LECTURE 1

Abnormal Behavior in Historical Context

Abnormal Behavior : Myths and Misconceptions Whats psychologically normal?

Whats not?
How do we describe people with mental illness? Lazy, crazy, dumb? Weak in character? Dangerous? Hopeless?

What is a Psychological Disorder? Psychological dysfunction Breakdown in function Cognitive Behavioral Emotional Harmful dysfunction (Wakefield)

What is a Psychological Disorder? Distress or impairment Individual versus others

Ex: mania

Appropriateness to situation

Ex: death

Degree of impairment

What is a Psychological Disorder? Response is not typical or culturally expected Frequency Deviations from average Eccentricity Violation of social norms

How Do We Classify Psychological Disorders? Diagnostic and Statistical Manual

DSM-IV-TR
Outlines criteria for disorders Prototypes/typical profiles Constant revision and modification DSM-V

What is a Psychological Disorder? Accepted DSM-IV-TR definition:

Behavioral, cognitive, emotional dysfunctions

Unexpected in cultural context Personal distress Substantial impairment in function

What is a Psychological Disorder? New areas of interest for the DSM-V:

Reevaluating underlying concepts

Surveys of mental health professionals Commonalities in disorders Discerning differences in degree

The Science of Psychopathology Study of psychological disorders

Conducted by
Clinical and counseling psychologists (PhD, PsyD) Psychiatrists (MD) Psychiatric social workers (MSW) Psychiatric nurses (MN, MSN, PhD) Marriage and family therapists (MA, MS, MFT) Mental health counselors (MA, MS)

The Scientist-Practitioner Framework Interaction of clinical work and science Consumer of science

Informs practice
Utilizes science Synthesizes both

Evaluator of practice

Creator of science

Clinical Description of Abnormality Presenting Problem

Clinical Description Dysfunction vs. common experience

Statistics Prevalence Incidence

Clinical Description of Abnormality Course Episodic Time-limited Chronic Onset Acute vs. insidious Prognosis Good vs. guarded

Age and Development in Abnormality Age of onset may shape presentation

Developmental psychology
Developmental psychopathology Life-span developmental psychopathology

Causation, Treatment, and Outcomes Etiology Cause or development of psychopathology Treatment Pharmacologic and/or psychosocial Treatment Outcome Research Have we really helped? Does the effect reveal the cause?

Historical Conceptions of Abnormal Behavior Major psychological disorders have existed across time and cultures Causes and treatment of abnormal behavior varied widely, depending on context

The Supernatural Tradition Deviance = Battle of Good vs. Evil

Etiology- devil, witchcraft, sorcery

Great Persian Empire (900 to 600 BC) 14th and 15th century Europe Salem witch trials in US

Treatments- exorcism, torture, and crude surgeries

The Supernatural Tradition: The Enlightened View Stress and melancholy in the 14th century

Etiology- natural, curable phenomenon Illness model Still connected with sin
Treatments- humanistic Rest, sleep, positive environment Community-based

The Supernatural Tradition Mass hysteria St. Vitus dance Tarantism Modern examples? Emotion contagion Mob psychology

The Supernatural Tradition Other Worldly Causes Moon and stars Paracelsus lunacy Modern examples? Astrology

The Biological Tradition Hippocrates (460-377 BC) Father of modern Western medicine Etiology = physical disease Brain pathology Head trauma Genetics Psychosocial factors Stress, family Precursor to somatoform disorders Hysteria

The Biological Tradition Galen (129-198 AD) Hippocratic foundation

Galenic-Hippocratic Tradition

Humoral theory of mental illness Etiology = brain chemical imbalances Treatments = Environmental regulation Heat, dryness, moisture, cold Bloodletting, induced vomiting

The Biological Tradition and the 19th Century Syphilis and General Paresis

STD with psychosis-like symptoms Delusions Hallucinations

Etiology = bacterial microorganism Louis Pasteurs germ theory Biological basis for madness

The Biological Tradition and the 19th Century

John Grey (1850s) American proponent of the biological tradition Etiology = always physical Treatments = as is physically ill Rest Diet Room temperature

Improved hospital conditions

The Development of Biological Treatments Mental Illness = Physical Illness The 1930s Insulin shock therapy Brain surgery ECT Benjamin Franklin (1750s) Treatment for depression?

