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Psychology, 5/e Wortman, Loftus & Weaver | |||||
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Psychology, 5/e Wortman, Loftus & Weaver | |||||
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Abnormal behavior can be defined in many ways. A statistical criterion specifies that abnormality is any substantial deviation from the average. A social norms criterion defines abnormal behavior as that which differs significantly from the norms of society. Another definition suggests that abnormality can be defined by adding some widely accepted standards of what is psychologically “unhealthy.” These standards would include emotional pain and suffering, behavior that is disturbing to others, failure to perform daily activities, and irrationality. All these definitions have advantages and disadvantages, and none is sufficient in itself. In fact, the more criteria that can be applied, the less confident we become of our diagnosis. Thus, mental health can be best viewed as a continuum, with extremes at the normal and abnormal ends, and with an ambiguous area in between.
Several theories have been proposed to account for abnormal behavior; each theory applies to different cases and each theory suggests different causes and cures.
The biological perspective likens psychological disorder to physical illness. Symptoms are used to diagnose the underlying “mental illness,” which results from a physical problem. The medical discovery that the madness associated with general paresis, the deterioration of mental and physical processes as the result of a syphilis infection, was the result of a venereal disease caused by microorganisms provided strong support for the biological perspective. Today biological researchers are trying to understand the brain chemistries of mentally disturbed people to try to understand the causes of mental illness.
Many mental-health professionals emphasize the role of psychological factors in the development of psychological disorders, and several perspectives stress explanations consistent with this view.
Psychoanalytic theory (psychosexual approach), developed by Freud, holds that unresolved sexual conflicts in early childhood or conflicts between the id, ego, and superego set the stage for psychological disorders later in life. When the ego becomes too weak, abnormal behavior results. Psychoanalysis, a deep probing of people’s thoughts and feelings, attempts to give patients insight into their unconscious conflicts and thereby make them healthier. The psychoanalytic perspective, like the biological model, views symptoms as being produced by underlying disorders.
The learning perspective differs sharply from the biological and psychoanalytic models because it proposes that psychological disturbances arise from learning abnormal responses. Treatment usually consists of trying to extinguish the maladaptive behavior and teach more normal methods of living.
The cognitive perspective suggests that, in addition to the influence of the learned behaviors, the interpretations a person places on an event are significant determinants of how he or she will respond to that event. Cognitive therapies emphasize changing negative cognitions so as to allow the person to break free of maladaptive behaviors.
Two other perspectives are also proposed. Both consider the social world in which a disturbed person lives. The interpersonal or family-systems perspective suggests that the source of a psychological disturbance may not be entirely within the person. The relationships the person has with others may also be a cause of maladaptive behavior. The sociocultural perspective looks for the source of psychological disturbances in the society in which a person lives. It suggests that conditions such as overcrowding and poverty may produce undesirable behavior. The poor are also less prepared to cope with severe stress, and research shows that mental illness is more prevalent among the poor.
None of these theories provides perfect answers, but each contributes a different perspective for the study of psychological disturbances. The diathesis-stress model attempts to combine some elements from several models. It argues that a person’s genetic makeup creates a diathesis, or predisposition, toward a certain mental disorder which may develop if certain environmental conditions are met.
In diagnosing a mental disorder, therapists classify it according to its syndrome, a set of symptoms which tend to occur together. Classification gives mental health professionals a shorthand means of communicating, helps suggest effective treatments, encourages the pooling of research data, and aids in making predictions. The standard classification system is the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). According to this manual, patients are evaluated on five axes that help clinicians determine the most effective treatment strategies. Axis I lists clinical syndromes; Axis II refers to maladaptive personality traits; Axis III evaluates the patient’s physical illness; Axis IV assesses the stress in the patient’s life; Axis V measures the highest level of functioning the patient has experienced in the previous year.
Some people criticize classification systems, arguing that they ignore relevant individual differences and lead professionals to see patients according to their diagnosis rather than their actual behavior. However, most classifications are quite reliable, and potential problems with validity do not override their usefulness.
The anxiety disorders are characterized by emotional distress caused by feelings of vulnerability, apprehension, or fear.
The anxiety disorders include panic disorder, phobic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Panic disorder involves attacks of inexplicable, intense fear, and it occurs in about 1% of both men and women. Often panic disorder is accompanied by agoraphobia, an intense fear of being in a place from which one cannot escape without embarrassment. Panic disorder is sometimes accompanied by depression, and tends to run in families.
