Abnormal psych week 1

Causes of Abnormal Behavior: Psychological

-Past learning experiences -Maladaptive thought patterns -Difficulties coping with stress

Ideally, in a RCT, prior to conducting the study the investigators define a what?

single primary outcome (i.e., a specific dependent variable). They may also define secondary outcomes, but need to be clear at the outset on their primary focus. Otherwise, the investigators may make the mistake of picking and choosing the results they report in a way that distorts the findings. For example, they may report only the findings that showed statistical significance, even if these did not involve the primary outcome variable. Imagine if a researcher found no effect of a clinical treatment for depression on depression, but instead found that it alleviated anxiety in the participants. This may be of interest, but because it was not predicted based on the study's underlying theory, it has no sound rationale and could have been due to chance factors.

The gold standard for research in clinical psychology is the randomized controlled trial (RCT):

in which researchers randomly assign participants to conditions in which they receive different forms of intervention. The key to this method is the use of randomization, which minimizes the chances that bias can enter into the decision of which participants receive which treatment. Because this is such a powerful design, RCT is used as the foundation for evidence-based treatment, in which clients receive interventions based on the findings of controlled clinical studies.

Young children may be especially subject to such factors as:

inadequate nutrition, harsh parental criticism, and neglect. -Protective factors, on the other hand, such as loving caregivers, adequate health care, and early life successes, can reduce an individual's likelihood of developing a disorder. -These early risk-protective factors become part of the individual's susceptibility to developing a disorder, and they remain influential throughout life.

The variable that the investigator manipulates is called the?

independent variable. -The investigator sets up at least two conditions that reflect different levels of the independent variable. -In most cases, these conditions are the "experimental" or treatment group (the group that receives the treatment) and the "control" group (the group that receives no treatment or a different treatment).

When using experimental design in research, an investigator sets up a test of a hypothesis by constructing the manipulation of a?

key variable of interest.

In research on the causes of abnormal behavior, it may be difficult to set up a true experimental study. Many of the variables that are of most interest to psychologists are what?

ones that the investigator cannot control; hence, they are not truly "independent." -For example, depression can never be an independent variable because the investigator cannot manipulate it.

Hieronymous Bosch's Removal of the Stone of Folly depicted a medieval "doctor" cutting out the presumed source of madness from a patient's skull. The prevailing belief was that spiritual possession was the cause of?

psychological disorder.

One year later, in 1845, German psychiatrist Wilhelm Greisinger published The Pathology and Therapy of Mental Disorders, which proposed ?

that "neuropathologies" were the cause of psychological disorders.

The fifth and final criterion for a psychological disorder is....

that it reflects a dysfunction within the individual. A psychological disorder cannot reflect a difference in political beliefs between citizens and their governments. Those campus protesters who want to keep college costs down could not, according to this criterion, be considered psychologically disordered, although they may be putting themselves at risk if they never attend a single class.

The third criterion for abnormality is..

the behavior must be associated with significant distress or disability in important realms of life. -This may sound similar to clinical significance, but the idea of distress or disability is that it applies to how the individual feels or behaves beyond having a measurable effect that the clinician can observe. The individual either feels negatively affected by the behavior ("distress") or suffers negative consequences in life as a result ("disability"). People may enjoy playing videogames to a point, but if they exclude their other obligations, this will negatively affect their lives. They may also feel distressed but unable to stop themselves from engaging in the behavior.

The newer models, along with integrative models that take a biopsychosocial approach, are producing the development of empirically based approaches to understanding what?

the causes of psychological disorder. Although some of these may ultimately prove not to retain their utility, the continued shaping and refinement of the field that empirical testing permits will help to ensure that application of the scientific perspective will result in treatments that are both humane and effective.

The Greeks sought advice from oracles, wise advisors who made pronouncements from?

the gods.

Fourth....

the individual's behavior cannot simply be socially "deviant" as defined in terms of religion, politics, or sexuality. The person who refuses to eat meat for religious, political, or other personal reasons would not be considered to have a psychological disorder by this standard. However, if that person restricts all food intake to some level far below what is healthy, then that individual may meet one of the other criteria for abnormality such as clinical significance and/or the distress-disability dimension.

