Abnormal Psychology: Leading

Research Perspectives 4th Edition

Elizabeth Rieger
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 4e

ABNORMAL PSYCHOLOGY
The fourth edition of the award-winning text, Abnormal
Psychology, provides students with a comprehensive and
engaging introduction to the subject. Building on the legacy
of previous editions, it provides cutting-edge coverage of
core concepts and promotes evidence-based learning and
research in the field.
Connect is proven to deliver better results. Content
This new edition is closely aligned with the DSM-5 and integrates seamlessly with enhanced digital tools
ICD-10 and includes a separate chapter on gender dysphoria. to create a personalised learning experience that
provides precisely what you need, when you need it.
The numerous examples and case studies from Australia
and the Asia–Pacific region will encourage students to Maximise your learning with SmartBook, the first and
consider the real-world application of their studies. only adaptive reading experience designed to change
the way you read and learn. It creates a personalised
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Written by a team of locally based, leading experts in their concepts you need to learn at that moment in time.
fields, Abnormal Psychology 4e can be relied on for its
To learn more about McGraw-Hill SmartBook® visit
up-to-date content, and innovative SmartBook technology www.mheducation.com.au/student-smartbook
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essential resource for students and instructors alike.

ELIZABETH RIEGER
edited by
ABNORMAL
Maree Abbott Carol Hulbert Greg Murray
Harjit Bagga Martina Jovev Richard O’Kearney
Sarah Bendall Riki Lane Nancy A. Pachana

PSYCHOLOGY
Alex Blaszczynski Marita McCabe Ken Pang
Richard Bryant Louise McCutcheon Elizabeth Rieger
Phyllis Butow Peter McEvoy Matthew Sanders
David Clarke Catharine McNab Marianna Szabó
David H. Gleaves Ross G. Menzies Robert Tait
John Gleeson
Phillipa Hay
Philip B. Mitchell
Alina Morawska
Stephen Touyz
LEADING RESEARCHER PERSPECTIVES

4e
edited by ELIZABETH RIEGER
www.mhhe.com/au/rieger4e

spine: 21.88mm
 4e

ABNORMAL
PSYCHOLOGY
LEADING RESEARCHER PERSPECTIVES

EDITED BY ELIZABETH RIEGER

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 Dedication
In memory of Karl Rieger, my father—generous in his love and affirmation,
contagious in his exuberance for life,
unmatched in his courage.

Copyright © 2017 McGraw-Hill Education (Australia) Pty Limited

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National Library of Australia Cataloguing-in-Publication Data

Title: Abnormal psychology : leading researcher perspectives / edited by Elizabeth Rieger.
Edition: 4th edition.
ISBN: 9781743766620 (paperback)
Notes: Includes index.
Subjects: Psychology, Pathological.
Psychology, Pathological—Case studies.
Psychiatry.
Clinical psychology.
Other Authors/Contributors:
Rieger, Elizabeth, editor.

Published in Australia by
McGraw-Hill Education (Australia) Pty Ltd
Level 33, 680 George Street, Sydney 2000
Product manager: Lisa Coady
Content developer: Isabella Mead
Senior content producer: Claire Linsdell
Permissions editor: Haidi Bernhardt
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Proofreader: Anne Savage
Cover design: Simon Rattray
Printed in China on 70 gsm matt art by CTPS

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Contents in brief
CHAPTER 1 Conceptual issues in abnormal psychology 1

CHAPTER 2 Anxiety disorders 41

CHAPTER 3 Obsessive-compulsive and related disorders 73

CHAPTER 4 Trauma- and stressor-related disorders 87

CHAPTER 5 Depressive disorders 99

CHAPTER 6 Bipolar disorder 125

CHAPTER 7 Psychotic disorders 147

CHAPTER 8 Somatic symptom and dissociative disorders 187

CHAPTER 9 Eating disorders 235

CHAPTER 10 Addictive disorders 281

CHAPTER 11 Sexual and relationship problems 327

CHAPTER 12 Gender dysphoria 369

CHAPTER 13 Personality disorders 399

CHAPTER 14 Disorders of childhood 443

CHAPTER 15 Ageing and psychological disorders 491

CHAPTER 16 Health psychology 537

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Contents in full
Preface xi Case matrix xix
About the editor xii What’s new in this edition? xx
Contributing authors xiii Text at a glance xxii
Acknowledgments xviii Digital resources xxiv

CHAPTER 1 Conceptual issues in abnormal psychology  1

Marianna Szabó

ABNORMAL PSYCHOLOGY: AN AUSTRALASIAN The cognitive-behavioural perspective 24

FOCUS 1 The humanistic perspective 25
The definitions of abnormal behaviour and mental The sociocultural perspective 27
disorder 2 An integrative approach 28
Abnormality 2 The classification and diagnosis of
Mental disorder 4 mental disorders 28
Perspectives on the classification, causation Advantages and disadvantages of diagnosis 30
and treatment of mental disorders 6 The development of the DSM system of classification
The biological perspective 6 and diagnosis 31
Psychological perspectives 11 Summary 37
The psychoanalytic perspective 12 Key terms 37
The behavioural perspective 17 Review questions 38
The cognitive perspective 21 References 38

CHAPTER 2 Anxiety disorders 41

Peter McEvoy • Maree Abbott

ANXIETY DISORDERS: AN AUSTRALASIAN FOCUS 41 Social anxiety disorder 55

Fear and anxiety disorders 42 The diagnosis of social anxiety disorder 55
The nature of fear and anxiety disorders 42 The epidemiology of social anxiety disorder 55
Types of anxiety disorders 45 CASE STUDY: SOCIAL ANXIETY DISORDER 55
Specific phobias 46 The aetiology of social anxiety disorder 56
The diagnosis of specific phobias 46 The treatment of social anxiety disorder 57
CASE STUDY: SPECIFIC PHOBIA 47 Generalised anxiety disorder (GAD) 58
The epidemiology of specific phobias 47 The diagnosis of generalised anxiety disorder 58
The aetiology of specific phobias 47 CASE STUDY: GENERALISED ANXIETY DISORDER 59
The treatment of specific phobias 48 The epidemiology of generalised anxiety disorder 59
Panic disorder and agoraphobia 50 The aetiology of generalised anxiety disorder 60
The diagnosis of panic disorder and agoraphobia 50 The treatment of generalised anxiety disorder 62
The epidemiology of panic disorder and agoraphobia 50 Summary 65
CASE STUDY: PANIC DISORDER AND AGORAPHOBIA 51 Key terms 66
The aetiology of panic disorder and agoraphobia 51 Review questions 67
The treatment of panic disorder and agoraphobia 52 References 67

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CHAPTER 3 Obsessive-compulsive and related disorders 73

Ross G. Menzies

OBSESSIVE-COMPULSIVE AND RELATED The aetiology of obsessive-compulsive disorder 78

DISORDERS: AN AUSTRALASIAN FOCUS 73 The treatment of obsessive-compulsive disorder 80
Obsessive-compulsive disorder: diagnosis OCD-related disorders 81
and presentation 74 Hoarding disorder 81
The diagnosis of obsessive-compulsive disorder 74 Body dysmorphic disorder 82
The presentation of obsessive-compulsive disorder 75 Trichotillomania (hair-pulling disorder) 82
CASE STUDY: OBSESSION WITH HARMING OTHERS 75 Excoriation (skin-picking) disorder 82
CASE STUDY: CONTAMINATION OBSESSIONS AND The treatment of OCD-related disorders 83
COMPULSIONS 77 Summary 83
The epidemiology and aetiology of obsessive- Key terms 84
compulsive disorder 77 Review questions 84
The epidemiology of obsessive-compulsive disorder 77 References 84

CHAPTER 4 Trauma- and stressor-related disorders 87

Richard Bryant

TRAUMA- AND STRESSOR-RELATED-DISORDERS: Avoidance 91

AN AUSTRALASIAN FOCUS 87 The treatment and prevention of posttraumatic
The diagnosis of posttraumatic stress disorder 88 stress disorder 92
The epidemiology of posttraumatic stress disorder 89 Treatment 92
The prevalence of posttraumatic stress disorder 89 Prevention 93
Risk factors for the development of posttraumatic Current challenges in treatment and prevention 94
stress disorder 90 CASE STUDY: POSTTRAUMATIC STRESS DISORDER 94
The aetiology of posttraumatic stress disorder 91 Summary 95
Cognitive models 91 Key terms 96
Learning accounts 91 Review questions 96
Biological accounts 91 References 96

CHAPTER 5 Depressive disorders 99

Richard O’Kearney

DEPRESSIVE DISORDERS: AN AUSTRALASIAN The aetiology of depression 107

FOCUS 99 Biological factors 107
Historical and current approaches to the Environmental factors 108
diagnosis of depression 100 Psychological factors 109
Historical approaches to the diagnosis of depression 100 Social factors 111
Current approaches to the diagnosis of depression 100 Protective factors 112
The epidemiology and associated The treatment of depression 112
features of depression 103 Pharmacological and physical approaches 113
The prevalence of depression 103 Psychological approaches 114
The age of onset of depression 105 Relapse prevention 116
The course of depression 105 The prevention of depression 116
Problems associated with depression 105 CASE STUDY: THE SYMPTOMS AND TREATMENT
CASE STUDY: ANXIETY AND DEPRESSION 107 OF MAJOR DEPRESSIVE DISORDER 117

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Summary 117 Review questions 118

Key terms 118 References 119

CHAPTER 6 Bipolar disorder 125

Philip B. Mitchell • Greg Murray

BIPOLAR DISORDER: AN AUSTRALASIAN FOCUS 125 The aetiology of bipolar disorder 134
Historical and current approaches The treatment of bipolar disorder 137
to the diagnosis of bipolar disorder 126 Pharmacological approaches 137
The history of bipolar disorder 126 Psychological approaches 137
The diagnosis of bipolar disorders 127 CASE STUDY: FIRST MANIC EPISODE 141
The epidemiology of bipolar disorder 130 Summary 143
Prevalence, age of onset and course of the disorder 130 Key terms 143
Problems associated with bipolar disorder 131 Review questions 143
Bipolar disorder and creativity 133 References 144

CHAPTER 7 Psychotic disorders 147

John Gleeson • Sarah Bendall

PSYCHOTIC DISORDERS: AN AUSTRALASIAN Vulnerability factors: psychosocial 166

FOCUS 147 Triggering factors 168
The definition and symptoms of psychosis 148 CASE STUDY: THE ROLE OF STRESS AND TRAUMA
Hallucinations 149 IN PSYCHOSIS ONSET 168
Delusions 149 Symptom-specific aetiological factors: hallucinations 169
Disorganised thinking 152 Symptom-specific aetiological factors: delusions 170
Grossly disorganised behaviour 152 Symptom-specific aetiological factors: thought
Negative symptoms 153 disorder 170
The diagnosis of psychotic disorders: core and The treatment of psychotic disorders 171
associated features 153 Prodromal phase interventions 171
Core features 153 Acute phase interventions 173
Associated features 156 Interventions to prevent relapse 175
Historical and current conceptualisations Interventions for enduring psychosis 176
of psychotic disorders 158 The consumer recovery model 177
Historical developments 158 Limitations of current treatment approaches 177
Ongoing controversies 158 CASE STUDY: FROM PRODROMAL PHASE TO EARLY
The epidemiology of psychotic disorders 159 RECOVERY 178
Prevalence and age of onset 159 Summary 179
The course of psychotic disorders 159 Key terms 180
The aetiology of psychosis 163 Review questions 180
Vulnerability factors: biological 163 References 181

CHAPTER 8 Somatic symptom and dissociative disorders 187

David H. Gleaves • David Clarke

SOMATIC SYMPTOM AND DISSOCIATIVE The definition of somatic symptom and dissociative
DISORDERS: AN AUSTRALASIAN FOCUS 187 disorders 188
Somatic symptom and dissociative disorders: Historical approaches to somatic symptom
definitions and historical approaches 188 and dissociative disorders 189

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Somatic symptom and related disorders 191 The diagnosis of dissociative disorders 210
The diagnosis of somatic symptom and related disorders 191 The epidemiology of dissociative disorders 213
The epidemiology of somatic symptom and The aetiology of dissociative disorders 215
related disorders 196 The treatment of dissociative disorders 219
The aetiology of somatic symptom and related CASE STUDY: THE RECOVERED MEMORY/FALSE
disorders 198 MEMORY DEBATE 220
The treatment of somatic symptom and related CASE STUDY: DISSOCIATIVE IDENTITY DISORDER 224
disorders 204 Summary 225
CASE STUDY: SOMATIC SYMPTOM DISORDER 206 Key terms 226
Dissociative disorders 208 Review questions 226
References 227

CHAPTER 9 Eating disorders 235

Stephen Touyz • Phillipa Hay • Elizabeth Rieger

EATING DISORDERS: AN AUSTRALASIAN FOCUS 235 The aetiology of bulimia nervosa 257
Historical and current approaches The treatment of bulimia nervosa 259
to the diagnosis of eating disorders 236 CASE STUDY: BULIMIA NERVOSA 262
Anorexia nervosa 237 Binge eating disorder 263
Bulimia nervosa 238 The epidemiology of binge eating disorder 263
Binge eating disorder 239 The aetiology of binge eating disorder 264
Other DSM-5 feeding or eating disorders 239 The treatment of binge eating disorder 266
CASE STUDY: AVOIDANT/RESTRICTIVE FOOD INTAKE CASE STUDY: BINGE EATING DISORDER 269
DISORDER (ARFID) 240 General topics in eating disorders 270
Anorexia nervosa 241 Current challenges and controversies 270
The epidemiology of anorexia nervosa 242 Eating disorder organisations 274
The aetiology of anorexia nervosa 243 Summary 274
The treatment of anorexia nervosa 249 Key terms 275
CASE STUDY: ANOREXIA NERVOSA 254 Review questions 275
Bulimia nervosa 256 References 275
The epidemiology of bulimia nervosa 256

CHAPTER 10 Addictive disorders 281

Alex Blaszczynski • Robert Tait

ADDICTIVE BEHAVIOURS: AN AUSTRALASIAN The aetiology of substance use disorders 292

FOCUS 281 The treatment of substance use disorders 297
Substance use disorders 282 Gambling disorder 301
The diagnosis of substance use disorders 282 Types of gamblers 303
CASE STUDY: SEVERE ALCOHOL USE DISORDER 283 Historical approaches to gambling and
CASE STUDY: CANNABIS WITHDRAWAL 285 problem gambling 304
The epidemiology of substance use The diagnosis of gambling disorder 305
disorders 285 The epidemiology of problem gambling 307
CASE STUDY ACUTE INTOXICATION: SYNTHETIC The aetiology of gambling disorder 309
CANNABINOIDS 287 CASE STUDY: A BEHAVIOURALLY CONDITIONED
CASE STUDY: STIMULANT-INDUCED PSYCHOTIC PROBLEM GAMBLER 314
DISORDER 288 The treatment of gambling disorder 315

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CASE STUDY: COGNITIVE THERAPY FOR A Key terms 320

PROBLEM GAMBLER 318 Review questions 320
Summary 319 References 320

CHAPTER 11 Sexual and relationship problems 327

Marita McCabe

SEXUAL AND RELATIONSHIP PROBLEMS: AN Historical and current approaches to understanding

AUSTRALASIAN FOCUS 327 paraphilias 343
Sexual problems: sexual dysfunctions 329 The diagnosis of paraphilic disorders 344
The definition of sexual dysfunction 329 The aetiology of paraphilic disorders 348
CASE STUDY: A MALE WITH HYPOACTIVE SEXUAL The treatment of paraphilic disorders 348
DESIRE DISORDER 331 Relationship problems 349
CASE STUDY: A MALE WITH PREMATURE Historical and current approaches to understanding
EJACULATION 332 relationship problems 349
The conceptualisation of sexual dysfunctions 333 The aetiology of relationship problems 350
The aetiology of sexual dysfunction 334 A developmental perspective on relationship problems 357
The treatment of sexual dysfunction 337 The treatment of relationship problems 358
CASE STUDY: A FEMALE WITH SEXUAL INTEREST Summary 361
DISORDER AND A MALE WITH ERECTILE Key terms 362
DISORDER 343 Review questions 362
Sexual problems: the paraphilic disorders 343 References 363

CHAPTER 12 Gender dysphoria 369

Ken Pang • Riki Lane • Harjit Bagga

GENDER VARIANCE: AN AUSTRALASIAN FOCUS 369 Concluding remarks 384

Definition of terms and the diagnosis Treatment options for gender dysphoria 385
of gender dysphoria 371 Guiding principles 385
What is meant by trans and gender diverse (TGD)? 371 CASE STUDY: KELSEY 387
The diagnosis of gender dysphoria 373 Changes in gender expression and role 387
Differential diagnosis 375 Psychological therapies 388
CASE STUDY: JARC 376 CASE STUDY: SURAJEK 389
The epidemiology of gender dysphoria 377 Pharmacological interventions 390
Prevalence 377 Current practices to access gender-affirming
Age of onset and course 379 medical interventions 391
Associated psychological and medical problems 379 Resources 393
CASE STUDY: AUBREY 380 CASE STUDY: NAYA 393
The aetiology of gender dysphoria 380 Summary 394
Gender identity formation: nature versus nurture 381 Key terms 395
Biological influences on gender variance 382 Review questions 395
Psychosexual theories on gender variance 383 References 395
Sociocultural influences on gender variance 384

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CHAPTER 13 Personality disorders 399

Louise McCutcheon • Carol Hulbert • Martina Jovev • Catharine McNab

PERSONALITY DISORDERS: AN AUSTRALASIAN The dimensional approach to personality dysfunction 409

FOCUS 399 What is the role of culture in the development
The definition of personality and personality of personality disorders? 409
disorder 401 The epidemiology of personality disorders 410
Personality 401 General models of the aetiology
Personality disorder 402 and treatment of personality disorders 411
CASE STUDY: PERSONALITY DISORDER 402 CASE STUDY: COGNITIVE ANALYTIC THERAPY 418
The diagnosis of personality disorder 402 Can the impact of personality disorders be reduced
The Cluster A personality disorders 404 through early-intervention programs? 421
CASE STUDY: PARANOID PERSONALITY DISORDER 405 The aetiology and treatment of specific
The Cluster B personality disorders 405 personality disorders 422
CASE STUDY: ANTISOCIAL PERSONALITY DISORDER 406 Summary 435
The Cluster C personality disorders 407 Key terms 435
CASE STUDY: OBSESSIVE-COMPULSIVE PERSONALITY Review questions 436
DISORDER 408 References 436

