Abnormality

Deviant behaviour - undesirable by society members, behaviour seen as antisocial. For example, Politeness is a social norm so rude people behave in a socially deviant way because others find it difficult to interact with them. Behaviours also include sexual behaviours, for example, in the past homosexuality was classified as deviant behavior in the UK. Now 'sexual and gender identity disorders' include paedophilia and transgender and are seen as socially deviant. 

Limitations 

• Deviant behaviour vary as time changes (eg. homosexuality). Allows proffessionals to classify those who transgress against social attitudes as abnormal, excluding nonconformists from society.
• Not a clear line between abnormal deviation and eccentricy, social deviance cant offer full explanation as its related to context and desgree. 
• Social norms are defines by the culture. Diagnosis is different for the same person in different cultures, no universal standards for social norms. 

As soon as a disorder interferes with day-to-day life, an individual may label their own behaviour as 'abnormal' and seek treatment. 

Limitations -

• The individual may not be the one to realise and its others that are uncomfortable and judge the behaviour as abnormal. 
• Some 'dysfunctional' behaviour can be adaptive and functional for example, some mental disorders may lead to attention. Cross-dressors make a living our of it even though transvestitism is a mental disorder.
• Different diagnosis for different cultures, standard of one culture measuring another. Explains why lower-class non-white patients often more diagnosed with mental disorders as their lifestyles are untraditional. 

JOHODA - suggested that we define physical illness by looking ar the absense of sighns of physical health, so we should do the same for mental illness. She identified 6 categories commonly reffered to in review of what people wrote about mental health:- 

Self-attitudes, personal growth, integration, autonomy, accurate perception of reality, mastery of environment. Absense of these indicates abnormality.

Limitations:-

• Noones achieves all these criteria. All of us would be abnormal to a degree, how many should be lacking to be abnormal. 
• Physical illnesses have physical causes but, some mental illnesses do not have physical causes but are consequences of experiences - unlikely that we can diagnose in the same way.
• Culture bound criteria. People from non-western/non-middle class higher abnormality.

PRINCIPLES

• Concentrates of behaviours - responses person makes to environment. These may be external or Internal. Behaviourists focus on role of external 
• All behaviour is learned, use of principles of Learning Theory to explain disorders where characteristics are behavioural. For example, avoidance of phobia (external).
• Learning environments reinforce problematic behaviours. Society provides deviant maladaptive models that children identify with and imatate for example, drug taking to gain reward from peers.

LIMITATIONS

• offers a limited view of factors that might cause abnormal behaviours. Ignore role of cognition in the oneset and treatment of abnormality.
• The success of this model comes from the effectiveness of the treatment, Behavioural Therapies. These therapies dont provide long-lasting solutions. By removing symptoms, the cause still remains. Symptoms are likely to resurface in other forms. Suggestingm symptoms are behavioural however, the cause may not be.  

• Based on counter conditioning. Enables individuals to overcome anxieties by learning to relax in the presence of stimuli that once made them unbearably afraid/nervous. Relaxation and Fear are incompatible - fear dispelled. 
• Asks individual to imagine the presence of phobia. 
• Particulary useful in treating psychological problems in which anxiety is difficulty (phobias).

PROCESS - Taught to relax muscles completely, Construct desensitisation hierachy, Work way through hierarchy, visualising in complete relaxation, Master one step, move onto next, masters feared situation.

STRENGTHS

• 75% of patients with phobias respond. Quick and Requires little effort.
• Only treatment possible for certain groups of people - those with learning difficulties

LIMITATIONS

• supressing sypmtoms results in symptom substitutions. 
• OHMAN - only effective in phobias acquired as result of personal experience. Not effective for evolutionary based anxieties such as fear of the dark or heights. 

