PSYC 431 Chapter 1-4

Continuing Influences of Freud and His Followers

-Childhood experiences help shape adult personality **Childhood Experiences and environmental events are crucial. ** Early relationships influence adult relationships. -There are unconscious influences on behavior ** People can be unaware of the causes of their behavior. The causes and purposes of human behavior are not always obvious. **Look under the surface to find hidden meaning in behavior

Biological Origins-General Paresis

-Deterioration of mental and physical abilities, and progressive paralysis (general paresis) Many people with general paresis also had syphilis. In 1905, biological cause of syphilis found: -Causual link between infection, damage to the brains and psychopathology. -Biological causes of psychopathology gained credibility.

The Four Characteristics of Stigma

1.A label is applied to a group of people that distinguishes them from others (e.g., "crazy"). 2.The label is linked to deviant or undesirable attributes by society (e.g., crazy people are dangerous). 3.People with the label are seen as essentially different from those without the label, contributing to an "us" versus "them" mentality (e.g., we are not like those crazy people). 4.People with the label are discriminated against unfairly (e.g., a clinic for crazy people can't be built in our neighborhood).

T/F Benjamin Rush is credited with beginning moral treatment in the United States.

False

T/F Exorcism was an early biological treatment.

False

True/False Close to 20 million people in the United States had some type of psychological disorder according to the Center for Behavior Health Statistics and Quality (2015) report.

False

E. Thorndike

In the 1890s, Edward Thorndike (1874-1949) began work that led to the discovery of another type of learning. Rather than investigate the association between stimuli, as Pavlov did, Thorndike studied the effects of consequences on behavior. Thorndike formulated what was to become an extremely important principle, the law of effect: Behavior that is followed by consequences satisfying to the organism will be repeated, and behavior that is followed by unpleasant consequences will be discouraged.

____________with psychological disorders can also help reduce stigma. For example, the singer and songwriter Demi Lovato openly discusses her life with bipolar disorder and has joined the campaign BeVocal to help reduce stigma

Celebrities or public figures

Thomas Kuhn

Central to scientific activity, suggested by philosopher of science _____(1962/1970), is the notion of a paradigm, a conceptual framework or approach within which a scientist works—that is, a set of basic assumptions, a general perspective, that defines how to conceptualize and study a subject, how to gather and interpret relevant data, even how to think about a particular subject.1 A paradigm has important implications for how scientists operate at any given time. Paradigms specify what problems scientists will investigate and how they will go about the investigation.

Rise of Behaviorism

After some years, many in the field began to lose faith in Freud's approach. Instead, the experimental procedures of the psychologists who were investigating learning in animals became a more dominant focus of psychology. Behaviorism focuses on observable behavior rather than on consciousness or mental functioning. We will look at three types of learning that influenced the behaviorist approach in the early and middle parts of the twentieth century and that continue to be influential today: classical conditioning, operant conditioning, and modeling.

The Importance of Cognition

Although behaviorism remains influential in many ways today, clinicians and researchers have recognized the limitations of focusing only on behavior. Human beings don't just behave; they think and feel, too! Early behavior theories did not leave much room for cognition and emotion. Beginning in the 1960s, the study of cognition began to become very prominent. Researchers and clinicians realized that the ways in which people think about, or appraise, situations can influence behavior in dramatic ways. For example, walking into a room of strangers can elicit thoughts such as "Great! I am so excited to meet all sorts of new and interesting people" or "I do not know any of these people and I am going to look and sound like a complete moron!" A person who has the first thought is likely to join a group of people enthusiastically and join in the conversation. The person who has the second thought, however, is likely to turn right around and leave the room.

Transference

Another key component of psychoanalytic therapy is the analysis of ______. _______ refers to the person's responses to his or her analyst that seem to reflect attitudes and ways of behaving toward important people in the person's past. For example, a person might feel that the analyst is generally bored by what he or she is saying and as a result might struggle to be entertaining; this pattern of response might reflect the person's childhood relationship with a parent rather than what's going on between the person and the analyst. Through careful observation and analysis of these transferred attitudes, Freud believed the analyst could gain insight into the childhood origins of a person's repressed conflicts. In the example above, the analyst might suggest that the person was made to feel boring and unimportant as a child and could only gain parental attention through humor.

Pavlov (1849-1936)

Around the turn of the twentieth century, the Russian physiologist and Nobel laureate Ivan Pavlov (1849-1936) (see photo) discovered classical conditioning, quite by accident. As part of his study of the digestive system, Pavlov gave a dog meat powder to make it salivate. Before long, Pavlov's laboratory assistants became aware that the dog began salivating when it saw the person who fed it. As the experiment continued, the dog began to salivate even earlier, when it heard the footsteps of its feeder. Pavlov was intrigued by these findings and decided to study the dog's reactions systematically. In the first of many experiments, a bell was rung behind the dog and then the meat powder was placed in its mouth. After this procedure had been repeated several times, the dog began salivating as soon as it heard the bell and before it received the meat powder. In this experiment, because the meat powder automatically elicits salivation with no prior learning, the powder is termed an unconditioned stimulus (UCS) and the response of salivation an unconditioned response (UCR). When the offering of meat powder is preceded several times by a neutral stimulus, the ringing of a bell, the sound of the bell alone (the conditioned stimulus, or CS) can elicit the salivary response (the conditioned response, or CR) (see Figure 1.3). As the number of paired presentations of the bell and the meat powder increases, the number of salivations elicited by the bell alone increases. What happens to an established CR if the CS is no longer followed by the UCS—for example, if repeated soundings of the bell are not followed by meat powder? The answer is that fewer and fewer CRs (salivations) are elicited, and the CR gradually disappears. This is termed extinction.

