Abnormal Psychology

asylum reform and moral treatment

- Actually former patient Jean-Baptiste Pussinw William Tuke (1732-1819)- English Quaker who established York Retreat

Early Biological Roots wHippocrates (460-377 B.C. Greece)

- Father of Modern Medicine- Rejected view of punishment from the Gods

What is problematic with relying on this definition? -incredibly subjective from observer and individual

- I might think procrastination is a big deal -but for you procrastination is a big deal and irresponsible

Return to the Supernatural-related to rise and power of the church-influence in government and world at large wEurope in the Middle Ages

- Importance of the church• Christian monks replaced physicians in treatment of mentally ill-including treatments a lot like old demonology days-like torture or murder-example witch trials

Dangerous behaviors -behavior that is a danger to self or other

- Most psychopathology-focus on danger to self but there are a hanful that focus on danger to others - Example-impulsivity -self harm

Early Demonology

- Psychological disorders caused by possession by evil spirits• Early Egyptian, Chinese, and Hebrew writings refer to demons

Early Demonology

- Psychological disorders caused by possession by evil spirits• Trephination- Stone age (1/2 million years ago)

What's dysfunctional to one person may not be dysfunctional to another, in one culture something might be dysfunctional but not in another

- Religious-certain behaviors to them are distressing or dysfunctional to them -sees behaviors as problematic-distressful to them

wDorthea Dix (1802-1887)

- School teacher and advocate who lobbied congress for better treatment of all mentally ill- Her work led to transition away from asylums to state hospitals for psychiatric problems

wPsychotropic medications (1950s)-medications that worked for some individuals but had knarly side effects

- Some developed in 50s are still used today or second generation medications where the basic mechanism is still the same

humors-

- Starting to get at maybe there are some underlying biological mechanisms outputting behavioral or emotional problems

Important on this slide- Shifted from abnormal behavior to cognition, emotion and behavior

- There's going to be a list of stuff going on-problematic emotions,cognitions and behviors that cause significant distress or impairment - - basic idea -problamatic emotions,cognitions and emotions-linked to significant distress and dysfunction

What is problematic about relying on this definition of dangerous?

- What is dangerous for one person may not be for another - Example : if I am stupid rich-if I gamble-not a big deal -o If someone is not financially stable-gamble excessively-that's there life savings

Idea of stress tolerance -if look at research on anxiety disorder-see the degree to which someone experiences anxiety, the degree to which someone experiences anxiety, the severity, the degree to which its distressing to them

- What sets many people apart is there distress tolerance -how well can I tolerate this stress - - some treatments are moved towards helping people to increase stress tolerance

Re-experiencing -in PTSD-reexperiencing

- a traumatic event in some way o People who have High external behaviors also have higher re-experiencing symptoms wth PTSD- by experiencing Exercise this reduces someone's reexperiencing symptoms-use as coping skill-avoid flashbacks

Substance dependence-long term -it is statistically infrequent-it is dysfunctional-because

- behavioral consequences -distressing because everything that is falling apart around you is itself distressing

- Example: drinking -hangovers

- most of time if you drink going to have a hangover-that is some dysfunction-but its a pretty normal dysfunction o -but if hangover is so severe or dysfunctional that you lose days or multiple days-but continue to drink the next morning to appeal withdrawal- that is tipping towards dysfunction o Significantly impaired drunk driving, getting in a wreck or running a person over -most people who drink -most of the time don't drive drunk-even when that happens -not typically black out driving -that is statistically infrequent and significantly dysfunctional

Another things DSM-BECAME A TOOL t

- that insurance company's need to use to get reimbursed for treatment services - Psych services-linked more and more to these disorders and whether or not they go reimbursed and specific psychiatric diagnosis was tied to insurance- DSM began growing

Kraepelin classifying systems

- ways in which organizing, labeling these psychiatric problems o Handful that he identified-such as manic depressive illness -Listed physical causes and expected course• Dementia praecox• Manic-depressive psychosis

Development of Asylums Asylums for lepers and used to house mentally ill

-(did not holdlow key melancholy-)very often people in asylums are the ones most disruptive to their communities -still a lot of torture therapy

- Distress and dysfunction

-almost everyone cognition, emotion and behavior that causes significant distress, dysfunction and impairment

Which of the following is one of the four D's that define abnormality?

-deviance -dangerousness(is it dangerous to you or others- dysfunction -distress

What makes behavior abnormal?