The scientific method involves a progression of steps from posing questions of interest to sharing the results with the scientific community. Throughout the scientific method, researchers maintain the objectivity that is the hallmark of the scientific approach. This means that?

they do not let their personal biases interfere with the data collection or interpretation of findings. - In addition, researchers must always be open to alternative explanations that could account for their findings. Toward this end, more and more scientists in the field of medicine and psychology are making their data available in open access repositories that allow for other researchers to examine their procedures, analyses, and conclusions.

Further advances occurred when German psychiatrist Emil Kraepelin (1856-1926) promoted a classification system much like that applied to medical diagnoses. He proposed that disorders could be identified by?

their patterns of symptoms. -Ultimately, this work provided the scientific basis for current diagnostic systems.

However, psychological disorders can also be produced by environmental influences alone if?

these affect the brain or related organs of the body. -For example, people with thyroid disturbances may experience wide mood or activity level fluctuations. -Brain injury resulting from a head trauma can result in altered thoughts, memory loss, and changes in mood.

Additionally, environmental deprivation caused by poverty, malnutrition, or social injustice can place individuals at risk by doing what?

threatening their physical health, which in turn affects their mental health

Beyond the RCT design, well-controlled research in clinical psychology has a placebo condition in which participants receive a what?

treatment similar to the experimental treatment, but one that lacks the key feature of the treatment of interest. If the study is evaluating effectiveness of medication, the placebo would have inert ingredients. If participants are randomly assigned to placebo versus treatment, the design is referred to as a placebo-controlled randomized clinical trial.

Causes of Abnormal Behavior: Sociocultural

-Social policies -Discrimination -Stigma

Within the biopsychosocial perspective, social factors interact with biological and psychological contributions, in that environmental influences can ?

alter behavior.

Exposure to toxic substances in the environment can also alter?

an individual's emotions and behavior by their effects on the nervous system.

The biopsychosocial perspective also incorporates a developmental viewpoint. This means that it is important to understand how these three sets of influences change over the course of what?

an individual's life. Some circumstances place the individual at risk, particularly if these occur at certain points in life.

Thus, in posing questions of interest, psychological researchers may wonder whether a particular kind of experience led to?

an individual's symptoms, or they may speculate about the role of particular biological factors.

Following from the biopsychosocial perspective, abnormal behavior is seen as reflecting a what?

combination of biological, psychological, and sociocultural factors as these evolve over time in the individual's growth and development.

The stigma of psychological disorders affects people from ethnic and racial minorities how?

more severely than those from mainstream society. -For example, European American adolescents and their caregivers are twice as likely as members of minority groups to define problems in mental health terms or to seek help for such problems

Scientific Approach: We now return again to ancient times when, surprisingly, the early Greek philosophers took a scientific approach to understanding psychological disorders. Hippocrates (ca. 460-377 b.c.), considered the founder of modern medicine, believed that four important bodily fluids influenced physical and mental health, leading to four personality dispositions. To treat a psychological disorder would require what?

ridding the body of the excess fluid. Although he was obviously incorrect, Hippocrates was far ahead of his time in putting forth the notion that mental health reflected factors within the body rather than possession by evil spirits.

The ritual of exorcism is another practice used to cure psychological disturbance, in which evil spirits are what?

ritually driven away. -A shaman, priest, or medicine man carries out rituals that put the individual under extreme physical and mental duress.

The most relevant genetic influences for our purposes are?

inherited factors that alter the functioning of the nervous system.

The correlation statistic is expressed in terms of a number between?

+1 and −1.

Conversely, negative correlations indicate that what?

, as scores on one variable increase, scores on the second variable decrease. An example of a negative correlation is the relationship between depression and self-esteem. The more depressed people are, the lower their scores are on a measure of self-esteem.

Causes of Abnormal Behavior: Biological

-Genetic inheritance -Physiological changes -Exposure to toxic substances

In late 2010, the U.S. government's Healthy People project released goals for the coming decade. These goals are intended both to improve the psychological functioning of individuals in the United States and to expand treatment services:

-Reduce the suicide rate. -Reduce suicide attempts by adolescents. -Reduce the proportion of adolescents who engage in disordered eating behaviors in an attempt to control their weight. -Reduce the proportion of persons who experience major depressive episodes. -Increase the proportion of primary care facilities that provide mental health treatment onsite or by paid referral. -Increase the proportion of children with mental health problems who receive treatment. -Increase the proportion of juvenile residential facilities that screen admissions for mental health problems. -Increase the proportion of persons with serious mental illness (SMI) who are employed. -Increase the proportion of adults with mental disorders who receive treatment. -Increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders. -Increase depression screening by primary care providers. -Increase the proportion of homeless adults with mental health problems who receive mental health services.

