Abnormality

All societies have social norms - standards of acceptable behaviour such as politness. These are not formal laws but implicit (unwritten) rules concerning what people expect from the behaviour of others. People who behave in a socially deviant way are considered anti-social or undesirable - therefore abnormal - by the rest of the group.

Limitations

• Judgements of deviance are dependent on the context of a behaviour. Some behaviours are considered acceptable in one context but not in another. Also it depends on the degree of the behaviour - how much does it occur?
• What is cosidered a diagnosable disorder & therefore abormal in one culture may be considered as acceptable & therefore normal in another. This means there are no universal standards for labelling a behaviour as normal (Cultural Relativsm)
• What may have been seen as abnormal a long time ago may now be seen as normal. For example same sexual relationships.

From an individual's point of view, abnormality can be judged in terms of 'not being able to cope'. Only when something interferes with their ability to ope with day-to-day living, do people label their own behaviour as abnormal & seek treatment. Psychologists use the GAF scale (DSM-IV) to assess abnormality - the higher up on the scale, the more normal you are.

Limitations

• Some behaviours that appear dysfunctional & abnormal may actually be adaptive for the person. For example: depression may lead to extra attention, which helps the person deal with the stressor that led to the depression in the first place.
• Definitions of adequate functioning are also related to cultural ideas of how one's life should be lived. This means that the 'failure to function adequately' criterion of abnormality is likely to result in different diagnosis when applied to people from different cultures as the standard of one culture is being used to measure another.

Jahoda identified 6 characteristics of ideal metal healththe absence of 1 = abnormality

• Resitance to stress
• Accurate perception of reality
• Positive attitudes towards the self
• Personal autonomy
• Adapting to the environment
• Self actualisation of one's potential

Limitiations

• According to this definition, all of us are abnormal to some degree, as it is unusual to find people that will meet all the criteria, all of the time.
• Most of these criteria are culture-bound. Some criteria, such as personal autonomy, are not relevant to some cultures e.g. in Japan, children are brought up to be dependent.

The Biological Approach assumes that mental disorders are related to change, illness or dysfunction in the body - especially the brain.

Biochemistry - 'Out of balance' neurotransmitter causes problems. Increased levels of dopamine is linked to schizophrenia. Low levels of serotonin thought to contribute to depression

Brain Injury - Abnormal behaviour may occur if the structure of the brain is somehow damaged. An explosion sent an iron rod through Phineas Gage's head, destroying parts of his frontal lobe. He survived but his personality changed.

Genetic Inheritance - Abnormality in brain anatomy & brain chemistry are a product of genetic inheritance & so are passed from parent to child. Concordance rates (CR) are a way of measuring the extent to which 2 people are alike. If identical twins display a high CR for a mental disorder, then it suggests a significant genetic inheritance.

Viral Infection - Some disorders may be explained in terms of exposure to viruses in the womb. Research has found that mothers of some SZ's have contracted a strain of the influenze virus during pregnacy. The virus is through to enter the unborn child's brain, remaining dormant until puberty.

Strengths

• It doesn't blame the individual & therefore could be considered ethical - they've done nothing wrong, there's something wrong with their genetic 'make-up'
• The use of brain scanning identified biological aspects of abnormalities
• Drug treatment is based on the biological model. Drugs target biological bases & can be effective in many conditions

Limitations

• Gottesman did a meta-analysis of 40 twin studies & found an overall CR of MZ twins to be 48% & DZ twins to be 17%. If mental disorders are caused by genetics alone, then CR's would be 100% suggesting environmental influences are equally important.
• It is reductionist - it reduces abnormality down to our biology & doesn't take into account environmental factors
• Drugs can lead to addiction & may only treat symptoms not cause - ethical issues
• There isn't a simple cause & effect relationship between biological infleunces & mental disorders

Drugs

Antipsychotic drugs are used to combat the symptoms of psychiatric disorders such as SZ. Conventional antipsychotics block the transmission of dopamine, & so the symptoms of this disorder are made less severe.

Antidepressant drugs - SRRIs work by blocking the transporter mechanism that reabsorbs serotonin into the nerve cell, therefore prolonging its activity & relieving the symptoms of depression.

Anti-anxiety drugs - BZs reduce anxiety by slowing down activity of the central nervous system. Beta-blockers reduce the activity of adrenaline & noradrenaline, part of the body's response to stress.

