History, Culture and Models of Abnormal Behavior

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History, Culture and Models of Abnormal Behavior

• RCS 6931
• 5/15/07
• Steven R. Pruett, Ph.D., CRC

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History of Psychopathology

• Deviant behavior has existed throughout history.
• Our ancestors considered many things beyond their
  control as having a supernatural cause
• Thus the early writings concerning
  psychopathology to be reflective of a displeased
  deity or demonic possession.

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Demonology

• Babylonians had a specific demon for each disease
• Idta was the demon of insanity.
• This type of thinking about mental illness also
  existed among the early Chinese, Greeks and
  Egyptians.
• This way of thinking also existed in the early
  Judeo-Christian tradition.

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Somatogensis

• Hippocrates (Greek 5th century BCE)
• Rejected the notion that illness was sent by the
  gods.
• Proposed serious illnesses had natural causes
  and therefore should be treated like common
  maladies.
• Thought the brain was the organ of consciousness,
  intelligence emotion.
• Believed that if something was wrong with the
  body it would disturb the individuals thoughts
  and actions.

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Hippocrates

• Classified mental disorders into 3 categories
• Mania
• Melancholia
• Phrenitis (brain fever)

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Hippocrates

• Thought health ( mental health) was dependent on
  the balance of four humors or fluids in the
  body
• Blood,
• Black Bile,
• Yellow Bile
• and Phlegm
• An imbalance produced disorders
• Too much blood would make a person highly
  temperamental and unstable (sanguine).
• If a person was sad he/she had too much black
  bile (melancholic).
• Too much yellow bile meant they were irritable or
  anxious (choleric).
• Too much phelgm would yield a person sluggish and
  dull (phlegmatic).

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Dark Ages

• Associated abnormal behavior again with
  demonology.
• Viewed mental illness as spiritual.
• Witches and warlocks.
• Isolation of mental illness.

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Dark Ages

• Monks generally cared for individuals with mental
  illness
• Witches
• Torture to admit to relationships with demons

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Dark Ages

• Lunacy Trials
• Trials held to determine sanity
• Began in 13th century England
• Lunacy
• Attributes insanity to the misalignment of the
  stars and moon.

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Asylums

• Asylums were established to confine individuals
  with mental illness
• Priory of St. Mary of Bethlehem (1243 CE)
• One of the first mental institutions
• People paid to watch the insane for
  entertainment.
• Note treatment was either harmful or
  non-existent in asylums

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Reform Movement

• Europe and United States in the 1700s
• Public institutions were like dungeons
• Pinel and Pussin removed irons from mental
  patients a pioneered humane treatment.

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Moral

• Moral treatment - actually an advance
• Emphasized Responsibility
• William Tuke Society of Friends
• Establishment of York Retreat
• Calming environment
• Patents spoke with attendants
• Participated in purposeful, calming activities.

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Moral

• Benjamin Rush - Pennsylvania Hospital
• Part of Rush's treatment of the mentally ill was
  based upon his idea of the cause of physical
  disease. One of his prescriptions for a patient
  was "bleeding . . . strong purgeslow dietkind
  treatment, and the cold bath."
• Dorothea Dix
• Investigated the conditions of the Menally Ill in
  her home state of MA. Convinced legislature to
  increase funding for increasing the state mental
  hospital
• After this she documented conditions of indigent
  mentally ill from N.H. to LA.
• This led to legislation passed by both houses of
  Congress to set aside 10 million acres of Federal
  land, with the proceeds from its sale to be
  distributed to the states to build and maintain
  asylums, However President Pierce vetoed it
  (1854), arguing that the federal government
  should not be involved in social welfare.

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Tranquilizing Chair
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Return to Somatogenesis

• Emil Kraepelin (1883)
• Published the first psychiatry text
• Mental Illness as a syndrome
• Cluster of symptoms that appear together
  regularly
• Suggested two major syndromes
• Dementia paecox
• Manic-depressive psychosis

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Biological approach

• Advanced by understanding of general paresis
• Degenerative disorder with psych symptoms
• Related to syphilis
• Advance of the germ theory (Pasteur)
• In 1905, cause of syphilis was discovered

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Early biological treatments

• ECTs
• Cerletti Bini (1938)
• Prefrontal lobotomy
• Montz (1935)

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Genetics

• In the early 20th century the idea that mental
  illness could be inherited
• Behavioral genetics
• Relates to the relationship of genetics and
  behavioral differences
• Eugenics
• Promotion of enforced sterilization to eradicate
  undesirables from the population
• Many state laws required the mentally ill and
  retarded to be sterilized.

