PENGENALAN

PSIKOPATOLOGI
Md Aris Safree Md Yasin
019 964 7324
aris_safree@yahoo.com

PSYCHOPATHOLOGY - a term clinical psychologists

use as a synonym for abnormal behaviour.

ABNORMAL PSYCHOLOGY - the scientific study

whose objectives are to describe, explain, predict,
and modify behaviours that are considered strange
or unusual

1)Describing Abnormal Behaviour

Understanding a particular case of abnormal

behaviour begins with systematic observations
by an attentive professional.

These observations, usually paired with the

results of the persons psychological history,
become
the
raw
material
for
a
PSYCHODIAGNOSIS.

PSYCHODIAGNOSIS - an attempt to describe,

assess, and systematically draw inferences
about an individuals psychological disorder.

2)Explaining Abnormal Behaviour

To explain abnormal behaviour, the psychologist first

identifies possible causes for the described behaviour.

This information, in turn, bears heavily on the

program of treatment chosen.

Depending on your viewpoint, some explanations

may appear more valid than others.

No one explanation is sufficient to explain the

complexity of the human condition;
normal and
abnormal behaviours result from a combination of
factors.

3)Predicting Abnormal Behaviour

If a therapist can correctly identify the source of

a clients difficulty, he or she should be able to
predict the kinds of problems the client will face
during therapy and the symptoms the client will
display.

4)Modifying Abnormal Behaviour

Abnormal behaviour may be modified through

THERAPY, which is a program of systematic
intervention designed to improve a clients
behavioural, affective (emotional), and/or
cognitive state.

Psychologists focus first on understanding the

cause of abnormal behaviour and from there
plan treatment.

Just as there are many ways to explain abnormal

behaviours, there are many possible ways to
conduct therapy and many professional helpers
offering their services.

Along with the demand for mental health

treatment, the numbers and types of qualified
helping professionals have grown.

In the past, mental health services were offered

primarily by psychiatrists, psychologists, and
psychiatric social workers. The list of service
providers has expanded rapidly.

TYPES OF MENTAL HEALTH

PROFESSIONALS

Clinical Psychologist
Counseling Psychologist
School Psychologist
Psychiatrist
Psychoanalyst
Clinical Social Worker
Psychiatric Nurse
Occupational Therapist
Pastoral Counselor
Community Mental Health
Worker
Alcohol- or Drug-Abuse
Counselor

DETERMINING ABNORMALITY

Implicit in our discussion is the one overriding concern of

abnormal psychology: ABNORMAL BEHAVIOR itself.

What exactly is abnormal behaviour,

psychologists define a mental disorder?

The Diagnostic and Statistical Manual of Mental Disorders

(DSM), the most widely used classification system of mental
disorders, defines abnormal behaviour as:

and

how

do

a behavioural or psychological syndrome or pattern that

reflects an underlying psychobiological dysfunction, that is
associated with distress (e.g., a painful symptom) or
disability (i.e., impairment in one or more important areas
of functioning) and is not merely an expectable response to
common stressors or losses. (www.dsm5.org)

The DSM 5 Definition

MENTAL
DISORDER

This definition is quite broad and raises many questions.

1.
2.
3.

when is a syndrome or pattern of behaviour significant

enough to have meaning?
what constitutes present distress and painful
symptoms?
what criteria do we use in ascertaining an underlying
psychobiological dysfunction and not merely an
expectable response to common stressors?

Despite problems in defining abnormal behaviour,

practitioners tend to agree that it represents behaviour
that departs from some norm and that harms the
affected individual or others.

Nearly all definitions of abnormal behaviour use some

form of statistical average to gauge deviations from
normative standards.

THE ELEMENTS OF
ABNORMALITY
Suffering

Elements of
abnormality
include:

Maladaptiveness
Deviancy
Violation of the Standards of Society
Social Discomfort
Irrationality and Unpredictability
Dangerousness

SUFFERING

If people suffer or experience psychological pain we are inclined

to consider this as indicative of abnormality. Depressed people
clearly suffer, as do people with anxiety disorders.

But what of the patient who is manic and whose mood is one of
elation? He or she may not be suffering. In fact, many such
patients dislike taking medications because they do not want to
lose their manic highs.

