Abnormality

Anlagen:

• Definitions of Abnormality

1. Deviation from Social Norms
   1. People who behave in a socially deviant way are considered anti social and undesirable, therefore abnormal, by the rest of the group.
   2. Limitations
      1. Context and Degree
         1. Judgement of deviance is dependent on the context of the behaviour.
         2. No clear line between deviance and harmless eccentricity.
      2. Cultural Relativism
         1. No universal standards for labelling a behaviour as abnormal.
2. Failure to Function Adequately
   1. When people cannot cope with their day to day living they can be labelled as abnormal.
   2. Limitations
      1. Adaptive or Maladaptive?
         1. Some behaviours that appear dysfunctional or abnormal may be adaptive for the individual.
      2. Cultural Relativism
         1. Different diagnoses of failure to function adequately between cultures, one culture's standards being used to measure anothers.
3. Deviation from Ideal Mental Health
   1. Jahoda - 6 Charachteristics
      1. Self-attitudes
         1. High self esteem and strong sense of identity.
      2. Personal growth and self actualisation
         1. Individual develops their full capabilities.
      3. Integration
         1. Able to cope with stressful situations.
      4. Autonomy
         1. Independent and self-regulating.
      5. Accurate perception of reality
      6. Mastery of the environment
         1. Ability to love,function at work, have interpersonal relations, adjust to new situations and solve problems.
   2. Limitations
      1. Who Can Achieve All of These Criteria?
         1. Suggests that all of us are abnormal to some degree.
      2. Cultural Relativism
         1. Criteria can't be applied to all cultures.
         2. Self-actualisation is relevant to individualist cultures but not necessarily collectivist cultures.

Anlagen:

• Biological Approach

1. Abnormality is Caused by Physical Factors
   1. Mental disorders are related to physical change, illness or dysfunction in the body.
   2. Genetic Inheritance
      1. Abnormalities in neuroanatomy or neurochemistry are a product of genetic inheritance.
      2. Can be shown by concordance rates, if twins display high concordance rates for mental disorder it suggest genetic influence.
2. Viral Infection
   1. Mothers of some schizophrenics contracted influenza during pregnancy. Thought to enter the child's brain and remain dormant until puberty.
3. Neuroanatomy and Neurochemistry
   1. Abnormalities in brain structure may determine abnormality.
      1. Some schizophrenics have large ventricles in their brain.
   2. Altered brain chemistry can lead to abnormal behaviour.
      1. Low levels of serotonin in the brain of individuals suffering from depression.
4. Limitations
   1. Humane or Inhumane?
      1. Szasz - the concept of 'mental illness' was created to control individuals who society could not accept.
   2. Inconclusive Evidence
      1. If mental disorder caused by genetic factors alone concordance rates would be 100%.
      2. Twin studies of schizophrenia, concordance rates 50%. Might inherit vulnerability to disorder which only develops under certain stressful conditions.
   3. Cause or Effect?
      1. No causal relationship between biological influence and mental disorder.
      2. Schizophrenics large ventricles in brain, they may be caused by schizophrenia rather than cause it.

Anlagen:

• Psychodynamic Approach

1. Mental Disorders Have Psychological Causes
   1. Freud - mental disorders are not caused physically but by unresolved childhood conflicts.
   2. Conflicts between the id, ego and superego create anxiety.
      1. Id - irrational, primitive part of personality. Ruled by the pleasure principle.
      2. Ego - conscious, rational part of personality. Governed by the reality principle.
      3. Superego - embodies our conscience with ideas of right and wrong, as well as notions of the ideal self.
   3. Ego defences relieve anxiety.
      1. Repression
         1. Moving unpleasant thoughts into the unconscious.
      2. Projection
         1. Blaming someone else for something a child cannot deal with.
      3. Regression
         1. Behaving like a child when faced with a difficult situation.
2. Early Experiences Cause Mental Disorder
   1. In childhood the ego is not developed enough to deal with traumas leading to repression of associated emotions.
   2. Individual may re-experience the earlier trauma later in life, leading to depression.
3. Unconscious Motivations
   1. Underlying problems cannot be controlled until brought into conscious awareness.
4. Limitations
   1. Abstract Concepts
      1. Id, ego and superego are hard to demostrate through research. unconscious, know way to know they are operating at all.
   2. Lack of Research Support
      1. Fisher and Greenberg - 2500 experimental studies of Freudian hypotheses, many of Freud's major claims received support. -ve results used as support.
   3. Sexism
      1. Freud's theory is sexually unbalanced. Limits the relevance of approach to understanding development of mental disorders for women.