Drug therapy is also known as chemotherapy. Drug therapy is based on the assumption that the illness is caused by a chemical imbalance

Strengths

• Research suggests that chemotherapies do work when compared to placebo conditions. However, drugs alone are less effective than drugs combined with psychological therapy.
• Drug therapies require little effort from the patient, therefore they are likely to be more motivated to continue treatment compared to more time-consuming psychological treatments.

Limitations

• Drugs only offer temporary alleviation of symptoms. As soon as the patient stops taking the drug, its effectiveness decreases & symptoms return - they treat the symptoms not the cause.
• All drugs have side effects, e.g. SSRIs can cause nausea & suicidal thoughts. This is one of the main reason why drug treatments faily, as patients stop taking their medication because they can no longer stand the side effects
• People taking drug medication can become addicted to the drugs, therefore suggesting some psychological dependence.

ECT (Electro-Convulsive Shock Therapy)

ECT is generally used for severly depressed patients for whom psychotherapy & drug medication have proved ineffective. Psychologists are not completely sure how ECT works.

• An electrode is placed above one temple or both temples. 
• The patient is unconscious & is given a muscle relaxant. 
• A small amounth of electric current, lasting about half second, is passed through the brain. 
• This current produces a seizure which lasts for about 1 minute. 
• ECT is given 3 times a week for 5 weeks.

Strengths

• ECT can be an effective treatment, particularly in cases of severe depression, As a result, it can be life-saving, especially when depression is so severe that it could have lead to suicide.
• Comer states that 60-70% of ECT patients improve after treatment, although critics have also suggested that 84% of these patients had relapsed within 6 months of having ECT.

Limitations

• Studies that have compared the use of 'sham' ECT with real ECT have found that those receiving rela ECT were more likely to recover. However, some sham ECT patients also recovered, suggesting that attention plays a part in recovery.
• Possible side effects include impaired memory,  CV problems & headaches. A report found that those receiving ECT over the previous 2 years, 30% reported that it left them with permenant anxiety & fear.
• Psychologists are not completely certain how ECT works yet.

Psychosurgery

Also know as brain surgery. Psychosurgery involves the removal of brain tissue which is irreversable. Psychosurgery is only a last resort. It is ocassionally used for conditions such as depression or OCD that are resistant to other treatments. A brain scan is used to locate the part of the brain they want to remove.

In the 1950's the amygdala was lesioned in over-aggressive people to reduce levels of violence.

Strengths

• Although there is no evidence to say that psychosurgery improves the symptoms of schizophrenia, it can make the patients more manageable.

Limitations

• There is no evidence to say that psychosurgery improves the symptoms of psychiatric disorders, such as schizophrenia.
• Psychosurgery is so rare that it is hard to judge its effectiveness.
• People with severe disorders are unlikely to fully understand the procedure & give informed consent. 
• Damage to the brain is irreversible & consequences are unpredictable.

Freud's psychodynamic approach believed that mental illnesses were not physical but were the result of unresolved childhood conflicts.

Conflicts between the id, ego & superego create anxiety. This can be relieved by the use of ego defences: 

• repression - moving unpleasant thoughts into the unconscious
• projection - e.g. accusing someone of being angry/thoughtless when it is actually you feeling like this
• regression - behaving in a childish way
• denial - refusing to believe events that promote anxiety
• displacement - diverting emotions onto someone else
• sublimation - diverting emotions onto something else e.g. playing sport

Freud's Psychosexual Stages - Oral, Anal, Phallic, Latency & Genital. Freud believed that people could become stuck/fixated at any stage. A person who smokes is described as having an 'oral' personality.

Early experiences cause mental disorder - In childhood, the ego is not mature enought to cope with traumas such as the loss of a parent, so this may lead to repression of any associated emotions. Later in life, further losses may cause the person to re-experience this earlier loss, leading to depression.

Unconscious motivations & mental disorder - The unconscious mind exerts a powerful effect on behaviour through the influence of previously repressed emotions or trauma. This frequently leads to distress, as the individual does not understand why they are acting in that particular way. The underlying problem cannot be controlled until it is brought into the conscious awareness.

Strengths

• The defence mechanisms have been tested in the current climate & are still relevant, plus they're testable.
• It is a unique approach which suggests that childhood is important & that disorders may be linked to unresolved conflicts.
• It has face validity - it makes sense & is true today. We have all bee in the position where our id & superego have been in conflict.

Limitations

• Concepts such as the id, ego & superego are absract & therefore difficult to define & to demonstrate through research. Because conflicts between these 3 aspects of personality operate at an unconcious level, there is no way to know for certain that they are operating. As a result there has been little research support.
• The theory is difficult to prove/disprove using scientific methodology, therefore much of the support is from case studies - small sample size.
• Freud's theory is sexually unbalance. Freud himself was male, & at the time he was writing, the cultural bias meant that women were considered less significant than men. This does therefore limit the relevance of this approach to understanding mental disorders in women.

