Abnormality

Abnormality

Definitions of Abnormality
1. Deviation from Social Norms
  1. Standards of acceptable behaviour are set by a social group (i.e social norms)
  2. Anything that deviates from acceptable behaviour is considered abnormal
  3. What is acceptable may change over time
  4. Limitations
    1. Susceptible to abuse, e.g excluding nonconformists or political dissenters
    2. Deviance is hard to identify because it is related to context and degree
    3. Cultural Relativism- DSM includes culture bound syndromes, acknowledging cultural differences in what is considered 'normal'
2. Failure to Function
  1. Not being able to cope with the demands of everyday life e.g got to work, eat in public, wash
  2. Abnormal behaviour interferes with day-to-day living
  3. Individual judges when their behaviour becomes 'abnormal'
  4. Limitations
    1. Who judges? Patient may feel quite content even when their behaviour is clearly dysfunctional
    2. Apparently dysfunctional behaviour may sometimes be adaptive e.g depression elicits help from others
    3. Cultural Relativism- what is considered 'adequate' differs from culture to culture so may result in different diagnoses when applied across cultures
3. Deviation from Ideal Mental Health
  1. Jahoda: suggested using the same criteria as for physical illness, i.e absence of signs of health
  2. Six categories: self attitudes, self actualisation, integration, autonomy, accurate perception of reality, mastery of environment
  3. Limitations
    1. A matter of degree- few people experience all these positive criteria, therefore would be considered 'abnormal'
    2. Mental illnesses do not always have physical causes, so are not the same as physical illness
    3. Cultural Relativism- Jahoda: her criteria reflects individualist cultural ideals, e.g autonomy
Treating Abnormality- Biological Therapies:
1. Drugs
  1. Conventional antipsychotics used to combat the positive symptoms of schizophrenia.
    1. They work by blocking the action of dopamine in the brain
  2. Antidepressants increase availability of serotonin e.g by blocking its reabsorption (SSRIs)
  3. Anti-anxiety drugs e.g BZz increase effect of GABA
  4. Strengths
    1. Effective e.g better than placebos in treatment of schizophrenia
    2. Relatively easy to use
    3. Best used in conjunction with psychotherapy
  5. Limitations
    1. Kirsch et al: placebo just as effective
    2. tackles symptoms not problem
    3. Side effects e.g SSRIs linked to anxiety or increased aggression
2. ECT
  1. Used for severe depression
  2. unconscious, relaxed patient given 0.6 amps for 1/2 sec seizure
  3. 3-15 treatments
  4. Unilateral/bilateral
  5. not clear why it works, may alter action of neurotransmitters
  6. Strengths
    1. can prevent suicide, benefits greater than risk
    2. Comer: effective, 60-70% patients improve
      1. Sackheim et al: claims 84% relapse within 6 months
  7. Limitations
    1. some patients recover even with 'sham' ECT, suggesting extra attention's important
    2. Sde effects e.g memory loss + increased levels of fear + anxiety
  8. Ethics
    1. 50% of patients not well-informed about procedure
Treating Abnormality- Psychological Therapies
1. SD- Systematic De-sensitisation
  1. Developed by Wolpe (1950)
    1. form of CBT used to treat phobias and axiety
  2. How does it work? gradual exposed to or imagines the threatening situation under relaxed conditions until anxiety reaction is gone
  3. Why does it work? the 2 responses of relaxation and fear are incompatible, therefore you can't be relaxed and still fearful
  4. Evolution: Early days, patients directly confront fear, recently patient simply imagines the source of anxiety
  5. Evaluation
    1. Strengths
      1. Quick + little effort
      2. Only option e.g learning difficulties
      3. Research shows it's successful
      4. McGrath et al (1990): 75% patients with phobias respond
      5. Capafons et al (1998): those who underwent it reported lower levels of fear compared to control group
    2. Limitations
      1. 'Symptom Substitution
      2. May appear to resolve but suppressing symptoms may present others
      3. Ohman et al (1975): not effective in phobias related to evolution e.g heights/dark/dangerous animals
      4. ethical issues- psychologically distressing
2. CBT- Cognitive Behavioural Therapy
  1. Ellis (1957): developed REBT a form of CBT
  2. What does it do? helps client understand irrationality and helps them substitute it
  3. How does it work? Tries to change self-defeating thoughts and so make people happier and less anxious
  4. How does it work? ABCDEF model
    1. D- disputing irrational beliefs
    2. E- new Effects the patient wishes to achieve
