Psychopathology
Chapter 1: Introduction psychopathology
Introduction
The use of the word ‘crazy’ in different circumstances:
• When someone’s behavior deviates from expected norms.
• When we are unclear about the reasons for someone’s actions.
• When a behavior seems to be irrational.
• When a behavior or action appears to be maladaptive or harmful to the individual or others.
Psychopathology ® Current definition: the in-depth study of mental health problems. Not disorders, but the
product of perfectly healthy psychological processes in response to stressful life experiences.
Traditional/old definition: the scientific study of mental disorders (medical or illness model).
Clinical psychology ® The branch of psychology responsible for understanding and treating psychopathology.
1.1 History of psychopathology
Demonic possession ® Historical explanations of psychopathology such as ‘demonic possession’ often alluded
to the fact that the individual had been ‘possessed’ in some way.
In Western societies until 18th century, when witchcraft and demonic possession were common explanations.
Currently still in Haiti and some areas of Western Africa.
↳ Psychopathology is often accompanied by personality changes. These changes are some of the first things that
are noticed (reserved person becomes manic). So, people thought they were possessed (e.g. by bad spirits). Often
linked to religious beliefs.
‘Treatment’ ® Elaborate ritualized ceremonies that frequently involved direct physical attacks on the sufferer’s
body in an attempt to force out the demons (e.g. torture/starvation). This often increased the distress of the
victim.
Medical or disease model ® An explanation of psychopathology in terms of underlying biological or medical
causes. By the middle of the 17th century, religious, spiritual and superstitious explanations were replaced by
more objective, medical explanations (because of empirical scientific methods).
↳ The body-mind dualism of Descartes introduced some significant reorientations. Minds could not be diseased,
so mental health problems must be located in the body, and more specifically in the brain.
↳ Psychopathology moved from being a concern of demonology to being in the realm of medicine.
Psychiatry ® A scientific method of treatment that is based on medicine, the primary approach of which is to
identify the biological causes of pathology and treat them with medication or surgery.
Implications for the way we conceive mental health problems:
• It implies that medical or biological causes underlie psychopathology. This is by no means always the
case. ® In contrast to the medical model, both psychodynamic and contemporary cognitive accounts of
pathology argue that many problems are the result of someone learning dysfunctional ways of thinking
and acting through normal processes. The experiences are dysfunctional, not biology.
• Adopts what is basically a reductionist approach by attempting to reduce the complex psychological
and emotional features of pathology to simple biology.
• Assumption in this model that pathology is caused by ‘something not working properly’. This
assumption is problematic for a number of reasons:
1. Mental health problems may just be stronger versions of normal emotions, not signs that something
is broken. Everyone feels worry or sadness; some people simply experience these feelings more
intensely or more often.
1
, 2. Saying that mental disorders come from something ‘broken’ in the brain can create stigma. It
makes people with mental health problems seem flawed or less capable, even though their
experiences are common and human.
Recovery model ® Broad-ranging treatment approach which acknowledges the influence and importance of
socio-economic status, employment and education and social inclusion in helping to achieve recovery from
mental health problems.
Asylum ® In the 18th and 19th century, asylums were hospices converted for the confinement of individuals with
mental health problems. ‘Madhouses’. Life was often cruel and inhumane. Asylums were for financial profit, so
many expanded to take more sufferer’s. Not only mental health problems, but also poor people pr pregnant
women.
↳ Treatments: Crude and painful, e.g. hot/cold baths, mercury pills, drawing blood from the brain.
Asylums gave rise to ad hoc approaches. They were based on combating moral degeneration and ‘social
weakness’. These approaches probably represent the roots of modern-day stigma.
Bethlem hospital ® One of the first psychiatric hospitals originally established in Moorfields, London.
Philippe Pinel ® First to introduce more humane treatments. Treating inmates in asylums as sick people, rather
than animals.
Moral treatment ® Approach to the treatment of asylum inmates, developed by the Quaker movement in the
UK. Abandoned contemporary medical approaches in favor of understanding, hope, moral responsibility, and
occupational therapy.
Into the 20th century ® Lifelong hospitalization was not uncommon, but it was not economically viable and
patients didn’t improve.
Social breakdown syndrome ® Consisting of challenging behavior, aggressiveness, and lack of interest in
personal welfare and hygiene. Often caused by restraint as intervention (because nurses didn’t know what to do
with these people).