Case study:

An individual or a small group of individuals is studied intensively -A therapist describes the cases of members of a family who share the same unusual disorder.

The next major advance occurred in 1844, when a group of 13 mental hospital administrators formed the?

Association of Medical Superintendents of American Institutions for the Insane. -This organization eventually changed its name to the American Psychiatric Association.

Behavioral genetics:

Attempt to identify genetic patterns in inheritance of particular behaviors -Genetic researchers compare the DNA of people with and without symptoms of particular psychological disorders.

Laboratory study:

Collect data under controlled conditions -An experiment is conducted to compare reaction times to neutral and fear-provoking stimuli.

Survey:

Obtain population data -Researchers working for a government agency attempt to determine disease prevalence through questionnaires administered over the telephone.

Single case experimental design:

The same person serves as subject in experimental and control conditions -Researchers report on the frequency of a client's behavior while the client is given attention (experimental treatment) and ignored (control condition) for aggressive outbursts in a psychiatric ward.

Definition of a Mental Disorder:

There are five criteria for a mental disorder in the DSM-5, the same number as was included in DSM-IV. The criteria still refer to "clinically significant" to establish the fact that the behaviors under consideration are not passing symptoms or minor difficulties. DSM-5 refers to the behaviors as reflecting dysfunction in psychological, biological, or developmental processes, terms that DSM-IV did not use. Both the DSM-IV and DSM-5 state that disorders must occur outside the norm of what is socially accepted and expected for people experiencing particular life stresses. DSM-5 also specifies that the disorder must have "clinical utility," meaning that, for example, the diagnoses help guide clinicians in making decisions about treatment. During the process of writing the DSM-5, the authors cautioned against changing the lists of disorders (either adding to or subtracting from) without taking into account potential benefits and risks. For example, they realized that adding a new diagnosis might lead to labeling as "abnormal" a behavior previously considered "normal." The advantage of having the new diagnosis must outweigh the harm of categorizing a "normal" person as having a "disorder." Similarly, deleting a diagnosis for a disorder that requires treatment (and hence insurance coverage) might leave individuals who still require that treatment vulnerable to withholding of care or excess payments for treatment. With these cautions in mind, the DSM-5 authors also recommend that the criteria alone are not sufficient for making legal judgments or eligibility for insurance compensation. These judgments would require additional information beyond the scope of the diagnostic criteria alone.

Second, to be considered evidence of a psychological disorder...

a behavior must reflect a dysfunction in a psychological, biological, or developmental process. Concretely, this means that even if scientists do not currently know what that dysfunction is, they assume that it can one day be discovered.

Public outrage over the worsening situation in mental hospitals finally led to a more widespread realization that mental health services required dramatic changes. The federal government took emphatic action in 1963 with the passage of groundbreaking legislation. The Mental Retardation Facilities and Community Mental Health Center Construction Act of that year initiated what?

a series of changes that would affect mental health services for decades to come. Legislators began to promote policies designed to move people out of institutions and into less restrictive programs in the community, such as vocational rehabilitation facilities, day hospitals, and psychiatric clinics. After their discharge from the hospital, people entered halfway houses—rehabilitation-oriented group living homes that provided a supportive environment to support their learning the necessary social skills to reenter the community.

The first criterion for a psychological disorder is ....

clinical significance, meaning that the behavior involves a degree of impairment that a clinician can observe. -People who feel jinxed about not having a lucky seat available for an exam would fit this criterion only if they could not concentrate on the exam at all unless they sat in that seat.

Similarly, investigators cannot randomly assign people to groups based on their what?

biological sex. -Studies that investigate differences among groups not determined by random assignment are known as "quasi-experimental."

In general, during the sixteenth and seventeenth centuries, views about medicine were primitive. Thus, as was true for people with physical illness, the "treatment" of people with psychological disorders involved what?

bleeding, forced vomiting, and purging.

