CHAPTER 1 CONCEPTUAL ISSUES IN ABNORMAL PSYCHOLOGY

1. CHAPTER 1CONCEPTUAL ISSUES IN ABNORMAL PSYCHOLOGY

2. AIMS AND OBJECTIVES Discuss how we define “abnormal” How do we know who has a psychological disorder and needs treatment? Provide overview of biological and psychological perspectives on classification, causation, and treatment of mental disorders Describe the prominent classification system for mental disorders Preview future directions in the field of psychiatric classification

3. DEFINING ABNORMAL Statistical rarity Any deviation from the norm = abnormal But lots of positive characteristics are rare, e.g., very talented or highly intelligent people Norm violation Behavior is abnormal if it is socially unacceptable Must be careful not to use this criterion to oppress non-conformist behaviour

4. DEFINING ABNORMAL Distress If a person is bothered by a certain behaviour, it may be classified as abnormal In some situations, however, an individual may not be bothered by a maladaptive behaviour Dysfunction Behaviours that interfere with a person’s life are classified as abnormal This criterion is limited because how functional an individual is depends on societal expectations

5. DEFINING ABNORMAL Independently, rarity, norm violation, distress and dysfunction are neither necessary nor sufficient to define abnormal behaviour Cumulatively, they help to clarify what we think is “normal” vs. “abnormal” Another approach to this issue is Wakefield’s (1992, 1999) harmful dysfunction analysis A disorder involves a factual component (dysfunction) and a value component (harmful)

6. THE BIOLOGICAL PERSPECTIVE Classification Emil Kraepelin (1856-1926) was the first to classify types of mental disorders based on systematic empirical observations Before then, there was little agreement on what constituted mental illness Some believed “insanity” was a single disease, others classified symptom clusters based on hypothesized causes (e.g., balance of the four humours: blood, yellow bile, black bile, and phlegm) Kraeplin used a descriptive approach and offered diagnostic categories defined by common patterns of symptoms

7. THE BIOLOGICAL PERSPECTIVE Causation In the late 19th century, a German neurologist discovered that general paresis, a type of “insanity” characterised by bizarre behaviours, hallucinations, and delusions, was caused by a biological disease (syphilis) Other researchers began identifying associations between certain syndromes, such as difficulty producing or understanding speech, and localised brain damage These types of discoveries led to increasing acceptance of the idea that mental disturbances have a biological cause, such as infection, toxins, or structural brain abnormality

8. THE BIOLOGICAL PERSPECTIVE Treatment Early biological treatments included electroconvulsive therapy (ECT) and psychosurgery Contemporary approaches focus on two causes of mental disorders: structural brain abnormalities and neurochemical imbalances Since the discovery of effective medications in the 1950s, they are commonly used to treat mental disorders. Some argue that there are drawbacks to psychopharmacological approaches: Psychiatric medications may be overused - not a universal cure High risk of relapse and possible side effects

9. THE PSYCHOLOGICAL PERSPECTIVE Psychoanalytic Approach Developed by Sigmund Freud in the late 19th Century Reasons for human behaviour are hidden in the unconscious and involve complex interactions between: the Id - driven by instincts the Ego - conscious, realistic, logical, aims to balance pressures of Id with external world the Superego - internalised influences of parents and societal moral standards, seeks perfection and control Failure to manage conflict can lead to anxiety/neuroses, which may be treated by psychoanalysis

10. THE PSYCHOLOGICAL PERSPECTIVE • Psychoanalytic Approach • History of activities and objects to which the libido (psychic energy of Id) attaches itself: • Oral stage, 0 to 2 years • Anal stage, 2 to 3 years • Phallic stage, 3 to 6 years • Latency Period, 6 to 12 years • Genital stage, 12 and beyond • Criticisms of the psychoanalytic movement are that it is: • untestable • unfalsifiable • unable to meet societal demands for accountability

11. THE PSYCHOLOGICAL PERSPECTIVE The Behavioural Approach Emphasises examining observable causes of behaviour in the immediate environment Classical conditioning Operant conditioning Avoidance learning Treatment from the behavioural perspective includes: Functional analysis Extinction Aversion therapy Token economies

12. THE PSYCHOLOGICAL PERSPECTIVE The Cognitive Approach • Emphasises dysfunctional cognitive processes cause emotional and behavioral disturbances • ABC model – Albert Ellis • Cognitive distortions – Aaron Beck • e.g., black and white thinking, over-generalising, personalising

13. THE PSYCHOLOGICAL PERSPECTIVE • The Cognitive Approach • Recent research has also focused on the ways in which individuals process information, including • Selective attention • Memory patterns, e.g., negative bias in depressed individuals • Cognitive therapy techniques include: • Thought diaries • Cognitive restructuring • Behavioural experiments • Important features of the cognitive-behavioural perspective: • Scientist-practitioner model • Emphasis reliable and valid assessment, clear goals, and basing treatments on empirical evidence

14. THE PSYCHOLOGICAL PERSPECTIVE Humanistic & Sociocultural Approaches Humanistic perspective emphasises: Uniqueness of individuals Potential for positive human growth Freedom and responsibility to make choices Carl Rogers – founder of client centred therapy and concept of unconditional positive regard Sociocultural perspective argues that abnormal behaviours are best understood in terms of the social environment of the individual e.g., eating disorders a result of Western culture’s emphasis on thinness

15. DIAGNOSIS OF MENTAL DISORDERS Advantages Improved communication Collaboration among mental health professionals Disadvantages Reification of diagnostic categories – mental disorders are hypothetical concepts, not independent of societal values Stigma – applying diagnoses may sometimes be harmful to people

16. THE DEVELOPMENT OF THE DSM SYSTEM DSM-I published in 1952 by the American Psychiatric Association, followed by DSM-II in 1968 DSM I and II did not have much influence on mental health Lacked reliability and validity DSM-III was a radical departure Atheoretical, topographical approach - precise descriptions rather than etiology Specificity – improved reliability and validity Multiaxial assessment DSM-IV (1994) and DSM-IV-TR (2000) retained principal features but more research-based

17. CURRENT CONTROVERSIES FOR DSM-V (PROJECTED RELEASE 2010) Categorical versus dimensional approach? More etiologically-based diagnostic system? Ascertaining the applicability of diagnostic criteria across cultures Proposed rating system to indicate the extent and quality of empirical support for diagnostic criteria

18. SUMMARY Defining Abnormal The Biological Perspective Classification Causation Treatment The Psychological Perspective Psychoanalytic Approach Behavioural Approach Cognitive Approach Humanistic/Sociocultural Approach Diagnosis of Mental Disorders Advantages and Disadvantages Development of the DSM system Current Controversies for DSM-V