Key Study Title: Relates to:Rosenhan and Seligman (1989) Definitions of abnormality: Failure to functionJahoda (1958) Definitions of abnormality: deviation from idealmental health.Watson and Rayner (1920) Key features of the behavioural approach topsychopathologyElkin et al (1989) Psychological and Biological therapiesDavidson et al (2004) Psychological and Biological therapiesWhat is abnormality?Jot down any ideas you already have concerning abnormalityIs this abnormal?
7 features of abnormalityRosenhan and Seligman (1989) suggest that the most suitable approach todefining mental abnormality may be to identify a set of abnormalcharacteristics. Each of these on its own may not be sufficient to cause aproblem but, when several are present, then they are symptomatic ofabnormality. The fewer of the seven features of abnormality displayed byindividuals in their everyday lives, the more they can be regarded asnormal. This approach allows us to think in degrees of normality andabnormality, rather than simply making judgements about whether abehaviour or a person is abnormal or not.• SUFFERING – Most abnormal individuals report that they are suffering, and so the presenceof suffering is a key feature of abnormality. However, it is not adequate on its own because,for example, nearly all normal individuals grieve and suffer when a loved one dies. Inaddition, some abnormal individuals (e.g. psychopaths or those with anti-social personalitydisorder) treat other people very badly but do not seem to suffer themselves.• MALADAPTIVENESS – Maladaptive behaviour is behaviour that prevents an individual fromachieving major life goals such as enjoying good relationships with other people or workingeffectively. Most abnormal behaviour is maladaptive in this sense. However, maladaptivebehaviour can occur because of an absence of relevant knowledge or skills as well asbecause of abnormality.• VIVIDNESS & UNCONVENTIALITY OF BEHAVIOUR – Vivid and unconventional behaviour isbehaviour that is relatively unusual. The ways in which abnormal individuals behave invarious situations differ substantially from the ways in which we would expect most peopleto behave in those situations. However, the same is true of non-conformists.• UNPREDICTABLITY AND LOSS OF CONTROL – Most people behave in a fairly predictable andcontrolled way. In contrast, the behaviour of abnormal individuals is often very variable anduncontrolled, and is inappropriate. However, most people can sometimes behave inunpredictable and uncontrolled ways.• IRRATIONALITY AND INCOMPREHENSIBILITY – A common feature of abnormal behaviour isthat it is not clear why anyone would choose to behave in that way. In other words, thebehaviour is irrational and incomprehensible. However, behaviour can seemincomprehensible simply because we do not know the reasons for it. For example, amigraine may cause someone to behave in ways that are incomprehensible to other people.• OBSERVER DISCOMFORT – Our social behaviour is governed by a number of unspoken rulesof behaviour. These include maintaining reasonable eye contact with other people and notstanding too close to other people. Those who see these rules being broken oftenexperience some discomfort. Observer discomfort may reflect cultural differences inbehaviour and style rather than abnormality. For example, Arabs like to stand very close toother people, and this can be disturbing to Europeans.
• VIOLATION OF MORAL AND IDEAL STANDARDS – Behaviour may be judged to be abnormalwhen it violates moral standards, even when many or most people fail to maintain thosestandards. For example, religious leaders have sometimes claimed that masturbation iswicked and abnormal, in spite of the fact that it is widespread.Evaluation of Rosenhan and Seligman (1989)• One of the greatest problems with the seven features of abnormality proposed byRosenhan and Seligman is that most of them involve making subjective judgements.Behaviour that causes severe discomfort to one observer may have no effect onanother observer, and behaviour that violates one person’s moral standards may beconsistent with another person’s moral standards. (an example might bevegetarianism).• Another problem with some of the proposed features of abnormality is that they canalso apply to people who are non-conformists or who simply have their ownidiosyncratic style.• This issue was addressed in the introduction tothe 3rdrevised version of the Diagnostic andStatistical Manual of Mental Disorders (DSM III-R), published in 1987.“Neither deviant behaviour, e.g.political, religious, or sexual, norTASK 1:With a learning partner, search fortwo strengths and two weaknesses ofthis definition of abnormality. Allowtime for you to state your point,explain what the point means andthen for you to apply your point (sayWHY it is a strength or a weakness).You can also suggest a way in whichthis definition of abnormality couldbe improved.TASK 1:With a learning partner, search fortwo strengths and two weaknesses ofthis definition of abnormality. Allowtime for you to state your point,explain what the point means andthen for you to apply your point (sayWHY it is a strength or a weakness).You can also suggest a way in whichthis definition of abnormality couldbe improved.
conflicts that are primarily between the individual and society are mentaldisorders unless the deviance or condition is a symptom of a dysfunction(i.e. impairment of function) in the person.”• This does support the concept of “dysfunction” that is subjective but in a way thatallows us to view the experience of mental disorder from the point of view of theperson experiencing it.The characteristics of mental healthWe define physical health in terms of the presence of healthy behaviours, such as normal bodytemperature and normal skin colour. Why not do the same for mental illness? We can considerabnormality as the absence of normality. In fact, Marie Jahoda (1958) argued that the concepts ofabnormality and normality were useless because they rely on the identification of a referencepopulation. She suggested that it was preferable to identify the criteria for positive mental healthand then look at the frequency of their distribution in any population.Jahoda wrote a report for the Joint Commission on Mental Illness and Health. She drew on the viewsof others and tried to identify common concepts that were used when describing mental health. Inher report she proposed that there were six categories that clinicians typically related to mentalhealth.• SELF-ATTITUDES – High self-esteem and a strong sense of identity are related to mentalhealth.• PERSONAL GROWTH – The extent of an individual’s growth, development or self-actualisation is important. These criteria are not concerned with one’s self perception butmore with what a person does over a period of time.• INTERGRATION – This is a “Synthesising psychological function”, the extent to which theabove two concepts are integrated. It can be assessed in terms of the individual’s ability tocope with stressful situations.• AUTONOMY –The degree to which an individual is independent of social influences and ableto regulate his or herself.
