THE HISTORICAL THE HISTORICAL

PERSPECTIVES ON PERSPECTIVES ON

ABNORMAL ABNORMAL

PSYCHOLOGYPSYCHOLOGY

PSYCHOPATHOLOGY the scientific study of psychological disorders

PSYCHOLOGICAL DISORDER or abnormal

behavior is a psychological dysfunction within

an individual that is associated with distress or

impairment in functioning and a response that is

not typical or culturally expected

PSYCHOLOGICAL DYSFUNCTION refers a

breakdown in cognitive, emotional, or behavioral

functioning

PERSONAL DISTRESS impairment; being upset

ATYPICAL/NOT CULTURALLY ACCEPTED

violation of social norms; deviant

DSM-IV-TR contains the current listing of

criteria for psychological disorders

ABNORMAL BEHAVIOR describes behavioral,

psychological, or biological dysfunctions that are

unexpected in their cultural context and

associated with present distress and impairment in

functioning, or increased risk of suffering, death,

pain, or impairment

SPECIALLY TRAINED PROFESSIONALS:

Clinical psychologist

Counseling psychologist

Psychiatrist

Psychiatric social workers

Psychiatric nurses

Marriage and family therapist

Mental health counselors

SCIENTIST-PRACTITIONER mental health

professionals who take a scientific approach to

their clinical work

DSM DSM -- 5 Definition 5 Definition -- 20132013 A mental disorder is a syndrome characterized by clinically

significant disturbance in an individuals cognition, emotional

regulation or behavior that reflects a dysfunction in the

psychological, biological, or developmental processes

underlying mental functioning. Mental disorders are usually

associated with significant distress or disability in social,

occupational, or other important activities. An expectable or

culturally appropriate response to a common stress or loss,

such as death of a loved one, is not a mental disorder.

Socially deviant behavior (e.g., political, religious, or sexual)

and conflicts that are primarily between individuals and

society are not mental disorders unless the deviance or

conflict results from a dysfunction in the individual, as

described above.

DSM-5, p. 20.

Clinical Description represents the unique combination of behaviors, thoughts and feelings that make up a specific disorder.

Clinical refers both to the types of problems or disorder that you would find in the clinic or hospital and to the activities connected with assessment and treatment

Important function : to specify what makes the disorder different from normal behavior or from other disorders

presents a traditional shorthand way of indicating why the person came to the clinic; describing the presenting problems is the first step in determining clinical description

Prevalence (of the disorder) figure on how many

people in the population as a whole have the

disorder

Incidence (of the disorder) statistics on how many

new cases occur during a given period, such as a

year

Course means individual pattern

= chronic tend to last a long time, sometimes a

lifetime

= episodic the individual is likely to recover

within a few months only to suffer a

recurrence of the disorder at a later

time; the pattern may repeat

throughout a persons life

= time-limited meaning the disorder will improve without treatment in a

relatively short period

Onset the beginning of the disorder

= acute meaning that they begin suddenly

= insidious develops gradually over an extended

period

Prognosis the anticipated course of a disorder

= the prognosis is good meaning the individual

will probably recover

= the prognosis is guarded meaning the probable

outcome doesnt look good

Dimensions of the ScientistDimensions of the Scientist--Practitioner Practitioner ModelModel

Figure 1.3

Three major categories make up the study and discussion of psychological

disorders.

Clinical Description Clinical Description

Begins with the Presenting Problem

Description Aims to

Distinguish clinically significant dysfunction from common human experience

Describe Prevalence and Incidence of Disorders

Describe Onset of Disorders

Acute vs. insidious onset

Describe Course of Disorders

Episodic, time-limited, or chronic course

Other features (e.g. age, developmental stage, ethnicity, race)

Add: Subtypes and Specifiers DSM 5

Causation, Treatment, and Outcome Causation, Treatment, and Outcome

What Factors Contribute to the Development of Psychopathology?

Study of etiology

How Can We Best Improve the Lives of People Suffering From Psychopathology?

Study of treatment development

Includes pharmacologic, psychosocial, and/or combined treatments

How Do We Know That We Have Alleviated Psychological Suffering?