Psychoanalysis

Psychoanalysis is a therapy developed by Freud to make the unconscious conscious. During psychoanalysis, the therapist attempts to trace these influences to their origins & help the individual deal with them. 

Free Association - The patient expresses thoughts exactly as they occur, even though they may appear irrelevant. This is intended to reveal areas of conflict & to bring memories that have been repressed into the consciousness. The therapist then attempts to interpret these for the patient, who corrects, rejects & adds further thoughts & feelings.

Word Association - The patient has to say/write whatever comes into their head after the therapist gives them a word.

Inkblot Test - Patients are shown a series of inkblot pictues & they have to interpret what they can see.

Dream Analysis - Patient shares their recent dreams with the therapist & the therapist then interprets the clients dreams.

Strengths

• It is effective - an analysis of 10,000 patients histories estimated that 80% benefited from pscyhoanalysis compared to 60% who received therapies based on different approaches.
• A study found that psychodynamic therapies, such as psychoanalysis, were more effective in the long term. The longer the treatment, the better the outcomes were, indicating that it takes motivation & effort from the patient for treatment to be truly effective. 

Limitations

• Psychoanalysis is based on Freud's theory of personality; if that is flawed then the explanations of mental illness arising from this theory must be flawed & the therapy itself must be flawed.
• When developing psychoanalysis as a therapy, Freud failed to appreciate the differences between individuals in the way that modern psychotherapists do. The development of person-centred approaches addressed this problem by putting the client first, rather than imposing specific theories on them.
• Critics argue that some therapists are not helping patients recover repressed memories, but are unwittingly planting false memories of sexual abuse or even alien abduction. All psychoanalysis assumes is that a patient can reliably recall early memories that have been repressed.

The Behavioural Approach focuses only on behaviours. Behaviourists believe that normal & abnormal behaviours are acquired as a result of experiences that we have in life. Abnormal behaviours are learned through the processes of classical & operant conditioning and social learning.

Classical conditioning - learning through association (Pavlov's dog). A neutral stimulus (NS) is associated with an unconditioned stimulus (UCS). Initially, the UCS produced an unconditioned response (UCR). After learning, the NS becomes a conditioned stimulus (CS) which produces a conditioned response.

Operant conditioning - learning through reinforcement (reward & punishment). This involves reinforcement each time you do something & it results in a pleasant consequence, the behaviour is 'stamped in' (reinforced). It becomes more probable that you will repeat that behaviour in the future. If you do something & it results in an unpleasant consequence (punishment), it becomes less likely you will repeat that behaviour.

Social learning theory - learning through observation (Bobo Doll - Bandura). People learning through indirect as well as direct rewards by observing the behaviour of models. They then imitate such behaviour if others have been rewarded for it (vicarious learning).

• Behaviourist explanations have been criticised for offering an extremely limited view of the factors that might cause abnormal behaviours. Behaviourist explanations tend to ignore the role of psysiological or cognitive factors in the onset & treatment of abnormality, both of which have been shown to have an important role to play in the consequence of abnormality & in its treatment.
• One of the strengths of this approach is that it lends itself to scientific validation. However, research does not always support its claims. For example, explanations of phobic behaviours that focus on the role of conditioning in the development of these behaviours struggle to explain why so many people with a phobia cannot recall an incident in their past which led to traumatic conditioning or even any contact wit the feared object.
• Part of the success of this approach comes from the effectiveness of behavioural therapies for treating abnormal behaviour. However, such therapies treat only the symptoms, & the cause may still remain. This suggests that although the symptoms of many disorder may be behavioural, the cause may not be.
• It is reductionist - it reduces abnormality down to our behaviour.

Systematic Desensitisation (SD)

SD is used in the treatment of anxiety, particularly anxiety with phobias. The aim of SD is to reduce, or even eliminate, the anxiety that people associate with feared objects or situations & which interferes with their ability to lead a normal, happy life. SD works by expanding the exposure time & gradually introducing the person to the feared situation, one bit at a time so it is not overwhelming.

• Step 1 - The patient is taught how to relax their muscles completely. (A relaxed state is incompatible with anxiety)
• Step 2 - The therapist & patient together construct a desensitisation hierachy - a series of imagined scenes, each one causeing a little more anxiety than the previous one
• Step 3 - The patient gradually works his/her way through the desensitisation heirachy, visualising each anxiety-evoking event while engaging in the competing relaxation response.
• Step 4 - Once the patient has mastered one step in the hierachy (they can stay relaxed), they are ready to move onto the next stage.
• Step 5 - The patient eventually masters the feared situation that caused them to seek help in the first place.