The Development of Biological Treatments The 1950s Psychotropic medications Increasingly available Systematically developed

Neuroleptics Reserpine and psychosis Tranquilizers Benzodiazepines and anxiety

The Development of Biological Treatments The cons of medications

Unwanted physical side effects

Addiction/dependence Effectiveness

Consequences of the Biological Tradition Increased hospitalization Untreatable conditions Improved diagnosis and classification Emil Kraepelin Increased role of science in psychopathology

The Psychological Tradition: Ancient Contributions

Plato, Aristotle, and Greece Etiology Social and environmental factors Treatment Reeducation via discussion Therapeutic environments

Similar practices in ancient Muslim countries

The Psychological Tradition

Moral Therapy Moral = emotional or psychological Treating patients normally Encouraging social interaction Focus on relationships Individual attention Education

The Psychological Tradition: Moral Therapy Key figures in humanistic reform: France Philippe Pinel (1745 1826) Jean-Baptiste Pussin

England William Tuke (1732 1822) United States Benjamin Rush (1745 1813) Horace Mann (1833)

Asylum Reform and the Decline of Moral Therapy

Declines in the Mid-19th Century

Increased numbers of patients Immigrants Homeless Mental Hygiene Movement Dorothea Dix (1802-1887)
Staffing problems Outcome = decreased treatment efficacy

The Psychoanalytic Tradition- Background Anton Mesmer (1734 1815) Mesmerism and hypnosis Suggestibility Jean Charcot (1825-1893) Hypnosis as treatment Mentor to Freud

Josef Breuer (1842-1925) Furthered hypnosis treatments Collaborator with Freud

Freuds Structure and Function of the Mind Conscious versus unconscious: Id Pleasure principle Illogical, emotional, irrational Ego Reality principle Logical and rational Superego Moral principles Balances Id and Ego

The Structure and Function of the Mind

Psychoanalysis - Defense Mechanisms Ego fights to stay on top of the Id and Superego Loss = anxiety Coping strategies include: Displacement Denial Rationalization Reaction formation Projection Repression Sublimation

Stages of Psychosexual Development

Patterns of gratifying basic needs Infancy to early childhood Oral Anal Phallic Latency Genital Conflicts at each stage must be resolved i.e. Oedipus complex in the phallic stage Adult personality reflects childhood experience

Later Developments in Psychoanalytic Thought

Self-Psychology Anna Freud (1895-1982) Ego defines behavior Object Relations Theory Melanie Klein and Otto Kernberg Children incorporation of objects Images Memories Values of significant others

Later Developments in Psychoanalytic Thought Freuds students de-emphasize sexuality Carl Jung (1875-1961) Collective unconscious Enduring personality traits Introversion vs. extroversion Alfred Adler (1870-1937) Birth order Inferiority complex Striving for superiority Self-actualization

Later Developments in Psychoanalytic Thought Emphasis on life-span development Influence of society and culture on personality Key figures: Karen Horney (1885-1952) Erich Fromm (1900-1980) Erik Erickson (1902-1994)

Psychoanalytic Psychotherapy Unearth intrapsychic conflicts Long-term treatment model Techniques Free Association Dream Analysis

Transference/Counter-Transference
Efficacy Data are Limited

Psychodynamic Psychotherapy
Emphasizes conflicts and unconscious Trauma and active defense mechanisms Focus on: Affect Avoidance Patterns Past experience Interpersonal experience Therapeutic relationship Wishes, dreams, fantasies

Psychoanalytic Psychotherapy
Criticisms Pejorative terms (i.e., neurosis) Unscientific Untested

Contributions Unconscious processes Emotions triggered by cues Therapeutic alliance Defense mechanisms

Humanistic Theory Theoretical constructs Intrinsic goodness Striving for self-actualization Blocked growth

Person-centered therapy Carl Rogers (19021987) Hierarchy of Needs Abraham Maslow (1908-1970)

Humanistic Theory Therapeutic process Unconditional positive regard Empathy Facilitation Non-directive approach Outcomes Study of therapeutic relationship Questionable efficacy data Severe psychopathology

The Behavioral Model Classical Conditioning

Ivan Pavlov (1849-1936)

Ubiquitous form of learning Unconditioned stimulus (UCS) Unconditioned response (UCR) Conditioned stimulus (CS) Conditioned response (CR)

The Behavioral Model

PLAY VIDEO

The Behavioral Model Classical Conditioning Concepts Stimulus generalization Extinction

Introspection

The Behavioral Model

PLAY VIDEO

The Behavioral Model Behaviorism John B. Watson (1878 - 1958) Scientific emphasis Objective Radical empiricism Little Albert experiment

The Behavioral Model

PLAY VIDEO

The Behavioral Model and Behavior Therapy Mary Cover Jones Preexisting phobia extinguished by exposure and modeling Joseph Wolpe (1915 -1997) Systematic desensitization Relaxation

The Behavioral Model - Operant Conditioning E.L. Thorndike (1874 1949) Law of effect: consequences shape behavior B.F. Skinner (1904 - 1990) Behavior operates on environment Reinforcements Punishments Behavior shaping

The Scientific Method and an Integrative Approach Defining and studying psychopathology

Requires a broad approach

Multiple, interactive influences Biological, psychological, social factors Scientific emphasis Neuroscience Cognitive, behavioral sciences