Deviation from Social Norms
- All societies have standard and norms- person act socially deviant way break societies standards is abnormal.
- Based abnormal behaviour percieved unpredictable, causes observer discomfort, violates moral standards- irrational differs from common ways.
- Culturally relative, vary from time periods.
- may be illegal, not abnormal e.g. speeding, can become outdated.
Deviation from ideal Mental Health
Marle Jahoda- 6 characteristics ideal mental health define abnormal.
- Positive attitude towards self
- Personal growth
- Integration- cope with stress
- Autonomy- independence
- Perception of Reality- realistic terms
- Adaptable to environment
- Used for a range of cultures, positive attitude to mental health- bettering ourselves.
- Many categories difficult to meet, how many not meet before abnormal?
Failure to function Adequately
- Most societies expectations of how people live lives, contribute to social groups around them, not meet them- society and person feel failure to function.
- If behaviour/mood affect wellbeing, danger to others and themselves are abnormal.
- Rosenhan and Seligman- 7 characteristics class abnormal:
- Suffering, maladaptiveness, unconventional behaviour, unpredictable behaviour, irrationality, violation of moral standards and observer discomfort.
- Can be adaptive to individual, based on the individual.
- Biased on who judges it, result economic/social conditions?
- Brain injury
Same symptoms frequently occur together, represent syndrome/disorder cause "aetiology" one of the above.
- Alzheimers- neurodegenerative disease- symptoms amnesia, intellectual impairment, ultimate cause unknown, genes important mutation possible cause.
- Korsakoff syndrome- brain disorder associated with alcoholism, AIDs, chronic infecion, poor nutrition, Thiamine how brain make energy, levels too low, brain cells not function properly, inability form new memories, loss existing memories, invented memories.
- Trauma to brain- TBI external force causes brain dysfunction, usually jolt, car crach, closed head injury, bullet to head, penetrating head injury, mild case headaches/temporary dysfunction, serious result bruising/bleeding result long term complications.
- Phineas Gage- iron rod driven through head, change personality behaviour, show part brain affected/to treat.
- symptoms less obvious/different, nothing wrong with brain but abnormal.
- Syphilis- an STI, can spread to heart, brain if untreated.
- Neurosyphilis- affect CNS, over late untreated disease, slow/gradual loss mental/physical function, alterations mood, personality, average 1-10yrs after infection.
- Meningovascular syphilis- inflamation of coverings small blood vessels in brain average 7yrs after initial infection, cause headache, dizziness, strokes, General paresis- chronic dementia severe complication, late stages death follow 2-3yrs, more mood changes, memory loss, confusion.
- Influenza- evidence mother exposed, higher chance schizophrenia in child, 15.7x increase, Ellman- blood samples 50s-60s 1200 pregnant women each trimester, correlation brain changes diagonised kids, increase levels interleukin-8 produced fighting infection during pregnancy.
- Seretonin- high levels decrease noradrenaline- create happiness, lead depression symptoms.
- Dopamine- Welcome Trust Centre Neuroimaging at UCL study increased dopamine made people opt instant gratification, impulsive behaviour.
- Explain ADHD, also could be responsible for schizophrenia, effective treatment with antipsychotic drugs, blow dopanie receptors in brain.
- research into effects dopamine on individual, clinical trials medication, recording effects of them on abnormality.
- not much proof seretonin liked/cause depression, mental health not necessarily caused biological issues- life events.
- McGuffin et al- 224 twins (106 monozygotic, 118 dizygotic) monitored for depression, in MZ 46% concordance depression, in DZ 20% concordance rate- if one had it the other one did too.
- Gottesman- meta analysis of 40 tiwms, MZ 49% concordance schizophrenia, DZ 17% concordance.
- Shows genetic reason but not in all cases as if not be 100% concordance.
- Kendler, Masterson and Davis- relation psychiatric illness and family history of it.
- Looked at paranoid psychosis, schizophrenia, risk greater with participants who had relatives with schizophrenia than medical control group, with relatives 18x more likely diagnose with illness than not affected.
