Abnormal Behavior in Ancient Times

1.      Abnormal behavior attributed to "possession"
                a. Differentiated good vs. bad spirits
                b. Religious significance of possession
                c. Treatment for possession was exorcism

2.      Shamans originally treated the possessed
                a. Priests assumed the role of exorcist
                b. Many priests advocated humane care

3.  Gods, demons, and magic are still afforded some consideration by certain cultural groups/subgroups.

        2.      Plato and Aristotle
                a.      Criminal acts examined by Plato
                        1 )     Suggested humane treatment
                        2 )     Addressed insanity as a legal defense
                b.  Plato said behavior was motivated by needs
                c.  Aristotle described contents of consciousness
                        1 )     People avoid pain & seek pleasure
                        2)      Followed Hippocrates
                        3)      Later Greek and Roman thought
                                a. Greek physician Galen studied nervous system
                                b. Roman culture made post-mortems possible

C. Views in the Middle Ages ("Dark Ages")
        1.      Islamic countries continued scientific Greek medicine
        2.      Avicenna wrote the Canon of Medicine
        3.      European's grew religious/superstitious
                a.      Mental disorders were prevalent in this period
                b.      Sin was seen in only a minority of cases as a cause (?)
        4.      Mass Madness
                a.      Tarantism episodes in Italy
                b.      Lycanthropy affected many rural residents
                c.      Oppression, disease,famine  --> mass hysteria
        5.      Exorcism
                a.  Attacks on Satan's Pride (justifying abuse)
                b.  Malleus Malefecarium epitomized witch hunting approach
                c.  Some exorcisms continue in contemporary practice

Witchcraft and mental illness: fact or fiction?
        1.    Witchhunts the fifteenth and sixteenth centuries
        2.    Controversies concering extent of the witchhunts
                a.  Schoeneman's denies mental disorder were  widely viewed as witchcraft
                b. The historical record isn't clear
 

Growth Of Humanitarian Approaches (1800)

B.    Establishment of early asylums and shrines
        1.      Early asylums
                    a.   Treatments designed to restore balance in the body
                    b.  Methods were powerful and aggressive
                    see p 41-42 for great quotes
        2.      The Geel Shrine provided humane care.

C.    Humanitarian reform
        1.   Pinel's Experiment
                a.      He removed chains from mental patients
                b.  Treated patients with kindness and as sick people
                c.  His Bicetre and Salpetriere
                        the first modern mental hospitals
        2.   Tuke's work in England
                a.      The York Retreat was established
                b.      helped change attitudes re: demonic possession
        3.   Rush and moral management in America
                a.    He founded American psychiatry
                b.    He invented the "tranquilizer"
                c.     Stresses or moral causes of insanity proposed
                d.    Moral management abandoned by late 1800s
                        An emphasis on physical basis of mental illness undermined Moral Management
        4.    Dix and the Mental Hygiene movement
                a.    Aroused awareness of inhumane treatment
                b.    Ironically, the Mental Hygiene movement condemned patients to dependency
                c.  Contemporaries criticized Dix's work as leading to the warehousing of the mentally ill
 

The Foundations of Twentieth-Century Views

The Growth of Scientific Research
        A.  The Roots of the Biological Viewpoint
                1.      Pasteur discovered microbes spoiling wine
                2.      General paresis.
                            a confusing pattern of symptoms, physical and mental
                            recognized as caused by syphillis, and underlying infection
        B.  The Establishment of brain pathology as a causal factor
        C.  The Beginnings of a classification system
                1.  Kraepelin
                2.  Recognizing & carefully documenting symptom patterns
        D.  Advances resulting from early biological views
        E.   Advances in psychological understanding of disorders:
                The psychodynamic perspective
                1.      The roots of the psychodynamic viewpoint
                        a. Mesmerism
                        b. The Nancy School
                2.      The beginnings of psychoanalysis
        F.   Advances in other psychological research
                1.    The behavioral perspective
                2.      Roots of the behavioral perspective
                        a.     Classical conditioning (Pavlov)
                        b.     Instrumental conditioning
                                Thorndike,  Watson,  Skinner

