Abnormality

Deviation from social norms:

Every society has rules known as social norms; these rules can be explicit e.g. laws. Whereas others are implicit e.g. behaving in the expected way in a social situation.

Deviating from these social norms means that the person is considered to be abnormal. The focus of this definition is to consider the impact of an individual’s behaviour on others. If an individual’s behaviour makes others feel uncomfortable (by not conforming to social norms), they are considered abnormal.

Behaviours that are deemed abnormal:

• Being confined to the house
• Considering suicide
• Being unable to read and write
• Speaking to oneself
• Hearing voices that nobody else can hear
• Committing murder
• Appearing naked in social situations

Criticism:

• It does not take into account how the patient feels, whether this behaviour would be considered normal/abnormal in different situations, historical periods or cultures
• Are all unusual acts actually abnormal?

Failure to function adequately:

•   People who cannot cope with the demands of everyday life – getting up, work, looking after themselves, etc. This is seen as abnormal.
•   Patient reports suffering (depressed mood)
•     Behaviour preventing them from reaching life goals (self harm)
•    Behaviour differs from most (hallucinations)
• Uncontrolled behaviour(OCD, panic attacks)
•   Behaviour against social norms

·         However, it is sometimes normal to not function adequately

Deviation from ideal mental health:

• Six criteria for optimal living –experiencing only a few of these is considered abnormal
• Positive attitude towards the self – self respect, self-reliance, self-confidence and self-acceptance
• Self actualisation (personal growth and development) & developing talents and abilities to the full
• Resistance to stress – having good strategies to cope with stressful situations
• Personal autonomy – the ability to make own decisions on the basis of what is right for ourselves
• Accurate perception of reality – seeing things as they really are, rather being too optimistic or pessimistic
• Adapting to the environment – being competent in all areas of life, flexible rather than rigid and can adjust to change

Criticism:very few people posses most of these characteristics

Deviation from social norms:

• The role of context: A certain behaviour is not always normal, it depends on the context. E.g. a naked man in the shower would be considered normal whereas at work he would be considered abnormal
• Era dependency: views on what is abnormal changes over time. A certain behaviour is not always abnormal, it depends on the era. E.g. homosexuality was classified as a mental disorder in the UK until the 1960s now it is socially acceptable.
• Cultural issues: Social norms vary: what is abnormal in one culture, may be acceptable in another. E.g. in certain Indian and African cultures it is normal to speak an invisible person following a bereavement.

Failure to function adequately:

Exceptions: it is sometimes normal to not function adequately e.g. at a time a stress due to an exam or loss of job. Sociopaths might exhibit violent or aggressive behaviour but are unlikely to be distressed or fail to function.

Cultural relativism: Failing to function may be the cause not the result of mental illness. E.g. being unable to cope makes you depressed rather than depression making you unable to cope. Can explain why there are more mental illnesses amongst ethnic minorities i.e: they may face more difficulties in life

Deviation from Mental Health:

Normal is Rare: very few individuals possess all six elements for optimal living, so Jahoda would see very few people as being ‘normal’. Therefore, ‘normal’ people are rare.

Cultural relativism: The criteria are based on Western society’s view of growth and achievement. Some of her criteria would be regarded as abnormal by collectivist cultures. E.g. self-actualisation and personal autonomy

Biological approach:

• Hormones

• Brain damage

• Genes

• Drugs -> neurochemicals

Psychological disorders should be looked at and treated in the same way as physical disorders. Abnormal thinking and behaviour are caused by biological malfunctions. Understanding mental illness involves understanding what has gone wrong with the brain.

