CH 1 Looking at Abnormality

Ancient China: Balancing Yin and Yang

- Ancient Chinese medicine was based on the concept of yin and yang. The human body was said to contain a positive force (yang) and a negative force (yin), which confronted and complemented each other. If the two forces were in balance, the individual was healthy. If not, illness, including insanity, could result. - Chinese medical philosophy also held that human emotions were controlled by internal organs. Vital Air was flowing on one of these organs an individual felt and emotion ( heart = joy; liver; anger) - Although the perspective on psychological symptoms represented by ancient texts was largely a biological one, the rise of Taoism and Buddhism during the Chin and T'ang dynasties led to some religious interpretations of abnormal behavior (evil winds and ghost were blamed for people being erratic).

Witchcraft

- Beginning in the eleventh century, the power of the Catholic Church in Europe was threatened by the breakdown of feudalism and by rebellions. The Church interpreted these threats in terms of heresy and Satanism. The inquisition was established originally to rid of the Earth of religious heretics, but eventually but eventually those practicing witchcraft or Satanism also became the focus of hunts. - Some psychiatric historians have argued that persons accused of witchcraft must have been mentally ill (delusions, torture, melancholy). - The church banned writings saying that

The Roots of Behaviorism

- Ivan Pavlov, a Russian physiologist, developed methods and theories for understanding behavior in terms of stimuli and responses rather than in terms of the internal working of the unconscious mind. He discovered that dogs could be conditioned to salivate when presented with stimuli other than food if the food was paired with these other stimuli-a process later called classical conditioning. - John Watson rejected psychoanalytic and biological theories of abnormal behaviors such as phobias and explained them entirely on the basis of the individual's history of conditioning. Watson went to far as to boast that he could train any healthy child to become any kind of adult he wished. -B.F. Skinner argued that behaviors followed by positive consequences are more likely yo be repeated than are behaviors followed by negative consequences. This process came to be known as operant, or instrumental, conditioning.

Ancient Egypt, Greece, and Rome: Biological Theories Dominate

- Other ancient writing on abnormal behavior are found in the papyri of Egypt and Mesopotamia (These disorders were said to occur only in women and were attributed to a wandering uterus) - Most average Greeks and Romans saw abnormal behavior as an affliction from the gods. Those afflicted retreated to temples honoring the god Aesculapius, where priests held healing ceremonies - For the most part, however, Greek physicians rejected supernatural explanations of abnormal behavior ( Hippocrates explained the body was made up of 4 humors, blood, phlegm, yellow bile, black bile, these out of order cause abnormalities) - The states claimed no responsibility for insane people. It would however take rights away from people declared insane (property, right to marriage, or even locked up if considered violent)

The Four Ds of Abnormality

-If we do not want to define abnormality only on the basis of cultural norms, and if we cannot define abnormality as the presence of a mental illness because no singular, identifiable disease process underlies most psychological problems, how do we define abnormality? - Modern judgments of abnormality are influenced by the interplay of four dimensions, often called "the four Ds: dysfunction, distress, deviance, and dangerous - Behaviors, thoughts, and feelings are DYSFUNCTIONAL when they interfere with the person's ability to function in daily life, to hold a job, or to form close relationships. The more dysfunctional behaviors and feelings are, the more likely they are to be considered abnormal by mental health professionals. (Ex: thinking you are Satan and need to be punished makes it difficult to function in everyday life; it's dysfunctional). - Behaviors and feelings that cause DISTRESS to the individual or to others around him or her are also likely to be considered abnormal.many of the problems we discuss in this book cause individuals tremendous emotional and even physical pain; in other cases, the person diagnosed with a disorder is not in distress but causes others distress-ex: chronic lying, stealing or violence. - Highly DEVIANT behaviors, such as hearing voices when no one else is around, lead to judgments of abnormality. What is deviant is influence by cultural norms, of course. finally, some behaviors and feelings, such as suicidal gestures, are of potential harm to the individual, whereas other behaviors and feelings, such as excessive aggression, could potentially harm others. Such DANGEROUS behaviors and feelings are often seen as abnormal.

Driving Away Evil Spirits

A person who acted oddly was suspected of being possessed by evil spirits. The typical treatment was exorcism, Shamans, or healers would recite prayers or incantations, try to talk to the spirits out of the body or make the body an uncomfortable place for the spirits to reside (starving or beating the person/ killed). - In the sonte/middle ages they would drill holes in the skull of the person displaying abnormal behavior to allow the spirits to depart.

The Emergence of Modern Perspectives

Although the treatment of people who exhibited abnormal behavior deteriorated somewhat at the turn of the twentieth century, the early twentieth century saw tremendous advances in the scientific study of disorders. These advances laid the groundwork for the biological, psychological, and social theories of abnormality that now dominate psychology and psychiatry.