Milieu therapies ® First attempts to structure the hospital environment for patients, which attempted to create a
therapeutic community on the ward in order to develop productivity, independence, responsibility and feelings of
self-respect. (1950-1970)
↳ Patients more likely to be discharged.
Token economy programmes ® A reward system which involves participants receiving tokens for engaging in
certain behaviors, which at a later time can be exchanged for desired items (based on operant reinforcement).
(1970)
↳ Was a success, but in decline since the 1980s. Reasons:
• Legal and ethical difficulties of withholding desired materials and events so they can be used as
reinforcers.
• Lack of consensus on whether behaviors nurtured in token economy schemes were maintained after the
scheme ended. And whether they generalized to other environments.
Community care ® Care that is provided outside a hospital setting.
Community Mental Health Act (US) ® Shift from long-term psychiatric hospitals to community-based support.
People had the right to receive broad range of services, such as outpatient therapy, emergency care preventative
care, and aftercare. Goal: reduce stigma and allow people to receive treatment while living at home.
↳ Consequences of this shift:
• Large decrease in hospital beds and long-term admissions.
• Increase in community services such as assertive outreach.
• More focus on supporting individuals within their own environment.
Why community support was needed:
2
, • Many people with severe mental health problems still needed supervision.
• Help required with daily tasks (hygiene, money management, appointments, dealing with stress).
• Social reintegration was a key goal.
Community mental health team (CMHT) ® They deliver outreach services. Multidisciplinary teams (nurses,
psychologists, social workers, psychiatrists).
Assertive Outreach Teams (AOT) ® Help individuals with mental health problems who find it difficult to work
with mental health services or have related problems (e.g., homelessness, self-harm, substance abuse). Focus on:
• Medication support
• Coping with everyday stressors
• Securing welfare benefits
• Long-term relationship between the individual and mental health services
Hospital care today ® Still needed for acute and severe symptoms, but length of stay is much shorter due to
improved community care and early interventions (from several months to days/weeks).
1.2 Defining psychopathology
Why can’t we provide classification based on causal factors?
1. Because psychological problems often don’t have underlying physical or biological causes.
2. Knowledge of aetiology of many pathologies is still very much in its infancy.
Abnormal psychology ® An alternative definition of pathology, but with stigmatizing connotations relating to
not being ‘normal’.
Service user groups ® Groups of individuals who are end users of the mental health services provided by, for
example, government agencies.
Statistic norm ® The mean, average or modal example of behavior.
Two problems with using deviations from statistical norms as indications of pathology:
1. It forces an individual into a diagnostic category, instead of evaluating the needs of the individual.
2. Deviation from the norm doesn’t necessarily imply pathology. If you look at IQ, people with high IQ’s
are also rare, but they do not have intellectual disabilities.
3. Emotions such as anxiety and depression, that underlie the most common problems, are not statistically
rare emotions. They are experiences almost daily by most people.
It’s difficult to use deviation from social norms as a way of defining pathology:
• Different cultures often differ in what they consider to be socially normal.
• Cultural factors seem to affect how pathology manifests itself. For example:
a) Social and cultural factors will affect the vulnerability to causal factors (low-income countries).
b) Culture can produce ‘culture-bound’ symptoms of pathology which seem confined to specific
cultures and can influence ho stress, anxiety and depression manifest.
Maladaptive behavior ® Involves behaving in a way that is a threat to the health and wellbeing of the individual
and to others.
Harmful dysfunction ® Assumption that pathology is defined by the ‘dysfunction’ of a normal process that has
the consequence of being in some way harmful.
↳ It is difficult to know what ‘normal’ process might be dysfunctioning.
® Mental health symptoms are just more extreme versions of normal emotions and are not in any way different
from normal behavior as the harmful dysfunction model would imply.
Defining pathology in terms of the degree of distress and impairment is useful because:
1. It allows people to judge their own ‘normality’ rather than subjecting them to judgements made by
others.
2. It can be independent of the type of lifestyle chosen by the individual.
3
, 3. There is evidence that distress is closely associated with poor quality of life and a lowered ability to
cope with stress and life problems.