1. Deviance from social Norms 2. Distress a. Is the behavior distressful- is it distressing to society (serial killer cause distress to people harmed)? Global distress, micro distress( does a kid cause distress to parents or teqacher) 3. Dysfunction 4. Danger Statistical infrequency -is what we are seeing not typically common in the general population- the severity or the form and function-is it statistically infrequent

Johann Weyer

1515-1588): Deception of Demons• German physician - 1st to specialize in mental illness• Mind was as susceptible to sickness as the body• Mentally ill needed clinical treatment

To raise money for the asylums- they Would sell tickets w Tickets sold to public for viewing

15th & 16th Centuries: leprosariums converted to asylums - Priory of St. Mary of Bethlehem: • Better known as Bedlam

Abnormal psychology-flexibly defined

A branch of psychology concerned with mental and emotional disorders and with certain incompletely understood normal phenomena

Which of the following is not one of the four d's that define abnormality

A. Difference

Cara is a successful social media personality. She is the author of several best-selling books and recently gave a TED talk on building a personal brand. She also adheres to a strict diet wherein all of the food on her plate must be the same color. Cara is most likely:

A. eccentric. a. Just because statistically infrequent doesn't mean its abnormal -would need more information to see if abnormal

Defining abnormal What makes behavior abnormal?

Abnormal -deviation from baseline norm and deviation form societal norms Across cultures what we think is a deviation might be totally fine in another culture -Deviation in one culture may not be one in another culture -dysfunction-does it cause problems?

Dysfunction

Abnormal behavior tends to be dysfunctional; that is, it interferes with daily functioning. It so upsets, distracts, or confuses people that they cannot care for themselves properly, participate in ordinary social interactions, or work productively

distress

Anxiety disorder-severity-degree of which its distressing to them - How well can I tolerate this anxiety - Increase distress tolerance of anxiety

Reform Movement in AmericawBenjamin Rush (1745-1813):

Considered the Founder of American Psychiatry; Pennsylvania Hospital• Required staff to talk and read to patients, and regular walks

w Philippe Pinel (1745-1826):

Credited with removing chains from patients from La Bicêtre asylum in Paris - Was actually a former patient

Richard von Krafft-Ebing (1840-1902)

Discovery that general paresis caused by syphilis

Lessons from history Stone age

Early on The idea was that abnormal psychology and problems was demons-one way of dealing with that was Trephination -drilling holes in the head -1.not good,2.not curing -did have an effect-not right effect tho-hit parts of brain that have an aversive effect

Distress

Even functioning that is considered unusual does not necessarily qualify as abnormal according to many clinical theorists, behavior, ideas, or emotions usually have to cause distress before they can be labeled abnormal

humors-- Starting to get at maybe there are some underlying biological mechanisms outputting behavioral or emotional problems -maybe there is underlying biological things that are causing disease

Even though off about mechanism that treatments weren't too far off what we are doing today - Instead of humors-we look at neurotransmitters today- (maybe you don't have enough serotonin-that's why your depressed)

dysfunction example

Example where some behavior can cause some dysfunction but wouldn't reach threashhold of being significant dysfunction

- Violations of social norms not necessarily a disorder but it can be

Example-violation of social norm-not necessarily a disorder - committing a crime not necessarily a disorder-however there are instances where committing a crime may be a disorder - burglar-doesn't tell us if they have a disorder- what we would look at to see if that behavior is the result of a disorder -if its arising from dysfunction within the individual -internal process-emotional and emotion regulation-could be a dysfunction arising from the individual

Hippocrates - imbalance of humors

Imbalance of humors caused all disease • Yellow bile - excess of yellow bile might be causing mania, aggression • Black bile - excess of black bile-melancholia • Blood • Phlegm

Somatogenic treatments included a lot of harmful treatments -in the absence of guided knowledge about biological mechanisms- people just take stabs in the dark

Ineffective/Harmful Treatments: wTooth extraction wTonsillectomy wHydrotherapy wLobotomywEugenic sterilization -

Danger

Perhaps the ultimate psychological dysfunction is behavior that becomes dangerous to oneself or others. Individuals whose behavior is consistently careless, hostile, or confused may be placing themselves or those around them at risk.

Europe in Middle Ages-

Persecution of witches: Malleus Maleficarum- "The Witches Hammer"- Some enlightened governments• Lunacy Trials in 13th century England

Somatogenic

Return to beliefs about biological mechanisms are causes of mental illness

Cognition-decision making-if you have impaired decions making-if you have brain damage - If missing prefrontal cortex- biological abnormality that leads to impaired emotion regulation, impulsivity-may be more likely to commit crimes

Shooting people-context matters-depending on which laws are written -Depending on where you are as well

In the 20th Century- have rise of 2 competing perspectives- which are now both acceptedwTwo competing perspectives for abnormal psychology

Somatogenic-biological explanation for cause of mental illness-focused on the brain- Psychogenic-psychological explanation -assuming there is mind, soul, a psychological thins that is independent from biological processes Real explanation-is the combination of both

Decline of Moral Treatment As state hospitals become more common

Success led to overcrowding and money shortageswHumane treatment could not cure all mental illnesswPublic began to view mentally ill as strange and dangerouswNormwLong-term hospitalizationwIneffective and harmful medical treatments

What is problematic about relying on this definition? If its not causing problems-who cares if its rare?