Biochemistry: 

• Having an imbalance of neurotransmitters and hormones might cause parts of the brain to malfunction leading to mental illness
• E.g. the stress response reduces the levels of serotonin in the brain – this could explain why stress often leads to depression
• Equally people with schizophrenia have excess dopamine

Genes:

• We can inherit psychological abnormality if it is passed on through our genes
• E.g. relatives of schizophrenics are 18 times more likely to develop it themselves
• Gottesman found a 46% concordance rate (if one twin develops schizophrenia, the other one will) between MZ Twins (monozygotic – one egg) in schizophrenia

Brain damage:

• If the structure of the brain is damaged or is underdeveloped then thinking, emotion and behaviour may change
• E.g. the ventricles (part in the brain that stores fluid) in the brains of schizophrenics are larger than in people without schizophrenia
• Korsakoff linked to excessive alcohol abuse and leads to profound memory impairment (Korsakoff's Syndrome)

Infection/disease:

• Catching an infection or suffering a disease that could lead to a structural to the brain or a change in biochemistry
• E.g. 14% of schizophrenic patients have been exposed to a strain of the flu virus prior to the onset of schizophrenia

• Avoids blame: Changed people’s views on mental illness from the 18th century when it was blamed on evil spirits, now the patients aren’t so to blame.
• Successful in treating some psychological conditions: The assumption that disorders are due to chemical imbalance guides the search for relevant treatments e.g. antidepressants raise serotonin.
• Research evidence: Brain scans and post-mortems support the approach e.g. sufferers of schizophrenia have been found to have high levels of dopamine as well as loss of tissue in the brain
• Ignores social and psychological factors (reductionism) Not just the effect of genes – the environment must play some part in abnormality. A genetic predisposition to a certain disorder is triggered by environmental stressors
• Overemphasis on symptoms: Psychiatrists rely on drugs that treat the symptoms rather than the cause
• Cause or effect?: A disorder could cause the biological malfunction 

The Psychodynamic approach was originated by Freud. Freud believed that unconscious repressed thoughts motivate behaviour, particularly the ones from childhood (often of a sexual nature).

Freud assumed that the mind is divided into 2 parts: conscious and the unconscious and is further separated into the id, ego and superego.

The Id:

• Instincts
• Unconscious
• Selfish

The Id contains the innate sexual libido and aggressive instincts and is located in the unconscious mind. If demands immediate satisfaction and is completely selfish. Based on the Pleasure Principle. If this is overdeveloped the person might be asociopath, **********, sex addict & kleptomanic.

The Ego:

• Conscious
• Rational

The Ego is the conscious, rational part of the mind. It mediates between the pleasures of the ID and the demands of the super ego. Based on the Reality Principle it takes into the account what is going on in the real world

Superego:

• Morality
• Principle

The Superego is the last part of the psyche to develop and is the conscience of the child as it realises what is right and wrong. Develops through socialisation when we learn the moral standards and expectations of a culture. Based on the Morality principle.

If this was overdeveloped, a person might be suffer from OCD, Anorexia and anxiety disorders.

When a child is born it only has an Id as the child grows and develops the ID looks for gratification in different bodily areas.  These were called the erogenous zones.  If a child is deprived or over indulged during these stages they can become fixated on a particular stage which can affect their adult behaviour

Oral stage:

• The baby gains pleasure from sucking and biting
• Overindulged – gullible, over reliant on others
• Frustrated – greedy, addictive personalities

Anal Stage:

• The baby gains pleasure from retaining or expelling faeces
• Overindulged – lenient parents, disorganised, reckless, creative
• Frustrated – excessively clean, tidy, stubborn. Can develop OCD

Phallic Stage:

• The child gains pleasure(intrigued!) from their genitals. Start to appreciate difference between boys and girls
• If fixated people become obsessed with the opposite sex can be overly macho or girlie
• Phobias  can develop as a result of this stage

Latent stage:

• The child is repressing all sexual desires and redirecting them into socially acceptable behaviours
• Child's energy is focused into learning new skills

Little Hans was a 5 year old boy whose father wrote to Freud for help because his son had developed a phobia – a fear of horses. Freud’s analysis of Little Hans was based on the information reported in the letters written by the boy’s father when he was 3 years old. Hans has shown a ‘peculiarly lively interest in the part of the body which he used to describe as his widdler’.  He invited his mother to touch his penis, was told that would be ‘piggish’ and was warned that his penis would be cut off if he continued touching it.  According to Freud, Hans showed strong sexual urges, directed towards his mother and these were repressed for fear of castration by his father. About six months later, Hans was frightened when he saw a horse-drawn van tip over and thereafter he indicated he was afraid to go out in case he was bitten by a horse. Freud believed that the initial source of the boy’s fear was his father but the fear was transposed to a horse (a symbol for his father). The muzzles and blinkers on the horses were seen to represent the father’s moustache and spectacles.