PRINCIPLES

• All mental disorders result of a change in the body, they are illnesses caused by genes, biochemistry, nueroanatomy and viral infection. 
• Abnormalities in brain anatomy/chemistry can be caused by genetic inheritance. This has been investigated using twins concordance rates which showed phobias - low cc and schizophrenia high - cc. These genes are a product of evolutionary ancestors adaptations, these traits no longer useful. 
• Genes also determine our biochemistry. Increased Serotonin is linked with increased anxiety and Decreased Serotonin linked with depression. Genes also determine neuroanatomy, schizophrenics have enlarged ventricles in their brains.
• Disorders also may be due to exposure to viruses in the womb. TORREY - found mothers of schizophrenics had a strain of influenza while pregnant. Virus may enter childs brain, remail dormant  until puberty, when other hormones activate it - schizophrenia. 

LIMITATIONS

• The medical model led to a more humane treatment of mental patients, not evil/demons but an illness which is potentially treatable. However, SZASZ suggested rthe concept of mental ILLNESS was 'invented' as a form of social control. 
• Evidence doesnt support a simple cause and effect. For example, schizophrenia is often caused by excess dopamine however some patients shown reduced levels. 
• No evidence purely caused by genes - concordance rates are never 100%. GOTTESMAN AND SHIELDS - found Mz twins cc of 50% - should be 100 if purely biological. Suggests other factors have important role for example could be that disorder develops only when individual is exposed to stressful life conditions - Diathesis-stress model. 

ANTIPSYCHOTIC DRUGS-

• are used to combat posotive symptoms of schizophrenia. 
• Conventional - works by blocking dopamine by binding to it and not stimulating. 
• Atypical - works by temporarily occupying dopamine receptors the rapidly dissociating to allow normal transition.
•  Less side effects for Atypical such as involuntary movements of tounge and mouth.

ANTIDEPRESSANT DRUGS- 

• Work by reducing rate of reabsorption or by blocking the enzyme which breaks down nuerotransmitters to increase serotonin.
• Most common drugs is SSRI's which block transporter mechanism that reabsorbs serotonin so more serotonin is left.

STRENGTHS

• WHO reported relapse after 1 year 55% placebo, 25% antipsychotic, 23% antipsychotic and family intervention combined with social support most effective.
• Requires little time and effort compared to therapies such as psychoanalysis. However, a combination of both is often advised.

WEAKNESSES

• Effectiveness may be due to the psychological effect of drugs. KIRSCH - 38 studies reviewed of antidepressants. Patients who had placebos fared almost as well as real drugs.
• Drugs off temporary alleviatuon from symptoms, doesnt tackle the problem. Prefrable in long term to address the problem using therpies.
• Side Effects of SSRI's include anxiety, insomnia and sucidal thoughts.

Used on severly depressed patients whom psychotherapy and drugs failed. Used when risk of suicide is high because it often has quicker results. 

PROCEDURE

• electrode placed above temple of non-dominant side of brain and in middle of forehead. Or one electrode above each temple.
• Injected to make unconcious for shock. Nerve blocking agent, paralysing muscles preventing from contractions which could cause fractures. And oxygen to help them to breathe.
• Electrocurret (0.6 amps) in half a second passed through brain, producing a seizure which lasts 1 minute.
• 3 times a week, 3 - 15 treatments.

ABRAMS- concludes that after 50 yearsm we are no closer to understanding why it works. We knoq it changes the way in which the brain works but are unsure what causes improvement in depressed individuals. 

STRENGTHS

• supporters claim its effective, can be life-saving.
• COMER - 60-70% improve after treatment. However, other research shows, 84% relapsed within 6 months. 

LIMITATIONS

• Studies compared ECT with a fake ECT (placebo). A number of patients who recieved fake ECT recovered too.
• Side effects - impaired memory, cardiovascular changes, headaches, 30% report permanent fear/anxiety as a result of treatment.

PRINCIPLES

• FREUD - suggested origins of mental disorder lie in unresolved conflicts which are unconcious.
• Conflicts between id, ego and superego create anxiety. Ego protects itself with ego defences, if overused can cause disturbed behaviour. 
• Ego isn't developed in childhoos to deal with traumas, so they are repressed. Later, other traumas may cause individual to re-experience earlier trauma. Unexpressed emotions are directed inwards towards self causing depression.
• Ego defenced exert pressure through unconciously motivated behaviou. Unconcious consists of information hard/impossible to bring to concious. Frequently leads to distress as person doesnt understand why their acting in a particular way. Underlying problem cannot be controlled untill baught to conciousness. 

