Definitions of abnormality

Transcription

1 1 Psychopathology (psychological abnormality) Definitions of abnormality Deviation from social norms: Social norms are the implicit and explicit rules that a society has concerning the acceptable behaviours, traits and beliefs. Deviation from such norms is recognised as abnormal. Limitation of definition Eccentricity Criminal behaviour Context History Risk of abuse Cultural differences Explanation It is difficult to distinguish between behaviour that is abnormal and behaviour that is eccentric e.g. a genius professor who spends all their time completing scientific research may be seen as eccentric rather than abnormal. It is difficult to accept that perpetrators of serious crimes are actually normal, but just that their behaviour is abnormal. Additionally, sometimes normal people can behave in antisocial ways. Behaviour tends to be context specific e.g. a naked person on a nudist beach would not be considered abnormal compared to a naked person running down a street. There is a lack of continuity over time, as beliefs about abnormality and social norms of morally acceptable behaviour change over time. What is regarded as deviant by one generation may be perfectly acceptable to the next e.g. before the 1970 s homosexuality was incorrectly considered a disorder. If social deviance is always viewed as psychological abnormality, there is the possibility that this classification may be misused, where those who deviate can be easily labelled as mentally ill and treated accordingly e.g. labelling those who politically oppose as being mentally ill so they can be imprisoned. The behaviour of the white population in western societies is used as the basis for social norms, where deviation from this is considered abnormal. Someone classified as abnormal in one culture may not be seen as abnormal in another culture e.g. religious hallucinations may be regarded as normal by some. Failure to function adequately: Distress and inability to cope with everyday activities, especially difficulties concerning work, social activities and family relationships. Limitation Narrow definition Exceptions Direction of causality Explanation Corner (2005): abnormality can t be defined by dysfunction alone. It is when abnormal behaviour interferes with daily functioning i.e. the loss of motivation for work and to care for oneself- that is when it should be defined as abnormal. Psychopaths are recognised as abnormal, however they not display any general failure to function e.g. they are often sociable and hardworking. It could be an inability to cope with the demands of daily living that is the cause, rather than the outcome of a mental disorder.

2 2 Deviation from ideal mental health (Jahoda, 1958) Ideal mental health includes the following criteria: 1 Positive attitude towards self: high level of self-confidence 2 Self-actualisation: strive to fulfil potential 3 Resistance to stress: good coping strategies 4 Autonomy: reliant on themselves and stable when experiencing troubles as well not being too dependent on others 5 Accurate perception of reality: not extremely pessimistic or unrealistically optimistic. 6 Adapting and mastering their environment : competent in all areas of life and able to adjust to new environments and situations. Limitation Difficult to self-actualise Benefits of stress Cultural bias Explanation Most people would be considered mental ill as most are incapable of achieving self-actualisation. Some people may be more efficient while experiencing some stress in life. The criteria are based on western cultural concepts concerning selffulfilment and standing out as an individual. Approaches to psychopathology Biological approach to psychopathology Brain damage: changes in brain structure can result in mental illness. Infection: syphilis infection leads to paralysis and mental deterioration. Biochemistry : neurotransmitter imbalances: excess levels of dopamine are related to schizophrenia, low levels of serotonin are related to depression. Hormones: cortisol levels are related to depression. Genetics: concordance rates are found from studies involved monozygotic and dizygotic twins; these allow a determination of the genetic risk for developing a disorder. Evaluation of the biological approach No stigma and blame as the cause is recognised as being outside the patient s control. McGuffin (1996) : concordance rates have been found in twin studies, such as 46% MZ and 20% DZ genetic contribution for depression. Responsibility may be relinquished with the belief that the disorder is outside the patients control, they might give up trying to change. Reductionist: breaks mental illness down to the neural level, ignoring social factors.

3 3 Psychodynamic approach to psychopathology Causes: Id, ego, superego: Unresolved conflicts fixation Bad early experiences = trauma = repression Stages in psychosexual development : oral, anal, phallic, latency, genital Ego defence mechanisms distort reality and have an unconscious influence upon behaviour e.g. repression, projection, denial, regression, displacement, sublimation. Zeldow (1995): the vast amount of research which was developed to oppose Freud s research brought about new empirical research with improved methodological standards. Limited populations were originally researched as they were only Freud s patients from Austria. Ethical implications: a lot of blame is placed on the parents. Deterministic: childhood can t be changed. Current experiences are ignored. Data is retrospective and taken from memories, therefore it is prone to error and is unreliable. Behavioural approach to psychopathology Classical conditioning: abnormal associations between stimulus and response. Operant conditioning: abnormal behaviour is learned through reward and punishment where consequences of actions are considered. Social learning: behaviour is learned through imitation (Bandura, 1973) Free will: approach focuses on behaviour and behaviour is possible to change Ignores underlying causes related to the unconscious. Symptoms may just be substituted. Reductionist: reduces behaviour to stimulus and response. Cognitive approach to psychopathology Irrational thinking: distortions in thinking processes lead to emotional problems. Ellis (1962) : Errors in logic, overgeneralization and polarised thinking Beck (1967): The cognitive triad including negative thoughts about the future, self and world. Gustafson (1992): disorders are associated with maladaptive thinking e.g. depression. It is difficult to determine whether rational thinking is the cause or effect of a disorder. Individual is recognised as solely responsible; therefore they have to take control on their own. Szasz (1972): stigma is often associated with mental illness where people may be labelled as being permanently disordered leading others to view them negatively.

