Psychopathology

Statistical Infrequency:

Defining abnormality in terms of statistics, it is all about the number of times the action has been observed.

Behaviour that is rarely seen is defined as abnormal

An example is intellectual disabilty disorder: The average IQ is 100. Most people have an IQ between 85 and 115, only 2% have a score below 70 and they are diagnosed with intellectual disabilty disorder.

A strength of statistical infrequency is its real life application: -
All assessment of paitents with mental disorders includes some comparison to statistical norms. Intellectual disabilty disorder demonstrates how statistical infrequency can be used. Statistical infrequency is thus a useful part of clinical assessment.

A limitiation is that unusual charecteristics can also be positive:-
If very few people display a behaviour that make the behaviopur statistically abnormal but doesn't mean the person requires treatment. IQ scores over 130 are just as unusual as those below 70, but not regarded as undesirable and requiring treatment.

A futher limitation is that not everyone unusual benefits from a label
When someone is living a happy and stable life there is no benefit as labelling them as abnormal. Someone with a very low IQ who is not distressed would not need a diagnosis. Being labelled might affect there lives negatively

Deviation from social norms:

Abnormality is based on a social context.When a person behaves in a way that is different from how they are expected to behave they may be defined as abnormal.Societies and social groups make collective judgements about 'correct' behaviours in particular circumstances.

There a relativley few behaviours that would be considered universally abnormal therefore definitions are related to cultural context. This may include historical differences on for example homosexuality - it may have been considered abnormal in the past.

An example is the anti social personality disorder: one symptom is antisocial personality disorder ( pschopathy )is a failure to conform to lawful and and ethical behaviour. They deviate form the social norms and standards.

Deviation from social norms is not a sole explanation of abnormality:- anti social personality shows there is a place for deviation from social norms in thinking about what is abnormal. However there are other factors to consider, e.g distress to other people due to APD. So in practice, deviation from social norms is never the sole reason for defining abnormality.

A limitation is that social norms are culturally relative:- a person form one cultureal group may label someone as abnormal based on their schemas of normal. For example, hallucinating is acceptable in the UK but it may be abnormal elsewhere. This creates problems for people from one culture living within another group.

A futher limitation is that the definition could lead to human rights abuse:- Too much relaince on deviation form social norms to understand the concept of abnormality can lead to systematic abuse of human rights.

Failure to function adequately:-

Inabilty to cope with everyday living this is where they cannot meet the demands of everyday life.They fail to fucntion adequately. Examples may include: not being able to maintain relationships,jobs or basic standards of hygine and nuitrition.

Rosehan and Seligman (1989) proposed signs of failure to cope and suggested that 1) They no longer conform to interpesonal rules e.g maintaining personal space 2) They experience personal distress 3) They behave in a way which is irrational or dangerous

Example intellectual disability disorder: having a low IQ is a statistical infrequenxy but diagnosis would not be made on this basis alone. There would have to be clear signs that, as a result of this the persons cant cope with everyday life.

Failure to function adequately recognises the paitents perspective:-

This may not be a satisfactory approach beacuse it is difficult to assess distress. However, the definition acknowledges that the experience of the paitent is important. It captures the experience of many people who need help and is useful for assessing abnormality.

A limitation is that this is the same as deviation from social norms:-

It can be hard to say whn someone is reallly failing to function or just deviating from social norms. People who live alternative lifestyles or do extreme sports could be seen as behaving maldaptively. If we treat these behaviours as 'failures' of adequet functioning we may limit freedom.

A futher limitaition is that this is a subjective judgement

Someone has to judge whether the paitent is distressed or distressing. Some paitents may say that they are distressed but not suffering. There are methods for making such judgements as objective as possible ,including checklists such as the Global Assessment of Functioning Scale. However, the principle remains whetether someone e.g. a psycharatirist has the right to make a judgement

This definition changes the emphasis - a different way to look at normalirty and abnormality is to think about what majes sineone normal and psychologically healthy. Then identify anyone who deviates form this ideal.

