Psyc 162-001 Abnormal Psychology Spring, 2004

Lecture 2 Abnormality -A cultural (social, moral, religious) construct

Case Studies
Mr. Simpson -Under surveillance Jorgen -- Oslo Factory worker Joe College The Wealthy Widow

The Elements of Abnormality

Facets of the behavior we factor in to our decision about normality/abnormality: Is the person suffering? Is the behavior maladaptive? Is the behavior irrational? Is the person in control? Is the behavior vivid or unconventional? Are observers affected? Are moral rights or ideal standards violated?

Integrating the 7 Elements

Very rarely do all 7 elements appear in any single disorder or in any single clinical patient Therefore, degrees of abnormality What combination of the elements in what measure determines abnormality? Taxonomies aspire to fit the Aristotelian model -- necessary & sufficient conditions

Necessary conditions of group membership

A NECESSARY condition is one in which: A characteristic or feature must be present to obtain membership Consider: Are there necessary conditions for a geometric shape to be included in the group square?

Sufficient conditions of group membership

A SUFFICIENT condition is one in which: A characteristic or feature, if present, guarantees membership in the group Consider: Is there a single, sufficient condition for membership to the group triangle?

Aristotles formulation applied to abnormality

Consider: Are there any necessary conditions for abnormality? That is, are there any of the 7 elements which MUST be present for behaviors to be called abnormal? Consider: Are there any sufficient conditions for abnormality? That is, are there any features of abnormality which ALONE guarantee membership?

Is Suffering Necessary or Sufficient?

Not Necessary: Rarely present in Antisocial Personality Disorder Rarely present in manic phase of Bipolar Not Sufficient: Bereavement includes suffering, but is not considered to be abnormal and is not included as a mental disorder

Is Maladaptiveness Necessary or Sufficient?

Not Necessary: Certainly coded for in most cases as significant impairment of social or occupational functioning, BUT what about ASPD? Not Sufficient: Underachievement Disorder? their behavior is maladaptive even as defined by their own goals Some aspects of Bipolar, e.g., are adaptive

Is Irrationality Necessary or Sufficient?

Not Necessary:
In most diagnoses the patients thinking is somewhat distorted BUT, in few diagnoses would we call it irrational

Not Sufficient:
Some cases of irrationality are called art

Is Loss of Control Necessary or Sufficient?

Not Necessary:
e.g., some psychosexual disorders are due to the inability to surrender control

Not Sufficient:
In DSM is always loss of control + negative outcome

Is Vividness & Unconventionality Necessary or Sufficient?

Not Necessary:
e.g., up to 20% of females experience clinical depression

Not Sufficient:
e.g., what about genius?

Is Observer Discomfort Necessary or Sufficient?

Not Necessary:
e.g., solo disorders such as agoraphobia

Not Sufficient:
Most often coded for in the PDs, BUT each PD requires additional criteria What about the work of a surgeon?

Is Violation of Moral Rights and Ideal Standards Necessary or Sufficient?

Not Necessary:
e.g., not present in unipolar depression

Not Sufficient:
Certainly not from a cross-cultural perspective

Wittgensteins Family Resemblance Model

Wittgenstein proposed a classification system based on degree of shared characteristics This is the Family Resemblance Model For each specific case/instance, the more features possessed the more likely the case/instance belongs in the family This model allows for fuzzy boundaries -borderline cases that dont fit neatly into the model

The Elements of Abnormality -Revisited

Core Elements
Suffering Maladaptiveness Irrationality

Peripheral Elements
Loss of Control Vividness & Unconventionality Observer Discomfort Violation of Moral and Ideal Standards

Wittgenstein & Psychopathology

Unipolar Depression _ Suffering + Maladaptiveness Bipolar + +
Schizophrenia

Irrationality Specific Phobia _

Historical Perspectives on Abnormality

Earliest Conceptions of Abnormality

Ebers papyrus dates to 3000 BC
details anatomy of the brain recognizes brain-behavior relationship documents mental disorders treatment -- incantations, magic, prayer