gene-environment interaction

As we noted earlier, we know now that genes and environments work together. Life experience shapes how our genes are expressed, and our genes guide us in behaviors that lead to the selection of different experiences. ______ means that a given person's sensitivity to an environmental event is influenced by genes. Take a simple (and made-up) example. If a person has gene XYZ, he or she might respond to a snakebite by developing a fear of snakes. A person without the XYZ gene would not develop a fear of snakes after being bitten. This simple relationship involves both genes (the XYZ gene) and an environmental event (snakebite). We will discuss a real example of this in Chapter 5 where we present a gene-environment interaction study in major depressive disorder

Supernatural Explanations

Before the age of scientific inquiry, all good and bad manifestations of power beyond human control—eclipses, earthquakes, storms, fire, diseases, the changing seasons—were regarded as supernatural. Behavior seemingly out of individual control was also ascribed to supernatural causes. Many early philosophers, theologians, and physicians who studied the troubled mind believed that disturbed behavior reflected the displeasure of the gods or possession by demons. The belief that odd behavior was caused by possession led to treating it by exorcism, the ritualistic casting out of evil spirits. Exorcism typically took the form of elaborate rites of prayer, noisemaking, forcing the afflicted to drink terrible-tasting brews, and on occasion more extreme measures, such as flogging and starvation, to render the body uninhabitable to devils.

Watson & Rayner, 1920

Classical conditioning can even instill fear. A famous but ethically questionable experiment conducted by John Watson (see photo) and Rosalie Rayner (Watson & Rayner, 1920) involved introducing a white rat to an 11-month-old boy, Little Albert. The boy showed no fear of the animal and appeared to want to play with it. But whenever the boy reached for the rat, the experimenter made a loud noise (the UCS) by striking a steel bar behind Albert's head. This caused Little Albert great fright (the UCR). After five such experiences, Albert became very frightened (the CR) by the sight of the white rat, even when the steel bar was not struck. The fear initially associated with the loud noise had come to be elicited by the previously neutral stimulus, the white rat (now the CS). This study suggests a possible relationship between classical conditioning and the development of certain disorders, in this instance a phobia. It is important to note that this type of study could never be done today because it breaches ethical standards. However, the work of John Watson (1878-1958) helped to establish the promise of behavioral approaches.

Cognitive Therapy

Cognitive therapy, as mentioned earlier, is based on the idea that people not only behave, but also think and feel. All cognitive approaches have one thing in common. They emphasize that how people construe themselves and the world is a major determinant of psychological disorders. In cognitive therapy, the therapist typically begins by helping clients become more aware of their maladaptive thoughts. By changing cognition, therapists hope that people can change their feelings, behaviors, and symptoms.

Dysfunction

Developmental, psychological, and/or biological systems are not working as they should(impairment) These systems are interrelated.

Franz Anton Mesmer (1734-1815)

During the eighteenth century in western Europe, many people were observed to be subject to hysteria, which referred to physical incapacities, such as blindness or paralysis, for which no physical cause could be found. ______, an Austrian physician practicing in Vienna and Paris in the late eighteenth century, believed that hysteria was caused by a distribution of a universal magnetic fluid in the body. Moreover, he felt that one person could influence the fluid of another to bring about a change in the other's behavior. _______, conducted meetings cloaked in mystery and mysticism, and he originally developed a technique using rods to influence a person's alleged magnetic fields. Later, Mesmer perfected his routines by simply looking at people rather than using rods. onducted meetings cloaked in mystery and mysticism, and he originally developed a technique using rods to influence a person's alleged magnetic fields. Later, ____ perfected his routines by simply looking at people rather than using rods.

The history of treatment approaches has largely been negative, which damages the image of both mental illness and psychologists. Though awareness and knowledge have increased, stigma has remained. Impact of news/media reports of violent criminals? TV crime shows, movies, and books focus that on the "criminal mind? of "psychopaths?" Recent efforts have used social media, blogs, and websites to inform the public about mental illness and how common it is.

Ending Stigma

GWAS Involve:

Examining the entire genome of people. Large samples of participants. Analysis of millions of gene sequences to look for SNPs.

The Genetic Paradigm

Explores what Francis spoke about with genetics. Genes do not, on their own, make us smart, dumb, sassy, polite, depressed, joyful, musical, tone-deaf, athletic, clumsy, literary or incurious. Those characteristics come from a complex interplay within a dynamic system. Every day in every way you are helping to shape which genes become active. Your life is interacting with your genes.

Moral Treatment

For a time, mental hospitals established in Europe and the United States were relatively small, privately supported, and operated along the lines of the humanitarian changes at La Bicêtre. In the United States, the Friends' Asylum, founded in 1817 in Pennsylvania, and the Hartford Retreat, established in 1824 in Connecticut, were established to provide humane treatment. In accordance with this approach, which became known as ________, people had close contact with attendants, who talked and read to them and encouraged them to engage in purposeful activity; residents led lives as close to normal as possible and in general took responsibility for themselves within the constraints of their disorders. Further, there were to be no more than 250 people in any given hospital (Whitaker, 2002).

Lunacy Trials

From the thirteenth century on, as the cities of Europe grew larger, hospitals began to come under secular jurisdiction. Municipal authorities, gaining in power, tended to supplement or take over some of the activities of the Church, one of these being the care of people with psychological disorders. The foundation deed for the Holy Trinity Hospital in Salisbury, England, dating from the mid-fourteenth century, specified the purposes of the hospital, one of which was that the "mad are kept safe until they are restored of reason." English laws during this period allowed people with psychological disorders to be hospitalized. Notably, the people who were hospitalized were not described as being possessed. Beginning in the thirteenth century, lunacy trials to determine a person's mental health were held in England. As explained by Neugebauer (1979), the trials were conducted under the Crown's right to protect people with psychological disorders, and a judgment of insanity allowed the Crown to become guardian of the person's estate. The defendant's orientation, memory, intellect, daily life, and habits were at issue in the trial. Usually, strange behavior was attributed to physical illness or injury or to some emotional shock. In all the cases that Neugebauer examined, only one referred to demonic possession. Interestingly, the term lunacy comes from a theory espoused by the Swiss physician Paracelsus (1493-1541), who attributed odd behavior to a misalignment of the moon and stars (the Latin word for "moon" is luna). Even today, many people believe that a full moon is linked to odd behavior; however, there is no scientific evidence to support this belief.