Jahoda had listed a crieteria for ideal mental health:

1) We have no symptoms or distress
2) We are rational and percieve ourselves accurately
3) We self - actualise
4) We can cope with stress
5) We have a realistic view of the world
6) We have a good self esteem and lack guilt
7) We are independent of other people
8) We can successfully work love and enjoy our leisure

Inevitable overlap between definition - someones inability to keep a job may be a sign of their failure to cope with the pressures of work ( failure to function) 

One strength is that deviation from ideal mental health is comprehensive:-

The definition covers a range of criteria for mental health. It probaly covers most of the reasons somoone would seek help from mental health services or be referred to help. The sheer range of factors discussed in relation to Jahoda's criteria to make it a good tool for thinking about mental health.

One limitation is that the definition may be culturally relative:-

Some of the ideas in Jahoda's classification of ideal mental health are specific to Western European and North American cultures. For example, the emphasis on personal achievemen (self-actualisation) would be considered self indulgent in much of the focus is on community rather than oneself

Another limitation is a unrealistically high standard for mental health:-

Very few people will attain all Jahoda's criteria for mental health. Therefore, this approach would see most of us as abnormal. The postive side of it is it makes clear to people in ways in which they could benefit in seeking help to improve their mental health. However, it is probaly of no value in thinking about who might benefit from the treatment against their will,

BEHAVIOURAL:
Activity levels:
Sufferes of depression have reduced levels of energy making them lethargic. In extreme casesm this can be so severe that the suffere cannot get out of bed.
Distruption to sleep:Distruption to sleep and eating behaviour. Suffers may experience reduced sleep ( insomnia ) or an increase or decrease, leading weight gain or loss.
COGNITIVE:
Poor Concentration:
Sufferers may find themselves unable to stick with a task as they usually would, or they might find a simple decision making, difficult.
Absoulitist Thinking:
'Black and white thinking,when a situation is unfortunate it is seen as an absolute disaster.
EMOTIONAL:
Lowered Mood: More pronouced than the daily experience of feeling lethargic or sad. Sufferers often describe themselves as 'worthless' or 'empty'.
Angry:On occasion such emotions lead to aggression or self harming behaviour.

Faulty information processing:

Aaron Beck ( 1967) suggested that some people are prone to depression because of faulty information procesing i.e thinking in a flawed way.

When depressed people attend to the negative aspects of a situiation and ignore positives, they aklso tend to blow small problems out of proportion and think in 'black and white terms'.

Depressed people have negative self schemas

A schema is a 'package of ideas and information developed through experience. We use schemas to interpret the world, so if a person has a negative self schemas they interpret all information about themselves in a negative way.

The negative triad

There are three elements to the negative

• Negative views of the world e.g  the world is a cold dark place
• Negative view of the future, e.g there isn't much chance that the economy will get any better
• Negative view of the self, e.g ' I am a failure'

A strength of Beck's theory it has a good supporting evidence:-

For example, Grazoli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability before and after giving birth. They found out that they developed post natal depression.

Another strength is the theory has practical application as a theary:-

Beck's cognitive explanation forms the basis of cognitive behaviour therapy CBT. The components of the negative triad can be easily challenged in CBT. This means a paitent can test whether the elements of the negative triad are true. This is a strength of the explanation because it translates well into a successful therapy

A limitation is that Beck's theory does not explain all aspects of depression:-

Depression is a complex disorder. Some depressed paitents are deeply angry and Beck cannot easily explain this extreme emotion. Some depression paitents suffer halluciantions and bizarre beliefs, or suffer Cotard syndrome, the delusion that thye are zombies (  Jarrett 2013 )

Activiting Event:

Albert Ellis suggested that depression arises from irrational thoughts. According to Ellis depression occurs when we experience negative events, e.g. failing important test or ending a relationship.

Beliefs:

Negative events trigger irrational beliefs, for example,

• Ellis called the belief that we must we succed 'musterbation'
• ' I-can't stand-it-itis' is the belief that is it a disaster when things do not go smoothly
• 'Utopianism' is the belief that the world must always be fair and just

Consequences:

When an activating event triggers irrational beliefs there are emotional and behavioural consequences. For example, if you believe yopu must always succed and thyen you fail at sometyhing, the consequence is depression.

A limitation is that Elli's model is a partial explantion of depression:-

There is no doubt that somke cases of depression follow activating events. Psychologists call this reactive depression and see it as depression and see it as different from the kind of depression that arises without an obvious cause. This means that Ellis's explanation only applies to some kinds of depression.