Reflects etiological view dating back 30,000 years

Spirit possession as etiology

Site of function -- possession of the head animus possession versus evil spirit versus angry god Treatment was a logical corollary to the etiological model Trephining

Trephining

Biblical references to abnormality

Ancient Hebrews -- madness as the retraction of Gods protection New Testament -- Jesus cures a man with an unclean spirit (Mark 5:1-13) Treatment options:
magic, prayer, noisemaking purgatives including potions of wine and sheep dung starving, flogging

The Greek Reformation

Athens under Pericles (461-429 BC) Ancient Greek priests supplement exorcism with alternative strategies kindness, suggestion, recreational measures (plays, riding, walking, harmonious music) patients slept in temples of the god Asclepius to capture dreams which point to treatment reminiscent of anyone? Note: same etiological formulation, different treatment model

Harmonious music -- mechanisms of change

McGill study: subjective experience of harmonious music correlated with:
activation of dorsomedial midbrain and R thalamus suppression of R amygdala enhanced affect, reward & punishment centers

Blood & Zatorre (2001)

Hippocratres -- first biological formulation

Revolutionary concepts
defied demonology advocated biological causes and biological treatments mental disorders = brain pathology heredity & predisposition clinical observation & taxonomy

460-377 BC

Ironically without knowledge of anatomy

Hippocratic Taxonomy
4 humors from the 4 elements blood fire phlegm water black bile earth yellow bile air treatments concepts follow: melancholia - sobriety, vegetable diet, celibacy, exercise short of fatigue, bleeding some indications of theory of mind-body nexus tranquil life, removal of patients from family

Expansion of Hippocratic Typology

Galen -- Greek practicing in Rome Human autopsies still banned - studied animal anatomy Expanded 4 humors to theory of personality and disorder
misled as to psychological cause for centuries Fall of Roman Empire at end of C5th Dark Ages for Abnormal Psychology with death of Galen in A.D. 200

Contributions
experimental approach to diagnosis bodily health can be affected by the suffering of the psyche

Abnormality through the Middle Ages (500 - 1500 A.D.)

Reversion to etiological models based on demonic possession Fueled by emerging trend of mass madness
Tarantism - early C13th, Italy Saint Vituss Dance - Germany and rest of Europe Lycanthropy 1541 case tragic example of the misinterpretation of somatic delusions

Mass hysteria peaked during C14th & C15th

consider the events of this time

St. Catherine - canonized for exorcisms

Witchcraft as Insanity
Church doctrine on demonology and witchcraft culminated in publication of Malleus Maleficarum in 1486 Condoned and encouraged ritualized torture of an estimated 1 million people across next 3 centuries What proportion of these were psychotic?
intercourse with the devil (Zilboorg interpretation, 1941) Schoeneman - the typical accused witch was not a mentally ill person but an impoverished woman with a sharp tongue and a bad temper. - 1984

Avicenna -- the protector

Author of The Canon of Medicine The prince of physicians Kept alive the concept of abnormality due to physical and psychical disorder Advocated creative, humane treatment

C. 980-1037

The Era of Asylums - (1547-1792)

1547 - Henry VIII officially creates asylum at monastery of St. Mary of Bethlehem Origin of term bedlam:
bedlam beggars, who, with roaring voices, sometime with lunatic bans, sometime with prayers, enforce their charity (King Lear, II. iii)

Mexico 1566, Paris 1641, Moscow 1764, Lunatics Tower in Vienna 1784

Humanitarian Reform
Phillipe Pinel - 1792
received grudging approval of Revolutionary Committee to remove chains destroyed dungeons & created light & airy rooms

Benjamin Rush
continued the trend in US established Pennsylvania Hospital in 1783

Rushian innovations

Phillipe Pinel -- A Final Note