Abnormality

Abnormality

1. Definitions of Abnormality

   • Definitions of Abnormality
   • Deviation from Social Norms
     • People who behave in a socially deviant way are considered anti social and undesirable, therefore abnormal, by the rest of the group.
     • Limitations
       • Context and Degree
         • Judgement of deviance is dependent on the context of the behaviour.
         • No clear line between deviance and harmless eccentricity.
       • Cultural Relativism
         • No universal standards for labelling a behaviour as abnormal.
   • Failure to Function Adequately
     • When people cannot cope with their day to day living they can be labelled as abnormal.
     • Limitations
       • Adaptive or Maladaptive?
         • Some behaviours that appear dysfunctional or abnormal may be adaptive for the individual.
       • Cultural Relativism
         • Different diagnoses of failure to function adequately between cultures, one culture's standards being used to measure anothers.
   • Deviation from Ideal Mental Health
     • Jahoda - 6 Charachteristics
       • Self-attitudes
         • High self esteem and strong sense of identity.
       • Personal growth and self actualisation
         • Individual develops their full capabilities.
       • Integration
         • Able to cope with stressful situations.
       • Autonomy
         • Independent and self-regulating.
       • Accurate perception of reality
       • Mastery of the environment
         • Ability to love,function at work, have interpersonal relations, adjust to new situations and solve problems.
     • Limitations
       • Who Can Achieve All of These Criteria?
         • Suggests that all of us are abnormal to some degree.
       • Cultural Relativism
         • Criteria can't be applied to all cultures.
         • Self-actualisation is relevant to individualist cultures but not necessarily collectivist cultures.

2. Biological Approach

   • Biological Approach
   • Abnormality is Caused by Physical Factors
     • Mental disorders are related to physical change, illness or dysfunction in the body.
     • Genetic Inheritance
       • Abnormalities in neuroanatomy or neurochemistry are a product of genetic inheritance.
       • Can be shown by concordance rates, if twins display high concordance rates for mental disorder it suggest genetic influence.
   • Viral Infection
     • Mothers of some schizophrenics contracted influenza during pregnancy. Thought to enter the child's brain and remain dormant until puberty.
   • Neuroanatomy and Neurochemistry
     • Abnormalities in brain structure may determine abnormality.
       • Some schizophrenics have large ventricles in their brain.
     • Altered brain chemistry can lead to abnormal behaviour.
       • Low levels of serotonin in the brain of individuals suffering from depression.
   • Limitations
     • Humane or Inhumane?
       • Szasz - the concept of 'mental illness' was created to control individuals who society could not accept.
     • Inconclusive Evidence
       • If mental disorder caused by genetic factors alone concordance rates would be 100%.
       • Twin studies of schizophrenia, concordance rates 50%. Might inherit vulnerability to disorder which only develops under certain stressful conditions.
     • Cause or Effect?
       • No causal relationship between biological influence and mental disorder.
       • Schizophrenics large ventricles in brain, they may be caused by schizophrenia rather than cause it.

3. Psychodynamic Approach

   • Psychodynamic Approach
   • Mental Disorders Have Psychological Causes
     • Freud - mental disorders are not caused physically but by unresolved childhood conflicts.
     • Conflicts between the id, ego and superego create anxiety.
       • Id - irrational, primitive part of personality. Ruled by the pleasure principle.
       • Ego - conscious, rational part of personality. Governed by the reality principle.
       • Superego - embodies our conscience with ideas of right and wrong, as well as notions of the ideal self.
     • Ego defences relieve anxiety.
       • Repression
         • Moving unpleasant thoughts into the unconscious.
       • Projection
         • Blaming someone else for something a child cannot deal with.
       • Regression
         • Behaving like a child when faced with a difficult situation.
   • Early Experiences Cause Mental Disorder
     • In childhood the ego is not developed enough to deal with traumas leading to repression of associated emotions.
     • Individual may re-experience the earlier trauma later in life, leading to depression.
   • Unconscious Motivations
     • Underlying problems cannot be controlled until brought into conscious awareness.
   • Limitations
     • Abstract Concepts
       • Id, ego and superego are hard to demostrate through research. unconscious, know way to know they are operating at all.
     • Lack of Research Support
       • Fisher and Greenberg - 2500 experimental studies of Freudian hypotheses, many of Freud's major claims received support. -ve results used as support.
     • Sexism
       • Freud's theory is sexually unbalanced. Limits the relevance of approach to understanding development of mental disorders for women.