You may have a test tomorrow and be suffering with worry. But
we would hardly label your suffering abnormal.

Although suffering is an element of abnormality in many cases,

it is neither a sufficient condition (all that is needed) nor even a
necessary condition (a feature that all cases of abnormality
must show) for us to consider something as abnormal.

MALADAPTIVE

Maladaptive behavior is often an indicator of abnormality.

The person with anorexia may restrict her intake of food to the point
where she becomes so emaciated that she needs to be hospitalized.

The person with depression may withdraw from friends and family
and may be unable to work for weeks or months.

Maladaptive behavior interferes with our wellbeing and with our

ability to enjoy our work and our relationships.

However, not all disorders involve maladaptive behavior. Consider

the con artist and the contract killer, both of whom have antisocial
personality disorder.

The first may be able glibly to talk people out of their life savings,
the second to take someones life in return for payment.

Is this behaviour maladaptive?

Not for them!, because it is the way in which they make their
respective livings.

We consider them abnormal, however, because their behaviour is

maladaptive for and toward society.

STATISTICAL DEVIANCY

The word abnormal literally means away from the normal.

But simply considering statistically rare behavior to be abnormal does

not provide us with a solution to our problem of defining abnormality.

Genius is statistically rare - however, we do not consider people with

such uncommon talents to be abnormal in any way.

Also, just because something is statistically common doesnt make it

normal - the common cold is certainly very common, but it is regarded
as an illness nonetheless.

On the other hand, mental retardation (which is statistically rare and

represents a deviation from normal) is considered to reflect
abnormality.

This tells us that in defining abnormality we make value judgments - If

something
is statistically rare and undesirable (as is severely
diminished intellectual functioning), we are more likely to consider it
abnormal than something that is statistically rare and highly desirable
(such as genius) or something that is undesirable but statistically
common (such as rudeness).

VIOLATION OF THE STANDARDS

OF SOCIETY

All cultures have rules. Some of these are formalized as laws.

Others form the norms and moral standards that we are taught to
follow.

Although many social rules are arbitrary to some extent, when

people fail to follow the conventional social and moral rules of
their cultural group we may consider their behaviour abnormal.

Of course, much depends on the magnitude of the violation and

on how commonly the rule is violated by others.

A behaviour is most likely to be viewed as abnormal when it

violates the standards of society and is statistically deviant or
rare.

In contrast, most of us have parked illegally at some point. This

failure to follow the rules is so statistically common that we tend
not to think of it as abnormal.

SOCIAL DISCOMFORT

When someone violates a social rule, those around him or her

may experience a sense of discomfort or unease.

Imagine that you are sitting in an almost empty movie theatre.

There are rows and rows of unoccupied seats. Then someone
comes in and sits down right next to you. How do you feel?

In a similar vein, how do you feel when someone you met only 4
minutes ago begins to chat about her suicide attempt?

IRRATIONALITY and
UNPREDICTABILITY

We expect people to behave in certain ways. Although a little

unconventionality may add some spice to life, there is a point at
which we are likely to consider a given unorthodox behaviour
abnormal.

If a person sitting next to you suddenly began to scream and yell

obscenities at nothing, you would probably regard that behaviour
as abnormal. It would be unpredictable, and it would make no
sense to you.

The disordered speech and the disorganized behaviour of patients

with schizophrenia are often irrational.

Such behaviours are also a hallmark of the manic phases of bipolar

disorder.

Perhaps the most important factor, however, is our evaluation of

whether the person can control his or her behaviour.

DANGEROUSNESS

It seems quite reasonable to think that someone who is a danger to

him- or herself or to another person must be psychologically abnormal.

Indeed, therapists are required to hospitalize suicidal clients or contact

the police (as well as the person who is the target of the threat) if they
have a client who makes an explicit threat to harm another person.

But, as with all of the other elements of abnormality, if we rely only on

dangerousness as our sole feature of abnormality, we will run into
problems.

Is a soldier in combat mentally ill? What about someone who is an

extremely bad driver? Both of these people may be a danger to others.
Yet we would not consider them to be mentally ill.

Why not?

And why is someone who engages in extreme sports or who has a

dangerous hobby (such as free diving, race car driving or keeping
poisonous snakes as pets) not immediately regarded as mentally ill?

