Psychopathology AO3

• Some desirable behaviours e.g. genius, low anxiety are statistically infrequent but we wouldn't call them abnormal as they are beneficial and do not require treatment.
• Other behaviours are frequent but we would not want to class them as normal e.g. depression.

• This defintion relies on having accurate statistical data for the population and there are many reasons why statistical data may be inaccurate.
• Some have suggested gender bias as an issue and may be more a reflection of male/ female socialisation e.g. women are more likely to share their feelings with their doctors while men will bottle up their feelings. 

• This defintion is based on a standard set by a particular population and the standards may not apply to people of different cultures or ages.
• Also, the statistics may again reflect the likelihood to seek medical assisstance. For example, in China mental illness carries a great stiga and therefore is only diagnosed if the person is undisputedly psychotic.

• The concept of social deviancy changes over time as a consequence of prevailing social attitudes e.g. homosexuality being considered a mental illness of the DSM until 1973. Therefore, this defintion of abnormality would change over time and be inconsistent.

• Social standards vary from culture to culture and one society's norms should not be used to define another society's culture as abnormal. For example, in some countries they eat insects or practice sorcery. Mnay people in the world would view behaviours such as birth control and having one spouse as abnormal.
• Therefore, this defintion may result in the incorrect diagnosis of abnormality.

• It is argued that abnormality is a socially constructed concept that allows people who are unusual to be labelled and treated differently by others.
• For example,a diagnosis of insanity in Russia has been used to detain political dissidents and in Japan has been used to ensure a strong work ethic. 
• In the 19th century women were frequently diagnosed with moral insanity when they inherited money and spent it on themselves rather than on their male relatives. This diagnosis allowed men to strictly control women in line with their own interests.
• Thereforem in using this defintion social control becomes easy.

• This defintions involves making subjective judgements about others as to what constitues failure of function adequately.
• Who makes this judgement?
• There are ethical issues with doctors making judgements about other people's functioning as it involves labelling people. 
• But can the individual decide? For example, schizophrenics often deny they have a problem.

• Many 'normal' people fail to cope with the demands of life at certain times e.g. bereavement or before a stressful exam.
• In fact, in these situations if the person does cope we may consider them abnormal.
• Therefore, this defintion is flawed as there are exceptions.

• This defintion is likely to result in different diagnoses when applied to people in different cultures, because the standard of one culture is being used to assess another.
• This may explain why lower-class and non-white patients are more often diagnosed with mental health disorders- because their lifestyles are different from the dominant culture which may lead to a judgement of failing to function adequately.
• Therefore, using this defintion may result in an incorrect diagnosis of abnomrality.

• The criteria are so demanding for ideal mental health that everyone would be considered abnormal to some extent.
• For example, very few people reach self-actualisation.

• The list of attibutes has been criticised for being ethnocentic in that it describes individualistic cultures. In collectivist cultures, personal autonomy is thought to be far from idea and even unhealthy. 
• Some cultures, such as the Chippewa culture, deems visions as a great honour whereas in the West it is deemed as an inaccurate perception fo reality.
• Therefore, this definition could result in the diagnosis of abnormality cross-culturally.

• An accurate perception of reality is not a characteristic of normal people.
• Taylor found that depressed patients have a more accurate perception of the world than clinically sane people.
• Depressed patients make much more accurate assessments of their place in the world.
• Thereforem the idea of accurate perception of reality as ideal mental health is flawed.

• Perceptions of reality chnage with new knwoledge e.g. once peole thought the world was flat and in fact anyone who challeneged this was considered abnormal.
• Therefore, in using this defintion abnormality would change over time and be inconsistent.

• Lab experiments have found support for classical and operant conditioning.
• These are scientific and allow for controlled tests that are objective and provide empirical data.
• Therefore, the theory is falsifiable.

• The behavioural explanation has led to effective treatments for phobias, these show abnormal behaviour can be reduced by unlearning behaviours. 
• For example, SD and flooding both involve exposure to the phobia to help break the learnt association.
• SD has a 75% success rate.

