Historical Approaches to Abnormal Behavior, Part II January 20, 2012 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D.

1. Historical Approaches toAbnormal Behavior, Part IIJanuary 20, 2012PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

2. Postpartum OCD: Clarification Abramowitz, Schwartz, & Moore (2003)

3. From Last Class • What is a disease? • Are mental disorders diseases? • How could we know if mental disorders are diseases? • Does it matter if we call mental disorders diseases?

4. Disorder vs. Illness vs. Disease • What’s in a name? • Psychological problem • Mental disorder • Mental illness • Brain disease

5. Disorder vs. Illness vs. Disease • Implications for: • Stigma for having mental disorder • Stigma as parent of person with mental disorder • Public attitudes toward mental disorder • Perceptions of the controllability and chronicity of mental disorders • Selection of, and attitudes toward, different treatments

6. Disease Model and Stigma • “A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence” (Pescosolido et al, 2010) http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2010.09121743v1 • Reviewed changes in causal beliefs and stigma from 1996 to 2006 related to schizophrenia, depression, and alcohol dependence

7. Major Findings • Endorsement of biological causes increased • For depression: • Mental illness: 65% to 72% • Chemical imbalance: 67% to 80% • Genetic problem: 51% to 64% • For schizophrenia: • Mental illness: 85% to 91% • Chemical imbalance: 78% to 87% • Genetic problem: 61% to 71%

8. Major Findings • Endorsement of medical treatment (physician, psychiatrist, medication) increased • Stigma (desire for social distance and perceptions of dangerousness) did not decrease • Stigma actually worsened for schizophrenia

9. Major Findings • “…holding a neurobiological conception of mental illness either was unrelated to stigma or increased the odds of a stigmatizing reaction….In no instance was a neurobiological conception associated with significantly lower odds of stigma.”

10. Authors’ Conclusions • “What appears to have been mistaken is the assumption that global change in neuroscientific beliefs would translate into global reductions in stigma. Our analyses suggest that even if the embrace of neuroscience had been more pronounced, a significant and widespread reduction in stigma would not have followed.”

11. The Nature of Stigma • Stigma is multifaceted (Hayward & Bright, 1997) • Responsibility for one’s disorder (blame) • Unpredictability • Dangerousness • Desire for social distance • Prognosis (curability, chronicity)

12. Biological Explanations and Stigma • Summary of research findings from correlational and experimental studies • 1. Biological explanations reduce blame • 2. They worsen negative attitudes regarding: • Unpredictability • Dangerousness • Fear and desire for social distance • Poor prognosis Read (2007); Read, Haslam, Sayce, & Davies (2006)

13. Insanity – Not a Mental Disorder • A legal term, not a psychological term • American Law Institute Standard Criteria: • Persons has a mental illness • Can’t distinguish right from wrong • Cannot control behavior • Diminished capacity (absence of criminal intent)

14. Mental Health Professions • Clinical and counseling psychologists (Ph.D. or Psy.D.) • Psychiatrists (M.D.) • Social workers • Counselors • Psychiatric nurses • Marriage and family therapists

15. Getting into Graduate School in Clinical Psychology • Undergraduate course work • GPA, overall, last 2 years, and in major • GRE, both general and psychology tests • Research/scholarly experience • Clinically-relevant experience • Strong letters of recommendation • Personal statement • Clearly articulated research interests that match with a faculty member combined (ideally) with experience working in the faculty member’s area of research

16. Historical Conceptions of Abnormal Behavior • Mental disorders have existed in all cultures • Treatment based on how they were explained • Three dominant historical traditions: • Supernatural • Biological • Psychological

17. The Supernatural Tradition • Causes of mental illness: • External, supernatural causes (e.g., demons) • Battle of good vs. evil (e.g., sin) • Movement of moon and stars

18. The Supernatural Tradition • Treatment approaches: • Exorcism • Torture • Beatings • Crude surgeries (e.g., trephining) • Hanging patient over snake pit • “Hydrotherapy” • Witch hunts

19. The Supernatural Tradition Today • Schizophrenia and spirit possession • From “The Americanization of Mental Illness:” http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?th&emc=th • “NOWHERE ARE THE limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations. • This was the startling result of three large international studies carried out by the World Health Organization over the course of 30 years, starting in the early 1970s. The research showed that patients outside the United States and Europe had significantly lower relapse rates — as much as two-thirds lower in one follow-up study. These findings have been widely discussed and debated in part because of their obvious incongruity: the regions of the world with the most resources to devote to the illness — the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions — had the most troubled and socially marginalized patients.”

20. The Supernatural Tradition Today • “Trying to unravel this mystery, the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.”

21. The Supernatural Tradition Today • “McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. “Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,” McGruder determined. “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.”

22. The Supernatural Tradition Today • “For McGruder, the point was not that these practices or beliefs were effective in curing schizophrenia. Rather, she said she believed that they indirectly helped control the course of the illness. Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.” • Does the supernatural approach necessarily entail mistreatment of the individual? • Does the modern science-based approach necessarily entail benevolent treatment of the individual?

23. The Biological Tradition • Cause of mental illness: • Physical disease (like other medical diseases) • Hippocrates: “Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter and jests, as well as our sorrows, pain, grief, and tears … It is the brain which makes us mad or delirious; inspires us with dread and fear, whether by night or day; brings sleeplessness, mistakes, anxieties, absentmindedness, acts that are contrary to our normal habits. These things that we suffer all come from the brain, including madness.”

24. The Biological Tradition • Hippocrates’ Humoral Theory: psychopathology caused by humoral imbalance • Blood, black bile, yellow bile, & phlegm • Example: Too much black bile causes melancholia (depression) • Treatments were generally benign: rest, nutrition, bloodletting, vomiting, emetics

25. The Biological Tradition • General Paresis (Syphilis) – causes delusions and bizarre behavior • Pasteur discovered the cause – a bacterial microorganism • Led to penicillin as a successful treatment • Bolstered the view that mental illness = physical illness • Provided a biological basis for madness

26. The Biological Tradition • The 1930’s • Biological treatments were standard practice • Electro-convulsive therapy (ECT), brain surgery (e.g., lobotomy) • In depth: insulin coma therapy