Chapter 16

Psychological Disorders

What is normal?
A teacher I know is afraid of zombies and
fears going out of doors alone at night. Does
he have a disorder?
A friend of mine goes out at night, when
there is a full moon, and howls at it for 60
seconds. Is she crazy?
Is John depressed? His Dad died and he cries
every night and has done so for the last five
years.

In a nutshell
You have to be able to live with
ambiguity

As defined by your textbook,

A disorder is a harmful dysfunction
in which behaviour is atypical,
disturbing, maladaptive and
unjustifiable.

History of Abnormality
Possession by evil spirits
Animistic spirits: tarantism, lycanthropy
Satanic spirits: reports of witchcraft
increased rapidly with the extensive
instability in the late 15th and 16th
centuries (e.g., rise of capitalism,
Protestant Reformation)

Witchcraft
Malleus Maleficarum (The Witchs Hammer): a
guidebook to discovering and getting rid of
witches. Written by two monks.
Only women could be witches
All witchcraft comes from carnal lust which is, in
women, insatiable

Tests of witchcraft: fixed

Salem Witch Trials

Salem, MA (1691): First arrest in March, last
hanging in September.
Begins with 8 girls exhibiting a bizarre set of
symptoms that include: vomiting, convulsions,
slurred speech, and hallucinations
Doctors suggest possession
Accusations fly and eventually 19 people were
executed, 2 died in prison, and 1 was tortured to
death

Explanations for the Witch Trials

Political Explanations: political leverage,
diversion of attention. Tension between
growing town and farmers. New minister
had a number of enemies
Sociological Explanations: the accused were
undesirable members of society. Works for
first accusations but then unravels as the
elite are accused

More Explanations
Psychological Explanation: a hysterical mob
mentality blossomed out of control
Medical Explanation: inadvertent ergot
poisoning (fungus that grows on rye, contains
lysergic acid)
Heavy rains in 1691could have lead to fungus
Young girls were afflicted first and they
worked directly with the grains

The Biomedical Model

popular when behaviourists were popular

psychological disorders have physical

causes, therefore
they can be classified based on the
patients symptoms
they can be treated (with drugs and/or
therapy) and be cured

The Biological Model of

Abnormal Psychology
Includes the following general areas:
Neurotransmitter and Hormonal
Imbalances
Genetic Vulnerabilities
Brain Dysfunction and Neural Plasticity
Physical Deprivation or Disruption

Neurotransmitter
Imbalances

The Medical Model is not

Without Criticism

 What is Thomas Szazs main points about

Psychiatry what are his issues?
What is your opinion about his points
what do you agree with and what do you
disagree with?

Bio-psycho-social Perspective:
bio genes, brain/body structure and
chemistry
psycho stress and trauma
social cultural expectations and support
system
All three of these factors contribute to the
psychological disorder.
Supposedly what we use now. In reality, there is
still a heavy focus on the medical model.

Biopsychosocial
Paradigm

The bio-psycho-social paradigm used to

be called the
Diathesis-Stress Paradigm
According to Diathesis-Stress models, the cause of
abnormal behavior can be viewed as a combination
of or interaction between two types of factors:
Diathesis - previous biological (including genetic
predisposition) and environmental factors that
predispose an individual towards developing a
disorder.
Stress - trigger that taxes or exceeds the
individuals personal resource and results in
abnormal behavior.

What is a Paradigm?
A model of reality: the way reality is or is
supposed to be
It is a set of beliefs that shape our perception
of events and help us explain these events
It is a set of concepts and methods used to
collect and interpret data (Kuhn, 1992)
A paradigm guides the definition,
examination, and treatment of mental
disorders

Paradigms in Abnormal Psychology

Biological Paradigm
Cognitive-Behavioural Paradigm
Behavioural perspective
Cognitive perspective

Psychoanalytic Paradigm
Humanistic Paradigms
Integrative Paradigm

Models or Paradigms for Understanding

Abnormal Behavior
The value of viewpoints is that organize
observations, provide a system of thought, and
suggest areas of research, focus, and treatment.
However they can blind or limit us.
The current viewpoint in psychology is
multidimensional, eclectic, and integrative
Biopsychosocial viewpoint- an integrative
approach that acknowledges that biological,
psychosocial, and sociocultural factors all interact
and play a role in psychopathology and treatment.

Current History
American Psychological Association (APA)
published the first Diagnostic and Statistical
Manual (DSM) of Mental Disorders in 1952. This
manual had 60 categories of mental illness.
Subsequent versions came out in 1968, 1980,
1986, 1994 and 2013. Currently using the DSM-5
in which there are more than 300 categories of
mental illness
Changes based upon research, societal values, and
political pressure (e.g., homosexuality,
premenstrual dysphoric disorder)

Some Criticisms of the DSM

Historically, some diagnostic labels have marginalized, stigmatized
and harmed those who are different from the mainstream (e.g.,
homosexuality was once a DSM diagnosis).
There is limited evidence of cross-cultural validity in diagnostic
conceptualizations.
Counselors who focus narrowly on diagnosis may only look for
behaviors that fit within a medical or biological understanding of the
persons struggles
The DSM system does not include sufficient emphasis on contextual
factors (e.g., developmental struggles and transitions, culture,
gender), strengths, resources, and uniqueness that may better explain
the roots of client struggles and treatment implications.

