comerfund9e_lectureslides_ch01.pptx

Abnormal :
Past and Present
Chapter 1
Fundamentals of Abnormal
RONALD J. COMER | JONATHAN S. COMER| ninth edition

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Abnormal : Past and Present
Abnormal psychology
Scientific study of abnormal behavior in an effort to describe, predict, explain, and change abnormal patterns of functioning
Many definitions have been proposed, yet none has won total acceptance

Workers in the field may be:
Clinical scientists
Clinical practitioners

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In a Word

When did these and similar words (including slang terms) make their debut in print as expressions of psychological dysfunction?

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What Is Psychological Abnormality?
Common feature across definitions
The Four Ds
Deviance
Distress
Dysfunction
Danger
Influences
Norms
Culture
Context

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The Elusive Nature of Abnormality (part 1)
Abnormality is defined by general criteria in society.
Criteria are used to judge particular cases.
Szasz posits that societal involvement may invalidate the concept of mental illness.
Any definition of abnormality may be unable to be applied consistently.

Szaz:
Deviations called “abnormal” are only “problems of living.”
Societies invent the concept of mental illness to better control or change people who threaten the social order.
In short, although abnormality generally is defined as behavior that is deviant, distressful, dysfunctional, and sometimes dangerous, these criteria often are vague and subjective.
Few categories of abnormality are as clear-cut as they seem; most continue to be debated by clinicians.

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The Elusive Nature of Abnormality (part 2)

Which behaviors fit the criteria of deviant, distressful, dysfunctional, or dangerous, but would not be considered abnormal by most people?

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What Is Treatment? (part 1)
Treatment or therapy
Procedure designed to change abnormal behavior into more normal behavior
Definitional challenges closely related to defining abnormality

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What Is Treatment? (part 2)
Essential features of all therapy forms
Sufferer or patient
Trained, socially accepted healer or therapist
Series of therapeutic contacts between the healer and the sufferer
Despite their differences, most clinicians agree that large numbers of people need therapy of one kind or another

A sufferer who seeks relief from the healer
A trained, socially accepted healer, whose expertise is accepted by the sufferer and his or her social group
A series of contacts between the healer and the sufferer, through which the healer tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior
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How Was Abnormality Viewed and Treated in the Past?
Every society, past and present, has witnessed psychological abnormality.
Many present-day ideas and treatments have roots in the past.

Ancient Views and Treatments
Ancient societies
Probably regarded abnormal behavior as the work of evil spirits
May have begun as far back as the Stone Age
Treatment
Trephination and exorcism

Treatment for severe abnormality was to force demons from the body through trephination and exorcism.

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Greek and Roman Views and Treatments
500 b.c. to 500 a.d.
Philosophers and physicians offered different explanations and treatments for abnormal behaviors
Hippocrates believed and taught that illnesses had natural causes; four humors
Treatment
Quiet life
Vegetable diet
Temperance
Exercise
Celibacy
Bleeding

Humors: yellow bile, black bile, blood, and phlegm
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Europe in the Middle Ages: Demonology Returns
500–1350 a.d.
Church rejected scientific forms of investigation and controlled all education
Mental disorders had demonic causes; mass madness; shared delusions and hallucinations
At the close of the Middle Ages, demonology and its methods began to lose favor again
Treatment
Exorcism
Torture
Gradually hospitalization

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The Renaissance and the Rise of Asylums
1400–1700 a.d.
With increased scientific knowledge, demonological views of abnormality continued to decline
Weyer was the first mental health physician; believed that the mind was as susceptible to sickness as the body

Care at religious shrines (e.g., Gheel) was the precursor of community health programs
Asylums emerged by the mid-sixteenth century

Asylum crib

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The Nineteenth Century: Reform and
Moral Treatment
Nineteenth century
Care of people with mental disorders began to improve
Pinel (France) and Tuke (England)
Advocated moral treatment that emphasized humane and respectful techniques
Moral treatment movement ended in the United States and Europe by the early twentieth century

Benjamin Rush (father of American psychiatry) and Dorothea Dix (Boston schoolteacher)
Promoted moral treatment in the United States
Movement disintegrated in the late nineteenth century; mental hospitals warehoused inmates and provided minimal care

By the end of the nineteenth century, several factors led to a reversal of the moral treatment movement:
Money and staff shortages
Declining recovery rates
Overcrowding
Emergence of prejudice
By the early years of the twentieth century, the moral treatment movement had ground to a halt; long-term hospitalization became the rule once again.

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The Early Twentieth Century: Dual Perspectives (part 1)
Somatogenic perspective
Abnormal functioning has physical causes
Two factors responsible for the rebirth of this perspective
Emil Kraepelin: Physical factors are responsible for mental dysfunction
New biological discoveries linked such things as untreated syphilis and general paresis
Results were generally disappointing until effective medication was developed

The Early Twentieth Century: Dual Perspectives (part 2)
Psychogenic perspective
Abnormal functioning has psychological causes
Rise in popularity based on work with hypnotism
Mesmer: Hysterical disorders
Freud: Psychoanalysis; outpatient therapy
Psychoanalytic theory and treatment became widely accepted

Recent Decades and Current Trends
Negative public attitudes still exist, but there have been major changes in the last 60 years in the ways clinicians understand and treat abnormal functioning:
More theories and treatment types
More research and information
More disagreements about abnormal functioning

Survey: 43% of people believe that people bring mental health disorders upon themselves; 35% consider mental health disorders to be caused by sinful behavior.