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Psychogenesis

• Mesmers (1734 1815)
• Treatment of hysterical patients
• Animal magnetism
• First use of hypnosis
• Breuer (1842-1925)
• Utilized hypnosis to facilitate catharsis
• Catharsis
• Release of emotional tension triggered by
  reliving and talking about an event.

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Psychoanalytic theory

• Sigmund Freud
• Human behavior is determined by unconscious
  forces
• Psychopathology results from conflicts among
  these unconscious forces

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Structure of the Mind

• Id
• Unconscious
• libido
• Ego
• Primary conscious
• Reality principle
• Superego
• Conscience
• Develops as an individual incorporates parental
  and societal values

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Psychosexual Development

• Oral (to 18 mos)
• Anal (18 mos to 3 years)
• Phallic (3 to 5 or 6)
• Latency (6 to 12)
• Genital (adulthood)

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Fixation and Regression

• Too little (or too much) gratification leads to
  fixation at a given stage
• When stressed an individual may regress to an
  earlier stage

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Defense Mechanisms

• The Id, Ego Superego are continually in
  conflict.
• This conflict causes anxiety.
• Defense mechanism
• These are psychological maneuvers that are
  attempts to control stress and anxiety
• Repression
• Usually intentional, (but unconscious) forgetting
• Memories, impulses, traumatic events.

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Some selected Defense Mechanisms

• Repression
• Denial
• Projection
• Displacement
• Reaction Formation
• Rationalization
• Sublimation

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Major techniques of Psychoanalysis

• Free Association
• Interpretation
• Analysis of Transference

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Neo-Freudians

• Jung
• Analytical psychology
• Incorporates elements of Freudian and humanistic
  psychology
• Collective unconscious
• Elements of the unconsciousness are shared by all
  humans
• Archetypes
• Adler
• Individual Psychology
• Striving for superiority

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Behaviorism

• John Watson (1878-1958)
• Behaviorism
• Emphasis on learning vs. innate tendencies
• Focus on observable behavior rather than
  machinations of the psyche.

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Classical Conditioning

• Pavlov (1849 1936)
• Learning through association
• Elements of learning
• Unconditioned Stimulus (UCS)
• Conditioned Response (CS)
• Unconditioned Response (UR)
• Conditioned Response (CR)
• Watson Raynor (1920)
• Classically conditioned fear in Little Albert

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Operant Conditioning

• Operant Conditioning
• E. Thorndike (1874-1949)
• Learning through consequences
• Law of Effect
• B.F. Skinner (1904-1990)
• Principles of Reinforcement
• Positive Reinforcement
• Behaviors followed by pleasant stimuli are
  strengthened
• Negative Reinforcement
• Behaviors that terminate a negative stimulus are
  strengthened
• Shaping
• Reward a sequence of responses that approximate
  the final response

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Modeling

• Learning by imitating others behaviors
• Bandura Menlove (1968)
• Modeling reduced childrens fear of dogs
• Behavior Therapy
• Counterconditioning
• Systematic Desensitization
• Aversive Conditioning

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Counter conditioning
R1
Stimulus Original Situation
Elicits
R2
Stimulus After Therapist Intervention
Elicits
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Contemporary Developments

• Current dominance of medical model
• Syndrome, diagnosis, treatment
• Biochemical treatment
• Cognitive-behavioral therapies
• Empirically validated treatments
• Interpersonal/counseling therapies

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Contemporary Developments

• Community Mental Health
• Humanistic Approaches
• Family and Systems Analysis

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Mental Health Professionals

• Clinical Psychologist
• Ph.D. or Psy.D.
• Psychiatrist
• M.D. or D.O.
• Social Workers
• M.S.W.
• Licensed Mental Health Counselors
• M.H.S., M.S., M.A. WITH A LMHC designation

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Models of Abnormal Behavior

• The STATISTICAL APPROACH defines normal behavior
  by describing what the average person does and
  abnormality as deviance from this norm. Often a
  criterion is used of plus or minus two standard
  deviations from the mean on any behavior or
  standardized test. Problems with this definition
  are that it equates "normality" with conformity.
  Often deviation from the mean such as a high
  intelligence quotient may actually be desirable.

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The PSYCHODYNAMIC MODEL

• views abnormal behavior as the result of
  unresolved psychological conflicts from early
  childhood and from intrapsychic conflict between
  instinctual selfish desires of the id and the
  demands of the society and personal conscience
  present in the superego.