- Conscious- part of mind aware everyday thoughts/feelings
- Preconscious- thoughts and memories not accessible at all times, easily recalled.
- Unconscious- dark shameful, repressed thoughts, memories and feelings.
- Id- primary driving force used newborns meet basic needs, not care about reality, only own satisfaction- present at birth.
- Ego- child interact more world, based reality principle, undesrtand can't be impulsive/selfish meet needs of id take into account reality of situation, maintain balance of id and super ego- present at age 3.
- Super ego- morality principle end phallic stage, develop start rules/regulation, parents/society internal parent, moral and ethical restraints- present at age 5.
- Sublimation- direct emotion something else, socially acceptable form of displacement, e.g. sport tap aggression drives.
- Repression- prevent undesirable becoming conscious, make unconscious so not even aware not disappear, influence behaviour ways unaware of e.g. placid person act out and not recall doing so.
- Denial- refuse believe events, admit experiencing certain emotion provoke anxiety e.g. alcoholic deny dependent.
- Projection- own faults/attributes put onto someone else- can be paranoia e.g. accuse someone of being angry when angry yourself.
- Regression- act childish way- regress earlier behaviour e.g. 9yr old parents divorce, regress to bed wetting again.
- Displacement- divert emotions to someone else, not expressed concern, faults cause anxiety e.g. child angry at parents, resort to bullying.
- Reaction formation- unwanted feeling dealt with exaggeration in opposite tendency e.g. always arguing with someone because don't want to admit you like them.
- Child through stages id look gratification different areas, deprived or overgratified- fixated, effect adult behaviour.
- Oral stage- 18mnths- satisifed feeding, mouth focus, ****, bite may lead smoking, drinking, over eating, dependency of infant, fixated adult over dependence in relationships.
- Anal stage- 18mnths-3yrs- focus on ****, retaining/expelling faeces, child some control, obedience/disobedience fixated lead hygeine, OCD.
- Phallic stage- 3-4yrs- foucs gentails, gratification through stimulation, gender differences noticed, Oedipus complex- boys sex curiosity, mother close- intense desir,e father a rival, fear love father, so identifies with him, absorb/imitate attitude- super ego form.
- Electra complex- girl have no penis, penis envy, up to then close to mother, now father.
- Latency period- 4/5yrs- puberty- remerge at puberty, sexual feelings less focused on self, but on potential partners.
Little Hans Case Study
- AIM- report the findings of treatment of a 5yr olds phobia of horses.
- PROCEDURE- Freud attempt demonstrate linked to oedipus complex, phallic stage, intense love for mother, see father as rival, develop fear of him, cope with identification with aggression, becomes similar to father, so not see as hostile.
- Study carried out by father, Freud only met boy once, reported through correspondance.
- FINDINGS- First reports at 3- active interest in penis, afraid horse bite him in street, connected large penis, afraid go outside due to horses- Freud, want stay with mother.
- Dream- big giraffe and crumpled one, big one called out when took away crumpled, sat on the crumpled one- interpret morning Hans go to parents bed, Father object.
- Hans not like horses black around mouth- father had moustache, also had fantasy married mother, plumber came removed bottom and penis, replaced with bigger.
- Age 19, no recognision of this, now fit and well.
- CONCLUSION- Used study to explain phobias, conscious expression repressed anxieties, fear horses repressed anxieties related to oedipus complex.
- Study was not actually carried out by Freud, data could have been written down wrong by father, and Hans had no recollection of it in later life.
Dora Case Study
- Dora pseydonym for Ida, Freud diagnosed with hysteria.
- 1st dream- house on fire, father by bed woke her, dressed, mother wanted jewels dad said no, went outside.
- 2nd dream- in town not know, then in house, letter from mother saying father dead, can come home now, asked for station always 5mins away, then wods man say 2.5hrs more, offered accompany, saw station could not reach, then home, maid said already cemetry.
- Sexual life- Ida babysat for Herr, and Frau K, dad lover of Frau K, Herr K sexual advances, contact with Ida, from 14yrs, dad offered her, silence over affair.
