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Chapter Outline Judy’s Case Abnormal Behavior in...

Chapter Outline Judy’s Case Abnormal Behavior in Understanding Psychopathology Judy, a 16-year-old, was referred to our anxiety disorders clinic after increasing episodes of fainting. About 2 years earlier, in Judy’s first biology The Supernatural Tradition class, the teacher had shown a movie of a frog dissection to illustrate Historical Context The Biological Tradition various points about anatomy. This was a particularly graphic film, with vivid images of blood, tissue, and muscle. About halfway through, Judy felt a bit lightheaded and left the The Psychological Tradition room. But the images did not leave her. She continued to be bothered by them and occasionally felt slightly queasy. She began to avoid situations in which she might see blood or injury. She stopped looking at magazines Instructor: Keisha Charisse O. Digon that might have gory pictures. She found it difficult to look at raw meat, or even Band-Aids, because they brought the feared images to mind. Eventually, anything her friends or parents said that evoked an image of blood or injury caused Judy to feel lightheaded. It got so bad that if one of her friends exclaimed, “Cut it out!” she felt faint. …cont. Psychological Disorder Psychological Dysfunction Beginning about 6 months before her visit to the clinic, Judy actually fainted when she A psychological dysfunction within an individual associated with unavoidably encountered something bloody. Her family physician could find nothing wrong with her, nor could several other physicians. By the time she was referred to our clinic she was fainting distress or impairment in functioning and a response that is not 5 to 10 times a week, often in class. Clearly, this was problematic for her and disruptive in school; typical or culturally expected. each time Judy fainted, the other students flocked around her, trying to help, and class was Refers to a breakdown in cognitive, interrupted. Because no one could find anything wrong with her, the principal finally concluded that she was being manipulative and suspended her from school, even though she was an honor emotional, or behavioral student. 4Ds of Abnormal Behavior functioning. Judy was suffering from what we now call blood– injection–injury phobia. Her reaction was Dysfunction quite severe, thereby meeting the criteria for phobia, a psychological disorder characterized by Distress marked and persistent fear of an object or situation. But many people have similar reactions that are not as severe when they receive an injection or see someone who is injured, whether blood is Deviant visible or not. For people who react as severely as Judy, this phobia can be disabling. They may Danger avoid certain careers, such as medicine or nursing, and, if they are so afraid of needles and injections that they avoid them even when they need them, they put their health at risk.  Personal Distress or Impairment Atypical or Not Culturally Expected Danger That the behavior must be associated with The criterion that the response distress to be classified as abnormal adds be atypical or not culturally an important component and seems clear: the criterion is satisfied if the individual is expected is important but also extremely upset. insufficient to determine The judgment of a person who The concept of impairment is useful, abnormality by itself. At times, has a mental disorder is so although not entirely satisfactory. For example, many people consider something is considered impaired that he is unable to themselves shy or lazy. This doesn’t mean understand his need for that they’re abnormal. But if you are so abnormal because it occurs shy that you find it impossible to date or infrequently; it deviates from the treatment even interact with people and you make every attempt to avoid interactions even average. though you would like to have friends, then your social functioning is impaired. An Accepted Definition The Science of Psychopathology Clinical Description The most widely accepted definition used in DSM-5 describes Psychopathology is the scientific In hospitals and clinics, we often say that a patient “presents” with a behavioral, psychological, or biological dysfunctions that are study of psychological disorders. specific problem or set of problems or we discuss the presenting unexpected in their cultural context and associated with present Within this field are specially problem. distress and impairment in functioning, or increased risk of suffering, trained professionals, including A clinical description represents the unique combination of death, pain, or impairment. clinical and counseling behaviors, thoughts, and feelings that make up a specific disorder. psychologists, psychiatrists, psychiatric social workers, and Prevalence is the number of people in the population as a whole have psychiatric nurses, as well as the disorder. marriage and family therapists Incidence refers to the statistics on how many new cases occur during and mental health counselors. a given period, such as a year  In addition to having different symptoms, age of onset, and possibly a different sex ratio and prevalence, most disorders Prognosis and Etiology Historical Conceptions of follow a somewhat individual pattern, or course. For Prognosis refers to the anticipated course of a disorder. Abnormal Behavior example, some disorders, such as schizophrenia, follow a chronic course, meaning