A phobia is an extreme and irrational fear focused on a particular object. Social phobias involve a fear of doing something in public that could be embarrassing; specific phobias involve the fear of nonsocial things, such as enclosed places. About 13% of the population experiences phobias. Phobics know their fears are unreasonable, yet they are unable to control them. Freudians explain phobias as the result of a defense mechanism to protect the ego from the too powerful id. Learning theories see phobias as the result of conditioning, and some evidence suggests we are innately prepared to develop certain phobias. Observational learning may also play a role.
Generalized anxiety is a state of persistent apprehension without good cause, often accompanied by tension. The psychoanalytic view is that generalized anxiety disorder results from the ego’s fear that the id’s impulses will be punished, a condition Freud called “free-floating anxiety.” The cognitive perspective suggests this disorder is the result of one’s inability to control negative life events.
An obsession is a recurring, irrational thought that intrudes continuously, even though the person tries to avoid thinking about it. A compulsion is an uncontrollable, repetitive behavior such as excessive handwashing. Although obsessions and compulsions often occur together, they each occur separately as well. The psychoanalytic view sees these disorders as the result of ego defenses. The learning view suggests compulsions are reinforced by reducing anxiety, but cannot account for obsessions. The biological perspective views these disorders as the result of brain abnormalities and points out that they have an inherited component.
Posttraumatic stress disorder (PTSD) is a state of anxiety and depression that follows severe trauma, like warfare, rape, or natural disaster, and may appear long after the distressing event is over and last for years. Symptoms include tension, insomnia, trouble concentrating, a feeling of remoteness, and flashbacks. The major determinant of who experiences PTSD is the severity of the trauma.
Somatoform disorder involves the symptoms of a physical dysfunction, even though the ailment has no organic cause. Hypochondriasis is characterized by the irrational belief that one has contracted a serious illness, even though no corresponding symptoms are present. Even when medical examination reveals no physical impairments, the hypochondriac typically does not believe the favorable diagnosis.
A conversion disorder usually involves the real loss of some body function following a traumatic event. The conversion disorder arises to protect the person from being forced to confront a high-anxiety situation. Freud argued that conversion disorders are defenses against forbidden impulses. Learning theorists see them as leading to rewards by reducing anxiety. Family-systems theorists see them as serving a useful role in a family by helping other family members function.
The dissociative disorders involve the splitting of the personality into component parts so that memory or identity is disrupted. Dissociative amnesia, the forgetting of past experiences, involves the dissociation of present memories from certain memories of the past. In a dissociative fugue, people leave their identities and take up new lives, having entirely forgotten their pasts.
Dissociative identity disorder (multiple personality disorder) is the dissociation of the mind into several “people,” each with different characteristics. These personalities tend to form three clusters: those which are demure, shy, and withdrawn; those which are aggressive and promiscuous; and those which are level or rational. Often the personality which goes for help does not know about the other personalities but is troubled by memory lapses or unexplained events. Multiple personality usually begins in childhood, often coincides with severe sexual abuse.
Mood disorders involve intense moods which last for longer than normal periods of time. There are two major categories: depressive disorders and bipolar disorders.
Major depressive disorder is characterized by one or more episodes of deep sadness and despair which last all day long for two or more weeks. Symptoms include: loss of energy, slowing down of behavior, agitation, difficulty thinking, eating disturbances, problems in sleeping, an exaggerated sense of worthlessness, and recurring thoughts of death and suicide. Depressive episodes typically last three to six months, and relapses occur in about 50% of the cases. Dysthymic disorder (dysthymia) is like major depression except it endures for years at a time with only short remissions.
Nearly 30,000 deaths are recorded as suicides each year in this country, and the actual number is much higher, perhaps 100,000. Suicide is the second most common cause of death for the 15 to 24 age group in the U.S. Three times more men kill themselves than women, but three times more women than men attempt suicide. Many of the common myths about suicide are not true. For example, there is little truth to the notion that people who attempt suicide are not serious about killing themselves.
Different theories have attempted to explain depression in a variety of ways. The psychoanalytic perspective suggests that depression is the result of self-loathing due to the rage one feels when abandoned by a loved one. Another view suggests that depression is the result of the loss of something valuable by a person whose needs in infancy were not met.
Peter Lewinsohn, a learning theorist, proposes that depression occurs because a person is no longer receiving any pleasurable reinforcement from life. Without rewards, a person gives up trying and becomes depressed and withdrawn. This only worsens the problem.