Criticisms continued
The DSM system cannot predict treatment outcomes or
point to the etiology of mental disorders.
Some people may use diagnosis to accept a self-fulfilling
prophecy that their situation is hopeless and that they are
sick.
Diagnosing may preclude a focus on the clients unique
construction of his or her experience.
There are flaws in the science behind DSM diagnoses;
what is and is not classified as a mental disorder is often
rooted in a political agenda and historical influences

 Despite its limitations, the DSM system is useful in a number of ways (APA, 2013; Dailey et al.,
2014; Eriksen & Kress, 2005, 2006; Kress & Paylo, 2014). Primarily, it serves as a way of
communicating about client problems and struggles. Assuming that all client-related information
is considered, it offers a vehicle for reducing complex information into a manageable form
(Kress & Paylo, 2014). Through the categorization of psychological symptoms into disorders, the
DSM system provides a means for counselors to select evidence-based treatments that correspond
to said disorder. Some clients may benefit from receiving a diagnosis as it may help them to
normalize and understand their experiences, sometimes even helping them to reduce the shame
and self-blame that often relate to symptoms (Eriksen & Kress, 2005). Finally, categorization and
identification of disorders allows researchers to study the etiology and treatment of various
mental disorders. Such a process lends itself well to the development of prevention, early
intervention and effective treatment measures that have very real impacts on clients lives (APA,
2013). The DSM-5 (APA, 2013) also provides systematic information about diagnostic features,
associated features supporting diagnosis, subtypes and/or specifiers, prevalence, development
and course, risk and prognostic factors, diagnostic measures, functional consequences, culturerelated diagnostic issues of each diagnosis; this information may be helpful to counselors who are
struggling to fully understand their clients experiences

David L. Rosenhan
Professor of Law and Psychology at
Stanford University, Stanford, CA.
1951 AB Mathematics
1953 MA Economics
1958 Ph. D. Psychology

However much we may be personally convinced

that we can tell the normal from the abnormal, the
evidence is simply not compelling.
D. L. Rosenhan, 1973

Rosenhans Questions:
Are mental health professionals able to tell the
difference between those who are mentally healthy
and those who arent?
Rosenhan wanted to know that if the patients
were misdiagnosed, what the consequences were.
He also wanted to know whether the
characteristics that lead to physiological diagnoses
reside in the patients themselves or in the
situations and contexts in which the observers
(those who do the diagnosing) find the patients.
(Hock, 2000)

Rosenhans Study
He conducted a study where he had eight
pseudopatients pretend to be mentally ill and
try to gain admittance into various psychiatric
institutions.
There were five men and three women all
from various backgrounds used in the study.
There were three psychologists, one graduate
student, one psychiatrist, one homemaker,
and one painter.

Participants Instructions:
Participants were instructed to call the 12
different hospitals on both the east and west
coasts and set up an appointment.
All participants complained of the same
thing hearing voices saying empty, hollow,
and thud.
All participants were admitted into the
institutions and all but one were diagnosed to
have schizophrenia.

Hospital Admission
There were 12 hospitals in five different
states located on the east and west coast that
patients tried to gain admittance to.
Immediately after being admitted to the
hospitals the pseudo patients stopped
showing any symptoms of abnormality.
The patients would commonly try to
engage other patients and staff into
conversation.

After being Admitted

The pseudo patients had no idea of when they
were going to be released, when being admitted
they were told they would have to get out on their
own devices.
Each person was discharged with the label of
schizophrenia in remission.
The length of hospitalization was 7 to 52 days
with an overall average of 19 days.

Observations
Each pseudo patient took notes on their
observations while being in the hospitals.
Many times the patients would witness
physical abuse of other patients.
Powerlessness became a huge issue with the
pseudopatients.
Rosenhan found that the average daily
contact with psychiatrists, psychologists,
residents, and physicians combined ranged
from 3.9 to 25.1 minutes with a mean of 6.8.

Why was Rosenhans Study Important?

People became aware that the basis for
diagnosis might not be correct.
The study also showed in certain situations the
label becomes self-limiting and self-confirming.
Most of all Rosenhans Studies proved that the
hospital could not distinguish the mentally sane
from the insane.
The hospital itself imposes a special environment
in which the meaning of behavior can be easily
misunderstood. Rosenhan, 1973

Questions The Study Created:

How valid are psychological diagnosis
across mental health settings?
Is diagnosing more of a bias opinion
then science?
Do labels injure patients rather than
help guide therapy?

Has Psychology Changed?

Could you replicate this study today
and achieve the same results?