• PERCEPTION OF REALITY – Many clinicians identify the link with reality as a prime factor inmental healthiness. This includes being free from “need-distortion” (an individual’s need todistort their perception of reality) and demonstrating empathy and social sensitivity.• ENVIRONMENTAL MASTERY – The extent to which an individual is successful and well-adapted. This includes the ability to love, adequacy at work and play, adequacy ininterpersonal relations, efficiency in meeting situational requirements, capacity foradaptation and adjustment, and efficient problem solving.Evaluation of Jahoda (1958)• This approach has the benefit of being positive. It seeks to identify the characteristics thatpeople need to be mentally healthy rather than identifying the problems (i.e. ill health). Assuch it could be translated into useful therapeutic aims – goals to set during treatment.• However, it may not provide useful criteria for identifying what constitutes abnormality.When we use signs of physical health to identify physical ill health, we rely on fairly objectivemeasurements, such as blood pressure. The same is not true when we are usingpsychological concepts. A psychological scale that measures a person’s self-esteem cannever be an objective measurement.• A further problem is that any setof values is inevitably culture-bound; related to the specifichistoric period and the views ofa particular society. Nobles(1976) wrote about theextended concept of self inAfrican people. He claimed thatthey have a sense of “we”TASK 2:Which of the above categories might be affectedby cultural bias? In what way might they beaffected? With a learning partner, give anexample of a cultural bias for each category.How might the “environmental mastery”category be criticised?
instead of the Western “me”. This means that they value co-operation whereas Westernersvalue independence and autonomy, as reflected in Jahoda’s list of mentally healthybehaviours.Different cultures may view the themes of The Simpsons in different ways.
TASK 3: In what way does the above article make Marie Jahoda a more credible source?
Asessement Task 1Definitions of AbnormalityDeviation from ______norms definition: We have _________rules that we must abide by. People who deviate from these are seen to abnormal. This approach takes in to account behaviours that are _________for the individual and forsociety. Limitations: It is generally based on the opinions of ______ within society rather than themajority. ______ in society change over time as moral and social attitudes change e.g. womenwearing trousers and views on homosexuality. Abuse of human rights. _____ (1962) the term ‘mental illness’ is used to control people. Forexample _______ dissenters in the USSR after WW2 were proclaimed ‘mentally ill’ and sent tohospitals. It can be valuable to break norms. The _______ movement did this and _______ society. Cultural Relativism: Again these rules are different for different cultures. They are also based on white ideas about abnormality. ________ (1977) noted that in the UK there was a high rate of Afro-Caribbean and Asianpeople diagnosed as mentally ill. Based on the diagnosis of white doctors.________ to function adequately definition: This means how people ____ with certain situations in life. Most of us aim to cope with dayto day life. If we don’t we are seen as_______. This includes _______ behaviour and behaviour that distresses the individual/patient. Limitations: Who judges? Who is to say that the way a person lives their life is wrong? Theymay be comfortable and content with the way life is. It is others who do this. _________don’t seethemselves as abnormal but they may become dangerous or display _______ behaviour towardsothers. Cultural relativism: Again we are applying a western model to other cultures, which isinaccurate. It also affects class too. This is why non-white and ______ status people are diagnosedmore frequently with mental illness.Deviation from ideal mental health definition:________ (1958) noted that there are ways in which we diagnose physical ill health by noting theabsence of key things such as correct body temp, ______ skin colour, normal _____ pressure.She did the same for mental health, she noted 6 categories:1. Self-________ - having high self esteem and sense of self worth.
2. Personal ______ and actualisation- the extent to which a person wants to improve themselves.3. Integration-being able to _____ with stressful situations.4. Autonomy-being independent and self regulating.5. ________ perception of reality.6. Mastery of the environment- Ability to work, function well in relationships, solve problems andtake on new situations. Limitations: If we just looked at this criteria we would all be abnormal. It must be asked how many criteria have to be missing for us to judge it as abnormal. Cultural relativism: Self actualisation is relevant for individualist cultures and not collectivistcultures. Is it right to then diagnose them as ‘mentally ill’?Was this guy abnormal? Orsimply criminal? Why?Additional evaluative points/notes
Approaches to Psychopathology.....Psychology tries to explain!1. Behavioural2. Biological3. Psychodynamic4. CognitiveBiological Approach:Assumptions: The most widely used approach. Mainly used in West to diagnose mental illness. Developed by the medical profession, hence it’s name. This model has 5 key assumptions.1) Similar to a disease (Disease model): Can be compared to a disease. It assumes that mental illnessis physiological and is to do with brain damage/dysfunction.2) Symptoms: As with other diseases, mental illness has a list ofsymptoms that are listed in a diagnostic manual. This is called the DSM-IV ( Diagnostic StatisticalManual 4th Edition). They compare what the patient has with the well established criteria in themanuals.3) Genes: It is assumed that genes have a major effect on the development of mental illnesses.People may have a predisposition to the disorders. This is seen in twin/family studies. Kendler et al(1985) saw that relatives of schizophrenics were 18 times more likely to develop the disorder than acontrol group.4)Bio-chemistry: It could be that chemical imbalances in the brain cause mental illnesses. It has beenseen that on some cases of schizophrenia the hormone dopamine is very high. However a lot of thefindings are correlations and don’t always prove cause and effect.
