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Chapter 1: Abnormal Behaviour in Historical ContextMyths and MisconceptionsMYTH REALITYNormality and Abnormality are clearly definedNo single definition of psychological abnormality People who are mentally ill must be: lazy, crazy, or dumb weak in character dangerous to themselves or to others In ge...

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Chapter 1: Abnormal Behaviour in Historical Context Myths and Misconceptions MYTH Normality and Abnormality are clearly defined People who are mentally ill must be: - lazy, crazy, or dumb - weak in character - dangerous to themselves or to others Mental Illness is a hopeless situation

REALITY No single definition of psychological abnormality In general, having problems doesn’t make anyone any more lazy, crazy, dumb, weak or dangerous than the general population

There are effective treatments for many problems

Defining Abnormal Behaviour  psychological dysfunction o breakdown in cognitive, emotional, or behavioural functioning  distress or impairment o difficulty performing appropriate and expected roles o impairment is set in the context of a person’s background  you might be ABLE to do what you need to do, but you might be very distressed still  you might have somebody who isn’t subjectively distressed, but they are not functioning well (impairment)  atypical or unexpected cultural response o reaction is outside cultural norms  some behaviours are normal in certain cultures, but not normal in “our” culture  example: when is it OK to hear voices? In religious ceremony vs. not The Diagnostic and Statistical Manual  DSM is a widely accepted system for classifying psychological problems and disorders  Contains diagnostic criteria for behaviours that: o Fit a pattern o Cause dysfunction or subjective distress o Are present for a specified duration  For instance, if somebody has been exposed to a traumatic event, and they are reexperiencing it or showing other signs of distress… if the symptoms are around less than 30 days, that’s acute distress. POST 30 days, that’s post traumatic stress disorder  Otherwise the definitions are the same  Psychotic disorders…. There are 2 disorders that look very similar. Schizophrenia looks very similar to schizophrenoform disorder. The difference is really in the duration  Duration is super important o And are not otherwise explainable  If the behaviours you are observing are due to a medical condition, or the acute effects of intoxication… they are not a mental disorder  The rule-outs are always in the manual as well Dr Smith: Normal or Abnormal?

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PHD in Statistics Works as a statistician in a large medical school Good salary, successful researcher, expert in statistics, and a reasonably good instructor Interacts with colleagues very little, but gets along with them because he gets his work done No friends, no romantic relationship, and no kids Has a dog No desire to have a social life Prefers to engage in hobbies that do not involve others, like gardening and watching television When asked “How are you?” by students or colleagues, he responds “good” He honestly thinks things are going well

Does Dr. Smith have a psychological disorder? A. he seems pretty normal B. he seems a little off, but still in the normal range C. he seems abnormal, but probably DOES NOT have a psychological disorder D. He seems abnormal, and probably DOES have a psychological disorder E. He seems normal, but would probably get diagnosed with a psychological disorder. Probably would be diagnosed with: SCHIZOID PD  the thing that gives it away is the lack of relationship and NOT being distressed by it  doesn’t have distress or impairment  often people with personality disorders are diagnosed because they are causing distress to others  this subjective distress thing can be tricky. It’s not the right way to diagnose people, but that’s often how it happens  evidence-based treatment is important January 8, 2016 Abnormal Behaviour Defined  abnormal behaviour = a psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response  psychological disorder and psychological abnormality are used interchangeably o disorder refers to category in the DSM o mental illness = more of a legal term (used in laws that are relevant to getting yourself involuntarily committed… that kind of thing. You don’t hear psychologists talking this way)  mental illness is a less preferred term  psychopathology is the scientific study of psychological disorders Mental Health Disciplines  mental health professionals o Ph.D.: Clinical and counseling psychologists o Psy.D.: Clinical and counseling “Doctors of Psychology”  Three Psy.D. programs currently exist in Canada  U Quebec, Laval, and MUN (Memorial) o In Canada, regulation of the profession is under the jurisdiction of the provinces and territories o M.D.: Psychiatrists o M.S.W.: Psychiatric and non-psychiatric social workers o M.N./M.S.N.: Psychiatric nurses o Lay public and community groups

