Understanding Psychopathology

Present- day understandings
Abnormal Behavior in Historical
Context
Chapter 1A
Understanding Psychopathology

As defined in the DSM-IV-TR, abnormal
behavior is behavioral, emotional or
cognitive dysfunctions that are unexpected
in their cultural context and associated with
personal distress or substantial impairment
in functioning
Understanding Psychopathology

Psychological dysfunction - breakdown in
cognitive, emotional, or behavioral
functioning

Often defined as a continuum or as a dimension
rather than categories

Hard to draw the line between normal or
abnormal dysfunction

Jerome Wakefield’s definition of “Harmful
Dysfunction” (1992, 1999)

An inability of some internal mechanism to perform its
natural function

Something beyond an individual’s control
Understanding Psychopathology

Three criteria must be met:

Psychological dysfunction

An atypical or not culturally expected response

Personal distress or impairment

Why not just one or two?
Understanding Psychopathology

Personal distress is often associated with
extreme expressions of otherwise “normal”
emotions, behaviors, and cognitive
processes

The concept of impairment refers to an
inability to function optimally and
independently

Bereavement or impairment because of lack of
personal volition (aka laziness) is not abnormal
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Understanding Psychopathology The Science of Psychopathology

An atypical or not culturally expected
The study of psychological disorders

response refers to those behaviors or
Done by Mental Health Care Professionals (Different
attitudes that do not occur in a society very background, training, & approach)
frequently.
Done through the scientist-practitioner model

Violates social norms
The function of a scientist-practitioner

Problem is when you’re poor you’re “crazy” when
Consumer of science
you’re rich you’re “eccentric”
Evaluator of science

However, atypical traits, like being 7 feet tall,
Creator of science
redheaded, or left-handed is not considered a
disorder

The Science of Psychopathology The Science of Psychopathology

Main idea is the Clinical Description
Clinical Description starts with a presenting

Behaviors, thoughts, feelings that make up the problem or original complaint (the reason for
disorder coming to a clinical setting)

Specifies what makes a disorder different from
Can be related to, but a modification of, the
normal behavior and other disorders disorder or completely different from the actual
disorder

Somatoform disorders

Bruce Willis in Color of Night

The sleepless student

Clinical Description Clinical Description

What specifies this as a disorder?
What specifies this as a disorder that’s

Prevalence - Number of people in the population as
a whole who have the disorder

Incidence - Number of new cases of a disorder
occurring during a specific period of time (e.g., a
year)

Specific cultural or familial features

Anorexia Nervosa is more prevalent in industrialized societies
different from other disorders?

Course - pattern of the disorder in time

Chronic- Lasts a long time, even a lifetime (Sz)

Episodic- Lasts a short time, but is recurring (Bipolar)

Time-limited- Lasts a short time and may resolve itself
(Delirium)

Results in a good, guarded, or bad prognosis (L. pro
- before; gno - to know)

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Clinical Description

Sex ratio

MDD has a lifetime risk of 10- 25% for women

Typical age of onset

Schizophrenia occurs in the late teens to mid thirties

Types of onset

Acute onset- Occurs suddenly (substance- induced
amnestic disorders)

Insidious onset- Develops gradually over a long period
(some types of dementia)
Clinical Description

Treatment can include psychological,
psychopharmacological, or some combination
of the two

Treatments for the disorder usually gives hints
about the variables leading to and maintaining a
disorder

But solutions do not necessarily imply the causes of
a problem (e.g., aspirin alleviates headache, but
headache is not caused by deficits of aspirin in the
brain)
The Supernatural Tradition

Agents were outside our bodies manipulating
behavior, not inherent in our personality

Divinities, demons, spirits, the moon (lunatic), and
magnetic fields influencing behavior

Middle Ages - due to the presence of evil
demons

Treatment included exorcism, tortuous (L. tortuosus
- twist), religious rituals, hydrotherapy, and snake
pits
Clinical Description

Etiology - factors or dimensions that cause
psychological disorders

Genetics, prenatal stress, traumatic life events,
chemical imbalances, and/or disease
Historical Conceptions of Abnormal Behavior

Three models to explain Psychopathology

The Supernatural Tradition

The Biological Tradition

The Psychological Tradition
The Supernatural Tradition

15th Century - due to sorcery, witches, and
evil

One of the seven deadly sins, acedia (Gr. a -
without; kedos - care), are the symptoms of
depression