CHAPTER 14 Disorders of childhood 443

Alina Morawska • Matthew Sanders

DISORDERS OF CHILDHOOD: AN AUSTRALASIAN CASE STUDY: PARENT MANAGEMENT TRAINING FOR

FOCUS 443 OPPOSITIONAL DEFIANT DISORDER 470
Psychological and behavioural disorders in Internalising disorders 472
children 444 The diagnosis and epidemiology of separation
Myths, realities and research challenges 444 anxiety disorder 473
Historical and current approaches to the The aetiology of separation anxiety disorder 473
understanding and classification of childhood The treatment of separation anxiety disorder 474
disorders 447 CASE STUDY: COGNITIVE-BEHAVIOURAL TREATMENT
Neurodevelopmental disorders 450 FOR ANXIETY 475
The diagnosis and epidemiology of attention-deficit/ The diagnosis and epidemiology of selective mutism 476
hyperactivity disorder 450 The aetiology of selective mutism 476
The aetiology of attention-deficit/hyperactivity The treatment of selective mutism 477
disorder 451 Elimination disorders 477
Specific learning disorder 453 The diagnosis and epidemiology of enuresis 477
Autism spectrum disorder 455 The aetiology of enuresis 478
Intellectual disability 457 The treatment of enuresis 478
Externalising disorders 460 The diagnosis and epidemiology of encopresis 479
The diagnosis and epidemiology of oppositional The aetiology of encopresis 479
defiant disorder 461 The treatment of encopresis 479
The aetiology of oppositional defiant disorder 462 Summary 480
The diagnosis and epidemiology of conduct disorder 463 Key terms 480
The aetiology of conduct disorder 464 Review questions 481
The treatment and prevention of externalising disorders 465 References 481

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CHAPTER 15 Ageing and psychological disorders 491

Nancy A. Pachana

AGEING AND PSYCHOLOGICAL DISORDERS: CASE STUDY: ANXIETY 520

AN AUSTRALASIAN FOCUS 491 Life events associated with later life: retirement,
Ageing 493 grandparenting, driving cessation and
The demographics and epidemiology of ageing 493 bereavement 521
Historical overview of the psychology of ageing 496 Retirement 521
Normal ageing processes: cognitive, emotional Grandparenting 522
and social functioning 497 Driving cessation 523
Psychological disorders in later life: the dementias 505 CASE STUDY: DRIVING 524
The definition of dementia and neurocognitive disorder 505 Bereavement 525
Alzheimer’s disease 506 Positive or successful ageing 527
Vascular dementia 508 Ageing organisations and resources
Other forms of dementia and related disorders 509 in Australia, New Zealand and worldwide 528
The assessment, treatment and prevention of dementia 509 Summary 529
Psychological disorders in later life: depression Key terms 529
and anxiety 515 Review questions 529
Depression 515 References 530
Anxiety disorders 517

CHAPTER 16 Health psychology 537

Phyllis Butow

HEALTH PSYCHOLOGY: AN AUSTRALASIAN FOCUS 537 Shared decision making and patient-centred care 562
The definition of health and health behaviour 539 Risk communication 564
Models of health behaviour 541 Interventions to increase the accuracy of risk
The health belief model 541 perception 566
Protection motivation theory 544 Quality of life and adjustment
The theory of reasoned action and the theory to chronic disease 567
of planned behaviour 545 Coping with and adjustment to disease 568
The stages of change model 547 Interventions to promote adjustment to illness 570
Self-regulation theory 549 CASE STUDY: A WOMAN WITH CANCER 574
Interventions based on health behaviour models 552 Summary 575
The relationship between stress and disease 555 Key terms 575
Definitions of stress 555 Review questions 576
Evidence of the impact of stress on health 558 References 576
Communicating with patients about health,
risk, disease and treatment 562

GRADUATE SPOTLIGHT
Sofia Robleda 72
Elong Gersh 124
Dr Tegan Cruwys 234
Dr Kristen Murray 368
Franco Scalzo 490

Glossary 583
Index 596

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Preface
The field of abnormal psychology is well served by several competent textbooks—so much so that in my
first years of teaching in the area I was not immediately aware of the need for an innovative approach.
Indeed, this impetus was initially provided through feedback from my students, who expressed their
frustration with the lack of local content in the available texts, most of which were American, so that the
content tended to distance them from, rather than more fully engage them with, the material. Having thus
been encouraged to take a closer look at the range of available texts, I became aware of the additional need
to have specialists presenting the current body of knowledge in their respective areas of expertise if students
were to be provided with material that most accurately reflects contemporary theorising and research.
Both of these innovative aspects of the book—that is, the local content and reliance on specialist
authors—require some elaboration. The local content is most obviously reflected in the selection of authors
from Australia and New Zealand; the inclusion of research from this region when such studies constitute
the best exemplars in the field; the presentation of topics of regional relevance; and the application of
concepts using regional examples, most notably in the ‘Australasian Focus’ pieces that introduce each
chapter. While these sections refer predominantly to Australian people and governmental policies, this
material was selected so as to be highly recognisable and pertinent in the New Zealand context as well.
Clearly, abnormal psychology is an international discipline, the knowledge base of which is informed by
theoretical and empirical work worldwide. Yet, by presenting this information in a manner that is also
sensitive to the reader’s cultural context, this text aims to generate maximum relevance and hence interest
and engagement on the part of the reader. Indeed, approximately 80 per cent of students in an undergraduate
abnormal psychology course that I taught stated that they appreciated the inclusion of local content in the
first edition of this book. We have sought to ensure that this local content remains highly current by, for
example, including new Australasian Focus pieces at the beginning of each chapter in this fourth edition.
Aside from its Australian and New Zealand content, this book is noteworthy for the high calibre of its
authors. The chapters have been written by eminent researchers and practitioners who continue to make
a significant contribution to understanding the disorders in which they have expertise. As such, they are
ideally placed to impart to the reader highly contemporary perspectives on the various disorders. While it
is common practice for undergraduate students to be availed only of textbooks written by generalists, the
use of specialist authors is intended to present readers with the most current scholarship from the time
of their earliest engagement with the subject matter of abnormal psychology. Given our commitment to
currency, we have introduced this fourth edition of the book only three years after the previous edition
so that readers can be acquainted with the most recent research across the various domains of abnormal
psychology, while also anticipating future challenges and innovations. Thus, while the book received its
initial inspiration from students, its state-of-the-art approach aims, in turn, to inspire the next generation
of leading researchers and clinicians by informing them of the limits of what is currently known and what
remains to be understood in the field of abnormal psychology.

Elizabeth Rieger

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About the editor

Elizabeth Rieger is an Associate Professor and
clinical psychologist in the Research School of
Psychology at the Australian National University
where she conducts research, teaching and clinical
work. In her research she specialises in eating
disorders and obesity, having completed her PhD on
anorexia nervosa at the University of Sydney and a
postdoctoral fellowship at the Center for Eating and
Weight Disorders of the University of California,
San Diego and San Diego State University. She
has published widely on both eating disorders and
obesity, including the motivational, cognitive and
interpersonal aspects of these conditions and their
effective treatments.
As well as teaching undergraduate courses on
abnormal psychology and health psychology, Elizabeth
has taught postgraduate courses on eating and weight
Photogragh by Scott Ogilvie disorders, motivational interviewing, cognitive
behaviour therapy and interpersonal psychotherapy.
She has over 20 years of experience as a clinical psychologist, during which time she has worked in a diverse
range of public and private settings.
Elizabeth is a member of the Eating Disorders Research Society, the Australia and New Zealand
Academy for Eating Disorders, the College of Clinical Psychologists of the Australian Psychological
Society and the Australian Clinical Psychology Association and is an editorial board member of the Journal
of Eating Disorders.

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Contributing authors
Maree Abbott is an Associate Professor in the
School of Psychology at the University of Sydney
and a practising clinical psychologist. She is the
Director of Clinical Training for the postgraduate
clinical psychology program and teaches in the
areas of psychopathology and the assessment
and treatment of adult psychological disorders,
in addition to conducting clinical and research
supervision. Prior to this appointment, Maree was
based at Macquarie University as the Royce Abbey
Postdoctoral Fellow. Her research focuses on further
understanding the nature and treatment of child and
adult anxiety disorders, particularly social phobia
and generalised anxiety disorder. She has served
on the Executive of the Australian Psychological
Society College of Clinical Psychologists in New
South Wales and currently chairs the Membership
and Professional Standards Committee for the
Australian Clinical Psychology Association.
Harjit Bagga is a Senior Clinical Psychologist at the
Gender Clinic, Monash Health, in Melbourne. She
has worked in public mental health (both state and
federal government services) and private practice.
Over the past 10 years, Harjit has developed a
special interest in gender variance through her work
at the Gender Clinic. Her research interests in this
field include the role of sex hormones on brain
function, prevalence, personality and psychometric
assessment with adults. She has presented at several
national and international gender conferences and
contributed to research projects and publications
examining the prevalence of gender dysphoria in
Australia, quality of life in individuals attending
the Gender Clinic and patient satisfaction with
services. Harjit’s work for this text was completed
independently from her employment at Monash
Health and does not necessarily reflect the views of
Monash Health or its Gender Clinic.
Sarah Bendall is a Senior Research Fellow at
Orygen: The National Centre of Excellence in
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xiii
Youth Mental Health and the Centre for Youth
Mental Health, at the University of Melbourne. Her
areas of research interest are trauma in first-episode
psychosis and the development and trialling of
new psychological therapies for recovery in early
psychosis. She teaches psychological assessment
of, and cognitive behaviour therapy for, psychosis
within the postgraduate clinical psychology
professional training program at the University of
Melbourne. Sarah is the author of two psychological
treatment manuals for early psychosis. She has
practised as a clinical psychologist for over
20 years in a variety of settings including adult
and adolescent outpatient mental health. She has
supervised clinical psychologists for over 10 years
and has provided training for treating trauma in
those with first-episode psychosis nationally and
internationally. She is the author of over 50 peer-
reviewed journal articles and several book chapters.
Alex Blaszczynski is a Professor of Clinical
Psychology and Director of the Gambling Treatment
& Research Clinic at the School of Psychology,
University of Sydney. He is a clinical psychologist
with extensive experience in treating individuals with
pathological gambling and other impulse control
disorders. His research interests are directed towards
the development of a conceptual pathway model of
problem gambling, the role of the personality trait of
impulsivity, treatment outcomes and their predictors,
and the effectiveness of warning signs on electronic
gaming machines as harm-minimisation strategies.
Alex has investigated the association between
pathological gambling and crime, and with co-authors
has developed a model for casino self-exclusion. He
is editor-in-chief of International Gambling Studies,
has published more than 200 peer-reviewed journal
articles, and has edited several books and book
chapters on the topic of gambling.
Richard Bryant is a Scientia Professor of
Psychology, Australian Research Council Laureate
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 xiv Contributing authors
Fellow, and Director of the Traumatic Stress Clinic at the
University of New South Wales. His research has included
conducting prospective studies of posttraumatic stress
responses, developing the first assessment measures of acute
stress disorder, implementing controlled treatment trials
of acute stress disorder and investigating the biological and
cognitive factors that influence psychological adaptation after
trauma. Richard has published more than 380 peer-reviewed
journal articles and co-authored the leading text on acute stress
disorder. His assessment and treatment protocols are currently
being employed by many civilian and military agencies around
the world, including those coordinating mental health projects
in the wake of terrorist and natural disaster events. Richard
is a Fellow of the Australian Psychological Society and the
Australian Academy of Social Sciences in Australia.
Phyllis Butow is a Professor, and National Health and
Medical Research Council Senior Principal Research Fellow,
in the School of Psychology, University of Sydney. She
co-directs the Centre for Medical Psychology and Evidence-
based Medicine (CeMPED) and chairs the Australian Psycho-
Oncology Co-operative Research Group (PoCoG). Phyllis
has worked for over 20 years in the area of psycho-oncology
and has developed an international reputation in this field and
the area of health communication. Phyllis has published more
than 450 articles in peer-reviewed journals and her work
has been translated into health communication modules for
oncology professionals’ guidelines and practice.
David Clarke is Professor of Psychological Medicine at
Monash University. He works at the interface between
psychiatry and physical medicine, as a consultation-liaison
psychiatrist at Monash Medical Centre. He is Clinical Director
of Consultation-Liaison and Primary Care Psychiatry at
Monash Health in Melbourne and teaches psychiatry at
undergraduate and postgraduate levels, with his main interests
being depression and somatisation. David has been the
recipient of a number of research grants from the National
Health and Medical Research Council, with research focusing
on the nature of distress and depression in the medically
ill, demoralisation as a concept and a particular form of
depression, the use of psychotherapy in the medically ill, and
the nature of psychiatric presentations and pathways to care
for people in the general medical and primary care settings. He
has published more than 100 articles in scientific journals and
regularly presents his work at conferences.
David H. Gleaves is Professor of Psychology (Clinical) at the
University of South Australia in Adelaide. He has previously
rie66620_fm_i-xxvi.indd xiv
directed the clinical psychology programs at both the University
of South Australia and the University of Canterbury, in New
Zealand. He has worked in the areas of dissociative and eating
disorders for approximately 30 years and has produced over 120
scholarly publications in these and related areas. He received
both the Morton Prince Award for Scientific Achievement
and the Pierre Janet Award for Writing Excellence from the
International Society for the Study of Trauma & Dissociation.
David is or has been a member of the editorial board of several
journals including Journal of Abnormal Psychology, Journal
of Clinical Psychology, Journal of Child Sexual Abuse and
Journal of Trauma & Dissociation. He is also a registered
clinical psychologist and a member of both the Australian
Psychological Society’s College of Clinical Psychologists and
the American Psychological Association.
John Gleeson is a Professor of Psychology at the Australian
Catholic University in Melbourne. Previously he held a joint
appointment between the North Western Mental Health Program,
a program of Melbourne Health, and the Psychology Department
of the University of Melbourne. His research interests include
cognitive behaviour therapy (CBT) for first-episode psychosis
and psychological treatments for the complex behavioural
problems associated with psychosis. He has taught psychological
assessment and CBT within the postgraduate clinical psychology
professional training program at the University of Melbourne.
John edited the first treatment handbook of psychological
interventions for early psychosis, which includes contributions
from Europe, North America, Australia and Scandinavia. He has
more than 10 years’ experience in providing clinical supervision
to clinical psychologists and has provided training workshops
nationally and internationally on CBT for psychosis. Together
with colleagues from Orygen: The National Centre of Excellence
in Youth Mental Health and the University of Melbourne he
has recently pioneered moderated online social therapy for
first-episode psychosis.
Phillipa Hay is a Professor and Foundation Chair of
Mental Health at the School of Medicine, Western Sydney
University. She has been researching and working in the area
of eating disorders for over two decades since completing
her postgraduate training in psychiatry and has two higher
research degrees in the area. She completed her DPhil under
the supervision of Professor Christopher Fairburn at the
University of Oxford. She has written more than 180 research
articles and has been invited to present her research at meetings
in the United States, Europe and South America. Phillipa
is co-Editor-in-Chief of the Journal of Eating Disorders, a
former President of the Australian and New Zealand Academy
08/01/17 10:34 AM

for Eating Disorders and has served at a senior level on
education and scientific committees of the Royal Australian
and New Zealand College of Psychiatrists, Australian Medical
Council and the international Academy for Eating Disorders.
In 2015 she received the Lifetime Achievement Award from
the Australia and New Zealand Academy for Eating Disorders.
Carol Hulbert is an Associate Professor in the School of
Psychological Sciences at the University of Melbourne and
also holds the position of Director of the Clinical Psychology
Program. She is a clinical psychologist and clinical researcher
with extensive experience in mental health services. She
has worked as a clinician, manager and regional senior
psychologist in public mental health. Carol’s program
development experience includes involvement in the setting
up of the Early Psychosis Prevention and Intervention Centre
and the establishment of the Spectrum Personality Disorder
Service of Victoria. Her research interests include social
cognition and social functioning in borderline personality
disorder, the aetiology and psychological treatment of
personality disorder, and the role of trauma in outcomes for
early psychosis.
Martina Jovev is a psychologist at Orygen: The National
Centre of Excellence in Youth Mental Health and a Research
Fellow at Orygen Research Centre in Melbourne. Since
completing her PhD, she has been an investigator on projects
in borderline personality disorder in young people and has
collaborated with leading researchers in the field of neuroimaging
and youth mental health at the Melbourne Neuropsychiatry
Centre and Orygen Research Centre to conduct pioneering work
on the relationship between brain development and environment
in risk for personality dysfunction in adolescence. Martina’s
previous research has examined the processing of psychosocial
threat in young people with borderline personality disorder
symptoms. She is also a co-investigator on several large clinical
projects in the field of borderline personality disorder in young
people, including a randomised controlled trial of cognitive
analytic therapy, screening for the disorder in youth, and sexual
and reproductive health among youth with the disorder. She
has published multiple articles in the area of cognitive biases
in borderline personality disorder and is a co-author on several
papers published in prestigious international peer-reviewed
journals, such as Psychiatry Research: Neuroimaging and
Journal of Clinical Psychiatry. Martina has presented her work
at numerous major national and international conferences,
including the International Society for the Study of Personality
Disorders Congress.
rie66620_fm_i-xxvi.indd xv
Contributing authors xv
Riki Lane is Research/Project Worker at the Gender Clinic,
Monash Health and Research Fellow at Southern Academic
Primary Care Research Unit, Monash University. Riki has
expertise in the sociology of transgender health care and
primary health, and research interests in changing models of
health care particularly for trans and gender diverse people and
generally in multi-disciplinary teams. Gender Clinic work has
included researching clinicians’ attitudes to approving gender
affirmation surgeries, facilitating consumer/community
participation, and the development and delivery of education
in affirmative healthcare practice with trans and gender diverse
people. Riki is Chair of the Australian and New Zealand
Professional Association for Transgender Health Research
Committee, a member of the Australian and New Zealand
Professional Association for Transgender Health Education
Committee, and a member of the Victorian State Department
of Health and Human Services Trans Expert Advisory Group.
The work presented here was completed independently from
employment at Monash Health and Monash University and
does not necessarily reflect their views.
Marita McCabe is Director, Institute for Health and Ageing
at the Australian Catholic University in Melbourne. She has
conducted research on a broad range of topics in the area of
human sexuality for the past 30 years. In particular, she has
studied the aetiology and treatment of sexual dysfunction.
This research has involved the evaluation of cognitive
behaviour therapy programs for male and female sexual
dysfunction, which in recent years have been successfully
converted to be delivered via the internet. Marita is on the
editorial board of a number of journals and has supervised
many doctoral students who have completed their theses in
the area of human sexuality.
Louise McCutcheon is a Senior Clinical Psychologist, Senior
Program Manager and an honorary Research Fellow with
Orygen, the National Centre of Excellence in Youth Mental
Health, and the Centre for Youth Mental Health at Melbourne
University. She jointly founded the Helping Young People
Early (HYPE) program, an early-intervention program for
borderline personality disorder in youth at Orygen Youth
Health. Louise coordinated the clinical program for 11 years
and has been an investigator on various research projects
including two randomised controlled trials of interventions for
youth with borderline personality disorder. Her current role
includes clinical, research and service development functions.
She is regularly invited to speak at national and international
conferences and assists mental health services to implement
08/01/17 10:34 AM
 xvi Contributing authors
early intervention programs for youth with personality
disorders and other complex problems. She established a
psychotherapy training program based on cognitive analytic
therapy, and is the founding President of the Australian and
New Zealand Association for Cognitive Analytic Therapy.
Peter McEvoy is a teaching and research Professor of Clinical
Psychology in the School of Psychology and Speech Pathology
at Curtin University, and a Senior Clinical Psychologist at
the Centre for Clinical Interventions, Perth. He previously
worked at the Anxiety Disorders Clinic at St Vincent’s
Hospital in Sydney. Peter has extensive clinical experience
providing evidence-supported group and individual treatments
for emotional disorders. His research interests include
treatment outcome evaluation, transdiagnostic approaches
to conceptualising and treating emotional disorders, the use
of imagery in psychotherapy, repetitive negative thinking,
mechanisms of behavioural and cognitive change, and the
epidemiology of mental disorders. Peter is an associate
editor for the Journal of Anxiety Disorders and the Journal
of Experimental Psychopathology, and teaches adult
psychopathology and psychotherapy in the Master of Clinical
Psychology program.
Catharine McNab is a Senior Clinical Psychologist in the
Orygen Youth Health Clinical Program in Melbourne. Her
clinical experience has focused on mental illness in adolescents
and young adults, most recently in indicated prevention and
early intervention for borderline personality disorder in young
people. She consults with and provides training to medical
and allied health staff about effective collaboration with
young people with these difficulties, particularly in acute
service settings. Her research interests include examining
the experiences of families of people with early-onset mental
illness and identifying what the consequences of appropriately
supporting families might be, both for families and patients.
Ross G. Menzies is Associate Professor of Psychology in the
discipline of Behavioural and Community Health Sciences at
the University of Sydney. In 1991 he was appointed founding
Director of the Anxiety Disorders Clinic, Faculty of Health
Sciences, University of Sydney, a post he held for more than
20 years. He is the past NSW and National President of the
Australian Association for Cognitive and Behaviour Therapy.
He was the President and Convenor of the 2016 World
Congress of Behavioural and Cognitive Therapies and is Editor
of Australia’s national cognitive behaviour therapy scientific
journal, Behaviour Change. Ross holds numerous national
rie66620_fm_i-xxvi.indd xvi
competitive grants in the area of anxiety. He has produced
more than 170 international journal papers, books and book
chapters and is regularly invited to speak at conferences and
leading universities and institutions around the world.
Philip B. Mitchell is Scientia Professor and Head of the
School of Psychiatry at the University of New South Wales.
His research and clinical interests are in bipolar disorder and
depression, with particular focus on youth at high genetic
risk of bipolar disorder, the molecular genetics of bipolar
disorder, transcranial magnetic stimulation for depression,
and the pharmacological and psychological treatment of
bipolar disorder and depression. Philip has published (in
conjunction with colleagues) more than 450 papers and
chapters on these topics. In 2002 he was awarded the Senior
Research Award of the Royal Australian and New Zealand
College of Psychiatrists. In 2004 he received the Founders
Medal of the Australasian Society for Psychiatry Research.
In the 2010 Australia Day honours list he was appointed a
Member of the Order of Australia. He is a Visiting Professor
at Harbin Medical University in China and Guest Professor at
Shanghai Jiao Tong University in China. He recently served
as Chairman of the Australasian Society for Bipolar and
Depressive Disorders.
Alina Morawska is the Deputy Director (Research) at the
Parenting and Family Support Centre at the University of
Queensland. Her research focuses on behavioural family
intervention as a means of promoting positive family
relationships, and the prevention and early intervention
for young children at risk of developing behavioural and
emotional problems. In particular, her focus is on improving
the health and overall wellbeing of children and families. She
completed her PhD in Clinical Psychology at the University
of Queensland in 2004, for which she received the Australian
Psychological Society’s Excellent PhD Thesis in Psychology
Award. She has published extensively in the field of parenting
and family intervention and has received numerous grants
to support her research. She is a Director of the Australian
Association for Cognitive and Behaviour Therapy Ltd.
Greg Murray is a Professor of Psychology at Swinburne
University in Melbourne. He has an international reputation
for clinical psychology research, having published more than
120 peer-reviewed articles since taking out his PhD from the
University of Melbourne in 2001. Expertscape ranks him
in the top 1 per cent of researchers worldwide in the fields
of bipolar disorders, circadian rhythms, personality and
08/01/17 10:34 AM