Difficulties to defining pathology in terms of the degree of distress and impairment:
1. This approach doesn’t provide standards by which we should judge behavior itself.
2. Psychopathology classification schemes do include diagnostic categories in which diagnosis doesn’t
require that the client reports any personal distress or impairment.
1.3 Explanatory approaches to psychopathology
Explanatory paradigms:
• Biological models
1. Genetics
2. Neuroscience
• Psychological models
1. Psychoanalytical or psychodynamic model
2. Behavioral model
3. Cognitive model
4. Humanist-existential approach
Biological models
Genetics ® Provides techniques that allow an assessment of whether pathology symptoms are inherited or not.
Ways of studying how genetics might influence pathology:
1. Studying pathological symptoms across different family members who may differ in the extent to which
they are genetically related to each other.
↳ Concordance studies ® Studies designed to investigate the probability with which family members
will develop a disorder depending on how closely they are related.
2. Compare the probability with which monozygotic/identical (MZ) and dizygotic/nonidentical (DZ) twins
both develop pathological symptoms.
↳ Twin studies
3. Studying the offspring of twins, rather than the twins themselves. Because both families and twins are
likely to share similar environments as well as genes, interpretation of family and twin studies can be
difficult.
Diathesis-stress model ® Model that suggests a mental health problem develops because of an interaction
between a genetic predisposition (diathesis) and our interactions with environment (stress).
Heritability ® A measure of the degree to which symptoms can be accounted for by genetic factors. Ranges
from 0 to 1. The nearer to 1, the more important are genetics in explaining symptoms.
Molecular genetics ® Genetic approach that seeks to identify individual genes that may be involved in
transmitting pathology symptoms.
• Genetic linkage analysis ® A method of identifying individual genes by comparing the inheritance of
characteristics for which gene location is known (e.g. eye color) with the inheritance of pathology
symptoms.
For example: If the inheritance of eye color follows the same pattern within a family as particular
pathological symptoms, then it can be concluded that the gene controlling the symptoms can probably
be found on the same chromosome as eye color. (Rare)
• Using animals to manipulate specific genes in animals with some accuracy, and in mice studies even
delete individual genes. Enables the researcher to determine whether that gene is linked to changes in
the animal’s behavior.
4
Chapter 1: Introduction psychopathology
Introduction
The use of the word ‘crazy’ in different circumstances:
• When someone’s behavior deviates from expected norms.
• When we are unclear about the reasons for someone’s actions.
• When a behavior seems to be irrational.
• When a behavior or action appears to be maladaptive or harmful to the individual or others.
Psychopathology ® Current definition: the in-depth study of mental health problems. Not disorders, but the
product of perfectly healthy psychological processes in response to stressful life experiences.
Traditional/old definition: the scientific study of mental disorders (medical or illness model).
Clinical psychology ® The branch of psychology responsible for understanding and treating psychopathology.
1.1 History of psychopathology
Demonic possession ® Historical explanations of psychopathology such as ‘demonic possession’ often alluded
to the fact that the individual had been ‘possessed’ in some way.
In Western societies until 18th century, when witchcraft and demonic possession were common explanations.
Currently still in Haiti and some areas of Western Africa.
↳ Psychopathology is often accompanied by personality changes. These changes are some of the first things that
are noticed (reserved person becomes manic). So, people thought they were possessed (e.g. by bad spirits). Often
linked to religious beliefs.
‘Treatment’ ® Elaborate ritualized ceremonies that frequently involved direct physical attacks on the sufferer’s
body in an attempt to force out the demons (e.g. torture/starvation). This often increased the distress of the
victim.
Medical or disease model ® An explanation of psychopathology in terms of underlying biological or medical
causes. By the middle of the 17th century, religious, spiritual and superstitious explanations were replaced by
more objective, medical explanations (because of empirical scientific methods).
↳ The body-mind dualism of Descartes introduced some significant reorientations. Minds could not be diseased,
so mental health problems must be located in the body, and more specifically in the brain.
↳ Psychopathology moved from being a concern of demonology to being in the realm of medicine.
Psychiatry ® A scientific method of treatment that is based on medicine, the primary approach of which is to
identify the biological causes of pathology and treat them with medication or surgery.