Just because we may be a danger to ourselves or to others does not

mean we are mentally ill.

Conversely, we cannot assume that someone diagnosed with a

mental disorder must be dangerous.

Although mentally ill people do commit serious crimes, serious

crimes are also committed every day by people who have no signs
of mental disorder.

Indeed, research suggests that in people with mental illness,

dangerousness is more the exception than it is the rule (Corrigan &
Watson, 2005).

What Do We Mean by
Abnormality?
ABNORMALIT
Y

THE ELEMENTS OF
ABNORMALITY

FOUR major means of judging psychopathology

include
DISTRESS,
DEVIANCE
(bizarreness),
DYSFUNCTION
(inefficiency
in
behavioural,
affective,
and/or
cognitive
domains),
and
DANGEROUSNESS.

DISTRESS

Most people who seek the help of therapists are suffering

psychological distress that may show up physically and/or
psychologically.

In the psychological realm, distress is manifested in

extreme or prolonged emotional reactions such as anxiety
and depression.

Of course, it is normal for a person to feel depressed after

suffering a loss or a disappointment.

But if the reaction is so intense, exaggerated, and

prolonged that it interferes with the persons capacity to
function adequately, it is likely to be considered abnormal.

DEVIANCE

Deviance is most closely related to using a statistical average.

Statistical criteria equate normality with those behaviours that

occur most frequently in the population.

Abnormality is therefore defined in terms of those behaviours

that occur least frequently.

Bizarre or unusual behaviour is an abnormal deviation from an

accepted standard of behaviour (such as an antisocial act) or a
false perception of reality (such as a hallucination or delusion).

This criterion can be extremely subjective; it depends on the

individual being diagnosed, on the diagnostician, and on the
particular cultural context.

DYSFUNCTION

In everyday life, people are expected to fulfil various

roles.

Emotional problems sometimes interfere with the

performance of these roles, and the resulting role
dysfunction may be used as an indicator of abnormality.

Thus one way to assess dysfunction is to compare an

individuals performance with the requirements of a role.

Another related way to assess dysfunction is to compare

an individuals performance with his or her potential.

DANGEROUSNES
Dangerousness
S

Predicting the dangerousness of clients to

themselves and others has become an
inescapable part of clinical practice.

Therapists to assess the dangerousness of

clients (to themselves and others) and to protect
any intended victim.

Psychologists have attempted to devise riskassessment procedures and to ascertain what

actions a therapist must take to comply with a
duty to protect.

MULTICULTURAL LIMITATIONS
IN DETERMINING
ABNORMALITY

Perhaps one of the strongest criticisms of abnormality definitions comes

from the multicultural perspective.

If deviations from the majority are considered abnormal, then many

ethnic and racial minorities who show strong cultural differences from
the majority could be classified as abnormal.

When we use a statistical definition, the dominant or most influential

group generally determines what constitutes normality and abnormality.

Multiculturalists contend that all behaviors,

abnormal, originate from a cultural context.

Psychologists are increasingly recognizing that this is an inescapable

conclusion and that culture plays a major role in our understanding of
human behaviour.

whether

normal

or

What is Culture?

CULTURE is the configuration of shared learned behaviour

that is transmitted from one generation to another by
members of a particular group; the components of culture
include the values, beliefs, and attitudes embedded in a
groups worldview and symbolized by artifacts, roles,
expectations, and institutions (Sue & Sue, 2008a).

Three important points should be

emphasized:
1.

Culture is not synonymous with race or ethnic group. Jewish, Polish,

Irish, and Italian Americans represent diverse ethnic groups whose
individual members may share a common racial classification. Yet
their cultural contexts may differ substantially from one another.
Likewise, an Irish American and an Italian American, despite their
different ethnic heritages, may share the same cultural context.

2.

Every society or group that shares and transmits behaviours to its

members possesses a culture.

3.

Culture is a powerful determinant of worldviews (Sue & Sue, 2008a).

It affects how normal and abnormal behaviors are defined and how
disorders encountered by members of that culture are treated.

These three points give rise to a major problem: one groups definition
of mental illness may not be shared by another.

