Individual Differences

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Deviation from Social Norms

The term deviation refers to deviant behaviour (behaviour which is considered anti-social by the majority of society.) In any society there are social norms, that are standards of acceptable behaviour. example of social norms: politeness. Social standards are not restricted to rule of etiquette but also more serious moral issues, such as what is acceptable in sexual behaviour. Our culture permits sex between consenting adults of any gender but regards some behaviours as sexually deviant. For example, in the past homosexuality was classified as deviant behaviour in the UK. Currently the DSM classification scheme contains a category called 'sexual and gender identity disorders' which includes paedophilia and voyeurism. Such behaviours are considered socially deviant.

Limitations : Susceptible to abuse - the main difficulty with the concept of deviation from social norms, is that it varies as times change. What is socially acceptable now may not have been socially acceptable 50 years ago. Today homosexuality is acceptable but in the past it was included under sexual and gender identity disorders. If we define abnormality in terms of deviation from social norms we open the door to definition based on prevailing social moral and attitudes. This then allows mental health professionals to classify as mentally ill those individuals who transgress against social attitudes. In fact, Szasz (1974) claimed that he concept of mental illness was simply a way to exclude nonconformists from society.

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Deviation from Social Norms

Deviance is related in context and degree: Making judgments on deviance is often related to the context of a behaviour. A person on a beach wearing next to nothing is regarded as normal, whereas the same outfit in the classroom would be regarded as abnormal and possibly an indication of a mental disorder. In many cases there is not a clear line between what is an abnormal deviation and what is simply more harmless eccentricity. Being rude is deviant behaviour but not evidence of mental disturbance unless it is excessive and therefore pathological. What this means is that social deviance, on it's own, cannot offer a complete definition of abnormality, because it is inevitably related to both context and degree.

  • Cultural Differences:
  • Social norms themselves are defined by the culture.
  • Disorders are hard to define in all cultures collectively as they are usually defined in a different way, in different places, and by different people.
  • This means that diagnosis may be different for the same person in two different cultures.
  • For example, what may be viewed as a disorder in the UK might be viewed differently in another country.
  • Culture Bounds syndrome has been founded in order to describe patterns of behaviour in certain areas.
  • There are no universal standards or rules of labelling a behaviour as abnormal.
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Failure to Function Adequately

From an individual's point of view, abnormality can be judged in terms of not being able to cope. For example, if you are feeling dpressed, this can be coped with as long as you can continue to do normal everyday things. As soon as depression or indeed any other disorder, interferes with such things then the individual might tend to label their own behaviour abnormal, and would seek treatment.

  • Limitations :
  • In order to determine failure to function adequately, someone needs to decide if this is actually thecase. It may be that the patient is experiencing personal distress at, for example being unable to get to work. The patient themselves then determines that this behaviour is undesirable. On the other hand, it may be that the individual is quite content with the situation and simply unaware that they are not coping. It is others who are uncomfortable and judge the behvaiour as abnormal.
  • Some apparently dysfunctional behaviour can actually be adaptive and functional for the individual. For example, some mental disorders such as eating disorder, may lead to welcome extra attention for the individual.
  • Definitions of adequate functioning are also related to cultural ideas of how one's life should be lived. The failure to function criterea is different diagnoses when applied to people from different cultures because the standard of one culture is being used to measure another.
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Deviation from Ideal Mental Health

Deviation from ideal mental health mixes both other people's perceptions on us and the individual's mental health and functioning. It is seen as turning away from an ideal picture of mental health. Marie Jahoda (1958) claims that we look for the absence of physical signs for physical health such as skin colour, blood pressure etc. We also look for signs and examples of what might indicate poor mental health and deviation.