The key feature of correlational studies is that they cannot determine what?

cause and effect. -Just knowing that there is a correlation between two variables does not tell you whether one variable causes the other. The correlation simply tells you that the two variables are associated with each other in a particular way. Sleep disturbance might cause a higher score on a measure of depression, just as a high degree of depression might cause more disturbed sleep patterns. Or, a third variable that you have not measured could account for the correlation between the two variables that you have studied. Both depression and sleep disturbance could be due to an underlying process that alters the body's hormones and causes both physiological and psychological disturbances.

Expectations about the experiment's outcome can affect both the investigator and the participant. These so-called "demand characteristics" can compromise the what?

conclusions about the intervention's true effectiveness. Obviously, the investigator should be as unbiased as possible, but there still may be subtle ways that he or she communicates cues that affect the participant's response. The participant may also have a personal agenda in trying to prove or disprove the study's supposed true intent.

Humanitarian explanations view psychological disorders as the result of?

cruelty, stress, or poor living conditions.

Researchers then compare the groups on the?

dependent variable, which is the variable that they observe. -For example, a researcher may wish to investigate the efficacy of group therapy to reduce the symptoms of a type of anxiety. The independent variable would be the provision of therapy versus control. The dependent variable, measured before and after the independent variable was manipulated, would be number of anxiety symptoms

Investigators evaluate a treatment's effectiveness by comparing the groups on what?

dependent variables such as number of symptoms. -Depending on the nature of the particular study, there may be more than one experimental group. For example, an investigator may want to compare two different treatments against each other, and a control group.

One important unique sociocultural contribution to psychological disorders is?

discrimination, whether based on social class, income, race and ethnicity, sexual orientation, or gender. Discrimination not only limits people's ability to experience psychological well-being, but can also have direct effects on physical health and development. For example, it has long been known that people from lower economic income and status brackets are more likely to have psychological disorders due to the constant strain of being discriminated against as well as lack of access to education and health resources. As we pointed out earlier, moreover, people who are diagnosed with a psychological disorder are likely to be stigmatized as a result of their symptoms and diagnostic label. The stress of carrying the stigma of mental illness increases the emotional burden for these individuals and their loved ones. Because it may prevent them from seeking badly needed help, it also perpetuates a cycle in which many people in need become much worse.

As you will see when reading about the conditions in this textbook, the degree of influence of each of these variables differs among what?

disorders. -For some disorders, such as schizophrenia, biology seems to play a particularly dominant role. -For other disorders, such as stress reactions, psychological factors predominate. -Conditions such as post-traumatic stress disorder as a result, for example, from experiences under a terrorist regime, have a primarily sociocultural cause.

The best way to eliminate demand characteristics is to use a what?

double-blind method, which shields both investigator and participant from knowing either the study's purpose or the nature of the patient's treatment.

The majority of true experimental studies in abnormal psychology, at least those on humans, test not the causes of abnormal behavior but the ?

effectiveness of particular treatments, making it possible to design randomly assigned control and experimental groups.

To ensure that RCT-based studies conform to acceptable standards, researchers are increasingly being required to do what?

enter their work, prior to its being started, in a public trial registry. If they do not, the research will not be eligible for publication in a top-tier (most prestigious) research journal. Unfortunately, the implementation of these standards is falling behind; as of 2013-14, in the area of health psychology and behavioral medicine, about half of the eligible published studies had been registered and only 21 percent reported primary outcomes (Riehm, Azar, & Thombs, 2015). Perhaps a word to the consumer is needed, then, on the importance of checking out the adherence of a study to these guidelines before seeking a new intervention.

Although the scientific method is based on objectivity, this does not mean that scientists have no personal interest in what they are studying. In fact, many researchers become involved in the pursuit of knowledge in areas that relate to what?

experiences in their own lives, particularly in the field of abnormal psychology. They may have relatives afflicted with certain disorders or they may have become puzzled by a client's symptoms. In conducting their research, however, they cannot let these personal biases get in the way.

Studies based on a correlational design involve tests of relationships between variables that researchers cannot?

experimentally manipulate.