Aaron Beck, a cognitive theorist, believes that depressed people make errors in their thinking, which leads them to put a consistently negative interpretation on nearly everything. They concentrate on small details taken out of context which reinforce their erroneous thinking. To reduce depression, Beck argues that a therapist must help a depressed client break free from negative outlooks.
Depression is also influenced by biological factors. Studies comparing identical twins to fraternal twins and studies investigating rates of depression in adopted infants demonstrate the presence of a genetic tendency toward depression. Other biological theories have proposed that depression arises from disruptions in the amount of neurotransmitters such as serotonin or norepinephrine. Support for these biological views comes from the fact that certain antidepressant drugs alter brain chemistry and also alter mood, and can sometimes reduce depression, although the mechanism by which they work is currently unknown. In addition to neurotransmitters, hormones may be implicated in depression.
Seasonal affective disorder (SAD) is a form of depression that occurs in response to a relative lack of sunlight, most often in winter. This type of depression is more common in higher latitudes where the winters are longer and darker. SAD can be effectively treated with artificial light therapy.
The interpersonal, or family-systems, approach specifies that depression results from disturbed interactions among family members. Research supporting this view shows that people do have more negative reactions to depressed people than to those who are not depressed. Depressed people have also been found to have more negative conversation styles, smile less, and are less animated and pleasant. These negative responses are usually met by negative reactions, which causes depression to become more severe.
Because the roots of depression are many and complex, a combination of perspectives helps us understand this disorder.
In 5 to 10% of people with depression, mania is also involved, resulting in a syndrome called manic-depressive (bipolar) disorder, which affects about 1% of the population. Mania is a state of exaggerated elation characterized by irritability, hyperactivity, decreased need for sleep, constant talkativeness, flight of ideas, distractibility, inflated self-esteem, and reckless behavior. Mild manic episodes produce a feeling of power and competence, but more severe forms produce severe impairments. Manic-depressive (bipolar) disorder appears to differ from unipolar depression in that it starts earlier in life, runs more in families, and responds favorably to the drug lithium carbonate. Cyclothymia is a chronic but milder form of manic-depressive disorder.
Manic-depression has been linked to certain genes, and a biological explanation is strongly implicated. The exact cause is not understood, but it probably involves a complex interaction between genetic, neurochemical, cognitive, and developmental factors.
Schizophrenia, a severe mental disorder which affects about 1% of the population, is responsible for about half of all people committed to mental hospitals. It is highly resistant to treatment with little more than a third of schizophrenics recovering. Schizophrenia is usually characterized by a deterioration of behavior which results in an active phase, which may improve to a residual phase, only to be followed by more active phase-residual phase cycles. Symptoms of schizophrenia include the following: disturbances in the content of thought, including delusions (irrational beliefs); disturbances in form of thought as evidenced by disjointed and impoverished speech; disturbances of perception; disturbances of emotion; disturbance in the sense of self; disturbances in volition (ability to act); disturbances in interpersonal relationships; and disturbances in motor behavior, as exemplified by the catatonic stupor, in which the person remains in one position for hours. Most schizophrenics exhibit a split between various ideas and emotions. Often, their language indicates an inappropriate shifting from one thought to the next as they ramble through meaningless and unrelated phrases. Schizophrenics also have a distorted view of reality. They see, feel, and hear things that have no existence in reality. They may also display bizarre and inappropriate behaviors. Sometimes, when in a catatonic stupor, a schizophrenic displays no behavior at all, just remaining motionless for long periods of time. There is a tendency to be withdrawn into an inner world and to avoid social interaction.
Schizophrenia is organized into subtypes which include a disorganized, or hebephrenic, type; a catatonic type; a paranoid type; and an undifferentiated type. A newer classification divides schizophrenics into three categories: those with positive or active symptoms; those with negative or passive symptoms; and those with mixed symptoms. It seems likely that different subtypes might well have different causes.
Different theories propose various explanations of the causes of schizophrenia. The biological perspective has suggested that schizophrenia may result from a genetic predisposition (schizophrenia is positively correlated with similarity of genetic makeup), too much dopamine in the brain (drugs that block dopamine absorption sometimes reduce schizophrenic symptoms), unusually sensitive dopamine receptors in critical areas, or too many dopamine receptors in critical brain locations.
Interpersonal, or family-systems, theorists believe that schizophrenia is related to inappropriate family functioning. Families high in expressed emotion, which involves an emotionally charged atmosphere high in hostility and criticism, tend to be linked with higher relapse rates of schizophrenic family members. Fortunately, relatives of schizophrenics can be taught to lower their levels of expressed emotion.
