chapter 1 abnormal behavior in historical context

1. Chapter 1

3. Myths and Misconceptions About Abnormal Behavior No Single Definition of Psychological Abnormality No Single Definition of Psychological Normality Many Myths Are Associated With Mental Illness Lazy, crazy, dumb Weak in character Dangerous to self or others Mental illness is a hopeless situation

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

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

6. Approaches to Defining Abnormal Behavior Does Strangeness Define Abnormality? Someone who breaks social norms is considered strange; however, this concept changes with time. Naked Guy, crying after 911, fashion.

7. Approaches to Defining Abnormal Behavior Does the Behavior Itself Define Abnormality? Andrea Yates; Britney Spears. The �celebrity effect� of Michael Jackson, Tom Cruise, Marv Albert.

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

9. Psychological Dysfunction Breakdown in cognitive, emotional, or behavioral functioning Personal Distress Difficulty performing appropriate and expected roles Impairment is set in the context of a person�s background Atypical or Unexpected Cultural Response Reaction is outside cultural norms

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

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

12. Approaches to the Scientific Study ofPsychological Disorders Mental Health Professionals The Ph.D.�s: Clinical and counseling psychologists The Psy.D.�s: Clinical and counseling �Doctors of Psychology� M.D.�s: Psychiatrists M.S.W.�s: Psychiatric and non-psychiatric social workers MN/MSN�s: Psychiatric nurses The lay public and community groups

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

14. The Past: Historical Conceptions of Abnormal Behavior Although Psychological Disorders Have Existed In all cultures Across all time periods Assumed Causes and Treatment of Abnormal Behavior Have Varied Widely Across cultures Across time periods Depending on prevailing paradigms or world views

15. The Past: Historical Conceptions of Abnormal Behavior Three Dominant Traditions/Worldviews Include Supernatural Biological Psychological Not necessarily linear; we tend to move recursively through these traditions at different points in time.

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

17. The Past: Abnormal Behavior and the Supernatural Tradition Example of mass hysteria in the U.S.?

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

19. The Past: Abnormal Behavior and the Supernatural Tradition What really happened? Most believe that the abnormal behaviors exhibited by people during this era were caused by a psychoactive �psychedelic� substance�ergot poisoning.

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

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

22. The Past: Abnormal Behavior and the Biological Tradition Hippocrates: Greek physician born 460 b.c. However, he also suggested that emotional disorders were partly genetic (true), possibly caused by brain pathology or head trauma (true), or stress (true).

23. The Past: Abnormal Behavior and the Biological Tradition Galen Extends Hippocrates Work (129-200 a.d.) Humoral theory of mental illness First animal researcher Knew the importance of the brain in mental health

24. The Past: Abnormal Behavior and the Biological Tradition Galen�s �humors� (fluids in the body): Blood: ruddy, cheerful, optimistic Black bile: melancholy, depressed, gloomy Yellow bile: angry, irate, irascible Phlegm: apathetic, stoic, numb. If the fluids were out of balance: disorder of the mind For instance, domestic violence caused by too much yellow bile; depression by too much black bile.

25. The Past: Abnormal Behavior and the Biological Tradition Treatments remained crude - bloodletting, leeches, stimulating kidneys by drinking salt water, induced vomiting, deep breathing to �soothe the soul,� etc. but also involved manipulating the environment in an attempt to correct levels of the humors.

26. The Past: Abnormal Behavior and the Biological Tradition Galenic-Hippocratic Tradition Linked abnormality with brain chemical imbalances Foreshadowed modern �medical model� of emotional disorders.

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

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

29. The Past: Historical Conceptions of Abnormal Behavior Three Dominant Traditions Include Supernatural - evil spirits or outer force, morality-based. Biological - physical abnormality, biologically-based. Psychological - social distress, mentally-based. Not necessarily linear; we tend to move recursively through these traditions at different points in time.

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

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

34. The Present: The Scientific Method andan Integrative Approach Defining Abnormal Behavior Is complex, multifaceted, and also has evolved over time as more scientific data is gathered. The Supernatural Tradition Has no place in a science of abnormal behavior.

35. The Importance of Research Our therapies must be tested in well-controlled research studies; otherwise we don�t know if they work or not!

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

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

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

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

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

41. Approaches to the Scientific Study ofPsychological Disorders So, all mental health care workers are committed to science and research. But what makes them different? Refer to models.doc handout