Psychological

Disorders
What is normal?

 A teacher I know is afraid of zombies and fears going out

of doors alone at night. Does he have a disorder?
 A friend of mine goes out at night, when there is a full
moon, and howls at it for 60 seconds. Is she crazy?
 Is John depressed? His Dad died and he cries every night
and has done so for the last five years.
In a nutshell…

 There is so much variation to what is normal and in

essence, you have to be able to live with
ambiguity
As defined by your
textbook,
A disorder is a harmful
dysfunction in which
behaviour is atypical,
disturbing, maladaptive and
unjustifiable.
History of Abnormality
 Possession by evil spirits

Animistic spirits: tarantism,

lycanthropy
Satanic spirits: reports of witchcraft
increased rapidly with the
extensive instability in the late 15th
and 16th centuries (e.g., rise of
capitalism, Protestant
Reformation)
Witchcraft

 Malleus Maleficarum (The Witch’s Hammer): a guidebook to

discovering and getting rid of witches. Written by two monks.
 Only women could be witches
 “All witchcraft comes from carnal lust – which is, in women,
insatiable”
 Tests of witchcraft: fixed
Salem Witch Trials

 Salem, MA (1691): First arrest in March, last hanging in

September.
 Begins with 8 girls exhibiting a bizarre set of symptoms that
include: vomiting, convulsions, slurred speech, and
hallucinations
 Doctors suggest possession
 Accusations fly and eventually 19 people were executed, 2
died in prison, and 1 was tortured to death
Explanations for the Witch
Trials
 Political Explanations: political leverage, diversion
of attention. Tension between growing town and
farmers. New minister had a number of enemies
 Sociological Explanations: the accused were
undesirable members of society. Works for first
accusations but then unravels as the elite are
accused
More Explanations

 Psychological Explanation: a hysterical mob mentality

blossomed out of control
 Medical Explanation: inadvertent ergot poisoning (fungus
that grows on rye, contains lysergic acid)

 Heavy rains in 1691could have lead to

fungus
 Young girls were afflicted first and
they worked directly with the grains
The Biomedical Model
 popular when behaviourists were popular

 psychological disorders have

physical causes, therefore
they can be classified based on
the patient’s symptoms
they can be treated (with drugs
and/or therapy) and be cured
The Biomedical Model of
Abnormal Psychology
 Includes the following general areas:

Neurotransmitter and
Hormonal Imbalances
Genetic Vulnerabilities
Brain Dysfunction and Neural
Plasticity
Physical Deprivation or
Disruption
Neurotransmitter
Imbalances
The Medical Model is not
Without Criticism
Good and Bad
 Thomas Szaz
 He was an early critic of psychiatry’s former
disease model of homosexuality and
argued vigorously against the use of
involuntary hospitalizations, the insanity
defense, among other extremes
 His influence has left both clinical
psychiatry and psychology with a stronger
emphasis on social justice and a legacy of
psychiatric skepticism.
 Believed that many patients were simply
faking their symptoms
Bio-psycho-social
Perspective:
bio – genes, brain/body structure and
chemistry
 psycho – stress and trauma
 social – cultural expectations and support
system
All three of these factors contribute to the psychological
disorder.
Supposedly what we use now. In reality, there is still a heavy
focus on the medical model.
Biopsychosocial
Paradigm
 The bio-psycho-social paradigm
used to be called the
Diathesis-Stress Paradigm
 According to Diathesis-Stress models, the cause of abnormal
behavior can be viewed as a combination of or interaction
between two types of factors:
Diathesis - previous biological (including
genetic predisposition) and
environmental factors that predispose
an individual towards developing a
disorder.
Stress - trigger that taxes or exceeds the
individuals personal resource and results
in abnormal behavior.
 What is a Paradigm?
 A model of reality: the way reality is or is supposed to be
 It is a set of beliefs that shape our perception of events and
help us explain these events
 It is a set of concepts and methods used to collect and
interpret data (Kuhn, 1992)
 A paradigm guides the definition, examination, and treatment
of mental disorders
Paradigms in Abnormal Psychology