The Spread of Asylums

As early as the twelfth century, many towns in Europe took some responsibility for housing and caring for people considered mentally ill. - Hospital of Saint Mary of Bethlehem, also known as Bedlam, was famous for its deplorable conditions (chained to the wall or locked in cages). - Common Law states "It is lawful for the patents, kinsmen or other friends of a man that is mad.. to take him and put him into a house, to bind or chain him, and to beat him with rods" - The first Act for Regulating Madhouses in England was passed in 1774, with the intention of cleaning up the deplorable conditions in hospitals and madhouses and protecting people from being unjustly jailed for insanity ( applied to wealthy people not the poor) - These asylums typically were established and run by people who thought that abnormal behaviors were medical illnesses. Ex, Benjamin Rush (founders of American Psychiatry) believed abnormal behaviors were caused by excessive blood in the brain and prescribed bleeding the patient.

Deinstitutionalization (paragraph)

By 1960 a large and vocal movement known as the patient's rights movement had emerged. They advocated that mental patients can recover more fully or live more satisfying lives if they are integrated into the community, with the support of community based treatment facilities- a process known as deinstitutionalization. - Halfway houses offer people with long-term mental health problems the opportunity to live in a structured, supportive environment as they try to reestablish working relationships and ties to family and friends. Day treatment centers allow people to obtain treatment during the day, along with occupational and rehabilitative therapies, but live at home at night. - Deinstitutionalization had cons since not many of these new mental health operations were opened but thousands of institutions were closed leaving many mentally ill to fend for themselves, even on the streets.

Cultural Norms

Context, or circumstances surrounding behavior, influences whether the behavior is viewed as abnormal (aka, nailing your hands in Mexico on good Friday is not abnormal cause culture and religion). - Culture norms play a large role in defining abnormality. In Buddhist cultures, it is customary to build altars to honor dead loved ones, to offer them food and gifts, and to speak with them as if they were in the room. To Christians and Jews, these behaviors can be seen as abnormal. - Cultures have strong norms for what is considered acceptable behavior for men versus women, (as in being a beta can be seen as abnormal vs a bossy female) - Cultural relativism is the view that there are no universal standards or rules for labeling a behavior abnormal; instead, behaviors can be labeled abnormal only only relative to cultural norms. Pros: this perspective honors the norms and traditions of different cultures rather than imposing the standards of one culture on judgments of abnormality. Cons: dangers arise when cultural norms are allowed to dictate what is normal and abnormal, in history, societies have labeled individuals and groups as abnormal to justify controlling or silencing them (holocaust, slave trade). - Most mental health professionals these days do not hold an extreme relativist view on abnormality, recognizing the dangers of basing definitions of abnormality solely on cultural norms. Yet even those who reject an extreme cultural-relativist position recognize that culture and gender have a number of influences on the expression of abnormal behaviors and on the way those behaviors are treated. - First, culture and gender can influence the ways people express symptoms, people who lose touch with reality believe they have divine powers, either Jesus or Mohammad, depending on their religious background. - Second, culture and gender can influence people's willingness to admit to certain types of behaviors or feelings. (Eskimo/Tahitian cultures may not admit being mad because their culture is very against it) - Third, culture and gender can influence the types of treatments deemed acceptable or helpful for people exhibiting abnormal behaviors. Some cultures may view drug therapies for psychotherapy as most appropriate, while others may be more willing to accept psychotherapy.

General Paresis

Disease that leads to paralysis, insanity, and eventually death; discovery of this disease helped establish a connection between biological diseases and mental disorders.

Psychic Epidemics (Paragraph)

During the Middle Ages, reports of dance frenzies or manians were frequent. A monk describied a rash of dance frenzies that broke out over a 4-month period in 1374 Germany. - 1518 a large epidemic of uncontrolled dance frenzy occurred (people died). - People suddenly developed an acute pain, which they attributed to the bite of a tarantula. They jumped around and danced wildly in the streets, tearing at their clothes and beating each other with whips. At the time, many people interpreted dance frenzies and tarantism as the results of possession by the devil . - Psychic epidemics are no longer viewed as the result of spirit possession or the bite of a tarantula. Rather, psychologists attempt to undersand them through research from social psychology on the influence of others on individual's self-perception (Like conformity).

Classical Conditioning

Form of learning in which a neutral stimulus becomes associated with a stimulus that naturally elicits a response, thereby making the neutral stimulus itself sufficient to elicit the same response.

Psychoanalysis

Form of treatment for psychopathology involving alleviating unconscious conflicts driving psychological symptoms by helping people gain insight into their conflicts and finding ways of resolving these conflicts.