 The boy’s fear of horses represented his fear of castration at the hands of his father because Hans and his father were rivals for his mother’s love. Freud advised Hans’ father to continue being loving towards his son, to talk through his fears with him until the phobia disappeared and Hans identified with his father.

Repression – push fears and desires into unconscious mind but they continue to influence our behaviour 

Denial – failing to face reality or admit an obvious truth – addictions

Regression – going back to childlike behaviour – depression

Displacement – taking out frustrations on people or objects that are less threatening

Projection – taking our own unacceptable qualities and attributing them to others

• Before Freud, mental illness was described in terms of physical causes or possession be evil spirits. This approach changed people’s perspective by looking at psychological factors.
• First theory to acknowledge the importance of unconscious processes and to suggest how adult behaviour could be influenced by childhood experiences
• Emphasis on sexual factors: Assumption that later psychological disorders could be caused by problems with early psychosexual development. 
• Freud developed his theory on the basis of case studies of adults who came to him with neurotic disorders which he linked to their early experiences.
• Lack of scientific evidence: Cannot test concepts such as id and repression using scientific methodology. Case studies are open to subjective interpretation.
• Freud’s theory was developed in the late 19th and early 20th centuries: Aspects of this theory are related to the historical and cultural period it was developed in e.g. sexually repressed Victorian society – we should have less need to repress sexual desires today

The cognitive approach assumes that thinking, expectations and attitudes (cognitions) control behaviour.  Therefore abnormal behaviours are caused by irrational thoughts and faulty thinking.  So, the issue is not the problem itself but the way you think about it. Emotional problems are caused by distortions in our thinking processes (cognitions).  For example, negative thoughts, irrational beliefs and illogical errors such as polarised thinking (e.g. everybody hates me) and over generalisations (drawing negative conclusions based on one event)

These negative thoughts can be seen in the cognitive thoughts that depressed people apply when they interpret situations. They prevent the person focusing on the positive and reinforce their negative views.

Thinking can be rational or irrational; this only becomes maladaptive (detrimental to survival) if it begins to effect the person’s life or those around them. If we think rationally we behave rationally and consequentially are happy, competent and effective.  However, if we think irrationally this can lead to psychological disturbance as we become accustomed to disturbed thoughts. (look at flow chart)

Depressed people tend to draw negative conclusions when they evaluate themselves. These can then be over generalised to many areas of life. 

Arbitrary influence: the drawing of unjustified conclusions based on little or no evidence

Selective abstraction: the focusing of attention on one detail without regard of the rest of the picture

Over-generalisation: the drawing of conclusions based upon a limited event

Magnifications: making mountains out of molehills; a small problem becomes magnified

Minimumisation: an undervaluation of positive attributes; any positive aspects in life are minimised

Beck believed negative thoughts underlie mental disorders and was particularly interested in Depression and he identified two mechanisms which he believed caused the disorder. These were errors in logic and the cognitive triad.

(Look at seperate sheet)

• Emphasis on the individual’s power to shape their own thinking: The approach allows the individual to take responsibility for changing their behaviour
• Effective therapies: The approach has led to effective therapies for depression and anxiety disorders 
• Takes no account of biological or genetic factors in psychopathology: perhaps overemphasises importance of cognitive behaviour and ignores other factors
• Negative thoughts and beliefs may be totally rational and reflect the circumstances that a person is living in: It perhaps over emphasises the importance of cognitive factors. Sometimes people have a lot of negative life events, making their thoughts rational. Therefore these events rather than their thoughts should be targets.
• Problem of cause and effect: In some cases, disorders such as depression may lead to dysfunctional thinking rather than the other way around. Depression may encourage a focus on the negative aspects of life and the future.

Behavioural psychologists believe all behaviour is learned through experience.

They base their ideas on laboratory experiments that examine observable behaviour.

Abnormality is seen as the development of maladaptive (undesirable) behaviours. They explain phobias, anxiety and depression through the processes of classical conditioning, operant conditioning and social learning.

‘Albert, eleven months of age, was an infant with a phlegmatic disposition, afraid of nothing “under the sun” except a loud noise made by striking a steel bar.  This made him cry.