4. Behavioural Approach

   • Behavioural Approach
   • Only Behaviour is Important
     • Focuses only on behaviours; the observable responses a person makes to the environment.
     • Examples
       • OCD might be displayed by compulsive behaviours such as constant hand washing.
       • Someone with a phobia may display extreme anxiety in presence of phobic object.
   • Abnormal Behaviours are Learned
     • Operant Conditioning
       • Psychological disorder might be produced when a maladaptive behaviour (such as panic attacks) lead to the desired increased attention.
     • Social Learning Theory
       • Abnormal behaviours may be acquired by seeing others rewarded for the same behaviours.
   • Learning Environments
     • Environments in which behaviours are learned may reinforce maladaptive behaviours.
     • Examples
       • For an individual with agoraphobia, not leaving home lowers anxiety.
       • For those with depression, depressive behaviours may elicit help from others.
   • Limitations
     • Limited View
       • Limited view of factors which cause abnormality. Ignore role of physiological and cognitive factors.
     • Counter Evidence
       • Struggles explain why people with phobias cannot recall an incident in their past which led to traumatic conditioning.
     • Symptoms not the Cause
       • Therapies only treat symptoms not the cause. Cause can resurface, often in a different form.

5. Cognitive Approach

   • Cognitive Approach
   • Abnormality is Caused by Faulty Thinking.
     • Assumes that thinking, expectations and attitudes direct behaviour.
     • Mental illness is the result of cognitive distortions in the way a person thinks about a problem.
     • Faulty and irrational thinking prevents the individual behaving adaptively.
   • A-B-C Model (Ellis, 1962)
     • A - activating event
     • B - belief (may be rational or irrational)
     • C - consequence (rational beliefs lead to healthy emotions, irrational beliefs lead to unhealthy emotions)
   • Individual is in Control
     • Individual is the cause of their own behaviour as they control their own thoughts. Abnormality is result of faulty control of this process.
   • Limitations
     • Blames the Patient
       • Overlooks situational factors, such as life stressors. Recovery only involves changing the way patient thinks about stressors, not removing them.
     • Consequence Rather than Cause
       • Individual might develop way of thinking because of their disorder.
       • Individuals with maladaptive cognitions may be at greater risk of developing mental disorders.
     • Irrational Beliefs may be Realistic
       • Alloy & Abrahmson - people with depression have more realistic view of the world. Gave more accurate estimates of likelihood of disaster.

6. Biological Therapies

   • Biological Therapies
   • Drugs
     • Antipsychotics
       • Used to combat symptoms of psychotic illnesses such as Schizophrenia.
       • Conventional antipsychotics block transmission of dopamine, and so alleviate many symptoms of the disorder.
     • Antidepressants
       • SSRIs block the transporter mechanism which reabsorbs serotonin into the nerve cell prolonging its activity and relieving the symptoms of depression.
     • Anti-anxiety
       • Benzodiazepines reduce anxiety by slowing down the central nervous system.
       • Beta-blockers reduce anxiety by reducing the activity of adrenaline and noradrenaline, part of the body's response to stress.
     • Evaluation
       • Strengths
         • Effectiveness
           • Chemotherapies work when compared to placebo. However, drug alone is less effective than when combined with psychological therapies.
         • Ease of Use
           • Require little effort from patient, more motivated to continue treatment than time consuming psychological treatments.
       • Limitations
         • Symptoms not Cause
           • When patient stops taking drugs, effectiveness ceases and symptoms return.
         • Side Effects
           • Patients stop taking medication as they cannot cope with side effects.
           • SSRIs cause nausea or even suicidal thoughts.
   • ECT
     • Generally used for severely depressed patients for whom psychotherapy and drugs don't work.
     • How it Works
       • Small current lasting about half a second is passed through the brain. Produces a seizure, which affects the whole brain.
     • Why it Works
       • Affects action of neurotransmitters, recovery from depression may be due to improved communication between different parts of the brain.
     • Evaluation
       • Strength
         • Saves Lives
           • Can be effective treatment for severe depression which may otherwise lead to suicide.
         • Effectiveness
           • Comer - 60-70% of ECT patients improve after treatment, critics claim 84% relapse within 6 months.
       • Limitations
         • Sham ECT
           • Some sham patients recover, suggesting that attention plays a part in recovery.
         • Side Effects
           • Include impaired memory, cardiovascular problems and headaches. DOH found 30% had permanent fear or anxiety after.