There are a lot of things that are rare that are positives -not disordered-abnormal but not in a bad way -if we take everything unique and make it abnormal and stigmatize it -close us off or boxes us in

Asylum Reforms & Moral Treatment-late 1700s- early 1800s wMoral Treatment

Treating institutionalized patients as normal as possible- Reinforced normal social interaction

treatments for humors-alot like tratments we use today -

Treatment: including things like rest, sobriety, change in diet

development of asylums treatments:

Treatments:w Rotational therapy, hydrotherapy, beatings, starvation

DSM-5 Definition of Mental Disorder:w "A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning..."

`- Harmful disturbance that deviates from typical processes

1. Distress

a. Is the behavior distressful- is it distressing to society (serial killer cause distress to people harmed)? Global distress, micro distress( does a kid cause distress to parents or teqacher)

The Thoughts feelings and emotions and behaviors is psychiatric construct includes stuff that we have experienced to some degree-but what makes it a disorder

a. the form, function and severity of that stuff-is infrequent and causes distress

eccentric

as a person who deviates from common behavior patterns or displays odd or whimsical behavior. - suggests that eccentrics do not typically suffer from mental disorders. Whereas the unusual behavior of persons with mental disorders is thrust upon them and usually causes them suffering, eccentricity is chosen freely and provides pleasure

Effective Treatments- there was effective treatments such as:wElectroconvulsive therapy (ECT; 1930s)was misused-but despite that-for many individuals is was effective Modern ect was very different than those back in 30s,40s,50s-but

basic process was still the same-where you are using large amounts of electrical current passing them through panels of brain-all electricity are effecting psych symptoms especially depression

Decline of Moral Treatment As state hospitals become more common

because effective treatments yet exist-these state hosipitals became like psychiatric jails -really solution is long term hospitalization-if you have this for increasing population-more are coming in than are going out-that's going to lead to overcrowding, money shortage, wellbeing treatment is suffering as a result

Distress

behavior that causes distress to the person who is suffering or to others - Example- everyone has experienced anxiety-that is distressful, but many have not significantly distressful

Day 2 notes Four Ds of abnormal behavior Dysfunction

behavior that prevents the important demands of life from being met - Just because there is a wiff of dysfunction doesn't mean its abnormal - By dysfunction we mean Significant dysfunction o Significant behavioral impairment

Idea was that no one of those humors were responsible for x,y,z behavioral problems

but it was an imbalance between these humors -very similar to explanations for other things like cancer or syphilis

Trend in behavioral science -we increasingly focus on hostile processes -focus on ways to integrate holistic processes into our evident based treatments-because we know not just these learning, cognitive mechanisms, and neurotransmitters

but those exist and are effected by stress, exercise, alcohol, stress

Vince struggles with periodic bouts of mania, and during those times he drives back and forth to work at speeds over 95 miles an hour. In classifying this behavior as abnormal, which of the four D's best describes this behavior?(Answer)

dangerousness

Informing Contemporary Perspectives In the 20th Century

have rise of 2 competing perspectives- which are now both acceptedwTwo competing perspectives for abnormal psychology

Psychoanalysis-Freudian years What psychiatric disorder hold hysteria

hysteric personality disorder-were result of wandering wound-was reserved woman who were acting out or not with accordance of patriarchal standards of time -treatment-do things that would affect the womb

IN 80S -NOT ONLY USED FOR RESEARCH ANYMORE treatment some time in 80s something happened

in part pharmaceutically related -I STUDY A MEDICATION-HAVING A DISORDER I CAN TIE IT TO IS INCREDIBLY IMPORTANT FOR ME TO BE ABLE TO STUDY THOSE DRUGS, AND MARKET DRUGS TO GET A PROFIT -having a disorder I can relate that drug to -and market that drug

Defining AbnormalityDistress- Behavior that causes distress • to the person who is suffering or • to others

in person experiencing the symptom or distress for others - What behaviors cause distress to the suffering person? Anxiety-when reaches point where distressing-cause problem Drugs use-causing distress-to the person and can be distressing to other people?