However, some thought insanity was a
curable, natural phenomenon

Caused by emotional, mental distress, can be cured
by simple things like sleep and rest
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The Biological Tradition

Beginnings were a search for physical causes
of mental disorders

Biggest influence was Hippocrates the
“father” of modern medicine

He brought us the “Hippocratic Oath”
The Biological Tradition

Galen’s (128-198 AD) “humoral” theory

Build up of bodily humors (chemical imbalances) led
to disordered temperaments

Sanguine (blood)- Optimistic (mania)

Choleric (yellow bile)- Irritable (mood lability, hostility)

Melancholic (black bile)- depressed

Phlegmatic (phlegm)- stoic, not easily bothered
(withdrawal, apathy)
The Biological Tradition

Syphilis (19th Century)

General paresis, the final stage of syphilis when
bacteria invaded the brain

Symptoms mimic psychosis (delusions of
persecution or grandeur or other bizarre behaviors),
followed by paralysis and death within 5 years of
onset

Kraft-Ebbing demonstrated the association of
syphilis to general paresis in 1897
The Biological Tradition

Hippocrates (460-377 BC)

Psychopathology was like any other disease

Caused by brain pathology or trauma

Can be influenced by family (He was right- your
family can make you crazy... through stress or genetic
heredity)

Hippocrates also coined the term hysteria and
believed the cause to be due to a wandering uterus

Treatment included marriage and pregnancy
The Biological Tradition

Cures for Hippocratic- Galenic disorders
involved regulating the environment, rest,
good nutrition, exercise, and bloodletting

Most of these are still recommended for those with
psychological disorders

These views foreshadowed modern views
linking psychological disorders with chemical
imbalances in the brain.
The Biological Tradition

Eventually scientists (Pasteur) discovered that
syphilis could be cured by penicillin

Syphillis was also cured by fevers from malaria

Combined with Pasteur’s germ theory cemented the
somatogenic view

Not necessarily a good model for most forms of
psychopathology

Today most etiologies are combination between biology
and environment
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The Biological Tradition The Biological Tradition

Purely biological tradition was championed by
Eyesenck

John P. Grey

Beliefs led to hospital reform that increased the size
and population of hospitals

This era also led to development of physical
interventions

Insulin shock therapy, EST (later ECT), resperine,
neuroleptics, and benzodiazepines (still a major
class of drugs today)

Classification theory maps on to Greeks, the
description can be useful even if its etiologically
wrong

Medical Model: biological factors (disease) are the
basis (cause) of psychopathology

Emil Kraeplin (1856-1926) contribution to
diagnosis and classification of disorders

Supported scientific approach to psychological
disorders and their classification

The Biological Tradition

Consequences

Diverted attention away from treatment

Effort was devoted to diagnosis, legal issues, and
the study of brain pathology itself Abnormal Behavior in Historical

But existing treatments were more humane Context

Reformers, such as Dorothea Dix, advocated the practice
of “deinstitutionalization”

Chapter 1B

Review Review

Three Criteria of a Psychological Disorder
Three Models for Explaining Psychological

Psychological dysfunction Disorders

An atypical or not culturally expected response
The Supernatural Tradition

Personal distress or impairment
Demons and outside forces

Early treatments

Clinical Description of Psychological Disorders

The Biological Tradition

Presenting problem, prevalence, incidence, course,

Hippocrates and Galen
prognosis, onset, sex ratio, etiology, and treatment

Syphillis and Biological Treatments

Champions and Consequences

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The Psychological Tradition

Psychoanalytic, humanistic, behavioral
approaches to understanding abnormal
behavior

Treatment practices focuses on social,
cultural, and psychological influences
The Psychological Tradition

Moral Therapy (First half of 18th Century)

Psychosocial approach emphasizing treatment of
institutionalized patients as normally as possible

Transformation of Asylums resulted in almost
miraculous recoveries in many patients

Probably because most patients were not ill in the first
place
The Psychological Tradition

Rise of Psychoanalysis (late 1800’s)

Mesmer

“Mesmerized” or Hypnotized revealed the power of
suggestion

Led to the “discovery” of the unconscious

Charcot

Treated “Grand Hysteria” or “Conversion Disorder”
(pseudo-neurological symptoms) with hypnosis