that they tend to last a long time, Etiology, or the study of origins, has to do with why a disorder begins sometimes a lifetime. Other disorders, like mood disorders, (what causes it) and includes biological, psychological, and social dimensions. follow an episodic course, in that the individual is likely to recover within a few months only to suffer a recurrence of the disorder at a later time. This pattern may repeat throughout a person’s life. Still other disorders may have a time-limited course, meaning the disorder will improve without treatment in a relatively short period. The Supernatural Tradition The Supernatural Tradition The Supernatural Tradition Although many have thought that the mind can influence the body and, in turn, Common treatments were rest, sleep, and a healthy and happy environment. In the Middle Ages, if exorcism failed, some authorities thought that steps were the body can influence the mind, most philosophers looked for causes of abnormal Other treatments included baths, ointments, and various potions. necessary to make the body uninhabitable by evil spirits, and many people were behavior in one or the other. This split gave rise to two traditions of thought about In the 14th century, one of the chief advisers to the king of France, a bishop and subjected to confinement, beatings, and other forms of torture. abnormal behavior, summarized as the biological model and the psychological Mass hysteria may simply demonstrate the phenomenon of emotion contagion, philosopher named Nicholas Oresme, also suggested that the disease of model. melancholy (depression) was the source of some bizarre behavior, rather than in which the experience of an emotion seems to spread to those around us. During the last quarter of the 14th century, religious and lay authorities supported demons. these popular superstitions and society as a whole began to believe more strongly Paracelsus, a Swiss physician who lived from 1493 to 1541, rejected notions of in the existence and power of demons and witches. The Catholic Church had split, As we see in the handling of the severe psychological disorder experienced by possession by the devil, suggesting instead that the movements of the moon and and a second center, complete with a pope, emerged in the south of France to late - 14th century King Charles VI of France, both influences were strong, stars had profound effects on people’s psychological functioning. compete with Rome. In reaction to this schism, the Roman Church fought back sometimes alternating in the treatment of the same case. King Charles VI of The Roman Catholic Church requires that all healthcare resources be exhausted against the evil in the world that it believed must have been behind this heresy. France was under a great deal of stress, partly because of the division of the first before spiritual solutions such as exorcism can be considered. Catholic Church. A variety of remedies and rituals of all kinds were tried, but Treatments included exorcism, in which various religious rituals were performed in none worked. an effort to rid the victim of evil spirits.  The Biological Tradition The Biological Tradition The Biological Tradition The Greek physician Hippocrates is considered to be the father of modern One of the more interesting and influential legacies of the Hippocratic - Terms derived from the four humors are still sometimes applied to Western medicine. He and his associates left a body of work called the Galenic approach is the humoral theory of disorders. personality traits. For example, sanguine (literal meaning “red, like blood”) Hippocratic Corpus, written between 450 and 350 BC, in which they suggested describes someone who is ruddy in complexion, presumably from copious that psychological disorders could be treated like any other disease. Hippocrates assumed that normal brain functioning was related to four blood flowing through the body, and cheerful and optimistic, although Hippocrates considered the brain to be the seat of wisdom, consciousness, bodily fluids or humors: blood, black bile, yellow bile, and phlegm. insomnia and delirium were thought to be caused by excessive blood in intelligence, and emotion. Therefore, disorders involving these functions would Blood came from the heart, black bile from the spleen, phlegm from the the brain. logically be located in the brain. brain, and choler or yellow bile from the liver. Melancholic means depressive (depression was thought to be caused by Hippocrates also recognized the importance of psychological and interpersonal Physicians believed that disease resulted from too much or too little of one black bile flooding the brain). contributions to psychopathology, such as the sometimes negative effects of of the humors; for example, too much black bile was thought to cause family stress; on some occasions, he removed patients from their families. A phlegmatic personality (from the humor phlegm) indicates apathy and melancholia (depression). sluggishness but can also mean being calm under stress. The Roman physician Galen, later adopted the ideas of Hippocrates and his The humoral theory was, perhaps, the first example of associating associates and developed them further, creating a powerful and influential psychological disorders with a “chemical imbalance”, an approach that is A choleric person (from yellow bile or choler) is hot tempered. school of thought within the biological tradition that extended well into the 19th widespread