The Scientist-Practitioner Model  scientist practitioners are: o producers of research o consumers of research o evaluators of their work using empirical methods Mental Health Professional  consumer of science o enhancing the practice  evaluator of science o determining the effectiveness of the practice  creator of science o conducting research that leads to new procedures useful in practice Three Focuses of Science Studying psychological disorders: 1) clinical description 2) Causation (etiology) 3) Treatment and outcome Focus on Clinical Description  distinguishing clinically significant dysfunction from common human experience o how do you parse out just being sad from depression?  May study the prevalence and incidence of disorders o Prevalence = rates in the general population (how many would score in the particular category?) o Incidence = number of new cases per year (they will not necessarily be the same as the prevalence rates, that’s because people move into and out of the diagnostic category)  May describe the onset of disorders o Acute (suddenly) vs. insidious (symptoms creep up on you until you one day meet the diagnosis) onset  May describe the course of disorders o Episodic (move from episode to episode with full symptom reduction between the episodes, or partial symptom reduction between the episodes…), time-limited (brief psychotic disorder… remits and then it’s like you’d never know that it happened), or chronic course (they always stay with you in some form). Focus on Causation  the study of factors that contribute to the development of psychopathology = etiology  a disorder may have a number of etiologies o biological (genetic inheritance… genetic vulnerability) o psychological (thinking styles that leave you vulnerable to certain things like depression) o social (cultural background, how to express certain kinds of emotion, SES) o environmental (living in a climate where there is less sunlight in the winter… developing Seasonal Affectiveness Disorder…. Etc) Focus on Treatment and Outcome  studying treatment development = researching how to best improve the lives of people suffering from psychopathology

o treatments may be pharmacologic, psychosocial, or combined  studying treatment outcome lets us ask whether we have effectively reduced suffering o outcome studies are limited in their ability to specify the actual causes of disorders there’s different theories about how people develop problems. We want to test these theories to see if they actually help people get better. You want to match the effective approach with whatever the client has. You can pick from many possibilities… balancing with client preference too. Historical Conceptions of Abnormal Behaviour  major psychological disorders have existed o in all cultures o across all time periods  understandings of the etiologies and treatment of abnormal behaviour have varied widely o across cultures o across time periods o as a function of prevailing world views  three dominant ways of understanding have included: o supernatural, biological, and psychological link the names with the concepts – either who they were or what idea they brought FOR THE TEST! THE NAMES ARE IMPORTANT FOR THIS CHAPTER

The Biological Tradition: Early Years  Hippocrates (c. 4th and 5th centuries BCE)  Ancient Greek Physician  Believed abnormal behaviour had natural, rather than supernatural, causes o E.g., believed hysteria resulted from a “wandering uterus” o “hysterical behaviour” – the roots of the word suggest removal of the uterus.. hysterectomy etc. The Biological Tradition: Early Years Galen  a physician in 2nd century Greece  expanded the work of Hippocrates, including the humoral theory of mental illness o humoral theory: that your bodily fluids – blood, phlegm, 2 types of bile, black & yellow, depending on the relative levels of each of these fluids in the body, that would account for different symptoms  choleric (anger… yellow bile)  sanguine (cheerful… it’s happy. Related to blood)  melancholy (sadness… related to black bile)  Phlegmatic (sluggishness… related to phlegm)  crude treatments (e.g., bloodletting) The Biological Tradition  Galenic-Hippocratic tradition foreshadowed modern views linking abnormality with brain chemical imbalances  After Galen, the supernatural tradition would predominate, especially during the Middle Ages The Supernatural Tradition

