Abnormality

• Unwritten rules that members of society regard as being normal and acceptable and any deviation from them is considered abnormal behaviour.

• Behaviour that may be unpredictable, cause observers discomfort and is seen as unacceptable and undesirable.

• For example obsessive hand washing or repetition of an action for sufferers of OCD like checking the back door 20 times before going to bed.

• :( this definition has been criticised for being very subjective. Norms differ over time periods and over different cultures and countries, so therefore it is difficult to establish what is a norm. For example, if one was homosexual in the 1960s, they were seen as abnormal and often institutionalised, but in modern times, this is more socially acceptable.
• :( Another problem is that context can affect what is abnormal or not – you would not be considered abnormal if you were ******* on a nudist beach but you would be if you walked around town like that. Solely looking at one’s behaviour is not enough; you must look at where it happened.
• :( it can be beneficial to break social norms: Suffragette campaigners for women’s votes broke many social norms and this led to positive electoral reform.
• :( Another strong limitation is that what is considered abnormal differs between cultures. For example dissidents in the former Soviet Union were considered undesirable because they opposed the system of government.  As a result they were imprisoned. However, the rest of the world considered these people heroes, or at least desirable. Also, powerful groups can establish norms themselves and therefore decide who and what is abnormal – this definition can be used for social control. For example in Japan those who do not submit to the country’s strong work ethic are considered abnormal according to this definition.

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  • Marie Jahoda devised 6 criteria for mental well-being, and people who did not possess these traits may be susceptible to mental illness. The 6 criteria are:
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1. Positive attitudes towards yourself – This is having self-respect, self-confidence and being able to accept yourself. By doing this, you can live with yourself and accept your limitations.
2. Self-actualisation – This is realisation of your own potential and being able to achieve your goals and be the best you can be.
3. Resistance to stress – This is the ability to take upon stress without becoming ill or breaking down.
   
4. Personal autonomy – This is independence – people who are not reliant on others, and make decisions for themselves rather than other people.
5. Accurate perception of reality – This is not being too optimistic or too pessimistic. Both extremes can lead to ill mental health – pessimism leads to depression and so can optimism.
6. Adapting to the environment – This is being able to cope with change easily.

:( The main limitation of this definition is that it is near impossible to meet all these criteria – in order to self-actualise, a person much reach the pinnacle of their abilities, ambitions and desires in life, but the majority of people comfortably settle for a situation somewhat below self-actualisation. So, according to this definition, the majority of people would be classified as being abnormal.

:( Being resistant to stress and not suffering from its consequences is an ideal state of mental health, however, stress can actually be beneficial in some situations, many people perform better under a degree of stress. Also, being resistant to stress and not suffering in some situations could also be seen as abnormal - for example, not suffering from the death of a family member or close friend.

:( A further limitation is that these criteria are largely culture-bound. For example, personal autonomy and self-actualisation would not be valued in a collectivist culture – it would be regarded as selfish and therefore it would be preferable if one did not have these traits. The definition is limited as it is based on the ideals of western and individualistic cultures

• Rosenhan & Seligman suggested that people who are unable to function adequately are unable to cope well with change and their behaviour affects their daily lives such as relationships.
  

• someone’s behaviour is considered abnormal if it causes great distress and torment to them leading to dysfunction and causes observer discomfort, are unpredictable and are irrationa.
  

• someone who’s maladaptive behaviour which stops them attaining satisfactory goals, both socially and occupationally.

:( abnormality isn’t always accompanied by dysfunction. People with anti-social personality disorders have been known to commit murders and still appear to lead a “normal” life. For example Harold Shipman who was a serial killer while working as a GP.

:( may be due to situational pressures rather than psychological abnormality. If a person loses their job and is unable to get a new one, they may be unable to look after their family, but this may be due to the economic situation rather than psychological abnormality.

:( A person who has just lost a loved one may show signs of "maladaptiveness" and "suffering" but few people would regard this as abnormal behaviour, and in fact not showing signs of suffering in this situation could be seen as abnormal.