- Found upsetting, cause mental anguish, trouble breathing, loss voice, coughing, oral problems, manifestation Herr K against her, pressure in chest repressed orally fixated sexuality masking true desires, unconscious encouraging sexual advances.
- Analyse dreams- desire for father, Herr K, Frau K, himself- due to repression hysteria.
- 11 weeks broke off, faced tormentors, admitted all true and symptoms cleared.
Evaluation of Psychodynamic Approach
- Understands humans are complex, disorders could be linked to unresolved conflicts.
- Therapies can be effetive for some people, so they can understand their causes of problems and thus relate anxieties.
- Hard to scientifically test as Freud's claims based subjective interpretations patients dreams focus is on past of patient rather than problems they are currently suffering.
The Behavioural Approach- classical conditioning
- Learn through association, used account phobias- traumatic experience lead conditioning, fear of the experience, generalise to similar situation, adult have phobias.
- Watson and Rayner- clasically condition 11month childn, Little Albert fear fluffy animals.
- Present tame white rat loud noise cause fear, eventually associate rat and fear other fluffy objects, no systematic measure fear, record verbal description.
- No time to decondition as removed before could be done.
- Seligman- preparedness- prepared sensitive biologically relevent stumuli- dangerous animals.
- Ohm et al- for humans condition spiders not flowers.
- Explain phobias, support with Little Albert case study
- Not explain all phobias, some scared spiders without traumatic experience.
The Behavioural Approach- operant conditioning
- learn through consequence
- Skinners rars schedules of reinforcement.
- Through reward and punishment, fundamental human development.
- Normal and disordered behaviour shaped via years conditioning.
- Abnormal behaviour go unpunished, may thing behaviour is acceptable.
- can explain depression/anxiety- see people get attention, do it themselves.
- some behaviour innate- may not be able to stop themselves.
The Behavioural Approach- social learning theory
- Albert Bandura 1960s- humans learn by watching human models who are rewarded for particular behaviour- vicarious learning.
- Imitate models rewarded not punished.
- Used explain much normal behaviour, difficult disorders/abnormality.
- can explain eating disorders, people see models anorexic, copy behaviour.
- Can't explain schizophrenia/never seen behaviour, cannot have copied it.
The Cognitive Approach- Cognitive Triad
- Individuals mental disorders distorted continual thinking, faulty thought process, way think of a problem not the problem itself causes disorder.
- 3 negative schemata- negative self, negative world, negative future.
- Cognitive biases often used by people with depression.
The Cognitive Approach- ABC Model
- Ellis- activating events (A) have consequences (C) affected by beliefs (B), rational or irrational beliefs, affected by cognitive biases also.
e.g A- Mary and her boyfriend break up. B- rationally- sad but learn from it, irrationally- break up her fault, not lovable, always fail. C- desirable emotion- sad, hopeful for better success in future, lead to desirable behaviour- look forward to new relationships, undesirable emotion-guilty, spoilt relationship, unlovable lead to undesirable behaviour- not form new relationships, only fail again.
- Minimisation- not believe do well, how successful they are, not get promotion etc. don't feel would get it.
- Maximisation- burn meal, could be a massive thing, one more thing re-inforce a failure, make smallest failures big deals.
- Selective Abstraction- focus on negatives, even if good things happen not recognise as in shuch a negative view of life, not look at wider picture.
- All or nothing thinking- either success or failure rather than middle ground, not good at something, instantly a failure.
Evaluation of Cognitive Approach
- Therapy based on the model can be very effective in treating anxiety disorders and depression.
- Evidence for cognitive biases/dysfunctional thinking- Clark- panic disorder exaggerate significance of anxiety symptoms e.g. raised heart rate.
- Not taken into account biological factors.
- Depressive realism- negative thoughts an accurate view of world
- Little account for situational/environmental factors.
Biological Treatment- Psychosurgery
- cutting neural tissues in brain- alter symptoms severe disorders.