Some Unresolved Issues on Interpreting Historical Events
        A.      Retrospective analysis has limitations
                1.      There is an absence of direct observation
                2.      Written accounts may be incomplete
                    a.      Historical articles are out of context of the times
                    b.      A propaganda element may be present in them
        B.      Current viewpoints color our interpretation of past events
                1.    Conclusions are only working hypotheses
                2.    Need to search for "new" historical documents

Models for Understanding Abnormal Behavior
        1. Competing explanations can be confusing, esp. to laymen or the simple-minded
        2. Professionals often utilize many theoretical perspectives rather than one

The Biological Viewpoint

• Mental disorders are viewed as medical diseases produced by physical abnormalities
• Bodily conditions can disrupt the brain's information processing

"behind every twisted thought lies a twisted molecule"
• The biopsychological model is a less extreme

 

 

Biological Causal Factors
A.   Neurotransmitter and Hormonal Imbalances
B.    Genetic defects
       1.    Chromosomal anomalies
               Normal chromosomes versus abnormal.
               Down's syndrome produced by trisomy 21
       2.  Structures of genes are seen by electron microscopes
       3.  Contrasts between dominant and recessive genes
       4.  Gene expression is the result of an intricate process
       5.  Polygenetically transmission is probably common
       6.  Methods for studying genetic influences
C.   Other Constitutional liabilities
        1.      Physical handicaps
              a.      Congenital defects are present at birth
              b.      Low birth weight is a risk factor
              c.      can Emotional distress of mother induce prematurity?
              d.      Importance of prenatal development is documented
        2.      Primary reaction tendencies and temperament
              a.      Longitudinal Studies show enduring reaction tendencies
                       fearfulness, irritability, positive affect, activity level,
                       persistence, extroversion are relatively stable
              b.     Childhood disturbance often followed by adult illness
        3.      Brain dysfunction

a.   Gross brain pathology causes 25% of mental retardation
b.   Increases in brain damage over time (with age)
              Basic physiological needs
                        a.  Blocking survival needs can decrease coping resources
                        b.  Sleep deprivation --> psychological disorganization
                        c.  Dietary deficiencies change psychological functioning
                        d.  Studies of former POWs during WWII & Korean War
 c.   Stimulation and activity
            a.    Hospitalism syndrome found by Spitz
            b.    Limits exist on optimal stimulation for the developing organism
            c.    The impact of the biological viewpoint

2.      Newer pschodynamic perspectives
        a.      Focus on objects toward which impulses are directed
        b.      Mahler and Kernberg's emphasize object relations

3.      Impact on our views of psychopathology
        a.      This was the first modern systematic psychosocial model.
        b.      Problems in coping associated with disorder
        c.      Critics focused on the overemphasis on the sex drive
        d.      Many insights now taken for granted as "generic"
                  defense mechanisms, trauma as cause of disorder, the unconscious, etc.
                  often, people associate Psychoanalysis with some of its stranger ideas

1.      Basics of the behavioral perspective
        a.      Classical and operant conditioning
        b.      Generalization and discrimination
2.      Impact of the behavioral perspective
        a.      Maladaptive behavior is failure to learn competencies
        b.      Maladaptive behavior is learning ineffective responses
c.      Therapy seeks to eliminate undesirable behaviors
                and learn desirable ones
        d.      Behavioristic approaches are precise and objective
        e.      Some behaviorists place value on thought processes

1.      The basics of the cognitive-behavioral perspective
        a.      Bandura, an early pioneer
        b.      Kelly's personality theory is a cognitive view
2.      Therapists shifted focus to underlying cognitions (Beck)
3.      The impact of the cognitve-behavioral perspective

1.      The roots of the humanistic approach
        a.      It emerged during the 1950s and 1960s
        b.      Concerned with issues not researched extensively
2.      Basics of the humanistic perspective
        a.      The self as a unifying themes
        b.      Focus on values and personal growth
3.      Impact of the Humanistic perspective
        a.      Emphasizes the capacity toward fully functioning individuals
        b.      Therapy fosters personal growth potential
        c.      This approach has been criticized for its diffuseness