today. King Charles VI’s physician moved him to the less stressful countryside was century. to restore the balance in his humors. The Biological Tradition The Biological Tradition The Biological Tradition In addition to rest, good nutrition, and exercise, two treatments were Hippocrates also coined the word hysteria to describe a concept he John P. Grey’s position was that the causes of insanity were always physical. learned about from the Egyptians, who had identified what we now call the Therefore, the mentally ill patient should be treated as physically ill. The developed. In one, bleeding or bloodletting, a carefully measured amount somatic symptom disorders. In these disorders, the physical symptoms emphasis was again on rest, diet, and proper room temperature and ventilation, of blood was removed from the body, often with leeches. The other was to approaches used for centuries by previous therapists in the biological tradition. induce vomiting; indeed, in a well-known treatise on depression published appear to be the result of a medical problem for which no physical cause can be found, such as paralysis and some kinds of blindness. In the 1930s, the physical interventions of electric shock and brain surgery were in 1621, Anatomy of Melancholy, Robert Burton recommended eating often used. Benjamin Franklin made numerous discoveries during his life with tobacco and a half-boiled cabbage to induce vomiting. Behavioral and cognitive symptoms of what we now know as advanced which we are familiar, but most people don’t know that he discovered syphilis, a sexually transmitted disease caused by a bacterial accidentally, and then confirmed experimentally in the 1750s, that a mild and In ancient China and throughout Asia, a similar idea existed. But rather microorganism entering the brain, include believing that everyone is modest electric shock to the head produced a brief convulsion and memory loss than “humors,” the Chinese focused on the movement of air or “wind” plotting against you (delusion of persecution) or that you are God (delusion (amnesia) but otherwise did little harm. throughout the body. Unexplained mental disorders were caused by of grandeur), as well as other bizarre behaviors. Emil Kraepelin was the dominant figure during this period and one of the blockages of wind or the presence of cold, dark wind (yin) as opposed to Louis Pasteur’s germ theory of disease, developed in about 1870, founding fathers of modern psychiatry. He was extremely influential in advocating warm, life-sustaining wind (yang). Treatment involved restoring proper facilitated the identification of the specific bacterial microorganism that the major ideas of the biological tradition, but he was little involved in treatment. flow of wind through various methods, including acupuncture. caused syphilis. His lasting contribution was in the area of diagnosis and classification.  The Psychological Tradition The Psychological Tradition The Psychological Tradition During the first half of the 19th century, a strong psychosocial approach to Asylums had appeared in the 16th century, but they were more like Franz Mesmer suggested to his patients that their problem was caused by an mental disorders called moral therapy became influential. The term moral undetectable fluid found in all living organisms called “animal magnetism”, which actually referred more to emotional or psychological factors rather than to a prisons than hospitals. It was the rise of moral therapy in Europe and the could become blocked. code of conduct. Its basic tenets included treating institutionalized patients as United States that made asylums habitable and even therapeutic. normally as possible in a setting that encouraged and reinforced normal social Mesmer is widely regarded as the father of hypnosis, a state in which extremely interaction. Unfortunately, after the mid-19th century, humane treatment declined suggestible subjects sometimes appear to be in a trance. Moral therapy as a system originated with the well-known French psychiatrist because of a convergence of factors. First, it was widely recognized that Many distinguished scientists and physicians were interested in Mesmer’s Philippe Pinel and his close associate Jean-Baptiste Pussin. powerful methods of suggestion. One of the best known, Jean - Martin Charcot. moral therapy worked best when the number of patients in an institution A distinguished neurologist, Charcot demonstrated that some techniques of When Pinel arrived in 1791, Pussin had already instituted remarkable reforms by was 200 or fewer, allowing for a great deal of individual attention. mesmerism were effective with a number of psychological disorders, and he did removing all chains used to restrain patients and instituting humane and much to legitimize the fledgling practice of hypnosis. positive psychological interventions. Pussin persuaded Pinel to go along with the A second reason for the decline of moral therapy has an unlikely source. changes. A close second was their discovery that it is therapeutic to recall and relive The great crusader Dorothea Dix campaigned endlessly for reform in the emotional trauma that has been made unconscious and to release the After William Tuke followed Pinel’s lead in England, Benjamin Rush, often treatment of insanity. accompanying tension. This release of emotional material became known as considered the founder of U.S. psychiatry, introduced moral therapy in his early catharsis. work at Pennsylvania Hospital.