The incidence of a disorder is the what?

frequency of new cases of a disorder within a given time period. -Respondents providing incidence data state whether they now have a disorder that they have never had before but are experiencing for the first time. -Incidence information can cover any time interval; epidemiologists tend to report it in terms of 1 month, 6 months, and 1 year. -Investigators use incidence data when they are interested in determining how quickly a disorder is spreading. -For example, during an epidemic, health researchers need to know how to plan for controlling the disease, and so incidence data is most pertinent to this question.

Investigators use a survey to gather what?

gather information from a sample of people representative of a particular population. Very often, an investigator uses a survey to gather data that will be analyzed through correlational statistics. In a survey, investigators design sets of questions to tap into these variables, using questions to be answered with rating scales ("agree" to "disagree"), open-ended answers, or multiple choice. For example, a researcher may conduct a survey to determine whether age is correlated with subjective well-being, controlling for the influence of health. In this case, the researcher may hypothesize that subjective well-being is higher in older adults, but only after taking into account the role of health. The survey questions provide responses that can be translated into variables and subjected to statistical analysis.

the factors within the body that can contribute to abnormal behavior include:

genetic abnormalities that alone, or in combination with the environment, influence the individual's psychological functioning. -Within the biopsychosocial perspective, these biological influences must impact or alter some feature of nervous system functioning.

However, the humanitarian goals that Dix advocated had a lasting influence on the mental health system. Her work was carried forward into the twentieth century by advocates of the mental hygiene movement, a term that reflects the goal of?

helping individuals maintain mental health and prevent the development of psychological disorders.

While these advances in medical science and psychiatry were taking place, the early roots of a psychological approach to abnormality began to emerge in the early 1800s, when European physicians experimented with ?

hypnosis for therapeutic purposes. -Eventually, these efforts led to the groundbreaking work of Viennese neurologist Sigmund Freud (1856-1939), who in the early 1900s developed psychoanalysis, a theory and system of practice that relied heavily on the concepts of the unconscious mind, inhibited sexual impulses, and early development.

Throughout the twentieth century, psychologists continued to develop models based on observations of the behavior of?

laboratory animals. -The work of Russian physiologist Ivan Pavlov (1849-1936), known for his discovery of classical conditioning, became the basis for the behaviorist movement begun in the United States by John B. Watson (1878-1958). -B. F. Skinner (1904-1990) formulated a systematic approach to operant conditioning, specifying the types and nature of reinforcement as a way to modify behavior. -In the twentieth century, these models continued to evolve into the social learning theory of Albert Bandura (1925-), the cognitive model of Aaron Beck (1921-), and the rational-emotive therapy approach of Albert Ellis (1913-2007).

For our purposes in this book, some of the most important survey data we will rely on comes from what?

large-scale epidemiological studies. -This is how we know how many people are likely to develop a disorder, and who particularly is at risk. -The type of data we use for these purposes falls into two categories: (1) number of new cases and (2) number of cases that have ever existed. -Both are calculated for the population as a whole and for particular segments of the population by sex, age group, geographic region, or social class, for example.

Although there are no pure psychological causes in the biopsychosocial perspective, those that reflect:

learning, life experiences, or exposure to certain situations may be thought of as reflecting predominantly psychological influences. -These can also include difficulty coping with stress, illogical fears, susceptibility to uncontrollable emotions, and a host of other dysfunctional thoughts, feelings, and behaviors that lead individuals to meet the criteria for psychological disorder.

In studies evaluating effectiveness of therapy, scientists must design the placebo in a way that what?

mimics, but is not the same as, the actual therapy. Ideally, researchers would want the placebo participants to receive treatments of the same frequency and duration as the experimental group participants who are receiving psychotherapy.

Adding to the growth of their populations, the widespread belief that psychologically disturbed people lacked ordinary sensory capabilities led to such practices as?

not providing them with heat, clean living conditions, or appropriate food.

Starting in the Middle Ages, the poorhouses and monasteries became established as shelters to house these individuals who often were?

ostracized by their families. -It remains present today as the underlying basis for reforms in mental health treatment and the actions of mental health advocacy groups.

Unfortunately, without an effective treatment, the shelters increasingly became what?

overcrowded and inhospitable. -Rather than provide protection, ironically, they became places of neglect, abuse, and maltreatment.

