Abnormality in 1

hour

Defining abnormality

Definitions of Abnormality

Defining a person or behaviour as „abnormal‟ implies

something undesirable and requiring change Therefore,

we must be careful how we use the term

Psychologists need methods for distinguishing „normal‟

from „abnormal‟

Our definition of abnormality must be objective:

– It must not depend on anyone‟s opinion or point of

view

– It should produce the same results whoever applies it

It must not be under- or over-inclusive

– It must not label as „abnormal‟ or „normal‟ behaviours

or traits that aren‟t

Definitions of Abnormality

Three definitions can be asked for in the

examination:

– Deviation from social norms

– Failure to function adequately

– Deviation from ideal mental health

Deviation from Social NormsUnder this definition, a person‟s thinking or behaviour is

classified as abnormal if it violates the (unwritten) rules about

what is expected or acceptable behaviour in a particular social

group.

Their behaviour may:

– Be incomprehensible to others

– Make others feel threatened or

uncomfortable

With this definition, it is necessary to consider:

– The degree to which a norm is violated, the importance of

that norm and the value attached by the social group to

different sorts of violation.

– E.g. is the violation rude, eccentric, abnormal or criminal?

Deviation from Social Norms:

evaluationSocial norms change between cultures and over time.

Consequently, so do people‟s conceptions of abnormality.

– Homosexuality was regarded as a mental illness until

1973, but not any more.

Cross-cultural misunderstandings are common, and may

contribute to e.g. high diagnosis rate of schizophrenia

amongst non-white British people.

Classification of abnormality can only based on the context

in which behaviour occurs

– Same behaviour might be normal or abnormal e.g.

undressing in bathroom or classroom

– A subjective judgement is usually necessary e.g. there

may be situational factors unknown to the observer

Failure to Function AdequatelyUnder this definition, a person is considered abnormal if they

are unable to cope with the demands of everyday life.

They may be unable to perform the behaviours necessary for

day-to-day living e.g. self-care, hold down a job, interact

meaningfully with others, make themselves understood etc.

Rosenhan & Seligman (1989) suggest the following characteristics:

– Suffering

– Maladaptiveness (danger to self)

– Vividness & unconventionality (stands out)

– Unpredictability & loss of control

– Irrationality/incomprehensibility

– Causes observer discomfort

– Violates moral/social standards

Failure to Function Adequately: Evaluation

Adequate functioning is defined largely by social norms and

these norms change through time and culture.

Most people fail to function adequately at some time, but

are not considered „abnormal‟

– After a bereavement most people find it difficult to cope

normally. Ironically, they might actually be considered

more abnormal if they functioned as usual

Many people engage in behaviour that is maladaptive/

harmful or threatening to self, but we don‟t class them as

abnormal

– Adrenaline sports

– Smoking, drinking alcohol

Deviation from Ideal Mental health

Under this definition, rather than defining

what is abnormal, we define what is

normal/ideal and anything that deviates

from this is regarded as abnormal

This requires us to decide on the

characteristics we consider necessary to

mental health

Deviation from Ideal Mental Health

Psychologists vary, but usual characteristics include:

– Positive view of the self

– Capability for growth and development

– Autonomy and independence

– Accurate perception of reality

– Positive friendships and relationships

– Environmental mastery – able to meet the varying demands of day-to-day situations

Deviation from Ideal Mental Health:

Evaluation

What is considered ideal is historically and

culturally specific (see „deviation from

social…‟)

Jahoda‟s and others‟ criteria set the bar

too high.

– Strictly applied, so few people actually meet

these criteria that everyone ends up classed

as abnormal and so the concept becomes

meaningless

Four approaches to

explaining mental disorders.

Psychodynamic approach

Behavioural approach

Cognitive approach

Biological approach

Psychological approaches

For each approach you need...

Assumptions

• Explain the assumptions then link to mental disorders and give an example.

Therapies

• Describe and evaluate the therapies.

• Does it work?

• Is it accessible by everyone?

• Ethical issues?

Evaluation of the approach

• What does it explain well?

• What doesn’t it explain?

• Does it offer effective therapies?

• Does it raise any ethical issues?

Biological approach

Assumptions:

– Abnormality is caused by physical processes.

