Chapter 1

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Chapter 1 2Abnormal Behavior in Historical
Context The Causes of Psychopathology
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Myths and Misconceptions About Abnormal Behavior

• Many Myths Are Associated With Mental Illness
• Lazy, crazy, dumb
• Weak in character
• Dangerous to self or others
• Mental illness is a hopeless situation

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The Myth of Mental Illness

• Thomas Szasz - outspoken critic
• Abnormal Behavior Unpleasant Behavior
• Psychiatric Dx - Tells us nothing meaningful
  about person (unlike medical dxs)
• Dx. used to control people and keep
  undesirables out of the way

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Mental Illness - More than a Myth

• Most believe mental illnesses are objective, and
  there is little to distinguish between mental and
  physical illnesses. Research supports this.
  This whole class will support this point.
• However, Szasz raises two important points
• (1) What impact does a society have on mental
  illness?
• Homosexuality, masturbation were once dxs
• (2) For a Dx to be given, lets make sure it does
  tell us something meaningful about a person

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Approaches to Defining Abnormal Behavior

• No Single Definition of Psychological Abnormality
• No Single Definition of Psychological Normality
• Does Infrequency Define Abnormality?
• Does Suffering Define Abnormality?
• Does Strangeness Define Abnormality?
• Does the Behavior Itself Define Abnormality?
• Should Normality Serve as a Guide?

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Toward a Definition of Abnormal Behavior

• Psychological Dysfunction
• Breakdown in cognitive, emotional, or behavioral
  functioning
• Distress or Impairment
• Difficulty performing appropriate and expected
  roles
• Impairment is set in the context of a persons
  background
• Atypical or Unexpected Cultural Response
• Reaction is outside cultural norms

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Why We Do This Clinical Description
(phenomenology)

• Describing the Problem
• Description Aims to
• Distinguish clinically significant dysfunction
  from common human experience
• Describe Cluster of Symptoms
• Describe Epidemiology
• Prevalence/incidence
• Onset of Disorders (Acute vs. insidious)
• Course (Episodic, time-limited, or chronic
  course)

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Why We Do This Causation, Treatment, and Outcome

• What Factors Contribute to the Development of
  Psychopathology?
• Study of etiology
• How Can We Best Improve the Lives of People
  Suffering From Psychopathology?
• Study of treatment development

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Who deals with Psychopathology Currently?

• Mental Health Professionals
• The Ph.D.s Clinical and counseling
  psychologists
• The Psy.D.s Clinical and counseling Doctors
  of Psychology
• M.D.s Psychiatrists
• M.S.W.s Psychiatric and non-psychiatric social
  workers
• MN/MSNs Psychiatric nurses
• LPC Licensed Clinical Counselors

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Historical Conception and Causes of Psychopathlogy
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Historical Conceptions of Abnormal Behavior

• Major Psychological Disorders Have Existed
• In all cultures
• Across all time periods
• The Causes and Treatment of Abnormal Behavior
  Varied Widely
• Across cultures
• Across time periods
• Particularly as a function of prevailing
  paradigms or world views

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The Past Abnormal Behavior and the Supernatural
Tradition

• Deviant Behavior as a Battle of Good vs. Evil
• Deviant behavior was believed to be caused by
  demonic possession, witchcraft, sorcery
• Mass hysteria (St. Vitusdance or Tartanism) and
  the church
• Treatments included exorcism, torture, beatings,
  and crude surgeries
• Movement of the Moon and Stars as a Cause of
  Deviant Behavior
• Paracelsus and lunacy
• Both Outer Force Views Were Popular During the
  Middle Ages
• Few Believed That Abnormality Was an Illness on
  Par With Physical Disease

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Trephination A Treatment in Line with the
Hypothesized Cause
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The Past Abnormal Behavior and the Biological
Tradition

• Hippocrates Abnormal Behavior as a Physical
  Disease
• Hysteria The Wander Uterus
• Galen Extends Hippocrates Work
• Humoral theory of mental illness
• Treatments remained crude
• Galenic-Hippocratic Tradition
• Foreshadowed modern views linking abnormality
  with brain chemical imbalances

