Defining & explaining psychological abnormality

Norms are commonly expected standards of behaving in a society according to the majority.  In other words, they are accepted ways of behaving in society.

Sometimes these are written (explicit) and form laws that govern behaviour. Sometimes though, these norms of behaviour are unwritten (implicit) but generally accepted (e.g. not standing too close to people whilst talking to them).

Whether explicit or implicit, social norms allow for the regulation of normal social behaviour. All societies have standards, or norms, for appropriate behaviours and beliefs (expectations about how people should behave as well as what they should think).

This definition, therefore, suggests that abnormality can be seen as someone who breaks these ‘rules of society’ (i.e. someone who doesn’t think or behave in a way that is accepted by that society).

• Behaviour that deviates from social norms is not always a sign of psychopathology. eccentricity for instance might involve avoiding the cracks in the pavements, but this mid supersition & not in itself a form of psychopathology. this also emphasies the importance of taking the context of behaviour into account!
  

• Social norms change over time… Homosexuality was included in the American Classification system for psychiatrics disorders up until the 60’s, sinc then attitudes havechanged & homosexuality is no longer seen as psychopathology. This means that DSN does not provide an absoulute deinfition of abnormality but is era-dependent.

• As social norms relfect the beliefs of a society they also have a political dimension. for instance in some countries dissidents, that is people who disagree with the ruling party, might be classified as scizo & locked up in psychiatric hospitals. in terms of deviation from social norms, this looks justifed, but of course only in a society that does accept a ranhe of political opinions as part of their social norms. in these cases the definition is being used as a means of political control

• The legal system assumes that people have control over their own behaviour, therfore those convincted of crimes are not usually considered mentally ill. so deviating from social norms by commiting illegal acts need not always involve pyschopathology. however an interesting development in this area is the idea that some violent offenders may have brain abnormalities that mean they are not responsible for their actions. in this case you might argue that they are showing a genuine form of psychopathology.

• Culturally relativity is key issues in relation to the DSN definition. social norms by their very definitions are specific to a particular culture/ society so a behavuour seen as deviation in 1 society may appear quite accetable in another & vice versa.

 “Failing to function” is generally taken to mean that a person is unable to cope with everyday life. Their behaviour is seen as maladaptive (not good for survival), disrupting their ability to work and conduct satisfying relationships and causes personal distress as well as distress to others.

Rosenhan and Seligman (1989) have suggested some key characteristics of ‘failing to function adequately’:

1. Observer Distress (or Discomfort)- Where someone’s behaviour causes discomfort and distress others observing the behaviour.

2. Maladaptive Behaviour- Where someone’s behaviour interferes with their ability to lead a normal life (e.g. agoraphobia) it can be seen as maladaptive or dysfunctional. This characteristic is central to the FFA definition.

3. Unpredictable Behaviour- We rely on the behaviour of people around us being predictable. Behaviour is unpredictable if it does not fit the situation or if it is unexpected and uncontrolled (e.g. sobbing for no reason or laughing at bad news)

4. Irrational Behaviour- If a person’s behaviour doesn’t make sense to other people (difficult to understand) or if others cannot communicate with them in a reasonable way; their behaviour is often classed as irrational.

• Failing to function does not always indicate psychological abnormality… This means that sometimes people ‘fail to function’ due to external factors rather than anything to do with the person themselves. For example, holding down a job and supporting a family may be impossible due to economic conditions or workplace discrimination. This is problematic as these environmental factors may cause the failure to function rather than any psychological abnormality.
  

• Equally, psychological disorders may not prevent a person from functioning… people often mantain adequate function in the face of clinical levels of anxiety & depression & others with personality disorders related to psychopathy can appear perfectly normal most of the time

• In a similar fashion to DSN, behaviour that looks like FFA may instead reprsent normal behaviour, depending on the context. some political prisoners go on hunger strike as part of protest, although starving yourself is technically unpredictable, irrational & maladptive, this example of FFA is understandable due to the context

• there is cultural dimension to FFA. standard patterns of behaviour will vary form culture to culture, so failing to function adequately may look v.different depending upon which culture you are in. however there may be aspects in common although details may vary; in any culture people need to earn their livelihood & raise kids & failing to carry out these functions would satify the FFA definition

This definition stands out by not defining abnormality directly. Instead, it attempts to define a state if ideal mental health (factors necessary for ‘optimal living’). Deviation from these would then be defined as abnormality.