Implications for the way we conceive mental health problems:
• It implies that medical or biological causes underlie psychopathology. This is by no means always the
case. ® In contrast to the medical model, both psychodynamic and contemporary cognitive accounts of
pathology argue that many problems are the result of someone learning dysfunctional ways of thinking
and acting through normal processes. The experiences are dysfunctional, not biology.
• Adopts what is basically a reductionist approach by attempting to reduce the complex psychological
and emotional features of pathology to simple biology.
• Assumption in this model that pathology is caused by ‘something not working properly’. This
assumption is problematic for a number of reasons:
1. Mental health problems may just be stronger versions of normal emotions, not signs that something
is broken. Everyone feels worry or sadness; some people simply experience these feelings more
intensely or more often.
1
, 2. Saying that mental disorders come from something ‘broken’ in the brain can create stigma. It
makes people with mental health problems seem flawed or less capable, even though their
experiences are common and human.
Recovery model ® Broad-ranging treatment approach which acknowledges the influence and importance of
socio-economic status, employment and education and social inclusion in helping to achieve recovery from
mental health problems.
Asylum ® In the 18th and 19th century, asylums were hospices converted for the confinement of individuals with
mental health problems. ‘Madhouses’. Life was often cruel and inhumane. Asylums were for financial profit, so
many expanded to take more sufferer’s. Not only mental health problems, but also poor people pr pregnant
women.
↳ Treatments: Crude and painful, e.g. hot/cold baths, mercury pills, drawing blood from the brain.
Asylums gave rise to ad hoc approaches. They were based on combating moral degeneration and ‘social
weakness’. These approaches probably represent the roots of modern-day stigma.
Bethlem hospital ® One of the first psychiatric hospitals originally established in Moorfields, London.
Philippe Pinel ® First to introduce more humane treatments. Treating inmates in asylums as sick people, rather
than animals.
Moral treatment ® Approach to the treatment of asylum inmates, developed by the Quaker movement in the
UK. Abandoned contemporary medical approaches in favor of understanding, hope, moral responsibility, and
occupational therapy.
Into the 20th century ® Lifelong hospitalization was not uncommon, but it was not economically viable and
patients didn’t improve.
Social breakdown syndrome ® Consisting of challenging behavior, aggressiveness, and lack of interest in
personal welfare and hygiene. Often caused by restraint as intervention (because nurses didn’t know what to do
with these people).
Milieu therapies ® First attempts to structure the hospital environment for patients, which attempted to create a
therapeutic community on the ward in order to develop productivity, independence, responsibility and feelings of
self-respect. (1950-1970)
↳ Patients more likely to be discharged.
Token economy programmes ® A reward system which involves participants receiving tokens for engaging in
certain behaviors, which at a later time can be exchanged for desired items (based on operant reinforcement).
(1970)
↳ Was a success, but in decline since the 1980s. Reasons:
• Legal and ethical difficulties of withholding desired materials and events so they can be used as
reinforcers.
• Lack of consensus on whether behaviors nurtured in token economy schemes were maintained after the
scheme ended. And whether they generalized to other environments.
Community care ® Care that is provided outside a hospital setting.
Community Mental Health Act (US) ® Shift from long-term psychiatric hospitals to community-based support.
People had the right to receive broad range of services, such as outpatient therapy, emergency care preventative
care, and aftercare. Goal: reduce stigma and allow people to receive treatment while living at home.
↳ Consequences of this shift:
• Large decrease in hospital beds and long-term admissions.
• Increase in community services such as assertive outreach.
• More focus on supporting individuals within their own environment.
Why community support was needed:
2
, • Many people with severe mental health problems still needed supervision.
• Help required with daily tasks (hygiene, money management, appointments, dealing with stress).
• Social reintegration was a key goal.
Community mental health team (CMHT) ® They deliver outreach services. Multidisciplinary teams (nurses,
psychologists, social workers, psychiatrists).
Assertive Outreach Teams (AOT) ® Help individuals with mental health problems who find it difficult to work
with mental health services or have related problems (e.g., homelessness, self-harm, substance abuse). Focus on:
• Medication support
• Coping with everyday stressors
• Securing welfare benefits
• Long-term relationship between the individual and mental health services
Hospital care today ® Still needed for acute and severe symptoms, but length of stay is much shorter due to
improved community care and early interventions (from several months to days/weeks).
1.2 Defining psychopathology
Why can’t we provide classification based on causal factors?