 during the Middle Ages (5th to 16th centuries), deviant behaviour was seen as a battle of “Good” versus “Evil” o demonic possession, witchcraft, sorcery  treatments included exorcism, torture, beatings, and crude surgeries o that’s why we say bless you when we sneeze. Because the demons enter through your orfices The Supernatural Tradition  Paracelsus was an alchemist in the 16th century o Believed movements of the moon and stars caused abnormal behaviour (e.g., lunacy, lunatics… as though the moon somehow affects how we act) o He also pioneered the use of chemicals in the treatment of disorders. He would put together a little bowl of something to swallow… usually something toxic… hopefully you would come to and feel better. ECT, producing seizures is still something we use today. Which leads us back to… The Biological Tradition Comes of Age  in the 19th century, it was discovered that a mental condition called general paresis was caused by the late stages of syphilis o around 1870, Pasteur discovered bacterial cause o eventually penicillin discovered as a treatment  John Grey o mid-19th century American psychiatrist o reformed hospitals & treated mental problems as physical illness  advocated for this approach of treating mental problems as a physical illness  moving away from the supernatural explanations of how people end up with psychological problems, or even character descriptions (they’re like that because they are lazy, dumb, etc.)  before we had these ideas of treating people in a medical sort of way, often people were sent to asylums. Just locked up and not treated well. The Biological Tradition Comes of Age  mid-19th century, Dorothea Dix started the mental hygiene movement in Canada and US o dramatically improved treatment of psychological disorders o unintended outcome: overcrowded hospitals, which undermined care due to inadequate resources (people wouldn’t get a divorce.. they would just throw their wife in the mental institution!)  early 20th century, Clarence Hincks reported on appalling institutional conditions in MB and elsewhere o refuted the idea that psychological disorders were incurable o moving away from supernatural o now they were located in peoples brains, and they thought that brains were unchangeable, they basically saw people as incurable o Clarence Hincks however refuted this idea because HE got better, and he realized that this idea that mental health problems are incurable is untrue January 11, 2016  his lectures may come across as being very CBT bias – but it’s more complicated than that  dialectical behaviour therapy  a branch of CBT o integrates zen (mindfulness)  to read online: Therapy wars: the revenge of Freud

Results of the Biological Tradition  20th century – mental illness seen as physical illness o some said, therefore, incurable  1930s – biological treatments were standard practice o e.g., insulin shock therapy (put you in a coma, when you wake up, your symptoms are relieved), ECT (delivering dose of electricity to the brain to induce seizure. Still used today for depression for cases that are not curable. We might use it also for people who cannot tolerate medication, like older people), brain surgery (lobotomy = severing connections from one part of the brain to the rest of the brain) Results of the Biological Tradition  1950s – several medications were established o e.g., neuroleptics (like reserpine) and major tranquilisers o the biological tradition still strongly influences many current understandings of abnormal behaviour  e.g., psychiatry, behavioural genetics (twin studies, that kind of thing), biopsychology  one of the downsides of these drugs is that if you take them for a long time, you get other symptoms o you’ll end up with Parkinson-like symptoms if you stay on the drug too long o a lot of people ended up addicted to Valium – a lot of women were on tranquilizers that was prescribed o we could finally offer hope to people who have symptoms that can be managed…. But of course there have been downsides The Psychological Tradition  emerged with the rise of moral therapy (late 18th and early 19th centuries) o “if you just treated people humanely, they would come around. Their symptoms would be reduced” o patients in institutions to be treated as normally as possible, encouraging and reinforcing social interaction o People who advocated for these approaches in various parts of the world: o France: Phillippe Pinel and Jean-Baptiste Pussin o England: William Tuke o U.S.: Benjamin Rush o Canada: Dorothea Dix  The downside : the asylums became overcrowded. There weren’t enough staff to meet the needs of the client, and so the conditions got worse Psychological Tradition  moral therapy declined in late 19th century o overcrowded asylums undermined quality of care  unintentional result of reforms by Dix, Hincks, et al. o psychological tradition lay dormant until early 20th century The Psychoanalytic Tradition  Freud’s structure of the mind o Id – operates on pleasure principle  Primary process: illogical, emotional, irrational  Id-type thinking is not rational, it is emotion-driven o Ego – operates on reality principle