Anlagen:

• Behavioural Approach

1. Only Behaviour is Important
   1. Focuses only on behaviours; the observable responses a person makes to the environment.
   2. Examples
      1. OCD might be displayed by compulsive behaviours such as constant hand washing.
      2. Someone with a phobia may display extreme anxiety in presence of phobic object.
2. Abnormal Behaviours are Learned
   1. Operant Conditioning
      1. Psychological disorder might be produced when a maladaptive behaviour (such as panic attacks) lead to the desired increased attention.
   2. Social Learning Theory
      1. Abnormal behaviours may be acquired by seeing others rewarded for the same behaviours.
3. Learning Environments
   1. Environments in which behaviours are learned may reinforce maladaptive behaviours.
   2. Examples
      1. For an individual with agoraphobia, not leaving home lowers anxiety.
      2. For those with depression, depressive behaviours may elicit help from others.
4. Limitations
   1. Limited View
      1. Limited view of factors which cause abnormality. Ignore role of physiological and cognitive factors.
   2. Counter Evidence
      1. Struggles explain why people with phobias cannot recall an incident in their past which led to traumatic conditioning.
   3. Symptoms not the Cause
      1. Therapies only treat symptoms not the cause. Cause can resurface, often in a different form.

Anlagen:

• Cognitive Approach

1. Abnormality is Caused by Faulty Thinking.
   1. Assumes that thinking, expectations and attitudes direct behaviour.
   2. Mental illness is the result of cognitive distortions in the way a person thinks about a problem.
   3. Faulty and irrational thinking prevents the individual behaving adaptively.
2. A-B-C Model (Ellis, 1962)
   1. A - activating event
   2. B - belief (may be rational or irrational)
   3. C - consequence (rational beliefs lead to healthy emotions, irrational beliefs lead to unhealthy emotions)
3. Individual is in Control
   1. Individual is the cause of their own behaviour as they control their own thoughts. Abnormality is result of faulty control of this process.
4. Limitations
   1. Blames the Patient
      1. Overlooks situational factors, such as life stressors. Recovery only involves changing the way patient thinks about stressors, not removing them.
   2. Consequence Rather than Cause
      1. Individual might develop way of thinking because of their disorder.
      2. Individuals with maladaptive cognitions may be at greater risk of developing mental disorders.
   3. Irrational Beliefs may be Realistic
      1. Alloy & Abrahmson - people with depression have more realistic view of the world. Gave more accurate estimates of likelihood of disaster.

Anlagen:

• Biological Therapies

1. Drugs
   1. Antipsychotics
      1. Used to combat symptoms of psychotic illnesses such as Schizophrenia.
      2. Conventional antipsychotics block transmission of dopamine, and so alleviate many symptoms of the disorder.
   2. Antidepressants
      1. SSRIs block the transporter mechanism which reabsorbs serotonin into the nerve cell prolonging its activity and relieving the symptoms of depression.
   3. Anti-anxiety
      1. Benzodiazepines reduce anxiety by slowing down the central nervous system.
      2. Beta-blockers reduce anxiety by reducing the activity of adrenaline and noradrenaline, part of the body's response to stress.
   4. Evaluation
      1. Strengths
         1. Effectiveness
            1. Chemotherapies work when compared to placebo. However, drug alone is less effective than when combined with psychological therapies.
         2. Ease of Use
            1. Require little effort from patient, more motivated to continue treatment than time consuming psychological treatments.
      2. Limitations
         1. Symptoms not Cause
            1. When patient stops taking drugs, effectiveness ceases and symptoms return.
         2. Side Effects
            1. Patients stop taking medication as they cannot cope with side effects.
            2. SSRIs cause nausea or even suicidal thoughts.
2. ECT
   1. Generally used for severely depressed patients for whom psychotherapy and drugs don't work.
   2. How it Works
      1. Small current lasting about half a second is passed through the brain. Produces a seizure, which affects the whole brain.
   3. Why it Works
      1. Affects action of neurotransmitters, recovery from depression may be due to improved communication between different parts of the brain.
   4. Evaluation
      1. Strength
         1. Saves Lives
            1. Can be effective treatment for severe depression which may otherwise lead to suicide.
         2. Effectiveness
            1. Comer - 60-70% of ECT patients improve after treatment, critics claim 84% relapse within 6 months.
      2. Limitations
         1. Sham ECT
            1. Some sham patients recover, suggesting that attention plays a part in recovery.
         2. Side Effects
            1. Include impaired memory, cardiovascular problems and headaches. DOH found 30% had permanent fear or anxiety after.

