusetts, which the experience of an emotion seems to witch trials in the late 17th century, which spread to those around us resulted in the hanging deaths of 20 women. - If one person identifies a “cause” of the problem, others will probably assume that their STRESS AND MELANCHOLY TREATMENTS FOR own reactions have the same source. POSSESSION - In popular language, this shared - Reflected the enlightened view that insanity response is sometimes referred to as was a natural phenomenon, caused by mob psychology. mental or emotional stress, and that it was curable THE MOON AND THE STARS - Mental depression and anxiety were - Paracelsus, a Swiss physician who lived from recognized as illnesses , although symptoms 1493 to 1541, suggested that the movements such as despair and lethargy were often of the moon and stars had profound effects identified by the church with the sin of acedia, on people’s psychological functioning or sloth - The gravitational effects of the moon on - Common treatments were rest, sleep, and a bodily fluids might be a possible cause of healthy and happy environment; other mental disorders treatments included baths, ointments, and - The movements of the moon and stars had various potions. profound effects on people’s psychological - During the 14th and 15th centuries, people functioning. with insanity, along with those with physical - Lunatic, which is derived from the Latin word deformities or disabilities, were often moved for moon, “luna.” from house to house in medieval villages as - This belief is most noticeable today in followers neighbors took turns caring for them. of astrology, who hold that their behavior and - Nicholas Oresme also suggested that the the major events in their lives can be predicted disease of melancholy (depression) was the by their day-to-day relationship to the position source of some bizarre behavior, rather than of the planets. demons. COMMENTS TREATMENTS FOR POSSESSION - The supernatural tradition in psychopathology - In the Middle Ages, if exorcism failed, some is relegated, for the most part, to small authorities thought that steps were necessary religious sects in this country and to to make the body uninhabitable by evil primitive cultures elsewhere spirits, and many people were subjected to - Miraculous cures are sometimes achieved by confinement, beatings, and other forms of exorcism, magic potions and rituals, and other torture methods that seem to have little connection - A creative therapist decided that hanging with modern science, but such cases are people over a pit full of poisonous snakes relatively rare, and almost no one would might scare evil spirits right out of their body advocate supernatural treatment for severe - Many other treatments based on the psychological disorders except, perhaps, as a hypothesized therapeutic element of shock last resort SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 7 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH THE BIOLOGICAL TRADITION - A choleric person (from yellow bile or choler) is hot tempered (Maher & Maher, 1985a). HIPPOCRATES AND GALEN - Excesses of one or more humors were treated - Hippocrates (460-377 BC) by regulating the environment to increase - Father of modern western medicine or decrease heat, dryness, moisture, or - Hysteria cold, depending on which humor was out of - Hippocrates considered the brain to be the balance. seat of wisdom, consciousness, - In Ancient China and throughout Asia, the intelligence, and emotion; therefore, movement of air or wind was focused, where disorders involving these functions would unexplained mental disorders were caused by logically be located in the brain. blockages of wind or cold, dark wind (yin) as - Hippocrates recognized the importance of opposed to warm, life-sustaining wind (yang). psychological and interpersonal contributions to psychopathology, such as TWO TREATMENTS WERE DEVELOPED the sometimes-negative effects of family - In one, bleeding or bloodletting, a carefully stress; on some occasions, he removed measured amount of blood was removed from patients from their families. the body, often with leeches. - The Roman physician Galen (approximately - The other was to induce vomiting; a.d. 129–198) later adopted the ideas of well-known treatise on depression published in Hippocrates and his associates and developed 1621, Anatomy of Melancholy, Robert them further, creating a powerful and influential Burton recommended eating tobacco and a school of thought within the biological tradition half-boiled cabbage to induce vomiting that extended well into the 19th century HYSTERIA HUMORAL THEORY OF DISORDERS - Hippocrates also coined the word hysteria to - Hippocrates: Normal brain functioning was describe a concept he learned about from the related to four bodily fluids or humors: Egyptians, who had identified what we now call blood, black bile, yellow bile, and phlegm. the somatic symptom disorders. - Blood came from the heart, black bile from - The physical symptoms appear to be the the spleen, phlegm from the brain, and result of a medical problem for which no choler or yellow bile from the liver physical cause can be found, such as - The humoral theory