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Abnormal Behavior

Psychopathology

Study of symptoms and causes of mental disorders

Objectives: describing, explaining, predicting, and modifying behaviors associated with mental disorders

People who work in the field strive to alleviate distress and life disruption of those with mental disorders

The Field of Abnormal Psychology

Mental health professionals

Health care practitioners

Assists in diagnosis of a patient’s mental health

Psychodiagnosis

Attempts to describe, assess, and understand the situation

Treatment plan

Proposes course of therapy

Focuses first on most distressing symptoms

Describing Behavior

Determine etiology (possible causes)

High priority for mental health professionals

Human behavior is complex

Multiple contributing factors

Explaining Behavior

Various risk factors for violent behavior

Civil commitment (involuntary confinement)

Extreme decision impacting an individual’s civil liberties

Predicting Behavior

Psychotherapy

Program of systematic intervention

Objective: improve a person’s behavioral, emotional, or cognitive state

Many types of therapies and professional helpers

Modifying Behavior

Group therapy is one type of evidence-based therapy described in Chapter 1.

The Mental Health Professions

Table 1.1 The mental health professions

The Mental Health Professions (cont’d.)

Table 1.1 The mental health professions

The most widely used classification system

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)

A mental disorder is characterized by:

Disturbance in thinking, emotion, or behavior

Distress or difficulty with daily functioning

Not being culturally expected, not explained by religious or political beliefs

Views of Abnormality

DSM Definitions

Questions to raise

When are symptoms or behavior significant enough to have meaning?

Is it possible to have a mental disorder without distress or discomfort?

What criteria are to be used in assessing symptoms?

What is culture?

Learned behavior that members of a group transmit to the next generation

Viewpoints

Expression/determination of behaviors depends on lifestyles, cultural values, and worldviews

Symptoms and causes of mental disorders are independent of culture

Cultural Considerations in Abnormal Behavior

E.g., hallucinations are considered normal and appropriate in some cultures whereas they are generally viewed as abnormal in American culture

Opinions of Thomas Szasz (1987)

A society labels behavior that is different as abnormal

Unusual belief systems are not necessarily wrong

Abnormal behavior a reflection of something wrong with society

Sociopolitical Considerations in Abnormality

A Sampling of Lifetime Prevalence

Figure 1.1 Lifetime prevalence of mental disorders in a sample of 10,000 U.S. adolescents

Source: Merikangas et al., 2010

Prevalence

Percentage of people in a population who have the disorder during a given interval of time

Dept. of Health and Human Services study

24.8 percent of U.S. adults have experienced a mental disorder in the past 12 months, excluding drug and alcohol disorders

Lifetime prevalence

Existence of a disorder during a person’s life

How Common Are Mental Disorders?

$135 billion a year spent on mental health and substance abuse services in U.S.

25 percent of adults have a diagnosable mental health condition

Many more experience mental health problems not meeting criteria for disorder

57 percent of adults with severe mental health conditions not receiving treatment

Implications to Society

Mentally ill are frequently stereotyped and stigmatized

Prejudice

Belief in negative stereotypes

Discrimination

Action based on prejudice

Self-stigma

Undermines self-worth and self-efficacy

Hinders recovery

Overcoming Social Stigma and Stereotypes

National Alliance on Mental Illness (NAMI)

“You Are Not Alone” campaign

Goals: educating the public and reducing stigma

Commending more accurate portrayals of mental disorders in movies and TV

Efforts to Increase Public Awareness

Public disclosures from well-known people such as actors and sports figures

Open acknowledgment and discussion of struggles

Reduces public social stigma

What you can do:

Be respectful when describing others in mental distress, choose words carefully

Encourage family and friends to seek help early

Decreasing Social Stigma

Prehistoric and ancient beliefs

Evil spirits residing in a person’s body

Trephining

Exorcism

Naturalistic explanations: Greco-Roman thought

Early thinkers: Hippocrates (460-370 B.C.)