5) Damage: This is common in physical illness but has also been seen on mental illness as well. Barret al (1990) found increased levels of schizophrenia amongst mothers who had the flu virus whilstthey were pregnant, suggesting a possible link with the disorder.Evaluation:1) Humane approach: this approach attaches no blame to the person suffering from mentalhealth issues. It is treated as though they have caught an infection. Or other type of illness.2) The treatments are effective. Drug treatments benefits outweigh the side effects. Thebenefits of ECT (electro-convulsive-therapy) and psychosurgery are less clear cut. Howeverpatients are glad to have tried them3) The physiological evidence is well supported from techniques such as brain scans and postmortems after death have added to our knowledge.4) Diagnosis is better post 1980 than it was pre 1980. This is because of new diagnosistechniques that don’t create as much disparity.Other evaluative points
Task 2 Outline the Aim, design, results, conclusions and evaluation of Rosenhan (1973) ‘On beingsane in insane places’. This study provides an insight in to how diagnosis of mental health problems was lessaccurate pre 1980. Complete this task in the space provided below:
Model 12 mark answerOutline and evaluate the biological model (12 marks)The biological model states that all illnesses have a physiological root. This model uses the diseasemodel to explain mental illnesses as having the same root cause as any other type of illness. Thismodel focuses on biological causes of illness and therefore there is no assumption of blame onto anindividual. The biological model also states that the mental illness can be solved by treating thebiological cause.The biological model has 5 key features.
1. Genetic factors: This model assumes that there is a genetic contribution to any mentalillness. Just as an individual inherits their parents hair/eye colour, height and body so theywill too inherit any vulnerability to disease.2. Biochemical Factors: Biologists state that any chemical imbalance in the brain could lead tomental illness. This could be a lack of neurotransmitters (chemicals used in electricalimpulses), or an excess of them. E.g. Schizophrenics have an excess of the neurotransmitterdopamine. Depression shows a lack of the same chemical.3. Damage Factors: This model states that damage to the brain, either through physicaldamage or infection can lead to changes in behaviour. Illnesses like meningitis can lead toswelling of the brain tissues which can cause pressure and therefore damage to the brain.We can see that damage to the brain in any form can alter someone’s thoughtpatterns/behaviour as seen in the H.M and Clive Wearing case studies.4. Symptoms: These are a key feature in the diagnosis of mental illness. Doctors andpsychiatrists use manuals like the ICD-10 and DSM-IV to characterise and group symptomsinto disorders.5. Similarity to other diseases: Abnormal behaviour is likened to any other disease in thismodel. It’s assumed that any biological defects in the brains functioning and structure maylead to psychological illnesses. These can be referred to as ‘organic’ disorders where obviousphysical damage has been caused to the brain.This model has much positive support, there is physiological evidence to support the model as wellas a history of case study to support the idea of genetic contribution. For example fMRI scans showthat areas of the brain are more/less active in schizophrenics, that there is globally less activity indepressed patients and that anorexic patients show different activity when looking at themselves.research has shown that schizophrenia has a genetic basis. Case studies on identical twins show a48% chance of developing schizophrenia if one twin has the condition.The approach leads to less “blame” being pushed onto the individual, it assumes that the factorscausing illness are out of the persons control.There is also a strong case to the control of the symptoms for mental illnesses with the treatments.Animal research also supports the concept of physiological causes behind mental illnesses; however,animal research cannot reliably establish a basis for understanding illness in human patients as thephysiology of animals differs to our own.Current biological treatments only treat the symptoms, they do not attempt to solve the cause ofthe illness and although this means that the person can live “normally” on treatments, it also leadsto them being reliant on the treatment.Although fMRi scans show physiological differences in individuals with mental illnesses, it isextremely hard to establish the cause of the illness – what we’re seeing in the scans may only be theeffect of something we can’t see!There is also no accountability in this model, people are told that the cause of their illness is nothingto do with them – not their fault, but this may not always be the case – for example if someone is inthe habit of recreational drug use, they may blame their genes for this instead of trying to change
their own habits. It also leads to the ‘blame’ being assigned to the healthcare professionalsresponsible for diagnosis and care.Studies also show that diagnosis is not a reliable tool. Rosenhan conducted an experiment where theaim was to see whether psychiatrists could reliably distinguish between people who were mentallyill and those who were not. The study consists of two conditions from which in one the hospital wereinformed that patients will be coming that are not actually mentally ill when in fact no patients weresent at all. In this condition the psychiatrists only diagnosed 41 out of 193 patients as being mentallyill when in reality all patients were mentally ill.In the other conditions, 8 people were told to report at the hospital that they hear noises in theirhead. As soon as they were administrated, they behaved normally. The doctors in this condition stillclassified these patients as insane, with a case of dormant schizophrenia. Rosenhan concluded thatno psychiatrist can easily diagnose the sane from insane. Though Rosenhan delivered a very accuratereport on diagnoses of patients, Rosenhan was criticised for deceiving the hospital for claiming thatsane patients were being sent over, though none were actually sent.A/B+ students would also add in the concepts of:• Determinism: are you always destined to turn out a certain way? (e.g. the warriorgene/Genie’s IQ) and the nature/nurture debate – what happens about our environment?• Reductionism: fact that this model simplifies things down to a very basic level of chemistry –what about the plethora of stimuli a human receives during a lifetime? Could that not havean interaction?• This supports the idea of ‘myth’ of mental illness – “a sane response to an insane world”(Laing 1959).Alternative points:Labelling/stigmaRelies on self-report methodThe Psychodynamic ApproachIntroduction One of the main psychologists in this approach isSigmund Freud