• The biological approach sees abnormality or mental illness as the result of faulty or abnormal biological processes in the body.
• According to this approach, abnormality may be the result of changes in the function of the brain for example an imbalance of chemicals can lead to psychological disorders– Schizophrenia is associated with high levels of the neurotransmitter dopamine whilst depression is associated with low levels of the neurotransmitter serotonin.
• The biological approach also assumes that disorders can be inherited from biological parents. For example, research has shown that if one twin has schizophrenia there is on average about a 42% chance that their identical brother or sister will also develop the disorder.
• Abnormality may also be caused by brain damage – Alzheimer’s is caused by malformation of the brain, the loss of brain tissue and the loss of brain cells.

:) A strength of this approach is that it is the most dominant approach used in Psychopathology. When we are depressed or mentally suffering, we turn to our G.P, who may refer us to a psychiatrist, who will most likely give us drugs (a biological treatment) for our illness. However, the drugs generated by this approach only work on masking symptoms rather than working on the underlying cause.

:) There is concrete evidence from brain scans and biochemistry that abnormal brain function can cause a mental illness (a loss of brain tissue was found in Schizophrenics) which offers the approach extreme scientific credibility,

:( Another weakness of this approach is that it is criticised for being largely reductionist – if we concentrate on physical definitions and physical treatments that we ignore the root causes of psychological illness such as environmental factors and past experiences or stressful events.

:( If we decide that schizophrenia is a physical disorder caused by a person’s genetic make up or the structure of their brain, then can we hold them responsible for their illness, and this has ethical issues as it is not right to hold someone responsible for a disorder they didn't deliberately put upon themselves.

• Anti-psychotic drugs – Also known as neuroleptics.

• Antidepressant drugs – thought to increase levels of serotonin as it has been found that depression has been linked to low levels of serotonin. Serotonin is released into the synapse between neurons and is then either reabsorbed or broken down by enzymes.  Anti-depressives work by either preventing reabsorption (such as SSRIs i.e. Prozac) or by stopping the action of enzymes (such as MAOIs).  Both actions will result in serotonin ‘hanging around’ longer at the synapse.

• Anti-anxiety drugs – Examples include valium and beta-blockers (specifically to alleviate physical symptoms such as shaking). They are designed to bring anxiety under control and are used for a variety of disorders, including phobias and general anxiety disorder. They slow down brain activity, causing relaxation. Beta-blockers reduce heart rate and blood pressure. 

:( A problem is that these drugs have that it has many side-effects such as muscle-tremors, rigidity, agitation and uncontrollable movement.

:( They also reduce symptoms rather than curing the disorder, if the drugs stop, the symptoms return and the patient may relapse. Schizophrenics will have to take these for life, usually.

:( There is undoubtedly a placebo effect.  Kirsch et al (2002) reported their meta analysis of 38 studies in which they found that drugs were only slightly more effective than placebo.  Most studies however, disagree with this.

:) because drugs have been tested in clinically controlled trials, there is sufficient evidence to support their effectiveness in the treatment of many different types of mental disorder. For example, major tranquillisers are thought to work for ⅔ of psychotic patients and 80% of schizophrenics (SANE, 2003)

:( it has been claimed that some drugs have been over-used to control patients particularly in institutionalised settings such as care homes. Their use in some circumstances has been compared to the use of straitjackets in the past and indeed have been called “pharmacological straitjackets”.

• Electroconvulsive Therapy (ECT)

• Patients are first injected with an anaesthetic (so that they are unconscious) and a nerve-blocking agent (that prevents fractures). Electrodes are placed on the scalp and an electric current between of about 100v lasting for 0.5 seconds is passed through the (non-dominant hemisphere of) the brain.

• This results in a seizure lasting for around two minutes. 5-10 minutes later the patient wakes up

• This treatment normally happen 3 times a week for 12-20 treatments. ECT is thought to increase serotonin and dopamine.

:) A strength of this therapy is it that it may be the only alternative to treat depression for some patients – without it they may be suicidal and die. It seems that 50-70% of people benefit from this.

