Abnormality

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  • Abnormality
    • Defining abnormality A01- Deviation from social norms: Behaviour which is anti social or undesirable in society, all societies have rules based on morals, if you break these rules according to this definition you are 'abnormal', Szasz suggested that 'madness is manufactured solely in order to label those in society who do not conform to the rules, these are cultural differences which is known as cultural realism, Cohen has shown that not conforming to the demands of industry are considered insane, leading to a rise in the mental hospitals in 1990.
      • A02: :)- is a person abnormal or eccentric?, social norms are defined by culture, times change, things which never used to be accepted are now accepted, definition distinguish's the difference between desirable and undesirable behaviour, social rules are set so that  people can live together, 'the greater group of society' is therefore considered.
        • A01- Failure to form adequately: an individuals inhibition to cope with everyday living, doctors use diagnostic manuals to determine if someone has a mental disorder (Global assessment functioning scale).
          • A02: :(- what is adequate coping and inadequate coping? exceptions to the rule i.e. a student who is very nervous before an exam is not abnormal, cultural factors could be that being unable to cope with everyday life is a persons mental disorder, Cochrane and Sashiaharan noted that racism and prejudice can have a significant impact upon psychological well-being. :)- allows us to view mental disorder from the point of view of the individual, easy to determine as we are able to list what we consider to be adequate functioning.
            • Comorbity: ie, if you have anxiety because of a mental disorder is it because of that or does your mental disorder give you anxiety.
              • A01- Deviations from ideal mental health: Jahoda viewed mental health rather than mental illness and came up with 6 criteria for optional living; Positive attitude towards self, self actualisation of ones potential, resistance to stress, personal autonomy, accurate perception toward reality and adapting to the environment.
                • A02: :(- You can never 'self actualise' we are sometimes poor at recognising our  'niche in life' and may not always achieve our full potential, stress as a positive? some people perform better under some stress therefore it shouldn't always be avoided, cultural factors: in some cultures 'realising your own potential' is not as important as bringing up your family. :)- more of a positive approach as it focuses on what it desirable rather than what is desirable.
    • Biological model (medical): abnormality is caused by physical factors: brain damage, abnormal behaviour may occur if structure of brain is damaged. Infection: can give rise to mental illness deterioration in specific regions of the brain results in delusions and irrational behaviour. Abnormality is inherited: Genes: some people are more at risk of developing abnormalities if their parents have had any, first degree relatives have 10% chance of developing schizophrenia, pairs of identical twins have been compared to see wether there is a concordance rate, there is low concordance rate for phobias but high for schizophrenia.
      • Certain genes lead to abnormal biochemistry and/or abnormal neuro-anatomy: Biochemistry:  unbalanced levels of hormones or neurotransmitters result in abnormality, neurotransmitters are responsible for transmitting nerve impulses around the body. Schizophrenia =high dopamine levels, depression = low serotonin levels, high cortisol levels i.e. Kirsch et al reviews studies of antidepressants and found that patients who received placebos fared almost as well as those getting new drugs.
        • A02: + succesful dominant approach (common), research evidence i.e. depression and schizophrenia you can research about your problem, drug therapy is successful, when given drugs it can make the patient feel better, no blame for the patient, when the patient is diagnosed, the doctor wouldn't say its their fault they got the illness they would tell them not to worry.
          • A02: Causes or effect?, drug therapy does not always solve cause maybe because the patient needs more than drugs to solve their illness, they might need therapy, promotes dependency in patient, lets them be totally independent as they're given the drugs and told to take them but the doctor does know if they're actually taking them.
    • Psycho dynamic approach- Psychoanalysis:(Sigmund Freud) the unconscious can affect our behavious, human personality and abnormality can develop from childhood, you can treat neurotic patients through talking, his ideas were based on dream interpretation , freud believed that the mind was made up of 3 parts; Conscious (what we are aware of at the time) ,Pre conscious (most of our ideas and thoughts are not accessible at that time), unconscious (the part of the mind which is unnaccesible and we are not aware of what lies here). parts of our personality: ID (devil side,demands immediate satisfaction of needs), ego (part of you which you are 90% of the time, controls fights between ID and superego), superego (this is like the angel side, it contains your morales/conscience).
