Psychopathology (Abnormality)

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Definitions of abnormality

  • The term "abnormal" means deviating from the average (norm)
  • if we adopt a literal approach to defining abnormality, we could conclude that any rare behaviour or ability was abnormal
  • this is not a useful way to define abnormality as it takes no account or whether or not the "abnormal" behaviour is desirable
  • Defining abnormality is not easy, but this does not mean that the phenomenon of abnormality does not exist
  • in every society, people identify behaviours that they consider abnormal
  • there are 3 ways of defining abnormality which can be considered
  • these are:
  • deviation from social norms
  • failure to function adequately
  • deviation from ideal mental health
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Deviation from social norms

  • Social norms are the explicit and implicit rules that a society has about what are acceptable behaviours, values and beliefs
  • every society sets up rules for behaviour based on a set of moral standards
  • some of these rules are explicit and to violate them that may mean breaking the law
  • behaviours that violate legal norms are called criminal
  • other rules are implicit and are agreed as a matter of convention within a particular society
  • these rules including not standing too close to someone in a face to face conversation
  • rules (codes) of conduct whether explicit or implicit become established as social norms
  • people who violate such norms are often regarded as deviant or abnormal
  • at a practical, every day level, deviation from social norms can be a useful way to identify mental problems
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Limitations of deviation from social norms definit

1) Eccentric or abnormal? :   deviation from social norms does not always indicate psychological abnormality we often decide that behaviours that deviate from the norm are merely eccentric rather than abnormal  in a pathological sense behaviour regarded as eccentric may be judged as indicating mental illness if the degree of eccentricity is great enough  2) Abnormal or criminal? behaviour of people who violate legal norms is usually regarded as criminal and the behaviour is rarely attirbuted to an underlying psychological disorder   3) the role of context: much of our behaviour is context specific and out of context may seem bizarre  4) Change with the times: beliefs about abnormality and social norms of morally acceptable behaviour change over time (homosexuality)

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Failure to function adequately

  • People with psychological disorders often experience considerable suffering and distress and a general inability to cope with their everyday activities such as being unable to go to work or take part in social activities
  • failure fo function adequately view of abnormality carried certain implications
  • if someone's behaviour appears strange or abnormal to others, then provided they aren't harming themselves or others and that their behaviour is not dysfunctional, then no intervention is required
  • this view of abnormality means that someone whose problem falls outside criteria for serious mental disorder should be given professional help if they experience a dysfunction in their daily living
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Limitations of failure to function adequately defi

1) doesn't show the whole picture:

  • not a true definition of abnormality
  • it is a way of determining the extent of a person's problems and the likelihood that they might need professional help
  • it's seen as abnormal when behaviour interferes with daily functioning such that people lose the ability to work or the motivation to care for themselves properly

2) exceptions to the rule:

  • student experiencing anxiety and distress may behave inadequately but this would not be regarded as abnormal

3) Direction of causality: cultural issues:

  • may be that the inablility to cope with demands of dail living is the cause rather than the outcome of mental disorders
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Deviation from ideal mental health

  • Notion of "ideal mental health" first put forward by Marie Jahoda in 1958
  • Turns the traditional approach to abnormality on its head by looking at positives rather than the negatives
  • the notion of mental health rather than mental illness
  • Jahoda identified 6 major criteria for optimal living which she believed promoted psychological health and wellbeing
  • anyone lacking these qualities, she claimed, would be vulnerable to mental disorder
  • the 6 criteria are:
  • 1) positives attitudes towards self: having a positive self concept and sense of identity
  • 2) Self actualization of potential: first proposed by Abraham Maslow who suggested that we all have potential and that we constantly strive to fulfil this potential
  • 3) resistance to stress: Jahoda called this the ability to tolerate anxiety without disintegration
  • 4) Personal autonomy: autonomous people are reliant on their own inner resources and can remain stable evenin the face of hard knocks, frustrations and deprivations
  • 5) accurate perception of reality
  • 6) adapting and mastering the environment
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Limitations of deviation from ideal mental health

  • Refreshing approach as it focuses on positive rather than negative aspects of life
  • specific limitations include the following:
  • difficulty of self-actualizing: very few people are able to achieve their full potential in life
  • possible benefits of stress: as far as resistance to stress is concerned, some people work more efficiently in moderately stressful situations
  • Cultural issues: Jahoda's ideas are based on Western ideals of self-fulfilment and individuality
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Biological approach to psychopathology

  • the biological approach says that mental disorders are caused by abnormal physiological processes such as genetic and biochecmical factors
  • psychological abnormality, according to this model, is an illness or disease
  • biological approach has dominated the field of mental health in the last 2 centuries

