DB2 - Chapter 1

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Abnormal Psychology: Past and Present

Chapter 1

Fundamentals of Abnormal Psychology

RONALD J. COMER | JONATHAN S. COMER| ninth edition

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Abnormal Psychology: Past and Present

Abnormal psychology

Scientific study of abnormal behavior in an effort to describe, predict, explain, and change abnormal patterns of functioning

Many definitions have been proposed, yet none has won total acceptance

Workers in the field may be:

Clinical scientists

Clinical practitioners

In a Word

When did these and similar words (including slang terms) make their debut in print as expressions of psychological dysfunction?

What Is Psychological Abnormality?

Common feature across definitions

The Four Ds

Deviance

Distress

Dysfunction

Danger

Influences

Norms

Culture

Context

The Elusive Nature of Abnormality (part 1)

Abnormality is defined by general criteria in society.

Criteria are used to judge particular cases.

Szasz posits that societal involvement may invalidate the concept of mental illness.

Any definition of abnormality may be unable to be applied consistently.

Szaz:

Deviations called “abnormal” are only “problems of living.”

Societies invent the concept of mental illness to better control or change people who threaten the social order.

In short, although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and sometimes dangerous, these criteria often are vague and subjective.

Few categories of abnormality are as clear-cut as they seem; most continue to be debated by clinicians.

The Elusive Nature of Abnormality (part 2)

Which behaviors fit the criteria of deviant, distressful, dysfunctional, or dangerous, but would not be considered abnormal by most people?

What Is Treatment? (part 1)

Treatment or therapy

Procedure designed to change abnormal behavior into more normal behavior

Definitional challenges closely related to defining abnormality

What Is Treatment? (part 2)

Essential features of all therapy forms

Sufferer or patient

Trained, socially accepted healer or therapist

Series of therapeutic contacts between the healer and the sufferer

Despite their differences, most clinicians agree that large numbers of people need therapy of one kind or another

A sufferer who seeks relief from the healer

A trained, socially accepted healer, whose expertise is accepted by the sufferer and his or her social group

A series of contacts between the healer and the sufferer, through which the healer tries to produce certain changes in the sufferer's emotional state, attitudes, and behavior

How Was Abnormality Viewed and Treated in the Past?

Every society, past and present, has witnessed psychological abnormality.

Many present-day ideas and treatments have roots in the past.

Ancient Views and Treatments

Ancient societies

Probably regarded abnormal behavior as the work of evil spirits

May have begun as far back as the Stone Age

Treatment

Trephination and exorcism

Treatment for severe abnormality was to force demons from the body through trephination and exorcism.

Greek and Roman Views and Treatments

500 b.c. to 500 a.d.

Philosophers and physicians offered different explanations and treatments for abnormal behaviors

Hippocrates believed and taught that illnesses had natural causes; four humors

Treatment

Quiet life

Vegetable diet

Temperance

Exercise

Celibacy

Bleeding

Humors: yellow bile, black bile, blood, and phlegm

Europe in the Middle Ages: Demonology Returns

500–1350 a.d.

Church rejected scientific forms of investigation and controlled all education

Mental disorders had demonic causes; mass madness; shared delusions and hallucinations

At the close of the Middle Ages, demonology and its methods began to lose favor again

Treatment

Exorcism

Torture

Gradually hospitalization

The Renaissance and the Rise of Asylums

1400–1700 a.d.

With increased scientific knowledge, demonological views of abnormality continued to decline

Weyer was the first mental health physician; believed that the mind was as susceptible to sickness as the body

Care at religious shrines (e.g., Gheel) was the precursor of community health programs

Asylums emerged by the mid-sixteenth century

Asylum crib

The Nineteenth Century: Reform and Moral Treatment

Nineteenth century

Care of people with mental disorders began to improve

Pinel (France) and Tuke (England)

Advocated moral treatment that emphasized humane and respectful techniques

Moral treatment movement ended in the United States and Europe by the early twentieth century

Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher)

Promoted moral treatment in the United States

Movement disintegrated in the late nineteenth century; mental hospitals warehoused inmates and provided minimal care

By the end of the nineteenth century, several factors led to a reversal of the moral treatment movement:

Money and staff shortages

Declining recovery rates

Overcrowding

Emergence of prejudice

By the early years of the twentieth century, the moral treatment movement had ground to a halt; long-term hospitalization became the rule once again.