Strengths

• Behavioural therapies, such as SD, are relatively quick & require less effort on the patient's part. Patient's are more likely to continue, making treatments more likely to suceed. SD can also be self-administered by using computer simulations. This has the potential to make delivery of SD even more efficient for the patient.
• SD is successful for a range of anxiety disorders such as flying. A study found that people with aerophobia has less anxiety after SD compared with a control group. A psychologist estimated that SD is effective in about 75% of patients with phobias.

Limitations

• SD may appear to resolve a problem, but simply eliminating symptoms rather than dealing with the cause of anxiety may result in other symptoms appearing.
• SD appears to be less effective in treating anxietes that have an underlying adpative component (e.g. a fear of dangerous animals) than those that are acquired as a result of personal experience. The reason for this is most probably that these 'ancient' fears helped our ancestors survive, & are therefore harder to remove, even for modern humans.

The Cognitive Appraoch to abnormality assumes that thinking, expectations & attitudes direct behaviour. Mental illness is the result of cognitive distortions in the way a person thinks about a problem. Faulty & irrational thinking prevents the individual behaving adaptively. Unlike the other 3 models, where abnormal behaviour is thought to be determined by factors outside the individual's control, the cognitive model portrays the individual as being the cause of their own behaviour, beacuse they control their own thoughts. Abnormality is the result of faulty control of this process.

The ABC Model - Ellis

• A - activating event (e.g. the sight of a large dog)
• B - belief which may be rational (the dog is harmless) or irrational (the dog will attack me)
• C - consequence - rational beliefs lead to healthy emotions (amusement) & irrational beliefs lead to unhealthy emotions (fear)

• The Cognitive Approach blames the patient & therefore overlooks situational factors such as like stressors. By focusing only on evets in the patient's mind, the implication is that recovery is only possible by changing the way the person thinkings about these stressors. Research on stress suggests that complete recovery must also target the sources of stress in a person's life.
• It is not clear which comes first - Do maladaptive thoughts cause mental disorder, or does the mental disorder cause faulty thinking? It is possible that an individual devlelops a negative way of thinking because of their disorder. It is also possible that faulty thinking is a vulnerability factor for abnormality, with indivdiuals with faulty cognitions being at greater risk of developing mental disorders.
• Not all irrational beliefs are 'irrational'. Some psychologists suggest that people with depression actually have a much more realistic view of the world than non-depressives. Psychologists found that depressed people gave a much more accurate estimate of the likelihood of a disaster than 'normal' controls. (The sadder but wiser effect)

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapies, such as REBT, are based on the idea that many problems are the result of irrational thinking. REBT helps the client understand this irrationality & the consequences of thinking in this way. It enables them to change any self-defeating thoughts & become happier & less anxious.

REBT tries to change irrational beliefs into more rational ones.This leads to a more healthy emotional state & more positive behaviours.

• During therapy, the patient is encourage to dispute self-defeating thoughts
• Change is achieved through logical disputing (does thinking this way may sense?), emperical disputing (where is the proof that thinking this way is accurate?) & pragmatic disputing (how is this belief helping me?)
• The patient then moves to more rational interpretations of events. This adds to the ABC model - disputing (D), a more effective attitude to life (E) & a new set of feelings (F).

Beck's Cognitive Triad - negative view of world, negative view of themselves & negative view of future. These 3 forms of negative thoughts are typical of depressives.

Strengths

• Its usefulness is not limited to people suffering from mental disorderrs, but is also useful for non-clinical populations (e.g. people with examination anxiety). REBT can be effective even in the absence of an actual therapist - a computer-based counselling programme based on REBT has produced decreases in anxiety.
• A meta-analysis showed REBT to be effective in the treatment of a number of different types of disorder. REBT was more effective in the treatment of anxiety disorders than SD.

Limitations

• REBT does not always work & is not always what people want. Some people fail to put the principles into practice & others do not want the 'direct' sort of advice of REBT.
• Disputing what appears to be an irrational belief 'to the therapist' may create difficulties for a client from whom this 'irrational belief' is based on a fundamental religious belief.
• CBT is not a quick fix. A therapist is like a personal trainer that advises & encourages but cannot 'do' it for you and therefore you have to concentrate & be motivated. However, if you are feeling low, it can be difficult to concetrate & be motivated.