 Secondary process: logical and rational  Mediates between other two structures  Between all the stuff you shouldn’t do and all you want to do  It’s the reality principle o Superego - moral principles  Conscience  Rules from society about how you’re supposed to act. It’s the stuff that tells you, “you really shouldn’t just take sex whenever you want. That’s sexual assault, don’t do that” The Psychoanalytic Tradition  see brain slide Fleeing Feeding Fighting Fornicating (the 4 Fs) Superego  type of thinking: conscience  driven by: Moral principles Ego type of thinking: Logical, rational  driven by: reality principle Id  type of thinking: Illogical; emotional; irrational  driven by: Pleasure principle The Psychoanalytic Tradition  defence mechanisms: when the ego loses the battle with the id and superego o denial (you see this a lot in addiction. “I don’t have a problem”) o displacement (you’re angry at your boss, you come home and kick your dog) o projection (I’m not angry, you’re angry) o rationalization (justify your behaviour, making it reasonable) o reaction formation (displaying the exact opposite emotion than you’re feeling. It’s the idea that homophobia masks homosexual tendencies) o repression (unconsciously shoving it down) – different from suppression o sublimation (you take this urge to do something destructive, and you do something else with it. Instead of kicking your dog because you are mad at your boss, you go for a run)  sometimes called “coping styles” today  to defend the ego from the anxiety it feels when overwhelmed by the id Healthy Defences? Which of the following defence mechanisms is considered part of healthy psychological functioning? A. denial B. projection C. rationalization D. repression E. sublimation The Psychoanalytic Tradition  Freudian stages of psychosexual development o Oral stage (we need to take in nourishment – we nurse from our mothers… the conflict there is that the child does not differentiate the self from the mother. The biological lines are blurred. Beginnings of individuation that occurs as the child gets older and starts to ween off the breast. The challenge is to soothe yourself without relying on the breast) o Anal stage (now that the child is older, dealing with toddler through young childhood, this Is about individuation and autonomy. Still about the poop. When do you poop? Under what circumstances do you poop? Do you withhold poop? Figuring out what you can say no to – the “terrible twos”)

o Phallic stage (ages 5-8ish, Oedipal complex, Electra complex, penis envy, little girls want their dad) o Latency stage (age 7-puberty ish, all this stuff goes underground, not a lot of conflicts going on. This is also when children get more compliant, they want to be your friend) o Genital stage (sexual awakening starts to happen around puberty.)  The theory is that if you don’t successfully resolve these conflicts you will get stuck in a stage  Unresolved conflict or particular engagement in a certain stage theorized to lead to fixation o Addictive problems – stuck in the oral stage o “he’s anal” = stuck in the anal stage Neo-Freudian Ideas  the neo-Freudians generally de-emphasized the sexual core of Freud’s theory  Anna Freud and self-psychology o Emphasized the influence of the ego in defining behaviour  Melanie Klein, Otto Kernberg, and object relations theory o Emphasized how children incorporate or introject objects (not the actual mother, but your idea about your mother. We might call these schemas now. Then how do you relate to that internalized image of your mother?) o Objects include images, memories, and values of significant others (becomes part of your consciousness. “I know my mother told me not to do this but I’m doing it anyways. How do I cope with that?)  Others developed concepts different from those of Freud o Carl Jung, Alfred Adler, Karen Horney, Erich Fromm, and Erik Erickson o Read more about what each of these guys thought in the textbook o Neo-freudians – people who tried to take Freud’s theory and make it work without so much sex in it January 13, 2016 Coming from that came… Humanistic Theory:  Carl Rogers (unconditional positive regard), Abraham Maslow, and Fritz Perls  Major themes: o People are basically good o People strive toward self-actualization  “if you provide a warm, nurturing environment, people will do well.”  Humanist treatment o Therapist conveys empathy and unconditional positive regard o Minimal therapist interpretation  No strong empirical evidence that humanistic therapies work  Albert Ellis: “You feel better but you don’t get better.” Maslow’s Hierarchy (see slide)  self-actualization (morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts)  esteem (self-esteem, confidence, achievement, respect of others, respect by others)  love/belonging (friendship, family, sexual intimacy)  safety (security of body of employment, of resources, of morality, of the family, of health, of property)  physiological (breathing, food, water, sex, sleep, homeostasis, excretion)

 if you take these too concretely, step-wise, linear,…. You run into problems. A homeless person could be concerned with confidence … The Behavioural Model (see slide)  Pavlov, Watson, and classical conditioning o Requires repeated co-occurrences of neutral stimuli and unconditioned stimuli CLASSICAL (the behaviour of interest is under control of the prompting event or stimulus) vs. OPERANT conditioning (the behaviour is more under control of the consequences of the behaviour – the way it is reinforced) The Behavioural Model  Thorndike, Skinner, and operant conditioning o Most voluntary behaviour is controlled by the consequences that follow behaviour  Both classical and operant traditions greatly influenced the development of behaviour therapy Behaviourism was like a really big F U to Freud  science solving problems From Behaviourism to Beh...