Chapter 1

The History of Abnormal Psychology

Understanding Psychopathology
What is a psychological disorder?

Whats not?

How do we describe people with mental illness?
Lazy, crazy, dumb?
Weak in character?
Dangerous?
Hopeless?
What is a Psychological Disorder?
Psychological dysfunction
Breakdown in function
Cognitive
Behavioral
Emotional
Harmful dysfunction


What is a Psychological Disorder?
Distress or impairment
Individual versus others
Appropriateness to situation
Degree of impairment
What is a Psychological Disorder?
Response is atypical or culturally expected
Deviations from average
Violation of social norms


What is a Psychological Disorder?
Accepted DSM-IV-TR definition:
Behavioral, cognitive, emotional dysfunctions
Unexpected in cultural context
Personal distress
Substantial impairment in function

What is a Psychological Disorder?
Diagnostic and Statistical Manual
DSM-IV-TR
Outlines criteria for disorders
Prototypes/typical profiles
Constant revision and modification
DSM-5

What is a Psychological Disorder?
New areas of interest for the DSM-5:
Reevaluating underlying concepts
Surveys of mental health professionals
Commonalities in disorders
Discerning differences in degree
The Science of Psychopathology
Psychopathology is the scientific study
psychological disorders

Conducted by
Clinical and counseling psychologists (PhD,
PsyD)
Psychiatrists (MD)
Psychiatric social workers (MSW)
Psychiatric nurses (MN, MSN, PhD)
Marriage and family therapists (MA, MS, MFT)
Mental health counselors (MA, MS)

The Scientist-Practitioner
Interaction of clinical work and science
Consumer of science
Informs practice
Evaluator of practice
Utilizes science
Creator of science
Synthesizes both
The Scientist-Practitioner
Clinical Description
Presenting Problem

Clinical Description
Dysfunction vs. common experience

Statistics
Prevalence
Incidence

Clinical Description
Course
Episodic
Time-limited
Chronic

Onset
Acute vs. insidious

Prognosis
Good vs. guarded
Clinical Description
Age of onset may shape presentation
Developmental psychology
Developmental psychopathology
Life-span developmental psychopathology


Clinical Description
Causation, Treatment, and Outcomes
Etiology
Cause or development of psychopathology

Treatment
Pharmacologic and/or psychosocial


Historical Conceptions of Abnormal Behavior
Major psychological disorders have existed
across time and cultures

Causes and treatment of abnormal behavior
varied widely, depending on context
The Supernatural Tradition
Deviance = Battle of Good vs. Evil
Etiologydevil, witchcraft, sorcery
Great Persian Empire (900 to 600 BC)
14
th
and 15
th
century Europe
Salem witch trials in U.S.
Demons and witches
Treatmentsexorcism, torture, and crude
surgeries


The Supernatural Tradition
Stress and melancholy in the 14
th
century
Etiologynatural, curable phenomenon
Illness model
Still connected with sin
Treatments for possession
The Supernatural Tradition
Mass hysteria
St. Vituss dance
Tarantism

Modern Mass hysteria
Emotion contagion
Mob psychology

The Supernatural Tradition
The moon and the stars
Moon and stars
Paracelsus
Lunacy
Modern examples?
Astrology


The Biological Tradition
Hippocrates (460-377 BC)
Father of modern Western medicine
Etiology = physical disease
Precursor to somatoform disorders
Hysteria

The Biological Tradition
Galen (129-198 AD)
Hippocratic foundation
Galenic-Hippocratic Tradition
Humoral theory of mental illness
Black, blue, yellow and phlegm biles
Etiology = brain chemical imbalances
Treatments = environmental regulation
Heat, dryness, moisture, cold
Bloodletting, induced vomiting
19
th
Century
Syphilis and General Paresis
STD with psychosis-like symptoms
Delusions
Hallucinations
Etiology = bacterial microorganism
Louis Pasteurs germ theory
Biological basis for madness
19
th
Century
John Grey (1850s)
American proponent of the biological tradition
Etiology = always physical
Treatments = as is physically ill
Rest
Diet
Room temperature
Improved hospital conditions
The Development of Biological Treatments
Mental Illness = Physical Illness

The 1930s
Insulin shock therapy
Brain surgery
ECT
Benjamin Franklin (1750s)
Treatment for depression?
The Development of Biological Treatments
The 1950s
Psychotropic medications
Increasingly available
Systematically developed
Neuroleptics
Reserpine and psychosis
Tranquilizers
Benzodiazepines and anxiety

Consequences of the Biological Tradition
Increased hospitalization
Untreatable conditions

Improved diagnosis and classification
Emil Kraepelin

Increased role of science in psychopathology

The Psychological Tradition
Plato, Aristotle, and Greece
Etiology
Social and environmental factors
Treatment
Reeducation via discussion
Therapeutic environments