7. Psychological Therapies

   • Psychological Therapies
   • Systematic Desensitisation
     • Used to treat anxiety, particularly phobias.
     • How it Works
       • Patient taught how to relax using relaxation techniques.
         • Create hierarchy of scenes each causing more anxiety than the previous.
           • Works through the hierarchy gradually.
             • Two responses of relaxation and fear are incompatible and fear is eventually dispelled.
               • Client can imagine feared situation or be in presence of phobic stimulus.
     • Evaluation
       • Strengths
         • Appropriateness
           • Relatively quick and require less effort from patient, more likely to continue.
           • Can be self-administered using computer simulation, makes delivery of treatment even more efficient for patient.
         • Effectiveness
           • Capafons et al - people with aerophobia had less anxiety compared to control group and showed less physiological signs of fear.
           • McGrath et al - estimated that SD is effective with 75% of patients with phobias.
       • Limitations
         • Symptom Substitution
           • Doesn't deal with cause of anxiety, other symptoms can appear later on. Langevin - no evidence support.
         • Not Universally Effective
           • Less effective with treating anxiety with underlying adaptive component (e.g. dangerous animal) than if personal. 'Ancient' fears helped ancestors.
   • Cognitive Behavioural Therapy
     • CBTs such as REBT are based on the idea that many problems are a result of irrational thinking.
       • Rational-emotive behaviour therapy (REBT) helps people change dysfunctional emotions into behaviours.
     • How it Works
       • Based on ABC model, tries to change irrational beliefs into more rational ones.
       • Patient is encouraged to dispute self-defeating beliefs.
       • Change achieved through...
         • Logical disputing
           • Showing that beliefs do not follow logically from info available.
         • Empirical disputing
           • Showing beliefs are not consistent with reality.
         • Pragmatic disputing
           • Showing the lack of usefulness of existing beliefs.
       • Extends ABC model - disputing (D), a more effective attitude to life (E) and a new set of feelings (F).
     • Evaluation
       • Strengths
         • Appropriateness
           • REBT usefulness not limited to people with mental disorders but also to non-clinical population, e.g. exam anxiety.
           • Yoichi et al - developed computer based counselling programme based on REBT that has produced significant decreases in anxiety.
         • Effectiveness
           • Engels et al - meta-analysis found REBT more effective in treatment of different types of disorder and more effective than SD or others.
       • Limitations
         • Irrational Environments
           • REBT fails to address irrational environments which may exist beyond the therapeutic situation which reinforces maladaptive behaviour.
         • Not Suitable for All
           • REBT doesn't always work and some people dislike the direct advice or fail to put principles into practice.
         • Ethics
           • Disputing what appears to be an irrational belief may create difficulties for client for whom the belief is based on a fundamental religious belief.
   • Psychoanalysis
     • Behaviour is influenced by repressed memories, psychoanalysis traces influences to their origins and help patient deal with them.
     • How it Works
       • Free Association
         • Patient expresses thoughts as they occur, even if seemingly unimportant. Reveals areas of conflict to bring repressed memories to the conscious.
       • Therapist Interpretation
         • Therapist draws conclusions about possible causes. Patient displays resistance or transference, where they recreate feelings associated with problems.
       • Working Through
         • Patient and therapist examine same issues repeatedly to gain clarity of causes. Freud believed this produced greatest changes in the patient.
     • Evaluation
       • Strengths
         • Effectiveness
           • Bergin - analysis of 10,000 patient histories estimated that 80% benefitted compared to 60% who received different approaches.
         • Length of Treatment
           • Tschuschke et al - 450 patients, found that psychodynamic therapies more effective in long term. The longer the treatment, the better the outcomes.
       • Limitations
         • No Better than Placebos
           • Eysenck - failure of Freudian therapy to improve on spontaneous remission or placebo treatment proves inadequacy of Freudian theory.
         • Appropriateness
           • Freud failed to appreciate individual differences, therapies are not adjusted to suit the individual.
         • False Memories
           • Critics claim that some therapists are unwittingly planting false memories of sexual abuse or abduction.
           • Can't assume patient can reliably recall early memories that have been repressed.