 Biological Paradigm
 Cognitive-Behavioural Paradigm
 Behavioural perspective
 Cognitive perspective
 Psychoanalytic Paradigm
 Humanistic Paradigms
 Integrative Paradigm
Models or Paradigms for
Understanding Abnormal Behavior
 The value of viewpoints is that they organize observations,
provide a system of thought, and suggest areas of research,
focus, and treatment.
 However they can blind or limit us.
 The current viewpoint in psychology is multidimensional,
eclectic, and integrative
 Biopsychosocial viewpoint- an integrative approach that
acknowledges that biological, psychosocial, and sociocultural
factors all interact and play a role in psychopathology and
treatment.
 Current History
 American Psychological Association
(APA) published the first Diagnostic and
Statistical Manual (DSM) of Mental
Disorders in 1952. This manual had 60
categories of mental illness.
 Subsequent versions came out in 1968,
1980, 1986, 1994 and 2013. Currently
using the DSM-5 in which there are
more than 300 categories of mental
illness
 Changes based upon research, societal
values, and political pressure (e.g.,
homosexuality, premenstrual dysphoric
disorder)
 Some Criticisms of the
DSM
 Historically, some diagnostic labels have marginalized,
stigmatized and harmed those who are different from the
mainstream (e.g., homosexuality was once a DSM
diagnosis).
 There is limited evidence of cross-cultural validity in
diagnostic conceptualizations.
 Counselors who focus narrowly on diagnosis may only look
for behaviors that fit within a medical or biological
understanding of the person’s struggles
 The DSM system does not include sufficient emphasis on
contextual factors (e.g., developmental struggles and
transitions, culture, gender), strengths, resources, and
uniqueness that may better explain the roots of client
struggles and treatment implications.
Criticisms continued

 The DSM system cannot predict treatment

outcomes or point to the etiology of mental
disorders.
 Some people may use diagnosis to accept a
self-fulfilling prophecy that their situation is
hopeless and that they are sick.
 Diagnosing may preclude a focus on the
client’s unique construction of his or her
experience.
 There are flaws in the science behind DSM
diagnoses; what is and is not classified as a
mental disorder is often rooted in a political
agenda and historical influences
 David L. Rosenhan

Professor of Law and Psychology at

Stanford University, Stanford, CA.
1951 AB Mathematics
1953 MA Economics
1958 Ph. D. Psychology

“However much we may be personally convinced

that we can tell the normal from the abnormal, the
evidence is simply not compelling.”
D. L. Rosenhan, 1973
Rosenhan’s Questions:
Are mental health professionals able to tell the difference between those
who are mentally healthy and those who aren’t?

Rosenhan wanted to know that if the patients were misdiagnosed, what the
consequences were.

He also wanted to know whether the characteristics that lead to

physiological diagnoses reside in the patients themselves or in the situations
and contexts in which the observers (those who do the diagnosing) find the
patients. (Hock, 2000)
Rosenhan’s Study

He conducted a study where he had

eight pseudopatients pretend to be
mentally ill and try to gain admittance
into various psychiatric institutions.

There were five men and three women

all from various backgrounds used in the
study. There were three psychologists,
one graduate student, one psychiatrist,
one homemaker, and one painter.
Participants’ Instructions:
Participants were instructed to call the 12 different hospitals on both
the east and west coasts and set up an appointment.

All participants complained of the same thing… hearing voices saying

“empty”, “hollow”, and “thud”.

All participants were admitted into the institutions and all but one
were diagnosed to have schizophrenia.
Hospital Admission

There were 12 hospitals in five different

states located on the east and west coast that
patients tried to gain admittance to.

Immediately after being admitted to the

hospitals the pseudo patients stopped
showing any symptoms of abnormality.

The patients would commonly try to

engage other patients and staff into
conversation.
After being Admitted
The pseudo patients had no idea of
when they were going to be released,
when being admitted they were told
they would have to get out on their own
devices.

Each person was discharged with the

label of schizophrenia in remission.

The length of hospitalization was 7 to

52 days with an overall average of 19
days.
Observations
Each pseudo patient took notes on
their observations while being in the
hospitals.
Many times the patients would witness
physical abuse of other patients.
Powerlessness became a huge issue
with the pseudopatients.
Rosenhan found that the average daily
contact with psychiatrists, psychologists,
residents, and physicians combined
ranged from 3.9 to 25.1 minutes with a
mean of 6.8.
Why was Rosenhan’s Study
Important?
People became aware that the basis for diagnosis might not be correct.

The study also showed in certain situations the label becomes self-
limiting and self-confirming.

 Most of all Rosenhan’s Studies proved that the

hospital could not distinguish the mentally sane
from the insane.
“The hospital itself imposes a special environment in which the
meaning of behavior can be easily misunderstood.” Rosenhan,
1973
Questions The Study
Created:
How valid are psychological diagnosis across mental health
settings?

Is diagnosing more of a bias opinion then science?

Do labels injure patients rather than help guide therapy?

 What is Thomas Szaz’s main points about
Psychiatry – what are his issues?

 What is your opinion about his points – what do

you agree with and what do you disagree with?

 How valid do you think Thomas Szaz’s concerns

about “Patient Malingerers” are?