was, perhaps, the first paralysis and some kinds of blindness example of associating psychological disorders - Egyptians (and Hippocrates) mistakenly with a “chemical imbalance,” an approach assumed that they were restricted to women. that is widespread today. - Wandering uterus theory, which was thought - Galen: Related to the Greeks’ conception of to be treated by marriage or fumigation of the four basic qualities: heat, dryness, the vagina moisture, and cold. - Sanguine (literal meaning “red, like blood”) 19TH CENTURY describes someone who is ruddy in complexion, presumably from copious blood SYPHILIS flowing through the body, and cheerful and - Advanced syphilis, a sexually transmitted optimistic, although insomnia and delirium disease caused by a bacterial microorganism were thought to be caused by excessive blood entering the brain, includes believing that in the brain. everyone is plotting against you (delusion - Melancholic means depressive (depression of persecution) or that you are God was thought to be caused by black bile (delusion of grandeur), as well as other flooding the brain). bizarre behaviors. - A phlegmatic personality (from the humor - Although these symptoms are similar to those phlegm) indicates apathy and sluggishness of psychosis—psychological disorders but can also mean being calm under stress. characterized in part by beliefs that are not SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 8 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH based in reality (delusions), perceptions DEVELOPMENT OF BIOLOGICAL TREATMENTS that are not based in reality (hallucinations), - In the 1930s, the physical interventions of or both—researchers recognized that a electric shock and brain surgery were often subgroup of apparently psychotic patients used. deteriorated steadily, becoming paralyzed and dying within 5 years of onset INSULIN SHOCK THERAPY - In 1825, the condition was designated a - In 1927, a Viennese physician, Manfred Sakel, disease, general paresis began using increasingly higher doses of - Louis Pasteur’s germ theory of disease, insulin (calmed patients down and stimulated developed in about 1870, facilitated the appetite) until, finally, patients convulsed and identification of the specific bacterial became temporarily comatose (Sakel, 1958). microorganism that causes syphilis. - Some actually recovered their mental health, - Many recovered because the high fever which was attributed to the convulsions. (blood with malaria after being injected) - The procedure became known as insulin “burned out” the syphilis bacteria. shock therapy, but it was abandoned because - Ultimately, clinical investigators discovered that it was too dangerous, often resulting in penicillin cures syphilis, but with the malaria prolonged coma or even death. cure, “madness” and associated behavioral and cognitive symptoms for the first time were ELECTROCONVULSIVE THERAPY traced directly to a curable infection. - Benjamin Franklin discovered accidentally, - Many mental health professionals then and then confirmed experimentally in the assumed that comparable causes and cures 1750s, that a mild and modest electric might be discovered for all psychological shock to the head produced a brief disorders. convulsion and memory loss (amnesia) but otherwise did little harm. JOHN P. GREY - Dutch friend of Franklin wondered if it - Grey’s position was that the causes of might be a useful treatment for insanity were always physical; therefore, the depression due to feeling of being mentally ill patient should be treated as “strangely elated” physically ill. - Hungarian psychiatrist Joseph von Meduna - Emphasis was again on rest, diet, and proper observed that schizophrenia was rarely found room temperature and ventilation, in individuals with epilepsy (which ultimately approaches used for centuries by previous did not prove to be true), with some of his therapists in the biological tradition. followers concluding that induced brain - Grey even invented the rotary fan to ventilate seizures might cure schizophrenia. his large hospital - Italian physicians Ugo Cerletti and Lucio Bini - Under Grey’s leadership, the conditions in suggested possible benefits of electric shocks hospitals greatly improved and they became - in 1938—a surgeon in London treated a more humane, livable institutions, but in depressed patient by sending six small shocks subsequent years they also became so large directly through his brain, producing and impersonal that individual attention was convulsions; the patient recovered. not possible - Although greatly modified, shock treatment is - It was almost 100 years before the community still with us today—the controversial modern mental health movement was successful in uses of electroconvulsive therapy are reducing the population of mental hospitals described in Chapter 7. with the controversial policy of deinstitutionalization, in which patients were DRUGS released into their communities. - With the discovery of Rauwolfia serpentine (later renamed reserpine) and another class of drugs called neuroleptics (major tranquilizers), for the first time hallucinatory SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 