Over the next 100 years, governments built scores of state hospitals throughout the United States following the humanitarian model originally advocated by Dix. Once again, however, it was only a matter of time before the hospitals became what?

overcrowded and understaffed. -It simply was not possible to cure people by providing them with the well-intentioned but ineffective interventions proposed by moral treatment. Making deinstitutionalization possible was the development, in the 1950s, of pharmacological treatments that for the first time in history could successfully control the symptoms of psychological disorders. Now, patients could receive treatments that would allow them to live for extended periods of time on their own outside psychiatric hospitals. This legislation paved the way for the deinstitutionalization movement and subsequent efforts to continue to improve community treatment. By the mid-1970s, the state mental hospitals, once overflowing with patients, were practically deserted. These hospitals freed hundreds of thousands of institutionally confined people to begin living with greater dignity and autonomy. This process, known as the deinstitutionalization movement, promoted the release of psychiatric patients into community treatment sites. Unfortunately, the deinstitutionalization movement did not completely fulfill the dreams of its originators. Rather than abolishing inhumane treatment, deinstitutionalization created another set of woes. Many of the promises and programs hailed as alternatives to institutionalization ultimately failed to come through because of inadequate planning and insufficient funds. Patients were shuttled back and forth between hospitals, halfway houses, and shabby boarding homes, never having a sense of stability or respect. Although the intention of releasing patients from psychiatric hospitals was to free people Page 14who had been deprived of basic human rights, the result may not have been as liberating as many had hoped. All too often, people who would have been in psychiatric hospitals four decades ago are moving through a circuit of shelters, rehabilitation programs, jails, and prisons. A disturbing number of these individuals spend long periods of time as homeless and marginalized members of society. Advocates of the humanitarian approach today suggest new forms of compassionate treatment for people who suffer from psychological disorders. These advocates encourage mental health consumers to take an active role in choosing their treatment. Various advocacy groups have worked tirelessly to change the way the public views mentally ill people and how society deals with them in all settings. These groups include the National Alliance for the Mentally Ill (NAMI), as well as the Mental Health Association, the Center to Address Discrimination and Stigma, and the Eliminate the Barriers Initiative. The U.S. federal government has also become involved in antistigma programs as part of efforts to improve the delivery of mental health services through the President's New Freedom Commission (Hogan, 2003). Looking forward into the next decade and beyond, the U.S. government has set the Healthy People 2020 initiative goals as focused on improving significantly the quality of treatment services

In later adulthood, different risk and protective factors may what?

play a role. -Individuals who are experiencing physical health problems due to a lifetime of poor dietary habits may be more likely to develop psychological symptoms due to altered cardiovascular functioning. -On the other hand, if they have developed an extensive social support network, this can somewhat offset the risk presented by their poor physical health.

Although the spiritual approach is no longer the prevalent view in Western culture as an explanation for psychological disorders, there are still what?

pockets of believers in modern society. -Across other cultures, however, shamans and medicine men continue to practice, reflecting perhaps longstanding cultural and religious beliefs.

Positive numbers represent?

positive correlations, meaning that, as scores on one variable increase, scores on the second variable increase as well. For example, because one aspect of depression is that it causes a disturbance in normal sleep patterns, you would expect then that scores on a measure of depression would be positively correlated with scores on a measure of sleep disturbances.

Although deinstitutionalization was designed to enhance the quality of life for people who had been held years in public psychiatric hospitals, many individuals left institutions only to find a life of?

poverty and neglect on the outsid

In either case, the ideal approach to answering these questions involves a progression through a set of steps in which the psychologist:

proposes a hypothesis, conducts a study, and collects and analyzes the data. Eventually, they communicate results through publication in scientific journals, which makes it possible for other scientists to examine their data, procedures, and conclusions.

We might argue, however, that from a strictly psychological perspective, some causes of abnormal behavior reflect entirely what?

psychological factors. -For example, individuals may find themselves repeating distressing behaviors that are instilled through learning experiences. They may also express emotional instability as the result of feeling that their parents or caretakers could not be relied on to watch over them.

Researchers also use surveys to gather statistics about the frequency of what?

psychological symptoms. -For example, the Substance Abuse and Mental Health Services Administration of the U.S. government (SAMHSA) conducts yearly surveys to establish the frequency of use of illegal substances within the population. -The World Health Organization (WHO) conducts surveys comparing the frequency of psychological disorders by country. -By asking approximately the same questions on each occasion, it is possible for these agencies, and users of the data set, to track changes in health and health-related behaviors over time.

