Summary PYC3702 STUDY GUIDE

Tutorial Letter 501/3/2022 Abnormal Behaviour and Mental Health PYC3702 Semesters 1 & 2 Department of Psychology IMPORTANT INFORMATION: One of three tutorial letters, numbered 501, 502 and 503 for this module code. These tutorial letters are your study guides for this module code. lOMoARcPSD| 2 Tutorial Letter 501/2022 (First Study Guide for PYC3702) Tutorial Letter 501/3/2022 Contents Page Introduction 4 Learning Unit 1 Abnormal Behaviour (Chapter 1 in Sue et al., 2022) 9 Learning Unit 2 Prevention of Abnormal Behaviour 12 Learning Unit 3 Perspectives/Models of Abnormal Behaviour 17 (Chapter 2 in Sue et al., 2022) Learning Unit 4 Psychopathology from an African Perspective 20 Learning Unit 5 Assessment and Classification of Abnormal 42 Behaviour (Chapter 3 in Sue et al., 2022) Learning Unit 6 Personality Psychopathology and Disruptive, 56 Impulse-Control and Conduct Disorders (Chapter 15 in Sue et al., 2022) (Personality Disorders-DSM-5) Learning Unit 7 Anxiety, Obsessive-Compulsive and Related 90 Disorders (Chapter 5 in Sue et al., 2022) lOMoARcPSD| PYC3702/501/3/2022 3 Tutorial Letter 502/3/2022 (Second Study Guide for PYC3702) Tutorial Letter 502/3/2022 Contents Learning Unit 8 Somatic Symptom and Dissociative Disorders (Chapter 7 in Sue et al., 2022) Learning Unit 9 Trauma- and Stressor-Related Disorders (Chapter 6 in Sue et al., 2022) Learning Unit 10 Substance-Use Disorders (Chapter 11 in Sue et al., 2022) Learning Unit 11 Sexual Dysfunction and Gender Dysphoria (Chapter 14 in Sue et al., 2022) Learning Unit 12 Depressive and Bipolar Disorders (Chapter 8 in Sue et al., 2022) Learning Unit 13 Suicide (Chapter 9 in Sue et al., 2022) Tutorial Letter 503/3/2022 (Third Study Guide for PYC3702) Tutorial Letter 502/3/2022 Contents Learning Unit 14 Schizophrenia and Other Psychotic Disorders (Chapter 12 in Sue et al., 2022) (Schizophrenia Spectrum and Other Psychotic Disorders-DSM-5) Learning Unit 15 Neurocognitive Disorders (Chapter 13 in Sue et al., 2022) Learning Unit 16 Disorders of Childhood and Adolescence (Chapter 16 in Sue et al., 2022) (Neurodevelopmental Disorders-DSM-5; Elimination Disorders-DSM-5) Downloaded by Thomas Mboya () lOMoARcPSD| 4 Introduction Our blue, green and white planet earth is an incredibly beautiful, diverse spherical space that floats serenely in a universe of moons, planets, stars and galaxies of mysteriously unknown dimensions. Planet earth is surrounded by a unique life giving and life supporting atmospheric space that enables breathing life for an array of abundant, rich and varied soil and rock formations, plant and animal systems, as well as human beings. Life on earth is supported and maintained by the same mechanisms and systems for all living organisms, which are all dependent upon clean sources of air and water. This makes us aware, that everything depends on everything else. Thus, by deciding to neglect, destroy, or eradicate aspects of what constitutes a part of the earth system, we opt to destroy parts of ourselves. If we want to protect something, we must first be able to appreciate it, and by learning to appreciate something, we need to learn as much as possible about everything. This philosophy is particularly valid in the hybrid knowledge space we call psychology. The discipline of psychology can be referred to as both a science and an art. These two dimensions i.e. generating knowledge (science) and expressing knowledge (art) mutually interact with each other. This interaction of science and art in psychology forms the basis of the problems we encounter when we engage in psychological research. For example, in order to conceptualise abnormality (objective science) we need to have experienced a world in which normality exists (subjective experience). However, when we experience a world in which abnormality exists (subjective experience) we need to have objective conceptualisations of what constitutes normality (someone else’s subjective experience) in order to understand our own experiences of abnormality. When we express our subjective experience in a story (art), we are communicating to the readers what it feels like to have such a normal or abnormal experience (subjective experience). As you can see, it can become quite complicated to think psychologically. It is therefore important to learn as much as possible about the subjective normal and abnormal experiences of others in order to understand our own experiences in the context of our complicated multicultural world of complex family systems, customs, rituals, rites, traditions, parenting practices, languages, personal interests, thought patterns, emotions, interactions and patterns within our social systems, religious thought and practices, political thought, environmental circumstances, and economic conditions. It is equally important to learn as much as possible about