PowerPoint  Lecture Notes Presentation

Chapter 1
Introduction and
Historical Review

Abnormal Psychology, Twelfth Edition

DSM-5 Update
by
Ann M. Kring,
Sheri L. Johnson,
Gerald C. Davison,
Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.
& John M. Neale
 Chapter Outline
 Chapter 1: Introduction and Historical
Review

I. Introduction to the Study of Mental Disorders

II. History of Psychopathology
III. The Evolution of Contemporary Thought
IV. The Mental Health Professions

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Psychopathology
 Study of the nature, development, and treatment of
psychological disorders

 Challenges to the study of psychopathology:

• Maintain objectivity
• Avoid preconceived notions
• Reduce stigma

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Figure 1.1: Four Characteristics of Stigma

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Labeling
Rosenhan
rosenhan.htm

© 2012 John Wiley & Sons, Inc. All rights reserved.

 Stigma
 In Medical News Today (MNT) Colleen L. Barry, PhD, MPP, an
associate professor in the Department of Health Policy and
Management at the Johns Hopkins Bloomberg School of Public
Health conducted a study regarding issues of persons with drug
addictions and persons with mental health issues in the workplace.
 Her findings were not surprising - respondents had a much higher
negative opinion of those with drug addiction problems than those
with mental illness. “Only 22 percent of respondents said they
would be willing to work closely on a job with a person with drug
addiction compared to 62 percent who said they would be willing
to work with someone with mental illness.”

© 2012 John Wiley & Sons, Inc. All rights reserved.

 Defining Mental Disorder
 Personal Distress
• The condition causes the individual distress
• Emotional pain and suffering
 Helplessness and hopelessness of depression
 Disability
• Impairment in a key area (e.g., work, relationships)
 Chronic substance abuse results in job loss
 Violation of Social Norms
• Makes others uncomfortable or causes problems
 Antisocial behavior of the psychopath
 Dysfunction
• Wakefield's Harmful Dysfunction: failure of internal mechanisms in
the mind to function properly
• Behavioral, psychological, and/or biological systems are impaired

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Defining Mental Disorder, DSM-5 Definition
 The disorder occurs within the individual
 It involves clinically significant difficulties in thinking,
feeling, or behaving
 It involves dysfunction in processes that support mental
functioning
 It is not a culturally specific reaction to an event (e.g.
death of a loved one)
 It is not primarily a result of social deviance or conflict
with society
© 2014 John Wiley & Sons, Inc. All rights reserved.
Figure 1.2: Key Characteristics in the Definition of Mental
Disorder

© 2014 John Wiley & Sons, Inc. All rights reserved.

 History of Psychopathology
 Early Demonology
• Possession by evil beings or spirits
 Exorcism
 Early Biological Explanations
• Hippocrates (5th century BC)
 Mental disturbances have natural (not supernatural) causes
(problems with the brain)
 Three categories of mental disorders: mania, melancholia, & phrenitis
(brain fever)
 Normal brain functioning depended on balance of four humors: blood,
black bile, yellow bile, & phlegm

© 2014 John Wiley & Sons, Inc. All rights reserved.

 History of Psychopathology:
Dark Ages
 Dark Ages (2nd century AD)
• Monks cared and prayed for mentally ill

 Witches (13th century AD)

• Torture sometimes led to bizarre delusional sounding
confessions, e.g., concourse with demons.
 Initially, historians concluded many of the accused were mentally
ill.
 Further research found little support for this conclusion.

© 2014 John Wiley & Sons, Inc. All rights reserved.

 History of Psychopathology:
Lunacy Trials
 Lunacy Trials
• Trials held to determine sanity
 Began in 13th century England
• Municipal authorities assumed responsibility for care of
mentally ill
• Lunacy attributes insanity to misalignment of moon
(“luna”) and stars

© 2014 John Wiley & Sons, Inc. All rights reserved.

 History of Psychopathology:
Asylums
 Asylums (15th century AD)
• Establishments for the confinement and care of mentally ill
• Priory of St. Mary of Bethlehem (founded in 1243)
 One of the first mental institutions
 The wealthy paid to gape at the insane
 Origin of the term bedlam (wild uproar or confusion)
• Treatment non-existent or harmful at asylums
 Benjamin Rush recommended drawing copious amounts of blood,
to relieve brain pressure

© 2014 John Wiley & Sons, Inc. All rights reserved.