This Model assumes that experiences in our earlier years can affect our emotions, attitudesand behaviour in later years without us being aware that it is happening. Freud suggested that abnormal behaviour is caused by unresolved conflicts in theUnconscious. These conflicts create anxiety, and we use defence mechanisms such as repression anddenial to protect our Ego against this anxiety.Early experiences in childhood: Freud (1935) stated that children proceed through Psychosexual stages. During the stages certain body parts are sensitive to sexual stimulation and the child’s libido(sexual energy)is focused on these body parts:1. The mouth (oral stage 0-18 months).2. The anus (anal stage 18 months to 3 years).3. Genital region (phallic stage 3-6 years). For example a child in the oral stage will seek satisfaction through it’s mouth. Frustration occurs when the child can’t be satisfied. An overindulgence may lead to a fixation and may make a part of that child’s libido is lockedin that stage. This then can effect the individual in their adult life. The phallic stage is important in moral development. This is achieved through an identification with a same sex parent. The greater the identification the greater the conscience. The resolution of the Oedipus complex (sexual feelings towards his Mother) in boys isstrong, but a girls resolution of penis envy is never complete. According to this approach, this is why females are less mature in this area. Identification is also important in gender identity and in attitudes to authority.Personality:
1. Id-2. Ego-3. Superego- Ego ________ are created to deal with anxiety from conflicts between the _ areas. The defences are _________ and explain the dynamics of many behaviours. They are not totally _________ in dealing with ________, and unconsciously __________behaviours may, over time, result in ________ disorders. These defence mechanisms can include: Repression which is the major _______ _______ where emotionally _________ material isrepressed into the unconscious so that it is no longer in _________ awareness. _______, when the individual refuses to accept that something has happened (__________ ) as a means of protection from the trauma of having to deal with it.Evaluation of the Psychodynamic approachAdvantages:
FAIRY TALE PSYCHOANALYSISEgo = the balance between the Superego and the ID. It operates the reality principle so it balancesthe demands of the real world against the drive of the ID.Superego = our conscience. Basically this is the centre of all of our morality, it is developed in laterchildhood as our society teaches us moral rules and societal norms.Id = is our pleasure principle. It is the base of our animal instincts and drives – from desiring constantgratification to becoming violent.Can you identify the issues with these characters?Character Description Explanation according to FreudThe Wolf gobbled up red riding hood andthen gobbled up the three little pigs and wasnow looking for his fourth victim……This behaviour could be explained by an overdeveloped ID and a WEAK EGO. If the ID is strong itwill put it’s “I want it, and I want it now!” mentalityin to operation unchecked.Cinderella cleans everything in sight, she hasto make sure that everything is perfectly inorder and all the jars and ornaments areperfectly in line with each other...This behaviour could be explained by a personhaving very strong SUPEREGO and a weak egounable to balance out the demands of theSUPEREGO with the IDScrooge was always counting his money henever gave anything away and paid his staffpeanuts! He had more money than he couldever spend and still he kept on saving it up.Tom was always attacking Jerry, he would hithim with rolling pins, frying pans orwhatever he had to hand. He was a veryviolent cat!Penfold is always trying to get Danger Mouseto be more careful, he is very timid andthinks that rules are extremely important.If you got that, have a go at making your own character psychoanalysis – see if your partner canwork it out!
Assessment Task 2Using the model answer and template you’ve produced, answer this 12 mark question for full marks!Discuss the assumptions of the psychoanalytic approach (12 marks)
The Behaviourist ApproachDefinition:This approach looks at objectively, observable behaviour,and the role of the environment as a way of determininghuman behaviour.The 2 psychologists most closely associated with thisapproach are J.B. Watson and B.F. Skinner.Outline:• Humans are born blank slates: Behaviourists believe that all knowledge and learning areacquired through the senses. The role of heredity and instincts is largely ignored.Behaviourism takes the side of nurture in the nature-nurture debate.• All behaviour is learned through the environment: Behaviourists believe that behaviour islearned through ones environment. Learning is the key to behaviour and is determined byyour experiences. Experience helps us to adapt and change and therefore survive (Tavris andWade, 1997). Basic learning is called conditioning.• All behaviour is observable: They stress the importance of dealing with behaviours that aredirectly observable. External events dictate the occurrence of behaviour and these eventscan be observed and measured in an objective and unbiased way.• Humans and animals learn in a similar way: The laws of learning apply to both humans andanimals. Therefore observing animals in the lab can help us understand the ways humanslearn in their environments.3 main types of learning:Classical conditioning, operant conditioning and Social Learning:Classical Conditioning:Learning by association:• When two environmental changes (stimuli) occur together, we learn to associate them
• The response to one may transfer to the other• E.g. Pavlov (1901) taught dogs to salivate when they heard a bell.Operant Conditioning:Learning by consequences• Organisms operate on their environments• The likelihood of them repeating any given behaviour depends on its consequences• Reinforcement – more likely to repeat• Punishment – less likely to repeatSocial LearningLearning by observation• People observe the behaviour of other people (models).• They may imitate the behaviour they observe• Whether or not they do so depends on the observed consequences:• Vicarious reinforcement (being rewarded for a behaviour).• Vicarious punishment (being punished for a behaviour).
