- Share an explanation of your understanding of mental health.
- What do you think is the biggest challenge to the mental health profession today?
- What personal experiences have you had with mental illness and/or mental health?
Basic Statistics for the Behavioral Sciences Chapter One Abnormal Behavior * The Concerns of Abnormal Psychology What is abnormal psychology? Area of scientific study aimed at describing, explaining, predicting, and modifying behaviors that are considered unusual or strange Uses psychodiagnosis: attempts to describe, assess, and systematically draw inferences about psychological disorders * The Concerns of Abnormal Psychology (cont’d.) Modifying abnormal behavior Therapy: program of systematic intervention aimed at improving client’s behavioral, emotional, and/or cognitive state * Determining Abnormality Psychologists use the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) Most widely used classification system * Determining Abnormality (cont’d.) DSM-V defines abnormal behavior as: “a behavioral or psychological syndrome or pattern that reflects an underlying psychobiological dysfunction, that is associated with distress or disability and is not merely an expectable response to common stressors or losses.” (www.dsm5.org) * Determining Abnormality (cont’d.) Limitations of DSM-V definition DSM definition is quite broad and raises questions When is a syndrome or pattern of behavior significant enough to have meaning? What constitutes “present distress” and “painful symptoms”? What criteria are to be used in assessing symptoms? * Determining Abnormality (cont’d.) Four major means of judging abnormal behavior Distress Deviance Dysfunction Dangerousness * Abnormal Behavior in Context Culture: shared learned behavior transmitted from generation to generation Powerful determinant of how behavior is defined and treated Cultural universality: Origins, processes, and manifestation of disorders are the same across cultures Cultural relativism: What is normal/abnormal may vary from culture to culture * Sociopolitical and Cultural Limitations Mental illness as a sociopolitical construction Must be sensitive to individual value systems, societal norms and values, and potential sociopolitical ramifications Multicultural limitations How does culture affect our understanding of human behavior? * Sociopolitical and Cultural Limitations (cont’d.) Two key questions to consider: What is universal in human behavior that is also relevant to understanding psychopathology? What is the relationship between cultural norms, values, and attitudes and the incidence and manifestations of behavior disorders? * Frequency and Burden of Mental Disorders Psychiatric epidemiology: Study of the prevalence of mental illness in a society Prevalence: Percentage of people in a population who suffer from a disorder at a given point in time * Frequency and Burden of Mental Disorders (cont’d.) Lifetime prevalence: The percentage of people in the population who have had a disorder at some point in their life Incidence: Onset or occurrence of a given disorder over a period of time * Frequency and Burden of Mental Disorders (cont’d.) Figure 1-1 One year prevalence of mental disorders in adult Americans and lifetime prevalence of mental disorders in American adolescents * Frequency and Burden of Mental Disorders (cont’d.) Cost and burden to society is great: At least 25% of adult Americans and almost 50% of American children suffer from diagnosable disorder. What might account for the higher prevalence rates seen in the youth sample? * Stereotypes about the Mentally Disturbed Mentally ill are frequently stereotyped Common myths: Mentally disturbed people can always be recognized by their abnormal behavior Mentally disturbed have inherited their disorder Biopsychosocial model: mental disorder are the result of an interaction of biological, psychological, and social factors * Stereotypes about the Mentally Disturbed (cont’d.) More common myths Mental illness is incurable People become mentally ill because they’re weak Mental illness is always a deficit Mentally ill are unstable and potentially dangerous * Historical Perspectives on Abnormal Behavior Prehistoric and ancient beliefs: Demonology treated by trephining or exorcism Naturalistic explanations (Greco-Roman): Naturalistic explanations supplanted supernatural Hippocrates believed deviant behavior caused by brain pathology, the dysfunction of the brain * Historical Perspectives on Abnormal Behavior (cont’d.) The Middle Ages: Reverted to supernatural explanations The Dark Ages Mass madness, or group hysteria Witchcraft The Renaissance: The rise of humanism Humanism: emphasizes human welfare and the worth/uniqueness of the individual * Historical Perspectives on Abnormal Behavior (cont’d.) The Reform Movement: Moral treatment movement: shift to more humane treatment of the mentally disturbed Philippe Pinel William Tuke Benjamin Rush Dorothea Dix Clifford Beers * Historical Perspectives on Abnormal Behavior (cont’d.) What role should spirituality and religion play in mental health care? Spirituality: animating life force or energy of the human condition that is broader but inclusive of religion What does research show us about the relationship between religiosity and mental health? * Causes: Early Viewpoints Biological (organic) view: Mental disorders have a physical or physiological basis (Griesinger) Kraepelin Symptoms occur in clusters (syndromes) to represent mental disorders, each with a unique cause, course, and outcome. Classified mental disorders based on organic causes: metabolic disturbance, endocrine difficulty, brain disease, heredity Eventually became DSM of APA * Causes: Early Viewpoints (cont’d.) Biological view gained greater strength with discovery of general paresis, a progressively degenerative and irreversible physical and mental disorder Lead to Pasteur (germ theory) von Kfrafft-Ebing (infection) Schaudinn (microorganisms) * Causes: Early Viewpoints (cont’d.) Psychological view: Mental disorders are caused by psychological and emotional (not biological/organic) factors Mesmerism and hypnotism The Nancy School: Charcot and hypnotism Josef Breuer and Sigmund Freud: relief by talking about traumatic experiences Cathartic method: therapeutic use of verbal expression to release pent-up emotional conflicts * Causes: Early Viewpoints (cont’d.) Behaviorism: Psychological perspective that stressed the importance of learning and behavior in explanations of normal and abnormal development Stressed conditions that evoke, reinforce, or extinguish directly observable behaviors Rooted in laboratory science * Contemporary Trends