The process by which genes are turned on or off is referred to as:

Gene Expression

Phenotype

Genetic material is expressed(The world can see) Observable behavioral characteristics Depends on interaction of genotype and environment

Dark Ages (2nd century AD)

Historians have often pointed to the death of Galen (a.d. 130-200), the second-century Greek who is regarded as the last great physician of the classical era, as the beginning of the so-called Dark Ages in western European medicine and in the treatment and investigation of psychological disorders (see photo). Over several centuries of decay, Greek and Roman civilization ceased to be. The Church now gained in influence, and the papacy was declared independent of the state. Christian monasteries, through their missionary and educational work, replaced physicians as healers and as authorities on psychological disorder. The monks in the monasteries cared for and nursed the sick, and a few of the monasteries were repositories for the classic Greek medical manuscripts, even though the monks may not have made use of the knowledge in these works. Monks cared for people with psychological disorders by praying over them and touching them with relics; they also concocted fantastic potions for them to drink in the waning phase of the moon. Many people with psychological disorders roamed the countryside, destitute and progressively becoming worse. During this period, there was a return to a belief in supernatural causes of psychological disorders.

Disability

Impairment in an important area like work or relationships. Ex: Chronic substance abuse could lead to job loss Social anxiety could lead to peer rejection or isolation. Not all psychological disorders involve disability(Bulimia; specific phobia) Not all disabilities are considered to be psychological disorders (someone who is blind or deaf.)

Biological Treatments- Prefontal Lobotomy

In 1935, Egas Moniz, a Portuguese psychiatrist, introduced the _______, a surgical procedure that destroys the tracts connecting the frontal lobes to other areas of the brain. His initial reports claimed high rates of success Moniz, 1936), and for 20 years thereafter thousands of people with psychological disorders underwent variations of this psychosurgery. The procedure was used especially for those whose behavior was violent. Many people did indeed quiet down and could even be discharged from hospitals, but largely because their brains were damaged. During the 1950s, this intervention fell into disrepute for several reasons. After surgery, many people became dull and listless and suffered serious losses in their emotional experience and cognitive capacities—for example, becoming unable to carry on a coherent conversation with another person—which is not surprising given the destruction of parts of their brains that support emotion, thought, and language

in his groundbreaking report on mental illness, wrote that stigma is the "most formidable obstacle to future progress in the arena of mental illness and mental health" (U.S. Department of Health and Human Services, 1999). Sadly, this is still true today. In 2010, a staff person working with then Wisconsin gubernatorial candidate Scott Walker wrote dismissively about an election opponent's plan to make mental health care a focus of the campaign, "No one cares about crazy people." This awful phrase was turned into something hopeful when author Ron Powers opted to use it as the title of his book, an unflinchingly honest memoir about his two sons with schizophrenia and the current state of mental health care in the United States (Powers, 2017).

In 1999, then Surgeon General of the United States David Satcher,

Counselors

Master's psychology or counseling(2-3 years) + post-graduate supervision. Trained in counseling techniques; individuals, couples/families and groups; minimal training in psychological assessment.

Dorothea Dix

In the nineteenth century, ______ played a major role in establishing more mental hospitals in the United States. Moral treatment was largely abandoned in the latter part of the nineteenth century. Ironically, the efforts of Dorothea Dix (1802-1887), a crusader for improved conditions for people with psychological disorders who fought to have hospitals created for their care, helped effect this change (see photo). Dix, a Boston schoolteacher, taught a Sunday school class at the local prison and was shocked at the deplorable conditions in which the inmates lived. Her interest spread to the conditions at mental hospitals and to people with psychological disorders who had nowhere to go for treatment. She campaigned vigorously to improve the lives of people with psychological disorders and personally helped see that 32 hospitals were built. These large public hospitals took in many of the people whom the private hospitals could not accommodate. **In 1830, there were 4 hospitals w/200 patients in the U.S ** By 1870, there were 75 hospitals w/35,000 patients. Unfortunately, the small staffs of these new hospitals were unable to provide the individual attention that was a hallmark of moral treatment

Aaron Beck's Cognitive Therapy

Increase awareness of maladaptive thoughts. Changing thoughts-changing feelings and behaviors-reducing symptoms.

Behavior Genetics

Is the study of the degree to which genes and environmental factors influence behavior. To be clear, behavior genetics is not the study of how genes or the environment determine behavior.

What is an advantage of the DSM-5 definition of psychological disorder?

It includes any components, none of which alone can account for psychological disorder.

Clinical Case of Jose

José didn't know what to think about his nightmares. Ever since he returned from the war, he couldn't get the bloody images out of his head. He woke up nearly every night with nightmares about the carnage he witnessed as a soldier stationed in Fallujah. Even during the day, he would have flashbacks to the moment his Humvee was nearly sliced in half by a rocket-propelled grenade. Watching his friend die sitting next to him was the worst part; even the occasional pain from shrapnel still embedded in his shoulder was not as bad as the recurring dreams and flashbacks. He seemed to be sweating all the time now, and whenever he heard a loud noise, he jumped out of his chair. Just the other day, his grandmother stepped on a balloon left over from his "welcome home" party. To José, it sounded like a gunshot, and he immediately dropped to the ground. His grandmother was worried about him. She thought he must have ataque de nervios, just like her father had back home in Puerto Rico. She said her father had been afraid all the time and felt like he was going crazy. She kept going to Mass and praying for José, which he appreciated. The army doctor said he had posttraumatic stress disorder (PTSD). José was supposed to go to the Veterans Administration (VA) hospital for an evaluation, but he didn't really think there was anything wrong with him. Yet his buddy Jorge had been to a group session at the VA, and he said it made him feel better. Maybe he would check it out. He wanted these images to get out of his head.