affect. Greg authored the psychological aspects of the Royal
Australian and New Zealand College of Psychiatrists mood
disorder guidelines, and the Australian Psychological Society
guidelines for treating bipolar disorder. He is Research Lead
for an international network studying psychosocial issues
in bipolar disorder, and a member of a National Institute of
Mental Health working group on activation in mood disorders.
Greg has won multiple individual awards for teaching, and
provided professional development workshops for hundreds
of psychologists and psychiatrists across Australia and
overseas. He is a practising clinical psychologist, and was
elected a Fellow of the Australian Psychological Society in
2013. Through 2016–2019, he is leading a trial funded by the
National Health and Medical Research Council investigating a
novel online intervention for bipolar disorder.
Richard O’Kearney is a Professor and Senior Research
Fellow in the Research School of Psychology at the Australian
National University. His research includes evaluation of
interventions and prevention programs for depression in the
community and schools, as well as work on the development
of emotional regulation abilities in children and adolescents.
He has published applied and basic research on obsessive-
compulsive disorder and posttraumatic stress disorder. As
a member of the Cochrane Collaboration, Richard has been
actively involved in the dissemination of the evidence base
for interventions in mental health and has authored and
co-authored several systematic reviews. He also practises as a
clinical psychologist in Canberra.
Nancy A. Pachana is Professor of Clinical Geropsychology
in the School of Psychology at the University of Queensland.
A clinical psychologist and clinical neuropsychologist, she
received extensive postdoctoral training in the assessment and
treatment of older populations at the University of California
Los Angeles Neuropsychiatric Institute and the Palo Alto
Veterans Affairs in California. A fellow of the Australian
Psychological Society, she is also a past chair of the Society’s
Psychology and Ageing Interest Group, as well as a Fellow of
the Academy of the Social Sciences in Australia, and a faculty
affiliate of the Royal Australian and New Zealand College of
Psychiatrists in the Faculty of Psychiatry of Old Age. Nancy
has published more than 200 peer-reviewed articles, book
chapters and books in the field of ageing, including a sole
authored text for Oxford University Press, Ageing: A Very
Short Introduction. Her main research interests include the
assessment and treatment of late-life anxiety disorders, driving
and driving cessation in later life, and novel assessment and
interventions for nursing home residents.
rie66620_fm_i-xxvi.indd xvii
Contributing authors xvii
Ken Pang is a Consultant Paediatrician at the Royal Children’s
Hospital in Melbourne and Clinician Scientist Fellow at the
Murdoch Children’s Research Institute. His clinical experience
encompasses both paediatrics and child psychiatry, and his
current work is focused on the care of transgender children
and adolescents. His research background is in genetics and
cell biology, and includes postdoctoral studies at Harvard
University as a Fulbright Scholar and National Health and
Medical Research Council RG Menzies Fellow. To date, he has
published over 35 peer-reviewed papers (including in Science,
Genome Research and Molecular Psychiatry) that have
been cited more than 8000 times. More recently, motivated
by a desire to improve the clinical outcomes of transgender
children and adolescents, Ken’s research has started to focus
on questions related to transgender health.
Matthew Sanders is a Professor of Clinical Psychology and
Director of the Parenting and Family Support Centre at the
University of Queensland. He is also a consulting Professor
at the University of Manchester, a visiting Professor at the
University of South Carolina and holds adjunct Professorships
at Glasgow Caledonian University and the University of
Auckland. As the founder of the Triple P—Positive Parenting
Program, he is considered a world leader in the development,
implementation, evaluation and dissemination of population-
based approaches to parenting and family interventions.
Triple P is currently in use in many countries worldwide.
Matthew’s work has been widely recognised by his peers
as reflected by a number of prestigious awards. In 2007, he
received the Australian Psychological Society’s President’s
Award for Distinguished Contribution to Psychology and in
2004 he received an International Collaborative Prevention
Science award from the Society for Prevention Research in
the United States. In 2007 he received a Trailblazers Award
from the Parenting and Families Special Interest Group in
the Association for Behavioural and Cognitive Therapy and
in 2008 became a fellow of the New Zealand Psychological
Society. He has also won a Distinguished Career Award from
the Australian Association for Cognitive Behaviour Therapy,
was named Honorary President of the Canadian Psychological
Association (2009) and Queenslander of the Year (2007). In
2013, he was named one of the University of Queensland’s top
five innovators for his work with Triple P.
Marianna Szabó is a Senior Lecturer in the School of
Psychology at the University of Sydney. She coordinates the
undergraduate Abnormal Psychology course in the school and
lectures on conceptual issues in classification and diagnosis, as
08/01/17 10:34 AM
xviii Acknowledgments

well as on the nature and causation of anxiety and depression
in adults and youth. She also contributes to teaching abnormal
psychology at different levels of training, from the first year
Introductory Psychology course to postgraduate training.
Marianna’s research interests include examining basic
diagnostic and conceptual issues in abnormal psychology,
as well as further understanding the nature of child and
adult anxiety and mood disorders, particularly generalised
anxiety disorder and depression. She is a registered clinical
psychologist in private practice and member of the Australian
Psychological Society’s College of Clinical Psychologists.
Robert Tait is a senior research fellow at the National
Drug Research Institute, Faculty of Health Sciences, Curtin
University. His research interests are in the areas of alcohol,
tobacco and other drug use and in particular how these relate
to mental health disorders. He has used administrative health
data to assess the long-term relationships between substance
use and mental health and to evaluate the effectiveness of
interventions. Robert is also interested in the development
of new interventions, in particular using internet-delivered
programs. His work has included those in the general
population, high-risk groups and clinical samples.
Stephen Touyz is Professor of Clinical Psychology and
Clinical Professor in Psychiatry at the University of Sydney.
He is also the executive Chair of the Centre for Eating and
Dieting Disorders. He has written or edited six books and
more than 270 research articles and book chapters on eating
disorders and related topics. He is a Fellow of the Academy
of Eating Disorders and the Australian Psychological Society
and is a past President of the Eating Disorders Research
Society. Stephen was the inaugural treasurer of the Australian
and New Zealand Academy for Eating Disorders and a past
executive member of the Eating Disorders Foundation. He is
the Co-founding Editor of the Journal of Eating Disorders and
a member of the editorial advisory boards of the International
Journal of Eating Disorders, European Eating Disorders
Review and Advances in Eating Disorders: Theory, Research
and Practice. In 2012 he was presented with a Leadership
in Research award by the prestigious Academy of Eating
Disorders (International).

Acknowledgments
Teamwork has been an essential part of the creation of this important book. We are very proud to
acknowledge the contributions made by the esteemed author team; without their experience and passion
this text would not have been possible.
Peter McEvoy wishes to acknowledge Professor Andrew Page for his contribution to Chapter 2 of both
the first and second editions.
Thank you also to the following academics for their work on the accompanying digital resources:
Kimberley Norris, Siavash Bandarian-Balooch, Stephanie Quinton and Jessica Paterson.

PUBLISHERS
Our thanks and acknowledgment go to the McGraw-Hill Education Australia team. The publication of a
work of this scope and innovation would not have been possible without them.
We appreciate the work of our publisher Lisa Coady, for her vision and faith in this project, and our
content developer Isabella Mead, for her organisational skills and enthusiasm for the project.
Our thanks go to senior content producer Claire Linsdell for her methodical project management during
production; and to Simon Rattray, our cover designer; the digital team Marisa Rey Bulen and Bethany Ng;
and our copyeditor, Alison Moore.

rie66620_fm_i-xxvi.indd xviii 08/03/17 10:42 AM

 xix

Case matrix
CHAPTER OPENING CASE STUDY
1 Abnormal psychology: an Australasian focus
2 Anxiety disorders: an Australasian focus
3 Obsessive-compulsive and related disorders:
an Australasian focus
4 Trauma- and stressor-related disorders:
an Australasian focus
5 Depressive disorders: an Australasian focus
6 Bipolar disorder: an Australasian focus
7 Psychotic disorders: an Australasian focus
8 Somatic symptom and dissociative disorders:
an Australasian focus
9 Eating disorders: an Australasian focus
10 Addictive disorders: an Australasian focus
11 Sexual and relationship problems:
an Australasian focus
12 Gender dysphoria: an Australasian focus
13 Personality disorders: an Australasian focus
14 Disorders of childhood: an Australasian focus
15 Ageing and psychological disorders:
an Australasian focus
CHAPTER CASE STUDIES
∙ Specific phobia
∙ Panic disorder and agoraphobia
∙ Social anxiety disorder
∙ Generalised anxiety disorder
∙ Obsession with harming others
∙ Contamination obsessions and compulsions
∙ Posttraumatic stress disorder
∙ Anxiety and depression
∙ The symptoms and treatment of major depressive disorder
∙ First manic episode
∙ The role of stress and trauma in psychosis onset
∙ From prodromal phase to early recovery
∙ Somatic symptom disorder
∙ The recovered memory/false memory debate
∙ Dissociative identity disorder
∙ Avoidant/restrictive food intake disorder (ARFID)
∙ Anorexia nervosa
∙ Bulimia nervosa
∙ Binge eating disorder
∙ Severe alcohol use disorder
∙ Cannabis withdrawal
∙ Acute intoxication: synthetic cannabinoids
∙ Stimulant-induced psychotic disorder
∙ A behaviourally conditioned problem gambler
∙ Cognitive therapy for a problem gambler
∙ A male with hypoactive sexual desire disorder
∙ A male with premature ejaculation
∙ A female with sexual interest disorder and a male with erectile disorder
∙ Jarc
∙ Aubrey
∙ Kelsey
∙ Surajek
∙ Naya
∙ Personality disorder
∙ Paranoid personality disorder
∙ Antisocial personality disorder
∙ Obsessive-compulsive personality disorder
∙ Cognitive analytic therapy
∙ Parent management training for oppositional defiant disorder
∙ Cognitive-behavioural treatment for anxiety
∙ Anxiety
∙ Driving

16 Health psychology: an Australasian focus ∙ A woman with cancer

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 xx

What’s new in this

edition?
CHAPTER MAJOR UPDATES

1 Conceptual issues in abnormal ∙ 

New Australasian Focus piece
psychology ∙ 
Updated research on topics such as the contributions and limitations of the
biological perspective

2 Anxiety disorders ∙ 

New Australasian Focus piece
∙ 
New case study on panic disorder and agoraphobia
∙ 
Updated research on topics such as habituation and inhibitory learning, and
CBT and generalised anxiety disorder

3 Obsessive-compulsive and related ∙ 

New Australasian Focus piece
disorders ∙ 
New case study on obsession with harming others
∙ 
Updated research on topics such as OCD-related disorders, including hoarding
disorder, body dysmorphic disorder, trichotillomania and excoriation disorder

4 Trauma- and stressor-related ∙ 

New Australasian Focus piece
disorders ∙ 
Updated case study on PTSD
∙ 
Updated research on topics such as the prevalence and epidemiology of PTSD,
and on prevention

5 Depressive disorders ∙ 

New Australasian Focus piece
∙ 
New case study on anxiety and depression
∙ 
Updated research on topics such as interpersonal psychotherapy and relapse
prevention

6 Bipolar disorder ∙ 

New Australasian Focus piece
∙ 
Updated research on topics such as the connection between bipolar disorder
and creativity, and evidence-based psychological therapies and bipolar disorder

7 Psychotic disorders ∙ 

New Australasian Focus piece
∙ 
New case study on the role of stress and trauma in psychosis onset
∙ 
Updated research on topics such as vulnerability factors and delusions

8 Somatic symptom and dissociative ∙ 

New Australasian Focus piece
disorders ∙ 
Updated research on topics such as the diagnosis of somatic symptom and
related disorders, and conversion disorder

9 Eating disorders ∙ 

New Australasian Focus piece
∙ 
New case studies on avoidant/restrictive food intake disorder (ARFID), anorexia
nervosa, bulimia nervosa and binge eating disorder
∙ 
Updated research on topics such as the treatment of anorexia nervosa and
binge eating disorder

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 What’s new in this edition? xxi

CHAPTER MAJOR UPDATES

10 Addictive disorders ∙ 

New Australasian Focus piece
∙ 
New case studies on severe alcohol use disorder and acute intoxication:
synthetic cannabinoids
∙ 
Updated research on topics such as the diagnosis and prevalence of substance
use disorders, and gambling disorder

11 Sexual and relationship problems ∙ 

Updated Australasian Focus piece
∙ 
New case studies on hypoactive sexual desire disorder, and premature
ejaculation
∙ 
Updated research on topics such as the treatment of paraphilic disorders

12 Gender dsyphoria ∙ 

New chapter on gender dysphoria
∙ 
Five case studies
∙ 
Content covering the diagnosis, epidemiology, aetiology and treatment of
gender dysphoria

13 Personality disorders ∙ 

New Australasian Focus piece
∙ 
New case studies on personality disorder, and paranoid personality disorder
∙ 
Updated research on topics such as the diagnosis of personality disorders,
personality disorders across cultures, and cognitive analytic therapy

14 Disorders of childhood ∙ 

New Australasian Focus piece
∙ 
New case study on cognitive behavioural treatment for anxiety
∙ 
Updated research on topics such as the prevalence of mental disorders in
childhood, and the diagnosis and epidemiology of oppositional defiant disorder

15 Ageing and psychological ∙ 

New Australasian Focus piece
disorders ∙ 
New case studies on anxiety and driving
∙ 
Updated research on topics such as physical activity, disability and ageing, and
executive functioning and ageing

16 Health psychology ∙ 

New Australasian Focus piece
∙ 
Updated research on topics such as the health belief model and behaviour
change interventions, and stress-response syndromes

rie66620_fm_i-xxvi.indd xxi 08/01/17 10:34 AM

 Philip B. Mitchell
Greg Murray

CHAPTER OUTLINE
●
Historical and current approaches to the diagnosis of bipolar disorder
The epidemiology of bipolar disorder

Text at a glance - 4e
●

●
The aetiology of bipolar disorder
● The treatment of bipolar disorder
● Summary

LEARNING OBJECTIVES (LO)

6.1 Differentiate bipolar I disorder, bipolar II disorder and cyclothymic disorder.
6.2 Understand the epidemiological aspects of bipolar disorder.
6.3 Describe the possible causes of bipolar disorder.
6.4 Describe the medical and psychological interventions used to treat and prevent bipolar disorder.