Famous for his students Freud and Tourette
The Psychological Tradition

Psychosocial models of mental disorder began
as early as Plato and Aristotle, but did not
predominate until the 18th century with the
advent of moral therapy

Originated by Philippe Pinel and his former
patient Jean-Baptiste Pussin.
The Psychological Tradition

Decline of Moral Therapy (After the Civil War)

Mid 19th century, mental illness was deemed as
caused by brain pathology and therefore believed to
be incurable

Increase in mentally ill hospital population lead to
custodial care institutions

Immigrants were not deemed worthy of treatment
The Psychological Tradition

Freud and Breuer

Via hypnosis brought the unconscious to conscious
through catharsis, free association, and recovered
memories

Freud was founder of Psychoanalytic Model, a
theory about the development and structure of
personality and origin of abnormal behavior

Three structure mind (Id, Ego, and Superego)

Intrapsychic conficts, neuroses, and defense mechanisms

Psychosexual stages of development
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The Psychological Tradition

Freud’s ideas led to

Neo-Freudian theories

Ego or Self-psychology (Anna Freud and Kohut)

Object relations (Winnicott, Klien, Kernberg)

Ideas like self- actualizing (Jung and Adler)

Life-span development (Horney, Fromm, and Erikson)
The Psychological Tradition

Today a purely psychoanalytic approach is less
widely accepted

Freud’s original ideas were parochial and
unscientific

Although concepts like transference, counter-
transference, and therapeutic alliances remain
The Psychological Tradition

Behavioral Model (Pavlov, Watson, Skinner)

Based behavior and dysfunction on principles of
learning and adaptation

Based on experimental psychology, it was a more
scientific approach to understanding behavior
The Psychological Tradition

The goal of psychoanalysis, is to help clients
understand the true nature of their intrapsychic
conflicts and psychological problems.

The relationship between therapist and client in
psychoanalysis is very important

Transference

Countertransference

Therapy is often long term, taking 4-5 weekly
sessions over a period of 2 to 5 years.
The Psychological Tradition

Humanistic Theory (Rogers, Maslow, and
Perls)

Major view is that people are basically good.

Central concept of this approach is self-actualization

All people strive to reach their highest potential, but if
this drive is thwarted, psychological problems may
develop

Unlike psychoanalysis, the therapist takes a passive
role, makes very few interpretations, and attempts
to convey to the client a sense of unconditional
positive regard
The Psychological Tradition

Ivan Pavlov discovered a simple form of
learning known as classical conditioning

Neutral stimulus is paired with a response until it
elicits that (conditioned) response (e.g., phobias,
nausea associated with chemotherapy, food
aversions)
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The Psychological Tradition

John Watson stated that the field of psychology
should be based on scientific analyses of observable
and measurable behavior.

Analyses could then be used in the prediction and
control of behavior.

Watson created the school of Behaviorism

His student, Mary Cover Jones, provided one of the first
demonstrations of successful treatment (via extinction) of
fear of furry objects in a 2-year-old boy named Peter.
The Psychological Tradition

B. F. Skinner

Psychology was to account for all behavior, even behavior
that can not be observed directly (e.g., thoughts, feelings)

Operant conditioning - Learning which occurs when
responses are modified as a function of the consequence of
the response

Applicable to daily learning and society/culture in general

Not a behavior therapist, but many of his technologies and
concepts form the core of several contemporary behavior
therapies
The Psychological Tradition

Critics of Cognitive Behaviorism:

Skinner was a pure behaviorist, therefore thinking is
not a causal factor in behavior, rather confidence is
acquired after the behavior

Bandura thought that the primary goal of therapy is
to help the patient attain control or mastery over
the environment so that they can reach self-efficacy
The Psychological Tradition

Joseph Wolpe (mid-20th century)

Based on the work of these early behaviorists,
particularly the work of Pavlov and Hull

Systematic desensitization- a person may extinguish
fear by practicing relaxation and pairing it with the
phobic stimulus
The Psychological Tradition

Cognitive Behaviorism (Ellis, Beck, Clark)

Incorporate thinking process into behavior

How we think about and interpret stimuli

Therapists must work to affect how people think
about themselves
The Present: The Scientific Method and an
Integrative Approach

Psychopathology is determined by different
processes does have an historical basis

Recent evidence suggests a strong reciprocal
influence among biological, psychological, and
social factors

Therefore we use an integrative
multidimensional approach in describing
abnormal pszychology