Modeling

Learning often goes on even in the absence of reinforcers. We all learn by watching and imitating others, a process called modeling. In the 1960s, experimental work demonstrated that witnessing someone perform certain activities can increase or decrease diverse kinds of behavior, such as sharing, aggression, and fear. For example, ***Bandura and Menlove (1968) used a modeling treatment to reduce fear of dogs in children. After witnessing a fearless model engage in various activities with a dog, initially fearful children showed an increased willingness to approach and touch a dog. Children of parents with phobias or substance use problems may acquire similar behavior patterns in part by observing their parents' behavior.

Charcot (1825-1893)

Mesmer came to be regarded as a quack by his contemporaries, which is ironic, since he had earlier helped discredit an exorcist, Father Johann Joseph Gassner, who was performing similar rituals (Harrington, 2008). Nevertheless, hypnosis gradually became respectable. The great Parisian neurologist Jean-Martin Charcot (1825-1893) also studied hysterical states. Although Charcot believed that hysteria was a problem with the nervous system and had a biological cause, he was also persuaded by psychological explanations. One day, some of his enterprising students hypnotized a healthy woman and, by suggestion, induced her to display certain hysterical symptoms. Charcot was deceived into believing that she was an actual patient with hysteria. When the students showed him how readily they could remove the symptoms by waking the woman, Charcot became interested in psychological interpretations of these very puzzling phenomena. Given Charcot's prominence in Parisian society, his support of hypnosis as a worthy treatment for hysteria helped to legitimize this form of treatment among medical professionals of the time (Harrington, 2008; Hustvedt, 2011).

Genes

People have 23 pairs of chromosomes; 46 total. Each chromosome is made up of many genes, the carriers of the genetic information (DNA) passed from parents to child. People have between 20,000 and 25,000 genes; the absolute number is hard to fully estimate

Elaboration on Personal Distress

Personal distress also characterizes many of the forms of psychological disorder considered in this book—people experiencing anxiety disorders and depression suffer greatly. But not all psychological disorders cause distress. For example, an individual with antisocial personality disorder may treat others coldheartedly and violate the law without experiencing any guilt, remorse, anxiety, or other type of distress. And not all behavior that causes distress is disordered—for example, the distress of hunger due to religious fasting or the pain of childbirth.

Goals of Psychoanalysis

Psychotherapy based on Freud's theory is called psychoanalysis or psychoanalytic therapy. It is still practiced today, although not as commonly as it once was. In psychoanalytic and newer psychodynamic treatments, the goal of the therapist is to understand the person's early-childhood experiences, the nature of key relationships, and the patterns in current relationships. The therapist is listening for core emotional and relationship themes that surface again and again (see Table 1.4 for a summary of psychoanalysis techniques).

Albert Ellis Rational Emotive Therapy

Self-statements reflect unspoken assumptions(irrational beliefs) bout what is necessary to lead a meaningful life Stinking Thinking In Ellis's REBT (Ellis, 1993, 1995), the aim is to eliminate these ultimately self-defeating beliefs. A person with depression, for example, may say several times a day, "What a worthless jerk I am." Ellis proposed that people interpret what is happening around them, that sometimes these interpretations can cause emotional turmoil, and that a therapist's attention should be focused on these beliefs rather than on historical causes or, indeed, on overt behavior.

Violation of Social Norm

Social norms are widely standards: -Beliefs and attitudes used to make judgements about behaviors. Behaviors that violate social norms may be classified as disordered. -Repetitive Rituals(OCD) -Talking to nonexistent voices (schizophrenia). -Too broad and too narrow of a definition Criminals violate social norms (too broad) Highly anxious people typically do not violate social norms (too narrow). Social norms may vary across cultures and ethic groups.

In 2007, psychologist _______ published a book entitled The Mark of Shame: The Stigma of Mental Illness and an Agenda for Change. In this important book, _______ discusses several steps that can be taken to end stigma surrounding psychological disorders. Here we briefly discuss some of the key suggestions for fighting stigma in many arenas, including community, mental health professions, and individual/family behaviors and attitudes.

Stephen Hinshaw

It can be frightening and disorienting for families to learn that a loved one has been diagnosed with an illness, and this may be particularly true for psychological disorders. Receiving current information about the causes and treatments of psychological disorders is crucial because it helps to alleviate blame and remove stereotypes families might hold about psychological disorders. Educating people with a psychological disorder is also extremely important. Sometimes termed psychoeducation, this type of information is built into many types of treatments, whether pharmacological or psychosocial. For people to understand why they should adhere to certain treatment regimens, it is important for them to know the nature of their illness and the treatment alternatives available.

Stephen Hinshaw- Individual and Family Strategies Education for Individuals and Families-

Providing greater housing opportunities for people with psychological disorders will likely mean that people with these disorders will shop and eat in local establishments alongside people without these disorders. Research suggests that this type of contact—where status is relatively equal—can reduce stigma. In fact, personal contact is more effective than education in reducing stigma (Corrigan, Morris, et al., 2012). Informal settings, such as local parks and churches, can also help bridge the personal contact gap between people with and without psychological disorders.

Stephen Hinshaw-Community Strategies- Personal Contact

Educating people about psychological disorders (one of the goals of this book!) is an important step toward reducing stigma. Education alone won't completely eradicate stigma, however. By learning about psychological disorders, though, people may be less hesitant to interact with people who have different disorders. Many of you already know someone with a psychological disorder. Sadly, though, stigma often prevents people from disclosing their history with a psychological disorder. Education may help lessen people's hesitancy to talk about their illnesses.

Stephen Hinshaw-Community Strategies-Education

Rates of homelessness in people with psychological disorders are too high, and more programs to provide community residences and group homes are needed. However, many neighborhoods are reluctant to embrace the idea of people with a psychological disorder living among them. Lobbying legislatures and community leaders about the importance of adequate housing is a critically important step toward providing housing for people with psychological disorders and reducing stigma.