Key features of the biological approach:

  • Mental disorders are thought to be related to the physical structure and functioning of the brain 
  • disorders where a clear oganic cause has not been identified have been traditionally referred to as functional disorders
  • people who adopt the biological approach believe that research will eventually show that all mental disorders have an underlying physical cause
  • Physical causes include the following
  • Brain damage: abnormal behaviour may occur if the structure of the brain is damaged in some way
  • Infection: we are familiar with the idea of bacteria or viruses causing physical illness such as meningitis or flu
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Biological approach to psychopathology

Physical causes of mental disorders (continued):

  • Biochemistry: neurotransmitters are thought to be out of balance in the nervous system of individuals with certain psychological disorders
  • for example, schizophrenia has been associated with an excess of activity in the neurotransmitter dopamine
  • Hormones: also have been implicated in the origins of some mental disorders.
  • for example, people with depression are often found to have higher than normal levels of the hormone cortisol
  • Genes: important new genetic research has highlighed the possibility that some people may be genetically at risk of developing a mental disorder
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Evaluation of the biological/medical model

No blame:

  • a diagnosis of mental "illness" implies that the person is not responsible for their abnormal behaviour and as a reuslt is not to blame

Stigma:

  • Szasz pointed out that, even more than physical illness, mental illness is something that people fear, largely because it is something they do not understand

Relinquishing responsibility:

  • people are encouraged to become passive patients, handing over respnsibility for their wellbeing to professionals

Reductionist:

  • biological explanation of abnormality is criticized for being reductionist i.e breaking it down to a fundamental level 
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Psychodynamic approach to psychopathology

Psychodynamic approach views abnormal behaviour as caused by unconscious, underlying psychological forces. Freud believed all behaviour, normal and abnormal, derived from unconscious forces and that psychopathology arose from the dynamic working of the personality rather than from physical causes According to Freud, the psyche consists of 3 interrelated structures and the id and the superego are bound to conflict Strong ego: the well adjusted person develops a strong ego able to cope with the demands of both the id and superego by allowing each expression at appropriate times.  if the Ego is weakened, then either the id or superego may dominate personality  Unchecked id impulses: if id impulses emerged unchecked, they are expressed in destructiveness and immorality  too powerful superego: rigidly restricts the id to the extent the person will be deprived of socially acceptable pleasures

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Unconscious conflicts cause psychopathology

Unresolved conflicts: ego may be unable to balance the competing demands of the id and the superego Freud maintained that these internal conflicts occur at an unconscious level so we may be unaware of their influence Freud believed people go through stages of psychosexual development, oral, anal, phallic, latency and genital if conflict is not satisfactorily resolved then psychological or behavioural problems may arise later on children who fail to identify with their parents during the phallic stage will find it impossible to develop a conscience and will be at risk of antisocial personality disorder Early experiences: immature ego is not developed fully enouogh to deal with external events such as maternal absences, parental shortcomings or competition with siblings traumatic or confusing events in childhood are pushed into the unconscious, a process which Freud called repression because they are too painful for the ego to bear

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Ego defence mechanisms

  • In order to balance the demands of the id and superego and to protect itself, the ego employs defence mechanisms
  • these mechanisms distort or deny reality and are essential ways of protecting the ego from distress and allowing the person to cope with life
  • they have a powerful yet unconscious influence upon our behaviour and everyone uses them
  • according to Freud, the behaviour of all people is to some extent "abnormal" in that none of us is free from the dynamic conflicts caused by our unconscious drives and repressed memories 
  • 6 stages are as follows
  • Repression: prevents unacceptable desires, motivations or emotions from becoming conscious
  • Projection: when people's own unacceptable faults or wishes are attributed to someone else
  • Denial: refusing to believe events or admit they are experiencing anxiety-provoking emotions
  • Regression: responding to anxiety by behaving in childish ways
  • Displacement: diverting emotions to someone else because the emotions can't be expressed to the person concerned
  • Sublimation: divering emotions onto something else rather than someone else
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Evaluation of psychodynamic model

Influential:

  • Freudian theory has been enormously influenial and was the first model to establish talking therapy as an acceptable form of treatment in the mainstream mental health practice
  • Untestable: psychodynamic model has proved difficult to test scientifically
  • Retrospective data: research indicates that many people with psychological problems do recollect having experienced emotional truama in childhood 
  • Determinism: psychodynamic model claims that abnormal behaviour results from unconscious psychic conflict related to innate, biological drives. Model also claims that early relationships with parents are important for psychological development
  • Current experiences: Freud's psychoanalytic approach has been criticized for understimating the importance of current difficulties the clients might be facing 
  • Ethical implications: implicit assumption of the psychoanalytic approach is that people are not to blame for their own abnormal behaviour but may be partially responsible for the development of abnormal behaviour in their offspring
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The behavioural approach