Marie Jahoda (1958) defined ideal mental health through a list of characteristics indicates psychological health and therefore the absence of the characteristics (rather than presence as with the FFA definition) suggests abnormality.

Characteristics for ‘Optimal Living’: (Vaillant 2003)

1.      Strong sense of self-Identity - A psychologically healthy individual should be in touch with their own identity and feelings.

2.      Resistant to stress - Someone with ideal mental health should be resistant to stress and its negative effects.

     3. Self-actualisation - The mentally healthy individual should also be    focused on the future and on fulfilling their potential (self-actualisation).

4.      Autonomy - They should function as autonomous individuals, recognising their own needs and with an accurate perception of reality.

5.      Empathy – The individual should show understanding towards others.

The fewer of these qualities you have,

the more abnormal you are seen to be.

• The definition is ‘ethnocentric’…

 This means the criteria may be based on and limited to one culture.

 Psychological research often identifies two types of culture:

 Individualistic: Cultures that place their emphasis on personal achievement

 Collectivist: Cultures that strive for the greater good of the community.

 Which culture would be seen as abnormal according to Jahoda’s criteria? Why?

For example, they can be seen as reflecting Western, individualistic culture (e.g. North-American) and not collectivist cultures.This is a problem because it means the definition may be biased and whole cultures may be seen as ‘abnormal’ because of this.

• The characteristics are too idealistic…

This means the criteria for optimal living are set too high. Evidence to support this comes from Maslow (1968) who argued that only a few people ever achieve ‘self-actualisation’. This is a limitation because if this is true, most of us would be considered abnormal based on the requirements of this definition.

Defining behaviour as abnormal is only the 1st stage in classifying psychopathology. the 3 definitions looked at can give some indication that an abnormality exists, but each has limitations & none is entirely satsifactory.

The dominant approach to psychopathology is the biological/ medical model. it uses the model of physical illness (disease model) & applies to psychological disorders. this approach has several elements:

• abnormality is associated with certain signs/ symptoms. these may be reported by the person concerned (always refereed to as the 'patient in the disease model) or observed my fam, friends or the doctor/ psychiatrist

• signs & symptoms that reg occur together are referred to as syndromes so depression is characterised by a depressed mood, apathy, sleeping probs etc. siczo is hallucinations & delusions

• the disease model assumes that the various syndromes represent distinctive disorders that can be considered independently of 1 another. it then tries to develop explanations & treatments

There are 2 widely used systems in psychiatry for defining & classifying psychopathology into separate systems. The International Classification System for Diseases (ICD) is used mainly in Europe, while the American-based Diagnostic and Statistical Manual of Mental Disorders (DSM) has a more international usage. Both follow the approach of categorising diff orders, but differ in some particulars. They have evolved over the years with changes in approaches to defining & classifying psychopathology. At present we have the 10th version of ICD (ICD-10) & the revised 4th version of DSM (DSM-IVR). both systems categorise disorders on the basis of signs & symptoms, with over 150 currently recognised

The DSM-VR systsem also uses elements of the definitions reviewed earlier. after using signs & symptoms to identify the particular syndrome, DSM-IVR also takes into account social & environmental problems that might influence the disorder. Finally it uses a global assessment of functioning scale to rate the impact of the disorder on the patient's daily life; this is closely relation to the deviation from social norms & failure to function adequately approaches. however it is important to note that this global rating is secondary to the main aim of identifying the disorder through signs & symptoms

There are variety of issues with this medical disease model of psychopathology, both practical & ethical:

• Although identifying specific syndromes sounds objective & straightforward, in fact can be significant disagreements between psychiatrists. Hallucinations & delusions can indicate scizo, but they sometimes occur in association with bipolar disorder & can also be caused by infections on the brain. anxiety & depression can often occur together & can be hard to distangle

• the medical model of psychopathology emphasise the biological aspects of the disorder. although DSM-IVR takes some account of social & economic factors, the possible role of psychological factors in causing psychopathology is minimised

• one ethical issue is that treating the individual as a patient in the medical sense has the advantage of taking away any blame for their condition; they are not responsible for their disorder.