Assessment Task 3Using the text book/s, briefly outline the main evaluation points of the three types of learning. Usethe space below to complete the task.
Key features of the behavioural approach to psychopathologyWatson and Rayner (1920)In one of the most celebrated if unethical studies inpsychology, Watson and Rayner (1920) classicallyconditioned an 11-month old child, since known as Little Albert, tofear fluffy animals. They did this by pairing presentation of a tamewhite rat with a sudden loud noise. The noise caused fear, anunconditional reflex equivalent to salivation in Pavlov’sexperiment, while the rat was the equivalent of the bell. EventuallyAlbert was conditioned to associate the rat with fear. Little Albert alsobecame afraid of other fluffy objects similar to the white rat such as a rabbit and white dog; this isknown as stimulus generalisation.
Cognitive Approach: Assumptions of the causes of abnormality To understand behaviour we must understand thoughts – including how people seethemselves and the world around them. Abnormal or disordered behaviour is caused by faulty and irrational thought processes Examples of irrational thinking include:- Magnification and minimisation – people magnify failure and minimise achievement (the glass ishalf empty rather than half full)- Overgeneralization – a person makes a sweeping conclusion based on a single trivial event (failingan exam means you are completely useless in life) Beck used the term cognitive triad to refer to the three main forms of negative thinking –negative views of (1) self (2) world and (3) future Becks negative (irrational) thoughts that depressed individuals have about... Themselves: "I am helpless and inadequate" The world: "The world is full of obstacles I can’t overcome" The future: "I am worthless, so theres no chance that the future will be any betterthan the present"
Beck’s cognitive triadAdvantages: Concentrates on _______thought processes. It does not depend on the ______ history of the client, for example, recovering repressedmemories from the _________. This is an ________ because details about a person’s pastare often unclear, ________, misleading and misremembered. Studies show that individuals who are suffering from _______ disorders and ___________do experience irrational thoughts and distorted processing. Similarly, studies show that ________ and _______ people have various ________ biases,e.g., they remember more negative than positive informationLimitations: Like all other approaches, the ________ Model rarely supplies the complete solution to________ behaviour by itself. There may be ________ and environmental influences affecting aperson’s_________ . Focusing only on a person’s cognition may be too narrow anapproach The thoughts could be a ______ of the disorder but they could equally be an effect. Forexample, with ________ it is difficult to know if the ________ view of the world has causedthe disorder or if it is a consequence of being depressed. Cognitive therapy only changes _________; it does not address behaviour or other_________ issues.
The Cognitive ______ sometimes places the ______ for any disorder unfairly on theindividual – “It’s your disordered thinking, so you are at fault”. For example, a person suffering from depression may be living in awfulcircumstances where depression is a perfectly valid and rationale response to thesituation. It will hardly be surprising if he perceives the world and his future asnegative and grim.Models of Abnormality activity:Match each of the following statements with one or more of these approaches:MEDICALBEHAVIOURALCOGNITIVEPSYCHODYNAMICa) We do not need to know what has caused a person to have a particular problem in order totreat themb) Therapy consists mainly of talkingc) People need to be helped to make sense of how they experience the world.d) The root cause of the problems are to be found in childhood experience.e) Drugs are a useful way of helping people with problems.f) Mental illnesses have an organic cause.
The case of Suzanne Andrews:During the day, Suzi sits on a black bin liner on the side of the road, smiling at people who pass bywho stop and hand her some money. Many of these people live in nice houses and feel quiteprotective towards her. At night she collects all her belongings-a couple of bags-and carries themhalf a mile to the doorway of a bank. She puts her things down carefully and then stands near thecurb and shouts and swears all night.Suzi is 41 years old and her face is very red form all her outdoor living. When she is calm she has asweet expression on her face. She wears layers of clothing – a black T-shirt, a loose flowery dress,and an orange sweater. She has long brown hair and she covers it with a wooly hat. She wears blueleg warmers and pink trainers.Sometimes she has rational conversations but sometimes appears totally confused. For example,one day she said to a reporter, ‘Do you know that this is a very nice neighbourhood and is veryhistorical, you should write a report about it’. However a minute later she said that she owned all theland in the area and that she had lived there for centuries.Suzi didn’t always act this way. Growing up in Birmingham, her childhood and adolescence were verynormal. She sang in her church choir and was invited to join her High School Council. She marriedand had a daughter.Eventually though her behaviour became a little strange. Her husband said that she made things upand started talking to herself. Most of the time, however, she acted normally. She went to universityand gained a master’s and was a very good Mother.After several years though her conversations with imaginary individuals became more frequent, hermother tried numerous times to enter a psychiatric ward. Suzi refused. Eventually Suzi agreed, butthe lawyer who met her to prepare her for her hearing convinced her that it was the wrong thing forher to do.Since then Suzi has lived on the streets. She is meticulous about cleaning herself, washing daily withbottled water and she can have many coherent conversations with people., but she has anotherside. There are times when she screams for hours and swears. She argues with people who aren’tthere and also is convinced there is a government conspiracy against her. She refuses psychologicalhelp. She thinks she doesn’t need it.