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The BEHAVIORAL MODEL

• proposes that disorders are caused by poor
  LEARNING ENVIRONMENTS that reinforce problematic
  behaviors. To a behaviorist there is "no such
  thing as an abnormal person, only a normal person
  in an abnormal environment." SOCIAL LEARNING
  theorists emphasize that society often provides
  deviant maladaptive models that children imitate.
  The key to modifying problem behaviors lies in
  providing positive learning experiences, healthy
  models to imitate and in rewarding positive
  behaviors.

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The HUMANISTIC MODEL

• proposes that we are self-actualizing our
  potential. If our natural growth toward
  self-fulfillment is blocked by negative criticism
  and conditions of worth we may develop a negative
  self-concept that obstructs our growth and
  distorts our view of the world. We may begin to
  withdraw emotionally and lose touch with our
  inner self that longs to self-actualize. Through
  unconditional positive regard, empathy,
  acceptance and respect we can rediscover our
  inner beauty and seek our self-fulfillment.

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The COGNITIVE APPROACH

• views abnormal behavior as a result of distorted
  or irrational thinking. The cognitive model
  asserts the psychological disorder is the result
  of faulty thinking that leads to inappropriate
  and self-defeating behavior.
• For example, Beck, a well-respected cognitive
  therapist, believes depression is the result of
  thinking negative and depressing thoughts about
  lifes experiences and challenges patients ideas
  about their illness, helping them to think more
  positively. These thoughts become "automatic
  thoughts" and are difficult to break.

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The SOCIOCULTURAL MODEL OF ABNORMALITY

• argues that abnormal behavior is an attempt to
  adjust to an unjust mad world. To sociocultural
  theorists it is society, not the person, that is
  sick. They contend that we who "adjust" to this
  "insane world" do so at the heavy price of
  "conformity" to the madness around us and a loss
  of our individuality. R.D. LAING argues that it
  is we who conform to this age of anxiety who are
  mad and it is the mentally ill who are able to
  express their individuality.
• Although not a prominent theory, the
  sociocultural theory gives us pause. Perhaps
  "normality" is but a "half-crazed adjustment to a
  crazy world." Perhaps the violence, materialism,
  focus on superficial qualities, social ills, the
  drug-craze are signs of social madness that we
  would be wise to alienate ourselves from rather
  than try to conform and fit into a "normal" box.
  Certainly the sociocultural theory calls to
  question current psychiatric practices of
  institutionalization and chemotherapy as the
  proper "therapy" for those who do not choose to
  conform to "normality". Many of our best-known
  artists, writers and geniuses have been labeled
  "abnormal".

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The LEGAL MODEL

• defines INSANITY as a person who is not
  responsible for their actions because they cannot
  understand the difference between right and
  wrong. To be declared "not guilty by reason of
  insanity" the person must have a mental illness
  that causes them to engage in the criminal act.

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The PSYCHOPHYSIOLOGICAL APPROACH

• views abnormal behavior as due to underlying
  physiological abnormalities in the nervous system
  and particularly the brain. Recent research with
  brain-imaging machines gives credence to the
  approach as the brains for instance of
  schizophrenics differ from normal brain scans.

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The MEDICAL MODEL

• Assumes that the behavior disorder is caused by
  an underlying illness. Just as when one has a
  physical illness he goes to the doctor explains
  his symptoms, the physician makes a diagnosis and
  generally prescribes medication. The medical
  model also uses symptoms, diagnosis and
  chemotherapy as the main steps in mental illness
  treatment of mental illness. The American
  Psychiatric Association has adopted a DIAGNOSTIC
  AND STATISTICAL MANUAL (4th edition) to assist in
  the diagnosis of mental illness. It lists the
  symptoms for each "mental disorder" as well as
  the statistics of occurrence in a population.

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The BIOPSYCHOSOCIAL model,

• attempts to recognize the shortcomings of the
  medical model (Engel, 1977, 1980). A basic
  assumption remains the "disease model" is the
  essential frame of reference (Carpenter, 1987).
  However, the biopsychosocial model, in contrast
  to the medical model, conceptualizes disease as a
  multilevel phenomenon. It rejects the
  reductionistic bias of the medical model. The
  biopsychosocial level identifies numerous levels
  that may be relevant in understanding
  psychopathology, including social, psychological,
  biological, and physical variables