Anlagen:

• Psychological Therapies

1. Systematic Desensitisation
   1. Used to treat anxiety, particularly phobias.
   2. How it Works
      1. Patient taught how to relax using relaxation techniques.
         1. Create hierarchy of scenes each causing more anxiety than the previous.
            1. Works through the hierarchy gradually.
               1. Two responses of relaxation and fear are incompatible and fear is eventually dispelled.
                  1. Client can imagine feared situation or be in presence of phobic stimulus.
   3. Evaluation
      1. Strengths
         1. Appropriateness
            1. Relatively quick and require less effort from patient, more likely to continue.
            2. Can be self-administered using computer simulation, makes delivery of treatment even more efficient for patient.
         2. Effectiveness
            1. Capafons et al - people with aerophobia had less anxiety compared to control group and showed less physiological signs of fear.
            2. McGrath et al - estimated that SD is effective with 75% of patients with phobias.
      2. Limitations
         1. Symptom Substitution
            1. Doesn't deal with cause of anxiety, other symptoms can appear later on. Langevin - no evidence support.
         2. Not Universally Effective
            1. Less effective with treating anxiety with underlying adaptive component (e.g. dangerous animal) than if personal. 'Ancient' fears helped ancestors.
2. Cognitive Behavioural Therapy
   1. CBTs such as REBT are based on the idea that many problems are a result of irrational thinking.
      1. Rational-emotive behaviour therapy (REBT) helps people change dysfunctional emotions into behaviours.
   2. How it Works
      1. Based on ABC model, tries to change irrational beliefs into more rational ones.
      2. Patient is encouraged to dispute self-defeating beliefs.
      3. Change achieved through...
         1. Logical disputing
            1. Showing that beliefs do not follow logically from info available.
         2. Empirical disputing
            1. Showing beliefs are not consistent with reality.
         3. Pragmatic disputing
            1. Showing the lack of usefulness of existing beliefs.
      4. Extends ABC model - disputing (D), a more effective attitude to life (E) and a new set of feelings (F).
   3. Evaluation
      1. Strengths
         1. Appropriateness
            1. REBT usefulness not limited to people with mental disorders but also to non-clinical population, e.g. exam anxiety.
            2. Yoichi et al - developed computer based counselling programme based on REBT that has produced significant decreases in anxiety.
         2. Effectiveness
            1. Engels et al - meta-analysis found REBT more effective in treatment of different types of disorder and more effective than SD or others.
      2. Limitations
         1. Irrational Environments
            1. REBT fails to address irrational environments which may exist beyond the therapeutic situation which reinforces maladaptive behaviour.
         2. Not Suitable for All
            1. REBT doesn't always work and some people dislike the direct advice or fail to put principles into practice.
         3. Ethics
            1. Disputing what appears to be an irrational belief may create difficulties for client for whom the belief is based on a fundamental religious belief.
3. Psychoanalysis
   1. Behaviour is influenced by repressed memories, psychoanalysis traces influences to their origins and help patient deal with them.
   2. How it Works
      1. Free Association
         1. Patient expresses thoughts as they occur, even if seemingly unimportant. Reveals areas of conflict to bring repressed memories to the conscious.
      2. Therapist Interpretation
         1. Therapist draws conclusions about possible causes. Patient displays resistance or transference, where they recreate feelings associated with problems.
      3. Working Through
         1. Patient and therapist examine same issues repeatedly to gain clarity of causes. Freud believed this produced greatest changes in the patient.
   3. Evaluation
      1. Strengths
         1. Effectiveness
            1. Bergin - analysis of 10,000 patient histories estimated that 80% benefitted compared to 60% who received different approaches.
         2. Length of Treatment
            1. Tschuschke et al - 450 patients, found that psychodynamic therapies more effective in long term. The longer the treatment, the better the outcomes.
      2. Limitations
         1. No Better than Placebos
            1. Eysenck - failure of Freudian therapy to improve on spontaneous remission or placebo treatment proves inadequacy of Freudian theory.
         2. Appropriateness
            1. Freud failed to appreciate individual differences, therapies are not adjusted to suit the individual.
         3. False Memories
            1. Critics claim that some therapists are unwittingly planting false memories of sexual abuse or abduction.
            2. Can't assume patient can reliably recall early memories that have been repressed.