The Early Twentieth Century: Dual Perspectives (part 1)

Somatogenic perspective

Abnormal functioning has physical causes

Two factors responsible for the rebirth of this perspective

Emil Kraepelin: Physical factors are responsible for mental dysfunction

New biological discoveries linked such things as untreated syphilis and general paresis

Results were generally disappointing until effective medication was developed

The Early Twentieth Century: Dual Perspectives (part 2)

Psychogenic perspective

Abnormal functioning has psychological causes

Rise in popularity based on work with hypnotism

Mesmer: Hysterical disorders

Freud: Psychoanalysis; outpatient therapy

Psychoanalytic theory and treatment became widely accepted

Recent Decades and Current Trends

Negative public attitudes still exist, but there have been major changes in the last 60 years in the ways clinicians understand and treat abnormal functioning:

More theories and treatment types

More research and information

More disagreements about abnormal functioning

Survey: 43% of people believe that people bring mental health disorders upon themselves; 35% consider mental health disorders to be caused by sinful behavior.

How Are People with Severe Disturbances Cared For?

New psychotropic medications discovered in 1950s

Antipsychotic drugs

Antidepressant drugs

Antianxiety drugs

Led to deinstitutionalization and rise in outpatient care

The Impact of Deinstitutionalization

Psychotropic medications: Drugs that mainly affect the brain and reduce many symptoms of mental dysfunction.

The number of patients (around 42,000) now hospitalized in public mental hospitals in the United States is a small fraction of the number hospitalized in 1955. (Information from Lang, 1999; Smith & Milazzo-Sayre, 2014; Torrey, 2001.)

How Are People with Severe Disturbances Treated?

Before 1950

Almost all outpatient care took the form of private psychotherapy

Today

Outpatient care is the primary mode of treatment; more insurance coverage

Prevention programs are increasing; positive psychology has grown

Programs dealing with one kind of psychological problem have been created

Multicultural Psychology

A new area of study that emerged in response to the growing diversity of the United States

Multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically

The Increasing Influence of Insurance Coverage

Today the dominant form of insurance coverage is the managed care program, in which the insurance company determines key care issues

The dominant form of insurance for people in the United States consists of managed care programs

Reimbursements for mental disorders tend to be lower than those for medical disorders

In 2008, a federal parity law went into effect; in 2014, the Affordable Care Act (ACT) went into effect

In 2011, a federal parity law went into effect.

What Are Today's Leading Theories and Professions? (part 1)

Numerous theoretical perspectives

Psychoanalytic

Biological

Cognitive-behavioral

Humanistic-existential

Sociocultural

Developmental psychopathology

No single perspective dominates the clinical field

What Are Today’s Leading Theories and Professions? (part 2)

A variety of professionals offer help to people with psychological problems

	Degree	Began to Practice	Current Number	Average Annual Salary	Percent Female
Psychiatrists	MD, DO	1840s	49,000	$194,000	35%
Psychologists	PhD, PsyD, EdD	Late 1940s	188,000	$73,000	67%
Social workers	MSW, DSW	Early 1950s	649,000	$46,000	84%
Counselors	Various	Early 1950s	570,000	$45,000	71%

Technology and Mental Health

The digital world provides new triggers and vehicles for the expression of abnormal behavior

The multitude of digital distractions provides the foundation for shorter attention spans

Use of tele-mental health services rapidly increasing

Mental health apps in the marketplace are increasing sharply

Enormous volume of Web-based misinformation

What Do Clinical Researchers Do? (part 1)