 By striking the bar at the same time that Albert touched a white rat, the fear was transferred to the white rat.

 After seven combined stimulations, rat and sound, Albert not only became greatly disturbed at the sight of a rat, but this fear had spread to include a white rabbit, cotton wool, a fur coat and the experimenter’s (white) hair.

 It did not transfer to wooden blocks and other objects very dissimilar to the rat’.

Before conditioning:

The unconditioned stimulus was the loud noise, which induced fear in Albert. The neutral stimulus was the rat; which had no effect on Albert.

During conditioning:

The unconditioned stimulus was associated with the sight of the neutral stimulus: the rat.

After conditioning:

The fear of the rat became the conditioned stimulus and invoked fear in Albert.

This study is not ethical because they could not get fully informed consent from the child, since he was too young. Moreover, the event could have affected him for the rest of his life.

Learning occurs through reinforcement.  

Skinner showed in rats that a response such as pressing a bar could be learned if the behaviour was rewarded.

 A psychological disorder occurs when a maladaptive (undesirable) behaviour has been rewarded. This increases the probability it will be repeated.

Behaviours are learned by seeing others rewarded and punished.  

Bandura (1973) believed that behaviours are learned through imitation – by observing others who are role models for behaviour.  

Some phobias, such as a fear of spiders, may be learned by observing other people showing fear when they see a spider. This theory can also be applied to the development of eating disorders

• Focus on specific behaviour – doesn’t label people. Concentrates on adaptive (survival) and maladaptive behaviour rather than labelling someone as abnormal
• Successful in treating some psychological conditions. Especially anxiety disorders (phobia) best combined with cognitive (improved the therapy) approach particularly effective for treating children
• The behavioural approach is reductionist: Explains behaviours in terms of simple learning principles. Some behaviour is too complex to be explains in this way. Behaviour is not just learned through association/reinforcement
• Exaggerates the environmental factors: takes only environmental factors into account rather than physical factors of inborn factors – a focus on nurture
• Doesn’t provide an explanation for the most serious disorders such as schizophrenia

Outline the accepted procedure for ECT (electro-convulsive therapy):

• The patient lies on a bed in loose clothes and receives an anaesthetic and muscle relaxant before treatment
• ECT involves passing a current (70-130 volts) through the brain for approximately half a second. This is done by fixing electrodes to the patient’s temples. It is more common to use unilateral ECT by fixing one electrode to the non-dominant hemisphere (the right side for most people) as this reduces side effects such as memory loss
• The current induces convulsions that last for approximately one minute
• Once the patient comes round from the anaesthetic they recall nothing about the procedure
• used to treat schizophrenia but now used for severe depression

How often is ECT administered?

• To treat severe depression – 2/3 times a week for a month
• 11,000 patients given ECT in 1999 in England

• Efficacy – ECT is a quick form of treatment compared with drugs or psychological therapies. It can be an effective short-term treatment for depression with 60-70% of patients showing improvement. However, approximately 60% of patient will become depressed again within a year
• When to use – ECT should only be administered if anti-depressant drugs have no effect and there is a risk that the person will commit suicide. Some psychiatrists argue that the prevention of suicide is sufficient justification for its use.
• Mode of action – it is not clear exactly how ECT works, but it may increase the availability of certain neurotransmitters in the brain and the secretions of hormones that may improve a depressed mood
• Side effects – when ECT was first introduced there were serious side effectsincluding bone fracture and memory loss. They have been reduced after the change from bilateral to unilateral but opinions are divided regarding the severity of cognitive and emotional impairments following treatment
• Ethical issues – ECT has a history of abuse, being used as a means of punishing or controlling people in mental hospitals

What is the key biological assumption on which drug therapy is based upon? 

That chemical imbalance is the root of the problem.

What are anti-anxiety drugs and how do they work? 

(minor tranquilizers called benzodiazepines) such as Valium. They have a calming effect by inhibiting the nervous system and  causing muscles to relax. BZ’s work by enhancing the action of the chemical messenger (neurotransmitter), GABA, which acts to calm brain activity. 