9 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH and delusional thought processes could be - By the end of the 1800s, a scientific approach diminished in some patients; these drugs to psychological disorders and their also controlled agitation and classification had begun with the search for aggressiveness. biological causes. - Other discoveries included benzodiazepines - Furthermore, treatment was based on humane (minor tranquilizers, Valium & Librium), principles. which seemed to reduce anxiety, but prescriptions somewhat decreased over time. THE PSYCHOLOGICAL TRADITION - Throughout the centuries, as Alexander and - Plato thought that the two causes of Selesnick point out, “The general pattern of maladaptive behavior were the social and drug therapy for mental illness has been one of cultural influences in one’s life and the initial enthusiasm followed by learning that took place in that environment. disappointment” - If something was wrong in the - For example, bromides, a class of environment, such as abusive parents, sedating drugs, were used at the end one’s impulses and emotions would of the 19th century and beginning of overcome reason. the 20th century to treat anxiety and - The best treatment was to reeducate other psychological disorders. the individual through rational - By the 1920s, they were reported as discussion so that the power of reason being effective. would predominate. - By 1928, one of every five - This was very much a precursor to prescriptions in the United States was modern psychosocial treatment for bromides. approaches to the causation of - When their side effects, including psychopathology, which focus not only various undesirable physical on psychological factors but also on symptoms, became widely known, and social and cultural ones. experience began to show that their - Other well-known early philosophers, including overall effectiveness was relatively Aristotle, also emphasized the influence of modest, bromides largely social environment and early learning on disappeared from the scene. later psychopathology. - Neuroleptics have also been used less as - These philosophers wrote about the attention has focused on their many side importance of fantasies, dreams, and effects, such as chronic tremors and shaking. cognitions and thus anticipated, to some - However, the positive effects of these drugs on extent, later developments in psychoanalytic some patients’ psychotic symptoms of thought and cognitive science. hallucinations, delusions, and agitation - They also advocated humane and revitalized both the search for biological responsible care for individuals with contributions to psychological disorders psychological disturbances. and the search for new and more powerful drugs, a search that has paid many dividends, MORAL THERAPY as documented in later chapters. - Moral therapy became influential; the term moral actually referred more to emotional or CONSEQUENCES psychological factors rather than to a code of - In the late 19th century, Grey and his conduct. colleagues ironically reduced or eliminated - Basic tenets included treating interest in treating mental patients, because institutionalized patients as normally as they thought that mental disorders were the possible in a setting that encouraged and result of some as yet undiscovered brain reinforced normal social interaction, thus pathology and were therefore incurable. providing them with many opportunities for - Emil Kraepelin (1856–1926) was the appropriate social and interpersonal contact. dominant figure during this period and one of - Relationships were carefully nurtured. the founding fathers of modern psychiatry SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 10 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH - Individual attention clearly emphasized - Increase in patients: this led to a rapid positive consequences for appropriate transition from moral therapy to custodial interactions and behavior, and restraint and care because hospitals were inadequately seclusion were eliminated. staffed - The principles of moral therapy date back to - Dix reformed asylums and single handedly Plato and beyond. inspired the construction of numerous new - The Greek Asclepiad Temples of the institutions here and abroad 6th century b.c. housed the chronically - 19th century—final blow to the practice of ill, including those with psychological moral therapy was the decision, that mental disorders—patients were well cared for, illness was caused by brain pathology and massaged, and provided with soothing was therefore incurable music. - 20th century - Evident as well in Muslim countries. - Psychoanalysis—elaborate theory of - Originated with the well-known French the structure of the mind and the role psychiatrist Philippe Pinel (1745–1826) and of unconscious processes in his close associate Jean-Baptiste Pussin determining behavior (1746–1811), who was the superintendent of - Behaviorism—associated with John the Parisian hospital La Bicêtre B. Watson, Ivan Pavlov and B.F - Moral therapy was introduced by Pinel Skinner, which focuses on how and followed by William Tuke in learning and adaptation affect the England. development