Key to the objectivity of experimental research is the requirement that the researchers always do what?

randomly assign participants to the different groups. -A study would be flawed if all the men were in the experimental group, for example, and all the women were in the control group.

During the Middle Ages, people used a variety of magical rituals and exorcism to "cure" people with psychological disorders, but this also took the form of treating these individuals as what?

sinners, witches, or personifications of the devil. -Accordingly, they were punished severely. This view of afflicted individuals as possessed by evil spirits became apparent from the 1486 book, Malleus Maleficarum, in which two German Dominican monks justified their punishment of "witches." Depicting them as heretics and devils who the Church had to destroy in the interest of preserving Christianity, the book's authors recommended "treatments" such as deportation, torture, and burning at the stake. Starting in the 1500s, and continuing up until the late 1600s, the majority of individuals accused of witchcraft were women. The burning and hanging of witches by the Puritans in the United States eventually ended after the Salem witchcraft trials (1692-93) when townspeople began to doubt the authenticity of the charges.

Returning to the Middle Ages, then, although the shelters built to house individuals with psychological disorders could not offer treatment, they initially provided what?

some protection.

Within the biopsychological perspective, however, psychological causes are viewed as part of a larger constellation of factors influenced by ?

something going on within the body interacting with exposure to a certain environment.

By the end of the eighteenth century, throughout hospitals in France, Scotland, and England, a few courageous people began to recognize what?

the inhumanity of the conditions in the poorhouses and monasteries housing those with psychological disorders. -They initiated sweeping reforms in an attempt to reverse these harsh practices. The idea of moral treatment took hold—the notion that people could develop self-control over their behaviors if they had a quiet and restful environment. Institutions following this model used restraints only if absolutely necessary, and even in those cases the patient's comfort came first. Yet again, however, conditions in the asylums originally formed to protect patients began to worsen in the early 1800s due to overcrowding and the increasing use by staff of physical punishment as a means of control. In 1841, Boston schoolteacher Dorothea Dix (1802-1887) took up the cause of reform. Horrified by the inhumane conditions in the asylums, Dix appealed to the Massachusetts legislature for more state-funded public hospitals to provide humane treatment for mental patients. From Massachusetts, Dix spread her message throughout North America and Europe.

Furthermore, when it comes to making an actual diagnosis of a client, the mental health professional must further weigh what?

the merits versus disadvantages of using a diagnostic label. -The merits are that the individual will receive treatment (and be able to receive insurance reimbursement) but the disadvantages can be that the individual will be labeled with a psychological disorder that becomes part of his or her health records. At a later point in life, that diagnosis may make it difficult for the individual to qualify for certain jobs.

The existence of multiple forms of discrimination means, then, that individuals must cope not only with their symptoms and the stigma of their symptoms, but also with what?

the negative attitudes toward their socially defined group. Clinicians working with individuals from discriminated-against groups are increasingly learning the importance of taking these factors into account in both diagnosis and treatment. We will learn about the specific guidelines that mental health experts are developing to help ensure that clinicians receive adequate training in translating theory into practice.

Several hundred years later, the Roman physician Claudius Galen (a.d. 130-200) developed a system of medical knowledge based on anatomical studies. This approach also helped to advance what?

the position that diseases had their source in abnormal bodily functioning.

Most recently, the field of abnormal psychology is benefiting from the positive psychology movement, which emphasizes what?

the potential for growth and change throughout life. The movement views psychological disorders as difficulties that inhibit the individual's ability to achieve highly subjective well-being and feelings of fulfillment. In addition, the positive psychology movement emphasizes prevention rather than intervention. Instead of fixing problems after they occur, this viewpoint proposes that it would be more beneficial to emphasize prevention. Although its goals are similar to those of the humanitarian approach, the positive psychology movement has a strong base in empirical research and as a result is gaining wide support in the field.

As you've just learned, the scientific approach led to significant advances in the understanding and treatment of abnormal behavior. The essence of the scientific method is objectivity:

the process of testing ideas about the nature of psychological phenomena without bias before accepting these ideas as adequate explanations.