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The Past The Biological Tradition

• Mental Illness Physical Illness
• The 1930s Biological Treatments Were Standard
  Practice
• Insulin shock therapy, ECT, and brain surgery
  (i.e., lobotomy)
• By the 1950s Several Medications Were
  Established
• Examples include neuroleptics (i.e., reserpine)
  and major tranquilizers

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The Past The Biological Tradition Comes of Age

• General Paresis (Syphilis) and the Biological
  Link With Madness
• Associated with several unusual psychological and
  behavioral symptoms
• Pasteur discovered the cause A bacterial
  microorganism
• Led to penicillin as a successful treatment
• Bolstered the view that mental illness physical
  illness and should be treated as such
• John Grey, Dorothea Dix, and the Reformers

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The Past Abnormal Behavior andthe
Psychological Tradition

• The Rise of Moral Therapy
• The practice of allowing institutionalized
  patients to be treated as normal as possible and
  to encourage and reinforce social interaction
• Philippe Pinel and Jean-Baptiste Pussin
• William Tuke followed Pinels lead in England
• Benjamin Rush led reforms in the United States
• Reasons for the Falling Out of Moral Therapy
• Emergence of Competing Alternative Psychological
  Models

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The Past Abnormal Behavior andthe
Psychoanalytic Tradition

• Freudian Theory of the Structure and Function of
  the Mind
• The Minds Structure
• Id (pleasure principle illogical, emotional,
  irrational)
• Ego (reality principle logical and rational)
• Superego (moral principles keeps Id and Ego in
  balance)

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Freud and Psychopathology

• Freudian Stages of Psychosexual Development
• Oral, anal, phallic, latency, and genital stages
• Defense Mechanisms When the Ego Loses the
  Battle with the Id and Superego
• Displacement denial, rationalization, reaction
  formation, projection, repression, and
  sublimation

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Behavioral Perspectives

• Classical conditioning
• Operant conditioning
• Modeling/Social Learning
• Behavioral treatment interventions

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The Behavioral Tradition The Behavioral Tradition

• Classical Conditioning (Pavlov Watson)
• Learning ELICITED responses
• Pairing neutral stimuli and unconditioned stimuli
• Conditioning was extended to explain fear
  acquisition
• Operant Conditioning (Thorndike Skinner)
• Learning EMITTED responses
• Voluntary behavior is controlled by consequences
• Positive reinforcement
• Negative reinforcement
• Punishment
• Both Learning Traditions
• Greatly influenced the development of behavior
  therapy

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The Behavioral Tradition

• Social Learning Theory (Bandura)
• Learning through observation of modeling
• Bobo doll studies

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Cognitive Perspectives

• Cognitive explanations
• Cognitive treatment interventions
• Integrated cognitive-behavioral approaches

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The Cognitive Perspective

• Expanded upon behaviorism
• Thoughts, attitudes, beliefs interact with
  stimuli in the environment to produce emotion and
  behavior
• Attributions
• Cognitive Distortions
• Negative Automatic Thoughts

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Cognitive-Behavioral Tradition

• A merging of these two traditions and the
  dominant paradigm currently.
• Stimulus-response relationships are important as
  well as cognitive processing
• Most empirically validated treatments stem from
  this tradition

Cognitive Processing
Stimulus
Response Emotions Behaviors
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Biological Perspectives

• The central nervous system
• The neuron
• Neurotransmission
• The Brain
• The peripheral nervous system
• The endocrine system
• Genetics

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Division of the Nervous System
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The Central Nervous System

• The Neuron
• Soma Cell body
• Dendrites Branches that receive messages from
  other neurons
• Axon Trunk of neuron that sends messages to
  other neurons
• Axon terminals Buds at end of axon from which
  chemical messages are sent
• Synapses Small gaps that separate neurons
• Neurons Function Electrically, but Communicate
  Chemically
• Neurotransmitters are the chemical messengers

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Diagram of a Neuron
Dendrites
Soma
Axon Direction of impulse
Axon Terminals
Synapse
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The Synapse Neurotransmitters

• Information from one neuron flows to another
  neuron across a synapse. The synapse is a small
  gap separating 2 neurons. The synapse consists
  of
• a presynaptic ending that contains
  neurotransmitters, mitochondria and other cell
  organelles,
• a postsynaptic ending that contains receptor
  sites for neurotransmitters and,
• the synaptic cleft a space between the
  presynaptic and postsynaptic endings.