Classical conditioning:

  • theory of classical conditioning explains how behaviour is learned through "stimulus response" associations
  • an event in the environment (stimulus) results in physiological reaction (response) in the individual 
  • the event and the reaction are then forged into an association
  • phobias are thought to develop in this way 
  • In classical conditioning, it is not the object nor the situation which is the cause of the fear but the conditioned response to the object or situation 

Operant conditioning

  • Skinner (1974) explained how our behaviour is influenced by the consequences of our actions
  • we learn at an early age, which of our actions are rewarded and which are punished
  • psychological disorders have been explained in operant conditioning terms
  • if childhood aggression is rewarded, the behaviour is likely to be repeated
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The behavioural approach

Social learning:

  • according to social learning theory, many behaviours aer learned through imitation, by observiing others who serve as models for behaviour
  • observational learning is particularly powerful if those who model the behaviour are seen to be rewarded
  • some specific phobias such as fear of harmless spiders may be explained by social learning, by observing other people showing fear when they see a spider

Evaluation of the behavioural approach:

  • focus on behaviour- overcomes the ethical issue raised by the medical model of labelling and thereby stigmatizing someone as abnormal
  • focus on functioning- provided the behaviour presents no problems to the individual or to other people, there is no reason to regard the behaviour as a mental disorder 
  • underlying causes- those who support the model claim that it focuses only on symptoms and ignores the causes of abnormal behaviour
  • reductionism - accused of being reductionist and simplistic as it seeks to explain complex behaviours in very narrow terms
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Cognitive approach to psychopathology

  • Cognitive approach stresses the role of cognitive problems in abnormal functioning
  • this understanding of abnormality was founded by Albert Ellis (1962) and Aaron Beck (1963) who thought that the weaknesses of the model was that it did not take mental processes into account
  • Key features of the cognitive approach
  • Irrational thinking (Ellis 1962)
  • Cognitive approach assumes that emotional problems can be attributed directly to distortions in our thinking processes
  • these distortions take the form of negative thoughts, irrational beliefs and illogical errors e.g polarized thinking, overgeneralization 
  • Maladaptive thoughts usually take place automatically and without full awareness
  • Ellis maintained that everyone's thoughts are rational at times and irrational at others 
  • psychological problems occur only if people engage in faulty thinking to the extent that it becomes maladaptive for them and others around them
  • According to Ellis, when we think rationally, we behave rationally and as a result we are happy, competent and effective
  • when we think irrationally, the result can be psychological disturbance
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The cognitive triad and errors in logic (Beck 1967

  • Beck believed that negative thoughts underlie mental disorder
  • He was particularly interested in finding out why people became depressed
  • identified mechanisms that he thought were responsibile for depression
  • Errors in logic: found that ddepressed people tend to draw illogical conclusions when they evaluate themselves
  • this faulty logic is called overgeneralization, drawing a sweeping conclusion on the basis of a single event
  • Cognitive triad: Beck identified 3 forms of negative thinking that he called the cognitive triad
  • these were: negative views about the future, negative views about oneself and negative views about the world
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Evaluation of the cognitive model

  • Research support: Research has shown that many people suffering from mental disorders do exhibit thought patterns associated with  maladaptive functioning. 
  • Irrational thinking: Cause or effect? Criticism of the model is that it doesn't attempt to examine the origins of irrational thinking nor does the treatment address these origins
  • Individual is responsible: cognitive model has been criticized because it suggests that everyone should be self-sufficient
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Biological therapies

Biological treatments are interventions that aim to redress biological abnormalities such as biochemical imbalances

The treatments fall into 3 categories:

  • drug treatment
  • ECT (Electro convulsive therapy)
  • psychosurgery
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Drug treatment

  • Drug therapy (chemotherapy) is the main treatment for mental disorders and is based on the assumption that chemical imbalance is at the root of the problem
  • drugs for mental disorders include the following
  • anti-anxiety drugs, eg benzodiazepines like Valium 
  • Anti-depressant drugs which improve mood by increasing the availability of neurotransmitters such as serotonin
  • anti-psychotic drugs e.g major tranquillizers such as phenothiazines which sedate and alleviate symptoms of the preson suffering from psychotic disorders such as schizophrenia

Evaluation of drug treatment:

