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Chapter1HandoutsAbnormalPsychology:PastandPresentSlides&HandoutsbyKarenClayRhines,Ph.D. SetonHallUniversity1AbnormalPsychology:

PastandPresentWhatisabnormalpsychology?Thescientificstudyof_______________inorderto________,________,________,and________abnormalpatternsof__________Workersmaybe:____________________________________________________________2WhatIsPsychologicalAbnormality?Manydefinitionshavebeenproposed,yetnoneareuniversallyacceptedMostdefinitions,however,sharesomecommonfeatures…“TheFourDs”Deviance–______________________________Distress–______________________________Dysfunction– ______________________________Danger–______________________________3DevianceFromwhat?Frombehaviors,thoughts,andemotionsconsiderednormalinaspecificplaceandtimeandbyspecificpeople______________________________

StatedandunstatedrulesforproperconductinagivensocietyorcultureExamples?Judgmentsofdeviancealsodependonspecificcircumstances(i.e.,_________________)4DistressAccordingtomanyclinicalguidelines,behaviormustbe_______________beforeitcanbelabeledabnormalNotalwaysthecaseExamples?5DysfunctionAbnormalbehaviortendstobedysfunctional–itinterfereswithdailyfunctioningCulturehasaninfluenceondeterminationsofdysfunctionaswellDysfunctionalonedoesnotmeanabnormality6DangerAbnormalbehaviormaybecomedangeroustooneselforothersBehaviormaybecareless,hostile,orconfusedAlthoughcitedasafeatureofpsychologicalabnormality,_________________________________________________________7TheElusiveNatureofAbnormalityUltimately,asocietyselectsthegeneralcriteriafordefiningabnormalityandthenusesthosecriteriatojudgeparticularcasesSzaszarguesthat,becauseoftheinfluenceofculture,thewholeconceptofmentalillnessisinvalidDeviationscalled“abnormal”areonly“___________”Societiesusetheconceptofmentalillnesstocontrolthosewhothreatensocialorder8TheElusiveNatureofAbnormalityEvenifweagreewiththeconceptofabnormality,itisoftenappliedinconsistentlyExamples:DiagnosisofalcoholproblemsincollegesDiagnosisofthepoorversusthewealthyIssueofabnormalityversuseccentricityEccentric=apersonwhodeviatesfromcommonbehaviorpatternsordisplaysoddorwhimsicalbehavior(ACLOSERLOOK)9TheElusiveNatureofAbnormalityInsum,whileabnormalityisgenerallydefinedasbehaviorthatisdeviant,distressful,dysfunctional,anddangerous,thesecriteriaoftenarevagueandsubjectiveWhenisapatternofbehavior“enough”tobeconsideredabnormal?10WhatIsTreatment?Onceabnormalityisdetermined,cliniciansattempttotreatitTreatment(therapy)isaproceduretochangeabnormalbehaviorintomorenormalbehaviorItisrelatedtothedefinitionofabnormalityTherearevarioustypesoftreatment,butaccordingtoFrank,allhavethreeessentialfeatures…11WhatIsTreatment?A________whoseeksrelieffromthehealerAtrained,sociallyacceptable_______,whoseexpertiseisacceptedbythesuffererandhisorhersocialgroupA__________________betweenthehealerandthesufferer,throughwhichthehealertriestoproducecertainchangesinthesufferer’semotionalstate,attitudes,andbehavior12WhatIsTreatment?Despitetheclarityofthedefinition,clinicaltherapyissurroundedbyconfusionandconflictLackofagreementaboutgoalsoraimsLackofagreementaboutsuccessfuloutcomesLackofagreementaboutfailureArecliniciansseekingtocure?Toteach?Aresuffererspatients(ill)orclients(havingdifficulty)?Despitethesedisagreements,mostcliniciansagreethatlargenumbersofpeopleneedtherapyAndresearchindicatesthattherapyoftenishelpful!13HowWasAbnormalityViewed

andTreatedinthePast?InanygivenyearintheUS,___%ofadultsand___%ofchildrendisplayseriouspsychologicaldisturbancesandareinneedoftreatmentInaddition,mostpeoplehavedifficultycopingatvarioustimesintheirlivesIsthisthefaultofmodernsociety?Notentirely;historicalrecordsdemonstratethateverysocietyhaswitnessedpsychologicalabnormalityandhaditsownformoftreatment…14HowWasAbnormalityViewed

andTreatedinthePast?Muchoftoday’sthinkingaboutabnormalpsychologyisbuiltonpastapproachesandideas,ratherthanbeingarejectionoftheseideasTheoriesandthemesaboutabnormalpsychologyoccuragainandagain;progresshasnotbeenasteadymovementforward15AncientViewsandTreatmentMostofourknowledgeofprehistoricsocietieshasbeenacquiredindirectly,isbasedoninferencesfromarchaeologicalfindings,andislimitedMosthistoriansbelievethatprehistoricsocietiesregardedabnormalbehaviorastheworkofevilspiritsMayhavebegunasfarbackastheStoneAgeThecureforabnormalitywastoforcethedemonsfromthebodythrough________and________16GreekandRoman