– Psychological disorders are illnesses or

diseases affecting the nervous system

– Abnormal behaviour, thinking and emotion are

caused by biological dysfunctions

– Understanding mental illness involves

understanding what went wrong with the brain

Biological causes of

abnormality

Brain damage

• . Alzheimer’s disease is caused by degeneration of neurones.

Chemical imbalances

• Low level of serotonin (neurotransmitter) is associated with depression.

Infections

• Clive wearing suffered from viral encephalitis which damaged his hippocampus as a result he could not form new memories.

Genes

• Could code for abnormality in the structure and functioning of the brain i.e. schizophrenia shows a genetic pattern of inheritance.

Biological approach: evaluation

Uses scientific techniques to find evidence such

as objective measurements like brain scans and

blood tests so evidence is valid.

Schizophrenia shows a genetic pattern of

inheritance but environmental factors are also

involved as the concordance rate in MZ twins is

only 46% (should be 100% if it was only genetic).

The changes observed in schizophrenics

(enlarged ventricles) could be the effect rather

than the cause of the disorder as the brain is a

plastic organ which changes depending on the

way we use it.

More evaluationIt does not take into account the early childhood

experience which according to the psychodynamic

approach could cause unconscious conflicts

between the Id, the ego and superego which could

cause abnormal behaviour in later life.

The therapies proposed by the approach (drugs

and ECT) are effective but they are not a cure,

they only control the symptoms.

It does not blame the patient but it disempowers

them as they take a passive role in the treatment

i.e. just take the medication prescribed by the

professionals.

Therapies: ECT

Electro-convulsive therapy:

Patient is relaxed with a sedative.

Electrodes are attached to the temple.

A voltage of 70 – 130 volts is passed

through the brain for half a second.

This produces a convulsion for 1 minute.

Patient awakes and remembers nothing.

2 – 3 sessions a week for 3 – 4 weeks.

Evaluating ECTJohnson stated that 11,000 procedures were carried

out in the UK in 1999.

Can be useful in suppressing depressive symptoms

for up to one year. It is not known how it works.

Can cause temporary memory loss and emotional

side effects such as withdrawal and flatness.

Does not deal with the problem and symptoms

return usually after one year.

Can cause death (4 in 100 000).

Patients cannot give informed consent as they are in

a distressed and confused state, given only when all

other treatments have failed.

Therapies: DrugsAntidepressants: i.e. Prozac, act

by stopping the reuptake of the

serotonin in the synaptic gap.

Antipsychotic drugs: Block the

dopamine receptors (dopamine is

a neurotransmitter which is raised

in schizophrenia).

Drugs: evaluationCan be very effective and allow people to

lead a normal life but they do not cure the

disorder they only control the symptoms so

when the drugs are stopped the symptoms

reappear.

They do not work for all patients,

antipsychotic drugs work only for 50-60% of

schizophrenic patients.

They can have serious side-effects i.e.

antidepressants can be very addictive.

More evaluation..They target the biological changes but do

not change life circumstances, cognitive

biases and daily stressors which might

trigger mental disorders such as

depression.

They are a fairly cheap treatment and can

act fairly quickly; they can be used to

control the symptoms enough to allow the

patient to start psychological therapies

such as CBT or psychoanalysis.

Psychodynamic approach: Assumptions: The

tripartite structure of personality

The earliest part of the human personality

THE ID = the biological part

(instincts & drives)

Present at birth

Motivated by the pleasure principle

The second part of the human

personality to develop

THE EGO (the ‘self’) 1 - 3 years

Motivated by the reality

principle

The third part of the human

personality to develop

THE SUPEREGO (the moral part)

3 - 5 years

Motivated by the morality principle

The UnconsciousThe conscious. The small

amount of mental activity

we know about.

The preconscious. Things

we could be aware of if we

wanted or tried.

The unconscious. Things

we are unaware of and can

not become aware of.

Thoughts

Perceptions

Memories

Stored knowledge

Fears

Unacceptable sexual desires

Violent motives

Irrational wishes

Immoral urges

Selfish needs

Shameful experiences

Traumatic experiences

Bad

Worse

Really Bad

Explanation of abnormal behaviour

According to the psychodynamic approach

abnormality is caused by unconscious conflicts

between the Id, the superego and the ego. A

consequence of these conflicts is anxiety. In order

to protect itself against this the ego uses defence

mechanisms i.e. repression, displacement, denial.