Similar practices in ancient Muslim countries

Moral Therapy
Moral Therapy
Moral = emotional or psychological
Treating patients normally
Encouraging social interaction
Focus on relationships
Individual attention
Education

Moral Therapy
Key figures in humanistic reform:

France
Philippe Pinel (1745 1826)
Jean-Baptiste Pussin
England
William Tuke (1732 1822)
United States
Benjamin Rush (1745 1813)
Horace Mann (1833)

Asylum Reform and the Decline of Moral Therapy
Declines in the Mid-19
th
Century
Increased numbers of patients
Immigrants
Homeless
Mental Hygiene Movement
Dorothea Dix (1802-1887)
Staffing problems
Outcome = decreased treatment efficacy

Psychoanalytic Theory
Anton Mesmer (1734 1815)
Mesmerism and hypnosis
Suggestibility

Jean Charcot (1825-1893)
Hypnosis as treatment
Mentor to Freud

Josef Breuer (1842-1925)
Furthered hypnosis treatments
Collaborator with Freud


Psychoanalytic Theory
Conscious versus unconscious:
Id
Pleasure principle
Illogical, emotional, irrational
Ego
Reality principle
Logical and rational
Superego
Moral principles
Balances Id and Ego
Psychoanalytic Theory
Psychoanalytic Theory
Defense mechanisms
Ego fights to stay on top of the Id and Superego
Loss = anxiety
Coping strategies include:
Displacement
Denial
Rationalization
Reaction formation
Projection
Repression
Sublimation
Psychoanalytic Theory
Stages of Psychosexual Development
Patterns of gratifying basic needs
Infancy to early childhood
Oral
Anal
Phallic
Latency
Genital
Conflicts at each stage must be resolved
i.e., Oedipus complex in the phallic stage
Adult personality reflects childhood experience
Psychoanalytic Theory
Later Developments in Psychoanalytic Thought
Self-Psychology
Anna Freud (1895-1982)
Ego defines behavior
Object Relations Theory
Melanie Klein and Otto Kernberg
Children incorporation of objects
Images
Memories
Values of significant others
Freuds students de-emphasize sexuality
Carl Jung (1875-1961)
Collective unconscious
Enduring personality traits
Introversion vs. extroversion
Alfred Adler (1870-1937)
Birth order
Inferiority complex
Striving for superiority
Self-actualization

Psychoanalytic Theory
Emphasis on life-span development

Influence of society and culture on personality

Key figures:
Karen Horney (1885-1952)
Erich Fromm (1900-1980)
Erik Erickson (1902-1994)
Psychoanalytic Theory
Psychoanalytic Theory
Psychoanalytic Psychotherapy

Unearth intrapsychic conflicts

Long-term treatment model

Techniques
Free Association
Dream Analysis

Transference/Counter-Transference

Efficacy Data are Limited
Psychoanalytic Psychotherapy
Emphasizes conflicts and unconscious
Trauma and active defense mechanisms
Focus on:
Affect
Avoidance
Patterns
Past experience
Interpersonal experience
Therapeutic relationship
Wishes, dreams, fantasies
Psychoanalytic Psychotherapy
Criticisms
Pejorative terms (e.g., neurosis)
Unscientific
Untested

Contributions
Unconscious processes
Emotions triggered by cues
Therapeutic alliance
Defense mechanisms



Humanistic Theory
Theoretical constructs
Intrinsic goodness
Striving for self-actualization
Blocked growth

Person-centered therapy
Carl Rogers (19021987)

Hierarchy of Needs
Abraham Maslow (19081970)

The Behavioral Model
Classical Conditioning
Ivan Pavlov (18491936)

Ubiquitous form of learning
Unconditioned stimulus (UCS)
Unconditioned response (UCR)
Conditioned stimulus (CS)
Conditioned response (CR)

The Behavioral Model
Classical Conditioning Concepts
Stimulus generalization
Extinction
Introspection
The Behavioral Model
Behaviorism
John B. Watson (18781958)
Scientific emphasis
Objective
Little Albert experiment
The Behavioral Model and Behavior Therapy
Mary Cover Jones
Preexisting phobia extinguished by
exposure and modeling

Joseph Wolpe (19151997)
Systematic desensitization
Relaxation


The Behavioral Model - Operant Conditioning
E.L. Thorndike (18741949)
Law of effect: consequences shape
behavior

B.F. Skinner (19041990)
Behavior operates on environment
Reinforcements
Punishments
Behavior shaping
The Present: The Scientific Method and an
Integrative Approach
Defining and studying psychopathology

Requires a broad approach

Multiple, interactive influences
Biological, psychological, social factors

Scientific emphasis
Neuroscience
Cognitive, behavioral sciences