LIMITATIONS

• Concepts such as ID, EGO and SUPEREGO are difficult to define and research because ections motivated by them operate at an unconcious level therefore there is no evidence of them. Therefore they have limited empirical support and rely largely on evidence from individual care studies. 
• The pscyhodynamic theory is also critised for being sexist. It is sexually unbalanced, less developed for women. Cultural bias of victorian society and FRUED was male. Changes in modern psychoanalysis make explanation okay for women.
• Theory is difficult to prove or disprove. If individual behaves in manner predicted by FRUED its seen as support of his theory. However, if they dont FRUED argues it is a consequence of defence mechanisms.

PROCEDURE

• therapist aims to trace unconcious factors o their origins and then helps individual cope with them. The therapist uses a variety of different techniques to uncover repressed material and help the client deal with it.
• FREE ASSOCITION - patient expresses thoughts as they occure even unimportant/ irrelevent ones. FREUD suggested these are determined by unconcious factors which analysis tries tries to uncover. Designed to reveal conflicts and bring into conciousness repressed memories.
• THERAPISE INTERPRETATION - looks for clues and draws possible conclusions for cause of problem. Patients may resist therapists interpretation or display transference, recreate feelings and conflicts and transfer these to therapist.
• WORKING THROUGH - meet 4/5 times a week examining same issues over and over again to gain greater clarity concerning the causes of their neurotic behaviour. 

STRENGTHS

• BERGIN - 80% benefit from psychoanalysis compared to 60% from eclectic therapies (therapies based on a number of different approaches).
• TSCHUSCHKE- The longer psychotherapeutic treatments took - the better the outcomes were.

LIMITATIONS

• Critics claim some therapists plant 'false memories'. Psychoanalysis assumes that patient can reliably recall early memories that they repressed, little evidence to support this. 
• Therapy based on FRUEDS theory of personality - if this is flawed so must be the therapy.
• FRUED failed to appreciate the differences between individuals in the way modern psychotherapists do. Development of person centred approaches addresses this problem by putting client first.

PRINCIPLES

• assumes mental illness is result of inappropriate (disordered) thinking. Focus on the way the person thinks about it. Faulty thinking prevents adaptive behvaiour. 
• ELLIS ABC MODEL - a- activating event (sight of dog), b- belief (rational/irrational), consequence- (emotions)
• Deterministic, as portrays individual is own cause, as they control their thoughts. 

LIMITATIONS

• overlooks situational factors
• do thoughts cause disturbance or does disturbance cause faulty thinking?
• Not all 'irrational' beliefs are irrational. ALLOY & ABRAHSOM - suggest depressive realists see things for what they are.. 'sadder but wiser'

SUPPORT

• SMITH & GLASS - meta analysis. cognitive therapy had second highest success rate amonh 1- psychotherapies. 

CBT

The aim of it is to encourage people to examine the beliefs and expectations underlying their happiness and to replace irrational, negative thoughts with more positive, adaptive pattern of thinking.

The cognitive element: therapist encourages client to become aware of the negative thoughts that contribute to the anxiety or depression, through direct questioning.

The behavioural element: the client and therapist decide how the beliefs can be tested, either as role play or homework assignments. The aim is that the client will come to recognise the consequences of their faulty thoughts. The client and therapist then set goals in order to incorporate realistic and rational ways of thinking. 

Example of CBT= REBT

Helps them create more effective problem solving methods. It focuses of the self defeating beliefs.

1.Logical disputing: self defeating beliefs do not follow logically from the info available. 2.Empirical disputing: self defeating beliefs may not be consistent in reality 3.Pragmatic disputing: emphasises the lack of usefulness of self defeating

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