If these defence mechanisms are unsuccessful

this anxiety seep through to the conscious mind

and creates mental disorders such as phobias.

These conflicts originate mainly in early childhood

while the child goes through the psychosexual

stages of development.

Schizophrenia is explained as a

regression to the oral stage when the ego

(which operates on the reality principle) is

developing and the Id is dominant. The

weak ego explains the lack of grasp of

reality in schizophrenics.

Anorexia is explained by repressing fear of

sexual activities, by not eating the girls aim

at retaining their child physic thus avoiding

sexualisation.

EvaluationThis theory is almost impossible to test scientifically and the support

for the theory consist mainly of case studies carried out on upper-

class Austrian women, the sample does not represent the wider

population therefore the results cannot be generalised. They are not

replicable so the results are not reliable. They are high in ecological

validity the patients were real people in a real therapeutic situations.

The interpretation of the data was done by Freud so it might have

been biased.

This theory was the first theory which took into account the

childhood experiences as a possible cause of mental disorders.

This approach was the first to propose a “talking” cure which

changed the way mental patients were treated.

It does not explain the biological factors such as enlarged ventricles

in schizophrenics but they could be the effect rather than the cause

of the disorder as the brain is a plastic organ which changes

depending on the way we use it.

TherapyPsychoanalysis: its aim is to bring the unconscious

conflicts to the conscious mind where they can be dealt

with.

It uses two main strategies

1. Free association: Client is asked to talk about anything

that comes to mind and the therapist writes this down

and then later analysis the content to reveal repressed

desires. The client is made aware of this to then

overcome them.

2. Dream analysis: Client is asked to talk about dreams

(manifest content) the therapist then interprets the

hidden meaning (latent content) and makes client aware

of this so they can overcome repressed issues

EvaluationUses retrospective data (from childhood), this can

be inaccurate because people might have forgotten

and it can be distorted by schemas.

It may take a long time; sometimes years so is not

appropriate in cases when urgent intervention is

required (i.e. suicidal patients).

It is very expensive and rarely available in its original

form on the NHS, this limits access.

People with mental disorders such as schizophrenia

might not have the necessary insight to take part in

the treatment.

Can be very unethical to bring up repressed

memories as they can be painful.

Behavioural approachAssumptions:

Abnormal behaviour like any other behaviour is learned from the

environment.

Behaviour can be learned in 3 ways:

1. Classical conditioning: learning by association i.e. phobia UCS: bite

UCR: fear NS: dog, pairing dog and bite, dog becomes the CS, CR:

fear (phobia: the dog elicits the fear response).

2. Operant conditioning: learning by consequences i.e. depression. A

person displays depressed behaviour others shows sympathy

(positive reinforcement) and are likely to let them off their normal

duties (negative reinforcement) so the behaviour will be repeated

as it has been reinforced.

3. Social learning: learning by imitation i.e. anorexia. Young girls see

very thin models being praised and getting attention and money

(reinforcements) they try to get as thin as these models to get the

same reinforcements.

BANG

BANG

Rat: NS

Noise: UCS)

Fear: UCR

Pairing Rat: NS

Noise: UCS)

Fear: UCR

After conditioning

Rat: CS

Fear: CR

Classical conditioning: Learning a phobia

Evaluation of the behavioural

approachThis approach can offer satisfactory explanations for

some disorders such as phobias and eating disorders.

However many people have phobias of objects they

have never met (i.e. snakes) these cannot be explained

by classical conditioning. These could be due to

evolution.

It does not explain the biological factors such as

enlarged ventricles in schizophrenics but they could be

the effect rather than the cause of the disorder as the

brain is a plastic organ which changes depending on the

way we use it.

More evaluation....

It does not take into account the early childhood

experience which according to the psychodynamic

approach could cause unconscious conflicts between the

Id, the ego and superego which could cause abnormal

behaviour in later life.

Treatments based on the behavioural approach such as

systematic desensitisation can be very effective for

disorders such as phobias.

It does not take into account cognitive factors such as

cognitive biases i.e. even when severely underweighted,

anorexic see themselves as overweight.