      • Causes of abnormality: abnormalities arise from unresolved conflicts of childhood which are unconscious, therefore, mental illnesses  come about because of psychological conflict, conflicts between the ego, ID and superego lead to anxiety using defence mechanisms so you repress something. defence mechanisms: repression, displacement, denial, rationalisation.
      • A02: :(- ID,ego, superego are hard to define and research because actions motivated by them operate primarily at an unconscious level, Freud focused his theories on sex far too much and his views were also very sexist, research was poor because his studies were mostly done on  middle class,poor vietnamese women suffering from mental disorders, it lacks ecological validity. :)- Fisher and Greenberg discovered that many of Freud's major claims actually did receive experimental support therefore support the hypothesis.
    • Behavioural model: Classical conditioning- 'learning through association' i.e. pavlovs dogs and little albert. Operant conditioning- 'learning through rewards and punishments' i.e. Skinners rats, panic attacks with children. Social Learning theory- the idea that you learn from others. Bandura believed that abnormal behaviour could also be learnt from others, by seeing them rewarded and punished, this has implications for eating disorders and many other mental disorders like phobias, if someone in your family is scared of something or does something which can be classified as abnormal it is not surprising that you may also come to fear that object.
      • A02: :)- valid research: many studies have found similar results, animal research: without animals we wouldn't be able to understand as much about the behaviour model as we do. :(- a limited view (reductionist), underlying causes: focuses on symptoms only and doesn't look at the causes of mental disorder/abmormality, ethics: unethical as its imposed on people without consent, not nice to make a child be scared, can cause psychological harm, can't explain all abnormalities: fails to explain a common abnormality (phobias).
    • Cognitive model: Becks cognitive triad:
    • Psychological therapies of abnormality- Drugs: antidepressants,  work by reducing the rate of re-absorption or by blocking the enzyme which breaks down the neurotransmitter, this increases the amount of neurotransmitter (Serotonin) available, Anti-anxiety drugs, 2 types; benzodiazepines (BZ'S) and beta blockers (BB'S) BZ's used to treat anxiety and stress (valium and librium), BB's act directly on heart and circulatory system (used by sports people and musicians).
      • A02: :)- Research has shown that chemotherapy (drugs) do work, the world health organisation (WHO) reported that relapse rates after one year were highest, 55% for schizophrenics when treated with placebos, very easy to use when compared to psychological therapies. :(- a significant factor in the effectiveness of drugs may be their psychological effect as well as chemical, Kirsch et al found that patients who received placebo's card almost swell as those receiving real drugs, Mulrow et al compared the use of tricyclics and placebos  and found a success rate of 35% for placebos and 60% for tricyclics.
        • Looks at the symptoms and not the cause which could make relapse more likely, in the long term it mat be more appropriate to seek a treatment which addresses the problem, Side effects: all drugs have them, some are more damaging than others i.e. SSRI's can cause anxiety, sexual dysfunction, nausea, insomnia and suicide thoughts, there have been cases where patients have not been informed of these side effects and have murdered.
    • ECT:  ECT is an old method to treat abnormalities, still used today but only in extreme cases (depression when psychotherapy and medication don't work), used when patients are at risk of suicide because it offers quicker results than anti-depressant drugs. An electrode is placed above he temple of the non dominant side of the brain (right hemisphere) and a sec on in the middle of the forehead, alternatively, one electrode is placed above each temple, the patient is given a nerve blocking agent to paralyse their muscles, preventing any bone fractures, a small amount of electric current (0.6 amps) is passed through the brain, usually you have this 3 times a week.
      • A02: :)- there are cases which support it, 80% of cases have had substantial improvement, offers immediate beneficial effect, easy to monitor, can't be self administered therefore therapists know if treatment is being undergone, Comer states that 60-70% of ETC patients improve after, can save lives, works well with depression. :(- temporary side effects (amnesia, headaches, psychological effects i.e. anxiety, brain damage), 84% patients relapse after treatment (Sackham et al)  this suggests its not effective in the long term, focuses on symptoms not cause.
        • ECT vs sham ECT: patient is given same procedure but no electrical current is administered, those having real ECT were more likely to recover and quicker, however sham ECT recovered too, this suggests that attention received plays an important role in recovery.