DEVELOPED FOR BIPOLAR DISORDER: AN AUSTRALASIAN FOCUS

LOCAL STUDENTS
Bipolar disorder refers to a group of conditions where people typically experience the two poles of mood disturbance—
that is, episodes of depression and episodes with manic or hypomanic symptoms (such as an excessively agitated or
euphoric mood). ABC News journalist Jane Ryan, who had been living with bipolar disorder for a decade before she

BY LOCAL AUTHORS made her condition publicly known, provided a vivid description of her most recent episode of this condition:
First I became severely depressed. The strength went out of my arms and legs and it was hard to
walk . . . Everything became grey and hazy and hard to focus on. My brain slowed down to a snail’s pace . . .
Abnormal Psychology 4e has been I fixated on death—not because I wanted to kill myself, but because it seemed like the only way I could get
some rest. I knew it couldn’t last forever and that I’d survived it before, but somehow in the depths of that
developed by expert authors to despair I convinced myself that I would never be better, I would never recover, I would stay like this forever.
Then a switch was flicked . . . I became agitated . . . I stopped listening when people were talking because
help students studying in Australia my thoughts were racing and I couldn’t concentrate. I talked loud and fast without realising it, I felt so funny

and New Zealand engage with and and clever. Then I became irritable. Deeply irritable . . . Soon after, I became psychotic. I lost my grip on reality
and started to imagine the natural environment harboured terrible dangers [such as] a group of cyclists
apply the concepts and theories of approaching from behind was a swarm of buzzards swooping to peck me to death. It’s hard to describe the
terror you feel when you know your mind has become totally unhinged and you can’t tell what’s real and
abnormal psychology. Research what’s not. During that time I experienced incredible fear and anxiety that people at work might discover
the truth.
by Australian and New Zealand It was Jane’s fear of negative attitudes and discrimination from others regarding her bipolar disorder that led her to keep
her condition a secret. Fortunately, the stigma around the condition is decreasing as more people such as Jane are opening
academics and researchers,
local statistics, case studies and continued

examples are used throughout

the book.
rie66620_ch06_125-146.indd 125 07/08/17 01:44 PM

240 Abnormal psychology 4e

CRITICAL EXAMINATION
CASE STUDY: AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID) This text has been written to help students develop their
Rachel is a 32-year-old woman who was admitted to a general medical hospital ward after she presented to the
Emergency Department. She was referred to the Emergency Department by her family doctor, who was concerned
critical thinking skills by providing tools within the text.
about her low weight (a BMI of 16) and very low blood pressure during a routine yearly consultation to renew her oral
contraceptive pill prescription and for a ‘pap smear’. Blood tests taken in the Emergency Department found that she had
Case study features provide an in-depth focus on topics
severe anaemia and she reported that she had lost an extreme amount of weight (30 kg) during the past year. from the chapter. When related to a specific disorder, the
Rachel said her weight loss started when she choked while eating a beef steak about a year previously. She was eating
dinner in a restaurant when this occurred and she became very distressed, both because of the physical discomfort of case studies cover the history, assessment and treatment of
coughing and gagging for several minutes and the intense embarrassment she felt for causing a scene in public. Since
this event she had avoided eating in public and had become very restrictive in her eating habits. Initially she cut out the subject involved. Review questions have been written
all red meat, then all meat. Over time, she eventually eliminated all solid foods so that she consumed only liquid dairy
products or vegetables (e.g., carrot juice).
38
to help students improve their critical thinking skills.
While Rachel accepted that she was now underweight, was unhappy with her appearance at such a low weight and Abnormal psych
was no longer losing weight, she reported a terror of eating solid foods and that she struggled to drink enough to regain ology 4e
weight. So she agreed to nasogastric tube feeding in the hospital.
Rachel has no past history of an eating disorder or major mental illness. She described being anxious as a child,
beginning when she experienced high distress during her first weeks at school as a result of being separated from REVIEW QUES
her mother. Due to this anxiety, her school entry was delayed for six months and she was eventually enrolled in an
TIONS
alternate school where her mother could join her each day at school during her first year. Rachel has LO been1.otherwise
1
well and, even though she was previously moderately well-built (she described herself as ‘chubby’), she 1.1
has not dieted
What are the
or restricted her food intake in the past as a way to reduce her weight. 1.2 How does four main criteria that are use
Wakefield’s no d to differentia
A psychiatrist at the hospital diagnosed Rachel as having ARFID. A barium swallow test revealed no thephysical
concepts of me tion of ‘harmful te abnormal be
dysfunction’ he haviour from no
impediments to swallowing. As a result of finding no physical obstructions, Rachel was commenced on In what ways do dical disorder and social devia
1.3a ‘swallowing’ lp to differentia
te the concep
rmal behaviour?
rehabilitation program, with swallowing exercises, anxiety management training and gradual increases in the consistency es the classifica nce? t of mental dis
medical disord tion of psycholo order from
of her oral intake, starting with semi-solids such as baked custard and iron supplements given for anaemia. She made a ers (e.g., cancer)? gic al disorders (e.
g., depression
good recovery over the next three months, by which time she had resumed a solid diet with the exception LO 1.of2red meat, ) differ from the
classification of
which she did not want to eat ever again. She had also regained a healthy amount of weight and was 1.4 What
no longer anxious
were the main
about eating in public. perspective changes in be
? havio urism that allo
1.5
How is the be wed the deve
havioural appro lopment of the
psychoanalytic ach to underst cognitive-behavi
ap proach? an ding mental oural
barium swallow 1.6 If an
intake disorder, namely, ‘other specified feeding or eating disorder’ and ‘unspecified feeding ind or eating
ividual inherits dis ord ers fundamenta
A test that is used develop a biological vu lly different from
disorder’. Compared to the DSM-IV, the DSM-5 entails using less strict criteria for anorexia nervosa
a disorder? Ex lne rab ility for a menta the
to determine plain using the l disorder, does
and bulimia nervosa and includes binge eating disorder in its own right. TheseLO changes
1.3 reduce the biopsychosoc
ial model of me this mean that
the cause of ntal disorders. he/she is destin
number of people who are likely to fall into the residual eating/feeding disorder 1.7 categories. This ed to
difficulty with What were the
swallowing. The is an important development as the former residual DSM-IV category was relatively 1.8 Honeglected by main limitations of
w can the reliab the DSM-I and
patients drinks researchers despite evidence from many studies that between a third and a half 1.9of individuals with ility of a menta DSM-II?
In what ways did l disorder diagn
a preparation disturbances regarding their eating, shape and weight did not meet the DSM-IV criteria for
1.10 List the ma anorexia the DSM-III dif osis be improve
in In fer fro m its predecessors? d?
containing barium nervosa or bulimia nervosa and thus fell into the residual category (Fairburn & Harrison, 2003). limitations of the
categorical sys
sulphate, which other words, a substantial number of people with significant eating and body image disturbances were tem of classificatio
is a metallic
n reflected in the
being neglected. DSM-III and be
yond.
compound that
shows up on
REFERENCES
There are five ‘other specified feeding or eating disorder’ (OSFED) types described in the
X-rays and is
DSM-5. These are atypical anorexia nervosa (where all criteria are met for anorexia nervosa, except
Allard , J.,
used to see low weight); bulimia nervosa and binge eating disorder of low (less than weekly) yce frequency Suppesand/or
, T., & van Os,
the psychosis J. (2007). Dim
abnormalities in duration of binge eating/compensatory episodes; purging disorder (purging behaviours
Psychiatrin the phe
absence
notype. Interna
tional Journal
ensions and
Andrews, G.,
of binge eating); and night eating syndrome (excessive eating after the evening ic Research, 16, of Methods in Hall, W., Teeson
the oesophagus Americmeal or eating at S34–S40. . M.,
lth of Australian & Henderson, T. (1999).
an Psychiatric Ass The mental hea
and stomach. night after awakening from sleep). The ‘unspecified feeding or eating disorder’ category
manual of menta is to beoci atio n (19 52). Diagnostic Department of s. Canberra: Co
l disorders. Wa and statistical Health and Aged mmonwealth
used when the feeding or eating disorder causes significant distress and/orAm impaired
erican Psypsychosocial
chiatric Associatio
shington, DC: Au
thor.
Australian Psy Care.
chological Soc
functioning but there is insufficient information to specify the type of disorder (e.g.,
l of in n (1968). Diagno iety (2010).
manua meemergency
ntal disorders (2n stic and statistica psychological inte
rventions in the Evi dence-based
hospital settings). American Psychi d ed.). Washingt l literature review treatment of me
atric Associatio on, DC: Author. (3rd ed.). Melbo ntal disorders:
Two final conditions are listed among the DSM-5’s feeding and eating ma nual of methat
disorders, n (1980). Diagno Ayllon, T., & Az urne: Author. A
ntal is, pica
disord ers (3r
stic and statisti
cal rin, N. (1968).
Amsubstances
erican Psychi(e.g., d ed.). Washington, system for therap The token economy:
and rumination disorder. Pica refers to the eating of one or more non-food soap,
atric Ass ociatio DC: Author. y and rehabi A motivational
manual of menta n (1987). Diagno Century-Crofts litation. East No
l disorders (3rd stic and statistica . rwalk: Appleton
Author. ed., revised). Wa l Baker, D. B., -
shington, DC: & Benjamin,
American Psy the scientist-pr L. T. (2000). The
chiatric Associ actitioner: A affirmation of
statistical manua ation (1994). Psy cho look back at
l of mental disord Diagnostic and log ist, 55, 241–247. Boulder. Americ
Author. ers (4th ed.). Wa Bandura, A. (19 an
shington, DC: 77). Social learni
American Psychi Barton, W. E. ng theory. Oxford
: Prentice-Hall.
atric Associatio (1987). The his
rie66620_ch09_235-280.indd 240 manual of menta 07/11/17 06:50 AM n (2000). Diagno Psychiatric Ass tor y and influen
ce of the Americ
l disorders (4th stic and statistica ociation. Washi 08/01/17
rie66620_fm_i-xxvi.indd xxii DC: Author. ed., text revisio l Press. ngton, DC: Am 10:34 AM an
n). Washington, erican Psychiatri
American Psychi Bech, P. (2002) c
atr . Pha
 CHAPTER 6

126 Bipolar disorder

Abnormal ps
ychology 4e

scribes her
Philip B. Mitchell order. She de
of bipolar dis
ab ou t the ir experience nd itio n as follows:
up Greg
eak out ab out her co
Murray hotics
decision to sp the anti-psyc
Lyi ng on tha t hospital be
d waiting for
y am I so afr aid of people xxiii
. Wh so
gan to think h this illness,
to kick in, I be alians lives wit
e in 100 Austr lly hard—to ma
nage it so
finding out? On rk ha rd— rea wh at’ s
CHAPTERcy? I wo OUTLINE or relationships, so
why the secre on my work clean. It
impact and e totoco mediagnosis
that it doesn’t
●
Historical current
ed it wa s
approachestim the
d held
of bipolar disorder
here? I decid of bipolar k about it. I ha

DAL
the problemThe epidemiology
●
t pretty sicdisorder
era tin g,
The bu t I alsooffelbipolar
aetiology disorder ma ny ye ars that the
was lib ●
est for so r disorder
se to myofch nted around bipola
this secret so
Theclo treatment bipolar disorder ning. But I wa rs, the stigma
really frighte
●

ming out was

Summary re who feel the
need In recent yea as more peop
le open up
prospect of co
●

op le ou t the the de cre asi ng order.

the other pe let the rest of has be en ng with the dis
to do it for all secret, and to erience of livi
the ir diagnosis a h bip olar. about their exp
ke ep life wit
to LEARNING a normal
OBJECTIVES
u can live (LO)
world know yo an Broadca
sting iption of
Australibipolar aches, a descr
SUPPORTING STUDENT Corporation—L
du ce d
Repro 6.2 Understand
by
ary Sa
6.3ibr Describe
les ©
the
ion ofI disorder,
permissbipolar
6.1 Differentiate
the
AB C
epidemiological aspects a
order, pro
olar discauses
possible
viding
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ofbri
bipolar
of bipolar disorder.
ef ov erv iew regarding
disorder.
d a discussion
historical appro
of current bio ps
an
ych os ocial underst
and many oth
andings
ers around
on bip gy an Ry
LEARNING ter foc us es mi olo of Jan e people with
This chap 6.4 Describe the ati medical
on regand ing epide interventions
ardpsychological nue to
contiused the
treat rk prevent bipolar disorder.
woand possible for
criteria, inform also aims to ality of life is
the diagnostic tre atm en t. The chapter un de rlin ing that good qu
tiology and s diagnosis,
and
regarding ae ma out of thi
aking the stig
This book supports student reading and the world—t BIPOLAR
er.
DISORDER: AN AUSTRALASIAN FOCUS
bipolar disord Bipolar disorder refers to a group of conditions where people typically experience the two poles of mood disturbance—
comprehension of material through a that is, episodes of depression and episodes with manic or hypomanic symptoms (such as an excessively agitated or
roaches
d current app isorder
euphoric mood). ABC News journalist Jane Ryan, who had been living with bipolar disorder for a decade before she
pedagogical framework that provides learning ca l an
made her condition publicly known, provided a vivid description of her most recent episode of this condition:
is to ri
.1 Hdepressed. The strengthsiwent
LO 6severely larand
myoarms
ip
ooutfon.bofMy d legs and it was hard to
connections throughout the chapters. This
First I became
walk . . . Everything became ed
thand
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hazy
o tosfocus
gnhard brain slowed down to a snail’s pace . . .
I fixated on death—not because I wanted to kill myself, but because it seemed like the only way I could get
framework uses each chapter’s learning er and melancholi
a
bipolar disord
some rest. I knew it couldn’t last forever and that I’d survived it before, but somehow in the depths of that
mania
s ofthis
The history of
despair I convinced myself that I would never be better, I would never recover, st Ide
would ionlike
scriptstay forever. re
e earlie d depression we
objectives (LO) to keep the core concepts in Then a switch was flicked . . . I became agitated
er and
tor y (M
long hisconcentrate.
has aI couldn’t
itc . .ll,
.he 2017). Th
I stopped
I talkedrou
listening when people
most
out fast
ghand of histor y,
werema nia anbecause
talking
w of so bip olar dis ord er
Bipolar disord irritable. eek times. Thafter, I became ryit,vie
my thoughts were racing loud without realising I felt funny
classical Gr contempI ora to the conditio
n
front of the student from the beginning to the can be traced back to Deeply
and clever. Then I became
we a turning point
irritable . . . Soon
ver,harboured
for thepsychotic.
lre
lost my
(18a51group
tas] erron
grip
) ref edreality
al
and started to imagine the
d as sep ara te illn ess
natural es. Ho
environment
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terrible ier
dangers re Fa
[such
en tity inv of
olv ing the sequenti
cyclists
viewefrom behind was ete tury in swooping to peck a single
end of the chapter and beyond. These learning approaching
k pla
toofeel theknow
ce inyou
enth cen
nin a swarm of buzzards
madnesstotally
of become
s descrme
), thuunhinged ibing
to death. It’s hard to describe the
and you can’t tell what’s real and landmark
terror you when
laiIre’ (th cyclehas
youremind
lly ma de the
circu forma
objectives are tagged to sections in the chapter as ‘la
what’s not. foliethat
During time
the truth. ange between mania
ch
experiencedlan
and me ch oli
incrediblea. fear and anxiety that people
eteenth centur
y that Emil Kr aep at nwork
eli
of severe menta
might discover
l illness, partic
ularly
th
during the lat
e nin ms nts wi
s also attitudes and discrimination ’ and other for
ity regarding her bipolar ved that patie
where students can find the information, It was Jane’s fear wanegative
It of
on between ‘manic depressi
ve ins anothers
from
schizoisph renia). Krasaep elin (18disorder
ser led her to keep
96) obthat
impaare
e Jane
itivas
ent and
irmopening social
her condition adis tinctiFortunately,
secret. the stigma around thefor
term condition decreasing of cogn
more people such
ms between
ecox’ (an early going sympto r functioning
as well as to the Review questions so ‘dementia pra
x generally ex
pe rie nc ed on
ded to ex pe rie nc e bette
of mood disord
ers
dementia praeco ve patients ten classification continued
manic-depressi currence in the anity’ was too
students can check their understanding of withdraw al wh ere as
od disturbance.
The next lan dm ark oc
m ‘manic de pre ssi ve ins
experience
bipolar disord
er ued that the ter ere individuals
episodes of mo (1957), who arg a condition wh pressive
key concepts. Key term definitions from Mood disord
er
nic/ wa s ma de by Karl Leonhard
term bip ola r dis ord er to refer to
this cond itio n fro m on e involving de
marked by ma
lus ive . He coined the s, an d distinguished ical
the chapter are now provided as a margin hypoman ic inc
both depressive
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alo ne . ha ve ch an ged dramatic be rt Sc hu nn was str uck
ma01:44
s er Ro
definition on the page the term first appears depressive
rie66620_ch06_125-146.indd episode
125

The treatmen
ts for bipolar
disord
r example, the
composer 07/08/17
d-1800s. He suc
PM
cumbed
episodes great artists. Fo tted to an asylum in the mi
lives of some admi
and the end of chapter summary aids student (previously records of the
-depressive psy
ch osi s an d
down by manic
-
called manic
revision and summarises core concepts before depression).

moving on to the next chapter.

CONNECTING WITH TODAY’S STUDENTS 07/08/17 01:4
4 PM

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rie66620_ch06
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126

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rie66620_fm_i-xxvi.indd xxiii 08/01/17 10:34 AM

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rie66620_fm_i-xxvi.indd xxvi 08/01/17 10:34 AM
CHAPTER 1

Conceptual issues in
abnormal psychology
Marianna Szabó

CHAPTER OUTLINE
● The definitions of abnormal behaviour and mental disorder
● Perspectives on the classification, causation and treatment of mental disorders
● The classification and diagnosis of mental disorders
● Summary

LEARNING OBJECTIVES (LO)

1.1 Describe the difficulties inherent in defining abnormality and mental disorder.
1.2 Distinguish among the main theoretical approaches to understanding the classification, aetiology and treatment
of mental disorders.
1.3 Evaluate the changes made in psychiatric classification over time.