Research is the systematic search for facts through the use of careful observations and investigations

Clinical researchers

Discover universal laws and principles

Search for nomothetic understanding

Do not typically assess, diagnose, or treat individual clients

Rely on the scientific method

Discover universal laws and principles of abnormal psychological functioning

Search for nomothetic understanding of nature, causes, and treatment

Do not typically assess, diagnose, or treat individual clients

Rely on the scientific method to pinpoint relationships between variables

What Do Clinical Researchers Do? (part 2)

Clinical researchers depend on three methods of investigation

Case study

Correlational method

Experimental method

The Case Study (part 1)

How are case studies helpful?

Detailed, interpretative description of a person's life and psychological problems

Source of new ideas about behavior

Tentative support for a theory

Challenge of a theory’s assumptions

Introduction of new therapeutic techniques

Opportunities to study unusual problems

The Case Study (part 2)

What are the limitations of case studies?

Biased observers

Subjective evidence (low internal validity)

Little basis for generalization (low external validity)

The Correlational Method

Correlation

Degree to which events or characteristics vary with each other

Positive correlation

Negative correlation

Unrelated

Correlational method

Research procedure used to determine the co-relationship between variables

Subjects or participants

People chosen for study are collectively called a sample

Sample must be representative of the larger population

Researches need to know both the direction and the magnitude of the correlation

When Can Correlations Be Trusted?

Correlations can be trusted based on a statistical analysis of probability

Statistical significance: The finding is unlikely to have occurred by chance

Generally, confidence increases with the size of the sample and the magnitude of the correlation

What Are the Merits of the Correlational Method?

Advantages of the correlational method

Has high external validity (can generalize findings)

Can repeat (replicate) studies with other samples

Difficulties with correlational studies

Lack internal validity

Describe but do not explain a relationship or causation

Research Methods

	Provides Individual Information	Provides General Information	Provides Causal Information	Statistical Analysis Possible	Replicable
Case study	Yes	No	No	No	No
Correlational method	No	Yes	No	Yes	Yes
Experimental method	No	Yes	Yes	Yes	Yes

The Experimental Method (part 1)

Experiment

The variable is manipulated and the manipulation's effect on another variable is observed

Manipulated variable = independent variable

Variable being observed = dependent variable

Is animal companionship an effective intervention? A ring-tailed lemur sits on the shoulder of an individual at Serengeti Park near Hodenhagen, Germany. It’s part of a monthly program called “Psychiatric Animal Days” based on the premise that animals—even lemurs—have a calming effect on people. More than 400 kinds of intervention are currently used for psychological problems. An experimental design is needed to determine whether this or any other form of treatment causes clients to improve.

The Experimental Method (part 2)

Confound

Variables other than the independent variable that may also be affecting the dependent variable

Three features to guard against confounds

Control group

Random assignment

Masked (blind) design

The Control Group

Control group

Research participants who are not exposed to the independent variable, but whose experience is similar to that of the experimental group

Rules of statistical significance are applied

Clinicians may also evaluate clinical significance

By comparing the two groups, researchers can better determine the effect of the independent variable.

Random Assignment

Random assignment

Any selection procedure that ensures that every participant in the experiment is as likely to be placed in one group as another

Masked (blind) design

Experiment in which participants do not know which assigned group they are in

Placebo therapy

Double-masked design

Experiment in which both participants and experimenters are unaware of the groups to which participants are assigned

Researchers must also watch out for differences in the makeup of the experimental and control groups.

Alternative Research Designs (part 1)

Clinical researchers often must settle for designs that are less than ideal and include quasi-experimental designs

Matched designs

Natural experiments

Analogue experiments

Single-subject experiments

Longitudinal studies

Epidemiological studies

Alternative Research Designs (part 2)

Matched (mixed) designs

Participants are not randomly assigned to groups, but rather placed in existing groups

Matched control groups are used to address confounds based on demographic and other variables

These groups are matched to the experimental group based on demographic and other variables.