TherapiesAs the assumption of the behavioural

approach is that abnormal behaviour is

learned, the aim of the therapies it

proposes is to “unlearn” the abnormal

behaviour and replace it by a normal

behaviour.

Systematic desensitisation aims at

“unlearning” the association between the

phobic abject and fear to replace it by a

new association between the object and a

state of relaxation.

Systematic desensitisationIt is a step by step

approach

The client learns relaxation

techniques

The client works out a hierarchy of

fear from the least frightening to the

most frightening

Fur Paw

Dog Mouth

The client works

through the hierarchy

learning to use

relaxation techniques

in the presence of the

feared object

EvaluationIt can be very effective in the treatment of some phobias (60-

90% for spider phobias) but it does not seem so effective with

social phobias or phobias of objects or situations which relate

to evolution.

Once the phobia is improved it may be replace by another

phobia or another form of anxiety disorder which suggests

that phobias might have a deeper psychological cause.

It is an expensive treatment as it is carried out by a qualified

clinical psychologist so it is not accessible to everybody.

It requires 6-8 sessions for moderate phobias, more for strong

phobias so it requires commitment from the patient.

It does not address psychological factors for example the

psychodynamic approach argues that phobias are due to an

unconscious conflict and the phobic object is a symbol of the

real object of fear.

Basic assumptions

Emotional problems can be attributed

directly to distortions (maladaptive thoughts) in our

thinking processes.

These maladaptive thoughts usually take

place automatically and without full

awareness.

Examples of Cognitive Biases that may be used by people with

Depression

Cognitive Bias Explanation

Minimisation The bias towards minimising success in

life.

Maximisation The bias towards maximising the importance of even trivial failures.

Selective Abstraction A bias towards focusing on only the

negative aspects of life and ignoring

the wider picture

All or nothing Thinking A tendency to see life in terms of black

and white and ignoring the middle

ground; you are a success or a failure,

rather than not good at some things

but OK at others.

Ellis’s ABC ModelActivating events (A) have consequences

(C) which are affected by beliefs (B).It is not the event which

creates the problem, it is

the way you think about it

An example...Sally and Clive split

up

Activating

event

Rational thoughts

“we were not compatible”

Irrational thoughts

“It‟s my fault, nobody can ever

love me, all my relationships will

fail”

Beliefs

Consequences

Desirable emotions

“ I am sad but next time it

will work out”

Undesirable emotions

“ I feel so guilty, I am

unlovable”

Desirable behaviour

“ I have learned from this,

Lets go out”

Undesirable behaviour

“ I‟ll never have another

relationship. It hurts too

much”

Evaluating the cognitive approach

as an explanation of abnormality

It does not take into account biological factors

such as enlarged ventricles in schizophrenics

(but...)or genetic factors.

It suggests that it is the patient who is at fault

rather than the situation in which they are.

A disorder such as depression can change

the way we think so the faulty thinking might

be the effect rather than the cause of the

disorder

More evaluation

It does not account for the cause of the

faulty thinking (i.e. early childhood

experiences)

Some irrational beliefs are quite realistic

(Alloy & Abrahmson, 1979)

There is clear evidence for cognitive

biases and dysfunctional thinking and

beliefs in disorders such as depression

and anxiety disorders.

Let summarise....

Negative

schemata about

the self, the world

and the futureCognitive

bias

So what should the therapist

target?

disputes

Rational-Emotive-Behaviour Therapy (a form of CBT)

Helps the patient identify the maladaptive thoughts and the consequences of thinking in this wayThe therapist the beliefs and tries to show that they are not true i.e. the client does not always fail in all relationshipsThe client and the therapist set goals to think in a more adaptive way i.e. focus on the client’s success and trying to build on those.The treatment focuses on the present situation, looking back to the past only when it can be useful i.e. to learn from it

disputes

Logical disputing:Does it make sense?

Empirical

disputing:Is it consistent with

reality?

Pragmatic

disputing:Is this belief/attitude

helpful in the client‟s life?

Evaluation of the REBT

Suitable for treating a wide range of mental disorder

Gives the individual responsibility for their treatment

Less time consuming than psychoanalysis but how does it compare with the biological approach therapies?

Evidence to support CBT use for depression

Is it accessible to everyone?

Ethics?