ABNORMAL PSYCHOLOGY: AN AUSTRALASIAN FOCUS

In 1929, Henry Tasman Lovell, whose interest was in abnormal psychology, became the first Professor of Psychology in
Australia at the University of Sydney. A more recent, yet also momentous, milestone for the field of abnormal psychology
occurred in November 2006 when the Federal Government introduced the Better Access to Mental Health Care program,
which, for the first time in Australia, allowed people to receive Medicare rebates for psychological treatment provided
by trained mental health professionals. As a result of this program, access to psychological services is now available to
people who would not otherwise be able to afford it. The introduction of the Better Access initiative signalled a significant
recognition of the effectiveness of psychological treatments.
A 2017 report by the Australian Psychological Society entitled ‘Ten Years of Better Access’ provides a review of the
first decade of the Better Access program (Littlefield, 2017). The report highlights the program’s success in providing
accessible, effective and affordable treatment for psychological problems to many Australians. For example, by 2013
psychological services provided through Better Access had been accessed by more than three million people. In
addition, while only 35 per cent of Australians with mental disorders sought treatment prior to the introduction of Better
Access, this rate had increased to 46 per cent by 2010. Researchers attributed this increase in the treatment rate to the
availability of affordable psychological services through the Medicare system, and the de-stigmatisation of help-seeking
for mental health encouraged by this system (Pirkis, Harris, Hall, & Ftanou, 2011). A client satisfaction survey of more
than 2000 clients indicated that psychological treatment provided through Better Access resulted in significant or very
significant improvement for 91 per cent of clients, thus supporting the program’s effectiveness.
Nevertheless, the ‘Ten Years of Better Access’ report also highlights important limitations and challenges associated
with the program. For instance, it was announced in the 2011–2012 Federal Budget that the number of Medicare-
supported psychological consultations would be reduced from a possible maximum of 18 to 10 sessions per calendar year.

continued

rie66620_ch01_001-040.indd 1 07/31/17 05:14 PM

 2 Abnormal psychology 4e

Unfortunately, this number of sessions is inadequate to treat many

psychological disorders. A study investigating mental health outcomes
found that among individuals receiving psychological treatment,
65 per cent continued to have severe symptoms after 10 treatment
sessions, but that only 22 per cent continued to report severe symptoms
after receiving up to 18 sessions (see Littlefield, 2013). As many
individuals do not improve sufficiently after receiving the 10 treatment

COURTESY THE UNIVERSITY OF SYDNEY ARCHIVES

sessions available under Better Access, psychologists and clients alike
experience difficulty in achieving adequate client care. Among the less
than optimal options available to psychologists and their clients when
the maximum 10 sessions per year has been reached are: postponing
further treatment until the following year, when the client can once again
access Medicare-supported sessions; extending the interval between
sessions so that treatment can be available for a longer period of time,
even though more frequent sessions might be beneficial; or receiving
treatment from a public mental health service, which often entails long
waiting periods.
As well as summarising some of the key achievements and
difficulties of Better Access to date, the ‘Ten Years of Better Access’
report also highlights future potential challenges for the program.
Among these is the Federal Government’s proposal to limit access
Henry Tasman (Tassie) Lovell (pictured
to Better Access to those with moderately severe mental disorders,
with his son) was the first Professor of
while directing those with milder and more severe disorders to other
Psychology in Australia, taking up his
programs. However, these alternative programs raise concerns about
position in the Department of Psychology at
those with milder disorders having services delivered by inadequately
the University of Sydney in 1929.
trained practitioners and about those with more severe and complex
disorders receiving sufficient funds to meet their needs. The ability to
address the mental health needs of all groups in society therefore remains a significant challenge.
This chapter traces the development of abnormal psychology and the mental health professions from their beginnings to
the present and looks at possible future directions. Abnormal psychology is commonly defined as the field of psychology that
aims to understand and modify abnormal behaviours. Most of the field of abnormal psychology today, however, is concerned
only with a special subset of abnormal behaviours, a subset labelled ‘mental disorders’ or ‘psychological disorders’. Indeed,
most of the following chapters focus upon a specific category of mental/psychological disorder. The present chapter serves
as an introduction to some of the fundamental concepts of abnormal psychology. First, definitions of abnormality and mental
disorder will be discussed. The bulk of the chapter will focus on the main theoretical perspectives that have shaped current
knowledge in abnormal psychology. In this section, the biological perspective (the oldest and currently dominant approach
to understanding mental disorders) will be contrasted with various psychological perspectives to underline the differences
in their approaches to the conceptualisation, classification, explanation and treatment of mental disorders. The chapter will
end with a description of one of the major systems for diagnosing mental disorders, and a consideration of the directions for
future developments in the field of psychiatric classification.

LO 1.1 The definitions of abnormal behaviour

and mental disorder
Abnormality
Although the distinction between ‘normal’ and ‘abnormal’ behaviours seems intuitively clear to most
people, a more careful consideration reveals that this distinction is often difficult to make. Although
no clear rules have yet been identified to differentiate normality and abnormality, several elements

rie66620_ch01_001-040.indd 2 07/31/17 05:14 PM

 Chapter 1 Conceptual issues in abnormal psychology 3

have been proposed. The most common ones

are statistical rarity and the ‘three Ds’: deviance,
distress and dysfunction.

STATISTICAL RARITY
Statistical rarity is one criterion that has been used
to define abnormality. Individuals who possess a
characteristic that is rarely found in society can be
said to be abnormal, in the sense that they deviate
from the average to a large extent. This element
of abnormality, of course, can include positive
deviations as well. So, according to this definition,
people who are known for their musical or scientific
genius, for example, can be considered abnormal.
Clearly, the field of abnormal psychology cannot

DAL
be defined on the basis of statistical rarity alone,
otherwise individuals such as Wolfgang Amadeus The definition of abnormality often includes an element of statistical
Mozart or Albert Einstein would be prime candidates rarity. However, individuals whose statistically rare characteristics or
for treatment! abilities (such as those of a concert pianist or an Olympic athlete) are
positively evaluated by society would not be described as abnormal.
DEVIANCE OR NORM VIOLATION
Unlike the criterion of statistical rarity, the criterion of ‘deviance’ includes a value component.
According to this criterion, a behaviour is considered to be abnormal if it is negatively evaluated by
society. The ‘abnormal’ abilities of famous musicians, sportspeople or scientists are positively valued
by society and thus would not be defined as abnormal according to this criterion. On the other hand,
being unable to socialise because of extreme anxiety, avoiding all forms of public transport, hearing
voices, physically assaulting one’s spouse, or making a living by armed robbery are generally seen as
violating social expectations.
While adding the element of norm violation to statistical rarity can give a more precise definition of
abnormality, it still leaves a very broad class of behaviours for abnormal psychology to be concerned
with. Norm-violating behaviours encompass a diverse range of behaviours. These may include
instances of harmless eccentricity and serious criminal acts, as well as instances of mental disorder.
Moreover, using norm violation as a sole requirement to define abnormality can be dangerous as it
can be used to oppress any non-conformist behaviours. For example, homosexuality and a range of
other sexual behaviours such as masturbation were seen as both statistically rare and unacceptable by
society only a few decades ago. Therefore, people engaging in these behaviours were viewed as in
need of either punishment or treatment (Szasz, 1961).

DISTRESS
A third important element in defining abnormality, which is sometimes used to differentiate the
field of abnormal psychology from that of forensic psychology or criminology, is that the abnormal
behaviour causes distress to the person. At first sight, this would appear to be a necessary element in
defining psychological abnormality. In addition, this element allows the individual to self-define their
behaviours as abnormal or not, rather than allowing society at large to make that decision. People
who are happy and content with their lives tend to consider themselves normal, while those who are
distressed by their own thoughts, feelings or behaviours tend to seek treatment.
Unfortunately, this element also has its limitations and dangers in attempting to define abnormality.
On the one hand, some individuals cause themselves a great deal of personal suffering, for example,
by starving themselves to near death for religious, political or other reasons. Should these individuals
(e.g., great national leaders such as Mahatma Gandhi) be considered abnormal and requiring treatment?
On the other hand, many people whose behaviours come to the attention of mental health professionals
do not experience distress. For example, one of the defining features of a manic episode in bipolar

rie66620_ch01_001-040.indd 3 07/31/17 05:14 PM

 4 Abnormal psychology 4e

disorder (as discussed in Chapter 6) is abnormally elevated mood, self-esteem and creativity, all of
which are experienced as very pleasant by the individual.

DYSFUNCTION
maladaptive The fourth element in defining abnormality asks whether the behaviour is dysfunctional or maladaptive.
Behaviour that In other words, does the behaviour interfere with the person’s ability to meet the requirements of
interferes with a everyday life? For instance, is s/he able to have a job, a family, a social network and a necessary level
person’s ability
of financial security? This element is widely accepted among mental health professionals as crucial
to meet the
requirements of
in defining abnormality and is often incorporated in the diagnostic criteria for the various mental
everyday life. disorders. So, the person who experiences a manic episode with abnormally elevated mood, self-
esteem and creativity may not be distressed but may be making decisions that interfere with his/her
ability to function effectively in everyday life. During manic episodes, individuals often make risky
financial investments or engage in sexual or aggressive behaviours that they would normally see as
foolhardy and dangerous. In that sense, the behaviour is maladaptive or dysfunctional. On the other
hand, according to the dysfunction criterion, a person with an extreme snake phobia who never leaves
the city would not be considered abnormal because his/her fear of snakes does not interfere with the
ability to meet the requirements of everyday life.
The maladaptiveness criterion is highly practical and liberal in that it can accommodate an
individual’s life circumstances (as in the case of the urban-dwelling person with a fear of snakes).
However, it also has its limitations. Most importantly, it greatly overlaps with the concept of norm
violation: how functional an individual is considered to be is often based on how well s/he meets
social expectations. It is a social expectation that individuals should have a job, a family, financial
security and a social network, and not to do so is seen as dysfunctional. As such, this criterion suffers
from the same limitation as the criterion of norm violation: it may be the social expectations that are
wrong rather than the individual’s failure to adapt to these.
A commonly cited illustration of how a particular society’s values influence the idea of what
is dysfunctional is the mental disorder drapetomania (Szasz, 1971; Wakefield, 1992). Drapetomania
was described by Dr Samuel Cartwright in 1851 as a mental disorder. It was used to describe
African American slaves who repeatedly attempted to run away from slavery, even though running
away resulted in severe punishment for those who were caught. So, this behaviour was thought to be
causing distress to the individual (as it elicited punishment), as well as being ‘dysfunctional’ (as it was
inconsistent with what was thought to be the normal function of African Americans in society, that is,
to be a slave). Therefore, running away was seen as a type of insanity requiring treatment.
Clearly, neither rarity, norm violation, distress or dysfunction on its own is sufficient or necessary
for the definition of abnormality. Therefore, a common approach is to consider all of these elements
together: it is the accumulation of these elements that assists in defining behaviour as abnormal.
Nevertheless, it is important to remember that each of the criteria suffers from being closely tied with
societal norms and expectations that change over time and cultures. No clear, universally accepted
definition of ‘abnormality’ has yet been established.

Mental disorder
The field of abnormal psychology concerns itself with a wide range of behaviours that are considered
‘abnormal’. However, not all of them are currently defined as mental disorders. For example, much
research effort has been focused on understanding the reasons behind domestic violence or the eating
behaviours leading to obesity. Yet neither domestic violence nor obesity is currently classified as a
mental disorder.
Unfortunately, similar to the concept of abnormality, a precise definition of the general concept
of mental disorder continues to be elusive. Several theorists have offered their views on how to
differentiate mental from physical disorders (Brülde & Radovic, 2006), while others have concentrated
on attempting to clearly define the concepts of disease, illness and disorder (Wakefield, 1992).

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 Chapter 1 Conceptual issues in abnormal psychology 5

One of the most contentious issues has been whether disease, illness and disorder are purely
factual, medical terms, or whether they are purely value judgments based on social norms.
The label ‘mental disorder’ in its most common usage today implies that the abnormal behaviour is
not only statistically rare, unacceptable to society, causes distress and/or is maladaptive, but that it also
stems from an underlying dysfunction or illness. For example, the current edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5) defines mental disorder as follows:
A mental disorder is a syndrome characterized by clinically significant disturbance in an clinically
individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the significant
psychological, biological, or developmental processes underlying mental functioning. Mental Meaning the
disorders are usually associated with significant distress or disability in social, occupational, or disorder causes
other important activities. An expectable or culturally approved response to a common stressor substantial
or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior impairment
in social,
(e.g., political, religious, or sexual) and conflicts that are primarily between the individual and
occupational or
society are not mental disorders unless the deviance or conflict results from a dysfunction in the other areas of
individual, as described above. functioning.
American Psychiatric Association (APA), 2013, p. 20

Each specific mental disorder identified in the DSM must meet this general definition.
Wakefield (1992; 1999) proposes that the concept of mental disorder, as stated in the DSM,
involves both a factual component (there is an underlying dysfunction) and a value component (it
is seen by society as harmful). The factual component specifies that there is an internal dysfunction
present: that a psychological mechanism has failed to carry out its natural evolutionary function. For
example, the evolutionary function of anxiety may be to warn the individual of objective danger.
When anxiety occurs in the absence of objective danger, this psychological mechanism has failed to
perform its natural function. Therefore, the individual’s fear of harmless objects can be said to occur
as a result of an internal dysfunction. It is important to note that the meaning of the term ‘dysfunction’
in Wakefield’s approach is different from its usage in relation to the ‘three Ds’ above, where it refers
to an individual’s inability to carry out his/her social roles.
The ‘internal dysfunction’ specification helps demarcate instances of mental disorder from
instances of social deviance, non-conformity or crime. For example, individuals who go on hunger
strikes and starve themselves for political reasons do not do so as a result of an internal dysfunction
but as a means of effecting social change. On the other hand, individuals with anorexia nervosa may
be said to severely limit their food intake as a result of an internal psychological dysfunction: the
internal mechanisms that contribute to maintaining a minimum healthy weight do not perform their
natural function. Similarly, individuals who carry out violent, illegal or otherwise antisocial acts may
do so as a result of an internal dysfunction (e.g., a lack of impulse control or an inability to feel
empathy for others) and thus they may qualify for the diagnosis of a mental disorder (in this case,
antisocial personality disorder). Some of these individuals, however, may engage in such acts as a
result of belonging to a gang so as to protect themselves in a violent neighbourhood or simply because
they find it easier and more acceptable to earn a living by illegal means. Such cases would not qualify
for a diagnosis of mental disorder as no internal dysfunction is present.
However, according to Wakefield’s approach, for a behaviour resulting from an internal dysfunction
to qualify as a mental disorder it needs an additional value component: it needs to be causing harm to
the individual. So, hallucinating that results from an internal dysfunction is not necessarily seen as a
disorder in societies where hallucinating is evaluated positively, perhaps as a sign of psychic abilities.
In these societies, hallucinating causes no harm or social disadvantage to the person.
According to Wakefield’s analysis, therefore, mental disorders are best conceptualised as lying
somewhere between the concept of physical disorder, which involves mainly a factual component
(e.g., having a broken leg or a viral infection are facts that exist in nature, independent of any
evaluations) and the concept of social deviance, which involves mainly a value component (e.g., being a
nudist, taking recreational drugs, living in a commune or running away from slavery can be considered

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 6 Abnormal psychology 4e

instances of social deviance, as they are evaluated as right or wrong in relation to changing social
norms). The concept of mental disorder involves a bit of both.
Wakefield’s conceptualisation of mental disorder has received several criticisms, most of which
concentrate on the difficulty in ascertaining the normal evolutionary function of psychological
processes and the consequent difficulty in identifying when such processes are not carrying out their
functions (Lilienfeld & Marino, 1995; McNally, 2001). For example, while the function of anxiety is
likely to be to warn the organism of impending danger, the possible evolutionary function of sadness is
the subject of ongoing debate. It is difficult, therefore, to offer a conceptualisation of major depression
in terms similar to that of anxiety disorders. Further, some cognitive abilities, such as reading, have
been acquired too recently in human history to be regarded as natural functions designed by evolution.
According to an evolutionary analysis, therefore, reading disabilities such as dyslexia could not be
classified as a disorder. Although Wakefield’s analysis and the subsequent responses to it have made
important contributions, the ongoing debate regarding the most appropriate definition of mental
disorder continues to pose a fundamental conceptual challenge to the field of abnormal psychology
(Rounsaville et al., 2002).

LO 1.2 Perspectives on the classification, causation

and treatment of mental disorders
To appreciate how the understanding of mental disorders has developed to its current stage and in what
directions it may be developing in the future, an introduction to the main theoretical perspectives for
mental disorders is needed. These perspectives propose different conceptualisations of what a mental
disorder is, how many and what kinds of different mental disorders there are, what their primary causes
may be, and what the best treatments are.
The discussion will begin with the currently dominant (and oldest) biological/medical perspective,
followed by the main psychological perspectives, the sociocultural perspective and the integration of
these various perspectives in the biopsychosocial model. Such integration emphasises that the various
perspectives on mental disorders are not mutually exclusive. There is not one right way of explaining
mental disorders. Rather, the various perspectives emphasise different levels of explanation and are
best seen as complementing, rather than competing with, each other.

The biological perspective

HISTORICAL BACKGROUND OF THE BIOLOGICAL PERSPECTIVE
Before the emergence of psychoanalytic thinking and behaviourism in the early twentieth century,
the concept of mental illness was virtually identical with the concepts of madness or insanity. These
terms were applied to individuals with extremely severe disturbances involving hallucinations and
affect delusions, or severe disorganisation of speech, affect (emotion), thinking or behaviour. Most of these
Experience symptoms would today be summarised under the term ‘psychosis’ (as discussed in Chapter 7), while
of feeling or others might resemble dementia (as discussed in Chapter 15).
emotion.
Patients who displayed such severe disturbances were treated in mental asylums by ‘mad doctors’
or ‘alienists’, the forerunners of today’s psychiatrists. Until the early nineteenth century, a large
proportion of those treating the mentally ill were not even medically trained, let alone specialists in the
dementia study of mental illness—some were general physicians or surgeons, but others were simply charlatans.
Neurological
Madness was seen as a state that anyone could recognise, and often it was left to local magistrates to
disorder in which
a gradual decline
certify a person’s sanity or lack thereof (Routh, 1998).
of intellectual Psychiatry became recognised as a legitimate speciality within medicine only about 150 years ago
functioning (Barton, 1987). The forerunner of the American Psychiatric Association—the Association of Medical
occurs. Superintendents of American Institutions for the Insane—was established in 1844. The American

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 Chapter 1 Conceptual issues in abnormal psychology 7

Journal of Insanity, later called the American Journal of Psychiatry, was also first published in 1844,
and remains one of the leading journals in psychiatry to this day. By the end of the nineteenth century,
most of those treating mentally ill people were medically trained physicians who believed that symptoms
of madness arose from underlying biological diseases affecting the brain or the nervous system.

CLASSIFICATION AND CAUSATION FROM THE BIOLOGICAL PERSPECTIVE

There is only one kind of mental disease, we call it insanity.

Heinrich Neumann, 1859, cited in Hecker, 1871/2004, p. 351

Prior to the twentieth century, the symptoms of the various mental disorders (as currently defined)
were not usually seen as indicators of separate disorders. Instead, many doctors in the nineteenth
century agreed with Heinrich Neumann, believing insanity to be a single disease that progressed from
one major symptom to another over time, with the symptoms becoming increasingly severe. Thus,
the first symptom of insanity was thought to be depression, followed by agitation, then confusion,
paranoia and finally dementia (Misbach & Stam, 2006).
Others, however, believed that there were in fact several different mental diseases. The basis for this
belief was the observation that some individuals displayed groups of symptoms (called syndromes) syndrome
that others did not, or that people with certain types of symptoms got better while others with different Set of symptoms
symptoms got worse, or that some symptoms began early in life and others began later, or that some that tend to occur
together.
symptoms were more often seen in men while others were more often seen in women. The ultimate
aim of such observations was to identify symptoms that clustered together to form syndromes because
they had a common cause. Once the causal agents underlying these symptom clusters were identified,
it was hoped that it would become possible to discover an effective treatment that targeted those
underlying causes. In other words, the ultimate aim of psychiatric classification was, and still is,
to describe symptom clusters that have common causes and respond to common treatments. Such
symptom clusters are then labelled as ‘disorders’ or ‘diseases’.
An example of a similar process in the history of physical illnesses pertains to the treatment of
‘the fevers’. Such treatment had limited success. This was partly because people did not understand
that a high fever was not a disease in its own right, but that it could be a symptom of a diverse
range of disorders, caused by a diverse range of underlying pathologies that were unknown at the
time. However, once doctors noticed that some fevers were accompanied by red spots on the body,
while others were accompanied by abdominal pain, they were in a position to describe two different
syndromes or categories of illness (e.g., measles and appendicitis, respectively). They could then
begin to look for the specific causes and treatments of these different illnesses.
Unfortunately, the causes of most diseases were unknown for much of human history so that
classification of illnesses into separate categories was often based on hypothesised causes. The earliest
known attempt at such classification was offered by the ancient Greek physician Hippocrates (c. 460–
377 BCE), who is often referred to as the father of modern medicine given his emphasis on natural
(rather than supernatural) causation. He hypothesised that mental and physical health required the
balance of four ‘humours’ or fluids in the body: blood, yellow bile (choler), black bile (melancholer)
and phlegm. Too much of any of these was believed to result in certain personality types, such as a
melancholic or depressed personality arising from excessive black bile. An extreme imbalance of the
humours was thought to result in mental illness.
Another mental illness identified at the time was ‘hysteria’, which was thought to be caused by a
detached womb wandering in the body (and which, therefore, by definition, could afflict only women).
About 2000 years later, in the sixteenth century, the famous Swiss physician Paracelsus proposed that
there were three classes of mental illnesses: vesania, thought to be caused by poisons; lunacy, believed
to be influenced by phases of the moon; and insanity, a disease believed to be caused by heredity
(Charney et al., 2002). Unfortunately, because the assumed causation underlying these proposed
disorders was manifestly wrong, the treatments targeting the presumed causes also had limited success.