This contradicts
psychology, which
assumption that
disorders whose
cultures

the traditional view of abnormal

is based on cultural universalitythe
there exists a fixed set of mental
obvious manifestations cut across

The belief that a disorder such as depression is similar in

origin, process, and manifestation in all societies and,
therefore, no modifications in diagnosis and treatment
need be made; Western concepts of normality and
abnormality can be considered universal and equally
applicable across cultures

In contrast to the traditional view of cultural universality,

the principle of cultural relativism emphasizes that
lifestyles, cultural values, and worldviews affect the

THE FREQUENCY AND BURDEN

OF MENTAL DISORDERS

PSYCHIATRIC EPIDEMIOLOGY, the study of the prevalence

of mental illness in a society, provides insights into factors
that contribute to the occurrence of specific mental
disorders.

The PREVALENCE of a disorder indicates the percentage of

people in a population who suffer from a disorder at a given
point in time; lifetime prevalence refers to the percentage
of people in the population who have had a disorder at some
point in their life.

INCIDENCE refers to the onset or occurrence of a given

disorder over some period of time.

From this information, we can find out how frequently or

infrequently various disturbances occur in the population.

We can also consider how the prevalence of disorders

varies by ethnicity, gender, and age and whether current
mental health practices are effective.

Prevalence and Incidence

Prevalence and Incidence

Prevalence and Incidence

Prevalence Estimates for

Mental Disorder

HISTORICAL PERSPECTIVES
ON ABNORMAL BEHAVIOUR
PREHISTORIC AND ANCIENT BELIEFS

Prehistoric societies some half a million years ago did

not distinguish sharply between mental and physical
disorders.

Abnormal behaviors, from simple headaches to

convulsive attacks, were attributed to evil spirits that
inhabited or controlled the afflicted persons body.

According to historians, these ancient peoples attributed

many forms of illness to demonic possession, sorcery, or
the behest of an offended ancestral spirit.

Within this system of belief, called demonology, the victim

was usually held at least partly responsible for the misfortune.

It has been suggested that Stone Age cave dwellers may have
treated behaviour disorders with a surgical method called
trephining, in which part of the skull was chipped away to
provide an opening through which the evil spirit could escape.

People may have believed that when the evil spirit left, the
person would return to his or her normal state

Another treatment method used by the early Greeks, Chinese,

Hebrews, and Egyptians was exorcism.

In an exorcism, elaborate prayers, noises, emetics (drugs that

induce vomiting), and extreme measures such as flogging and
starvation were used to cast evil spirits out of an afflicted
persons body.

NATURALISTIC EXPLAINATIONS
(Greco Roman Thought)

With the flowering of Greek civilization and its

continuation into the era of Roman rule (500 b.c.a.d.
500), naturalistic explanations gradually became distinct
from supernatural ones.

Early thinkers, such as Hippocrates (460370 b.c.), a

physician who is often called the father of medicine,
actively questioned prevailing superstitious beliefs and
proposed much more rational and scientific explanations
for mental disorders.

Naturalistic explanations relied heavily on observations

the foundation of the scientific method.

These explanations negated the intervention of demons

in the development of abnormality and instead stressed
organic causes.

Fortunately, the treatment they prescribed for mental

disorders tended to be more humane than previous
treatments.

Hippocrates believed that, because the brain was the

central organ of intellectual activity, deviant behavior
was caused by brain pathologythat is, a dysfunction or
disease of the brain.

He also considered heredity and environment important

factors in psychopathology.

He classified mental illnesses into three categories

mania, melancholia, and phrenitis (brain fever)and

REVERSION TO SUPERNATURAL
EXPLAINATIONS (THE MIDDLE AGES) :
The Dark Ages (5th 20th Centuries)

People came to believe that many illnesses were the result of

supernatural forces, although they had natural causes.

In many cases, the mentally ill were treated gently and with
compassion in monasteries and at shrines, where they were
prayed over and allowed to rest.

In other cases, treatment could be quite brutal, especially if

illnesses were believed to be Gods wrath.

Because illness was then perceived to be punishment for sin,

the sick person was assumed to be guilty of wrongdoing, and
relief could come only through atonement or repentance.

During this period, treatment of the mentally ill

sometimes consisted of torturous exorcistic procedures
seen as appropriate to combat Satan and eject him from
the possessed persons body.

