Chapter 15

Abnormality, Therapy, and

Social Issues
 Abnormality, Therapy and Social Issues
• On the surface it would appear that there is normal and abnormal behavior,
and the __distinction____ between normal and “weird” is clear to everyone.
• Most of us feel sad, anxious, or angry occasionally.
• Our moods __change__________, we have or develop bad habits, and we
have “funny” beliefs.
• Mental health diagnoses are reserved for people with problems that
seriously interfere with their lives.

Defining Abnormal Behavior

• There is probably no definition of “__abnormal____________” that can’t be
questioned.
– If we use the standard of “subjective feelings of distress” then anyone
who thinks they have a problem automatically qualifies.
– If someone behaves in __bizzare______________and dangerous ways,
but insists that they are fine, many people who are in fact suffering from
mental illness could not be diagnosed and ____treated_________.
 Defining Abnormal Behavior

• If we say that behavior that could __result_______in

suffering or death is a sign of mental illness, then heroic
deeds would be a bona fide __sympton_____________.

• If we say that behavior that is very different from the

usual is a sign of a psychological
__disorder___________, then very depressed people
would be diagnosed, but so would very happy people.
• Cultural influences on abnormality
– Culture-specific disorders are found everywhere and in every era.
• Demonic possession has been a common
___diagnosis_______________ for thousands of years, where you are
possessed by the demons.
• Running amok (running wild) consists of episodes of indiscriminant
___violent____________behavior in young Southeast Asian men.

– An American example: Multiple Personality Disorder

• The “split personality” syndrome, this is now referred to as
dissociative identity disorder.
• There is alternation between two or more personalities.
• Each has its own disposition, behavior, and name, as if each were a
____seperate_______________person.

This was a very rare disorder until the 1950’s, when a few cases received
widespread publicity. It’s a disorder in which a person
___exhibits__________ two or more distinct and alternating
personalities, formerly called multiple personality disorder.
• The biopsychosocial model
– The predominant view in Western culture today uses the
biopsychosocial model to understand mental
___illness___________.

– Biological roots - include genetic factors, injury, disease

processes that result in abnormal brain development, damage,
imbalances of neurotransmitters and hormones, all of which can
result in abnormal __behavior____________.

– Psychological roots – an individual’s life history and

experiences contribute to his or her ability to cope and degree of
vulnerability to __stress_________.

– Social and cultural context – people are greatly influenced by

how other people act toward them and the expectations people
hold for them.
 Classifying Psychological Disorders
• The DSM-IV - The Diagnostic and Statistical Manual of Mental Disorders
• Establishes uniform definitions and standards for diagnosis.
• Now in its fourth edition (DSM-IV-TR). Lists acceptable labels for all
psychological disorders. Lists symptoms and criteria for making
diagnoses and contains information on differential diagnosis – making
distinctions between similar ___diagnosis_________________.

Axis I - Clinical disorders are diagnosed on Axis I.

These are disorders that involve deterioration of
__functioning____________________.
– Most common psychological disorders are listed on Axis I.

Axis II is reserved for personality disorders and mental retardation.

These are disorders that persist throughout __life_______.
– A personality disorder is a maladaptive, inflexible way of dealing with
situations and people.

There is a stigma associated with receiving a

____mental________health diagnosis.
 Table 15.1

Table 15.1 Some major categories of psychological disorders according to Axis I of

DSM-IV. A person can have one or more diagnoses on a given axis, or none at all.
 Table 15.2

Table 15.2 Some major categories of psychological disorders according to Axis II of DSM-IV.
• Psychoanalysis
– The psychodynamic therapies are based on the theories of
Sigmund Freud.
• Psychoanalysis is the oldest “talk” therapy. It attempts to
bring unconscious thoughts and emotions to awareness, and
help people understand their own thoughts and
__actions________.
Psychoanalysis uses free association and transference to
bring unconscious material to consciousness.
• This in turn produces catharsis, the release of pent-up
emotions associated with unconscious thoughts and
__consciousness___________.
• In free association, the client thinks about a symptom or
problem and then says everything that comes to mind related
to it. This process is supposed to uncover hidden thoughts
and __feelings_____________.
• Transference refers to the client’s experience of feelings
previously associated with a parent or other important figure
that are “transferred” to the therapist.
 Figure 15.2:

• Figure 15.2: The __goal__________ of psychoanalysis is to resolve psychological

problems by bringing to awareness the unconscious thought processes that created
the difficulty. Analysis literally means ”to loosen or break up, to look at the parts.”
 Schools of Psychotherapy