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 8 Abnormal psychology 4e

However, by the end of the nineteenth century the medical profession was optimistic that it was
only a matter of time before the biological causes of mental illnesses would be precisely known.
A number of important scientific discoveries gave impetus to this optimism. Foremost among
these were Louis Pasteur’s germ theory of diseases, which stated that tiny creatures, invisible
to the naked eye, could invade the body and cause illness. This seemingly strange idea received
empirical support in the late nineteenth century and was followed by the discovery of various
bacterial microorganisms.
Concerning mental illness specifically, one of the most important early discoveries within the
biological perspective was the identification of the cause of a mysterious mental illness: ‘general
paralysis of the insane’, also known as general paresis (Routh, 1998). In many respects, general paresis
was similar to other types of ‘insanity’: it included bizarre behaviours, persecutory delusions and
hallucinations. However, it had a steadily deteriorating course, while most other types of insanity
tended to remain stable. Patients with general paresis almost invariably got worse, eventually becoming
paralysed and dying within about five years of disease onset.
This suggested that general paresis might be a specific disease category with its own causation and
treatment, different from other types of insanity. Additional descriptive information was then used to
hypothesise about and test various ideas about causation. As the condition was observed more often
in men, especially in sailors, it was initially thought that smoking, drinking alcohol or being in contact
with sea water might cause the illness. Experimental studies were conducted to discover the biological
disease process underlying the syndrome.
To test one hypothesis, in 1897 Richard von Krafft-Ebing, a German neurologist, injected
discharge from syphilitic sores into patients suffering from general paresis. None of the patients
developed symptoms of syphilis, suggesting that they were already infected. This finding gave support
to the notion that general paresis might be caused by syphilis. Indeed, the bacterium Treponema
electroconvulsive pallidum was discovered as the causal agent of syphilis in 1905 and it was found in the brains of
therapy (ECT) patients with general paresis in 1913, confirming the hypothesis. On the basis of this underlying
Treatment for biological causation, the syndrome general paresis was identified as a part of the last stage of syphilis,
mood disorders rather than being a separate category of mental illness with its own specific cause. Of course, after the
that involves
invention of antibiotics, it also became possible to treat it.
the induction of
a brain seizure
Other important discoveries at the time included the identification of associations between certain
by passing an syndromes and localised damage to the brain. The French physician Pierre P. Broca (1824–1880)
electrical current identified the area of the brain damaged in patients with expressive aphasia (an inability to produce
through the meaningful speech) and Carl Wernicke (1848–1905) later found damage in a different part of the brain
patient’s brain associated with receptive aphasia (an inability to understand speech).
while s/he is Following such discoveries, the idea that all mental disorders were caused by biological factors
anaesthetised. became increasingly accepted. Many doctors believed that all mental disturbances would eventually
be identified as having a biological origin, for instance, in the form of some bacterial or viral infection,
psychosurgery contact with toxic agents or structural brain abnormality.
Biological
An enduring contribution to the classification of mental disorders at this time was made by the
treatment (such
as lobotomy) for German psychiatrist Emil Kraepelin (1856–1926), one of the most influential thinkers to challenge
a psychological the single-disease concept of insanity in the nineteenth century. In the first edition of his great work
disorder in which of psychiatric classification, the Compendium of Psychiatry in 1883, he initially distinguished two
a neurosurgeon main mental illnesses: manic-depressive psychosis and dementia praecox. These historical definitions
attempts to are close to today’s concepts of bipolar disorder and schizophrenia, respectively. After a further
destroy small 30 years of work, in the final edition of his Compendium published in 1915, Kraepelin distinguished
areas of the
13 categories of mental illness.
brain thought
to be involved A crucial feature of Kraepelin’s classification system was that mental illnesses were either
in producing categorised according to their known causes (e.g., intoxication psychosis or infectious psychosis) or
the patient’s remained at the level of description (e.g., manic-depressive insanity or dementia praecox). Kraepelin
symptoms. expected that biological causes would eventually be identified for each mental illness. Where such

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 Chapter 1 Conceptual issues in abnormal psychology 9

causes were not yet known, Kraepelin adopted a descriptive approach.

That is, instead of classifying disorders in terms of hypothesised causes, he
simply described diagnostic categories of unknown causation in terms of
their symptoms, onset, duration or other characteristics until such time as
their causation was discovered.
Consistent with the idea that mental illness involves hallucinations,
delusions or other severe psychological disturbances, most of the
categories of mental illness in Kraepelin’s classification system referred
to some form of psychosis or dementia. Similarly, the first official
psychiatric classification system published in the United States in 1918
contained 22 categories of mental illness, 21 of which referred to different
forms of psychosis with presumably different causes. Until the middle of
the twentieth century, most classification systems included one residual
category, usually labelled ‘general neuroses’. This one category contained
most of the symptoms of anxiety, phobias, obsessions and other non-

WIKIPEDIA CREATIVE COMMONS

psychotic but psychologically abnormal states that psychologists treat
today (Horwitz, 2003).

TREATMENT FROM THE BIOLOGICAL PERSPECTIVE

In spite of the important discoveries and optimism of the nineteenth century,
the first biological treatments yielded disappointing results. Doctors
attempted to treat mentally ill patients in insane asylums using hot and
cold baths, bleeding, removal of teeth, electric shocks and drug treatments The work of Emil Kraepelin was an influential
including opium and alcohol. In the absence of effective treatments, forerunner of contemporary psychiatric
physical constraints, including straitjackets and solitary confinement, were classification.
also used to control patients.
The twentieth century saw the emergence of more enduring and effective treatments. After pre-frontal cortex
initial experiments with dogs and pigs, electroconvulsive therapy (ECT) was first tried on a Region at the
human patient in 1938 to treat schizophrenia. It was subsequently found to have a calming effect front of the
on many patients and became part of the standard treatment for a variety of mental disorders, brain important
in language,
until it was superseded by drug treatments in the 1960s. ECT is still in use, having proven emotional
to be an effective treatment for severe depression that is not responsive to other, less invasive expression, the
treatments. However, the action on the brain by which ECT produces its effects remains unclear planning and
(Fink, 2001). production of
Another commonly used treatment in the early part of the twentieth century was psychosurgery. new ideas, and
Pre-frontal lobotomy was developed by Egas Moniz in 1937 and involved severing the neural fibres the mediation of
connecting the pre-frontal cortex to the rest of the brain. As with ECT, this procedure was found to social interactions.
have a calming effect on patients and became widely used in mental hospitals, with several thousand
patients receiving psychosurgery each year. The use of psychosurgery declined rapidly after the 1950s,
partly as a result of the introduction of more effective, less expensive and less invasive drug therapies
(Routh, 1998). biological
approach
CONTEMPORARY BIOLOGICAL PERSPECTIVES Theories that
explain abnormal
Mental illnesses are real, diagnosable, treatable brain disorders. behaviours
in terms of
Hyman, 1998, p. 38 a biological
dysfunction
The biological model proposes that symptoms result from disturbances of the physical (also called
body. The above quote from Hyman (1998) is an illustration of the biological model applied the medical
to mental illness. In their traditional and strictest forms, the biological approach and the approach).

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 10 Abnormal psychology 4e

medical model of diseases are synonymous. However, it is important to point out that not all
contemporary biological approaches subscribe to the strict traditional model. In general,
contemporary biological perspectives focus on uncovering the interactions between behaviour
and biological functions, implying that behaviour influences biology as much as biology
influences behaviour. Nevertheless, contemporary psychiatry as a medical profession largely
upholds the biological model in its focus on seeking to find the causes of mental disorders in
underlying biological malfunctions.
There are two main areas that contemporary biological theories focus upon in trying to
identify the causes of mental disorders. These areas are (1) structural brain abnormalities and (2)
neurochemical imbalances. In turn, two main causes for brain abnormalities or neurochemical
imbalances are proposed: (1) a person’s genetic makeup and (2) trauma affecting the brain or
nervous system. For example, in the case of schizophrenia, researchers have discovered associations
between certain forms of the illness and abnormalities in specific areas of the brain. Using various
brain-scanning techniques, it has been shown that individuals who display mainly the negative
symptoms of schizophrenia (e.g., a marked reduction in emotional expression, motivation and
enlarged speech) tend to have enlarged ventricles (the brain cavities that contain cerebrospinal fluid). This
ventricles finding has been interpreted as an indication that nearby parts of the brain have not developed
Fluid-filled spaces properly or have been damaged. Neurochemical imbalances have also been implicated in
in the brain schizophrenia, as well as in many other mental disorders. For instance, excess activity of the
that are larger
dopamine neurotransmitter system is thought to be related to schizophrenia, while imbalances in
than normal
and suggest a the neurotransmitters serotonin and noradrenaline may be involved in severe depression. Genetic
deterioration in research has found evidence for the involvement of heredity in both of these disorders (Andreasen,
brain tissue. 2001; Maj & Sartorius, 2002).

CONTRIBUTIONS AND LIMITATIONS OF THE BIOLOGICAL PERSPECTIVE

The biological model enjoys considerable respect and influence in today’s society. Some
researchers within the biological tradition claim that eventually all human phenomena will be
able to be explained in terms of underlying biological processes. Others, however, warn against
the dangers of this form of reductionism (Valenstein, 1998). They argue that complex human
phenomena such as beliefs, values and interpretations cannot be reduced to basic biological
processes because the essence of the phenomenon is lost in the reduction. The whole is greater
than, and different from, its constituent parts. In addition, when associations between biological
processes and psychological states are found, the direction of causation is often unclear. That is, if
a psychological disorder is linked to a biological abnormality, it is possible that the disorder causes
selective
the abnormality rather than vice versa, or that a third factor causes both the biological abnormality
serotonin
and the psychological disorder.
reuptake
inhibitors (SSRIs)
Indeed, it is important to keep in mind that the evidence for the biological causation of disorders
Class of is often overstated in popular (and sometimes scientific) discourse. Much of the evidence for
antidepressant biological explanations is inconclusive. Many of the studies have been conducted on animals and
drugs (such it is not known how much animal models of depression or anxiety, for example, are applicable to
as fluoxetine) humans. The success of drug therapies has also resulted in erroneous claims about causation. For
that inhibit the example, the success of selective serotonin reuptake inhibitors (SSRIs) such as Prozac® or Zoloft®
reuptake of has been interpreted by some as evidence for the involvement of serotonin in the causation of major
serotonin.
depression (Bell, 2005; Moynihan & Cassels, 2005). It needs to be remembered, however, that the
effectiveness of treatment does not necessarily imply causation. For example, while aspirin is an
psychopharma-
effective treatment for headaches, this of course does not imply that headaches are caused by low
cological
levels of aspirin in the brain.
treatment
The use of One of the most important contributions of the biological perspective is the development of effective
drugs to treat drug treatments in recent decades. Since the discovery of the first effective psychopharmacological
psychological treatment in the 1950s, drug therapy has become a very commonly used treatment for a variety
disturbances. of mental disorders. An increasing number of people, however, now believe that medications are

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 Chapter 1 Conceptual issues in abnormal psychology 11

overused in the treatment of psychological disorders and, although they are effective in many
cases, they are by no means a universal cure. Perhaps the main drawback associated with drug
therapies is the high likelihood of relapse after the individual stops taking the drug. In addition,
the question as to whether long-term usage of certain medications can produce undesirable,
often very serious, side effects has not always been answered (Bech, 2002; Ma, Lee, & Stafford,
2005). These considerations underscore the importance of expanding treatments beyond a purely
biological approach.
Finally, empirical evidence is mounting to suggest that the traditional medical model of diseases,
where clearly identifiable sets of symptoms are assumed to reflect a common underlying causation, psychoanalysis
may not be applicable to the definition and classification of mental disorders (Krueger & Piasecki, Form of treatment
2002; Widiger & Sankis, 2000). Instead, it has been argued that while most physical disorders are pioneered by
clearly distinguishable from each other on the basis of their symptoms and underlying causes (e.g., Sigmund Freud
cancers are clearly distinguishable from heart disease), many mental disorders overlap and merge into that entails
each other in a continuous fashion (as may be the case, for example, between anxiety and depressive alleviating the
unconscious
disorders). Further, while there may be a clear qualitative difference between physical health and
conflicts driving
illness (e.g., between having cancer and not having cancer), such a difference is not quite so clear in psychological
the case of mental disorders. Instead, it is now increasingly accepted that many mental disorders are symptoms by
best conceptualised on a continuum between normality and abnormality, rather than as qualitatively helping the
distinct states of mental health versus illness. The idea of such continuity between normal and patient gain
abnormal mental states and among different types of psychological abnormality was first popularised insight into his/
by Sigmund Freud, the father of psychoanalysis and one of the forerunners of the contemporary her conflicts
psychological approach. through
techniques
such as dream
analysis and free
Psychological perspectives association.
The psychological approach sees the primary causes of abnormal behaviours not in underlying
biological disturbances, but in underlying psychological processes, including the manner in which psychological
people interpret their environment, their conscious or unconscious beliefs and motivations, or their approach
learning history. In this section, the development of the main psychological approaches to defining, Theories
that explain
understanding and treating mental disorders will be discussed. Traditional and more contemporary
abnormality
forms of the two earliest psychological perspectives—psychoanalysis and behaviourism—will be in terms of
briefly presented, followed by an introduction to the cognitive perspective that is currently dominant psychological
in abnormal psychology. factors such
Many of the mental health professions as they are known today—such as psychotherapists or as disturbed
clinical psychologists treating individuals with less severe, non-psychotic disorders in outpatient personality,
clinics using so-called talking therapies—did not exist until relatively recently. Abnormal psychology behaviour and
ways of thinking.
as a science and clinical psychology as a profession began to develop about 75 years after the
emergence of psychiatry as a specialised field of medicine. The American Psychological Association
was founded in 1892, and its Clinical Psychology Section was established in 1919. The Journal psychotherapy
Treatment for
of Abnormal Psychology, the preeminent journal in the field to this day, was founded in 1906. Its
abnormality
original title was the Journal of Abnormal and Social Psychology, clearly distinguishing it from that consists of
biological approaches to mental illness. In Australia, the development of the profession was somewhat a therapist and
slower. The first professional body of psychologists, the Australian Overseas Branch of the British client discussing
Psychological Society, was established in 1944 (O’Neil, 1987). It had an initial membership of 42, the client’s
slowly rising to about 200 by the 1950s (Turtle, 1995). symptoms;
Until well into the 1950s, psychologists around the world were involved mainly in psychometric the therapist’s
theoretical
assessment (i.e., assessing intellectual abilities) and research in educational or industrial settings,
orientation
rather than in providing psychotherapy. The diagnosis and treatment of mental illness was strictly determines
the domain of psychiatry alone (Benjamin, 2005). The impetus behind the change towards providing the focus of
psychological treatment for mental disorders by non-medical professionals was provided by the discussions with
increasing popularity of psychoanalysis. the client.

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 12 Abnormal psychology 4e

The psychoanalytic perspective

Sigmund Freud (1856–1939) was a medically
trained neurologist with a private practice in Vienna.
He set one of the most important milestones in the
history of the mental health professions in 1895
when, with his colleague Josef Breuer, he published
Studies on Hysteria, marking the beginning of
the psychoanalytic movement (Breuer & Freud,
1895/1955). After the initial reluctance of the
medical establishment to take his ideas seriously, he
became one of the most influential thinkers of the
twentieth century.
Psychoanalysis dominated the mental health field
for more than half a century. It was especially influential
in psychiatry between the 1940s and 1970s. By 1945,
most chairs of departments of psychiatry in medical
schools in the United States were psychoanalysts and
the standard training of psychiatrists included extensive
instruction in psychoanalytic therapy techniques.
However, by the end of the 1970s, the number of
DAL

psychoanalysts acting as the chairs of psychiatry

Sigmund Freud, the founder of psychoanalysis departments had reduced to near zero. Psychiatry
and one of the most influential thinkers of the as a profession returned largely to the biological
twentieth century. Psychoanalysis is both a perspective. As a consequence, psychiatrists now
theory to explain normal and abnormal human receive only a relatively limited training in psychological
functioning and a therapeutic technique to therapies and concentrate more on biological therapies
alleviate abnormal functioning. (Horwitz, 2003).
At the same time, clinical psychologists began
to establish themselves as experts in psychological
therapies, along with other emerging professions such as social workers and counsellors. One important
reason for this change was that psychoanalysis revolutionised the concept of mental illness to include
conditions other than severe psychotic states. As a therapy, psychoanalysis was applied mainly to
neurotic symptoms such as general anxiety, depression or various phobias, and foresaw the current
emphasis of the mental health field on such symptoms and disorders. This represented a significant
unconscious
In psychoanalytic
change from the earlier emphasis on psychotic symptoms described earlier.
theory, the part
of the personality KEY CONCEPTS OF PSYCHOANALYSIS
of which the Psychoanalysis is both a theory to explain normal and abnormal human functioning and a therapeutic
conscious ego is technique to uncover the causes of, and hence alleviate, abnormal functioning. The basic concepts of
unaware. psychoanalysis discussed in this section were initially proposed by Sigmund Freud; they formed the
foundation for the wide variety of contemporary psychoanalytic perspectives, collectively referred to
id as psychodynamic approaches (Freud, 1900/1997; 1923/1960; 1933/1965).
In psychoanalytic
theory, most The unconscious
primitive part of According to psychoanalytic theory, the reasons for much of human behaviour lie hidden in the
the unconscious;
unconscious. Psychoanalysts interpret the surface or manifest content of people’s behaviour (including
consists of
drives and their jokes, dreams, mistakes, choices or works of art) to understand their true meaning or unconscious,
impulses seeking latent content.
immediate What determines people’s behaviour is the complex interaction among the forces of the id, the ego
gratification. and the superego. The id was the collective term Freud used to refer to humans’ most primitive drives.