our biological reality in the context of the space in which we live on earth, and as organisms that transmute air (gases), water (minerals), plants (minerals and vitamins), and meat (protein and minerals), as well as the scientific understanding of the relevant metabolic and systemic processes in our bodies. Much of what I have mentioned, you have already touched upon in your other undergraduate courses. Therefore, by studying this module, Abnormal Behaviour and Mental Health, you aim to expand your previous knowledge base by building upon what you have already learnt. The purpose of this study guide People have always been fascinated by the strange and unusual. So, it is understandable that abnormal behaviour, and more specifically abnormal behaviour that is bizarre or dramatic, has always drawn people’s attention. The scientific study of abnormal behaviour, or adult and child pathology, does not cover only the dramatic or bizarre. The field of study of abnormal behaviour is vast and includes the study of psychological problems which vary from minor disorders to disorders which are so intense and serious that individuals suffering from them experience extreme discomfort and impaired functioning. In this module we focus on behaviour that deviates from the normal and also on factors that contribute to the development and maintenance of abnormal behaviour. An important consideration throughout this study of abnormal behaviour is that we can very seldom attribute abnormal behaviour to a single causative factor. Whereas the emphasis was previously on identifying and explaining abnormal behaviour, the emphasis in our modern society is increasingly on preventing abnormal behaviour and promoting mental health. Knowledge of abnormal behaviours and their possible etiological factors will enable you to initiate interventions that will improve people’s quality of life in your community. In this module we focus on Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 5 primary and tertiary prevention. When you qualify as a counsellor/psychologist, you will be able to work at the secondary level (that of therapeutic treatment). You need to remember that the authors of your prescribed book are Americans and wrote the prescribed book for the American market. Although the book does mention the incidence of psychological problems in other countries, it does not specifically refer to the situation in South Africa. We have therefore included material in this study guide (e.g. case studies and study tasks) which we trust you will find helpful in identifying and understanding abnormal behaviour in your community. The prescribed book for this module is: Sue, D., Sue, D.W., Sue, D., & Sue, S. (2022). Understanding abnormal behaviour (12th ed.). UK: Wadsworth, Cengage Learning. Please note: The textbook by Sue et al. (2013) was published after the DSM-5 was published and therefore please only use the 11 th or 12th edition. This module is divided into 14 sections which correspond to the relevant chapters in your prescribed book. Additional sections which are not covered in the prescribed book such as prevention, the African perspective, and DSM-5 diagnostic criteria for some disorders can be found in this study guide. Please note that there are three chapters in the prescribed book which you do not have to study, namely chapter 4 (“Research Methods for Studying Mental Disorders”), chapter 10 (“Eating Disorders”) and chapter 17 (“Law and Ethics in Abnormal Psychology”). This study guide will assist you in negotiating your way through the enormously complicated subject matter of identifying, classifying, and describing abnormal behaviour, and it will act as your body of lecturers who speak to you through the written words in this study guide. By means of the written word we will guide you systematically through the content of 14 chapters of your prescribed book, indicating along the way what you are expected to study in order to gain the necessary skills for enabling you to recognise abnormal behaviour and to make informed diagnostic choices. The time we have at our disposal to teach you as many mental disorders as possible, does not allow us to include everything we would like to teach you. We have therefore selected a few disorders from every category that will provide you with a good understanding of a number of disorders people suffer from. These disorders are no more or less important than the ones we did not select. Our choice is simply made on account of the time constraints of this course. We therefore hope that you will fill in the gaps left by this course in your own time. We have compiled this study guide in such a way that you are able to work from the study guide to the prescribed book. We strongly recommend that you diligently study all the sections in the prescribed book that are pointed out to you as study