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Neurotransmitter ReleaseDiffusion

• The neurotransmitter molecules diffuse across
  the synaptic cleft where they can bind with
  receptor sites on the postsynaptic ending to
  influence the electrical response in the
  postsynaptic neuron. In the figure on the left,
  the postsynaptic ending is a dendrite
  (axodendritic synapse), but synapses can occur on
  axons (axoaxonic synapse) and cell bodies
  (axosomatic synapse).

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Functions of MainTypes of Neurotransmitters

• Figure 2.12 Manipulating serotonin in the brain.

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Functions of MainTypes of Neurotransmitters

• Neurotransmitters have two basic function
• Excitation
• Inhibition
• Main Types and Functions of Neurotransmitters
• Acetylcholine
• Dopamine
• Norepinephrine and beta blockers
• Serotonin (5HT)
• Endorphins
• Gamma aminobutyric acid (GABA) and
  benzodiazepines

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Cholinergic system (Acetylcholine)
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ACETYLCHOLINE (ACh)

• Acetylcholine (ACh) is a neurotransmitter
  substance that is found both in the CNS and in
  the PNS.
• In the PNS it is the NT released at synapses on
  skeletal muscle and is also found in the ganglia
  of the autonomic nervous system.
• In the brain it appears to be involved in
  learning and memory and in sleeping and dreaming.

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Dopaminergic system (Dopamine)
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DOPAMINE (DA)

• Dopamine (DA) is an inhibitory neurotransmitter
• It is implicated in movement, attention and
  learning.
• Dopamine excess may be involved in Schizophrenia.
• Most importantly it is involved in the reward
  system of the brain.

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Noradrenergic system (Norepinephrine)
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NORADRENALINE (NA)

• Noradrenalin (NA) is not synthesised in the cell
  body but the dopamine synthesised there is
  converted into NA inside the synaptic vessicles.
• Like ACh, NA is found in the autonomic nervous
  system. Here it has an excitatory role.
• In the brain, NA is inhibitory and is primarily
  involved in control of alertness and wakefulness.
  
• The release of NA from the neuron is more
  complicated than for other neurotransmitters.
• NA stimulates the release of Adrenalin (a
  hormone) from the adrenal medulla.

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Serotonergic system (Serotonin)
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SEROTONIN

• At most synapses Serotonin (5-HT) is an
  inhibitory neurotransmitter.
• It plays a role in the regulation of mood,
  producing sedation or relaxation.
• It also has a role in the control of eating,
  sleep and arousal. In addition, it can regulate
  pain.

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Endorphins

• Generally inhibitory
• Modulate the experience of pain
• Involved in feelings of euphoria and reward

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GABA

• Most prevalent inhibitory neurotransmitter in the
  brain
• Implicated in relaxation/antianxiety
• Many drugs target this system

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The Brain
Forebrain
Midbrain
Hindbrain
Telencephalon
Diencephalon
Mesencephalon
Metencephalon
Myelencephalon
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Divisions of the Brain

• A review of this method of dividing the brain.

Forebrain
Midbrain
Hindbrain
Telencephalon
Diencephalon
Mesencephalon
Metencephalon
Myelencephalon
Cerebral Cortex Basal Ganglia Hippocampus Amygdala
Thalamus Hypothalamus
Tectum Tegmentum
Pons Cerebellum
Medulla
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Cerebral CortexAnatomical Divisions- 4 lobes

• The average human brain weighs about 1,400 grams
  (3 lb). The brain can be divided down the middle
  lengthwise into two halves called the cerebral
  hemispheres. Each hemisphere of the cerebral
  cortex is divided into four lobes
• Although most people have the same patterns of
  gyri and sulci on the cerebral cortex, no two
  brains are exactly alike.