Prayers, curses, obscene epithets, and the sprinkling of

holy water as well as such drastic and painful
therapy as flogging, starving, and immersion in hot
waterwere used to drive out the devil.

MASS MADNESS
(13th Century)

Belief in the power of the supernatural became so prevalent

and intense that it frequently affected whole populations.

Beginning in Italy early in the thirteenth century, large

numbers of people were affected by various forms of mass
madness, or group hysteria, in which a great many people
exhibit similar symptoms that have no apparent physical
cause.

One of the better known manifestations of this disorder was

tarantism, a dance mania characterized by wild raving,
jumping, dancing, and convulsions.

The hysteria was most prevalent during the height of

the summer and was attributed to the sting of a
tarantula.

A victim would leap up and run out into the street or

marketplace, jumping and raving, to be joined by others
who believed that they had also been bitten.

Another form of mass madness was lycanthropy, a

mental disorder in which victims imagine themselves to
be wolves and imitate wolves actions.

(Motion pictures about werewolves people who

assume the physical characteristics of wolves during the
full moonare modern reflections of this delusion.)

How can these phenomena be explained? Stress and

fear are often associated
with outbreaks of mass
hysteria.

WITCHCRAFT
(15th - 17th Centuries)

People whose actions were interpreted as peculiar were

often suspected of witchcraft.

It was acceptable to use torture to obtain confessions

from suspected witches, and many victims confessed
because they preferred death to prolonged agony.

Thousands of innocent men, women, and even children

were beheaded, burned alive, or mutilated.

How have explanations of

abnormal behaviour changed
over time?

Ancient peoples believed in demonology and attributed abnormal

behaviours to evil spirits that inhabited the victims body.
Treatments consisted of trephining, exorcism, and bodily
assaults.

Rational and scientific explanations of abnormality emerged

during the Greco-Roman era. Especially influential was the
thinking of Hippocrates, who believed that abnormal behaviour
was due to organic, or biological, causes, such as a dysfunction or
disease of the brain. Treatment became more humane.

With the collapse of the Roman Empire and the increased

influence of the church and its emphasis on divine will and the
hereafter, rationalist thought was suppressed and belief in the
supernatural again flourished.

During the Middle Ages, famine, pestilence, and dynastic

wars caused enormous social upheaval. Forms of mass
madness (mass hysteria) affected groups of people.

One of the better known manifestations of this disorder

was tarantism, a dance mania characterized by wild
raving, jumping, dancing, and convulsions. The hysteria
was most prevalent during the height of the summer and
was attributed to the sting of a tarantula. A victim would
leap up and run out into the street or marketplace,
jumping and raving, to be joined by others who believed
that they had also been bitten.

Another form of mass madness was lycanthropy, a

mental disorder in which victims imagine themselves to be
wolves and imitate wolves actions. (Motion pictures about
werewolves
people
who
assume
the
physical

In the fifteenth century, some of those killed in church

endorsed witch hunts were people we would today call
mentally ill.

People whose actions were interpreted as peculiar were often

suspected of witchcraft. It was acceptable to use torture to
obtain confessions from suspected witches, and many victims
confessed because they preferred death to prolonged agony.

Thousands of innocent men, women, and even children were

beheaded, burned alive, or mutilated.

The Rise of Humanism (Renaissance) brought a return to

rational and scientific inquiry, along with a heightened
interest in humanitarian methods of treating the mentally ill.

The eighteenth and nineteenth centuries were a period

characterized by reform movements.

What were early viewpoints

on the causes of mental
disorders?

In the nineteenth and twentieth centuries, major medical

breakthroughs fostered a belief in the biological roots of
mental illness.

An especially important discovery of this period was the

microorganism that causes general paresis.

Scientists believed that they would eventually find organic

causes for all mental disorders.

The uncovering of a relationship between hypnosis and

hysteria corroborated the belief that psychological processes
could produce emotional disturbances.

What are some contemporary

trends in abnormal
psychology?

Three major contemporary developments have had or are

having important influence in the mental health professions:
1.

the multicultural psychology movement,

2.

positive psychology and optimal human functioning, and

3.

changes in the therapeutic landscape (drug revolution,

prescription privileges for psychologists, managed care,
and evidence-based practice).