of psychopathology - Benjamin Rush brought moral therapy to the US, transforming PSYCHOANALYTIC THEORY asylums from prisons to therapeutic environments. FRANZ ANTON MESMER - Horace Mann reported remarkable - Hypnotized / mesmerized by someone success of moral therapy at Worcester - Suggested that the problem of his patients was State Hospital. caused by an undetectable fluid found in all - Treatment led to significant reduction living organisms called “animal magnetism” in violent and destructive behaviors which could become blocked in patients. - Regarded as father of hypnosis, a - Moral therapy demonstrated state which extremely suggestible effectiveness in cases previously subjects appear to be in trance considered incurable. BENJAMIN FRANKLIN ASYLUM REFORM AND THE DECLINE OF MORAL - Put animal magnetism to test; patients receive THERAPY either magnetized water/non magnetized water - It was widely recognized that moral therapy with strong suggestions that they would get worked best when the number of patients in better an institution was 200 or fewer, allowing for a - Neither the patient nor the therapist knew great deal of individual attention which water was has magnetism which makes - Has an unlikely source. it a double-blind experiment - The great crusader Dorothea Dix campaigned - Animal magnetism was only a strong endlessly for reform in the treatment of insanity suggestion (her work became known as the mental hygiene movement) JEAN-MARTIN CHARCOT - Through her efforts, humane treatment - Demonstrated that some techniques of became more widely available in the US mesmerism were effective with a number of institutions—she was acknowledged as a hero psychological disorders, and he did much to in the 19th century legitimize the fledgling practice of hypnosis (hysteria) SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 11 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH JOSEF BREUER - Anna O. was a bright, attractive young woman - Experimented with a somewhat different who was perfectly healthy until she reached 21 hypnotic procedure years of age. - While patients are in highly suggestible state - Throughout his illness, Anna O. had cared for of hypnosis, Breuer asked his patients to him; she felt it necessary to spend endless describe their problems, conflicts, and fears hours at his bedside. in as much detail as they could - Five months after her father became ill, Anna - Observed important phenomenon during the noticed that during the day her vision blurred process: and that from time to time she had difficulty - Patients often became extremely moving her right arm and both legs. emotional as they talked and felt quite - Soon, additional symptoms appeared. relieved and improved after emerging - She began to experience some difficulty from the hypnotic state speaking, and her behavior became - Seldom would they have gained an unpredictable. understanding of the relationship - Shortly thereafter, she consulted Breuer between the emotional problems and - Breuer dealt with one symptom at a time their psychological disorder through hypnosis and subsequent “talking - Material seemed to be beyond the through,” tracing each symptom to its awareness of the patient hypothetical causation in circumstances - Breuer and Freud had discovered the surrounding the death of Anna’s father. unconscious mind and its apparent - One at a time, her “hysterical” ailments influence on the production of disappeared, but only after treatment was psychological disorders administered for each respective behavior. - Catharsis—therapeutic to recall and relieve emotional trauma that has been made THREE MAJOR FACETS OF PSYCHOANALYTIC unconscious and to release the accompanying THEORY tension; release of emotional material - Structure of the mind and the distinct - Fuller understanding of the relationship functions of personality that sometimes clash between current emotions and earlier with another events is referred to as insight - Defense mechanisms with which the mind - Freud and Breuer’s theories were based on defends itself from these clashes/conflicts case observations, some of which were made - Stages of early psychosexual development in a systematic way that provides grist for the mill of our inner - Breuer dealt with one symptom at a time conflicts through hypnosis and subsequent “talking through,” tracing each symptom to its THE STRUCTURE OF THE MIND hypothetical causation in circumstances - Freud conceptualized the mental structures - The process of treating one behavior at a time described in this section to explain fulfills a basic requirement for drawing unconscious processes. scientific conclusions about the effects of - He believed that the id and the superego are treatment in an individual case study almost entirely unconscious. - Freud’s basic principles of mental functioning that he originally proposed remained constant through his writings and are still applied by psychoanalysts today ANNA O. - An excellent example is Breuer’s classic description of his treatment of “hysterical” symptoms in Anna O. in 1895 SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 12 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH DEFENSE MECHANISMS ID - Source of our strong sexual - Conflicts produce anxiety that threatens to (PLEASURE and aggressive feelings or overwhelm the ego PRINCIPLE) energies - Unconscious protective processes that - Libido—energy/drive within the keep primitive emotions associated with id conflicts in check so that the ego can - Thanatos—death instinct continue its coordinating function - Two basic drives, toward life - Anna Freud further conceptualized it and fulfillment on the one hand - They are sometimes adaptive and and death and destruction on maladaptive the other, are continually in opposition - Overriding goal of maximizing DENIAL - Refuses to acknowledge some pleasure and eliminating any aspects of objective associated tension/conflicts reality/subjective - Goal of pleasure, which is prominent in childhood, often DISPLACE- - Transfers a feeling about, or a conflicts with social rules and MENT response to an object that regulations causes discomfort onto another, - Primary process—this type of usually less threatening, object thinking is emotional, irrational, or person illogical, filled with fantasies, - Ego adaptively decides that and preoccupied with sex, expressing primitive anger to aggression, selfishness, and someone envy PROJEC- - Falsely attributes own EGO - We must find ways to meet our TION unacceptable feelings, (REALITY basic needs without offending impulses, or thoughts to another PRINCIPLE) everyone around us individual/object - Cognitive operations/thinking styles of the ego are RATIONALI- - Conceals the true motivations characterized by logic and ZATION for actions, thoughts/feelings reason and are referred to as through elaborate the secondary process, as reassuring/self-serving but opposed to the primary process incorrect explanations - Role: mediate conflict between the id and the superego, REACTION - Substitutes behavior, juggling their demands with the FORMATION thoughts/feelings that are the realities of the world direct opposite of unacceptable - Executive/manager of our ones minds SUBLIMA- - Directs potentially - Intrapsychic TION maladaptive feelings/impulses conflicts—conflicts within the into socially acceptable mind, if the id and superego is behavior; more constructive strong outlet SUPEREGO - Counteract the potentially dangerous aggressive and - Phobic and obsessive symptoms are sexual drives of the id, the especially common self-defeating defensive basis for conflict is readily reactions that reflect an inadequate attempt apparent to deal with an internally dangerous situation. SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 13 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH - Phobic symptoms typically incorporate HEINZ KOHUT elements of danger - Focused on the theory of the formation of - Defense mechanisms may be of potential self-concept and the crucial attributes of the import in the study of psychopathology self that allow an individual to progress toward - Coping styles—contemporary terminology of health/conversely, to develop neurosis defense mechanisms - Psychoanalytic approach in known as self psychology PSYCHOSEXUAL STAGES OF DEVELOPMENT - Have a profound and lasting impact OBJECT RELATION - Freud as one of the first to take a - The study how children incorporate the developmental perspective on the study images, memories and sometimes the values abnormal behavior of a person who was important to them and - Oral, anal, phallic, latency and genital to whom they are (or are) emotionally period—represents distinctive patterns of attached to gratifying our basic needs and satisfying our - Object—refers to the important people drive for physical pleasure - Introjection—process of incorporation - If we did not receive appropriate - Introjected objects can become an integrated gratification during a specific stage/if a part of the ego/may assume conflicting roles specific stage left a particularly strong in determining the identity/self impression (fixation), an individual’s - In this theory, you tend to see the world personality would reflect throughout adult through the eyes of the person life incorporated into yourself - Adult personality characteristic - It focuses on how these disparate images (oral)—dependency, passivity, rebellious and come together to make up a person’s identity cynicism and on the conflicts that may emerge - Early genital stimulation (phallic stage) - Oedipus complex CARL JUNG AND ALFRED ADLER - Electra complex - Rejected Freud’s ideas and form their own - Castration anxiety school of thought - Penis envy—conflict is resolved when - Jung introduced collective females develop healthy heterosexual unconscious—wisdom accumulated by relationships and look forward to having society and culture that is stored deep in a baby, which he viewed as healthy individual memories and passed down from substitute for having a penis generation to generation - Neuroses—disorders of the nervous system - He also suggested the spiritual and religious drives are as much as a part LATER DEVELOPMENTS IN PSYCHOANALYTIC of human nature as are sexual drives THOUGHT - Continues to draw attention to mystics ANA FREUD - Emphasized the importance of - Concentrated on the