The diathesis-stress model integrates the diathesis (biological predisposition) and the stress (environmental and learned aspects) to account for schizophrenia, and suggests both factors are necessary for the disorder to be manifested.
Personality disorders are deep-seated patterns of maladaptive behaviors that cause distress to others. Unlike the anxiety disorders, the personality disorders produce little or no guilt or anxiety.
People with antisocial personality disorder (sociopaths), are people who follow their impulses without guilt and without considering the consequences of their behaviors for others. About 4% of American men and 1% of American women have this disorder, which is usually apparent by age 15 and is characterized by impulsiveness; disregard for the truth; aggression; irresponsibility in family, occupational, and financial obligations; and incapacity for normal friendship or love. Psychoanalytic theorists explain sociopathy as the result of rejecting parents and the corresponding failure to develop a conscience. Learning theorists suggest that the sociopath receives reinforcement when he or she commits sociopathic acts. This view is supported by the fact that antisocial people tend to have antisocial fathers to model. Biological theorists suggest such a person may suffer from autonomic underarousal, and commit crimes to get a thrill.
People with narcissistic personality disorder have an overblown sense of their own importance, yet have very fragile self-esteem. Borderline personality disorder is characterized by instability in self-image, interpersonal relations, and mood. People with borderline personality disorder are very erratic in their behavior, which is characterized by extreme highs and lows.
Substance-related disorders involve psychological disturbances resulting from the abuse of drugs. Alcohol is the most commonly abused drug in our society. Alcohol dependence involves pathological and compulsive use of alcohol and physical need for the drug. Dependence involves the development of a tolerance (it takes more and more alcohol to get drunk) and the presence of withdrawal symptoms when consumption is temporarily halted. Alcohol abusers are people who are not alcoholics but who have a drinking problem. About 13% of Americans will at some point in their lives have a problem with alcohol. Although presently alcoholism affects mostly men, it is increasing in women and teenagers. Alcoholism takes a serious toll on the alcoholic’s health and on the productivity of our society, costing our economy as much as $120 billion per year in lost productivity and increased health care. About 85% of alcoholics receive no treatment.
The psychoanalytic perspective suggests that alcoholism results from conflict over oral gratification in infancy. Furthermore, these theorists suggest that alcoholism may be a means of coping with low self-esteem. Learning theorists argue that drinking provides the alcoholic with rewards, especially the reduction of stress that results from intoxication. This tension-reduction function may be the result of the body’s compensating for a reduction of the neurotransmitter endorphin which normally reduces pain and elevates mood. There is also evidence of a genetic link in alcoholism. Because no single theory or therapy seems satisfactory, treatment is often based on a combination of several different approaches.
Martin Seligman’s theory of learned helplessness has been extremely influential. Seligman’s research began with experiments on dogs. He noticed that dogs that were in situations where they could not escape a series of shocks exhibited classic signs of depression: lethargy, inactivity, and loss of appetite. Dogs that were in situations where they could escape the shocks did not exhibit these symptoms. Seligman concluded that the dogs in the uncontrollable situation had learned that they were helpless. Seligman speculated that this type of learning could be an important cause of depression in humans.
Seligman later modified this theory to state that it is not uncontrollable outcomes alone that determine human depression, but also the way the person explains those outcomes. People who attribute negative outcomes to their own personal inadequacies and assume that these inadequacies are enduring traits are the most susceptible to depression. Seligman developed a questionnaire to assess how people explained negative life events. Studies using this questionnaire supported Seligman’s theory that depressed people do attribute negative experiences to inborn traits. Seligman’s theory is similar to that of Aaron Beck’s in that both suggest that negatively distorted thinking can lead to depression.
Other psychologists do not totally agree with Seligman and Beck. Some studies have shown that depressed people are actually more realistic in estimating their degree of control in certain situations than nondepressed people. Depressed people also tend to be accurate in describing their lack of social skills. These findings question whether depressed people’s negative view of themselves is really that distorted.
Seligman counters by stating that it does not matter if the negative self-schemas of depressed people are accurate or not. If people think that personal faults lead to negative experiences, then this belief will lead to prolonged dejection. The findings on this theory are mixed. There is evidence that when people with negative self-schemas experience an upsetting event, they respond with more intense and prolonged dejection than others. Other studies have failed to support Seligman’s contention. Such findings have led to a new model known as the hopelessness theory. This theory states that a negative style of thinking is just one of many cognitive factors that contribute to depression. Research has tended to support the hopelessness theory.
In order
to further understand depression, psychologists will need to explore cognitive
factors. Future models of depression will probably include sev
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