ViewsandTreatments500B.C.toA.D.500ManypsychologicaldisorderswereidentifiedHippocratesbelievedthatabnormalityhadnaturalcausesandresultedfrominternalphysicalproblemsHelookedtoanunbalanceofthefourhumorsHissuggestedtreatmentattemptedto“rebalance”Warmbaths,massage,bloodletting17EuropeintheMiddleAges:DemonologyReturnsA.D.500–1350Withtheriseofclergycamethe_______________Abnormalitywasagainseenasaconflictbetweengood&evilTheincidenceofabnormalityincreaseddramaticallyasoutbreaksofmassmadnessoccurredEarlier(largelydiscarded)treatmentssuchasexorcismreemergedAtthecloseoftheMiddleAges,demonologybegantolosefavoragain18TheRenaissance

andtheRiseofAsylumsA.D.1400–1700GermanphysicianJohannWeyerarguedthatthemindwassusceptibletoillness,justlikethebodyWeyerisconsideredthefounderofmodernstudyofpsychopathologyPatientcareimprovedasdemonologicalviewsdeclined19TheRenaissance

andtheRiseofAsylumsShrinesdevotedtolovingcareofthementallyillwereestablishedandone,atGheel,becameacommunitymentalhealthprogramofsortsThistimealsosawariseofasylums–institutionswhoseprimarypurposewascareofthementallyillTheintentionwasgoodcare,butwithovercrowdingcame“warehousing”ofpatients20TheNineteenthCentury:

ReformandMoralTreatmentAs1800approached,asylumswerereformedintoplacesofcarePinel(France)andTuke(England)advocatedmoraltreatment–carethatemphasizedhumaneandrespectfultreatmentIntheUS,BenjaminRush(fatherofAmericanpsychiatry),DorotheaDix(Bostonschoolteacher)21TheNineteenthCentury:

ReformandMoralTreatmentBy1850s,therewasareversalofthemoraltreatmentmovementduetoseveralfactors:MoneyandstaffshortagesDecliningrecoveryratesLackofmoreeffectivetreatmentforseverelymentallyillLong-termhospitalizationbecametheruleonceagain22TheEarlyTwentiethCentury:

DualPerspectivesAsthemoralmovementwasdeclininginthelate1800s,twoopposingperspectivesemerged:TheSomatogenicPerspectiveAbnormalfunctioninghasphysicalcausesThePsychogenicPerspectiveAbnormalfunctioninghaspsychologicalcauses23TheEarlyTwentiethCentury:

TheSomatogenicPerspectiveTwofactorsresponsibleforreemergence:EmilKraepelin’stextbookarguedthatphysicalfactors(likefatigue)leadtomentaldysfunctionSeveralbiologicaldiscoveriesweremade,suchasthelinkbetweenuntreatedsyphilis&generalparesisThisapproach,whilecreatingoptimism,leadtofewpositiveresultsuntilthe1950s24TheEarlyTwentiethCentury:

ThePsychogenicPerspectiveRiseinpopularityofthismodelwasbasedonworkwithhypnotism:FriedrichMesmerandhystericaldisordersSigmundFreud:fatherofpsychoanalysisUnconsciousprocessescauseabnormalityThisapproachwasprimarilyappliedtothosenotrequiringhospitalization(outpatients)25CurrentTrendsHavewecomealongway?43%ofpeopleinterviewedbelievethatpeoplebringmentalhealthdisordersonthemselves35%considermentalhealthdisorderstobecausedbysinfulbehaviorHowever,thelast50yearshavebroughtmajorchangesintheassessment,diagnosis,andtreatmentofmentalhealthdisordersbutscientistsandpractitionersarestillstrugglingtomakeadifference…26HowArePeoplewithSevereDisturbancesTreated?1950s–_________________discoveredAntipsychoticsAntidepressantsAnxiolytics(antianxietydrugs)ThesediscoveriesledtodeinstitutionalizationandariseinoutpatientcareThischangeincarewasnotwithoutproblems27Handout2828HowArePeoplewithSevereDisturbancesTreated?OutpatientcareisnowtheprimarymodeoftreatmentWhenpatientsdoneedgreatercare,theyareusuallygivenshort-termhospitalizationsoroutpatientpsychotherapyandmedicationincommunitysettingsUnfortunately,therearetoofewcommunityprogramsavailable;only40%ofthosewithseveredisturbancesreceivetreatmentofanykind29HowArePeoplewithLessSevereDisturbancesTreated?Sincethe1950s,therehasbeenanincreaseinoutpatientcareWhilethistypeofcarewasonceexclusivelyprivatepsychotherapy,itnowincludesvarioussettingsaswellasspecialtycareInanygivenyear,__________adultsreceivesometypeofmentalhealthcare30AGrowingEmphasisonPreventingDisordersandPromotingMentalHealthThecommunitymentalhealthapproachhasgivenrisetothepreventionmovementManyoftoday’sprogramsaretryingto:Correctthesocialconditionsassociatedwithpsychologicalproblems________________________________________________Preventionprogramshavealsobeenenergizedbytheriseof_________________–thestudyandpromotionofpositivefeelings,traits,andabilities31TheGrowingInfluence

ofInsuranceCompaniesTodaythedominantformofinsurancecoverageformenta