Chapter 1 Abnormal Behavior | Lecture notes Health psychology

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

how do you parse out just being sad from depression?

May study the prevalence and incidence of disorders

Prevalence = rates in the general population (how

many would score in the particular

category?)

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

Acute (suddenly) vs. insidious (symptoms creep up on

you until you one day meet the

diagnosis) onset

May describe the course of disorders

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

biological (genetic inheritance… genetic vulnerability)

psychological (thinking styles that leave you vulnerable

to certain things like depression)

social (cultural background, how to express certain

kinds of emotion, SES)

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

treatments may be pharmacologic, psychosocial, or

combined

studying treatment outcome lets us ask whether we have

effectively reduced suffering

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

in all cultures

across all time periods

understandings of the etiologies and treatment of abnormal

behaviour have varied widely

across cultures

across time periods

as a function of prevailing world views

three dominant ways of understanding have included:

supernatural, biological, and psychological

The Biological Tradition: Early Years

Hippocrates (c. 4th and 5th centuries BCE)

Ancient Greek Physician

Believed abnormal behaviour had natural, rather than

supernatural, causes

E.g., believed hysteria resulted from a “wandering

uterus”

“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

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”

demonic possession, witchcraft, sorcery

treatments included exorcism, torture, beatings, and crude

surgeries

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

Believed movements of the moon and stars caused

abnormal behaviour (e.g., lunacy, lunatics… as though

the moon somehow affects how we act)

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

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Three Focuses of Science Studying psychological disorders:

clinical description
Causation (etiology)
Treatment and outcome Focus on Clinical Description  distinguishing clinically significant dysfunction from common human experience  how do you parse out just being sad from depression?  May study the prevalence and incidence of disorders  Prevalence = rates in the general population (how many would score in the particular  category?)  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  Acute (suddenly) vs. insidious (symptoms creep up on you until you one day meet the  diagnosis) onset  May describe the course of disorders  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  biological (genetic inheritance… genetic vulnerability)  psychological (thinking styles that leave you vulnerable to certain things like depression)  social (cultural background, how to express certain kinds of emotion, SES)  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  treatments may be pharmacologic, psychosocial, or combined  (^) studying treatment outcome lets us ask whether we have effectively reduced suffering  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  in all cultures  across all time periods  (^) understandings of the etiologies and treatment of abnormal behaviour have varied widely  across cultures  across time periods  (^) as a function of prevailing world views  (^) three dominant ways of understanding have included:  (^) supernatural, biological, and psychological The Biological Tradition: Early Years  (^) Hippocrates (c. 4 th^ and 5 th^ centuries BCE)  (^) Ancient Greek Physician  Believed abnormal behaviour had natural, rather than supernatural, causes  E.g., believed hysteria resulted from a “wandering uterus”  (^) “hysterical behaviour” – the roots of the word suggest removal of the uterus.. hysterectomy etc. The Biological Tradition: Early Years Galen  (^) a physician in 2 nd^ century Greece  expanded the work of Hippocrates, including the humoral theory of mental illness  (^) 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 16 th^ centuries), deviant behaviour was seen as a battle of “Good” versus “Evil”  demonic possession, witchcraft, sorcery  treatments included exorcism, torture, beatings, and crude surgeries  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 16 th^ century  Believed movements of the moon and stars caused abnormal behaviour (e.g., lunacy, lunatics… as though the moon somehow affects how we act)  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 19 th^ century, it was discovered that a mental condition called general paresis was caused by the late stages of syphilis  around 1870, Pasteur discovered bacterial cause  eventually penicillin discovered as a treatment  John Grey  mid-19th^ century American psychiatrist  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  dramatically^ improved^ treatment^ of^ psychological disorders  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 20 th^ century, Clarence Hincks reported on appalling institutional conditions in MB and elsewhere  refuted the idea that psychological disorders were incurable  moving away from supernatural  now they were located in peoples brains, and they thought that brains were unchangeable, they basically saw people as incurable  Clarence Hincks however refuted this idea because HE got better, and he realized that this idea that mental health problems are incurable is untrue dialectical behaviour therapy → a branch of CBT  integrates zen (mindfulness) Results of the Biological Tradition  20 th^ century – mental illness seen as physical illness  some said, therefore, incurable  1930s – biological treatments were standard practice  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  e.g., neuroleptics (like reserpine) and major tranquilisers  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  you’ll end up with Parkinson-like symptoms if you stay on the drug too long  a lot of people ended up addicted to Valium – a lot of women were on tranquilizers that was prescribed  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 18 th^ and early 19 th^ centuries)  “if you just treated people humanely, they would come around. Their symptoms would be reduced”  patients in institutions to be treated as normally as possible, encouraging and reinforcing social interaction  People who advocated for these approaches in various parts of the world: ● France:^ Phillippe^ Pinel^ and^ Jean-Baptiste^ Pussin ● England: William Tuke ● U.S.: Benjamin Rush ● 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 19 th^ century  overcrowded asylums undermined quality of care — unintentional result of reforms by Dix, Hincks, et al.  psychological^ tradition^ lay^ dormant^ until^ early^20 th century

 Melanie Klein, Otto Kernberg, and object relations theory  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?)  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 Icope with that?)  Others developed concepts different from those of Freud  Carl Jung  Alfred Adler  Karen Horney  Erich Fromm  Erik Erickson  Neo-freudians – people who tried to take Freud’s theory and make it work without so much sex in it Humanistic Theory:  Carl Rogers (unconditional positive regard), Abraham Maslow, and Fritz Perls  Major themes:  People are basically good  People strive toward self-actualization  “if you provide a warm, nurturing environment, people will do well.”  Humanist treatment  Therapist conveys empathy and unconditional positive regard  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  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  Pavlov, Watson, and classical conditioning  Requires repeated co-occurrences of neutral stimuli and unconditioned stimuli CLASSICAL (the behaviour of interest is under control of the prompting event or stimulus) OPERANT (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  Most voluntary behaviour is controlled by the consequences that follow behaviour  Both classical and operant traditions greatly influenced the development of behaviour therapy From Behaviourism to Behaviour Therapy  behaviour therapy movement reacted against psychoanalysis and non-scientific approaches  behaviour therapy tends to be time-limited and direct  uses principles of operant and classical conditioning to help people make the changes they want  strong empirical evidence supporting the effectiveness of behaviour therapy Pioneers of Behaviour Therapy  Joseph Wolpe – systematic desensitization  Where youre imagining yourself in a feared situation, gradually you get more exposed to that fear and it loses its power  Arnold Lazarus - multi-modal behaviour therapy  Hans^ Eysenck^ –^ conditioning^ therapy

 Aaron BECK – cognitive therapy  Albert Bandura – social learning or cognitive-behaviour therapy  “we can acquire certain behaviours just by observing somebody else experience the consequences of a behaviour  kids would watch other kids get punished for being violent  you can acquire behaviours by observing them  Stanley Rachman – one of the original founders of the behaviour therapy approach  Big name in behaviourism in CANADA Scientific Method and an Integrative Approach  behavioural science currently understands that:  psychopathology is multiply determined (there’s no one way to get there, and you need a lot of factors to come together to produce a behaviour)  unidimensional accounts of psychopathology are incomplete  it^ is^ necessary^ to^ consider^ reciprocal^ relations^ between biological, psychological, social, and experiential factors in an integrative approach

Chapter 1 Abnormal Behavior, Lecture notes of Health psychology

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