Jahoda came up with six categories in which display ideal mental health:

  • Self-attitudes: positive self esteem and a strong sense of identity.
  • Personal growth: development of a person and the extent to which they fully use their capabilities.
  • Integration: ability to cope with stressful situations.
  • Autonomy: Independance and self-regulating.
  • Accurate perception of reality.
  • Successful mastery of the environment: adapting to resolving problems, handling relationships and functions and abilities to love and to work and adjusting to new situations.
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Limitations of Deviation from Ideal Mental Health

According to this criteria most of us are abnormal to some degree, and not all of us possess these virtues. Jahoda said that they were ideal criteria. Doctors look at our health to detect any physical illnessand they also look for signs of illness such as fever. Physical illnesses have physical causes such as a virus infection and this makes them quite easy to detect and to diagnose. However mental illnesses also have physical causes such as brain injury or drug abuse. Therefore, it is unlikely that we could diagnose mental abnormality the same wya that we diagnose physical abnormality.

  • Cultural Differences
  • Cultural relativism: some disorders are specific to some cultures, or found in some populations more than other. It is difficult to say whether the disorders are really less common amongst some people, possibly for genetic reasons or whether there are differences in diagnosis.
  • Most of the criteria of ideal mental health model is culture-bound.
  • If we apply this criteria to people from non-western or even non-middle class social groups we will find higher rates of abnormality.
  • Some cultures are different to others, some abnormal behaviour in one culture could be seen as desirable behaviour in another.
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Biological Approach

The biological model assumes that all mental disorders are related to some change in the body. Mental disorders are like physical disorders. Such changes or illnesses may be caused by one of four possible factors; genes, biochemistry, neuroanatomy and viral infection.

  • Genetic inheritance: abnormalities are sometimes the result of genetic inheritance and so are passed from parent to child. One way of investigating the possibility is by studying twins. Pairs of identical twins can be compared to see whether, when on twin has a disorder, the other has it as well. This provides us with a concordance rate - the extent to which two individuals are similar to each other in terms of a particular trait.
  • Biochemistry/Neuroanatomy: Genes tell the body how to function. They determine the levels of hormones and neurotransmitters in the brain. An example of this is serotonin, high levels of serotonin are associated with anxiety, wheras low levels have been found in depressed individuals. Genes also determine the structure of the brain. Research has shown that schizophrenics have enlarged spaces in their brains, indicating shrinkage of brain tissue around those spaces.
  • Viral Infection: Torrey (2001) found that the mothers of many peopel with schizophrenia had contracted a particular strain of influenza during pregnancy. The virus may enter the unborn child's brain, where it remains dormant until puberty, when other hormones may activate it, producing the symptoms of schizophrenia.
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Limitations of Biological Approach

Humane or inhumane - More recent critics have claimed that the medical model is inhumane. Thomas Szasz (1972) argued that mental illnesses did not have a physical basis, therefore should not be thought of in the same way. He suggested that the concept of mental illness was 'invented' as a form of social control.

Cause and effect? - The available evidence does not support a simple cause and effect link between mental illnesses such as schizophrenia and altered brain chemistry.

Inconclusive evidence - there is no evidence that mental disorders are purely caused by genetic inheritance, concordance rates are never 100%. Gottesman & Shields (1976) reviewed the result of five studies of twins, looking for concordance rates for schizophrenia. They found that in monozygotic twins there was a concordance rate of around 50%. If schizophrenia was entirely the product of genetic inheritance, we might find this figure to be 100%. It is likely that, in the case of certain disorders, what individuals inherit is a susceptibility for the disorder, but the disorder itself only develops itself only develops if the individuals are exposed to stressful life conditions. This is called the diathesis-stress model.

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Psychodynamic Approach

Freud believed that the origins of mental disorder lie in the unresolved conflicts of childhood which are unconscious. Medical illnesses are not the outcome of physical disorders but of these psychological conflicts. Conflicts between the id, ego and superego create anxiety. The ego protects itself with various defence mechanisms. These defences can be the cause of disturbed behaviour if they are overused, e.g. (regression).

In childhood the ego is not developed enough to deal with traumas and therefore they are repressed. Later in life, other losees may cause the individual to experience the death of a parent early in life and repress associated feelings. Later in life, other losses may cause the individual to re-experience the earlier loss and can lead to depression.