Stephen Hinshaw-Housing Options-Community Strategies

Mental health professionals should receive training in stigma issues. This type of training would undoubtedly help professionals recognize the pernicious signs of stigma, even within the very profession that is charged with helping people with psychological disorders. In addition, mental health professionals need to keep current on the descriptions, causes, and empirically supported treatments for psychological disorders. This would certainly lead to better interactions with people and might also help educate the public about the important work being done by mental health professionals.

Stephen Hinshaw-Mental Health and Health Profession Strategies- Education and Training

Many children see their pediatricians for well-baby or well-child exams. The goal of these visits is to prevent illness before it occurs. Hinshaw (2007) makes a strong case for including similar preventive efforts for psychological disorders among children and adolescents by, for example, including rating scale assessments from parents and teachers to help identify problems before they become more serious.

Stephen Hinshaw-Mental Health and Health Profession Strategies- Mental Health Evaluations

Sigmund Freud's Defense Mechanism

Strategy used by ego to protect itself from anxiety Ex: Oh, she's in denial, she doesn't know the truth.

Psychological Disorder

The DSM______ defines as a clinically significant behavioral or psychological syndrome or patterns. The definition includes a number of key features, including distress, disability or impaired functioning, violation of social norms, and dysfunction.

Breuer (1842-1925)

Used hypnosis to facilitate catharsis in Anna O. Cathartic Method Release of emotional tension triggered by expressing previously forgotten thoughts about an earlier emotional trauma

Priory of St. Mary of Bethlehem(founded in 1243)

The Priory of St. Mary of Bethlehem was founded in 1243. Records indicate that in 1403 it housed six men with psychological disorders. In 1547, Henry VIII handed it over to the city of London, thereafter to be a hospital devoted solely to the housing of people with psychological disorders. The conditions in Bethlehem were deplorable. Over the years the word bedlam, the popular name for this hospital, came to mean a place or scene of wild uproar and confusion. Bethlehem eventually became one of London's great tourist attractions, by the eighteenth century rivaling both Westminster Abbey and the Tower of London. Even as late as the nineteenth century, viewing the people housed in Bethlehem was considered entertainment, and people bought tickets to see them. Similarly, in the Lunatics Tower, which was constructed in Vienna in 1784, people were confined in the spaces between inner square rooms and the outer walls, where they could be viewed by passersby. Unfortunately, housing people with psychological disorders in hospitals and placing their care in the domain of medicine did not necessarily lead to more humane and effective treatment. In fact, the medical treatments were often crude and painful. **Benjamin Rush (1745-1813), for example, began practicing medicine in Philadelphia in 1769 and is considered the father of American psychiatry. Yet he believed that psychological disorder was caused by an excess of blood in the brain, for which his favored treatment was to draw great quantities of blood from people with psychological disorders (Farina, 1976). Rush also believed that many people with psychological disorders could be cured by being frightened. Thus, one of his recommended procedures was for the physician to convince the patient that death was near!

Sigmund Freud

The apparently powerful role played by factors of which people seemed unaware led Freud to postulate that much of human behavior is determined by forces that are inaccessible to awareness. The central assumption of Freud's theorizing, often referred to as psychoanalytic theory, is that psychopathology results from unconscious conflicts in the individual. In the next sections, we take a look at Freud's theory Freud divided the mind into three principal parts: id, ego, and superego. According to Freud, the id is present at birth and is the repository of all the energy needed to run the mind, including the basic urges for food, water, elimination, warmth, affection, and sex. Trained as a neurologist, Freud saw the source of the id's energy as biological and unconscious. That is, a person cannot consciously perceive this energy—it is below the level of awareness.

The DSM-5 was released in 2013. The definition of mental disorder includes the following:

The disorder occurs within the individual. •It involves clinically significant difficulties in thinking, feeling, or behaving. •It usually involves personal distress of some sort, such as in social relationships or occupational functioning. •It involves dysfunction in psycho logical, developmental, and/or neurobiological processes that support mental functioning. •It is not a culturally specific reaction to an event (e.g., death of a loved one). •It is not primarily a result of social deviance or conflict with society.

Psychopathology

The field concerned with the nature and development of psychological disorders.

Biological Treatments- Sakel (1930s)

The general warehousing of people in mental hospitals earlier in the twentieth century, coupled with the shortage of professional staff, created a climate that allowed, perhaps even subtly encouraged, experimentation with radical interventions. In the early 1930s, the practice of inducing a coma with large dosages of insulin was introduced by ____ (1938), who claimed that up to three-quarters of the people with schizophrenia whom he treated showed significant improvement. Later findings by other researchers were less encouraging, and insulin-coma therapy—which presented serious risks to health, including irreversible coma and death—was gradually abandoned.

Stigma

The pernicious beliefs and attitudes held by a society about groups considered deviant in some manner, such as people with mental illness

Epigenetics

The study of how the environment can alter gene expression or function is called epigenetics. The term epigenetic means "above or outside the gene" and refers to the chemical "marks," such as DNA methyl tags or histones, that are attached to and protect the DNA in each gene. These epigenetic marks are what control gene expression, and the environment can directly influence the work of these marks, as shown in Figure 2.4 (Champagne, 2016; Zhang & Meaney, 2010). In studies with animals, research has shown that epigenetic effects can be passed down across multiple generations from parents (mothers and fathers; Braun & Champagne, 2014) to children, and even from grandparents to grandchildren

Genotype

The total genetic makeup of an individual, consisting of inherited genes, is referred to as the _____(physical sequence of DNA); the ____ cannot be observed outwardly.