 History of Psychopathology:
Pinel’s Reforms and Moral Treatment
 Philippe Pinel (1745-1826)
• Pioneered humanitarian treatment at LaBicetre
 Moral Treatment
• Small, privately funded, humanitarian mental hospitals
 Friends Asylum (1817)
 Patients engaged in purposeful, calming activities (e.g.,
gardening)
 Talked with attendants

© 2014 John Wiley & Sons, Inc. All rights reserved.

 History of Psychopathology:
Dorothea Dix
 Dorothea Dix (1802-1887)
• Crusader for prisoners and mentally ill
• Urged improvement of institutions
• Worked to establish 32 new, public hospitals
• Unfortunately, small staffs at these new public hospitals
could not provide necessary individual attention
• Hospitals administered by physicians, who were more
interested in biological rather than psychological aspects of
mental illness

© 2014 John Wiley & Sons, Inc. All rights reserved.

 The Evolution of Contemporary Thought :
Biological Approaches
 General paresis and Syphilis
• Degenerative disorder with psychological symptoms (delusions
of grandeur) and physical symptoms (progressive paralysis)
• By mid-1800’s, it was known that general paresis and syphilis
occurred together in some patients
• In 1905, biological cause of syphilis found
• Since general paresis had biological cause, other mental illness might
also
 Biological causes of psychopathology gained credibility

© 2014 John Wiley & Sons, Inc. All rights reserved.

 The Evolution of Contemporary Thought :
Genetics
 Galton’s (1822-1911) work lead to notion that mental illness
can be inherited
• Nature (genetics) and nurture (environment)
• Eugenics
 Promotion of enforced sterilization to eliminate undesirable characteristics
from the population
 Many state laws required mentally ill to be sterilized

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Early Biological Treatments
 Insulin-coma therapy
• Sakel (1930’s)
 Electroconvulsive Therapy (ECT)
• Cerletti and Bini (1938)
• Induce epileptic seizures with electric shock
 Prefrontal lobotomy
• Moniz (1935)
• Often used to control violent behaviors; led to listlessness,
apathy, and loss of cognitive abilities

© 2014 John Wiley & Sons, Inc. All rights reserved.

 ECT

ECT.htm

© 2012 John Wiley & Sons, Inc. All rights reserved.

 The Evolution of Contemporary Thought:
Psychological Approaches
 Mesmer (1734-1815)
• Treated patients with hysteria using “animal magnetism”
• Early practitioner of hypnosis
 Charcot (1825-1893) (neurologist)
• His support legitimizes hypnosis as treatment for hysteria
 Breuer (1842-1925) (Viennese physician)
• Used hypnosis to facilitate catharsis in Anna O.
• Cathartic Method
 Release of emotional tension triggered by reliving and talking
about event

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Freud
 Breuer and Freud (1856-1939) jointly publish,
“Studies in Hysteria” in 1895, which serves as the
basis for Freud’s theory.
 Freudian or Psychoanalytic theory
• Human behavior determined by unconscious forces.
• Psychopathology results from conflicts among these
unconscious forces.

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Freud’s Structures of the Mind
 Id
• Unconscious
• Pleasure principle
 Immediate gratification
• Libido
 Energy of ID
 Ego
• Primarily conscious
• Reality principle
 Attempt to satisfy ID’s demands within reality’s constraints
 Superego
• The conscience
• Develops as we incorporate parental and society values

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Defense Mechanisms
 Id, Ego, & Superego continually in conflict
• Conflict generates anxiety
• Ego generates strategies to protect itself from anxiety
 Defense mechanisms
 Psychological maneuvers used to manage stress & anxiety

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Table 1.2:
Selected Defense Mechanisms

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Psychoanalytic Therapy
 Goals of Psychoanalytic Therapy or
Psychoanalysis
• Understand early-childhood experiences, particularly key
(parental) relationships
• Understand patterns in current relationships
 Psychoanalytic Techniques
• Free Association
• Analysis of Transference
• Interpretation

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Table 1.3:
Major Techniques of Psychoanalysis

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Neo-Freudians
 Jung (1875-1961)
• Analytical psychology
• Collective unconscious
 Archetypes
• Catalogued personality characteristics
 Extraversion vs. Introversion

 Adler (1870-1937)
• Individual psychology
 Fulfillment derived from working for the social good

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Continuing Influences of Freud
and His Followers
 Childhood experiences help shape adult
personality
 There are unconscious influences on behavior
(most today don’t emphasize id instincts)
 The causes and purposes of behavior are not
always obvious.