What are anti-depressant drugs and how do they work?

e.g. MAOIs, TCAs and SSRIs – improve mood by increasing the availability of neurotransmitters such as serotonin. MAOIs block the action of an enzyme that breaks down serotonin, so increasing its availability in the nervous sytem

What are anti-psychotic drugs and how do they work?

Major tranquilisers such as phenothiazines. Sedate and alleviate symptoms of the person suffering from psychotic disorders such as schizophrenia. They seem to work by blocking the D2 receptor for dopamine.

Are drugs effective?

In many, but not all, people.

• Can be effective for range of psychological disorders, and people are able to live normal lives through drug therapy
• Effective 50/60% of the time
• Quick and easy to administer
• People are used to taking drugs
• Side effects – symptoms like Parkinson’s, stiffness and tremors
• Psychologists have criticised psychiatry for focusing on symptoms and assuming that relieving symptoms with drugs cure the problem

What are the main aims of Psychoanalysis?

To uncover repressed unconscious memories and bring them to the conscious so that they can be dealt with.

What is dream analysis? Why does it work?

• “Dreams are the royal road to the unconscious”
• The symbolic imagery of dreams was a reflection of unconscious material
• The therapy tries to find the latent content (symbolic meaning) from the manifest content (obvious imagery) of the dream.
• Therapists identify unconscious thoughts that are causing the mental illness by analysing the dream. E.g., dream with knife, this might be castration - Oedipus complex.

What is free association? Why does it work?

• Patient is encouraged to express their thoughts exactly as they come into their mind, even though they may seem irrelevant or inappropriate
• The ego will attempt to censor what is said
• Free thinking allows unconscious thoughts to be brought into consciousness memories that have been repressed
• This releases the power it had over their behaviour

What is transference? Why does it work?

• Therapist takes the role of key figure in the clients’ life/childhood – client transfers emotions to the therapist
• This would indicate to the therapist the kinds of childhood experiences that may have occurred and the feelings of the patient towards these experiences

• Successful/effective particularly for people with anxiety disorders
• Effective- Bergin found that patients who continued with therapy for the suggested time had a 91% success rate
• Not appropriate for treating schizophrenia
• Time consuming and costly – the patient would have to attend several sessions a week for a number of years

What are the main aims of systematic desensitisation?

To replace a maladaptive response to an object, situation or person with a healthy response.

Outline the procedure of relaxation

The therapist teaches the client how to use muscle relaxation techniques.

Outline the procedure of hierarchy of anxiety provoking situations:

• Imagine a hierarchy of anxiety provoking situations from least to most (looking at pictures, then holding it, then see a spider in a box, see the spider on the therapist’s hand, hold the spider.)
• Practice relaxation technique at the same time as imagining situations on the hierarchy- Cannot be anxious and relaxed at the same time
• Once completely relaxed during the first stage client moves up the hierarchy

• Ability to tolerate imagined situations is followed by reduced anxiety in real life situations
• Effective for treating phobias
• Not everyone can use their imagination – if situations are approached in real life it may be more effective for a long lasting reduction in anxiety
• Flooding is quicker and it is effective (inescapable exposure to feared stimulus until fear response disappears)

What are the main aims of CBT?

• To replace the irrational/maladaptive thoughts with more rational/adaptive thoughts
• To incorporate realistic rational beliefs into their way of thinking.

Outline the Cognitive element of CBT

• The client is encouraged to be aware of their beliefs and thoughts that may contribute to their feelings of anxiety or depression
• Hopefully the client will realise the consequences of their irrational thoughts
• New goals are then set for the client that incorporate rational thinking

Outline the Behavioural element of CBT

• The client and therapist work to test the reality of their thoughts, this can be achieved through role play
• Hopefully the client will realise the consequences of their irrational thoughts
• New goals are then set for the client that incorporate rational thinking

What behaviours are usually treated with Becks cognitive therapy?

Depression

How does Beck’s cognitive therapy work?

By altering irrational beliefs, challenging thought processes and behaviour to create a new rational approach to their lives.

• Halloon – found that CBT was just as effective as drugs for treating depression
• The treatment works on addressing the cause of the mental illness rather than simply improving the symptoms – therefore the result may be longer lasting
• It is intended to empower the client but sometimes the client may become dependent on the therapist
• Ignores biological factors