Applying models of abnormality to the case of Suzi AndrewsWe have looked at 4 models of abnormality, which of the models of abnormality brings us closest tounderstanding the reasons for Suzi’s behaviour?How might each model try to explain her behaviour?APPROACH EXPLANATIONPSYCHODYNAMICBEHAVIOURALCOGNITIVEMEDICAL
Treating Abnormality: Biological Therapies (Drugs/ECT) These therapies come from the biological model of abnormality. These treatments assume that changing the way the body functions will treat abnormalbehaviour. Two main biological treatments are Drugs and ECT. Drug Therapy: Around 25% of drugs prescribed by the NHS are for mental illness. They work by modifying the working of the brain, and affect mood and behaviour. People suffering from mental disorders are usually prescribed more than one drug. They work by entering the bloodstream in order to reach the brain. Drugs taken orally are absorbed by the gut and pass in to the Liver. Injected drugs bypass this area so a smaller dosage is needed in contrast to the larger doseneeded when taking the drug orally. Different doses are required for different individuals. Drugs affect chemicals in the nervous system. The chemicals are called neurotransmitters and they have a variety of effects on behaviour. Some of the main neurotransmitters are: dopamine, serotonin, acetylcholine, noradrenalineand GABA. The basic way the drugs work is by decreasing or increasing these neurotransmitters and tomodify the effect on a persons behaviour. Drugs can exert their influence in a number of ways. Facilitating or inhibiting production of a neurotransmitter. Increasing or decreasing the release of a neurotransmitter, orAltering what happensto it after it attaches to the receptor. There are different drugs for different disorders (you don’t need to know specific drugs inthe exam just about them in general). Anti-psychotic drugs are used for schizophrenia, manic depression, and for other psychoticsymptoms. They lower dopamine in the brain. Anxiolytics (anti-anxiety drugs, remember stress!) are given for stress related illnesses, suchas phobias. Antidepressants are used, unsurprisingly for stabilising mood. Either by reducing the moodor increasing it.
Elkin et al (1989)This was a study across several treatment centres. In all 240 patients with depression were treatedwith either CBT, psychotherapy or anti-depressant drugs. There was also a placebo control group.Treatment lasted for 16 weeks. The findings were:• There was a large placebo effect of 35-40%.• All therapies were significantly more effective than placebo, and overall had similar levels ofeffectiveness• Drugs tended to be the most effective therapy for severe depression.• The individual therapist was a significant factor in the effectiveness of psychotherapy.• Across all treatment groups, 30-40% of patients did not respond to therapy. It is a commonfinding in studies of effectiveness that no treatment is ever 100% effective.The conclusions were that drugs, CBT and psychotherapy are all more effective that placebo intreating depression. Also note that the follow-up was only 16 weeks. Ideally patients should befollowed up for 6-12 months, as there is evidence that the therapeutic effect of CBT in anxietyconditions is longer lasting than the effect of drugs (Bechdolf et al 2006)
Biological and psychological therapiesDavidson et al (2004)295 patients with generalised social anxiety (fear of social situations) were treated either with CBT,with the SSRI antidepressant fluoxetine, or with combined CBT + fluoxetine.The findings were:• The overall placebo effect was 19%• All therapies were effective over and above the placebo effect, and after 14 weeks therewere no differences between the therapy groups. The combined therapy was not superior toeither therapy alone.• 40-50% of patients did not respond to therapy.The conclusions were that drugs and CBT are equally effective in treating social anxiety, andcombining them does not improve their effectiveness. However many patients do not respond toeither treatment.Task 4:
In your own words outline the following evaluation points on drug therapies Efficacy Side-effects Treating symptoms Ethical issues.Eficacy:Side effects:
Treating symptoms:Ethical issues:Biological Therapies continued: ECT:Electroconvulsive Therapy (ECT) This therapy is used with drug resistant depressive disorders. It is most commonly used when medication and psychological therapies have not worked orthe patient does not respond to them. Approximately 22,000 people each year undergo ECT, in the UK. The course of treatments usually consists of 6-12 treatments.
Nowadays the patient is usually under a general anaesthetic and muscle relaxants to ensurethe patient does not feel pain. Electrodes are placed on the head with a controlled series of 110mv pulses entering thebrain. This causes a seizure in the brain for around a minute. After 5-10 minutes the patients wakeup. Types of ECT:1. Unilateral ECT-One side of the brain is stimulated. Usually the non-dominant hemisphere(left hand side of the brain, for left handed people).2. Bilateral ECT-Where both sides of the brain are stimulated. There are still arguments as to what makes ECT work on certain individuals. Some say it is to do with a change in various neurotransmitters that are sensitive to therelease of hormones such as serotonin and GABA, noradrenaline and dopamine (Sasa, 1999).Evaluation:Positive: Negative:
Psychological TherapiesPsychoanalysis: This is taken from Freud’s ideas, although the treatments were taken from Freud, theyaren’t practiced in the same way that he did them. It places importance on childhood and repressed memories. The goal is to bring the unconscious into the conscious. The patient can then learn to dealwith them with the help of the therapist. There are a number of techniques to do this.One such treatment is Free Association. This technique allows the patient to lie on the therapists couch and talk about whatevercomes to mind, it doesn’t matter whether it makes any sense or not. They can say anything. The therapist doesn’t comment, and if they do it is always in apositive way. As the patient is not responsible for what they are saying, they feel relaxed and thenhopefully unconscious thoughts can come to the conscious mind and be dealt with. The patient’s collection of thoughts gives the therapist clues to help understand theunconscious mind. Another technique used is Dream analysis.