  • efficacy: drug treatment has been found to be effective in relieving the symptoms of mental disorders in many but not in all people
  • side effects: drugs may also have side effects that may be considered worse than the original symptoms of the disorder
  • Treating the symptoms: psychologists have criticised psychiatry for focusing on symptoms and assuming that relieving symptoms with drugs cures the problem
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Electro-convulsive therapy (ECT)

Procedure:

  • patient lies on a bed in loose clothes and receives an anaesthetic and muscle relaxant before treatment
  • ECT involves passing a current through the brain for approximately half a second
  • this is done by fixing electrodes to the patient's temple
  • in the past, electrodees were put on each side of the forehead, nowadays it's more common to use unilateral ECT by fixing 1 electrode to the non-dominant hemisphere

Use of ECT:

  • Originally used in an attempt to help patients suffering from schizophrenia
  • now it's mainly used to treat people with severe depression
  • treatment is typically given 2 or 3 times a week for 3 or 4 weeks
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ECT

Evaluation of ECT:

  • efficacy: quick form of treatment compared with drugs or psychological therapies and can be an effective short term treatment for depression with 60-70% of patients showing improvement
  • when to use: ECT should only be administered if anti-depressant drugs have no effect and there is a risk that the person will commit suicide
  • Mode of action: not clear how ECT works, but may increase the availability of certain neurotransmitters in the brain 
  • side effects: when first introduced, there were serious side effects such as bone fractures and memory loss however these have been reduced
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Psychosurgery

  • Brain surgery to treat psychological disorders
  • it's the most invasive form of biological therapy because it involves removal of brain tissue and the effects are irreversible
  • nowadays, psychosurgery techniques involve less damage to neural tissue
  • psychosurgery is rarely used and is only offered as a last resort for treating otherwise intractable conditions

Evaluation of psychosurgery:

  • controversial treatment
  • used as a last resort
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Psychological therapies

  • term "psychological therapy" covers treatment that addresses psychological rather than biological factors associated with mental disorder
  • each psychological approach to abnormality has its own therapies
  • there are many different types of psychotherapy including:
  • psychoanalysis - based on the psychodynamic approach
  • systematic desensitization - based on the behavioural approach
  • aversion therapy - based on the behavioural approach
  • token economy - based on the behavioural approach
  • cognitive behavioural therapy - based on the cognitive approach
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Psychoanalysis

Aim of psychoanalysis:

  • aims to bring repressed impulses and traumatic memories into conscious awareness 
  • facilitate insight into the conflicts and anxieties that are the underlying causes of abnormal behaviour
  • cure neurotic symptoms, such as phobias or anxiety

Methods of psychoanalysis:

  • dream analysis: according to psychodynamic theory, the unconscious is revealed in dreams therefore one of the techniques of psychoanalysis is the analysis of dreams
  • free association: clients encouraged to let their thoughts wander and say whatever comes to their heads without editing or censorship
  • transference: important part of psychoanalysis is when the client projects on to the analyst characteristics they unconsciously associate with parents or other important people
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Systematic desensitization

  • If maladaptive or dysfunctional behaviours have been learned through classical or operant conditioning, it should be possible ot change them through the same processes
  • behavioural therapy, therefore takes a practical, problem-solving approach
  • therapies based on classical conditioning include systematic desensitization and aversion therapy

Aim:

  • systematic desensitization uses reverse conditioning and aims to replace maladaptive response to a situation or object by eliciting another healthier response to the situation or object that is incompatible with the undesirable response
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Aversion therapy (behavioural approach)

  • Aversion therapy is another behavioural treatment based upon classical conditioning 
  • aims to rid an individual of an undesirable habit by pairing the habit with unpleasant consequences 

Procedure in aversion therapy

  • aversion therapy is used to deal with addictions such as smoking or alcoholism 
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Behaviour modification (behavioural approach)

  • Behaviour modification is a procedure based on operant conditioning 
  • aims to modify behaviour that is antisocial or maladaptive by reinforcing appropriate behaviour and ignoring inappropriate behaviour
  • token economy - behaviour modification procedure where tokens are given when desirable behaviour is performed
  • tokens can later be exchanged for goods or privileges
  • procedure has been used to encourage self-care and social skills
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Cognitive Behaviour Therapy

  • Rationale behind CBT is that thoughts interact with and influence emotions and behaviour
  • thoughts are persistently negative and irrational and can lead to maladaptive behaviour

Aim:

  • CBT is aimed at encouraging people to examine the beleifs and expectations underlying their unhappiness and to replace irrational, negative thoughts with a more positive, adaptive pattern of thinking
  • therapists and clients work together to set new goals for the clients in order that more realistic and national beliefs are incoroprated into their ways of thinking

Procedures in CBT:

  • therapy session involves both cognitive and behavioural elemts with homework between sessions
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