A general issue is that cogntions may not cause all aspects of depression:-

cognitive explanations are closley tied up with the concept of cognitive primacy, the idea that emotions are influence by our cognition.This is sometimes the case, buit nhot neccasirly always. Other theories of depression see smotions such as anxiety and distress stroed like physcial enery to emerge some time after their causual event. This casts doubt on the idea that cognitions are alwaus the root cause of depression and suggests that cognitve theories may not explain all aspects of the disorder

Beck: Paitent and therapist work together

• They work together to clarify the paitents problem
• Identify where theremight be negative or irrational thoughts that will will benefit from the challenge

Challenging negative thoughts relating to negative triad

• The aim is to identify negative thoughts about the self, the world and the future - the negative triad
• These thoughts must be challenged by the patient taking an active role in their treatment

The paitent as a scientist

• Paitents are encouraged to test the reality of their irrational beliefs
• They might be set homework, e.g. to record when they enjoyed an event or when someone was nice to them this is referred as the patient as the scientist
• In future sessions if patients say that no- one is nice to them or there is not point going on, the therapist can produce eveidence to prove the paitents beliefs incorrect

A strength of CBT is that it is effective

• There is lots of evidence to support the effectiveness of CBT for depression, e.g. March Et Al (2007) compared the effects of CBT with anti- depressant drugs and a combination of the two in 327 depressed adolescents
• After 36 weeks 81% of the CBT group, 81% of the anti depressant and 86% of the CBT and anti depressants group were significally improved.
• CBT emerged as just as effective as the medication and helpful alongisde medication.
• This suggests there is a good case for making CBT the first choice of treatment in public health care systems like the NHS.

A limitation of CBT is it may not work for the most severe cases of depression

• In some cases depression can be so severe that patients cannot motivate themselves to take on the hard cognitive work required for CBT
• Where this is the case it is possibel to treat paients with anit depressant medication and commence CBT when they are more alret and motivated
• This is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression

Ellis's rational emotive behaviour therapy ( REBT )

REBT extends to the ABC model to an ABCDE  model

• D standing for dispute challenge irrational beliefs
• E for the effect

Challenging irrational beliefs

• A paitent might talk about how unlucky they have been or how unfair life is. An REBT therapist would identify this as untopianism and challenge it as a irrational belief
• Logical arguement - disputing whether the negative thought actually follows from the facts

Behavioural Activation

As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms

The goal of treatment, therefore, is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood, e.g. exercising , going out to dinner etc

Success may be aachived due to paitent therapist relationship

Rozenwieg (1936) suggested that the differences between various methods of psychotherapy might actually be quite small. All psychotherapies have one essential ingrident - the raltionship between therapist and patient. It may be the qualityy of this relationship that determines success rather than any particular technique. Many comparitive reviews (e.g Luborsky et al 2002) find very small differences between therapies, suggesting they share a common basis.

A limitation is that some patients really want to explore their past

• One of the basic principles of CBT  is that the focus of the therapy is on the patients present and future, rather than their past. In some other forms of psychotherapy paiteints make links between childhood experiences and current depression. The 'present focus' of CBT may ignore an imporatnat aspect of the depressed patients experience.

A limitation is that there may be an overemphasis on cognition

CBT may end up minimising the importance of the circumstances in which the patient is living ( McCusker 2014) A patient living in povery or sufffering abuse needs to change their circumstances, and any approach that emphasises what is in the patients mind rather than their environment can prevent this. CBT techniques used inappropiately can demotivate people to change their situation.

Behavioural:

• Activity levels- sufferers of depression have reduced levels of energy making them lethargic. In extreme cases, this can be so severe that the sufferer  cannot get out of bed.
• Distruption to sleep and eating behaviour -sufferers may experience reduced sleep (insomnia) or an increased need for sleep (hypersomnia)
• Appetite may increase or decrease, leading to weight gain or loss

Cognitive

• Poor concentration- sufferers may find themselves unable to stick with a taks as they usually would, or they might find a simple decision making difficult.
• Absolutist thinking - ' Black and white thinking' when a situation is unfortunate it is seen as an absolute disaster

Emotional

• Lowered mood - more pronouced than the daily experiecne of feeling lethargic or sad. Sufferers often describe themselves as 'worthless' or 'empty'
• Anger - on occasion, such emotions lead to aggression or self harm