Ego defences, such as repression and regression, exert pressure through unconsciously, motivated behaviour. Freud proposed that the unconscious consists of memories and other information that are either very hard or almost impossible to bring into conscious awareness. Despite this, the unconscious mind exerts a powerful effect on behaviour. This frequently leads to distress, as the person does not understand why they are acting in that particular way. The underlying problem cannot be controlled until brought into conscious awareness.

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Limitations of Psychodynamic Approach

Abstract concepts such as the id, ego and superego are difficult to define and research. Because actions motivated by them operate primarily at an unconscious level, there is no way to know for certain that they are occuring. As a result, psychodynamic explanations have received limited empirical support, and psychodynamic theorists have had to rely largely on evidence from individual case studies.

A common criticism of Freud's work is that it was ssexist. He himself accepted that his theory was less well developed for women. Changes in modern psychoanalysis have made this explanation perfectly applicable to women.

Although a number of researchers have attempted to test Freud's predictions experimentally, the theory is difficult to prove or disprove in this way. If an individual behaves in the manner predicted by Freud, this is considered to be supportive of the theory. However, if they do not, the theory is not rejected as it could instead indicate that the person is behaving in this way as a consequence of their defence mechnisms.

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Behavioural Approach

The behavioural model concentrates only on behaviours. Behaviours might be external or internal. Because the former are more observable, behaviourists tend to focus their attention on the role of external events and behaviours.

All behaviour is determined by external events. Abnormal behaviour is no different from normal behaviour in terms of how it is learnt. We can use the principles of learning theory to explain many disorders for which the major characteristics are behavioural.

Learning environments may reinforce problematic behaviours. Society also provides deviant maladaptive models that children identify with and imitate.

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Limitations of Behavioural Approach

Behaviourist explanations of mental disorders have been criticised for offering an extremely limited view of the factors that might cause abnormal behaviours. Behaviourists explanations tend to ignore the role of cognition in the onset and treatment of abnormality, although the emergence of cognitive behavioural therapies did take the role of cognition into account.

Although one of the strengths of this approach is the fact that it lends itself to scientific validation, research has not always supported its claims.

Part of the success of this model comes from the effectiveness of behaviorual therapies for treating abnormal behaviour. However, such therapies may not provide long-lasting solutions. This may be because the symptoms are just the tip of the iceberg. If you remove the symptoms, the cause still remains, and the symptoms will simply resurface, possibly in another form. This suggests that although the symptoms of many disorders are behavioural, the cause of these symptoms may not be.

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Cognitive Approach

The cognitive model assumes that hinking, expectations and attitudes direct behaviour. Mental illness, therefore, is a result of inappropriate thinking. The focus is not on the problem itself but the way a person thinks about it. Faulty and irrational thinking prevents the individual behaving adaptively. Ellis (1962) referred to this a-b-c model.

A - Refers to an activating event.

B - Is the belief, which may be rational or irrational.

C - Is the consequence, rational beliefs lead to healthy emotions, whereas irrational beliefs lead to unhealthy emotions.

The cognitive model portrays the individual as being the cause of their own behaviour because the individual controls their own thoughts. Abnormality, therefore, is the product of fault control.

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Limitations of Cognitive Approach

The cognitive model suggests that it is the patient who is responsible. This may lead one to overlook situational factors, for example, not considering how life events or family problems may have contributed to the mental disorder. The disorder is simply in the patients mind and recovery lies in changing that, rather than the individual's environment.

It is possible that faulty thinking is a vulnerability factor for abnormality. People with maladaptive cognitive processes are a greater risk of developing mental disorders.

Not all irrational beliefs are 'irrational'. In fact, Alloy & Abrahmson (1979) suggest that depressive realists tend to see things for what they are. They found that depressed people gave more accurate estimates of the likelihood of a disaster than 'normal' controls, and called this the 'sadder but wiser' effect.

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Biological Therapies : Drugs (Chemotherapy)

Antipsychotic drugs

  • Conventional drugs e.g. chlorpromazine which combats positive symptoms of schizophrenia (hallucinations, delusions, confusing thoughts). Also blocks dopamine.
  • Atypical Drugs, e.g. clozapine which temporarily occupies dopamine receptors, and therefore lowers levels of side effects such as 'tardive dyskinesia which is involuntary movements of the mouth and tongue.