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How Are People with Severe Disturbances Cared For?
New psychotropic medications discovered in 1950s
Antipsychotic drugs
Antidepressant drugs
Antianxiety drugs
Led to deinstitutionalization and rise in outpatient care

The Impact of Deinstitutionalization
Psychotropic medications: Drugs that mainly affect the brain and reduce many symptoms of mental dysfunction.
The number of patients (around 42,000) now hospitalized in public mental hospitals in the United States is a small fraction of the number hospitalized in 1955. (Information from Lang, 1999; Smith & Milazzo-Sayre, 2014; Torrey, 2001.)
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How Are People with Severe Disturbances Treated?
Before 1950
Almost all outpatient care took the form of private psychotherapy
Today
Outpatient care is the primary mode of treatment; more insurance coverage
Prevention programs are increasing; positive psychology has grown
Programs dealing with one kind of psychological problem have been created

Multicultural
A new area of study that emerged in response to the growing diversity of the United States
Multicultural psychologists seek to understand how culture, race, ethnicity, gender, and similar factors affect behavior and thought and how people of different cultures, races, and genders may differ psychologically

The Increasing Influence of Insurance Coverage
Today the dominant form of insurance coverage is the managed care program, in which the insurance company determines key care issues
The dominant form of insurance for people in the United States consists of managed care programs
Reimbursements for mental disorders tend to be lower than those for medical disorders
In 2008, a federal parity law went into effect; in 2014, the Affordable Care Act (ACT) went into effect

In 2011, a federal parity law went into effect.
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What Are Today’s Leading Theories and Professions? (part 1)
Numerous theoretical perspectives
Psychoanalytic
Biological
Cognitive-behavioral
Humanistic-existential
Sociocultural
Developmental psychopathology
No single perspective dominates the clinical field

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What Are Today’s Leading Theories and Professions? (part 2)
A variety of professionals offer help to people with psychological problems

Degree Began to Practice Current Number Average Annual Salary Percent Female

Psychiatrists MD, DO 1840s 49,000 $194,000 35%

Psychologists PhD, PsyD, EdD Late 1940s 188,000 $73,000 67%

Social workers MSW, DSW Early 1950s 649,000 $46,000 84%

Counselors Various Early 1950s 570,000 $45,000 71%

Technology and Mental Health
The digital world provides new triggers and vehicles for the expression of abnormal behavior
The multitude of digital distractions provides the foundation for shorter attention spans
Use of tele-mental health services rapidly increasing
Mental health apps in the marketplace are increasing sharply
Enormous volume of Web-based misinformation

What Do Clinical Researchers Do? (part 1)
Research is the systematic search for facts through the use of careful observations and investigations
Clinical researchers
Discover universal laws and principles
Search for nomothetic understanding
Do not typically assess, diagnose, or treat individual clients
Rely on the scientific method

Discover universal laws and principles of abnormal psychological functioning
Search for nomothetic understanding of nature, causes, and treatment
Do not typically assess, diagnose, or treat individual clients
Rely on the scientific method to pinpoint relationships between variables

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What Do Clinical Researchers Do? (part 2)
Clinical researchers depend on three methods of investigation
Case study
Correlational method
Experimental method

The Case Study (part 1)
How are case studies helpful?
Detailed, interpretative description of a person’s life and psychological problems
Source of new ideas about behavior
Tentative support for a theory
Challenge of a theory’s assumptions
Introduction of new therapeutic techniques
Opportunities to study unusual problems

The Case Study (part 2)
What are the limitations of case studies?
Biased observers
Subjective evidence (low internal validity)
Little basis for generalization (low external validity)

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The Correlational Method
Correlation
Degree to which events or characteristics vary with each other
Positive correlation
Negative correlation
Unrelated
Correlational method
Research procedure used to determine the co-relationship between variables
Subjects or participants
People chosen for study are collectively called a sample
Sample must be representative of the larger population

Researches need to know both the direction and the magnitude of the correlation
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When Can Correlations Be Trusted?
Correlations can be trusted based on a statistical analysis of probability
Statistical significance: The finding is unlikely to have occurred by chance
Generally, confidence increases with the size of the sample and the magnitude of the correlation

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What Are the Merits of the Correlational Method?
Advantages of the correlational method
Has high external validity (can generalize findings)
Can repeat (replicate) studies with other samples
Difficulties with correlational studies
Lack internal validity
Describe but do not explain a relationship or causation

Research Methods

Provides Individual Information Provides General Information Provides Causal Information Statistical Analysis Possible Replicable

Case study Yes No No No No

Correlational method No Yes No Yes Yes

Experimental method No Yes Yes Yes Yes

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The Experimental Method (part 1)
Experiment
The variable is manipulated and the manipulation’s effect on another variable is observed
Manipulated variable = independent variable
Variable being observed = dependent variable

Is animal companionship an effective intervention? A ring-tailed lemur sits on the shoulder of an individual at Serengeti Park near Hodenhagen, Germany. It’s part of a monthly program called “Psychiatric Animal Days” based on the premise that animals—even lemurs—have a calming effect on people. More than 400 kinds of intervention are currently used for psychological problems. An experimental design is needed to determine whether this or any other form of treatment causes clients to improve.

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The Experimental Method (part 2)
Confound
Variables other than the independent variable that may also be affecting the dependent variable
Three features to guard against confounds
Control group
Random assignment
Masked (blind) design

The Control Group
Control group
Research participants who are not exposed to the independent variable, but whose experience is similar to that of the experimental group
Rules of statistical significance are applied
Clinicians may also evaluate clinical significance

By comparing the two groups, researchers can better determine the effect of the independent variable.

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