During Greek and roman empires -see rise of early modern medicine- development of the first iteration of modern medicine and modern psychology and psychiatry -recognize not demons in

in skull but squishy stuff- the brain-viewing disease from the brain-what causes the disease in the brain was still pretty far off- Rise of philosophers and physicians - Psychological disorders as brain diseases

norms

norms A society's stated and unstated rules for proper conduct - Judgments about what constitutes abnormality depend on specific circumstances as well as on cultural norm

Externalizing behaviors

outside-stuff I do-generally not focused on avoidance or safety behaviors-tends to be focused on impulsive behaviors acting out acting rash, doing stuff risky or dangerous

Eugenic sterilization -

recognizing There is a genetic link-so they start sterilization-to prevent spread of mental illness -1907-1945: Approximately 45,000 Americans were sterilized

DSM-originally developed as a

research tool-we know that these psychiatric disorders are constructs, we know they differ between individuals - DSM-TO HELP STUDY SIMILAR PROCESSES AND CONSTRUCTS SO WE CAN DEVELOP

wHysteria: "wandering womb" Old idea-hystrianics were result of wandering womb-

reserved form woman not acting in accordance to patriarchal -treatments to things that affect the womb like Marriage, fumigation of the vagina

And the Early Biological RootswGreek & Roman Civilizations During Greek and roman empires

see rise of early modern medicine- development of the first iteration of modern medicine and modern psychology and psychiatry

Early Biological Roots Psychoanalysis-Freudian years

start to see increasing biological explanations for psychological problems

Departure from the SupernaturalwThe Renaissance w1400 - 1700,

still have belief of Supernatural causes of mental illness still popular -starting to phase out a bit as physicians come along and provide more psychological/measurable explanations for mental illness

-stress can cause dysfunction- The distress itself can cause dysfunction, but the same rule applies here. because it's not just this with distress-everyone has experienced anxiety -

that's distressing-but not significant for most of us - what we are looking for is significant amounts of distress- that is very subjective - I might be incredibly tolerance of anxiety ad might just role with it-even though its distressing its not significantly distressing

w Emil Kraepelin (1856-1926)-

the godfather of the DSM - Developed the First modern system for classifying abnormal behavior

Early on The idea was that abnormal psychology and problems was demons-one way of dealing with that was Trephination -drilling holes in the head -1.not good,2.not curing -did have an effect-not right effect tho-hit parts of brain that have an aversive effect highlights:

they are kind of on to something -thought demons existed in head/brain-no research-all the way back in stone age that there is still this intuition that something is happening in the brain- they are just attributing to the wrong things

- Psychological disorders caused by possession by evil spirits• Early Egyptian, Chinese, and Hebrew writings refer to demons -demons, evil spirits-spiritual bad guys-depending on culture and religion-are responsible for behavioral, emotional, psychological problems

to deal with this was exorcisms - Exorcism (e.g., prayer, potions, flogging, starvation, torture)

Example-dysfunction might arise-procrastination

underlying emotion=anxiety-why for many -people procrastinate- - motivated by anxiety-don't do as well-not a huge deal for most people -some need stress to perform well-some procrastination leads to not getting work done-fails classes and gets behind-falls into dysfunction -seen in anxiety, depression and perfectionism in OCD o Dysfunctional impairment because of procrastination

DSM-5 Definition of Mental Disorder:

w "...Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above"

Abnormality vs. DisorderwNo agreed upon definition of "abnormality"- None of the elements are sufficient on their own

w"Abnormal" is not necessarily the same as "Disorder" When talk about disorder-definitions in diagnostic manual and statistical manual that are carved out

Psychogenic

wCauses of mental illness are often psychologicalwHypnosis

Effective Treatments- there was effective treatments such as:wElectroconvulsive therapy (ECT; 1930s

was misused-but despite that-for many individuals is was effective

The DSM For defining specific disorders

we use to the Diagnostic and Statistical Manual for Mental Disorders (DSM)

o Externalizing behaviors-outside-stuff I do-generally not focused on avoidance or safety behaviors-tends to be focused on impulsive behaviors acting out acting rash, doing stuff risky or dangerous Example

§ Externalizing behaviors-action and impulsive behaviors in manic episodes are dangerous or destructive- example-reckless driving

§ Example -Externalizing behaviors-action and impulsive behaviors in manic episodes are dangerous or destructive- example-reckless driving § Gambling is dysfunction -externalizing § Risky sexual behaviors -externalizing Confrontation or fighting

§ Not just seen in mania-May see in manic state but also may see externalizing behaviors in PTSD , opposition defiance disorder or other disorders

- Franz Mesmer - German physician/ astronomer (1734-1815)

• Father of hypnosis - "Mesmerism

- Hysteretic personality disorder-more diagnosed in woman Now men are being diagnosed with this- its biopsycho social- Medical problem with no physical cause(e.g., blindness, paralysis)• Treatment:

Marriage, fumigation of the vagina

Culture and context is important- What might some examples of this be? -Grief -loss of job or relationship -bad anxiety before a job interview-normal

Normal to experience symptoms of depression and anxiety after a trauma -most people recover- some people do not recover from Trauma after a long period of time-when we go into PTSD -way DSM is structured doesn't match research but -after 3 months if not recover from trauma -considered PTSD