Distress = the experience of emotional or physical pain. Impairment involves reduction in ability to function at an optimal or even average level. Risk = danger or threat to well-being of a person. Socially and culturally unacceptable behavior.
Throughout the book, you will see that all three explanatory domains (biological, psychological, sociocultural) have relevance to the understanding and treatment of psychological disorders.
Trauma which took place years ago can continue to affect a person’s thoughts, behavior, and even dreams. Emotional disturbances can arise from distorted perceptions and faulty ways of thinking.
The term sociocultural refers to the various circles of social influence in the lives of people.
Related to the biopsychosocial approach is the diathesis-stress model.
Trephining: The drilling of a hole in the skull, presumably as a way of treating psychological disorders during prehistoric times, although it also occurred all over the world through the 18 th Century. Certain African tribes still use it to relieve head wounds. The procedures involved in exorcism seem more like torture to our contemporary eyes. The “possessed” person might be starved, whipped, beaten, and treated in other extreme ways with the intention of driving evil spirits out.
Hippocrates , whom many call the founder of Western medicine, was concerned with physical and psychological diseases. He believed 4 essential bodily fluids called “humors” influenced physical and mental health, and that an excess of any could account for changes in personality and behavior. Treatment by Hippocrates consisted of ridding the body of the excess fluid through such methods as bleeding , purging (forced excretion), administering emetics (nausea-producing substances), and establishing a healthier balance through proper nutrition.
Aesclepiades rebelled against the idea that an imbalance of bodily substances caused psychological disorders. He argued they were caused by emotional disturbances. Claudius Galen revolutionized previous thinking about psychological and physical disorders. Rather than rely on philosophical speculation, he studied anatomy as the first “medical researcher.” Unfortunately, he essentially maintained Hippocrates’ beliefs that imbalances of bodily substances caused abnormality.
During the Middle Ages, there was a resurgence of primitive beliefs regarding spiritual possession. The dominance of religious thinking had negative and positive effects. Negative: Treating the mentally ill as sinners and witches had harmful effects. Positive: Ideas about Christian charity led to establishment of poorhouses to shelter the indigent. The poorhouses became known as asylums . bedlam : Word derived from the name of the Hospital of St. Mary of Bethlehem in London; became synonymous with the chaotic and inhumane housing of psychologically disturbed people.
Vincenzo Chiarugi (1759-1820) led the reform movement for humane treatment of the mentally ill. The physician Philippe Pinel (1745-1826) instituted reforms in La Bicêtre, a hospital in Paris. A hospital worker, Jean-Baptiste Pussin , had begun reform at La Bicêtre and influenced Pinel. After Pinel left La Bicêtre, Pussin made the bold gesture of freeing patients from their chains, an act for which Pinel is mistakenly given credit.
In England, 1792, William Tuke established the York Retreat , an institution based on the religious humanitarian principles of the Quakers. Their methods became known as moral treatment . Benjamin Rush (1745-1813), known as the founder of American psychiatry, was appalled by asylum conditions, although he himself advocated methods we now regard as barbaric, even sadistic. Boston schoolteacher Dorothea Dix spent 40 years campaigning for the proper treatment of psychologically disturbed people and was a very effective champion of this cause.
Rush advocated what we now regard as barbaric psychiatric interventions but were accepted conventions at the time: bloodletting purging the “tranquilizer” chair intended to reduce blood flow to the patient’s head and limbs submerging in cold shower baths frightening patients with threats of death the “well-cure” in which a patient was placed at the bottom of a well as water was slowly poured into it
Medical model: The view that abnormal behaviors result from physical problems and should be treated medically. Mesmerism: Derived from the name Mesmer; a process of bringing about a state of heightened suggestibility . In the picture above, Jean-Martin Charcot demonstrates a hypnotic technique during a lecture. Hypnotism: The process of inducing a trance state. Psychoanalytic model: An approach that seeks explanations of abnormal behavior in the workings of unconscious psychological processes. Psychoanalysis: A theory and system of practice that relies heavily on the concepts of the unconscious mind, inhibited sexual impulses, early development, and the use of the "free association" technique and dream analysis. Psychotherapy: The treatment of abnormal behavior through psychological techniques.
In the 1950s, scientists introduced medications that controlled some of the debilitating symptoms of severe psychological disturbance. In the 1970s, the deinstitutionalization movement reacted to deplorable conditions in mental hospitals by promoting the release of psychiatric clients into community treatment sites. Deinstitutionalization created another set of problems: Planning was inadequate, funds were insufficient, and patients were often shuttled back and forth between hospitals, halfway houses, and shabby boarding homes, never having a sense of stability or respect. Halfway house: A community treatment facility designed for deinstitutionalized clients leaving a hospital who are not yet ready for independent living. Managed health care has become the standard by which third-party payers, such as insurance companies, oversee reimbursement for health services.
The scientific method involves applying an objective set of methods for observing behavior, making an hypothesis about the causes of behavior, setting up proper conditions for studying the hypothesis, and drawing conclusions about its validity. Observation process: The stage of research in which the researcher watches and records the behavior of interest. Hypothesis formation process: The stage of research in which the researcher generates ideas about a cause-effect relationship between the behaviors under study.
In the experimental method , the researcher adjusts the level of the independent variable and observes its effects on the dependent variable. The independent variable is the experimental variable that the researcher manipulates. An experimental group receives the “treatment” thought to influence the behavior under study, and the control group does not. (A special kind of control group in a placebo condition would receive an inert substance or treatment similar in all other ways except for its lack of the independent variable’s “treatment.”) The dependent variable is measured because it is believed to depend on the manipulated changes in the independent variable. The quasi-experimental method is a variant of this procedure and is used to compare groups that differ on a predetermined characteristic.
The correlational method studies associations, or co-relations, between variables.
In the case study method , one individual is studied intensively, and a detailed and careful analysis of that individual is conducted. In the single-subject design , one person at a time is studied in both the experimental and control conditions, as treatment is applied and removed in alternating phases. Studies of genetic influence may examine concordance rates, biological markers, or genetic mapping. Concordance rate: Agreement ratios between people diagnosed as having a particular disorder and their relatives. Biological markers: Measurable characteristics or traits whose patterns parallel the inheritance of a disorder or other characteristic. Genetic mapping: The attempt by biological researchers to identify the structure of a gene and the characteristics it controls.
Psychological disorders affect not only the people who suffer from them but also the family, community, and society.
Individuals with psychological disorders suffer great stigma which adds to their emotional problems.
Family members are affected by the distress of their loved ones and also share a sense of stigma. The degree of impact depends the nature of the problem and the dynamics of the family. Families have also banded together for support and mutual education, forming organizations like the National Alliance for the Mentally Ill (NAMI) .
In some programs and communities, discharged individuals are adequately cared for; however, in many areas, particularly large cities, there are a great many formerly institutionalized people who go without homes, food, or health attention. On a broader level, the social and financial costs of mental health problems are inestimable , but mental health professionals and public health experts agree psychological problems exert a tremendous toll on society: Families are often torn apart and communities are divided.