Modern Mental Health Care

Halfway through the twentieth century, major breakthroughs were made in drug treatments for some of the major forms of abnormality. In particular, the discovery of a class of drugs that can reduce hallucinations and delusions, known as the phenothiazines. The biomedical approach has revolutionized the way we understand and treat mental disorders as biological phenomena

Managed Care

Health care system in which all necessary services for an individual patient are supposed to be coordinated by a primary care provider; the goals are to coordinate services for an existing medical problem and to prevent future medical problems.

The Cognitive Revolution

In the 1950s, psychologist argued that behaviorism was limited in its explanatry power by its refusal to look at internal though processes that mediate the relationship between stimulus and response. It wasn't until the 1970s that psychology shifted its focus substantially to the study of cognition (thought process, attention, interpretation of events, beliefs that influence behavior and emotion). - Albert Bandura played a role in the revolution. He argued that people's belief about their ability to execute the behaviors necessary to control important events-which he called self-efficacy beliefs, are crucial in determining people's well-being.

Halfway houses

Living facilities that offer people with long-term mental health problems the opportunity to live in a structured, supportive environment while they are trying to reestablish employment and ties to family and friends.

Chapter Integration

Many clinicians and researchers now believe that theories that integrate biological, psychological, and social perspectives on abnormality will prove most useful. We will be discussing theories of anxiety disorders that take into acount individual's genetic and biochemical vulnerabilities, the impact of stressful events, and the role of cognition in explaining why some people suffer debilitating anxiety.

Ways abnormality has been defined

Mental Illness Cultural Norms Four D's of Abnormality

Continuum Model of Abnormality

Model of abnormality that views mental disorders not as categorically different from "normal" experiences but as lying somewhere along a continuum from healthy, functional behaviors, thoughts, and feelings to unhealthy, dysfunctional behaviors, thoughts, and feelings.

Deinstitutionalization

Movement in which thousands of mental patients were released from mental institutions; a result of the patients' rights movement, which was aimed at stopping the dehumanization of mental patients and at restoring their basic legal rights

Metal Hygiene Movement: Moral Treatment:

Movement to treat mental patients more humanely and to view mental disorders as medical diseases. A type of treatment delivered in mental hospitals in which patients were treated with respect and dignity and were encouraged to exercise self-control.

Ancient Theories

Our understanding of prehistoric people's conceptions of abnormality is based on inferences from archeological artifacts-fragments of bones, tools, artwork, and so on-as well as from ancient writings about abnormal behavior.

Psychic Epidemics

Phenomena in which large numbers of people begin to engage in unusual behaviors that appear to have a psychological origin

Professions Withing Abnormal Psychology

Psychiatrists can prescribe medications for the treatment of these problems and have been trained to conduct psychotherapies as well. - Clinical psychologists typically have a PhD in psychology, with a specialization in treating and researching psychological problems. Some have a PsyD degree from a graduate program that emphasizes clinical training more than research training. Clinical psychologists can conduct psychotherapy, but in most states they do not currently prescribe medication. - Marriage and family therapists - Clinical Social Workers: masters in social work and help people find jobs or the homeless -

Psychopathology

Symptoms that cause mental, emotional, and/or physical pain ex: hallucinations, life-altering depression

Medieval Views

The Middle Ages are often described as a time of backward thinking dominated by an obsession with supernatural forces. Prior to eleventh century, witches and witchcraft were accepted as real but were considered mere nuisances, overrated by superstitious people.

The Psychoanalytic Perspective

The development of psychoanalytic theory begins with Franz Anton, an Austrian physician who believed that people have a magnetic fluid in the body that must be distributed correctly to maintain health. He sat his patients in darkness around a tub containing chemicals and rods, he passed by them in an elaborate robe, touching his patents, supposedly realigning people's magnetic fluids through his own powerful magnetic force (He was seen as a charlatan by the scientific review committee). - Yet, his methods known as mesmerism were seen as real and people debated about it. The "cures" Mesmer effected in his psychiatric patients were attributed to the trancelike state that Mesmer seemed to induce in his patients. Later this state was labeled hypnosis. Under hypnosis, Mesmer's patients appeared very suggestible, and the mere suggestion that their ailments would disappear seemed enough to make them actually disappear. - Bernheim and Liebault showed that they could induce symptoms of hysteria, such as paralysis in an arm or the loss of feeling in a leg, by suggesting these symptoms under hypnosis (Which experts were astounded to find since Hysteria was taught to only happen do to brain degeneration; Charcot). - Sigmund Freud became convinced that much of the mental life of an individual remains hidden from consciousness. Freud worked with Josef Breuer, another physician interested in hypnosis and in the unconscious processes behind psychological problems. Breuer had discovered that encouraging patients to talk about their problems while under hypnosis led to a great upwelling and release of emotion (catharsis). They did a paper together which led to foundation steon in the development of psychoanalysis, the study of the unconscious.