Freud believed that dreams influence our lives a lot. He called them ‘the royal road into theunconscious’. Freud thought that our ego defences are lowered during sleep and that repressed materialsurfaces in symbolic form. They are disguised so that unacceptable thoughts don’t wake us up. The anxieties and concerns are ‘hidden’ (latent content), whereas the manifest content iswhat is immediately apparent in dreams. The aim is to reveal the latent content in dreams. For example a dream about a collapsingbridge (manifest content) may be symbolised as a problem with the patient’s marriage(latent content). There are a number of stages involved in both dream analysis and free association.184.108.40.206.Give 4 evaluation points of psychoanalysisBehavioural therapies:
• These therapies are based on classical and operant conditioning techniques to alter apersons behaviour.• Behaviourists look to treat symptoms, not the causes of abnormal behaviour.• They believe there is little point in looking for causes and it is more beneficial to treat thesymptoms.• Critics argue that symptoms of abnormality are merely the tip of the iceberg, and that othersymptoms will then take over from the ones removed.Systematic desensitisation:• This therapy is used to create a counter response to a phobia. They remove the fearresponse they have to something and replace it with a relaxation response.• It is based on the idea of classical conditioning.• This conditioning is used very gradually and introduces the feared stimulus in a step-by-stepway. This is why it is called systematic desensitisation.• SD involves 3 steps:• Training the patient to relax (using deep muscle relaxation and/or tranquilisers).• Establishing an anxiety hierarchy of the stimuli involved.• Counter conditioning relaxation as a response to each feared stimulus, beginning with theleast anxiety provoking stimulus (e.g. toy spider) and then systematically moving on to thenext anxiety-provoking stimulus (e.g. spider in a glass box). This goes on until all the things inthe anxiety hierarchy have been dealt with successfully.• Evaluation:• It is seen as an effective treatment for simple or specific phobias (Marks, 1987).• Wolpe and Wolpe (1988) both agree that it is effective. They claimed that around 80-90% ofpatients are either cured or much improved after around 25-30 sessions.• Klosko et al (1990), found that SD was as good as or better than the most popular drugs. Itwas found SD treatment group was 87% free of panic, compared to drug 50%, placebo 36%.• Therapies can be applied by non-professionals• Patients are in control of their own therapy as they work with the therapist on their ownhierarchy. They can also move back in the hierarchy if they feel uncomfortable.• It is not always practical for the patient to confront real situations. Real-life hierarchies canbe difficult to arrange and control.• This method only works well for minor anxiety disorders such as phobias.• It is claimed that the hierarchy and the relaxation techniques aren’t needed, and exposureto the feared situation is the most important aspect.Cognitive behavioural therapy (CBT):• This assumes that abnormal behaviour comes from faulty/disordered thinking.• It is an umbrella term for a number of therapies.Rational Emotive Behaviour Therapy (REBT) (Ellis, 1975)• Irrational thoughts cause emotional distress. Irrational thoughts cause negative self-statements.
• Therapy involves making these thoughts more positive and rational.• Ellis (1990) thought that there are a number of beliefs that are emotionally damaging e.g. ‘Imust be loved by everyone’.• The aim is to challenge thinking and show how irrational their thoughts are.Ellis (1975) used the ABC technique.• It involves 3 steps to analyse the way a person has developed their irrational beliefs:• A-Activating event: client records the event that lead to the disordered thinking (failingexams).• B-Beliefs: client recalls the negative thoughts associated with the event (I’m useless andstupid).• C-Consequence: the client records the negative thoughts that follows (feeling upset aboutleaving school).• The client is then challenged to think of the situation in a more positive light e.g. there waslittle time for revision, the exam was difficult.• Treatment of automatic thoughts (Beck, 1967, 1993)• This therapy is often used for depression.• Beck thought that depressed people see the world negatively.• Depressed people expect to fail in life, blame themselves and have a negative view ofthemselves.• This forms the cognitive triad-negative view of self, world and future.• Beck identified a number of cognitive biases and distortions that occur in depressed people.Some of these are:• Arbitrary inference-drawing unjustified conclusions based on little or no evidence.• Selective abstraction- the focusing of attention on one detail without regard to the rest ofthe picture.• Over-generalisation-the drawing of a general conclusion based on a limited event.• Therapy is a joint effort between the therapist and client.• The first thing is to identify the problem and the desired goal.• Then it is to challenge the negative thoughts.• The last step is to get the client to monitor their own perceptions accurately.• When they do this the client can then learn why they hold these thoughts.
Task:Give 3 evaluation points on the Behavioural therapies on page 246 of the textbook.
In groups plan the answer to the following 12 mark essay question:“Abnormality is very difficult to define. It can be hard to decide where normal behaviour ends andabnormal behaviour begins”.Discuss two or more definitions of abnormality (12 marks).You have 20 mins to plan this answer. Then on your own, and using your plan, you will have 20 minsto write the answer to the question above.You may use this page to plan your answer.Use a separate sheet of paper when you are answering the question.