defensive reactions of enduring personality traits such as the ego determine our behavior introversion (shy and withdrawn) and - Ego psychology extroversion (tendency to be friendly - Individual slowly accumulates adaptational and outgoing) capacities, skill in reality testing, and defenses - Adler—created the term inferiority complex - Abnormal behavior develops when the ego is - Both believed the basic quality of deficient in regulating such functions as human nature is positive and that there delaying and controlling impulses/in is a strong drive toward self- marshaling appropriate normal defenses to actualization (realizing one’s own strong internal conflicts potential) - They also believed that by removing barriers to both internal and external SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 14 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH growth the individual would improve unless the underlying conflict was dealt with and flourish adequately, because another symptom may emerge ERIK ERIKSON - Greatest contribution was his theory of PSYCHODYNAMIC PSYCHOTHERAPY development across the lifespan, in which - Focus on affect and the expression of he described in some detail the crises and patients’ emotions conflicts that accompany eight specific stages - Exploration of patients’ attempts to avoid (stages of psychosocial development) topics/engage in activities that hinder the progress of therapy PSYCHOANALYTIC PSYCHOTHERAPY - Identification of patterns in patients’ actions, - Designed to reveal the nature of thoughts, feelings, experiences, and unconscious process and conflict through relationships catharsis and insight - Emphasis on past experiences - Free association—patients are instructed to - Patients’ interpersonal experiences say whatever comes to mind without the - Emphasis on therapeutic relationship usual socially required censoring - Exploration of patients’ wishes, dreams or - Intended to reveal emotionally fantasies charged material that may be - It is significantly briefer than classical repressed because of too psychoanalysis painful/threatening to bring into - Psychodynamic therapists deemphasize the consciousness goal of personality reconstruction, focusing - Couch is the symbol for psychotherapy instead on relieving the suffering associated - Dream analysis—therapist interprets the with psychological disorders contents of the dreams, supposedly reflecting the primary process thinking of the COMMENTS id - Psychoanalysis is of historical interest more - Often difficult because the patient may than current interest, and classical resist the efforts of the therapist to psychoanalysis as a treatment has been uncover repressed and sensitive diminishing in popularity for years conflicts - Major criticism: basically unscientific, relying - Goal: help patients gain insight into on reports by the patient of events that the nature of the conflicts happened years ago - Psychoanalyst—relationship of the therapist - Events have been filtered out through and the patient experiences of the observer and then - Transference—patients come to relate to the interpreted in ways that certainly could be therapist much as they did to important figures questioned and might differ from one analyst to in the childhood, particularly parents another - Patients who resent therapist but can verbalize - No careful measurement of any of these no good reason for it may be reenacting psychological phenomena and no obvious way childhood resentment toward a parent to prove/disprove the basic hypotheses of - Countertransference—therapist project psychoanalysis some of their own personal issues and - Measurement and the ability to feelings, usually positive to the patient prove/disprove a theory are the foundations - Therapist are trained to deal with their own of the scientific approach feelings as well as those of their patients, it is strictly against all ethical canons of the HUMANISTIC THEORY mental health professions to accept - Jung and Adler emphasized the positive, overtures from patients that might lead to optimistic side of human nature relationship outside therapy - Symptom substitution—eliminating phobia/depressive episode would be little use SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 15 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH - Adler believed that we all strive to reach - They stressed unique, non superior levels of intellectual and moral quantifiable experiences of the development individual, emphasizing that people are - Self-actualizing—assumption that all of us more different than alike could reach our highest potential, in all areas - This model found its greatest of functioning, if only we had the freedom to application among individuals grow; every person is basically good and without psychological disorders whole, most blocks originated outside the individual BEHAVIORAL MODEL - Abraham Maslow—postulated the hierarchy - Also known as the cognitive-behavioral of needs; he hypothesized that we cannot model or social learning model progress up the hierarchy until we have satisfied the needs at lower levels PAVLOV AND CLASSICAL CONDITIONING - Carl Rogers—originated person-centered - Classical