Study of treatment outcome - Evidence Based Treatment

Limited in specifying actual causes of disorders

Developmental psychology study of changes

in behavior overtime

Developmental psychopathology study of

changes in abnormal behavior

Life-span developmental psychopathology

a field that is relatively new but expanding rapidly

which deals with the study of abnormal behavior

across the entire age span

Etiology or the study of origins, has to do with

why a disorder begins (what causes it) and

includes biological, psychological, and social

dimensions

Historical Conceptions of Abnormal BehaviorHistorical Conceptions of Abnormal Behavior

Major Psychological Disorders Have Existed

In all cultures

Across all time periods

The Causes and Treatment of Abnormal Behavior Varied Widely

Across cultures

Across time periods

As particularly as a function of prevailing paradigms or world views

Three Dominant Traditions Include: Supernatural, Biological, and Psychological

Historical Models of Historical Models of BehaviourBehaviour

Supernatural

Biological

Psychological

SupernaturalSupernatural

Deviant Behavior as a Battle of Good vs. Evil

Deviant behavior was believed to be caused by demonic possession, witchcraft, sorcery

Suggested that it was done to release demons possessing the victim

Technique = trephination still done today to relieve pressure of fluids on the brain.

The Moon and the Stars

Paracelsus and lunacy

3000BCE evidence of ancient surgical techniques in human skulls. Holes cut while person was still alive and showed healing survived!

TreatmentsTreatments

Exorcism: various religious rituals to rid the victim of evil spirits.

Torture to make the bodies uninhabitable

Shaving the pattern of a cross in the hair of the victims head

Securing sufferers to a wall near the front of a church for mass

Hanging people over a pit full of snakes to scare the evil spirits out of the bodies

Shock treatments (ice cold water dunkings)

Supernatural todaySupernatural today

The supernatural tradition in

psychopathology still exists today,

although it is restricted to small religious

sects and in some developing countries.

Biological Biological Abnormal Behavior as a

Physical Disease Hippocrates (460-377BC)

father of modern medicine.

Believed that psychological disorders might be caused by brain pathology or head trauma and could be influenced by heredity.

Considered brain as seat of wisdom, consciousness, intelligence and emotion. Logically concluded disorders involved with these functions are located in the brain.

Galen (129Galen (129--198AD)198AD) Roman physician

adopted and

further develop

Hippocrates ideas

Humoral Theory

of disorders

Galens TheoryGalens Theory

The belief that normal brain functioning was related to four bodily fluids or humors:

Blood/Sanguine (came from the heart link to cheerful/optimistic)

Black bile/Melancholer (from the spleen link to depression)

Yellow bile/Choler (from the liver link to hot temper)

Phlegm (from the brain like to apathy)

Physicians believed that disease resulted from too much or too little of one of the humors; e.g. >black bile = melancholia (depression)

Theory perhaps the first to associate psychological disorders with chemical imbalance.

TreatmentsTreatments

Excesses of one or more humors were treated by regulating the environment to increase or decrease heat, dryness, moisture, or cold, depending on which humor was out of balance as each humor was related to either heat, dryness, moisture or cold.

Bleeding/Bloodletting: a carefully measured amount of blood removed from the body, often with leeches.

Induce vomiting

The 19The 19thth CenturyCentury

General Paresis (Syphilis) and the Biological Link With Madness

Associated with several unusual psychological and behavioral symptoms

Pasteur discovered the cause A bacterial microorganism

Led to penicillin as a successful treatment

Bolstered the view that mental illness = physical illness and should be treated as such

John Grey and the Reformers

John Grey - 1850s: influential American

psychiatrist

Believed insanity was always due to physical

causes, therefore mentally ill patients should

be treated as physically ill.

Hospital conditions grew.

Took almost 140 years before community

mental health movement succeeded in

deinstitutionalization

The Psychological TraditionThe Psychological Tradition

The Rise of Moral Therapy

Involved more humane treatment of institutionalized patients

Encourage and reinforced social interaction

Proponents of Moral Therapy

Dorothea Dix

Philippe Pinel and Jean-Baptiste Pussin

William Tuke followed Pinels lead in England

Reasons for the Falling Out of Moral Therapy

Emergence of Competing Alternative Psychological Models

TreatmentTreatment

1920s-now: electric shock, brain surgery,

effects of drugs (e.g. insulin shock

therapy)

HISTORY OF ABNORMAL HISTORY OF ABNORMAL

PSYCHOLOGYPSYCHOLOGY

PhasesPhases

Stone Age

Demonology, gods and magic

Early Greek thinkers

Later Greek thinkers

Middle Ages

Humanitarian approaches

Mental Hospital Care by 20th century

Contemporary developments

Stone Age (half a million years ago)Stone Age (half a million years ago)