Alternative Experimental Designs (part 1)

Natural experiments

Nature manipulates the independent variable and the experimenter observes the effects

Events cannot be replicated at will

Broad generalizations cannot be drawn from a single study

Alternative Experimental Designs (part 2)

Analogue experiments

Independent variables are freely manipulated while ethical and practical limitations are avoided

Laboratory subjects are induced to behave in ways that resemble real life

Experimenters cannot be certain that phenomena observed in the lab are the same as the psychological disorders being investigated

Animals are often used as participants

Similar enough? Celebrity chimpanzee Cheetah, age 59, does some painting along with her friend and trainer. Chimps and human beings share more than 90 percent of their genetic material, but their brains and bodies are very different, as are their perceptions and experiences. Thus, abnormal- like behavior produced in animal analogue experiments may differ from the human abnormality under study.

Alternative Experimental Designs (part 3)

Single-subject experiment

A single participant is observed before and after manipulation of the independent variable

Experiments rely on baseline data to set a standard for comparison

Has higher internal validity than the case study because the independent variable is manipulated

ABAB (reversal) design

Special Forms of Correlational Research (part 1)

Longitudinal studies (high-risk or developmental studies)

Same individuals are observed on many occasions over a long period

Independent variable manipulation or random assignment of participants to conditions is not possible

Causes cannot be pinpointed

Life is a longitudinal study Photos of this same individual at different points in his life underscore the logic behind longitudinal studies. Just as this person’s eyes, nose, and overall smile at the age of 5 seem to predict similar facial features at the ages of 35 and 55, so too might an individual’s early temperament, sociability, or other psychological features sometimes predict adult characteristics. In some longitudinal studies, clinical researchers have found that a number of children who seem to be at particular risk for psychological disorders do indeed develop such disorders at later stages of their lives.

Special Forms of Correlational Research (part 2)

Epidemiological studies

Reveal the incidence and prevalence of a disorder in a particular population

Incidence: Number of new cases that emerge in a given period

Prevalence: Total number of cases in a given period

Studies

Epidemiologic Catchment Area Study (Cottler et al.)

National Comorbidity Survey

National Comorbidity Survey Replication

Protecting Human Participants (part 1)

Researchers’ primary obligation

Avoid physical or psychological harm for human participants

Institutional Review Board (IRB)

Ethics committee in a research facility empowered to protect the rights and safety of human research participants

A national disgrace In a 1997 White House ceremony, President Bill Clinton offers an official apology to 94-year-old Herman Shaw and other African American men whose syphilis went untreated by government doctors and researchers in the Tuskegee Syphilis Study, a research undertaking conducted from 1932 to 1972, prior to the emergence of Institutional Review Boards. In this infamous study, 399 participants were not informed that they had the disease, and they continued to go untreated even after it was discovered that penicillin is an effective intervention for syphilis.

Mind Tech: The Use and Misuse of Social Media

Researchers have increasingly turned to social networks for their studies

An area that has raised ethical concerns involves the direct and secret manipulation of social media users by researchers

A core problem for all social media studies is that most social media sites do not really have policies prohibiting researchers from studying subscribers or subscriber profiles without clear permission

Can an argument be made that ethical standards for studies using the Internet and social media should be different from those applied to other kinds of research?

Protecting Human Participants (part 2)

IRBs try to ensure that each study grants the following rights to participants:

The participants enlist voluntarily.

Before enlisting, the participants are adequately informed about what the study entails (“informed consent”).

The participants can end their participation in the study at any time.

Protecting Human Participants (part 3)

IRBs try to ensure that each study grants the following rights to participants: (cont.)

The benefits of the study outweigh its costs/risks.

The participants are protected from physical and psychological harm.

The participants have access to information about the study.

The participants’ privacy is protected by principles such as confidentiality or anonymity.