1. Because psychological problems often don’t have underlying physical or biological causes.
2. Knowledge of aetiology of many pathologies is still very much in its infancy.
Abnormal psychology ® An alternative definition of pathology, but with stigmatizing connotations relating to
not being ‘normal’.
Service user groups ® Groups of individuals who are end users of the mental health services provided by, for
example, government agencies.
Statistic norm ® The mean, average or modal example of behavior.
Two problems with using deviations from statistical norms as indications of pathology:
1. It forces an individual into a diagnostic category, instead of evaluating the needs of the individual.
2. Deviation from the norm doesn’t necessarily imply pathology. If you look at IQ, people with high IQ’s
are also rare, but they do not have intellectual disabilities.
3. Emotions such as anxiety and depression, that underlie the most common problems, are not statistically
rare emotions. They are experiences almost daily by most people.
It’s difficult to use deviation from social norms as a way of defining pathology:
• Different cultures often differ in what they consider to be socially normal.
• Cultural factors seem to affect how pathology manifests itself. For example:
a) Social and cultural factors will affect the vulnerability to causal factors (low-income countries).
b) Culture can produce ‘culture-bound’ symptoms of pathology which seem confined to specific
cultures and can influence ho stress, anxiety and depression manifest.
Maladaptive behavior ® Involves behaving in a way that is a threat to the health and wellbeing of the individual
and to others.
Harmful dysfunction ® Assumption that pathology is defined by the ‘dysfunction’ of a normal process that has
the consequence of being in some way harmful.
↳ It is difficult to know what ‘normal’ process might be dysfunctioning.
® Mental health symptoms are just more extreme versions of normal emotions and are not in any way different
from normal behavior as the harmful dysfunction model would imply.
Defining pathology in terms of the degree of distress and impairment is useful because:
1. It allows people to judge their own ‘normality’ rather than subjecting them to judgements made by
others.
2. It can be independent of the type of lifestyle chosen by the individual.
3
, 3. There is evidence that distress is closely associated with poor quality of life and a lowered ability to
cope with stress and life problems.
Difficulties to defining pathology in terms of the degree of distress and impairment:
1. This approach doesn’t provide standards by which we should judge behavior itself.
2. Psychopathology classification schemes do include diagnostic categories in which diagnosis doesn’t
require that the client reports any personal distress or impairment.
1.3 Explanatory approaches to psychopathology
Explanatory paradigms:
• Biological models
1. Genetics
2. Neuroscience
• Psychological models
1. Psychoanalytical or psychodynamic model
2. Behavioral model
3. Cognitive model
4. Humanist-existential approach
Biological models
Genetics ® Provides techniques that allow an assessment of whether pathology symptoms are inherited or not.
Ways of studying how genetics might influence pathology:
1. Studying pathological symptoms across different family members who may differ in the extent to which
they are genetically related to each other.
↳ Concordance studies ® Studies designed to investigate the probability with which family members
will develop a disorder depending on how closely they are related.
2. Compare the probability with which monozygotic/identical (MZ) and dizygotic/nonidentical (DZ) twins
both develop pathological symptoms.
↳ Twin studies
3. Studying the offspring of twins, rather than the twins themselves. Because both families and twins are
likely to share similar environments as well as genes, interpretation of family and twin studies can be
difficult.
Diathesis-stress model ® Model that suggests a mental health problem develops because of an interaction
between a genetic predisposition (diathesis) and our interactions with environment (stress).
Heritability ® A measure of the degree to which symptoms can be accounted for by genetic factors. Ranges
from 0 to 1. The nearer to 1, the more important are genetics in explaining symptoms.
Molecular genetics ® Genetic approach that seeks to identify individual genes that may be involved in
transmitting pathology symptoms.
• Genetic linkage analysis ® A method of identifying individual genes by comparing the inheritance of
characteristics for which gene location is known (e.g. eye color) with the inheritance of pathology
symptoms.
For example: If the inheritance of eye color follows the same pattern within a family as particular
pathological symptoms, then it can be concluded that the gene controlling the symptoms can probably
be found on the same chromosome as eye color. (Rare)
• Using animals to manipulate specific genes in animals with some accuracy, and in mice studies even
delete individual genes. Enables the researcher to determine whether that gene is linked to changes in
the animal’s behavior.
4