Homework and past paper questions:SPECIMEN PAPER9. One assumption of the biological approach to psychopathology is that abnormality is inherited.Explain ONE way in which psychologists have investigated the genetic basis of abnormality (4 marks)10. Outline key features of the psychodynamic approach to psychopathology (6 marks)11. James is afraid of flying. Just thinking about flying causes him distress and even going to theairport is a problem. In order to overcome this fear, he consults a behavioural psychologist who feelsthat he may benefit from systematic de-sensitisation.(a) Which approach to psychopathology would be most likely to advocate the use of systematic de-sensitisation? (1 marks)(b) Explain how systematic de-sensitisation might be carried out to overcome James’s fear of flying.(6 marks)ADDITIONAL SAMPLE QUESTIONS1. Three of the following statements descibe limitations of different definitions of abnormality.A What seems like abnormal behaviour may actually be beneficial to an individualB This definition does not tell us which infrequent behaviours are undesirableC It is difficult, maybe impossible, for an individual to achieve all the criteria that make upthis definitionD This criteria has sometimes been used as a justification to punish social deviants
In the table below, insert the limitation A B C or D that matches the corresponding definitionof abnormality (3 marks)Definitions of abnormality Limitation of definitionsDeviation from ideal mental healthFailure to function adequatelyDeviation from social norms2. Some patients, especially children and those with mental impairments, may not be able to giveinformed consent for treatment of their mental disorders.Explain how informed consent could be gained in an ethical manner for these types of patients (4marks)3. (a) Which of the following three options describes ECT as a type of treatment? (1 mark)A A biological therapyB A form of psychoanalysisC A cognitive behavioural therapy4. Discuss the behavioural approach to explaining psychological abnormality (12 marks)FURTHER PRACTICE QUESTIONS1. Describe the use of electro-convulsive therapy in the treatment of mental disorders (6 marks)2. Describe the use of drugs to treat psychological disorders (4 marks)3. Discuss the use of drugs to traet psychological disorders (6 marks)
4. Outline ONE definition of abnormality (3 marks)5. (a) The following are four approaches to the understanding of mental disorder:A PsychodynamicB BehaviouristC CognitiveD BiologicalIn the table below, write down which approach, A B C or D, is associated with each assumption. (3marks)Assumption about abnormality ApproachPeople become ill because of negative thoughtsPeople become ill due to imbalances of neurotransmittersPeople become ill due to unresolved unconscious conflicts(b) Select ONE of the approaches, A B C or D, and explain ONE strength of this approach (3marks)JANUARY 20091. Before leaving the house each morning, Angus has to go round checking that all the lightsare switched off. He has to do this several times before he leaves and it makes him late forwork.a) Give ONE definition of abnormality (1 mark)b) Use this definition to explain why Angus’ behaviour might be viewed as abnormal (2marks)2. A) Which TWO of the following statements apply to the behavioural approach topsychopathology? (2 marks)A Unresolved conflicts in childhood affect adult behaviour
B All behaviour is learned in the same wayC Abnormal behaviour is caused by faulty thinkingD The same basic laws that explain animal behavour can also explainhuman beahviourE Irrational thoughts lead to abnormal behaviourB) Explain ONE limitation of the behavioural approach to psychopathology (2 marks)3. Claire constantly worries that she will be unable to finish a task. She thinks that if she doesnot complete it perfectly, it will not be worth doing. These thoughts are so bad that she findsit difficult starting anything and her work is suffering.a) Outline what is involved in Cognitive Behavioural Therapy (3 marks)b) Why might Cognitive Behavioural Therapy be appropriate for Claire? (2 marks)4. Outline and evaluate the biological approach to psychopathology (12 marks)May 20091. A) Describe key features of the behavioural approach to psychopathology (4 marks)B) Outline ONE limitation of the behavioural approach to psychopathology (2 marks)2. One way of defining abnormality is to see whether or not someone meets the criteria formental health. Ivan has high self-esteem and a strong sense of identity.a) Describe TWO other criteria that you would expect Ivan to display if he werepsychologically healthy (2+2 marks)b) Outline ONE weakness of defining abnormality in terms of mental health (2 marks)3. Sally often gets anxious for no apparent reason. She believes that people do not like her andbecomes distressed when she has to meet strangers. She is very nervous when faced withnew or unexpected situations. Sally has been referred to a therapist for psychoanalysis.a) Outline TWO techniques used in psychoanalysis (2+2 marks)b) Sally asks whether there are any problems with this therapy. What would you tell her?(2 marks)c) Cognitive Behavioural Therapy is another psychological therapy. Explain why this mightbe an appropriate therapy for Sally’s problems. (2 marks)4. Describe the use of ECT (electro-convulsive therapy) in treating abnormality (4 marks)January 2010
1. Identify and outline key features of TWO psychological approaches to psychopathology (6marks)2. Hamish has a phobia of heights. This phobia has now become so bad that he has difficulty ingoing to his office on the third floor, and he cannot even sit on the top deck of a bus anymore. He has decided to try systematic de-sensitisation to help him with his problem.Explain how the therapist might use systematic to help Hamish to overcome his phobia. (6mark)
Student checklist for Individual Differences PSYA2 AQA (A)Sub-sections Do I haveclassnotes?Do Iunderstandthis?Have Irevisedthis?Definitions ofabnormalityAbnormality as deviation from social norms –definition plus evaluationAbnormality as failure to function adequately –definition plus evaluationAbnormality as deviation from ideal mental health– definition plus evaluationApproachesto / models ofabnormalityAssumptions of the biological (medical) model ofabnormality, plus evaluation of this approachAssumptions of the biological (medical) model ofabnormality, plus evaluation of this approachAssumptions of the biological (medical) model ofabnormality, plus evaluation of this approachAssumptions of the biological (medical) model ofabnormality, plus evaluation of this approachFeatures of drug therapy plus evaluation
Treatingabnormality(therapies)Features of Electro-convulsive therapy (ECT) plusevaluationFeatures of Systematic Desensitisation plusevaluationFeatures of Cognitive Behavioural Therapy (CBT)plus evaluationFeatures of Psychoanalysis plus evaluation