:) ECT can have an immediate beneficial effect.  Weiner  and Coffey found that ECT produces a substantial improvement in at least 80% of depressed patients.

:( A criticism of this therapy is that we should not use it as we know so little about it or how it works, it may be more dangerous than we think.

:) However, some researchers such as Weiner have found no evidence that ECT damages the brain. It is argued that people can have many epileptic seizures and these don’t harm the brain and ECT-induced seizures take place under far more controlled conditions than epilepsy.

:( However, there have been reported side-effects including memory impairment, headaches, cardiovascular changes and even increased anxiety levels.

• The behavioural approach assumes that all behaviour is learnt through conditioning. Behaviour is learnt in three ways, association, reinforcement and learning socially. In the same way, abnormal behaviour can be learnt and the approach also assumes that it can be unlearnt in the same way it was learnt. There are three types of conditioning:
• Classical Conditioning (Learning by association) – If we come across things that occur together, we can associate them to learn a new response. An example of this happening is the case study of Little Albert – who heard a loud banging noise at which he begun to display fear. During conditioning, he saw the white rat and the loud banging noise at the same time and soon enough, Albert only had to see the white rat by itself to show fear.
• Operant Conditioning (Learning by reinforcement) – Abnormal behaviour may be learnt if the behaviour is reinforced or rewarded in a number of ways. For example, if a young child shows fear of a dog, their parent might give them a treat (such as ice cream) or comfort them with a hug which encourages their behaviour more. Therefore, they repeat the same behaviour in order to get these reactions and it often turns into a phobia.
• Social learning theory: The idea that we acquire behaviour by copying others. If a person is observed behaving in a certain way and is then rewarded for their behaviour then the observer is far more likely to copy that behaviour.

:) The social learning theory can be backed up by the research of Fearn: he found that there was a sudden increase in eating disorders amongst teenage girls in Fiji after the arrival of TV in 1995. 74% had reported in a survey to feel big or fat. Fearn concluded that they may have been influenced by western ideas of beauty by observing high-status people on TV being rewarded for their ‘skinny’ looks.

:( This approach offers a simple and testable theory of learning. However, it is seen as far too simplistic. Even in the case of phobias it is often not possible for people to think of any incident like this that may have triggered the phobia in the first place.  Menzies & Clark reported that only 2% of children who had hydrophobia had suffered a traumatic event involving water.

:(  Another weakness of this approach is that it is deterministic – it sees humans as passive creatures which have no free will or do not think for themselves. It assumes abnormality is determined by the environment and an individual has no control – this is pessimistic, too simplistic and can bring up important moral implications.

:( Another weakness of this approach is that it cannot explain why phobias tend to be about stimuli that would have been threats to our survival in the evolutionary past. This suggests that phobias are not just acquired through conditioning but we also have a biological preparedness to be fearful of some stimuli rather than others.

• Systematic Desensitisation developed by Wolpe to put out the fear response and replace it with relaxation. The therapy is based on reciprocal inhibition which is the idea that it is impossible to make people feel two opposite responses at once so one must disappear:

1. Relaxation Techniques – The therapist teaches the client techniques such as controlled breathing and progressive muscle reaction gently and slowly so that it calms the client.
2. Constructing a Desensitisation or Fear Hierarchy – Here, the patient and the therapist will write up a list of scenarios involving the thing they fear most and put them in order of the amount of fear they would cause (from lowest to highest). Each following scenario should cause more anxiety than the previous. A small example using a fear of dogs: the least feared scenario would be seeing a picture of a dog, and the most fearful would be stroking the dog.
3. Working through the hierarchy – Through the aid of the therapist, the client works through the scenarios whilst learning to be completely relaxed using the techniques they learnt. The client must be able to get through each scenario whilst maintaining a state of calmness and relaxation. Once they have mastered one stage, they move on to the next, and if they show fear, they move backwards until the client can do all the scenarios calmly.

Eventually, the client replaces the fear with the relaxation, gaining control over their phobia. Patients can use the In Vivo (actually doing the scenarios) method or the In vitro (imagining the scenarios) method.