Moral treatment in the Eighteenth and Nineteenth Centuries

The eighteen and nineteenth centuries saw the growth of a more human treatment of people with mental health problems, a period known as the mental hygiene movement. This new treatment was based on the psychological view that people developed problems because they had become separated from nature and had succumbed to the stresses imposed by the rapid social changes of the period. - Pinel (leader of moral treatment) believed that many forms of abnormality could be cured by restoring patient's dignity and trangquility. He ordered that patients be allowed to walk freely around the asylum. They were provided with clean and sunny rooms, comfortable sleeping quarters, and good food. - One of the most militant crusaders for moral treatment of the insane was Dorothea Dix. She discovered the negligence and brutality that characterized the treatment of poor people exhibiting abnormal behavior, many of whom were simply warehouse in jails. She helped establish more than 30 mental institutions in the United States, Canada, Newfoundland, and Scotland. - Unfortunately, the moral treatment movement grew too fast. As more asylums were built and more people went into them, the capacity of the asylums to recruit mental health professionals and to maintain a humane, individual approach to each patient declined. With so many patients receiving moral treatment, the number of patients who failed to benefit from it increased, and questions about its effectiveness grew louder. - At the same time, the rapid pace of immigration into the United States in the late nineteenth century meant that an increasing percentage of its asylum patients were from different cultures and often lower socioeconomic status. Effective treatments for most major mental health problems were not developed until well into the twentieth century. Until then, patients who could not afford private care were warehoused in large, overcrowded, physically isolated institutions that did not offer treatment.

Managed Care (Paragraph)

The entire system of private insurance for health care in the U.S., underwent a revoluton in the second half of the twentieth century, when managed care emerged as the dominant means for organizing health care. Managed care is a collection of methods for coordinating care that ranges from simple monitoring to total control over what care can be provided and paid for. - Often, health care providers are given a set amount of money per member (patient) per month and then must determine how best to serve each patient - Theoretically, managed care can have tremendous benefits for people with long-term, serious mental health problems. (it is expensive though and not always covered by insurance.)

Behaviorism

The study of impact of reinforcements and punishments on behavior-has had a profound an impact on psychology and on our common knowledge of psychology, as has psychoanalytic.

Historical Perspectives on Abnormality

Three types of theories have been used to explain abnormal behavior. The biological theories have viewed abnormal behavior as similar to physical disease, cause by the breakdown of systems in the body. The appropriate cure is the restoration of bodily health. The supernatural theories have viewed abnormal behavior as a result of divine intervention, curse, demonic possession, and personal sin. To rid the person of the perceived affliction, religious rituals, exorcisms, confessions, and atonement have been prescribed. The psychological theories have viewed abnormal behavior as a result of traumas, such as bereavement, or of chronic stress. According to these theories, rest, relaxation, a change of environment, and certain herbal medicines are sometimes helpful.

Mesmerism

Treatment for hysterical patients based on the idea that magnetic fluids in the patients' bodies are affected by the magnetic forces of other people and objects; the patients' magnetic forces are thought to be realigned by the practitioner through his or her own magnetic force.

Cultural Relativism

View that norms among cultures set the standard for what counts as normal behavior, which implies that abnormal behavior can only be defined relative to these norms and that no universal definition of abnormality is therefore possible; only definitions of abnormality relative to a specific culture are possible. -Abnormality only exists when compared to one specific culture

Mental Illness

When people say that an individual has schizophrenia, they imply that the disease should show up on some biological test (like diabetes) - To date, however, no biological test is available to diagnose any of the types of abnormality we discuss in this book. - Mental disorders are not viewed as singular disease with a common pathology that can be identified in all people with the disorder. - Instead, mental disorder is a collection of problems in thinking or cognition, in emotional responding or regulation, and in social behavior. - A person diagnosed with schizophrenia has a collection of problems in rational thinking and in responding emotionally and behaviorally in everyday life, and it is this collection of problems that we label schizophrenia - It is still possible, and in the case of schizophrenia likely, that biological factors are associated with these problems in thinking, feeling, and behaving. But it's unlikely that a singular disease process underlies the symptoms we call schizophrenia.

The Beginnings of Modern Biological Perspectives

Wilhelm Griesinger said that all psychological disorders can be explained in terms of brain pathology, he emphasized the importance of brain pathology in psychological disorders. - One of the most important discoveries underpinning modern biological theories of abnormality was the discovery of the cause of general paresis, a disease that leads to paralysis, insanity, and eventually death (Found it was due to syphilis). - Modern biological theories of the psychological disorders have focused on the role of genetics, structural and functional abnormalities in the brain, and biochemical imbalances. The advances in our understanding of the biological aspects of psychological disorders have contributed to the development of therapeutic medications.

Self-Efficacy Beliefs

people's beliefs about their ability to execute the behaviors necessary to control important events (confidence).

trephination

procedure in which holes were drilled in the skulls of people displaying abnormal behavior, presumably to allow evil spirits to depart their bodies; performed in the stone age.