Deviation from ideal mental health (DIMH)

DIMH does not define abnormality directly but instead, attempts to define a state of ideal mental health. 

Jahoda introduced the 1st systematic approach in 1958. Listed a no. of characteristics she felt indicated ideal mental health:

• an individual should be in touch with their own identity and feelings. 
• they should be resistant to stress. 
• they should be focused on the future and self-actualisation (our motivation to achieve our full potential)
• should function as autonomous (ability to function as an independent person) individuals, recognising their own needs and with an accurate perception of reality. 
• should show empathy (ability to put yourself in another person's shoes) and understanding towards others. 

The DIMH has a positive approach to defining normality but also has its limitations.

Limitations: 

• Characteristics listed by Jahoda are rooted in Western cultures. In non-Western collectivist cultures concepts such as autonomy and self-actualisation would not be recognised and the individual would instead follow collectivist goals. Cultural relativity severely limits DIMH.

• DIMH represents deviation from an ideal state. Very few people would match the criteria and so by definition the majority of the population would be classified as abnormal. Unclear at how far a person could deviate before being defined as abnormal. 

The disease model = psychological disorders can be seen similar to physical illnesses and diseases. This approach has several elements: 

• Abnormality is associated with certain signs or symptoms. These are referred to the patient or observed by family/psychiatrist/doctor.
• Signs and symptoms regularly occur together are referred to as syndromes. Schizophrenia is a syndrome in this case, associated with hallucinations and delusions. 
• The disease model assumes that the various syndromes represent distinctive disorders that can be considered independently of one another. Then tries to develop explanations and treatments for each separate disorders.

The International Statistical Classification of Diseases (ICD) based mainly in Europe and in America the Diagnostic and Statistical Manual of Mental Disorders (DSM) - two systems used in psychiatry for defining psychopathology into separate syndromes.

Tenth version of ICD-10 and the revised fourth version of DSM-IVR. Both systems categorise disorders on the basis of signs and symptoms. 

DSM-IVR also takes into account social and environmental probles that might influence the disorder. It uses a global assessment of functioning scale (assess the impact of the disorder on the individual's everyday life)  - closely related to the deviation from social norms and FFA approaches. GAF scale is secondary to the main aim of identifying the disorder through signs and symptoms. 

Various issues with the disease model both practical and ethical: 

• Significant disagreements between psychiatrists with specific syndromes. Hallucinations and delusions can indicate schizophrenia but they sometimes occur in association with bipolar disorder and can also be caused by infections of the brain. Anxiety and depression often occur together. 
• The medical model of psychopathology emphasises the biological aspects of disorders. DSM-IVR takes some account of social and eonomic factors, the possible role of psychopathology factors in causing psychopathology is minimised.
• Ethical issue: treating the individual as a patient in the medical sense has an advantage of taking away any blame for their condition, they are not responsible for their dirosrder. 

• Labelling a person as a schizo can stigmatise (treat/identify them as a negative person). Labelling patients is a serious ethical issue for the medical model

Assumes that adult behaviour reflects complex dynamic interactions btw conscious and unconscious processes. Two key elements in Freud's work on abnormality were his model of human personality and detailed theory of psychosexual development in childhood.

Structure of personality: 

• The id: reservoir of unconscious and instinctual psychic energy that we're born with. Most important aspect is the libido (sexual energy) but this energy may also be directed into aggression. The id operates on pleasure principle.
• The ego: represents our conscious self. Develops during early childhood and regulates interactions with our immediate environment. Balances demands with the id for self-gratification with the moral rules bu the superego for conscience. The ego operates on reality principle in that it constantly balances.
• The superego: our personal moral authority. Develops later in childhood thru identification with parent  at which the child internalises(takes moral attitudes from parent which can make superego)

Conflicts may arise and psychological disorders may result if ego cannot balance between id and superego. Dominance of id impulses may lead to destructive tendencies. If the superego dominates, then one may not be able to experience any form of pleasurable gratification. 

As id is present from birth and superego and ego develop at early childhood, such conflicts are likely to occur at this time. Hence Freud's focus on early years for adult disorders. We are not consious of these underlying dynamics and conflicts. 