• however, labelling a person as sicizo for instance, is likely to stigmatise them. society on the whole has little understanding of mental illness & people tend to avoid those with serious disorders. labelling patients is a serious ethical issue for the medical model

The brain is the focus for most biological psychologists as it is the processing centre controlling all complex behaviour. It is argued that, in theory, all behaviour, normal and abnormal, can be related to changes in brain activity.

Brain scanning techniques such as PET or CAT scans are often used to find evidence for the physical basis for psychological abnormality.  The biological model is favoured by medicine and psychiatry - the branch of medicine that specialises in mental disorders.

Tgy:

1. The brain

As all behaviour is associated with changes in brain function, psychopathology will be caused by changes in either the structure or function of the brain. This might involve changes in the size of brain structures, or in the activity of brain neurotransmitters and hormones.

 For example, biological psychologists suggest that mental disorders may be due to an imbalance of chemicals in the brain. In other words, there may be too much or too little of a certain neurotransmitter or hormone (i.e., bio-chemicals).  These bio-chemicals can affect mood and behaviour, potentially causing mental illness.

2. Genetics

The development of the body, including the brain, is heavily influenced by genetics. Biological psychologists tend to assume that most behaviours, normal and abnormal, involve a component genetically inherited from the biological parents.

Biological psychologists, then, are very much on the nature side of the nature-nurture debate. There is research evidence from a range of sources suggesting psychological abnormality is passed on through family lines.

• Modern techniques have identified biological aspects of many psychopathologies…This means psychologists have identified biological symptoms in a range of mental disorders. For example, depression seems to be associated with low levels of the neurotransmitter, serotonin, while schizophrenia has been linked to increased levels of the neurotransmitter, dopamine. In addition, brain scans have revealed that some patients with schizophrenia appear to have brain pathology (i.e. loss of tissue in certain areas of the brain).

• Research into behavioural genetics has identified a genetic, or inherited, component in many psycho-pathologies, such as scizo, bipolar disorder & some phobias

• drug treatment based on the biological/ medical model , targets the biological bases of disorders & can be v.effective in conds such as depression, scizo & anxiety disorder

So a wealth of scientific evidence has been produced to support the approach, & this is its greatest  strength. there are also some problems:

• Reductionistic…

  This means the approach reduces the complex issues down to its most basic elements or parts. For example, it suggests that complex mental disorders are caused solely by our biology. This is a problem because it ignores the role of the environment, such as our childhood and the stressors within our lives and, as a result, the biological approach may be too simplistic.

• although a genetic component has been identified in many disorders, in no case does this component provide a complete explanation. so even when there is evidence for a genetic influence, it is assumed that this must interact with non-genetic environmental factors. a popular choice for the environmental factor is stress, & the hypothesis that some disorders involve a genetic vulnerability triggered by the stress is known as diathesis-stress
  

• although drug treatment can provide support for the biological approach, they are never effective for all people with a particular cond. in fact some conds, such as phobias & eating disorders, drugs are largely ineffective

BACKGROUND

“I’m Freud and I believe that abnormalities result from unconscious processes rather than physical causes.”

Freud’s psychodynamic approach assumes that adult behaviour reflects complex interactions between conscious and unconscious forces operating within the ‘psyche’. The two key elements of Freud’s work on abnormality were his model of the structure of personality (model of the ‘human psyche’) and his detailed theory of psychosexual development in childhood:

The psyche – In Freudian psychoanalysis, the mind, or psyche, is seen as being governed by three main mental processes – innate drives, reason and morality

The ld:  This part of the psyche is instinctual psychic energy that we are born with. The most important aspect of this psychic energy is the libido (sexual energy). The Id operates on the pleasure principle and constantly tries to gratify these instincts through sex and other forms of pleasurable activity, but may also lead to aggression and violence

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The Ego: This part of the psyche represents our conscious self and it develops during early childhood (around 2 years old). It tries to balance the demands of the id for self-gratification with the moral rules imposed by the superego. The ego operates on the reality principle as it constantly balances the demands of the real world against the instinctive drives of the id. Due to this, it is also referred to as the executive of the personality.