• Psychoanalysis
– The psychodynamic therapies
• Psychoanalysts and other psychodynamic
therapists make active interpretations of the
client’s _statements_______________.
• If a client disagrees with the therapist’s
interpretations, they may label this as
resistance, a continued repression that
interferes with __therapy____________.
• Therapies that focus on thoughts and beliefs
– Some therapies focus on what current mental processes, not
past thoughts and feelings.
• Cognitive therapy improves functioning by changing
people’s thoughts and beliefs about situations.
• Rational-emotive therapy (RET) assumes that thoughts
precede emotions, and that unpleasant feelings result from
irrational _thoughts_______________.
• The goal of RET is to replace irrational thoughts

– Cognitive-behavior therapy sets clear goals for changing

behavior (like a behavioral ___therapist______________).
– The therapist puts more emphasis on also changing the
person’s interpretation of thoughts and
__events____________(like a cognitive therapist).
Humanistic therapists, founded by Abraham Maslow, believe that
people naturally strive to achieve their full
___potentials_______________.
The most common humanistic therapy is person-centered
(nondirective/client-centered) therapy, which Carl Rogers
promoted.

Person-centered therapy
• The therapist listens to the client non-judgmentally and
provides unconditional positive regard, an ideal state like
the regard that a loving parent has for a __child________.
• The therapist tries to be genuine, empathetic and caring, and
tries not to interpret the client’s thoughts or feelings or offer
____advice__________.
 Table 15.4

Table 15.4 Comparison of five types of psychotherapy

• Family systems therapy
– Family systems therapy treats the person in the context of the family.
• The underlying assumption is that an individual’s problems arise in a
family ___setting_______________. The best way to deal with these
is to improve family relationships and communication.
– Eclectic therapists do not use a single method exclusively, but a
combination of approaches. Psychologists may use behavior therapy
with one client and RET with another, or shift therapy approach if
____ineffective_______________.
– Brief therapy models in which the therapist and client agree to a certain
length, number of meetings, expectations and ___goals_____ for the
treatment are becoming more popular. Ex- once a week for 2 months, a
set agreement btw therapist and client, instead of dragging on for yrs.
– Group therapy involves the treatment of many clients by one or two
therapists on an ongoing basis. It’s less expensive and allows the clients
to help each other with advice and feedback. Group session lets people
examine how they relate to others, practice social skills, and receive
feedback, and they find out that other people have similar problems
which is ___reassuring___________________.
– Self-help groups work in a similar way but there is no therapist involved.
Ex – AA. There’s no therapist involved. Members can call on each other
for ___help________.
 Psychotherapy

• How effective is psychotherapy?

– Evaluating effectiveness of psychotherapeutic treatment is
complicated, but there are distinct advantages to seeking
professional mental health __care_____________.
– A trained clinician keeps confidentiality, uses methods with some
demonstrated level of effectiveness, makes referrals to other
professionals if other problems are suspected (for example,
additional medical ___problem_________________).
– As with any other “remedy” be skeptical of overconfidence and
claims of amazing results.
– Expect at least some small improvement within a couple of months
of starting, and don’t be afraid to ask for your therapist’s input if this
doesn’t ___happen_____________.

Be an active participant in your own treatment – nobody

“__fixes_____” you, rather, you receive help in changing your own
life.
 Deinstitutionalization

• Deinstitutionalization refers to the trend over the second part of the

twentieth century of removing patients from mental
__hospitals___________
• There are alternatives to long-term inpatient care. Unfortunately,
many patients were discharged without the benefit of adequate
planning for their future __care________.

• As a result of this lack of foresight, many former mental hospital

patients are now:
– Homeless
– Placed in nursing homes
– Imprisoned
– Dead
 The Duty to Protect

• The insanity defense

– Insanity is a legal term, not a psychological or
__medical__________ one
• Its definition is more judicial than scientific.
• Bizarre crimes in and of themselves do not demonstrate
___insanity________________.

• The insanity defense

– Under 1% of accused felons plead insanity.
– If the person is found not guilty by reason of insanity, they will
likely be institutionalized for a very long time.
 Preventing Mental Illness

• Some psychologists, especially community

psychologists have started to create movement
towards preventing mental ____ illness __.

– Community psychologists focus on the needs

of groups rather than _
individuals________________.
– They look at various routes to circumventing
mental illness or lessening its damaging
___effec___________.
 Preventing Mental Illness

• Prevention methods are aimed at stopping mental

illness before it __begins_______________.
• Intervention involves identifying a disorder in its early
stages and relieving it.
• Maintenance is taking steps to prevent an illness from
becoming more __serious______________.

“An ounce of prevention is worth a pound of cure.”

-- Old aphorism
 Preventing Mental Illness

• Some steps that would help in prevention efforts:

– Ban use of environmental __toxins___________
– Promote good prenatal care and education
– Control smoking in public places and educate the
public about the risks of __smoking___________
– Promote full employment
– Provide high quality and affordable child care
– Improve educational
___opportunities______________