Evaluation of the Genetic Paradigm

There are two huge challenges facing scientists working within the genetic paradigm. The first is to specify exactly how genes and environments reciprocally influence one another. Making the leap to understanding how genes interact with complex human environments throughout the course of development is a great challenge. The second is to recognize the complexity of the task, knowing that several genes (not just one) will contribute to a specific disorder and that currently there is a long pathway between the genes and the complex behaviors that make up psychological disorders, with several biological processes unfolding along the way. For example, the pathway between genes and eye color is short: genes give instructions for production of the chemicals that produce pigment. Indeed, just one SNP accounts for blue eye color (Sturm, Duffy, et al., 2008). By contrast, the pathway between genes and the behavioral phenotypes of psychological disorders is a long and winding road, filled with many biological and psychosocial processes, each of which is influenced by multiple genes. Thus, each individual gene or genetic mutation may reveal a very small effect. Putting all the small genetic pieces together to tell the gene-via-environment story for psychological disorders remains a very big challenge (Chabris, Lee, et al., 2013). Putting all the small genetic pieces together to tell the gene via environment story for psychological disorder remains a very big challenge.

T/F Hippocrates was one of the first to propose that psychological disorders had a biological cause.

True

T/F The term lunatic is derived from the ideas of Paracelsus.

True

True/False Phobias can product both distress and disability.

True

Evaluation of the Genetic Paradigm

Two Challenges: Understanding how genes and environments reciprocally influence one another. Recognizing the complexity of the task **Several genes contribute to a specific disorder. **Each individual gene or genetic mutation may reveal a very small effect **Putting all the small genetic pieces together to tell the gene via environment story for psychological disorders remains a very big challenge

Asylums

Until the fifteenth century, there were very few hospitals for people with psychological disorders in Europe. However, there were many hospitals for people with leprosy. As leprosy gradually disappeared from Europe (probably because with the end of wars came a break with the sources of the infection), these buildings were now underused. Attention seems to have turned to people with psychological disorders, and the old leprosy hospitals were converted to asylums, refuges for the housing and care of people with psychological disorders

Have We Learned From History?

We have made several advancements and still have much to learn! Do "Reality TV shows depicting psychological disorders educate or perpetuate stigma? Consider, for example, recent popular "reality" television shows of today such as Hoarders, Beyond Scared Straight, Obsessed, or Intervention that, respectively, showcase the lives of people with hoarding disorder (see Chapter 7), conduct disorder (see Chapter 13), obsessive compulsive disorder (see Chapter 7), or substance use disorder (see Chapter 10). Perhaps these shows help to educate people about psychological disorders, but perhaps also they perpetuate stigma by serving as the twenty-first-century version of viewing people in asylums for entertainment, as was done in the eighteenth century. On the other hand, other television shows present realistic and compassionate portrayals of psychological disorders, such as Homeland (bipolar disorder; see Chapter 5) or The United States of Tara (dissociative identity disorder; see Chapter 8). Yet even these shows can simplify or magnify some of the rarer aspects of psychological disorders, perhaps to amplify their entertainment value. People with psychological disorders are more likely to be housed in jails than in a hospital due to gaps in available services Some are unable to work and thus have very little income, limiting housing resources. Medications may have unpleasant side effects

gene expression

What genes do is make proteins that in turn make the body and brain work. Some of these proteins switch other genes on and off, a process___

Free Association

With ______, a person reclines on a couch, facing away from the analyst, and is encouraged to give free rein to his or her thoughts, verbalizing whatever comes to mind, without censoring anything.

ego

begins to develop from the id during the second 6 months of life. Unlike the contents of the id, those of the ego are primarily conscious. The task of the ego is to deal with reality, and it mediates between the demands of reality and the id's demands for immediate gratification.

Behavior Therapy

________ emerged in the 1950s. In its initial form, this therapy applied procedures based on classical and operant conditioning to alter clinical problems. One important behavior therapy technique that is still used to treat phobias and anxiety today is called systematic desensitization. Developed by Joseph Wolpe in 1958, it includes two components: (1) deep muscle relaxation and (2) gradual exposure to a list of feared situations, starting with those that arouse minimal anxiety and progressing to those that are the most frightening. Wolpe hypothesized that a state or response opposite to anxiety is substituted for anxiety as the person is exposed gradually to stronger and stronger doses of what he or she fears.

Characteristics of stigma include all of the following except:

a label reflecting desirable characteristic's

_________ refers to different forms of the same gene; _________ refers to different genes contributing to a disorder.

allele,polygenic

Biological Treatments- Electroconvulsive Therapy (ECT)

as interested in epilepsy and was seeking a way to induce seizures experimentally. Shortly thereafter he found that by applying electric shocks to the sides of the human head, he could produce full epileptic seizures. Then, in Rome in 1938, he used the technique on a person with schizophrenia. In the decades that followed, ECT was administered to people with schizophrenia and severe depression, usually in hospital settings. As we will discuss in Chapter 5, it is still used today for people with severe depression. Fortunately, important refinements in the ECT procedures have made it less problematic, and it can be an effective treatment.

clinical psychologist

degree, which entails 4 to 8 years of graduate study. Training for the Ph.D. in clinical psychology is similar to the training in other psychological specialties, such as developmental or cognitive neuroscience. It requires a heavy emphasis on research, statistics, and the empirically based study of human behavior. As in other fields of psychology, the Ph.D. is basically a research degree, and candidates are required to produce independent research. But candidates in clinical psychology learn skills in two additional areas, which distinguish them from other Ph.D. candidates in psychology.

Nonshared Environment

factors are those things believed to be distinct among members of a family, such as relationships with friends or specific events unique to a person (e.g., being in a car accident or on the swim team), and these are believed to be important in understanding why two siblings from the same family can be so different. Consider an example. Jason is a 34-year old man who is dependent on alcohol and struggling to keep his job. His sister Joan is a 32-year-old executive in a computer company in San Jose and has no alcohol or drug problems. Jason did not have many friends as a child; Joan was one of the most popular girls in high school. Jason and Joan shared several influences, including their family atmosphere growing up. They also had unique, nonshared experiences, such as differences in peer relationships. Behavior genetics research suggests that shared environmental factors are important for the development of child psychopathology (Burt, 2009, 2014). The nonshared, or unique, environmental experiences can also play a role, although these can be difficult to measure and change a great deal, at least during childhood and adolescence (Burt, Klahr, & Klump, 2015).