- Used last resort all other treatment failed- banned in most countries currently.
- Lobotomy- leukomoty or prefrontal lobotomy first done 1936 in by Moniz, nobel prize 1949.
- Popular in US by Dr Freeman, peform "icepick lobotomy"
- Lobotomy- sever connection frontal cortex and lower parts of brain.
- Inconsistend outcomes as change occurs in some not not others, difficult to predict how affect.
- Procedures irreversible as neural tissue destroyed.
Biological Treatment- ECT
- Electro Convulsive Therapy- Electrical shocks 70-130 volts applied to brain induce seizures, usually 6 sessions over a few weeks.
- Cause seizures like in epilepsy, resets brain, can lift mood of someone who is depressed, unsure how actually works.
- effective for some people, placebo effect could be applied, constant improvement.
- Long term memory impairment, informed consent, have been deaths and bone fractures, unsure how it works.
Biological Treatment- Drugs
- Assume chemical imbalance root of problem
- Antidepressants- MAOIs, TCAs, SSRIs- increase available neurotransmitters e.g. seretonin.
- SSRI- block reabsorption of seretonin so more in system, cause violent outburst.
- MAOIs- raise seretonin levels and noradrenaline in brain, interacts badly with various food groups/other medications.
- TCAs- raise seretonin and noradrenaline in brain, long term use associated with heart problems.
- Monoamine theory depression- brain neurotransmitters seretonin/noradrenaline, joint monamines relate to depression reduced levels these neurotransmitters.
- effective, research support, readily available/cost effective, can live normal lives.
- Short term problem for long term cause, 30% respond to placebo, psychological/physical dependency.
Evaluation of Biological Treatments
- There are ethical concerns as someone may accept a biological treatment without understanding the full consequences as they are too severely depessed etc. to make a fully informed descision.
- Dependency on drugs could become an issue.
- Usually discrepencies on how effective treatments are as work for some but not for others as with all treatments.
Behavioural Treatments- systematic desensitisation
- Extinguish undesirable behaviour of fear replacing it with more desirable behaviour of relaxation, can't be relaxed and fearful simeltaneously- reciprocated inhibition.
- Functional Analysis- therapist and client construct hierachy of fear situations, come up range situations arrange least to most fearful.
- Relaxation Training- client trained methods relaxation, releasing muscular tension, control breathing and visualisation techniques.
- Graduated Exposure- client gradual contact with phobia stimulus, following hierachy established with therapist. Each stage exposure client use techniques stay relaxed, only when full relaxation achieved treatment move on to more intense exposure.
- 60-90% effective- Barlow et al, target problem directly.
- Expensive, can cause stress/psychological harm.
Behavioural Treatments- flooding
- Full on exposure to phobia.
- Body cannot sustain fear particularly long, gradually come down, actually fine.
- Over time learn phobia not dangerous, therefore no phobia.
- If end too soon, could have opposite effect and reinforce phobia.
- Can be effective for phobias.
- very quick, meet fear full on.
- Can have opposite effect, could cause psychological harm.
Behavioural Treatments- Aversion Therapy
- Associate undesirable behaviour with unpleasent stimulus.
- Used in 1950s to "cure" homosexualiy, electric shocks with pictures naked men.
- Alligned fear with pictures- ethically and scientifically unsound- never evidence worked.
- can be an effective way to treat alcoholism
- Over time may go back to habits.
Behavioural Treatments- token economy
- increase desirable behaviour, reward polite reinforcement.
- Mainly used psychiatric hospitals, tokens for improved behaviour.
- Exchange for sweets, cigarettes etc. aim reduce levels antisocial behaviour substitiue desirable, modify behaviour not address symptoms directly.
- Used schizophrenia improve general behaviour.
- Used in eating disorders, life threatening anorexia, visitors of weight good/eat properly.
- can make schizophrenia patients more manageable.
- Behaviour may be changed for the institution and not by what is desirable.
Cognitive Behavioural Therapy- Beck
- Negative schemata lead to pessemistic thoughts, aim approach challenge irrational cognitions replace more realistic appraisal.