4 4 Treatments Drug treatment Anti-anxiety (Benzodiazepine): increase GABA to reduce levels of serotonin. Anti-depressants (SSRI): increase levels of serotonin Anti-psychotic (tranquilisers): decrease levels of dopamine Fisher and Greenberg: Anti-psychotics are fast and effective for schizophrenia. Drug treatments often have side effects such as heart issues. Drugs only cure the symptoms of a disorder rather than the underlying psychological issue. Patient may become dependent on the drug Patient may become tolerant of the drug and require ever increasing doses. Ethical consideration must be taken as drugs may be used to take control of patients. Electro-convulsive therapy (ECT) Patient lies on bed Receives anaesthetic and muscle relaxant Unilateral electrodes fixed to non-dominant hemisphere (right) volts into brain through electrodes for 0.5 seconds Current should induce convulsions that last for a minute Treatments given 2-3 times a week for 3-4 weeks Cerletti and Bini (1938): ECT originally developed to treat patients suffering from schizophrenia but is now used for depression. Sackheim: short-term effectiveness for treating depression Can prevent suicide with its efficiency. Side effects include severe memory impairment Unclear how exactly it works Expensive and difficult to set up Psychosurgery Surgical removal of brain regions that are related to a patient s mental illness. Advantage Effective as a last resort Disadvantage Controversial treatment in which, after treatment, there is no way to reverse the effects of it.

5 5 Psychoanalysis Awareness of repressed thoughts leads to insight concerning underlying causes. This allows a cure of neurotic symptoms. Dream analysis: this is used to uncover the unconscious which is revealed in dreams in the form of symbols. Free association: patient says everything on their mind where thoughts are accumulated and the repressed thoughts become conscious. Successful free association can lead to emotional release i.e. catharsis. Transference: Client projects important people from the past onto the analyst so that repressed feelings are exerted on to the analyst and can be easily seen. Useful for neurotic disorders e.g. depression and anxiety Corsini and Wedding (1995): 30% to 60% success rate Not useful for psychotic disorders e.g. schizophrenia Expensive and time consuming Ethical issue: therapist has complete power over the patient (Masson, 1988) Extreme focus on the past may cause patient to relive trauma. Systematic desensitisation Reverse conditioning to replace a maladaptive response to a situation or object by eliciting another incompatible healthier response to the situation or object. 1) Training in techniques for muscle relaxation 2) Patient imagines anxiety-provoking situations: starting from least powerful moving to most 3) Reciprocal inhibition: where incompatible emotional states are experienced relaxation can inhibit the anxiety 4) Treatment completion: treatment ends when the client is desensitised, involving desensitization to imagined situations and then finally real-life situations. Emmelkamp (1994): learning the ability to tolerate imagined stressful situations leads to a reduction in anxiety with real-life situations. Symptoms can be substituted: where some symptoms are removed by the desensitisation their underlying cause is not removed so other symptoms may rise. Imagination techniques rely on the patient s imagination skill. Alternatives involve flooding where the patient is instantly exposed to e.g. what they fear. This may be a faster alternative.

6 6 Aversion therapy Association of an undesirable habit with unpleasant consequences Can be used for smoking and alcohol addictions. e.g. Alcoholic drink is combined with an emetic (a drug which causes vomiting), so eventually alcohol is strongly associated with illness and is consequently avoided. Baker and Brandon (1988): nausea paired with alcohol can result in effective conditioned aversions Difficult to maintain associations after discontinuation of therapy. Use of emetic can cause pain and discomfort Behaviour modification Operant conditioning: maladaptive behaviour can be changed by reinforcing positive behaviour e.g. using token economies where patient is provided reward for healthy behaviour. Isaac et al. (1960) behaviour modification treatment helped relieve mutism in schizophrenia Token learning (Baddeley, 1990) behaviour may become dependent on reinforcement and therefore the treatment loses effectiveness when reward is no longer offered. Institutional bias: goals set may be biased and influenced by the needs of institution Cognitive Behavioural Therapy (CBT) Overall beliefs and expectations underlying unhappiness are examined. Irrational negative thoughts are replaced with a more positive, adaptive pattern of thinking. Cognitive element: raise awareness of beliefs that contribute to anxiety or depression to help client understand the consequences of their faulty beliefs. Behavioural element: role play and homework assignments allow patient to observe consequences of their faulty cognitions. Goals are set for more realistic and rational beliefs to replace irrational thoughts Examples of CBT: Ellis (1962) Rational- Emotive Behaviour Therapy: the treatment becomes part of the patients way of living, where it is effective in relieving anxiety and making the patient less disturbed. Beck et al. (1985) Cognitive Therapy: depression is relieved by challenging depressive thoughts Hollon et al. (1992) :as effective as drugs in treating depression Fava et al. (1998) :CBT is a successful alternative to long-term drug treatment Hole et al. (1979): treatment found effective where it enables a reality testing of delusions in schizophrenia to reduce these delusions Doesn t address the causes of mental illness Patient may become dependent on therapist