Shared Environment

factors include those things that members of a family have in common, such as family income level, child-rearing practices, and parents' marital status and quality. Research is done on twins for genetics.

Philippe Pinel (1745-1826)

has often been considered a primary figure in the movement for more humane treatment of people with psychological disorders in asylums. In 1793, while the French Revolution raged, he was put in charge of a large asylum in Paris known as La Bicêtre. A historian described the conditions at this particular hospital: shackled to the walls of their cells, by iron collars which held them flat against the wall and permitted little movement. They could not lie down at night, as a rule. Oftentimes there was a hoop of iron around the waist of the patient and in addition chains on both the hands and the feet. These chains [were] sufficiently long so that the patient could feed himself out of a bowl, the food usually being a mushy gruel—bread soaked in a weak soup. Since little was known about dietetics, [no attention] was paid to the type of diet given the patients. They were presumed to be animals and not to care whether the food was good or bad. (Selling, 1940, p. 54) Many texts assert that Pinel removed the chains of the people imprisoned in La Bicêtre. Historical research, however, indicates that it was not Pinel who released the people from their chains. Rather, it was a former patient, Jean-Baptiste Pussin, who had become an orderly at the hospital. In fact, Pinel was not even present when the people were released (Weiner, 1994). Several years later, though, Pinel praised Pussin's efforts and began to follow the same practices. Pinel came to believe that people in his care were first and foremost human beings, and thus these people should be approached with compassion and understanding and treated with dignity. He surmised that if their reason had left them because of severe personal and social problems, it might be restored to them through comforting counsel and purposeful activity. Thus, light and airy rooms replaced dungeons. People formerly considered dangerous now strolled through the hospital and grounds without creating disturbances or harming anyone. Although Pinel did much good for people with psychological disorders, he was no paragon of enlightenment and egalitarianism. He reserved the more humanitarian treatment for the upper classes; people of the lower classes were still subjected to terror and coercion as a means of control, with straitjackets replacing chains.

Social Workers

have an M.S.W. (master of social work) degree. Training programs are shorter than Ph.D. programs, typically requiring 2 years of graduate study. The focus of training is on psychotherapy. Those in social work graduate programs do not receive training in psychological assessment. Some M.S.W. programs offer specialized training and certification in marriage and family therapy.

Genetic Paradigm in depth

have transformed the way we think about genes and behavior. We no longer must wonder, "Is nature or nurture responsible for human behavior?" We now know that (1) almost all behavior is heritable to some degree (i.e., it involves genes) and (2) despite this, genes do not operate in isolation from the environment. Instead, throughout the life span, the environment shapes how our genes are expressed, and our genes also shape our environments The current way to think about genes and the environment is cast as "nature via nurture" (Ridley, 2003). In other words, researchers are learning how environmental influences, such as stress, relationships, and culture (the nurture part), shape which of our genes are turned on or off and how our genes (the nature part) influence our bodies and brain. We know that without genes, a behavior might not be possible. But without the environment, genes could not express themselves and thus contribute to the behavior.

Psychiatrists

hold an M.D. degree and have had postgraduate training, called a residency, in which they have received supervision in the practice of diagnosis and pharmacotherapy (administering medications). By virtue of the medical degree, and in contrast to psychologists, psychiatrists can function as physicians—giving physical examinations, diagnosing medical problems, and the like. Most often, however, the only aspect of medical practice in which psychiatrists engage is prescribing medications, chemical compounds that can influence how people feel and think. Psychiatrists may receive some training in psychotherapy as well, though this is not a strong focus of their training.

neuroscience paradigm

holds that psychological disorders are linked to aberrant processes in the brain. For example, aspects of schizophrenia are associated with neurotransmitter problems; anxiety disorders may be related to a problem within the autonomic nervous system; dementia can be traced to impairments in structures of the brain. In this section, we look at three components of this paradigm in which the data are particularly interesting: neurons and neurotransmitters, brain structure and function, and the neuroendocrine system. We then consider some of the key treatments that follow from the paradigm.

The case of Jack

illustrates how stigma can lead to discrimination. Jack was denied an apartment because of his schizophrenia. The landlord believed Jack's schizophrenia meant he would be violent. This belief is based more in fiction than reality, however. A person with a psychological disorder is not necessarily any more likely to be violent than a person without such a disorder (Steadman, Mulvey, et al., 1998; Swanson, Holzer, et al. 1990), even though people with psychological disorders can be violent if they do not receive treatment

B.F. Skinner (1904-1990)

introduced the concept of operant conditioning, so called because it applies to behavior that operates on the environment. Renaming Thorndike's "law of effect" the "principle of reinforcement," Skinner distinguished two types of reinforcement. Positive reinforcement refers to the strengthening of a tendency to respond by virtue of the presentation of a pleasant event, called a positive reinforcer. For example, a puppy will be more likely to sit if it is given a treat after doing so. Negative reinforcement also strengthens a response, but it does so via the removal of an aversive event, such as when the beeping noise in your car stops once you fasten your seatbelt.

Polygenic

meaning several genes, perhaps operating at different times during development, turning themselves on and off as they interact with a person's environment, is the essence of genetic vulnerability. Psychopathology is ______

Which of the following definitions of psychological disorder is currently thought best?

none of the above

id

seeks immediate gratification of its urges. When the ___is not satisfied, tension is produced, and the id drives a person to get rid of this tension as quickly as possible. For example, a baby feels hunger and is impelled to move about, sucking, in an attempt to reduce the tension arising from the hunger urge.