Antidepressant drugs

  • Insufficient amounts of neurotransmitters such as serotonin.
  • Antidepressants reduce the rate that neurotransmitters are re-absorbed into the nerve endings or blocks the enzymes which break down the neurotransmitters.
  • Most common are the selective serotonin re-uptake inhibitors.
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Chemotherapy Strengths & Weaknesses

Chemotherapy Strengths:

  • Effectiveness (World Health organisation published that) there was a relapse 55% when placebos used, 25% when the chloropromazine used. 2-23% when chloropromazine combined with family intervention.
  • Easy to use - less effort than pscyhoanalysis, and most clinicans combine chemotherapy and psychotherapy.

Chemotherapy Limitations:

  • Placebo effect - Kirsch et al (2002) placebos are as good as the real thing. however, mulrow et al (2000) found a success of 35% for placebos and 60% for tricyclics.
  • Tackles symptoms rather than the problem - Drugs only alleviates the symptoms.
  • Side effects - e.g. anxiety, sexual dysfunction, insomnia, nausea and suicidal thoughts.
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Electroconvulsive Therapy (ECT)

How does it work? A small electric current is passed through the brain, causing a seizure lasting about a minute. A patient is usually required between three and fifteen treatments.

Why does it work? We know it causes changes in the brain, and we dont know the exact effect (Abrams 1997). In depression, ECT alters the way the neurotransmitters act.

ECT strengths :

  • ECT can save lives - helps people with severe depression who may be suicidal.
  • Effectiveness - Comer (2002) 60-70% patients improve. However, Sackheim et al (2001) found that 84% relapse within 6 months.

ECT limitations :

  • Sham ECT - Some patients recovered after sham ect. the attention may have an effect on them.
  • Side effects - Impaired memory cardiovascular changes and headaches (Datto 2000). 30% resulted in fear and anxiety (department of health 1999).
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Systematic Desensitisation

An individual may feel that a feared stimuli .may not be fearful once re- experiencing the feared stimuli. It Is overcome when you introduce the feared stimuli at a gradual pace. It is based on counter conditioning which is when you teach a behaviour that is incompatible with the feared stimuli.Joseph Wolpe (1950) developed systematic desensitisation. This can allow your fear to overcome. Relaxation and fear are not compatible so the fear will gradually be expelled making a person feel calmer. A patient is taught to relax, the therapist and the patient both create a hierarchy which is imagined scenes that each cause more anxiety than the previous one. The patient visualises each event whilst relaxing. Once their relaxed in one scene they can move on to the next, until the fear is mastered.

  • Strengths
  • It is a very quick process and requires less effort than other psychotherapies. It is good for people with learning difficulties a s this may be the only treatment which is possible for them.
  • SD has been very successful for a range of anxiety disorders. (McGrath et al 1990) 75% of patients with phobias respond to SD.
  • Capafons at al (1998) said when it was used in people who were scared in flying they showed much less fear when treated with SD (compared to a control group).

Weaknesses:

  • SD may appear to resolve a problem by eliminating the symptoms but another symptom may occur (symptom substitution).
  • Ohman et al (1975) found it maybe less effective in treating anxieties that are an evolutionary survival component. e.g. fear of dangerous animals, than treating normal phobias that have occurred from personal experiences.
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+ / - of Systematic Desnsitisation

  • Strengths
  • It is a very quick process and requires less effort than other psychotherapies. It is good for people with learning difficulties a s this may be the only treatment which is possible for them.
  • SD has been very successful for a range of anxiety disorders. (McGrath et al 1990) 75% of patients with phobias respond to SD.
  • Capafons at al (1998) said when it was used in people who were scared in flying they showed much less fear when treated with SD (compared to a control group).
  • Weakenesses
  • SD may appear to resolve a problem by eliminating the symptoms but another symptom may occurs (symptom substitution).
  • Ohman et al (1975) found it maybe less effective in treating anxieties that are an evolutionary survival component. e.g. fear of dangerous animals, than treating normal phobias that have occurred from personal experiences.
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