1 important consequence of intra-psychic (the psyche is made up of id, ego and superego)  conflict btw id, ego and superego is anxiety. Ego defence mechanisms(protect our conscious self from anxiety produced by intra-pyschic conflict) occur when the ego balances between id and superego. 

Defence mechanisms: 

• Repression: most signifcant. Threatening impulses are repressed into the unconscious. Repressed conflicts can emerge into symptoms of anxiety.
• Displacement: an unacceptable drive such as hatred is displaced from its primary target to a more acceptable target. 
• Denial: an individual refuses to accept that a particular event has happened. 

Psychosexual development: 

A child goes through a series of stages where the instinctive energy of the id looks for gratification in diff bodily areas: the erogenous zones.  A child may become fixated(failure to resolve one of the stages) if deprived from at a particular stage or over-gratified. They will have effects from this and the stages are: 

Oral stage:  lasts from birth to 18 months. Id impulses are satisfied by feeding and the mouth is the focus. Sucking initially, as teeth develop, biting. Fixation at this stage could lead to adults over-eating, smoking or drinking. Fixated adult may also show overdependence in their relationships. 

Anal stage:  from 18 months to 3 years gratification focuses on the anus. Key activites revolve around retaining and expelling faeces. He or she can show obedience or disobedience by expelling or retaining faeces. Fixation at this stage may lead to obsession with hygiene and maybe OCD. 

Phallic stage: lasts until 4 or 5 focus is on genitals and gratification comes through genital stimulation. Most important feature is Oedipus complex - Freud developed this concept in relation to boys, proposing that their sexual curiosity and close physical contact with the mother leads to intense affection and desire for the mother. Leads to the boy seeing father as rival. Boy internalises with father's moral attitudes - foundation of the superego.

Latency period: during the period from 4-5 up to puberty psychosexual development enters a latent period, to re-emerge at puberty. Sexual feelings at puberty become more focused on potential partners. 

Evaluation of the psychodynamic approach:

• it was the first to emphasise the significance of unconscious processes and repressed material influencing our behaviour. 
• Freud was the first to suggest how our adult behaviour could be influenced by early childhood experiences. Approach supported by Ainsworth.
• He assumed that later psychological disorders could be caused by problems with early psychological development. 
• Based work on case studies with adults who came to him with neurotic disorders (disorders such as anxiety where the person has an insight on the condition). Then linked these disorders to early experiences.
• Id, defence mechanisms such as repression - impossible to test using conventional scientific methodology.
• His approach was influenced by the historical period and cultural like phallocentric nature. 

Emphasises the role of learning and experience in causing psychological disorders. Behaviourists deal with 3 main forms of learning: operant conditioning/classical and social learning. 

Classical conditioning: 

Pavlov (1927) using dogs and the natural salivation response to the presence of food. By pairing sound of a bell with the presentation of food he eventually could stimulate salivation merely by sounding the bell. He conditioned the stimulus of the bell to the response of salivation. 

Watson and Raynor 1920:  classically conditioned an 11-month old baby Little Albert to fear fluffy animals. 

Methodological issues: single case study - no systematic and objective measure of any sign of 'fear', they relied on general verbal descriptions. 

Ethical issues: scaring a young child, causing psychological harm - they did not de-condition Little Albert and his mother removed him from the research. 

Seligman 1971 proposed the concept of prepardness - it is the idea that our evolutionary history has prepared humans to be sensitive to biologically-relevant stimuli such as dangerous animals. 

Operant conditioning:  Skinner 1974 - complex patterns of behaviour can be learned by suitable patterns or schedules of reinforcement (patterns of rewards can be used to shape behaviour) 

Social learning theory:  developed by Bandura and others in 1960s. Observing another's actions and their consequences is known as vicarious learning - people will tend to imitate models that are rewarded but will not imitate models that are punished. 

Social learning explanations can be applied in areas such as eating disorders. Anorexia can attract attention from family and friends. If this attention and concern is rewarding, then the behaviour itself is reinforced and more likely to continue.