Brain pathology

Historical Perspectives on Abnormal Behavior – Ancient and Naturalistic

Middle Ages

Reversion to supernatural explanations

Exorcism

Group hysteria

Tarantism

Witchcraft: 15th through 17th centuries

Period of social and religious reformers

Witch hunts

100,000 people (mostly women) executed

The Middle Ages Through the 17th Century

14th through 16th centuries

Horrendous conditions in asylums

The rise of humanism

Philosophical movement emphasizing uniqueness and worth of the individual

Johann Weyer, German physician

Challenged prevailing beliefs of witchcraft

Sixteenth Century Perspectives

Shift to more humane treatment of mentally disturbed people

Philippe Pinel (1745-1826)

Took charge of mental hospital in Paris

Removed chains, replaced dungeons with sunny rooms, and encouraged exercise

Changes shown to foster recovery

The Moral Treatment Movement (18th and 19th Centuries)

Benjamin Rush

“Father of U.S. Psychiatry”

Patients treated with respect and dignity, and gainfully employed during treatment

Dorothea Dix

Campaigned for better treatment of mentally ill

Clifford Beers

Wrote book on his experience with mental illness

Humane Treatment Movement in the U.S.

The biological viewpoint

Mental disorders have a physical or physiological basis (Griesinger)

Idea flourished in the 19th century

Kraepelin (1856-1926)

Defined syndromes based on clusters of symptoms

Foundation for DSM used today

Causes of Mental Illness: Early Viewpoints

Louis Pasteur’s germ theory of disease

Biological view gained greater strength

Discovery of general paresis

Degenerative physical and mental disorder

von Kfrafft-Ebing

Proved that mental symptoms of general paresis are linked to syphilis bacteria

Schaudinn

Isolated microorganism of general paresis

Causes: Early Viewpoints (cont’d.)

Belief that mental disorders are caused by psychological and emotional factors

Friedrich Anton Mesmer (1734-1815)

Practiced therapies that evolved into modern hypnotism

Mesmer was discredited

Idea that suggestion could treat hysteria

Liébeault and Bernheim demonstrated psychological basis of mental illness

The Psychological Viewpoint

Breuer

Discovered symptoms disappeared after female patient spoke about past trauma while in a trance

Freud (1856-1939)

Technique of psychoanalysis

Built on practices of Breuer

Cathartic method

Therapeutic use of verbal expression

Breuer and Freud

Viewpoint rooted in laboratory science

Focus on directly observable behaviors

Also conditions that evoke, reinforce, and extinguish them

Alternative explanation

Offered successful procedures for treating some psychological conditions

Behaviorism

The influence of multicultural psychology

Culture, race, ethnicity, gender, age, and socio-economic class relevant to understanding and treating abnormal behavior

Mental health professionals need to:

Increase cultural sensitivity

Acquire knowledge of diversity

Develop culturally relevant therapy approaches

Contemporary Trends in Abnormal Psychology

Racial and Ethnic Composition of the U.S.

Figure 1.2 2013 Census Projections: Racial and Ethnic Composition of the United States

Minorities now constitute an increasing proportion of the U.S. population. Mental health providers will increasingly encounter clients who differ from them in race, ethnicity, and culture.Source: http://quickfacts.census.gov/qfd/ states/00000.html

Cultural values and influences

Sociopolitical influences

Cultural and ethnic bias in diagnosis (e.g., the tendency to overpathologize)

Dimensions Related to Cultural Diversity

Objectives

Study, develop, and achieve scientific understanding of positive human qualities that build thriving individuals, families, and communities

Focuses on human strength and capacity for resilience

Psychological resilience

Prevention

Positive Psychology

Perspective that people with mental illness can recover

Live satisfying, hopeful, and contributing lives

Some of the recovery model assumptions

Recovery is possible and begins when person realizes that positive change is possible

Recovery involves occasional setbacks

Healing involves separating one’s identity from the illness

Recovery Movement

The drug revolution in psychiatry

Introduction of psychotropic medications in the 1950s

Considered one of the great medical advances in the 20th century

Naturally occurring lithium found to radically calm some mental patients

Many drugs made available for different disorders

Resulted in depopulation of mental hospitals

Changes in the Therapeutic Landscape

Some changes brought about by industrialization of health care

Business interests of insurers influence treatment duration

Cost-cutting focus affects hiring

Increased appreciation for research

Denial of coverage for unproven treatments

Technology-assisted therapy

Online programs

The Development of Managed Health Care

What is abnormal psychology?

How do we differentiate between normal and abnormal behaviors?

What societal factors affect definitions of abnormality?

How common are mental disorders?

Review

Why is it important to confront the stigma and stereotyping associated with mental illness?

How have explanations of abnormal behavior changed over time?

What were early explanations regarding the causes of mental disorders?

What are some contemporary trends in abnormal psychology?

Review (cont’d.)