© 2014 John Wiley & Sons, Inc. All rights reserved.

 The Evolution of Contemporary Thought: Rise
of Behaviorism
 John Watson (1878-1958)
 Behaviorism
• Focus on observable behavior
• Emphasis on learning rather than thinking or innate
tendencies
 Three types of learning:
• Classical Conditioning
• Operant Conditioning
• Modeling

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Classical Conditioning
 Discovered by Pavlov (1849-1936)
• Unconditioned Stimulus (UCS)
 Meat powder (automatically elicits salivation)
• Unconditioned Response (UR)
 Salivation (automatic response to meat powder)
• Neutral Stimulus (NS)
 Initial ringing of bell (does not automatically elicit salivation)
• Conditioned Stimulus (CS)
 After pairing the NS and the UCS, the NS becomes a CS (bell now
automatically elicits salivation)
• Conditioned Response (CR)
 Salivation (automatic response to bell)
• Extinction
 CS (bell) not followed by UCS (meat powder) causes gradual
disappearance of CR (salivation)
© 2014 John Wiley & Sons, Inc. All rights reserved.
 Figure 1.3:
The process of classical conditioning

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Operant Conditioning
 E. Thorndike (1874-1949)
• Learning through consequences
• Law of Effect
 Behavior that is followed by satisfying consequences will be repeated; behavior
that is followed by unpleasant consequences will be discouraged

 B.F. Skinner (1904-1990)

• Principle of Reinforcement
 Positive reinforcement
 Behaviors followed by pleasant stimuli are strengthened
 Negative reinforcement
 Behaviors that terminate a negative stimulus are strengthened

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Modeling
 Learning by watching and imitating others’
behaviors
• Can occur without reinforcement
 Bandura & Menlove (1968)
• Modeling reduced children’s fear of dogs

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Behavior Therapy

 Behavior Therapy or Behavior Modification

• Systematic Desensitization
 Used to treat phobias and anxiety
 Combines deep muscle relaxation and gradual exposure to the
feared condition or object
 Starts with minimal anxiety producing condition and gradually
progresses to most feared
• Intermittent Reinforcement
 Rewarding a behavior only occasionally more effective than
continuous schedules of reinforcement

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Importance of Cognitions
 Limitations of Behavior Therapy
• How we think or appraise a situation influences our feelings
and behaviors
 Cognitive Therapy
• Emphasize how people think about themselves and their
experiences can be a major determinant of psychopathology
• Focus on understanding maladaptive thoughts
• Change cognitions to change feelings and behaviors
 Ellis (1913-2007)
• REBT (Rational-Emotive Behavior Therapy)

© 2014 John Wiley & Sons, Inc. All rights reserved.

 Mental Health Professions
 Psychologists
• Clinical or Counseling
• Ph. D. or Psy. D.
 Psychiatrists
• M.D.’s can prescribe psychotropic medications
 Psychiatric Nurses and Psychiatric Nurses Practitioners
• Nurse Practitioners can prescribe psychotropic medications
 Social Workers
• M.S.W.
• Not trained in psychological assessment
 Master’s Level Therapists & Counselors
• MFT’s (Marriage and Family Therapists)
© 2014 John Wiley & Sons, Inc. All rights reserved.
 COPYRIGHT
Copyright 2014 by John Wiley & Sons, New York, NY.
All rights reserved. No part of the material protected by
this copyright may be reproduced or utilized in any form
or by any means, electronic or mechanical, including
photocopying, recording or by any information storage
and retrieval system, without written permission of the
copyright owner.

© 2014 John Wiley & Sons, Inc. All rights reserved.