Spiritual explanations regard abnormal behavior as?

the product of possession by evil or demonic spirits.

The scientific approach would eventually recede for hundreds of years as the predominant view of psychological disorder in favor of explanations rooted in the spiritual perspective. Benjamin Rush (1745-1813), the founder of American psychiatry, rekindled interest in what?

the scientific approach to psychological disorders. -In 1783, Rush joined the medical staff of Pennsylvania Hospital. Appalled by the poor treatment of psychologically disturbed patients there, Rush advocated for improvements such as placing patients in their own wards, giving them occupational therapy, and prohibiting hospital visits from curiosity seekers looking for entertainment. Positive psychology emphasizes personal growth through meditation and other alternate routes to self-discovery. Reflecting the prevailing methods of the times, though, Rush also supported the use of bloodletting and purging in the treatment of psychological disorders as well as the so-called "tranquilizer" chair, intended to reduce blood flow to the brain by binding the patient's head and limbs. Rush also recommended submerging patients in cold shower baths and frightening them with death threats. He thought that by inducing fear, he could counteract their violent behavior (Deutsch, 1949).

Humanitarian Approach: The humanitarian approach to psychological disorders developed in part as a reaction against what?

the spiritual approach and its associated punishment of people with psychological disorders.

The greatest thinkers of the world, from ancient times to the present, have attempted to explain the varieties of human behavior that we now regard as evidence for a psychological disorder. Throughout history, three prominent themes seem to recur:

the spiritual, the humanitarian, and the scientific.

From the Middle Ages to the present time, the humanitarian movement has remained an important perspective. However, until relatively recently, it was not possible without some type of scientific basis for treatment for individuals with psychological disorders to receive what?

the type of care that would guarantee their welfare.

Spiritual Approach: Archaeological evidence dating back to 8000 b.c. suggests that the spiritual explanation prevailed in prehistoric times. Skulls were discovered in caves inhabited by prehistoric peoples in which a hole had been cut, a process called?

trephining. -It would appear that these holes were cut as an effort to release the "evil spirits" from the person's head (Maher & Maher, 1985). Archaeologists have found trephined skulls from many countries and cultures, ranging from the Far and Middle East to Britain and South America (Gross, 1999). The idea that the spirits can be literally released from the skull suggests that across cultures, people believed that the cause of psychological disturbance lay in the head rather than in other parts of the body.

In studies involving medication, a completely inert placebo may not be sufficient to establish what?

true experimental control. In an "active placebo" condition, researchers build the experimental medication's side effects into the placebo. If they know that a medication produces dry mouth, difficulty swallowing, or upset stomach, then the placebo must also mimic these side effects or participants will know they are receiving placebos.

In many cases, there is no correlation between what?

two variables. In other words, two variables show no systematic relationship with each other. For example, depression is unrelated to height but it may be related to sleep disturbances, such that the more depressed people are, the more sleep disturbances they experience.

We will follow the trajectories of each of these perspectives throughout history. As you will see, each one has had its period of major influence, but the issues remain the same today in some ways as in ancient times, in that the actual causes of psychological disturbance remain what?

unknown. -The scientific approach will undoubtedly provide the key toward discovering what causes psychological disorder, but it will nevertheless be important for mental health professionals to follow the principles of the humanitarian approach. Spiritual explanations may never completely disappear from the horizon, but the idea that psychological disorder can be understood will certainly provide the best prospects for turning that understanding into treatment.

Investigators who use correlational methods in their research must always be on guard for the potential existence of?

unmeasured variables influencing the observed results. However, increasingly sophisticated statistical modeling procedures are making it possible to go beyond simply linking two variables to see if they are correlated. A researcher can use such methods to assess the relative contributions of such variables as self-esteem, gender, sleep patterns, and social class to predict depression scores.

The term sociocultural perspective refers to the ?

various circles of influence on the individual ranging from close friends and family to the institutions and policies of a country or the world as a whole. These interact in important ways with biological processes affecting the brain, as discussed, and with the psychological contributions that occur through exposure to particular experiences.

Scientific explanations look for causes that what?

we can objectively measure, such as biological alterations, faulty learning processes, or emotional stressors.

Clinical psychologists are also interested in finding out?

whether a certain treatment will effectively treat the symptoms of a disorder.