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 Chapter 1 Conceptual issues in abnormal psychology 13

According to this theory, human beings are born with two primitive biological drives: the sexual drive libido
and the aggressive drive, with the sexual drive being the most important. The energy stemming from In psychoanalytic
this drive, called libido, was proposed to motivate much of human behaviour. theory, psychical
energy within
The id operates on the pleasure principle—it is driven purely by a need for instant gratification of
the id.
its desires without any reference to logic, reality, morality or the needs of others. In order to respond
adaptively to the world, it is necessary to develop a second component of the mind, the ego (or pleasure principle
conscious self). When the id signals its desire, the ego locates a potential gratifier of that desire in Drive to maximise
the environment and assesses the best ways of attaining it. Therefore, the ego operates on the reality pleasure and
principle. The ego comprises higher cognitive functions such as learning, memory, language and minimise pain
as quickly as
planning, which have developed in order to find ways of satisfying id impulses. Finally, the superego
possible.
is the part of the mind that develops last. It operates on the morality principle, based on the values and
moral standards of society that are often in conflict with the sexual and aggressive drives of the id. It ego
is then the task of the ego to meet the competing demands of external reality, the desires of the id and According to
the ideals of the superego. psychoanalytic
theory, part of
the psyche that
The stages of psychosexual development
channels libido
These three aspects of the human mind develop in a predictable fashion during several stages of acceptable to
psychosexual development. In each of these stages, the motivation to gratify the sexual and aggressive the superego
urges of the id is centred on different pleasure-producing parts of the body: the mouth, the anus and and within the
the genitals. The oral stage (0–2 years), when the primary focus of id gratification is the mouth, begins constraints of
at birth. Gratification and pleasure is achieved by the infant sucking, biting and chewing. During reality.
the anal stage (2–3 years), gratification is derived mainly from the retaining and expelling of faeces.
reality principle
At this stage, toilet training usually interferes with this gratification. Toilet training is seen as an Idea that the
important event in the development of the ego, because this is the first time the child is confronted by ego seeks to
the demands of the external world. satisfy one’s
The phallic stage (3–6 years) in turn is crucial because it sets the scene for the development of the needs within
superego. In boys, this process has been associated with the ‘Oedipus complex’. During this stage, the constraints
boys’ extreme dependence on their mother is said to culminate in a sexual desire for her. This desire of reality rather
then leads to ‘castration anxiety’: boys fear that their fathers will cut off their penis as a punishment. than following the
pleasure principle.
To reduce this anxiety, boys resolve this conflict by repressing their desire for their mother and
identifying with their father instead of competing with him. This internalisation of the father, who superego
represents the values and morals of society, then leads to the development of the superego. In girls, In psychoanalytic
the superego develops with the resolution of the ‘Electra complex’. When girls realise that they lack a theory, part of
penis, they experience ‘penis envy’. This causes them to develop a sexual interest in their father, since the unconscious
that consists
seducing him is the only way to obtain a penis, even if only vicariously. At the resolution of the Electra
of the absolute
complex, girls repress their desire for their father and regress to their earlier identification with the moral standards
mother. Because of their lack of internalisation of the father, girls develop a less sound morality, less internalised from
self-control and a weaker ability to use sublimation as a defence mechanism later in life. Consequently, one’s parents and
women are less able to successfully take part in professional, artistic or political endeavours, according the wider society
to this theory. After a latency period between 6 and 12 years of age, psychosexual development enters during childhood.
the final phase: the ‘genital stage’. With the onset of puberty, young people achieve their ability for
morality principle
mature love and healthy functioning in society. In psychoanalytic
theory, the
CLASSIFICATION AND CAUSATION FROM THE PSYCHOANALYTIC PERSPECTIVE motivational
According to psychoanalytic theory, all behaviours, both normal and abnormal, are the result of conflict force of the
superego, driving
among the id, ego and superego. While the true generator and motivator of behaviour is the id, the ego the individual
controls whether and how the strivings of the id are expressed, trying to keep such expressions consistent to act strictly in
with the moral values contained in the superego. As a result, the three components of the mind are in accordance with
constant conflict. At other times, the id’s own desires can be in conflict with each other or the id’s energy internalised moral
threatens to overwhelm the controls of the ego. At any of these times, the person experiences anxiety. standards.

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 14 Abnormal psychology 4e

Defence mechanisms
In psychoanalysis, anxiety is the ultimate signal of psychic distress. It is very similar to the anxiety
experienced when the ego (the conscious self) is threatened in some way. For example, a person might
feel anxious before an important exam because of the threat of failing. It is possible to reduce this
anxiety by studying harder or by avoiding sitting the exam. However, the anxiety arising from
intrapsychic conflicts between the id, ego and superego is more difficult to deal with. To avoid the
pain of overwhelming anxiety and the feelings of guilt, embarrassment and shame that often
defence accompany intrapsychic conflict, the ego employs defence mechanisms. As shown in Table 1.1,
mechanisms defence mechanisms work by distorting the id impulses into acceptable forms or by rendering them
In traditional unconscious.
psychoanalytic
theory,
strategies (such TABLE 1.1 Some of the defence mechanisms postulated by psychoanalytic theory
as repression
or reaction DEFENCE DESCRIPTION
formation)
the ego uses Repression The person avoids anxiety by not allowing painful or dangerous thoughts to
to disguise become conscious.
or transform
unacceptable, Denial The person reduces anxiety by refusing to perceive the anxiety-provoking aspects
unconscious of external reality.
wishes or
Projection The person attributes his/her own unacceptable thoughts, emotions or desires to
impulses.
another person.

Rationalisation The person creates a socially acceptable reason for an action, thought or emotion
that has unacceptable underlying reasons.

Reaction formation The person acts in a way that is the exact opposite of the impulses s/he is afraid to
consciously acknowledge.

Displacement The person reduces anxiety by shifting sexual or aggressive impulses from an
unacceptable target to an acceptable substitute.

Intellectualisation The person creates an overly logical, rational response to distance him/herself from
anxiety-provoking emotions.

Regression The person retreats to an earlier developmental stage to reduce anxiety in the face
of unacceptable impulses.

Sublimation The person expresses sexual or aggressive impulses in ways that are acceptable to
society, such as in artistic or professional achievements.

Defence mechanisms can be more or less successful in reducing the anxiety caused by unconscious
intrapsychic conflict. If the defence mechanisms fail to control the anxiety, it is directly experienced,
resulting in significant distress. At other times, this anxiety is unconsciously controlled by the
defences, but the defences themselves can then create suffering or interfere with the individual’s
ability to function. For example, depression has often been thought of as resulting from the defence
mechanism of displacement: a person who has unacceptable aggressive or hateful impulses against
another (e.g., his/her father) may try to reduce the anxiety resulting from such unacceptable impulses
by turning this aggression and hatred towards the self. Another way to keep such impulses out of
conscious awareness is to use the defence mechanism of reaction formation: overprotective or
excessively dependent behaviour towards the hated person may be an expression of this defence
mechanism. Finally, the defence mechanism of projection in this situation could cause the individual
to believe that others (especially authority figures symbolically representing the father) hate him/her
(rather than vice-versa), thereby possibly resulting in paranoid beliefs.

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 Chapter 1 Conceptual issues in abnormal psychology 15

Neuroses and psychoses

The symptoms of anxiety, depression or extreme dependence can be examples of one type of
abnormality, collectively called the neuroses. These symptoms can have relatively milder forms, neurosis
manifesting within the normal range of behaviours. In other words, most people become anxious, sad According to
or dependent on occasion. The dividing line between the normal and abnormal manifestations of these psychoanalytic
theory, set of
behaviours is not clear.
maladaptive
Further, from the psychoanalytic perspective, psychoses that could not be identified as having symptoms caused
a clear physical cause such as toxins or infections were also seen as manifestations of intrapsychic by unconscious
conflict. Psychoses are more serious manifestations than neuroses, occurring when the usual defence conflict and
mechanisms fail to protect the person from the pain of intrapsychic conflict. In these cases, the only its associated
way the ego can cope with such pain is by withdrawing from reality, finding respite in hallucinations, anxiety.
delusions and severe disorganisation of speech, affect and behaviour.
psychosis
Differences between the medical and psychoanalytic models State involving
Several important conceptual differences exist between the medical and the psychoanalytic model of a loss of
classifying mental disorders. First, psychoanalysis sees no qualitative difference between normal and contact with
abnormal functioning—the difference is merely one of degree. Freud believed that all human beings, reality in which
both the sane and the insane, are driven by the same underlying forces originating from the id. Thus, the individual
both normal and abnormal behaviours, including the various forms of neuroses and psychoses, have experiences
symptoms such
the same underlying causes: there is no specific disease process that causes various types of insanity
as delusions and
or that differentiates sanity from insanity. In other words, psychoanalysis introduced and popularised hallucinations.
the idea that normal and abnormal behaviours lie on a continuum, rather than belonging to distinct
categories of health versus illness.
Further, the traditional medical model of diseases held that different symptom profiles were
manifestations of different underlying causes, such as bacteria or toxins. Therefore, it was crucial to
describe categories of mental disorders based on their symptoms and associated characteristics, such
as their onset and course over time, in order to find the specific underlying cause of each proposed
disorder. In contrast, the basic premise of psychoanalysis was that symptoms merely disguise a more
complex, underlying, unconscious reality. No strong one-to-one connection was proposed to exist
between specific underlying conflicts and specific symptoms. According to psychoanalytic thinking,
the same unresolved conflicts could result in widely different symptoms in two different individuals,
depending on the defence mechanisms they employ to keep the conflict (and the anxiety associated
with it) out of conscious awareness. Thus individuals with the same underlying conflicts may respond
to the anxiety arising from this conflict by developing sexual perversions, paranoia, a phobia of
specific animals or situations, or great artistic or scientific achievements. By the same token, two
individuals who present with very similar symptoms may have developed those symptoms as a result
of very different underlying conflicts. Moreover, the same individual may develop different symptom
profiles over time, depending on the primary defence mechanism s/he uses at the time to cope with
the underlying conflict. Symptoms themselves, unlike in the traditional medical model, were not
crucially important to understanding and treating individuals. What was crucial was to uncover the
unconscious conflict kept out of awareness by defence mechanisms, as this was believed to be causing
the symptoms.

TREATMENT FROM THE PSYCHOANALYTIC PERSPECTIVE

According to the psychoanalytic perspective, in order to uncover the true causes of the patient’s
feelings and behaviours it is crucial to reduce the ego’s ability to keep the conflict out of conscious
awareness. Psychoanalytically trained therapists use a variety of techniques to achieve this aim. In
dream analysis, the manifest content of dreams is interpreted in terms of an underlying latent content,
which is thought to be an indication of unconscious id impulses. In the technique of free association,
the patient is encouraged to say freely what comes to mind, without attempting to keep any conscious
control over the content of his/her speech. Again, this technique is thought to provide insight into
the unconscious parts of the mind. Another important technique is the analysis of transference and

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 16 Abnormal psychology 4e

countertransference processes. Psychoanalysts believe that the manner in which people respond to
others is influenced by their unconscious projections. In transference, patients who feel angry or
irritated with their analyst, for example, may experience these feelings because they are transferring
them from another important figure from earlier stages of their lives to the therapist. Such transference
is believed to be helpful in uncovering themes from past relationships. In countertransference, it is the
therapist who unconsciously transfers feelings derived from his/her past into the relationship with the
patient, a problem of which the therapist needs to be aware and must overcome.
Because of the unclear lines between normal and abnormal behaviours, psychoanalytic therapies do
not have clearly defined goals in terms of symptom reduction—it is not easy to tell when someone is
no longer in need of psychoanalysis. Many individuals sought the help of analysts to resolve problems
in their lives, such as their relationship difficulties. Therapy usually proceeded for several years, or
until the patient decided that it was no longer needed, or s/he could no longer afford it.

CONTEMPORARY PSYCHODYNAMIC PERSPECTIVES

Several of Freud’s colleagues and students, such as Alfred Adler (1870–1937), Karen Horney (1885–1952),
Carl Gustaf Jung (1875–1961), as well as his daughter, Anna Freud (1895–1982), developed their own
psychodynamic theories about normal and abnormal human functioning. Although these psychodynamic theories uphold
theories Freud’s fundamental principles, they depart from some of his original ideas in important ways. The most
Theories that significant departure from Freud’s original thinking was a more pronounced emphasis on the processes
focus on the and development of the ego, instead of analysing human behaviour largely in terms of the strivings of
interplay between
the id.
unconscious
psychological ‘Object relations’ is one of the most influential contemporary psychodynamic concepts. According
processes in to theorists of the object relations school, such as Margaret Mahler (1897–1985), ‘objects’ are the people
determining to whom individuals are strongly attached. The primary motive of human behaviour is the need for
thoughts, feelings close relationships with others. The prototype of this strong emotional attachment is the relationship
and behaviours. between an infant and his/her primary caregiver, usually the mother. According to this theory, newborns
have no sense of self separate from their mothers. The crucial process of developing a separate sense
of self and a secure internal image of the mother is called separation-individuation. As the success of
this process strongly influences the nature of attachment in later intimate relationships, disturbance
in the separation-individuation process can result in psychological problems (Mahler, Pine, &
Bergman, 1975).
Contemporary psychodynamic theories have also revised Freud’s original ideas about penis envy
and girls’ moral development. Freud originally proposed that girls have a less well-developed superego
and therefore a weaker sense of morality. The first neo-Freudian theorist to challenge this concept was
Karen Horney (1922/1967), who pointed out that it was social conditions, rather than the lack of a penis,
that doomed females of that era to inferiority and envy. Later theorists such as Carol Gilligan (1982)
proposed that the crucial process in the development of the superego is separation-individuation, rather
than the Oedipus and Electra conflicts. Separation-individuation from the mother is crucial in the
development of masculinity, whereas it is not required for the development of femininity. Therefore,
boys are more strongly motivated to place an emphasis on separation-individuation, while girls have
more difficulty with that process. Thus, it is proposed that males may have difficulty with intimate
relationships, while females may have difficulty with independence during adulthood.

CONTRIBUTIONS AND LIMITATIONS OF THE PSYCHODYNAMIC MODEL

Perhaps one of the most enduring contributions of the psychoanalytic movement to mental health
is that it popularised concepts of mental health and disorder that were radically different from the
hitherto dominant medical model. Psychoanalysis also extended the boundaries of the definition of
mental disorder to include not only symptoms of insanity, but also symptoms of anxiety, depression
and other neuroses. By doing so, psychoanalysis initiated the current proliferation of mental disorder
categories. It also contributed to a radical change in the mental health professions by extending the
client base from a small number of severely psychotic individuals treated in asylums to a large number
of neurotic individuals treated at outpatient clinics (Horwitz, 2003). In addition to taking mental

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 Chapter 1 Conceptual issues in abnormal psychology 17

health out of the asylum and into the office, psychoanalysis was instrumental in enabling mental case study
health professionals other than psychiatrists to provide treatment. Freud thought of psychoanalysis as method
a field independent of medicine or psychiatry and was willing to train analysts who were not medical Research method
doctors. Mental health became the field not only of doctors but also of the variety of non-medical in which single
individuals are
practitioners seen today, such as psychologists, clinical psychologists, psychotherapists, counsellors studied in detail.
and social workers (Routh, 1998).
Several different factors contributed to the psychoanalytic movement’s loss of dominance during
control group
the 1970s. In spite of contemporary developments addressing some of the shortcomings of classical Group of
Freudian theory (e.g., its gender bias), the main problems of the psychodynamic model remained largely participants in
unresolved. These included pervasive criticisms of the problematic scientific basis of psychoanalysis an experimental
as a theory and data showing its limited success as a treatment (Eysenck, 1952; Firestone, 2002). study whose
Freud developed his theory using the case study method. This was a widely accepted method experience is the
of medical science at the time: most of medical knowledge was based on carefully observed and same as that of
the experimental
comprehensively documented cases of specific individuals with various illnesses. By the second
group in all
half of the twentieth century, however, the norms of medical science moved beyond the case study ways except
method to adopting large samples, control groups, statistical analyses and double-blind experiments that they do not
with placebo medications. Case studies are highly influenced by the interpretative framework of the receive the key
researcher (e.g., psychoanalysts focus on childhood material to a much greater degree than other manipulation;
theorists), do not allow the researcher to rule out competing hypotheses (e.g., did patients improve as this allows for
a result of the uncovering of unconscious material or some other aspect of therapy?) and are based on the effect of the
experimental
individual patients who may not be representative of broader groups. Hence they were increasingly
manipulation to
seen as unreliable and unacceptable as a primary research method. be determined.
Moreover, the theory of psychoanalysis was criticised for being virtually untestable using modern
empirical methods. Psychodynamic concepts are complex, hard to define and operate at a level that
double-blind
is not available to consciousness. Therefore, they are extremely difficult to measure and test using
experiment
reliable and valid empirical techniques. Indeed, there is little controlled research evaluating the Experimental
fundamental concepts of the psychodynamic perspective to this day. study in which
The theory has also been criticised for being unfalsifiable (Popper, 1968). The term ‘falsifiability’ both the
refers to the ability of a theory to be proven wrong. A theory is falsifiable if it can make clear researchers and
predictions that are testable either by collecting empirical data or by conducting a logical analysis. the participants
For example, one of the most important concepts of psychoanalysis is the Oedipus complex. To test are unaware
of which
whether the Oedipus complex exists, a researcher might want to ask a large group of men whether they
experimental
remember that, at about the age of 5, they developed a sexual desire towards their mothers. However, condition the
responding with either yes or no (due to the repression of unacceptable id impulses) is consistent with participants
the theory, rendering the theory unfalsifiable. are in so as to
The complexity and lack of clarity of the concepts involved in psychoanalytic theory also had reduce demand
important implications for the accountability of psychoanalysis as a treatment method. Clear and characteristics.
reliable diagnoses often could not be given, treatment progress and outcomes were very difficult to
specify, and the length and cost of treatment could not be predicted with any precision. With the validity
advent of medical insurance for psychiatric treatment, the demand for clearer and more specific In psychological
diagnoses and outcomes was ever-increasing. In summary, psychoanalysis was unable to meet the testing, degree
to which an
societal demand for greater accountability, as well as the professional demand for increased scientific
instrument
validity, occurring during the second half of the twentieth century (Horwitz, 2003). actually
measures what
it is intended
The behavioural perspective to measure. In
diagnosis, the
Psychoanalysis concerned itself with the subjective experience of the individual and sought to explain
degree to which
human behaviour in terms of unobservable, unconscious processes. The behavioural approach (also diagnostic criteria
known as the learning perspective) differed radically from this school of thought by emphasising that accurately define
the causes of behaviour are observable and identifiable in the immediate environment to the behaviour the features of
itself. These causes are simply stimuli that elicit, reinforce or punish the behaviour. disorders.