Trephination- chipping away an area of the

skull with crude stone instruments to

make a hole letting the evil spirit in head

to escape through it

Demonology, gods & magicDemonology, gods & magic

Chinese, Greek, Egyptian and Hebrew

Possession by good or evil spirits

Primary type of treatment: exorcism

Early Greek ThinkersEarly Greek Thinkers

Hippocrates(460-377BC)

Father of modern medicine

Natural causation for mental diseases

Brain pathology

Importance of heredity

Classified in to three- mania, melancholia

and phrenitis( brain fever)

Role of dreams in understanding

GalenGalen

Following Hippocrates Following Hippocrates

Doctrine of four humors

Temperaments: Sanguine, Melancholic,

Phlegmatic, Choleric

Plato (429Plato (429--347 BC)347 BC)

Plato (429Plato (429--347 BC)347 BC)

Mentally ill persons not responsible for

criminal acts

To provide hospital care for the mentally

ill

The divine causation

Aristotle( 384Aristotle( 384Aristotle( 384Aristotle( 384--322)322)

Lasting contribution regarding

consciousness

Wrote extensively on mental disorders

Follows generally the views of

Hippocrates

Middle Ages Middle Ages

the middle eastthe middle east

Islamic countries of the middle east

continued the scientific aspects of Greek

tradition

The first mental hospital was established in

Bagdad in 792 A D

Avicenna of Arabia the outstanding person

Also known as the prince of physicians

Wrote the book Canon of Medicine

Middle agesMiddle ages

EuropeEurope

Largely devoid of scientific thinking and

humane treatment for the mentally disturbed

Supernatural explanations of the causes of

mental illness grew in popularity.

Two events of the times: mass madness and

exorcism.

Mass madness: the widespread occurrence

of behavior disorders that were apparently

cases of hysteria

Whole groups of people were affected simultaneously

Dancing manias( epidemics of raving, jumping, dancing and convulsions) were reported as early as the 10th century

Tarantism: a disorder that included an uncontrollable impulse to dance that was often attributed to the bite of the southern European tarantula or wolf spider

This dancing mania later spread to Germany and to the rest of Europe where it was known as Saint Vituss dance.

Isolated rural areas were also afflicted with outbreaks of lycanthropy- a condition in which people believed themselves to be possessed by wolves and imitated their behavior

Today so called mass hysteria occurs occasionally, the affliction usually mimics some type of physical disorder such as fainting spells or convulsive movements.

Exorcism and witch craftExorcism and witch craft

Management of the mentally disturbed was left largely to the clergy

Monasteries served as refuges and places of confinement

During the early part of the medieval period the mentally disturbed were for the most part, treated with considerable kindness

Exorcism- symbolic acts that are performed to drive out the devil from persons believed to be possessed.

It was usually performed by the gentle laying of hands

Such methods were often joined with vaguely understood medical treatments, derived mainly from Galen.

It had long been thought that during the middle ages, many mentally disturbed people were accused of being witches and thus were punished and often killed.

But several more recent interpretations have questioned the truthfulness of such accusations.

Toward Humanitarian approachesToward Humanitarian approachesToward Humanitarian approachesToward Humanitarian approaches

During the latter part of the middle ages

and the early Renaissance, scientific

questioning reemerged and a movement

called humanism began.

With this the traditional understanding

and therapeutic treatment of mental

disorders began to be challenged.

Paracelsus(1490Paracelsus(1490Paracelsus(1490Paracelsus(1490--1541)1541)

Swiss physician, insisted that the dancing mania was not a possession, but a form of disease that should be treated as such.

Formulated the idea of psychic causes for mental illness and advocated treatment by bodily magnetism later called hypnosis.

although he rejected demonology, his view of abnormal behavior caused by astral influences. Believed that the moon excreted a supernatural influence on human brain (lunatic, lunacy)

Johann Johann WeyerWeyer(1515(1515--1588)1588)

German physician and writer

Deeply disturbed by the imprisonment, torture and burning of people accused of witchcraft

Published Deception of Demons in 1563 which contains a step by step rebuttal of the Malleus Maleficarum, a witch hunting hand book published in 1486 and a call for humane consideration towards those sick persons accused for witchcraft

One of the first physicians to specialize in mental disorders

Can be rightly called the founder of modern Psychopathology

He was scorned by his peers and his works banned by the church

The clergy like St Vincent de Paul(1576-1660) also declared Mental disease is no different to bodily disease and Christianity demands of the humane and powerful to protect, and the skillful to relieve the one as well as the other.