SNPs tell us about the _________ of genes, and CNVs tell us about the _________ of genes.

sequence; structure

Early Biological Explanation-Hippocrates (5th Century BC)

often called the father of modern medicine, separated medicine from religion, magic, and superstition. He rejected the prevailing Greek belief that the gods sent mental disturbances as punishment and insisted instead that such illnesses had natural causes and hence should be treated like other, more common maladies, such as colds and constipation. classified psychological disorders into three categories: mania, melancholia, and phrenitis, or brain fever. He believed that healthy brain functioning, and therefore mental health, depended on a delicate balance among four humors, or fluids of the body, namely, blood, black bile, yellow bile, and phlegm. An imbalance of these humors produced disorders. For example, if a person had a preponderance of black bile, the explanation was melancholia; too much yellow bile explained irritability and anxiousness; and too much blood, changeable temperament. The treatments he suggested were quite different from exorcism. For melancholia, for example, he prescribed tranquility, sobriety, care in choosing food and drink, and abstinence from sexual activity. Because ______ believed in natural rather than supernatural causes, he depended on his own keen observations and made valuable contributions as a clinician. He also left behind remarkably detailed records clearly describing many of the symptoms now recognized in seizure disorders, alcohol use disorder, stroke, and paranoia.

Biological Origins-Francis Galton (1822-1911)

often considered the originator of genetic research with twins because of his study of twins in the late 1800s in England, attributed many behavioral characteristics to heredity (see photo). He is credited with coining the terms nature and nurture to talk about differences in genetics (nature) and environment (nurture). In the early twentieth century, investigators became intrigued by the idea that psychological disorders may run in families, and beginning at that time, many studies documented the heritability of psychological disorders such as schizophrenia, bipolar disorder, and depression. These studies would set the stage for later theories about the causes of psychological disorders. alton is also credited with creating the eugenics movement in 1883 (Brooks, 2004). Advocates of this movement sought to eliminate undesirable characteristics from the population by restricting the ability of certain people to have children (e.g., by enforced sterilization). Many of the early efforts in the United States to determine whether psychological disorders could be inherited were associated with the eugenics movement, and this stalled research progress. Indeed, in a sad page from U.S. history, state laws in the late 1800s and early 1900s prohibited people with psychological disorders from marrying and forced them to be sterilized to prevent them from "passing on" their illness. Such laws were upheld by the U.S. Supreme Court in 1927 (Stern, 2015), and it wasn't until much later that these abhorrent practices were halted. For example, the eugenics law in California was not repealed until 1979. Still, investigative reporting uncovered 148 sterilizations of women in California prisons between 2006 and 2010, prompting a new law signed in 2014 that bans the practice in prisons. In the past 10 years, some states have provided compensation to survivors of this horrible practice (Stern, Novak, et al., 2017).

Three Characteristics of a Comprehensive Definition of Psychological Disorder

personal distress, disability/dysfunction, and violation of social norms. We will see that no single characteristic can fully define the concept, although each has merit and each captures some part of what might be a full definition. Consequently, psychological disorder is usually determined based on the presence of several characteristics at one time.

Heritability

refers to the extent to which variability in a particular behavior (or disorder) in a population can be accounted for by genetic factors. There are two important points about heritability to keep in mind. 1.Heritability estimates range from 0.0 to 1.0: the higher the number, the greater the heritability. 2.Heritability is relevant only for a large population of people, not a particular individual. Thus, it is incorrect to talk about any one person's heritability for a particular behavior or disorder. Knowing that the heritability of attention-deficit/hyperactivity disorder (ADHD) is around 0.70 does not mean that 70 percent of Jane's ADHD is the product of her genes and 30 percent, other factors. Rather, it means that in a population (e.g., a large sample in a study), the variation in ADHD is understood as being attributed to 70 percent genetic factors and 30 percent environmental factors. There is no heritability in ADHD (or any disorder) for a particular individual. Sample Heritability estimates: Schizophrenia: 80% ADHD: 70-80% OCD: 40-50% Autism: 50-80% Major Depression: 30-40%

intermittent reinforcement

rewarding a response only a portion of the times it appears—makes new behavior more enduring, many behavior therapies move away from reinforcing a desired behavior every time it occurs. For example, if a teacher has succeeded in helping a child spend more time sitting by praising the child generously for each math problem finished while seated, the teacher will gradually reward the child for every other success, and ultimately only infrequently.

Personal distress

that is, a person's behavior may be classified as disordered if it causes him or her great distress. Ex: Difficulty paying attention Emotional pain and suffering Ex: Felicia felt distress about her difficulty in paying attention and the social consequences of this difficulty—that is, being called names by other schoolgirls.

Interpretation

the analyst points out the meanings of a person's behavior. Defense mechanisms (see Table 1.3) are a principal focus of interpretation. For instance, a man who appears to have trouble with intimacy may look out the window and change the subject whenever the conversation touches on closeness during the course of a session.

Superego

the third part of the mind in Freud's theory—can be roughly conceived of as a person's conscience. Freud believed that the superego develops throughout childhood, arising from the ego much as the ego arises from the id. As children discover that many of their impulses—for example, biting—are not acceptable to their parents, they begin to incorporate parental values as their own to receive the pleasure of parental approval and avoid the pain of disapproval.

Sam and Sally are twins raised by their biological parents. Sam excelled in music and was in the high school band; Sally was the star basketball player on the team. They both received top-notch grades, and they both had part-time jobs at the bagel store. An example of shared environment variable would be _________; an example of a non-shared environment variable would be _________.

their parent's relationship; activities

Psychological disorders remain the most stigmatized of conditions in the ______

twenty-first century

Psychiatric Nurses

typically receives training at the bachelor's or master's level. Nurses can also receive more specialized training as a nurse practitioner that will allow them to prescribe psychoactive medications. There are currently over 18,000 psychiatric nurses in the United States, but the trend appears to be more toward emphasizing training as a nurse practitioner in order to secure prescription privileges (Robiner, 2006).