:) A strength of this therapy is that it has been found to be extremely successful in treating simple and specific phobias. Klosko found that it has a very high success rate (75%) with flying and spider phobias.

:( SD can be quite impractical, people’s imagination may not be vivid enough. However, the use of therapies involving in vitro method means that abstract fears such as a fear of failure can also be dealt with.

:) Even if a patient uses the In Vitro method, they have a reduced rate of anxiety in real life. Therefore, SD seems to generalise to real life situations – it has high ecological validity.

:( Systematic Desensitisation may be subject to the treatment aetiology fallacy that just because the the treatment is successful does not mean that the cause of the disorder has been found. The therapy may just be treating the symptoms such as panic and anxiety and therefore treatment substitution may easily happen.

• The main assumption of the cognitive approach is that all abnormality and mental disorders are the result of faulty and irrational thinking.
• Ellis developed the A-B-C model: the A (activating event) is just any event or situation that can bring about a B (belief which is either irrational or rational) and this belief brings about C (consequence which is either irrational or rational depending on the belief). An irrational belief leads to an irrational consequence, which is abnormal behaviour.
• The cognitive approach can also be used to explain illnesses like depression. For example, Beck believed that depression was the result of underlying negative thoughts. He identified two ideas that explained depression:

1. Cognitive Triad – in which a depressed patient has a negative view of themselves, the world and the future.
2. Errors in Logic – Beck also said that people who are depressed will use faulty logic – a depressed person has developed a negative set of schemas upon which their expectations about life are based.

:) there is evidence that irrational thoughts do correlate with psychological disorders. For example someone who develops anorexia because they think that they must lose weight even though their BMI is well below average. However, the irrational thoughts may not cause the disorder but may be a symptom of the disorder.

:) Lewinsohn et al followed a group of teenagers who had developed a negative pattern of thinking.  A year later they were far more likely than a control group to have developed major depression.  This would seem to suggest that the negative thinking is causing the depression as the cognitive model suggests.

:( people’s irrational way of thinking may not be so irrational given their situations. seeing the world through ‘rose-coloured spectacles’ could be seen as equally irrational yet psychologically healthy.

:( Another weakness of this approach is that it is criticised for being reductionist – the cognitive approach ignores all other factors and oversimplifies our behaviour as it reduces complex disorders into the simplistic idea that they are merely the result of ‘bad thinking’. In actuality, there are probably many factors apart from environment that also play a part in causing abnormality such as genetics, environment and childhood.

1. Developing a good relationship between the client and therapist
2. Identifying negative thoughts – The client is encouraged to keep a diary and record all the negative, irrational and self-defeating thoughts that come into their head.
3. The therapist takes a look at the diary and challenges the thoughts outlined in them – the arguments normally are very strong and so this therapy is more confrontational and involves heated debate so the negative thoughts can be destroyed once the patient loses the argument and their irrationality can be exposed to themselves.
   
4. Clients then use reality testing so they can accept more rational and truthful ideas – the client compares their irrational thoughts against the real world and the therapist demands for proof which is often unable to be provided. For example, if you were challenging the thought ‘everyone hates me’, you would first prove them impossible by saying that the client does not know everyone, and their family and friends do not hate them and prove this to them. Then, the client may come to the statement “Okay, but some people hate me” to which the therapist would reply “not everyone is going to like you, and that’s normal”. 
5. Once these have all been completed, the client is able to move from irrational beliefs to rational ones – this makes them feel better to the point that they can see themselves accurately and accept themselves and love themselves in spite of their faults and strengths.

:) A strength of this therapy is that it has shown to be very effective in treating depression (in fact, it has shown to produce longer lasting recovery than antidepressants). It is also effective in treating Obsessive Compulsive Disorder and social anxiety. Due to this, the therapy is extremely flexible and has diverse applications as it can deal with multiple disorders – CBT is widely used by the NHS

:) Another strength is that REBT are short as they are limited to some sessions that last no longer than a few weeks. Therefore, it is less time-consuming and very cost-effective when compared to psychoanalysis – it is cheaper and more convenient than it.