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 18 Abnormal psychology 4e

behavioural KEY CONCEPTS OF BEHAVIOURISM

approach John B. Watson (1878–1958) is credited as the founder of behaviourism, not primarily because of
Theories that rely any major theoretical contributions but because of his efforts in popularising this new approach to
on the principles psychology. In 1913 he published the manifesto of radical behaviourism, entitled Psychology as the
of learning to
Behaviourist Views It. In this paper he argued that psychology did not need to concern itself with
explain both
normal and complex, unobservable constructs such as thoughts and sensations. Instead, the proper domain of
abnormal psychology included only observable, readily measurable stimuli and responses. The basic premise
behaviour. of radical behaviourism was that the study of behaviour should be an objective, experimental science,
much like chemistry or physics. To illustrate this approach, he demonstrated experimentally, in the
classical famous case of ‘Little Albert’, that the phobic fear of furry animals and other furry objects could be
conditioning instilled in a child as a result of simple learning processes (Watson & Rayner, 1920).
Form of learning The basic mechanisms of learning were first discovered by the Russian physiologist Ivan Pavlov
in which a neutral (1849–1936), who earned the Nobel Prize in 1904 for his contribution to science. The fundamental
stimulus, through
principle of classical conditioning is that behaviour can be explained in terms of unconditioned
its repeated
association with
responses (UR) and conditioned responses (CR). Unconditioned responses are elicited automatically
a stimulus that by certain stimuli, such as salivating at the sight of food or experiencing fear when attacked. If such
naturally elicits a unconditioned stimuli (US) (food or attack) consistently occur together with some other, previously
certain response, neutral stimulus (such as the place where the attack has occurred), a response similar to the
acquires the unconditioned response will occur. In this example, the place of the attack is a conditioned stimulus
ability to produce (CS) and the response of anxiety upon entering the same place is a conditioned response. This process
the same is summarised in Table 1.2.
response.

unconditioned TABLE 1.2 The procedure for Pavlovian (classical) conditioning

response (UR)
In classical Pre-training
conditioning,
response that Unconditioned and conditioned Unconditioned stimulus (e.g., food) → Unconditioned response
naturally follows stimuli are presented separately. (e.g., salivation)
when a certain Conditioned stimulus does not Conditioned stimulus (e.g., bell) No response
stimulus appears, elicit a response.
such as salivation
in dogs at the Training
smell of food.
Unconditioned and conditioned Unconditioned stimulus (e.g., → Unconditioned response
stimuli are presented together, food) + conditioned stimulus (e.g., salivation)
conditioned several times. (e.g., bell)
response (CR)
Learned response Post-training
that is elicited
Conditioned stimulus is presented Conditioned stimulus (e.g., bell) → Conditioned response
by a conditioned
stimulus following alone. It elicits a response that is (e.g., salivation)
classical the same or similar to the original
conditioning. unconditioned response.

unconditioned
stimulus (US)
The principles of operant conditioning (also known as ‘instrumental conditioning’) were first discovered
In classical by Edward Lee Thorndike (1874–1949) and later refined by B. F. Skinner (1904–1990) and others.
conditioning, The fundamental principle of operant conditioning is that behaviours which are followed by satisfying
stimulus that consequences (‘rewards’) are likely to be repeated, while behaviours that are followed by unsatisfying
naturally elicits a consequences (‘punishments’) are likely to be avoided or decreased. In other words, all organisms,
reaction, such as including humans, are controlled by the consequences of their actions. Positive reinforcement increases a
the smell of food particular behaviour because the behaviour is followed by a reward. Negative reinforcement also increases
eliciting salivation
a particular behaviour because the behaviour is followed by the removal of negative or unpleasant
in dogs.
stimuli. Negative reinforcement should not be confused with punishment, which acts to suppress, rather

rie66620_ch01_001-040.indd 18 07/31/17 05:14 PM

Another random document with
no related content on Scribd:
The Project Gutenberg eBook of Corruption
in American politics and life
This ebook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this ebook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.

Title: Corruption in American politics and life

Author: Robert C. Brooks

Release date: December 5, 2023 [eBook #72328]

Language: English

Original publication: New York: Dodd, Mead and company, 1910

Credits: Bob Taylor, Turgut Dincer and the Online Distributed

Proofreading Team at https://www.pgdp.net (This file
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by The Internet Archive)

*** START OF THE PROJECT GUTENBERG EBOOK

CORRUPTION IN AMERICAN POLITICS AND LIFE ***
CORRUPTION IN AMERICAN
POLITICS AND LIFE
CORRUPTION in AMERICAN
POLITICS AND LIFE

By

ROBERT C. BROOKS
Professor of Political Science in the University of Cincinnati

NEW YORK
DODD, MEAD AND COMPANY
1910
 Copyright, 1910, by
DODD, MEAD AND COMPANY

Published October, 1910

THE QUINN & BODEN CO. PRESS

RAHWAY, N. J.
 TO

THE MEMORY OF

James Eugene Brooks

FATHER FRIEND

FIRST TEACHER OF CIVIC DUTY

 PREFACE

Corruption is repulsive. It deserves the scorn and hatred which all

straightforward men feel for it and which nearly all writers on the
subject have expressed. Conviction of its vileness is the first step
toward better things. Yet there is more than a possibility that the
feeling of repugnance which corrupt practices inspire may interfere
with our clearness of vision, may cloud our conception of the work
before us, may even in some cases lead to misrepresentation—
which is misrepresentation still although designed to aid in virtue’s
cause. Fighting the devil with fire is evidence of a true militant spirit,
yet one may doubt the wisdom of meeting an adversary in that
adversary’s own element, of arming oneself for the battle with that
adversary’s favorite weapon. Whatever views are held regarding the
tactics of reform there must always be room for cool, systematic
studies of social evils. These need not be lacking in sympathy for the
good cause any more than the studies of the pathologist are devoid
of sympathy for the sufferers from the disease which he is
investigating. Nor need social studies conceived in the spirit of
detachment, of objectivity, be lacking in practical helpfulness. We
recognise the immense utility of the investigations of the pathologist
although he works apart from hospital wards with microscope and
culture tubes. In an effort to realise something of this spirit and
purpose the following studies have been conceived.
Of the several studies making up the present work the first and
second only have been published elsewhere. The writer desires to
acknowledge the courtesy of the International Journal of Ethics in
permitting the reprint, without material alterations, of the “Apologies
for Political Corruption,” and of the Political Science Quarterly for a
similar favour with regard to “The Nature of Political Corruption.”
Objection will perhaps be made to the precedence given the
“Apologies” over “The Nature of Political Corruption” in the present
volume. Weak as it may be in logic this arrangement would seem to
be the better one in ethics; hence the decision in its favour. Definition
could wait, it was felt, until every opportunity had been given to the
apologists for corruption to present their case.
The extent of the author’s obligations to the very rich but scattered
literature of the subject will appear partly from the references in text
and footnotes. For many criticisms and suggestions of value on
portions of the work falling within their fields of interest, cordial
acknowledgment is made to Dr. Albert C. Muhse of the Bureau of
Corporations, Washington; Mr. Burton Alva Konkle of the Historical
Society of Pennsylvania, Philadelphia; Professor John L. Lowes,
Washington University, St. Louis; Mr. Perry Belmont, Washington;
Mr. Frank Parker Stockbridge, of the Times-Star, Cincinnati; and
finally to Professor Frederick Charles Hicks, the writer’s friend and
colleague in the faculty of the University of Cincinnati. Credit must
also be given for many novel points of view developed in class room
discussion by students of Swarthmore College and the University of
Cincinnati. The members of the graduate seminar in political science
at the latter institution have been particularly helpful in this way. To
one of them, Mr. Nathan Tovio Isaacs, of Cincinnati, the author is
indebted for a most painstaking reading of the whole MS., on the
basis of which many valuable criticisms of major as well as minor
importance were made.
To the members of the City Clubs of Philadelphia and Cincinnati,
the writer also returns most cordial thanks for the various pleasant
occasions which they afforded him of presenting his views in papers
read before these bodies. While there was some smoke and at times
a little heat in the resulting discussions, there were also many
flashes of inspiration emanating from the political experience and the
high unselfish ideals of the membership of the clubs. In appropriating
valuable suggestions from so many sources and with such scant
recognition, the writer trusts that his treatment of political corruption
may nevertheless escape the charge of literary corruption.
University of Cincinnati,
Cincinnati, Ohio,
April 1, 1910.
 CONTENTS

I. APOLOGIES FOR POLITICAL CORRUPTION

PAGE
oduction:—Corruption not defensible on the ground of the
strength and prevalence of temptation 3
ur main lines of apology 4
hat corruption makes business good 4
Protection of vice 5
Corrupt concessions to legitimate business 10
hat corruption may be more than compensated for by the high
efficiency otherwise of those who engage in it 14
hat corruption saves us from mob rule 17
hat corruption is part of an evolutionary process the ends of
which are presumed to be so beneficent as to more than atone
for the existing evils attributable to it 22
nclusion: The probable future development of corruption in
politics, the failure of the apologies for political corruption 37
II. THE NATURE OF POLITICAL CORRUPTION
oduction, definition, etc. 41
requent use of the word corruption 41
egal definitions contrasted with definitions from the point of view
of ethics, political science, etc. 42
Verbal difficulties 42
Levity in the use of the word 42
Metaphor implied by the word 43
Distinction between bribery and corruption; between corruption
and auto-corruption 45
entative definition of corruption 46
alysis of the concept of corruption 46
Corruption not limited to politics. Exists in business, church, 46
schools, etc.
ntentional character of corruption. Distinguished from inefficiency 48
Various degrees of clearness of political duties 51
Consequences of wide extension of political duties 52
Recognition of political duty 55
Legal and other standards 55
The radical view 57
Advantages sought by corrupt action 59
Various degrees and kinds of advantages 60
Rewards and threats 63
Degree of personal interest involved 65
Corruption for the benefit of party 71
mmary 74
III. CORRUPTION: A PERSISTENT PROBLEM OF SOCIAL AND
POLITICAL LIFE
reme consequences of corruption 81
s extreme consequences of corruption: recovery from corrupt
conditions 82
e continuing character of the problem of corruption 85
appearance of certain forms of corruption; changes of form of
corruption 88
Subsidies from foreign monarchs 89
nfluence of royal mistresses 90
ord Bacon’s case 90
Pepys and the acceptance of presents 93
Corruption and the administrative service appointments 95
Recent changes in the forms of municipal corruption 98
itation of corruption to certain branches or spheres of
government 100
n local government only, in central government only 100
Middle grade of Japanese officials 102
 itation of corruption in amount 105
Contractual character of most corruption 106
Prudential considerations restraining corruptionists 107
mmary 109
IV. CORRUPTION IN THE PROFESSIONS, JOURNALISM, AND
THE HIGHER EDUCATION
ms of corruption not commonly recognised as such; their
significance 113
neral classification of recognised forms of corruption 116
ilement of the sources of public instruction 117
Difficulty of defining and regulating corruption in this sphere 118
fessional codes of ethics 119
rruption in journalism: an extreme view; limitations 121
rruption in higher education 132
Growing influence of colleges and universities 133
Higher education and public opinion 134
Personal responsibility of the teacher 136
he struggle for endowments and resulting bad practices 137
he teaching of economic, political, and social doctrines in
colleges and universities 139
mmary 156
V. CORRUPTION IN BUSINESS AND POLITICS
rruption in business 161
Effect of consolidation in business 163
ect of state regulation in transforming character of business
corruption 165
Necessity of further reform efforts 167
ssification of forms of political corruption 169
Political corruption resulting from state regulation of business 171
New forms of state regulation; other means of strengthening the
position of government 174
e state as seller; difficulties and safeguards 179
Work of the Bureau of Municipal Research 184
e and crime in their relation to corrupt politics 186
Methods of repression 188
dodging as a form of political corruption; quasi-justification of
the practice 192
Methods of overcoming tax dodging 195
o-corruption, and its effects upon party prestige 199
rruption in relation to political control the basis of all other forms
of political corruption 201
mmary 208
VI. CAMPAIGN CONTRIBUTIONS AND THE THEORY OF PARTY
SUPPORT
ty functions in the United States 213
glect of the sources of party support 217
mpaign contributions as a part of the problem 220
yment of campaign expenses by the state 221
blicity of campaign contributions 229
State laws requiring publicity 229
Congressional publicity bill of 1908 230
Voluntary publicity in the presidential campaign of 1908; results 233
Publicity before or after election 236
Special information of candidates before election 239
Publicity as applied to political organisations other than campaign
committees 241
hibition or limitation of campaign contributions from certain
sources 244
Prohibition of corporate contributions 244
Partnerships, labour unions, clubs, etc. 247
Contributions by candidates 248
Contributions by civil service employees 256
imiting the amount of individual contributions 258
Effect of smaller campaign funds on political affairs 259
ime limits of large contributions 262
Geographical limits upon the use of campaign funds 263
Effect of campaign fund reform on business interests in their
relation to government 264
imitation of campaign gifts of services 267
ension of campaign contribution reforms to state and local
elections 268
o primary and convention campaigns 270
Administration of the reform measures 271
ssibilities of campaign fund reform 273
VII. CORRUPTION AND NOTORIETY: THE MEASURE OF OUR
OFFENDING
r damaged political reputation; how acquired 277
e garrulity of politicians, its explanation 278
nsationalism of the press 281
orm movements, to what extent are they evidence of moral
improvement 287
ecial privilege in England and Germany 290
Significance of the American attitude toward special privilege 291
Special privilege not always corrupt, but may come to be
considered such 292
American criticism of special privilege as corrupt not proof of our
inferiority to Europe in political morality 294
nsequences of the wide diffusion of political power in the United
States 296
nclusion: Corruption decreasing in the more progressive
countries of the world 299
APOLOGIES FOR POLITICAL CORRUPTION
 I
APOLOGIES FOR POLITICAL CORRUPTION

Nearly all current contributions on the subject of political corruption

belong frankly to the literature of exposure and denunciation. The
ends pursued by social reformers are notoriously divergent and
antagonistic, but there is general agreement among them and, for
that matter, among Philistines as well, that corruption is wholly
perverse and dangerous. How then may one have the temerity to
speak of apologies in the premises?
Certainly not, as one writer has recently done, by presenting a
detailed and striking picture of the force with which the temptation to
corrupt action operates upon individuals exposed to its malevolent
influence. No doubt such studies are of great value in laying bare to
us the hidden springs of part of our political life, the great resources,
material and social, of those who are selfishly assailing the honesty
of government, and the difficulties in the way of those who are
sincerely struggling for better things. In the last analysis, however, all
this is nothing more than a species of explanation and extenuation,
which if slightly exaggerated may easily degenerate into maudlin
sympathy. That men’s votes or influence are cheap or dear, that their
political honour can be bought for $20 or $20,000—doubtless these
facts are significant as to the calibre of the men concerned and the
morals of the times, but they do not amount to an apology for either.
[1] If, however, it can be shown that in spite of the evil involved
political corruption nevertheless has certain resultants which are
advantageous, not simply to those who profit directly by crooked
devices, but to society in general, the use of the term would be
justified.
Four main lines of argument have been gathered from various
sources as constituting the principal, if not the entire equipment of
the advocatus diaboli to this end. These are, first, that political
corruption makes business good; second, that it may be more than
compensated for by the high efficiency otherwise of those who
engage in it; third, that it saves us from mob rule; and fourth, that
corruption is part of an evolutionary process the ends of which are
presumed to be so beneficent as to more than outweigh existing
evils.
I. Of these four arguments the first is most frequently presented.
Few of our reputable business men would assent to it if stated baldly,
or indeed in any form, but in certain lines of business the tacit
acceptance of this doctrine would seem to be implied by the political
attitude of those concerned. In slightly disguised form the same
consideration appeals to the whole electorate, as shown by the
potency of the “full dinner-pail” slogan, and the pause which is
always given to reforms demanded in the name of justice when
commercial depression occurs. But while we are often told that
corruption makes business good, we are seldom informed in just
what ways this desirable result is brought about. One quite
astounding point occasionally brought up in this connection is the
favour with which a portion of the mercantile community looks upon
the illegal protection of vice and gambling. A police force must
sternly repress major crimes and violence. Certain sections of the
city must be kept free from offence. These things understood, a
“wide-open” town is held to have the advantage over “slower”
neighbouring places. A great city, we are told, is not a kindergarten.
Its population is composed both of the just and the unjust, and this is
equally true of the many who resort to it from the surrounding
country for purposes of pleasure or profit. The slow city may still
continue to hold and attract the better element which seeks only
legitimate business and recreation, but the wide-open town will hold
and attract both the better and the worse elements. Of course,
individuals of the latter class may be somewhat mulcted in dives and
gambling rooms, but they will still have considerable sums left to
spend in thoroughly respectable stores, and such patronage is not to
be sniffed at.[2]
Ordinarily this argument stops with the consideration of spending
alone. It may be strengthened somewhat by bringing in the reaction
of consumption upon production. A great city prides itself upon its
ceaseless rush and gaiety, its bright lights and crowded streets, its
numerous places of amusement and all the evidences of material
prosperity and pleasure. These may be held to be enhanced when
both licit and illicit pursuits and diversions are open to its people; and
further, the people themselves, under the attraction of such varied
allurements, may strive to produce more that they may enjoy more.
In the Philippines, it is said that the only labourers who can be relied
upon to stick to their work any considerable length of time are those
who have caught the gambling and cock-fighting mania. Under
tropical conditions a little intermittent labour easily supplies the few
needs of others, whereas the devotee of chance, driven by a
consuming passion, works steadily. In the present state of a fallen
humanity there are presumably many persons of similar character
living under our own higher civilisation.
Strong as is the hold which the foregoing considerations have
obtained upon certain limited sections of the business community it
is not difficult to criticise them upon purely economic grounds. Of two
neighbouring towns, one “wide-open” and the other law-abiding, the
former might, indeed, prove more successful in a business way. But
we have to consider not simply the material advantage in the case of
two rival cities. The material welfare of the state as a whole is of
greater importance, and it would be impossible to show that this was
enhanced by corruptly tolerating gambling and vice anywhere within
its territory. On the contrary, economists have abundantly shown the
harmful effects of such practices, even when no taint of illegality
attaches to them. What the “wide-open” community gains over its
rival is much more than offset by what the state as a whole loses.
Moreover, it may well be doubted whether the purely economic
advantage of the “wide-open” city is solid and permanent. Even
those of its business men who are engaged in legitimate pursuits are
constant sufferers from the general neglect of administrative duty,
and sometimes even from the extortionate practices, of its corrupt
government. They may consider it to their advantage to have
gambling and vice tolerated, but only within limits. If such abuses
become too open and rampant legitimate business is certain to
suffer, both because of the losses and distractions suffered by the
worse element in the community and because of the fear and
avoidance which the prevalence of vicious conditions inspires in the
better classes. Indeed cases are by no means uncommon where the
better business element has risen in protest against lax and
presumably corrupt police methods which permitted vice to flaunt
itself so boldly on retail thoroughfares that respectable women
became afraid to venture upon them. There remain, of course, the
expedients of confining illicit practices to certain districts of the city,
or of nicely restraining them so that, while permitting indulgence to
those who desire it, they do not unduly offend the moral element in
the community. But such delicate adjustments are difficult to
maintain, since vice and gambling naturally seek to extend their field
and their profits and, within pretty generous limits, can readily afford
to make it worth while for a corrupt city administration to permit them
to do so. And even if they are kept satisfactorily within bounds, the
state as a whole, if not the particular community, must suffer from
their pernicious economic consequences.
It has been thought worth while to go at some length into the
criticism on purely economic grounds of the argument that corruption
makes business good; first, because the argument itself is primarily
economic in character, and secondly, because its tacit acceptance
by certain hard-headed business men might lead to the belief that its
refutation on material grounds was impossible. A broad view of the
economic welfare of the state as a whole and business in all its
forms leads, as we have seen, to the opposite conviction. And this
conviction that corruption does not make business good in any solid
and permanent way is greatly strengthened when moral and political,
as well as financial, values are thrown into the scale. It is not
necessary to recite in detail the ethical argument against gambling
and vice in order to strengthen this point. The general duty of the
state to protect the lives and health and morals of its people, even at
great financial sacrifice if necessary, is beyond question. There is a
possibility, as Professor Goodnow maintains,[3] that in the United
States we have gone too far in attempting to suppress by police
power things that are simply vicious, as distinguished from crimes;
but however this may be, some regulation or repression of vice is