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Neuroscience and the Brain Structure

• Lobes of Cerebral Cortex
• Frontal Thinking and reasoning abilities,
  memory
• Parietal Touch recognition
• Occipital Integrates visual input
• Temporal Recognition of sights and sounds and
  long-term memory storage
• Limbic System-emotion center
• Thalamus Receives and integrates sensory
  information
• Hypothalamus Eating, drinking, aggression,
  sexual activity

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Major Structures of the Brain
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Division of the Nervous System

• Figure 2.7b Major Structures of the Brain.

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Neuroscience Peripheral Nervous and Endocrine
Systems

• Somatic Branch of PNS
• Controls voluntary muscles and movement
• Autonomic Branch of the PNS-involuntary muscles
• Sympathetic and parasympathetic branches of the
  ANS
• Regulates cardiovascular system body
  temperature
• Regulates the endocrine system and aids in
  digestion

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AUTONOMIC NERVOUS SYSTEM
CONTROLS MOBILIZATION OF BODIES RESOURCES
FIGHT/FLIGHT RESPONSE
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THE EFFECTS OF ANS

• SYMPATHETIC
• INCREASE
• HR, RESPIRATION, BP, GLUCOSE UTILIZATION
• DECREASE
• IMMUNE SYSTEM , DIGESTIVE FUNCTIONS
• PARASYMATHETIC
• RETURN TO BASELINE
• RELAXATION DIGESTION

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ENDOCRINE SYSTEM
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The Endocrine System and Psychopathology

• Integration of endocrine and nervous system
  function
• The Hypothalamic-Pituitary-Adrenalcortical Axis
• (HPA axis)
• A circuit that runs through these neuroendocrine
  structures that drives the fight or flight
  response
• This system is can become dysregulated and lead
  to psychopathology
• Depression
• PTSD

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The Interaction of Genetic and Environmental
Effects

• The Diathesis-Stress Model, simplistic model
• Examples include blood-injury-injection phobia
  and alcoholism and probably schizophrenia (stress
  may be prenatal, not always stressful life event,
  crit periods)
• Reciprocal Gene-Environment Model, Genes interact
  with environment born with predisposition or
  personality for risk taking influences (does
  not cause) choice of boyfriend so more break-ups
  more break-ups lead to higher level of depression
  for people with certain genetic make-up
• stressful life events may be greater in people
  with depression . Not just coincidentalmay be
  because genetic loading may influence things like
  mate selection or procrastination that influence
  stress load

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Cultural, Social, and InterpersonalFactors in
Psychopathology

• Cultural Factors
• Influence form and expression of behavior
• Gender Effects
• Exerts a strong and puzzling effect on
  psychopathology
• Family Effects
• Family System Approaches
• Social Effects on Health and Behavior
• Frequency and quality are important
• Related to mortality, disease, and
  psychopathology
• Stigma of Psychopathology
• Culturally, socially, and interpersonally situated

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One-Dimensional vs. Multidimensional Models

• One-Dimensional Models
• Explaining behavior in terms of a single cause
• Problem Other information is often ignored,
• Multidimensional Models
• Interdisciplinary, eclectic, and integrative
• What were once traditions are now integrated
  factors of causality
• System of influences that cause and maintain
  suffering
• Uses information from several sources
• Abnormal behavior as multiply determined

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Multidimensional Models of Abnormal
BehaviorOverview

• Biological Factors
• Genetics (diathesis?)
• Physiology (endocrine function)
• Neurobiology (transmitter dysregulation/cell
  death)
• Behavioral Factors (coping)
• Cognitive Factors (attributional style)
• Social Factors (support of friends, family)
• Developmental Factors (developmental insults)
• Each of these factors may be weighted more than
  another for a particular person experiencing
  psychopathology

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CONTEXT
Genetics
Biological Structure and Function of Systems
Psychological Cognitive and Behavioral Function
Environmental Stimuli
Behavioral Response
Emotional Response
Cognitive Response