    • Psychoanalysis: made up of a lot of techniques which aims to bring material from the unconscious into the conscious, this could include free association, dream analysis and projective tests. Free association: expressing your thoughts exactly as they occur (exactly) even if they may seem irrelevant, the aim is to reveal conflict between ID and superego. Dream analysis: Freud said dreams are full of symbols,   you analyse your dreams and link them with the symbols, works in 2 stages: manifest content- patient can recall content of dream, latent content- therapists interpretation of what lies beneath dream
      • A02: :)- Bergin analysed 10,000 patients and found 80% benefitted from psychoanalysis compared to 85% compared to 65% from another therapies, Tschuskcke et al found the longer the treatment took the better the outcome. :(- some therapists actually plant false memories rather than recover repressed ones, little evidence to support (loftus), The American psychological association (APA) say that it is rate that people can forget such emotionally charged events and recover them during therapy, it is a self report technique so there is no way of measuring the effectiveness, its not effective with every mental disorder,
    • SD: Systematic de sensitisation: most popular form of behavioural therapy, aim is to reduce and hopefully eliminate the anxiety which is associated with the feared object or event. 5 steps: patient has to relax, patient and therapist think of scenes which involve feared object/thing (will cause anxiety), gradually the patient will be able to get through the scenes without feeling anxious, once its complete they will feel relaxed taking about feared object/thing, patient is around the feared object thing and is fine. In between each stage they go back to a relaxed state.
      • A02: :)- it is appropriate to treat anxiety disorders, quick and requires less effort on patients side, successful outcomes can be achieved quickly, it can be self administered and is good for people who suffer with learning difficulties, due to the simple nature of the therapy. :(-symptom substation, Ohman et al suggested that SD may not be effective in treating anxieties which have an underlying evolutionary elements. Effectiveness: Mcgrath et al found around 75% of patients with phobias respond to this.
    • CBT:  therapies are based on the idea that abnormal behaviours are the result of faulty thinking, how we think (cognitive) effects how we behave (behavioural) hence CBT.
      • REBT: Rational Emotive behavioural therapy (Albert Ellis), the aim is to turn irrational beliefs into more rational beliefs, this will then lead to a healthy emotional state and more positive behaviour. ABC to DEF, A= activating event, B= belief (rational/irrational), C= consequences, D= disputing beliefs, E= effective latitude to life, F= feelings more positive.
        • A02: :)- Engels et al concluded REBT is an effective treatment for a number of different disorders, more  effective in anxiety disorders than SD, its effective in the absence of a therapist. :(- fails to address the issue that the environment still exists after the therapy continuing to produce and reinforce irrational thoughts and maladaptive behaviours, it is not always put into force.
          • Becks cognitive therapy: built upon necks cognitive triad, collaborate process between the client and therapist, 1: identifying the problem and desired goal, 2: challenging negative thoughts associated with mental illness, 3: homework set between sessions to test their thoughts, 4: the patient monitors their own perception accurately, they are taught to monitor negative automatic thoughts and examine the evidence that supports them, this way they can see if their thoughts are distorted.
            • A02: :)- Shown to be highly effective in over 400 studies on children and adults and for a wide range of disorders as well, it is widely available in NHS.
  • SD: Systematic de sensitisation: most popular form of behavioural therapy, aim is to reduce and hopefully eliminate the anxiety which is associated with the feared object or event. 5 steps: patient has to relax, patient and therapist think of scenes which involve feared object/thing (will cause anxiety), gradually the patient will be able to get through the scenes without feeling anxious, once its complete they will feel relaxed taking about feared object/thing, patient is around the feared object thing and is fine. In between each stage they go back to a relaxed state.
    • A02: :)- it is appropriate to treat anxiety disorders, quick and requires less effort on patients side, successful outcomes can be achieved quickly, it can be self administered and is good for people who suffer with learning difficulties, due to the simple nature of the therapy. :(-symptom substation, Ohman et al suggested that SD may not be effective in treating anxieties which have an underlying evolutionary elements. Effectiveness: Mcgrath et al found around 75% of patients with phobias respond to this.

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