The Superego: This is our personal moral authority, or conscience. It develops later in childhood (around the age of 5 or 6) through identification with one or other parent, at which point the child internalises the moral rules and social norms of society.

Intra-psychic Conflict – If, within the psyche, the ego fails to balance the demands of the id and the superego, conflicts may arise and this can result in the development of psychological disorders.

If the ID is not kept in check by the ego then a person  acts on their immediate desires and impulses, whatever they may be, which can result in destructive behaviour pleasurable acts and uninhibited sexual behaviour.

If the SUPEREGO is not kept in check by the ego then a person deprives themselves of any sort of desires/impulses (even socially acceptable ones) which can result in anxiety disorders such as phobias and OCD.

Ego defence mechanisms – One important consequence of  intra-psychic conflict between the id, ego and superego is anxiety. In order to protect (defend) itself against this, the ego tries to maintain its balancing act using what Feud called ego defence mechanisms. The ego has three main defence mechanisms

Ego Defence Mechanism- Description

Repression- Repression occurs when negative experiences are ‘pushed’ into the unconscious. They do not disappear but the individual is unaware of them. However, such repressed conflicts can eventually emerge as symptoms of anxiety or other emotional disorders (e.g. phobias).

Displacement-Displacement occurs when an unacceptable drive such as hatred is moved (displaced) from its primary target to a more acceptable target. E.g. Hatred towards your father is socially unacceptable so the child displaces it, for instance, on to a brother or sister.

Denial-Denial occurs when as individual, child or adult, refuses to accept that a particular event has actually happened. E.g. The surviving partner of a long, happy marriage may act like their husband/wife was still alive.

Ego defence mechanisms protect our conscious self from the anxiety produced by unconscious intra-psychic conflict. If they are unsuccessful, this anxiety may reveal itself through clinical disorders such as phobias and generalised anxiety.

There are a number of other ego defence mechanisms than the ones listed above. and one of the aims of psychodynamic therapy (treatment) is to break through these defences to reveal the underlying conflicts & deal with them

According to Freud’s theory of psychosexual development, each child goes through a series of stages where the instinctive energy of the id looks for gratification form different areas of the body:the so-called erogenous zones. If the developing child is either deprived or over-gratified at a particular stage they may become fixated at this stage and this will affect their adult beahviour

1, Oral stage – This lasts from birth to about 18 months. Id impulses are satisfied by feeding, and so the mouth is the focus of this stage. Key activities include sucking initially, and then as teeth develop, biting. fixations at this stage may produce an adult graining pleasure from oral gratifaction through activities such as smoking, drinking or eating. as this stage also involves complete dependency of the infant, the fixated adult may also show over-dependence in their relationships

2, Anal stage – This takes place from 18 months to about 3 years of age. During this time, gratification focuses on the anus. Key activities revolve around retaining and expelling faeces. This is a significant stage in Freudian theory as for the first time the child can exert some control over its environment. He or she can choose to obey or disobey by expelling or retaining faeces. Fixation at this stage may lead to an obsession with hygiene & cleanliness & perhaps obsessive-compulsive disoder.

3, Phallic stage – After the anal stage comes the phallic stage, which lasts from age 3 until age 4 or 5, where the focus is on the genitals and gratification comes through genital stimulation. This is a key stage in sexual development as gender differences are noticed and psychosexual development differs between the sexes.

The most important feature of this stage is the Opedipus comples. Freud developed this concept in relation to boys, proposing that their sexual curiosity & close physical contact with the mother leads to intense affection & desire for the mother. this lead the boy to see his father as a rival & this in turn produces fear of losing his father's love & even castration. to cope with these conflicting feelings the boy identifies with the father & the process absorbs / internalises his father's moral attitudes; foundation of suprego

A justified criticism of F is that his theory is heavily phallocentric; ie focused v.much on the male, & this is particularly evident in his treatment of the Opedipus conflict. the equivalent in girls, the Elektra complex, lacks detail & is almost an afterthought. F proposed that in the phallic stage the girl realises she has no penis. this produced a state of penis envy, & although up to that time she has been closer to the mother, penis envy leads her to develop more affection for the father.