:) Another strength is that it can reduce ethical issues – the way this therapy works is that the client is actively involved and in control. They feel empowered as they are curing themselves. However, the therapy can create ethical issues as the client may feel blame as they are technically responsible for their disorder and if they are unable to change, this causes even more distress.

:( Another weakness of this therapy is that although it is successful in treating a range of disorders, it is very ineffective with disorders like schizophrenia – these patients are unable to monitor and change their own thoughts.

• Freud believed that abnormal behaviour is the result of unresolved unconscious conflicts of childhood and we repress our painful memories from our childhood into the unconscious.

• Freud also believed that there are three components to personality the Id, Ego and Superego and conflict between these components create anxiety, the Ego tries to protect us from this by using ego defence mechanisms but can cause abnormal behaviour if overused. Ego defence mechanisms are:

1. Repression – This is burying unpleasant memories into our unconscious mind to the point we can no longer remember them.
2. Regression - This is where one reverts back to an earlier stage in their development.
3. Reaction formation - were a person becomes ashamed of a particular desire and as an extreme form of denial takes an outward stance that is very anti to their desire.

• Freud believed there to be 5 psychosexual stages, oral, anal, phallic, latency and genital, and we can become fixated in these stages and show abnormal behaviour in adulthood.

:) A strength of this approach is that it puts no blame on the sufferer – they are not held responsible as the childhood experiences that have caused their abnormality are not their fault. It is therefore a humane, ethical approach and the patient itself is not stigmatised. However, other people receive considerable blame, particularly parents (the mother) and this can put distress and guilt on a family.

:( A weakness of this approach is that it is completely unscientific – the concepts are vague and impossible to test. We cannot ever know if there actually is an unconscious mind – it is impossible to falsify as the components of Freud’s theory cannot be observed or tested.

:( Another weakness is that the psychodynamic approach is deterministic – it sees humans as passive creatures that do not possess free will – all abnormal thoughts, emotions and behaviour is driven by unconscious forces from our childhood. We are slaves to our unconscious, which leads to important moral implications.

:) However, a great strength is that it focuses on the cause of disorders rather than just the symptoms they create – this approach believes abnormality is the result of hidden conflicts in the unconscious, and tries to uncover what is hidden. By attempting to deal with the cause, longer-lasting recovery is more possible.

Psychoanalysis:

• Dream Analysis – Freud thought dreams were extremely important and called them ‘the road to the unconscious’ as he believed they allowed us to understand are unconscious desires (our repressed wishes leak out whilst we sleep). Here, the patient will describe recent dreams to the therapist who will interpret everything they say as to what the hidden meaning (latent content) is.

• Free Association – This is where the client will often lie or sit facing away from their therapist and say whatever comes into their heads, their thoughts and feelings, and the therapist will note down what they say and offers interpretations to the client. This speaking offers insight and recovery although the client may resist the therapist’s interpretations initially but soon they are able to realise truth of themselves.

:( The effectiveness of psychoanalysis is uncertain – Eysenck thought that this therapy made patients worse than they were initially, let alone cure them. However, Bergin found that around 80% of the 10,000 patients he reviewed had benefited from Psychoanalysis, so he thought it was successful. As evidence is contradictory, it means the therapy may be unreliable or that the effectiveness depends on the disorder.

:( A very strong weakness of this therapy is that it is the longest of all the treatments. Uncovering unresolved conflicts can take months, even years but it is also extremely expensive and as this therapy lasts a long time. It is also disruptive to lifestyle as it requires several sessions a week that are very long. It is unrealistically inconvenient and expensive when compared to other therapies and drug treatments.

:) Another weakness of this therapy is that Psychoanalysis assumes that childhood memories can be recalled in this way and actively encourages this in order to access the unconscious mind.  In fact there is little evidence to suggest that childhood memories can be accessed in this way leading some to suggest that memories have been inadvertently implanted by the therapy.