• Some phobia may be learnt through processes other than the two-process model. Those who are scared of spiders are more likely to cite modelling as the cause.

• The theory is deterministic because it suggests that people have no control over their phobias as it is determined by the environment. 
• For example, the theory says a learnt association WILL lead to a phobia when in fact it might not.

• The theory is reductionist as it reduces phobias to learnt behaviours which is too simplistic. 
• In fact, there are other explanations that have been proposed to explain them such as the evolutionary, cognitive of social learning approaches.

• In SD, the patient does not have to experience intense anxiety as they are in in control i.e. they only move up the hierarcy when they feel relaxed and ready to do so.
• Therefore, there shouldn't be any ethical issues with this form of treatment.

• SD has a high success rate of 75% with simple phobias and 90% for blood-injection phobias after 5 sessions of gradual exposure. The treatment is most successful when real stimuli is used rather than imagined.

• SD is a relatively fast treatment and requires less effort from the patient compared to other psychological therapies e.g. CBT requires patients to understand their thoughts and consequent behaviour and apply these insights which lead to a change in thought and behavioural processes.
• The lack of 'thinking' involved in SD means it can be successful with children and those with learning difficulties.

• SD can be self-administered(people can work up the hierarchy on their own) and this has been shown to be just as effective as therapist guided therapy.
• This is a cheaper alternative to paying for a therapist.

• Some argued that behaviourist techniques are not dealing with the cause of the phobia only the symptoms.
• If the symptoms are removed by treatment, the cause still remains. This means the symptoms could resurface e.g. the psychodynamic approach argues that phobias occur due to projection.
• Little Hans had a fear of horses but his actual problem was the intense envy of his father but he could not express this directly so his anxiety projected onto the horse.
• The phobia was cured when he accepted his feelings about his father. If the threapise had only treated the horse phobia the underlying problem might have resurfaced elsewhere.

• Flooding is a relatively quick treatment compared to CBT and SD. This is because it only involves 1 single treatment session as it works on the basis that fear has a time limit, whereas SD involves multiple sessions exposing the patient to the stimulus.

• Flooding has been showen to be effective.
• Choy et al reported that both flooding and SD were effective but flooding was the most effective of the two.
• Another study found SD and flooding were equally effective.

• Flooding can be a highly traumatic treatment as patients will experience intense anxiety. Especially when compared with SD which gradually exposes the patient gradually to the phobic object/situation.
• Therefore, there are ethical issues with the use of this treatment.

• If patients quit during treatment (likely due to extreme dear repsonse the immediate exposure causes), its effectiveness will be reduced. In fact, it could make the phobia worse as it will reinforce the fear.

1. Identical twins may have more similar environments than DZ twins as they may be treated similarly because they look identical. Therefore, this may be the reason MZ twins are more similar rather than genes. This undermines the theory behind the comparisons.

2. Concordance rates are never 100% which means that environmental factors must play a rle too. The diathesis-stress model is a better explanation of the causes behind disorders, it is likley that genetics create vulnerability for OCD and other factors affect if the condition develops and which disorder it is. Supporting evidence for this is from Cromer who found that over half of OCD patients in their sample suffered a traumatic event in their past.

1. Supporting evidence comes from PET scans of patients with OCD taken while their symptoms are active. These scans show heightened activity of the OFC therefore supporting that this brain region is involved in OCD.

2. The neural explanation is supported by the findings that drug treatments which increase serotonin have been found to decrease OCD symptoms. Furthermore, this finding has implications for providing effective treatments for OCD. Drug treatments work on the premise that if an imbalance of neurotransmitters is the cuase of mental illness then using drugs to alter NTs can be effective in treating illnesses.

3. Because the cause is biological, it takes the blame of mental illness away from the patient.

On the other hand, the cognitive approach to OCD could make the patient feel they are to blame as it is their faulty thinking causing the disorder.

However, accepting the genetic cause of OCD may make parents feel guilty as they have passed on the genes to the individual.