    3. F- Further action e.g homework, deliberately attracting intolerable events
  5. Evaluation
    1. Strengths
      1. Engles (1993): meta analysis, shows it effective e.g OCD + social phobia
      2. Useful in variety of settings e.g clinical populations + non
      3. evidence long term effects are better than of drugs
      4. cost effective + quicker
      5. no side effects
      6. in conjunction with drugs- less chance of relapse
    2. Limitations
      1. Irrational environments
      2. only works if patient is willing
      3. Ethical issues, telling someone their belief is faulty
      4. no object to measure improvement
3. Psychoanalysis
  1. 1: Free association
    1. how? patient expresses thoughts exactly how they occur
    2. Why? Freud believed they linked to unconscious factors
  2. 2: Therapist Interpretation
    1. therapist listens to patients listening for clues and causes
    2. Shares interpretations with patient
    3. patients often resist by recreating feelings and conflicts and transfer onto therapist
  3. 3: Working Through
    1. discuss reasons for problems + find ways to improve situation
    2. not brief- meet up 5 times a week for months/years
  4. 4: Insight
    1. patient gets understanding of unconscious motivations for abnormal behaviour
    2. allows them to overcome it without transfer
  5. Evaluation
    1. Strengths
      1. Bergin (1971): 10,000 patient histories, estimated 80% benefited compared to eclectic
      2. Tschuchke et al (2007): 450 patients, found longer the treatment, better the outcomes
    2. Limitations
      1. Based on Freuds theory- could be wrong?
      2. Eysenck (1986):countered by spontaneous remission and placebo treatment
      3. could lead to creation of false memories
      4. too much reliance on memory- Loftus (1995) proves its not reliable
      5. Ethical issues- distressing material
Psychological Approaches to Psychopathology
1. Psychodynammic
  1. The Mind:
    1. conflicts occur between ids desire for immediate gratifications and superegos desire to maintain moral standards and ideals
    2. If conflicts are unsettled it may cause abnormality
    3. Conflicts can cause anxiety and the ego defends itself using defence mechanisms
  2. Defence Mechanisms
    1. Repression: burying traumatic memories in the unconscious, therefore not remembering the event
    2. Displacement: unconsciously moving impulses away from a threatening situation to a less threatening object
    3. Projection: unconsciously attributing your own undesirable characteristics onto others
  3. Psychosexual Development
    1. Oral: obtaining satisfaction orally i.e. eating
      1. Problems: Teething, weaning
    2. Anal: obtaining satisfaction anally i.e. withholding and expelling faeces
      1. Problems: Toilet training
    3. Phallic: genitals are a key source of satisfaction
      1. Problems: Oedipus complex
    4. Latent: sexuality repressed, girls and boys spend little time together
      1. Problems: Bullying
    5. Genital: Sexual pleasure in genitals
    6. Major conflicts over gratifications in one or more stages may result in mental disorder
      1. in times of stress a person may regress to an earlier stage, this is called fixation.
      2. missing a stage can also cause mental disturbance
  4. Evaluation
    1. Strengths
      1. highlights psychology in mental illness
      2. identifies childhood experience as a factor
      3. reduces blame from the person
    2. Limitations
      1. over emphasis on past
      2. non-scientific
      3. ignores culture and social factors
      4. Assumes behaviour isdefined by sex and gender
      5. false memory syndrome
2. Cognitive
  1. Abnormality is caused by faulty and irrational cognitive processes
    1. These thoughts are normally automatic, so are difficult to ignore and illogical or irrational
    2. most often applied to patient with anxiety and depression
  2. Beck (1976): identified the term cognitive triad to refer to a cycle of unusually negative thoughts in depressed patients
    1. The self, future, world
  3. Ellis (1962): developed ABC model
    1. A-activiating event
    2. B-belief
    3. C-consequences
    4. this approach suggested that there is faulty or irrational thinking linking these three parts of the model
  4. Evalutation
    1. Strengths
      1. focuses on peoples experiences and feelings
      2. gives person responsibility to increase power and change
    2. Limitations
      1. limited to certain mental disorders
      2. ignores other possible causes
      3. no causal relationship
      4. ethics, telling a person their beliefs are faulty
      5. implies the person is responsible

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