Psychosocial Causes of  Mental Illness
        A.      Early deprivation or trauma
                1.     Institutionalization
                        a.      Provence and Lipton's studied infants in institutions
                        b.      The reversibility of institutional deprivation
                2.     Deprivation and abuse in the home
                        a.      Failure to thrive
                        b.      View world as untrustworthy
                3.      Childhood trauma
                        a.      Childhood trauma causes lasting effects
                        b.      Traumas are generalized to other situations
                        c.  Effects of trauma resistant to cognitive reappraisal
                4.      Inadequate parenting
                        1.    Parental psychopathology
                            a.     depression
                            b.    alcoholism
                        2.    Parental warmth and control
                            a.    Parenting syles are described
                        3.      Pathogenic family structures
                            a.   Marital discord
                                    A lack of satisfaction can lead to frustration and  negative effects on children
                            b. Disturbed families have eccentricities or abnormalities
                                    e.g., marital schism and marital skew
                            c. Divorced and families
                                    single-parent and reconstituted families are increasing due to divorce
                                    Effects of disruption are greatest during the first year
                                    can have long-term consequences
                                            but, what exactly has the consequences? conflict? divorce? poverty?
                       4. Maladaptive peer relationships
                                  a. chronic or severe conflict with peers is upsetting and impedes normal development
                                  b. a lack of empathy interfers with social relations; a vicious circle
                                  c. the ability to understand and interact constructively with others develops with experience
                                        it seems central to mental health
                                  d.  Socialization "casualities" result from scapegoating peers
                                  e.  Peer relationship influence self-schemas
                                  f.  Sources of popularity versus rejection
                                            * Status stability is found by the fifth grade
                                            * Rejection by peers can have many causes and lead to social isolation
                                            * Adult outcomes are negative for the child with inadequate peer relations
    however, shy young children are not at appreciably higher risk

The Sociocultural Viewpoint

A.    Uncovering sociocultural factors through cross-cultural studies

1.Controlled experimentation is difficult in sociocultural investigation
2.Cross-cultural research is plagued by technological and methodological problems
3.Western-trained researchers bias observations
4.Cultural relativism sees no universal standards of normality
5.Sociocultural factors appear to influence the type of disorder and its course
a.   Swiss studies by Butcher show this
b.  Depression seen across cultures, but pattern varies

B.    Sociocultural influences in our own society
1.    US Socioeconomic status & schizophrenia
2.    Urban versus rural rates of mental disorder

A.    The sociocultural environment

1.      Sociocultural groups systematically perpetuate basic personality types

a.      Similarity in child rearing
b.      Education is similar for children

2.      Feminine and masculine traits illustrate cultural influences
a.Development of androgyny in recent years
b.Low masculinity associated with maladaptive behavior

1.      Low socioeconomic status
a.  Negative correlation are found between many forms of psychopathology and low SES
• i.e., many disorders are more common in poorer societal groups
• more stressors are common in the lower SES groups
• three causal possibilities
1. poverty causes psychopathology
2. psychopathology causes poverty
3. poverty and psychopathology are both influence by common variables (e.g., predjudice)

a.      Stereotypes are demoralizing
b.      many (all?) groups are targets of discrimination and disabling social roles
3..      Social roles can cause disorders
a.      Reactions of soldiers to the demands of war
b.      Militaristic regimes foster problematic social roles

4.      Economic and employment problems
a.      Chronic anxiety is produced by unemployment and recession
            family violence is greater under these circumstances
b.      Economic problems often hit the lowest social strata hardest

A.      Adherence to a systematic viewpoint has strengths and weaknesses

1.  The viewpoint orients practice and research within guidelines
2.  May limit a professional's practice and research outlook

1.    Use what works best in practice,  rather than follow a theory
2.    Critics view this as a "crazy quilt" approach.