1. A weakeness of the biological model is that it is reductionist. This is because it reduces the complex causes of abnormality down to just biological causes, such as genes. This is too simplistic as there are likely to be other causes to OCD, such as environment, out thought processes and the unconscious. For example, the two process model can be applied to OCD- initial learning occurs through CC when a stimulus is asscoiated with anxiety. This is maintained through OC as the stimulus is avoided using compulsive behaviours to reduce the anxiety. This then causes the obsession to form.

2. Because it argues that the cause is biological it removes responsibility and control from the individual and may make them feel powerless. This means the theory is determinist and removes freewill from the patient.

1. A weakeness of the biological model is that it is reductionist. This is because it reduces the complex causes of abnormality down to just biological causes, such as genes. This is too simplistic as there are likely to be other causes to OCD, such as environment, out thought processes and the unconscious. For example, the two process model can be applied to OCD- initial learning occurs through CC when a stimulus is asscoiated with anxiety. This is maintained through OC as the stimulus is avoided using compulsive behaviours to reduce the anxiety. This then causes the obsession to form.

2. Because it argues that the cause is biological it removes responsibility and control from the individual and may make them feel powerless. This means the theory is determinist and removes freewill from the patient.

• Improvement is reported in around 50-80% of OCD patients cases taken SSRIs. A review of 17 studies found them to be more effective than placebos in reducing OCD symptoms up to three months after treatment .However, as the studies were only 3 months in duration it is unclear as to whether the effects last long term.

1. SSRIs recently have been the target of media frnezy because there are many anecdotal reports of serious side effects including a preoccupation with violence and suicide. Compared to placebos patients are twice as likely to attempt suicide if taking SSRIs.

2. Other side effects include; nausea, insomnia, diarrhea and sexual dysfunction(70-80% of men).

3. SSRIs can take up to 4 week to be effective.

PRO: BZs have been effective in reducing feeling of anxiety and panic. Lecrubier found that 60% of patients with panic disorders remained free of panic whilst on medication, suggests they would have the same effect on OCD anxiety. In addition, they have almost immediate effects whereas anti-depressants can take up to 4 weeks to work.

CON: BZs create dependence on the drug, sometimes for many years after the inital problem has been resolved. Dependence also leads to physical withdrawal symptoms such as; tremors, irritability and insomnia. Therefore, nowadays GPs restrict such drugs to short courses.

PRO: BZs have been effective in reducing feeling of anxiety and panic. Lecrubier found that 60% of patients with panic disorders remained free of panic whilst on medication, suggests they would have the same effect on OCD anxiety. In addition, they have almost immediate effects whereas anti-depressants can take up to 4 weeks to work.

CON: BZs create dependence on the drug, sometimes for many years after the inital problem has been resolved. Dependence also leads to physical withdrawal symptoms such as; tremors, irritability and insomnia. Therefore, nowadays GPs restrict such drugs to short courses.

PRO: A strength of drug treatment is that it allows many people to live normal lives and greatly improves quality of life. Many people prefer drugs to receiving therapy, this may be because taking medicine is a familiar activity whereas psychological treatment is unfamiliar and many people feel threatened by it. 

CONS: 

1. Drugs remove control from the patient and place it into the hands of the doctor whereas therapy would give them more control. 

2. Drug treatments only treat the symptoms of the illness and not the cause. For example, anti-anxiety drugs just decrease the symptoms of OCD. This means that when the patient stops taking the drugs the symptoms will return. Statistics shows that there is a 90% relapse rate when BZ medication is ceased. In addition, ceasing the drugs can lead to rebound anxiety. In comparison psychologica treatments such as CBT offer a more long term cure because they address the cause behind the OCD.

3.There are issues with the studies showing the effectiveness of drugs. Some argue that the positive findings are a result of publication bias. Negative or neutral results are not published. Even more sinister are the accusations made about research funded by drug companies. It has been shown that research funded by these companies is more likely to find favourable results than research by other sources and it may be that drug companies actively suppress damaging findings.

