Enduring Issues in Psychological Disorders Perspectives on Psychological Disorders

Psychological Disorders12

Enduring Issues in Psychological Disorders Perspectives on Psychological Disorders • Historical Views of

Psychological Disorders • The Biological Model • The Psychoanalytic Model • The Cognitive–Behavioral

Model • The Diathesis–Stress Model

and Systems Theory

• The Prevalence of Psychological Disorders

• Mental Illness and the Law • Classifying Abnormal

Behavior

Mood Disorders • Depression • Suicide • Mania and Bipolar Disorder • Causes of Mood Disorders

Anxiety Disorders • Specific Phobias • Panic Disorder • Other Anxiety Disorders • Causes of Anxiety Disorders Psychosomatic and Somatoform Disorders Dissociative Disorders Sexual and Gender-Identity Disorders Personality Disorders

Schizophrenic Disorders • Types of Schizophrenic

Disorders • Causes of Schizophrenia Childhood Disorders Gender and Cultural Differences in Psychological Disorders • Gender Differences • Cultural Differences

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J ack was a very successful chemical engineer known for the meticulous accuracy of his work. But Jack also had a “little quirk.” He constantly felt compelled to double-, triple-, and

even quadruple-check things to assure himself that they were done properly. For instance, when leaving his apartment in the morning, he occasionally got as far as the garage—but invariably he would go back to make certain that the door was securely locked and the stove, lights, and other appliances were all turned off. Going on a vacation was particularly difficult for him because his checking routine was so exhaustive and time-consuming. Yet Jack insisted that he would never want to give up this chronic checking. Doing so, he said, would make him “much too nervous.”

For Claudia, every day was more than just a bad-hair day. She was always in utter despair over how “hideous” her hair looked. She perceived some parts of it to be too long, and others to be too short. In her eyes, one area would look much too “poofy,” while another area would look far too flat. Claudia got up early each morning just to work on her hair. For about 2 hours she would wash it, dry it, brush it, comb it, curl it, straighten it, and snip away infinitesimal amounts with an expensive pair of hair-cutting scissors. But she was never satisfied with the

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results. Not even trips to the most expensive salons could make her feel content about her hair. She declared that virtually every day was ruined because her hair looked so bad. Claudia said that she desperately wanted to stop focusing on her hair, but for some reason she just couldn’t.

Jonathan was a 22-year-old auto mechanic whom everyone described as a loner. He seldom engaged in conversation and seemed lost in his own private world. At work, the other mechanics took to whistling sharply whenever they wanted to get his attention. Jonathan also had a “strange look” on his face that could make customers feel uncomfortable. But his oddest behavior was his assertion that he sometimes had the distinct feeling his dead mother was standing next to him, watching what he did. Although Jonathan realized that his mother was not really there, he nevertheless felt reassured by the illusion of her presence. He took great care not to look or reach toward the spot where he felt his mother was, because doing so inevitably made the feeling go away.

Cases adapted from J. S. Nevis, S. A. Rathus, & B. Green (2005). Abnormal Psychol-

ogy in a Changing World (5th ed.) Upper Saddle River, NJ: Prentice Hall.

ENDURING ISSUES IN PSYCHOLOGICAL DISORDERS As we explore psychological disorders in this chapter, we will again encounter some of the enduring issues that interest psychologists. A recurring topic is the relationship between genetics, neurotransmitters, and behavior disorders (mind–body). We will also see that many psychological disorders arise because a vulnerable person encounters a particularly stressful environment (person–situation). As you read the chapter, think about how you would answer the question “What is normal?” and how the answer to that question has changed over time and differs even today across cultures (diversity–universality). Consider also whether a young person with a psychological disorder is likely to suffer from it later in life and, conversely, whether a well-adjusted young person is immune to psychological dis- orders later in life (stability–change).

PERSPECTIVES ON PSYCHOLOGICAL DISORDERS How does a mental health professional define a psychological disorder?

When is a person’s behavior abnormal? This is not always easy to determine. There is no doubt about the abnormality of a man who dresses in flowing robes and accosts pedestri- ans on the street, claiming to be Jesus Christ, or a woman who dons an aluminum-foil hel- met to prevent space aliens from “stealing” her thoughts. But other instances of abnormal behavior aren’t always so clear. What about the three people we have just described? All of them exhibit unusual behavior. But does their behavior deserve to be labeled “abnormal”? Do any of them have a genuine psychological disorder?

The answer depends in part on the perspective you take. As Table 12–1 summarizes, society, the individual, and the mental health professional all adopt different perspectives

L E A R N I N G O B J E C T I V E S • Compare the three perspectives on

what constitutes abnormal behavior. Explain what is meant by the statement “Identifying behavior as abnormal is also a matter of degree.” Distinguish between the prevalence and incidence of psychological disorders, and between mental illness and insanity.

• Describe the key features of the biological, psychoanalytic, cognitive–behavioral, diathesis–stress, and systems models of psychological disorders.

• Explain what is meant by “DSM-IV-TR” and describe the basis on which it categorizes disorders.

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when distinguishing abnormal behavior from normal behavior. Society’s main standard of abnormality is whether the behavior fails to conform to prevailing ideas about what is socially expected of people. In contrast, when individuals assess the abnormality of their own behavior, their main criterion is whether that behavior fosters a sense of unhappiness and lack of well-being. Mental health professionals take still another perspective. They assess abnormality chiefly by looking for maladaptive personality traits, psychological dis- comfort regarding a particular behavior, and evidence that the behavior is preventing the person from functioning well in life.