conditioning—type of learning in therapy (the therapist takes a passive role, which a neutral stimulus is paired with a making as few interpretations as possible, response until it elicits that response giving the individual a chance to develop - Conditioning (conditioned response)—a during the course of therapy, unfettered by response that occurred only on the condition threats to the self) of the presence of a particular - Humanistic theorists have the faith in event/situation (stimulus) the ability of human relations to foster - Conditioning is one way we acquire new this growth information, particularly information that is - Unconditional positive somewhat emotional in nature regard—complete and almost - Stimulus generalization—responses unqualified acceptance of most of the generalize to similar stimuli; this particular client’s feelings and actions, is critical to reaction is distressing and uncomfortable, the humanistic approach particularly if it associated with a variety of - Empathy—sympathetic objects/situations understanding of the individual’s - Classical conditioning process begins with a particular view of the world stimulus that would elicit a response in - Result of the therapy is that clients will almost anyone and requires no learning; no be more straight-forward and honest conditions must be present for the response to with themselves and will access their occur innate tendencies toward growth - Humanistic approach has had a substantial effect on theories of interpersonal relationships. - This also emphasized the importance of the therapeutic relationship in a way quite different from Freud’s approach - Humanistic therapists believed that relationships, including the therapeutic relationship, were the single most positive influence in - CR can be learned in one trial. facilitating human growth - Most learning of this type requires repeated - The humanistic model contributed little new pairing of the UCS and the CS information to the field of psychopathology. - Presentation of the CS without a stimulus for a - They had little interest in doing long period of time would eventually research that would discover/create eliminate the CR. new knowledge - This process is called extinction SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 16 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH EDWARD TITCHENER chose was relaxation because it was - Emphasized the study of introspection convenient - Subjects simply reported on their inner - Wolpe, Eysenck, and Stanley thoughts and feelings after experiencing Rachman—called the approach behavior certain stimuli, but the results of this therapy (use of desensitization and the “armchair” psychology were inconsistent wide-scale applications of the new science and discouraging to many experimental of behaviorism of psychopathology) psychologists - Wolpe’s procedures are seldom used today, but they paved way for modern-day fear and WATSON AND THE RISE OF BEHAVIORISM anxiety reduction procedures in which - John B. Watson—founder of behaviorism severe phobias can be eliminated as little as 1 - He decided to base psychology on day introspection - “Psychology, as the behaviorist views it, is a B.F SKINNER AND OPERANT CONDITIONING purely objective experimental branch of natural - The Behavior of Organisms (principles of science. Its theoretical goal is prediction and operant conditioning, a type of learning in control of behavior. Introspection forms no which behavior changes as a function of what essential part of this methods” follows the behavior) - Little Albert experiment—considered - Walden Two—depicts a fictional society run on unethical in today’s standards, and it turns out the principles of operant conditioning Albert may have also had some neurological - Beyond Freedom and Dignity—he lays out a impairment that could contribute to developing broader statement of problems facing our fear culture and suggests solutions based on his - Mary Cover Jones—thought that if fear could own view of a science of behavior be learned/classically conditioned in this way, - Influenced by Edward L. Thorndike perhaps it could also be - Law of effect—behavior is either unlearned/extinguished strengthened (likely to be repeated more frequently) or weakened (likely to THE BEGINNINGS OF BEHAVIOR THERAPY occur less frequently) depending on the - Joseph Wolpe—became dissatisfied with consequences of that behavior prevailing psychoanalytic interpretations of - Skinner coined the term operant conditioning psychopathology and began looking for because behavior operates on the something else environment and changes it in some ways. - Systematic desensitization—similar to - Most things that we do socially provide the treatment of little Peter (fear is gradually context for other people to respond to us in unlearned): individuals were gradually one way or another, thereby providing introduced to objects/situations they feared consequences for our behavior. so that their fear could extinguish; they could - The same is true of our physical environment, test reality and see that nothing bad happened although consequences may be long term in the presence of the phobic object/scene - Reinforcement—“reward” because it - Also added another element by having connotes the effect of behavior patients do something that was - All our behavior is governed to some incompatible with fear while they degree of reinforcement, which can were in the presence of the dread be arranged in an endless variety of object/situation ways, in schedules of reinforcements - Because he could not always - Using punishment as a consequence reproduce the phobic object in his is relatively ineffective in the long office, he had his patients carefully run and that the primary way to and systematically imagine the develop new behavior is to positively phobic scene, and the response he reinforce desired behavior SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 17 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH - Skinner did not see the need to go beyond - Increasing sophistication of scientific the observable behavior and quantifiable to tools and methodology establish a satisfactory science of behavior - Realization that no one - Skinner did not deny the influence of influence—biological, behavioral, biology or the existence of subjective cognitive, emotional/social—even states of emotion/cognition; he simply occurs in isolation explained these phenomena as relatively - Our behavior, both normal and abnormal, is the inconsequential side effects of a particular product of a continual interaction of history of reinforcement psychological, biological, and social - Shaping—a process of reinforcing influences successive approximations to a final - Adolf Meyer—considered the dean of behavior or set of behaviors American psychiatry - Pavlov, Watson, and Skinner contributed - He emphasized the equal significantly to behavior therapy, in which contributions of biological, scientific principles of psychology are applied psychological, and sociocultural to clinical problems. determinism COMMENTS TIMELINE - Behavioral model is incomplete and inadequate to account for what we know 400 Hippocrates suggests that psychological about psychopathology BC disorders have both biological and - Disorders were considered environmentally psychological causes. determined reactions - This model also accounts for development of 200 Galen suggests that normal and abnormal psychopathology across the lifespan CE behaviors are related to four bodily fluids, or humors. THE PRESENT: THE SCIENTIFIC METHOD AND AN INTEGRATIVE APPROACH 1300s Superstition runs rampant, and mental - Supernatural explanations have little disorders are blamed on demons and influence on scientists and other professionals witches; exorcisms are performed to rid - Biological, psychoanalytic, and behavioral victims of evil spirits. models continue to further our knowledge of psychopathology 1400s Enlightened view that insanity is caused by - Scientific methods were not often applied mental or emotional stress gains to the theories and treatments within a momentum, and depression and anxiety tradition, mostly because methods would are again regarded by some as have produced evidence necessary to disorders. confirm/disprove the theories and treatments had not been developed (this leads to people 1400- Bloodletting and leeches are used to rid believing to various fads and superstitions that 1800 the body of unhealthy fluids and restore proved to be untrue/useless) chemical balance. - Health professionals tend to look as psychological disorders narrowly, from their 1500s Paracelsus suggests that the moon and own point of view alone the stars, not possession by the devil, - Watson assumed that all behaviors, including affect people’s psychological functioning. disordered behavior, were the result of psychological and social influences and 1793 Philippe Pinel introduces moral therapy that the contribution of biological factors was and makes French mental institutions inconsequential more humane. - Developments that shed light to the nature of psychopathology SOURCE: ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH (8TH EDITION)—BARLOW, DURAND, HOFMANN 18 MODULE 1.1—DEFINITION AND HISTORY | ABPSYCH 1825- Syphilis is differentiated from other types 1950 The first effective drugs for severe 1875 of psychosis in that it is caused by a psychotic disorders are developed. specific bacterium; ultimately, penicillin is Humanistic psychology (based on ideas found to cure syphilis. of Carl Jung, Alfred Adler, and Carl Rogers) gains some acceptance. 1848 Dorothea Dix successfully campaigns for more humane treatment in US mental 1952 The first edition of the Diagnostic and institutions. Statistical Manual (DSM-I) is published. 1854 John P. Grey, head of New York’s Ultica 1958 Joseph Wolpe effectively treats patients Hospital, believes that insanity is the with phobias using systematic result of physical causes, thus desensitization based on principles of de-emphasizing psychological treatments. behavioral science. 1870 Louis Pasteur develops his germ theory 1968 DSM-II is published. of disease, which helps identify the bacterium that causes syphilis. 1980 DSM-III is published. 1895 Josef Breur treats the “hysterical” Anna 1987 DSM-III-R is published. O., leading to Freud’s development of psychoanalytic theory.