Diversity/multicultural psychology: Culture, race, ethnicity, gender, age, and socio-economic class relevant to understand and treat abnormal behavior Mental health professionals need to: Increase cultural sensitivity Acquire knowledge of diversity Develop culturally relevant therapy approaches * Figure 1-2 Census 2005 Racial/Ethnic Composition of the United States The rapid demographic transformation of the United States is illustrated in the fact that minorities now constitute an increasing proportion of the population. Several trends are evident. First, within several short decades, people of color will constitute a numerical majority. Second, the number of Hispanic Americans has surpasses African Americans. Third, mental health providers will increasingly be coming into contact with clients who differ from them in race, ethnicity, and culture. Source: U.S. Census Bureau, National Population Estimates * Contemporary Trends (cont’d.) Dimensions related to cultural diversity: Social conditioning Cultural values and influences Sociopolitical influences Bias in diagnosis * Contemporary Trends (cont’d.) Positive psychology: Study of positive human functioning, and the strengths and assets of individuals, families, and communities Optimal human functioning: Subjective well-being, happiness, optimism, resilience, hope, courage, ability to cope with stress Self-actualization and self-determinism * Contemporary Trends (cont’d.) Changes in therapeutic landscape: The drug revolution (1950’s): Rapidly and dramatically decreased or eliminated symptoms Deinstutionalization Prescription privileges for psychologists Managed health care: industrialization of health care, whereby large organizations in the private sector control the delivery of services * Contemporary Trends (cont’d.) Industrialization of health care has brought about major trends: Business interests are exerting increasing control over psychotherapy Current business practices are depressing income of practitioners Psychologists are being asked to justify use of their therapies Enactment of mental health and substance abuse parity legislation * Contemporary Trends (cont’d.) Appreciation for research Neuroanatomy: Role of neurotransmitters in mental disorders Success of psychopharmacology spawned new interest in brain-behavior relationship Increasing exploration of biological bases of abnormal behavior Combining drug therapy with psychotherapy Move toward empirically based treatments * Basic Statistics for the Behavioral Sciences Chapter Two Models of Abnormal Behavior * One-Dimensional Models of Mental Disorders Psychopathology: Clinical term meaning abnormal behavior Model: An analogy used by scientists, usually to describe or explain a phenomenon or process that they cannot directly observe Model, theory, viewpoint, and perspective are often used interchangeably * One-Dimensional Models of Mental Disorders (cont’d.) Etiology: Causes of disorders In the past, different pathways of thought were used exclusively without taking into consideration aspects of other viewpoints Such a narrow view of complex issues and conditions undermined understanding and treatment * One-Dimensional Models of Mental Disorders (cont’d.) Two main views of the past were: Mental disorders are caused primarily by biological problems Abnormal behavior is essentially psychosocial * One-Dimensional Models of Mental Disorders (cont’d.) These two views are overly simplistic: Set up a false “either/or” dichotomy between nature and nurture Fail to recognize the reciprocal influences of one on the other Mask the importance of acknowledging the biological, psychological, social, and sociocultural dimensions in the origin of mental disorders * A Multipath Model of Mental Disorders Biopsychosocial model attempts to integrate biological, psychological, and social factors but has limitations: Provides little information about how factors interact to produce illness Allows practitioners to do everything without guidance Fails to consider the equally powerful influence of culture * A Multipath Model of Mental Disorders (cont’d.) Multipath model: An integrative and interacting means of viewing disorders and their causes Assumptions Multipath model consists of following dimensions: Biological factors Psychological factors Social factors Sociocultural factors * A Multipath Model of Mental Disorders (cont’d.) Figure 2-1 The Multipath Model Each dimension of the multipath model contains factors found to be important in explaining abnormal behavior. * Dimension One: Biological Factors Biological pathway relies on certain assumptions: Genetics help make people who they are Human thoughts, emotions, and behaviors are associated with nerve cell activity of brain and spinal cord Change in thought, emotion, or behavior will be associated with change in activity or structure of brain Mental disorders are highly correlated with some form of brain or other organ dysfunction Mental disorders can be treated by drugs or somatic intervention * Dimension One: Biological Factors (cont’d.) The human brain: Neurons: Nerve cells that transmit messages throughout the body and that make-up the brain Two hemispheres control opposite sides of the body: Right hemisphere: Visual-spatial abilities and emotional behavior Left hemisphere: Language functions * Dimension One: Biological Factors (cont’d.) Human brain has three main parts: Forebrain Midbrain Hindbrain * Dimension One: Biological Factors (cont’d.) Figure 2-4 The Internal Structure of the Brain A cross-sectional view of the brain reveals the forebrain, midbrain, and hindbrain. Some important brain structures are identified within each of the divisions. * Dimension One: Biological Factors (cont’d.) Forebrain: Controls all the higher mental functions, such as learning, speech, thought, and memory Thalamus: “Relay station;” transmits nerve impulses throughout brain Hypothalamus: Regulates bodily drives and body conditions Limbic system: Involves experiencing/expressing emotions and motivation * Dimension One: Biological Factors (cont’d.) Midbrain: Involved in vision and hearing (along with hindbrain) and controls sleep, alertness, and pain Manufactures serotonin, norepinephrine, and dopamine Hindbrain: Controls heart rate, sleep, and respiration Manufactures serotonin * Dimension One: Biological Factors (cont’d.) Biochemical theories: Basic premise: Chemical imbalances underlie mental disorders Dendrites: Receive signals from other neurons Axons: Send signals to other neurons * Dimension One: Biological Factors (cont’d.) Figure 2-5 Major Parts of a Neuron The major parts of a neuron include dendrites, the cell body, the axon,