The establishment of early asylums The establishment of early asylums

and shrinesand shrines

The establishment of early asylums The establishment of early asylums

and shrinesand shrines From the 16th century on special

institutions called asylums or places of

refuge for the mentally ill were

established in many countries

E.g.: the Valencia mental hospital founded

by Father Juan Pilberto Jofre, Bedlam,

instituted by Henry VIII in London, the San

Hippolito established in Mexico, La

Maison de Charentone in Paris.

Humanitarian ReformsHumanitarian Reforms

By the late 18th century, most mental

hospitals in Europe and America were in

great need of reform

Philippe Pinel(1745-1826) in France

Pinels experiment in 1792 had

revolutionary effects on the betterment

of patients

William William TukeTuke(1732(1732--1822)1822)

Established the York Retreat in England, a

pleasant country house where mental

patients lived, worked and rested in a

kindly, religious atmosphere. this retreat

represented the culmination of noble

battle against the brutality, ignorance and

indifference of Tukes times.

Rush and Moral Management in Rush and Moral Management in

AmericaAmerica Benjamin Rush(1745-1813) the founder of

American Psychiatry, also one of the signers of the Declaration of Independence, encourages more humane treatment of the mentally ill

Moral management a wide ranging method of treatment that focused on a patients social, individual and occupational needs.

Dix and the Mental hygiene movementDix and the Mental hygiene movement

Dorothea Dix(1802-1887) advocated a method of treatment that focused almost exclusively on the physical wellbeing of hospitalized mental patients.

She is credited with establishing 32 mental hospitals, directed the opening of two large institutions in Canada, and completely reformed the asylum system in Scotland and many other countries

The Military and the mentally illThe Military and the mentally ill

Mental health treatment was also

advanced by military medicine

Psychiatrists, a number of whom made

great contributions to the field of

abnormal Psychology( Emil Kraepelin and

Richard Craft-Ebbing) worked with the

military administration conducting

research and training doctors to detect

mental health problems

Mental Hospital care in the 20Mental Hospital care in the 20thth

CenturyCentury In the first half of 20th century, hospital

care for the mentally ill afforded very little in the way of effective treatment.

In 1946, Mary Jane Ward published a very influential book, The Snake Pit which popularized in a movie of the same time. This work called attention to the plight of mental patients and helped to create concern to provide mental health care in the community

Deinstitutionalization- a movement

included vigorous efforts to close down

mental hospitals and return psychiatrically

disturbed people t the community

ostensibly as a means of providing more

integrated and humane treatment than

was available in the isolated environment

of the psychiatric hospitals

Contemporary views of Abnormal Contemporary views of Abnormal

BehaviorBehavior 1. Biological discoveries

2. The development of classification system

of mental disorders

3. The emergence of psychological

causation views

4. The experimental psychological research

developments

Biological discoveriesBiological discoveries

The disciplines of Anatomy, physiology, Neurology, Chemistry and general medicine advanced their knowledge which led to the identification of the biological or organic pathology underlying many physical ailments

The development of a Psychiatric classification system by Kraepelin played a dominant role in the early development of the biological view point. His works helped to establish the importance of brain pathology in mental disorders

Emergence of psychological Emergence of psychological

causationcausation The first major steps toward

understanding psychological factors in

Mental disorders were taken by Sigmund

Freud. His Psychoanalysis 'emphasized the

inner dynamics of unconscious motives

Other clinicians have modified and revised

Freuds theory which has thus evolved in

to new Psychodynamic perspective

Experimental Psychology Experimental Psychology

developmentsdevelopments The end of the 19th century and the early

20th century saw Experimental Psychology

evolve in to Clinical Psychology with the

development of clinics to study as well as

intervene in abnormal behavior

Two major schools of learning paralleled

this development and behaviorism

emerged as an explanatory model in

Abnormal Psychology

ConclusionConclusion

Understanding the history of Abnormal

Psychology, its forward steps and missteps

alike, helps us understand the emergence

of modern concepts of abnormal

behavior.

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