1. Research has supported Beck's notion of faulty info processing in depression. Perez et al compared sufferers of major depression with non-depressed Ps in whom a sad mood was induced by playing sad music and reclaling unhappy memories on a Stroop task involving unhappy stimuli. The major deressive group, but no the sad-mood Ps, paid significantly more attention to unhappy words in the Stroop task. The phenomenon, where depressed people pay more attention to unhappy stimuli is called negative attentional bias. Therefore, supporting the idea that people with depression show cognitive bias.

2. Grazioli and Terry assessed cognitive vulnerability in 65 women in the 3rd trimester of pregnancy and found that those with high levels of cognitie vulnerability were more likely to suffer post-natal depression. Thus, showing the negative thoughts did come first and later led to depression.

3. Applications for treatment- the cognitive model has given rise to cognitive behavioural therapy, which aims to chllenege and neutralise them them through techniques such as cognitive restructing. This has been found 90% effective.

1. Data between negative thinking an depression is only correlational so we cannot determine cause and effect. Many argue that the negative thinking is an effect of depression rather than a cause.

2. Some 'irrational beliefs' are in fact more accurate than those of most people, a phenomenon known as 'depressive realism' or the 'sadder but wiser' effect. For example, depressive people give more accurate estimates of the likelihood of diaster than controls do,

3. Negative thinking may not be specific to depression e.g. anxiety, eating disorders. This means it is dterministic- negative thinking may not lead to depression, it could also leave to other disorders.

4. The theory is rductionist as it reduces depression down to faulty thinking, this is too simplistic as there are other explanations of deoression such as biological factors. It may be that depression is caused by an imbalance in neurotransmitters. Anti-depressants which increase serotonin levels seem effective suggesting this may be the cause. Some research has shown a gene that is 10x more likely in people with depression. 

• Ellis claimed a 90% success rate for REBT taking an average of 27 sessions to complete treatment. However, these results could be biases as Ellis devised REBT.
• In a meta-analysis of other therapies they cited REBT as having the second highest average success rate of 10 forms of therapy.
• However, it may not be useful in situations where high levels of stress are due to realsitic stressors in a person's life that can't be changed. Also, CBT may not work for the most severe cases of depression because the patient may not feel able to motivate themselves to attend the session or to pay attention during the session. In this situation a combination of drug treatments and CBT may be more useful.
• Evidence: For major depression REBT in conjunction with medication is more effective than medication alone. CBT and antidepressants have been used together to reduce the risk of suicide.
• One study investigated 327 adolescents aged 12-17 with depression which were assigned to 3 conditions (prozac, CBT or prozac and CBT combined). They found that CBT significantly reduced suicidal thoughts from 30% at the beginning to 6% at the end(compared to 15% of those on prozac at the end of the study).

YES

• Cognitive therapies are cost-effective because they do not usually involve prolonged treatment or delve too deep into hidden fear such as psychoanalysis.

NO

• Some 'irrational beliefs' are in fact more accurate than those of most people- this is known as depressive realism. Is it therefore appropriate to 'change' their thinking if it is actually more accurate in the first place.
• REBT has been criticised for focusing on symptoms rather than causes e.g. changes faulty thinking but doesn't look at why these thoughts developed in the first place. If causes are not addressed depression might reoccur.

YES

• Cognitive therapies are cost-effective because they do not usually involve prolonged treatment or delve too deep into hidden fear such as psychoanalysis.

NO

• Some 'irrational beliefs' are in fact more accurate than those of most people- this is known as depressive realism. Is it therefore appropriate to 'change' their thinking if it is actually more accurate in the first place.
• REBT has been criticised for focusing on symptoms rather than causes e.g. changes faulty thinking but doesn't look at why these thoughts developed in the first place. If causes are not addressed depression might reoccur.

PROS

• REBT porvides clients with strategies for self-help, so the patient is in control which is helpful in itself. Therefore, it is less manipulative than other behavioural treatments.

CONS

• REBT is regarded as one of the most aggressive forms of CBT, as it is judgemental about the nature of a client's thoughts- We are essentially blaming them for their depression and telling them they must change the way they think. There are ethical issues surrounding this.