These three approaches to identifying abnormal behavior are not always in agree- ment. For example, of the three people previously described, only Claudia considers her own behavior to be a genuine problem that is undermining her happiness and sense of well-being. In contrast to Claudia, Jack is not really bothered by his compulsive behavior (in fact, he sees it as a way of relieving anxiety); and Jonathan is not only content with being a loner, but he also experiences great comfort from the illusion of his dead mother’s presence. But now suppose we shift our focus and adopt society’s perspective. In this case, we must include Jonathan on our list of those whose behavior is abnormal. His self-imposed isolation and talk of sensing his mother’s ghost violate social expecta- tions of how people should think and act. Society would not consider Jonathan normal. Neither would a mental health professional. In fact, from the perspective of a mental health professional, all three of these cases show evidence of a psychological disorder. The people involved may not always be distressed by their own behavior, but that behav- ior is impairing their ability to function well in everyday settings or in social relation- ships. The point is that there is no hard and fast rule as to what constitutes abnormal behavior. Distinguishing between normal and abnormal behavior always depends on the perspective taken.

Identifying behavior as abnormal is also a matter of degree. To understand why, imag- ine that each of our three cases is slightly less extreme. Jack is still prone to double-checking, but he doesn’t check over and over again. Claudia still spends much time on her hair, but she doesn’t do so constantly and not with such chronic dissatisfaction. As for Jonathan, he only occasionally withdraws from social contact; and he has had the sense of his dead mother’s presence just twice over the last 3 years. In these less severe situations, a mental health pro- fessional would not be so ready to diagnose a mental disorder. Clearly, great care must be taken when separating mental health and mental illness into two qualitatively different cate- gories. It is often more accurate to think of mental illness as simply being quantitatively dif- ferent from normal behavior—that is, different in degree. The line between one and the other is often somewhat arbitrary. Cases are always much easier to judge when they fall at the extreme end of a dimension than when they fall near the “dividing line.”

Table 12–1 PERSPECTIVES ON PSYCHOLOGICAL DISORDERS

Standards/Values Measures

Society Orderly world in which people assume responsibility for their assigned social roles (e.g., breadwinner, parent), conform to prevailing mores, and meet situational requirements.

Observations of behavior, extent to which a person fulfills society’s expectations and measures up to prevailing standards.

Individual Happiness, gratification of needs. Subjective perceptions of self-esteem, acceptance, and well-being. Mental health professional

Sound personality structure characterized by growth, development, autonomy, environmental mastery, ability to cope with stress, adaptation.

Clinical judgment, aided by behavioral observations and psychological tests of such variables as self-concept; sense of identity; balance of psychic forces; unified outlook on life; resistance to stress; self-regulation; the ability to cope with reality; the absence of mental and behavioral symptoms; adequacy in interpersonal relationships.

Source: From “A Tripartite Model of Mental Health and Therapeutic Outcomes with Special Reference to Negative Effects on Psychotherapy” by H. H. Strupp and S. W. Hadley, American Psychologist, 32 (1977), pp. 187–196. Copyright © 1977 by American Psychological Association.

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Historical Views of Psychological Disorders How has the view of psychological disorders changed over time?

The place and times also contribute to how we define mental disorders. Thousands of years ago, mysterious behaviors were often attributed to supernatural powers and madness was a sign that spirits had possessed a per- son. As late as the 18th century, the emotionally dis- turbed person was thought to be a witch or to be possessed by the devil. Exorcisms, ranging from the mild to the hair raising, were performed, and many people endured horrifying tortures. Some people were even burned at the stake.

By the late Middle Ages, there was a move away from viewing the mentally ill as witches and possessed by demons, and they were increasingly confined to public and private asylums. Even though these institu- tions were founded with good intentions, most were little more than prisons. In the worst cases, inmates were chained down and deprived of food, light, or air in order to “cure” them.

Little was done to ensure humane standards in mental institutions until 1793, when Philippe Pinel (1745–1826) became director of the Bicêtre Hospital in Paris. Under his direction, patients were released from their chains and allowed to move about the hospital grounds, rooms were made more comfortable and sanitary, and questionable and violent medical treatments were abandoned (James Harris, 2003). Pinel’s reforms were soon fol- lowed by similar efforts in England and, somewhat later, in the United States where Dorothea Dix (1802–1887), a schoolteacher from Boston, led a nationwide campaign for the humane treatment of mentally ill people. Under her influence, the few existing asylums in the United States were gradually turned into hospitals.

The basic reason for the failed—and sometimes abusive—treatment of mentally dis- turbed people throughout history has been the lack of understanding of the nature and causes of psychological disorders. Although our knowledge is still inadequate, important advances in understanding abnormal behavior can be traced to the late 19th and 20th cen- turies, when three influential but conflicting models of abnormal behavior emerged: the biological model, the psychoanalytic model, and the cognitive–behavioral model.

The Biological Model How can biology influence the development of psychological disorders?

The biological model holds that psychological disorders are caused by physiological mal- functions often stemming from hereditary factors. As we shall see, support for the biologi- cal model has been growing rapidly as scientists make advances in the new interdisciplinary field of neuroscience, which directly links biology and behavior (see Chapter 2, “The Biolog- ical Basis of Behavior”).

For instance, new neuroimaging techniques have enabled researchers to pinpoint regions of the brain involved in such disorders as schizophrenia (Kumra, 2008; Ragland, 2007) and antisocial personality (Birbaumer et al., 2005; Narayan et al., 2007). By unravel- ing the complex chemical interactions that take place at the synapse, neurochemists have spawned advances in neuropharmacology leading to the development of promising new psychoactive drugs (see Chapter 13, “Therapies”). Many of these advances are also linked to the field of behavior genetics, which is continually increasing our understanding of the role

In the 17th century, French physicians tried various devices to cure their patients of “fantasy and folly.”