Latency Period

during the period from 4-5 up to puberty psychosexual development enters a latent period, to re-emerge at puberty. At puberty sexual feelings become less focused on the self & instead directed at potential partners

• Influential…

 This means the approach has stimulated lots of further research and influenced a number of psychologists. For example, Ainsworth’s research into attachment types. This is positive as it has improved our understanding of psychopathology and Freud remains one of the most influential psychologists of all time.

• he was also the 1st to suggest how our adult behaviour could be influenced by early childhood experiences - Ainsworth

• F overemphasised infantile sexuality to the exclusion of other aspects of development. he assume that later psychosocial disorders could be caused by problems with early pyshcosexual development. later pscyhodynamic approaches places less emphases on this aspect   

• Freud’s theory lacks temporal validity…

 This means his theory of normal and abnormal behaviour was developed in the late nineteenth and early twentieth centuries in Vienna and so aspects of it are clearly related to this historical period. For example, the culture of the time may have far more sexually suppressed than today’s much more sexually liberal societies in the Western world. This is problematic as it brings into question the usefulness of Freud’s theory in modern day society and the approach may not generalise to modern times. However it has heavily influenced other major pschodynamic figures such as Jung & Adler, & contemporary psychodynamic approaches. many of his ideas & concepts, such as repression, fixation, denial etc have passed into everyday lang, & have been used in relation to adult psychopathology,regardless of the most influential psychologists of all time

• Influential…

 This means the approach has stimulated lots of further research and influenced a number of psychologists. For example, Ainsworth’s research into attachment types. This is positive as it has improved our understanding of psychopathology and Freud remains one of the most influential psychologists of all time.

• he was also the 1st to suggest how our adult behaviour could be influenced by early childhood experiences - Ainsworth

• F overemphasised infantile sexuality to the exclusion of other aspects of development. he assume that later psychosocial disorders could be caused by problems with early pyshcosexual development. later pscyhodynamic approaches places less emphases on this aspect   

• F did not study children directly, but developed his theory largely on the basis of case studies with adults who came to him with neurotic disorders. freud then linked these disorders to their early experiences

• the fundamental concepts of F pyshcoanalytic theory, such as the ID, & defence mechanisms such as repression, are almost impossible to test using conventional scientific methodology. this does not mean they are wrong but does leave a great deal of room for speculation & differing opinions. F himself constantly refined & developed his ideas, & even today some of his classical case studies of psychological disorders are subject to reinterpretation. TOLPIN 1993

• Freud’s theory lacks temporal validity…

 This means his theory of normal and abnormal behaviour was developed in the late nineteenth and early twentieth centuries in Vienna and so aspects of it are clearly related to this historical period. For example, the culture of the time may have far more sexually suppressed than today’s much more sexually liberal societies in the Western world. This is problematic as it brings into question the usefulness of Freud’s theory in modern day society and the approach may not generalise to modern times. However it has heavily influenced other major pschodynamic figures such as Jung & Adler, & contemporary psychodynamic approaches. many of his ideas & concepts, such as repression, fixation, denial etc have passed into everyday lang, & have been used in relation to adult psychopathology,regardless of the most influential psychologists of all time

• F did not study children directly, but developed his theory largely on the basis of case studies with adults who came to him with neurotic disorders. freud then linked these disorders to their early experiences

• the fundamental concepts of F pyshcoanalytic theory, such as the ID, & defence mechanisms such as repression, are almost impossible to test using conventional scientific methodology. this does not mean they are wrong but does leave a great deal of room for speculation & differing opinions. F himself constantly refined & developed his ideas, & even today some of his classical case studies of psychological disorders are subject to reinterpretation. TOLPIN 1993

Behaviourism insisted that psychology should be the study of observable behaviour rather than the inner workings of the mind.  Unlike mental processes, behaviour can be directly observed.  This provides the foundation for a scientific psychology based on empirical evidence – ‘hard facts’ which can be observed and measured in the laboratory.

According to behaviourists, there are three main forms of learning:

    1. Classical conditioning – learning by association

      2. Operant conditioning – learning by reinforcement (punishments and rewards

       3.     Social learning – learning by watching others in society be rewarded