- Therapist help identify negative thoughts, encouraged keep in diary.
- Using material, therapist challenge dysfunctional cognitions, contradict negative assumptions- form of reality testing.
- Challenge negative, also use behavioural techniques encourage positive behaviour.
- Specific training also be done e.g. social skills also relaxation techniques taught.
- Focus on cognitive restructing, behavioural change without cognitive change unlikely alter the depressed state.
Cognitive Behavioural Therapy- REBT
- Ellis- Rational Emotive Behavioural Therapy- similar to Beck's
- therapist and client work together to identify situations and negative reactions produced.
- Therapist help client rationalise situation, giving client more realistic perspective.
- More conrontational approach than Beck, challenge clients self-defeating beliefs in intense debates.
Evaluation of CBT
- Structured approach to therapy, combination of cognitive and behavioural
- Effective for depression and social anxiety, may last longer than drugs.
- Avoid in-depth probing associated with psychoanalysis which is unpleasant for some.
- Depression may be based on rational/accurate perception of reality.
- Ignore genetic/biological factors.
- Schemata lack detail, no clear reason how negative ones develop.
Psychoanalysis- Free Association
- Relatie whatever comes into their minds during session, not censor thoughts.
- Intendet to help patient learn more about how he/she feels and thinks, atmosphere of non-judgmental curiosity and acceptance.
- Assumes people often conflicted between need learn about themselves and conscious/unconscious fears of and defences against change and self-exposure.
- Analyst will interpret unconscious conflicts causing symptoms/character problems, confront/clarify pathological, ego defences, wishes and guilt.
Psychoanalysis- Projective Tests
- Client required impose own thoughts/associations some particular stimulus material.
- Rorschach inkblot test- presented series inkblot shapes, asked what shape means to them, repeat sequence different blots, themes/anxieties will emerge.
- projects on to analyst characteristics unconsciously associated with parents/other important people in life.
- Repressed feelings directed towards analyst.
- Repeating process helps client become aware of repressed feelings, gradually neurotic symptoms disappear.
- Important analyst remains neutral avoid counter transference- unconscious feelings to client.
Psychoanalysis- Dream Analysis
- dreams present way understand things patient buried didn't want look directly at, dreams symbolic of unconscious desires, from id
- If knew, be harmful activate Thanatos (death wish) self destruct, dream analysis allow us understand dreams/symbolism in non-harmful way.
- Deeper druth about self be understood if analyse them.
- Bring problems to conscious level.
- Can be effective, accepts humans complicated.
- Require trust from client, no reference other approaches, cannot falsify theory- if not work say too deep to uncover.
- Ethical issues- may be distressing memories brought forward.
- Not suitable all conditions- schizophrenia not aware of conditions.
Elkin et al
- AIM- look at the effects of different treatments for abnormality to compare effectiveness.
- PROCEDURE- across 7ral treatment centres, 240 depresion either CBT, psychotherapy, antidepressant drugs, also placebo control group- treatment last 16 weeks.
- FINDINGS- large placebo effect 35-50%, all more effective than placebo, similar level effectiveness, drugs most effective severe depression, individual therapist factor in effectiveness of psychotherapy, 30-40% not respond to all groups, no treatment ever 100% effective, 3 therapies equal effect over placebo in depression but usual trial followup 6-12 months, evidence theraputic effect CBT in anxiety long lasting than drugs (Bechdolf et al)
- CONCLUSION- Not all treatments are 100% effective, and their effectiveness relies heavily on the person that they are being used on.
Davidson et al.
- AIM- measure the effectiveness of different therapies for abnormality.
- PROCEDURE- 295 generalised social anxiety treatment CBT, or drug or combined.
- FINDINGS- overall placebo 19% effect, all therapies effective over this, after 14weeks no differences in therapy groups, combined not superior, 40-50% not respond to therapy.
- CONCLUSION- drugs and CBT equal effct social anxiety, combination not improve, but many do not respond to either treatment.