material. In some cases, we have added additional information in the study guide to clarify aspects that were inadequately dealt with in the prescribed book. We would like you to incorporate this additional material as part of your study plan. As you come across new words in your prescribed book, make sure that you learn to understand and use these new words. For this task you need to consult the glossary at the end of the prescribed book, or a good Dictionary of Psychology. For other general words you do not understand you need to consult a good English dictionary, such as the Oxford English Dictionary (UK) or the Collins English Dictionary (USA). Outcomes When you have completed this module, you should: • understand the complexity of abnormal behaviour and mental health; • be able to distinguish between normal and abnormal behaviour; • be able to identify abnormal behaviour in various multicultural contexts. You should become sensitive to the influence of cultural factors on the incidence, manifestation and type of abnormal behaviour in various multicultural contexts; Downloaded by Thomas Mboya () lOMoARcPSD| 6 • be able to classify abnormal behaviour according to the DSM-5 classification system. You should be able to analyse information in a scientific fashion and come to conclusions based on your theoretical knowledge of the DSM-5; • be able to explain abnormal behaviour according to different perspectives. You should realise that each of the different perspectives on abnormal behaviour has unique possibilities but also limitations. It would be unrealistic to expect a single theory to cover all psychological phenomena or to have satisfactory answers to all psychological problems. Knowledge of the different theoretical explanations of abnormal behaviour provides you with insight into the complex domain of abnormal behaviour; • be sensitive and be able to show understanding for and empathy with the suffering of people displaying abnormal behaviour; • have knowledge of professional and other support services in your community to which you can refer people with abnormal behaviour; • be able to refer people who display abnormal behaviour for professional treatment and support in an effective and appropriate manner; • be able to promote mental health in your community. You should be sensitive to factors that both threaten and promote mental health. We will expect you to plan and design primary and tertiary prevention programmes for promoting mental health at various levels. Some of the above outcomes can be achieved by studying the diagnostic criteria of the disorders we require you to study (that includes all the symptoms, the duration and the severity of every disorder), or a description of certain disorders or the complete DSM-5 diagnostic criteria for selected disorders. Due to the scientific nature of this subject matter as well as the combination of biological, psychological, social, and social-cultural factors in interaction with each other, the requirement for specific, detailed knowledge and understanding is very high, perhaps much higher than in any other subject you have studied thus far. Study In order to achieve the above-mentioned outcomes, we will provide you with a number of case studies of individuals who were diagnosed with one or more mental disorders. By reading and analysing these case studies, it becomes much easier to identify, classify and understand abnormal behaviour. Classifying abnormal behaviour The way in which we classify abnormal behaviour can differ. The ICD-10 is the World Health Organisation’s (WHO) International Classification of Diseases which originated in 1850. The latest version of the ICD was introduced in 1994 in all WHO Member States, and constitutes the international standard diagnostic classification for all general epidemiological cases, for the purpose of health management, for clinical use, and for mortality and morbidity statistics (Retrieved from http/ on 2010/03/28; http// The other classification system for classifying abnormal behaviour is the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, which is used in the United States of America and to varying degrees across the world. It provides standard criteria for the classification of mental disorders since its first publication in 1952. The current edition of the DSM-5 (2013) is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychological Association in 2013. For the purpose of this module we have chosen the DSM-5 to teach you the criteria for identifying and classifying selected mental disorders. The DSM is considered to be suitable for teaching and researching mental disorders due to its descriptive character. (The ICD on the other hand categorises not only mental disorders but also all the other diseases.) It is therefore the preferred classification system for clinicians, doctors and psychiatrists. The coding system which is used in the DSM-5 is designed to correspond with the codes that are used in the ICD-10. You may however find that the codes may not match at all times, because the two publications are usually not revised synchronously. Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 7 We now wish you a safe journey through your study material. Remember to reflect upon and think about what you read and study, maintain your focus consistently on what matters, and ignore what does not matter. Success comes to those who are aware that time is short and detail is essential. REFERENCES American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association. http// GLOSSARY Co-morbid/ Comorbidity refers to more than one disorder or disease in the same individual at the same time. Disease a medical syndrome or cluster of physical symptoms, or a physiological disease that manifests in parts of the body Hybrid offspring of a mixed union, which in this case refers to psychology as being partially art and partially science Psychological disorder a mental abnormality that manifests on the level of thinking, feeling or behaving The following list is a list of instruction words. If you take note of the instruction word, you will know what is expected of you in each question. You should therefore make sure that you know the meaning of each of the following instruction words: Name/give Make a numbered list of names, items or information in a specific category, for example the names of three psychotic disorders. When we ask you to name or give something, no discussion or explanation is required. Explain If you are asked to explain something, you should give a reasonably comprehensive answer. You have to make a phenomenon clear by showing how it is caused. You should therefore formulate your explanation as if it is for a reader who knows nothing about this subject, or for someone who is familiar with the technical vocabulary, but who does not understand the point you are trying to make. Concrete examples are very useful here. Indicate/show When you are asked to indicate or show something, you have to give proof or evidence to support the issue or point of view. Your answer should include a logical and systematic presentation of supporting evidence (proof) and appropriate conclusions. Characterise Describe only the most obvious or important characteristic Compare Indicate similarities and differences. Students often make the mistake of giving only similarities and disregarding the differences or vice versa. Downloaded by Thomas Mboya () lOMoARcPSD| 8 Contrast Point out the differences Distinguish/differentiate Point out details or characteristics which will help the reader to see the difference between two or more things; in other words, compare things by constantly pointing out the differences. Define Give the accurate meaning of a concept. Substantiate Give evidence and arguments to justify your point of view. Discuss Look at an issue from different points of view and give supporting evidence for each point of view. Unless you are asked to do so, it is not necessary to give a synthesis of the different points of view. Describe You have to draw a "picture" with words so that the reader can clearly "see" what you are describing. Describing something, therefore, requires a clear, systematic and logical demonstration of facts. Report This instruction is usually given in connection with research. The purpose of the research should be given, the research procedure should be explained, and the research results should be given. Outline/sketch Give a framework that consists of main ideas (summarised in single words) and supporting information (in concise sentences) Evaluate Here you have to make a value judgment using criteria that are provided or which you have to formulate yourself. It is a difficult task in the sense that the reasons for your value judgment have to be stipulated clearly. An evaluation question usually ends with a summary of your conclusions. Classify Divide information into categories. Sometimes the categories are given and sometimes not. Identify This involves recognising a phenomenon, issue or concept which belongs in a specific class. Abstract Find the essence of the topic under discussion and put it in your own words. In this instance, never give concrete examples. Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 9 Learning Unit 1: Abnormal Behaviour Dr Beate von Krosigk Contents Page Overview 9 1.1 Study unit: The Field of Abnormal Psychology 10 1.2 Study unit: Determining Abnormality 10 1.3 Study unit: The Causes/Aetiology of Abnormal Behaviour 11 Conclusion 11 Reference 11 Overview The study of abnormal behaviour represents the human quest to understand the causes, development, manifestation, and ultimately the alleviation and prevention of disturbances in thinking, feeling and behaving. Our attempts to understand, describe, explain, predict, and control abnormal behaviour are the objectives of the scientific approach/method for investigating abnormal behaviour, which consists of four steps: (a) formulating a research question, (b) expressing the research question in the form of a hypothesis, (c) applying methods of testing the hypothesis, and (d) drawing conclusions about the correctness or falseness of the hypothesis. Depending on the research question, researchers will choose one of the methods below that suits the investigation of their hypothesised problem. The naturalistic observational method is used when the investigator needs to observe naturally occurring phenomena/behaviour under naturally occurring conditions. The research method that explores relationships between variables attempts to find one or more possible correlations between the chosen variables. Such correlations cannot be considered as positive proof of cause-effect relationships; they do, however, have the potential to suggest possible underlying correlations amongst the assumed causes of the observed behaviour and may thus serve to tentatively predict the repetition of such behaviours in the future. The longitudinal research method is one of the methods that investigates possible correlations over time, by repeatedly observing a sample of subjects at periodic intervals over a very long period of time. In order to reveal cause-effect relationships, researchers will choose the experimental method. In this research method, the investigator controls the independent variable under controlled conditions. Experimental investigators need to randomly assign subjects to the treatment and to the control groups in order to eliminate experimenter bias, and to comply with the rules of scientific research. An ethical approach to doing research and an evaluation of internal, external, and construct validity of all experimentation are essential characteristics of value-added research methods. Downloaded by Thomas Mboya () lOMoARcPSD| 10 The epidemiological approach examines the rate at which abnormal behaviour occurs in various population groups and in a variety of settings, such as trying to differentiate between contributions from the environment and from heredity in twin study and adoptee study research. The case-study method’s limitations of possible therapist bias and inaccurate and biased case histories in the absence of control groups can be largely overcome by using single-case experimental designs. Despite the abovementioned precautions, many people still have a lack of understanding and lack knowledge with regard to abnormal behaviour. In order to alleviate this condition, this module ventures into the unknown territories of the body-mind to explore some of the various aspects of abnormal behaviour. The questions that will guide us through the entire module will revolve around the following issues: (a) the need to define abnormal behaviour, (b) the way we establish the causes of abnormal behaviour, and (c) how we can prevent abnormal behaviour. How we determine which research method should be used to study abnormal behaviour will be dealt with in your research module. In this Learning Unit, you will familiarise yourself with the concerns of Abnormal Psychology and how abnormality is determined. You will also learn about the causes/aetiology of abnormal behaviour and learn the new terminology by either consulting one of the dictionaries, or the glossary at the end of your prescribed book. 1.1 STUDY UNIT: The Field of Abnormal Psychology The Concerns of Abnormal Psychology consider the premises on which our definitions of abnormal behaviour are based by studying the sections “The Concerns of Abnormal Psychology” and “Determining Abnormality”. Activity 1.1 STUDY the section entitled “The Concerns of Abnormal Psychology” on pages 4 to 7 of the prescribed book: • “Describing Abnormal Behaviour” • “Explaining Abnormal Behaviour” • “Predicting Abnormal Behaviour” • “Modifying Abnormal Behaviour” 1.2 STUDY UNIT: Determining Abnormality How do we recognise abnormal behaviour? Unless we can agree on how to recognise and define abnormal behaviour, we cannot hope to progress much in our study of this subject. Activity 1.2 requires you to explore and critically think about the different aspects that are included in constructing a comprehensive definition of abnormal behaviour. In order to do this, you need to study the following sections in your prescribed book in conjunction with the American Psychiatric Association’s (2013) DSM5 definition. Activity 1.2 STUDY the sections entitled: • “Views of Abnormality” on pages 8 to 10 in the prescribed book: • “Distress” • “Deviance” • “Personal Dysfunction” • “Dangerousness” • “Cultural Considerations in Abnormal Behaviour and Socio-political Considerations in Abnormality” pages 10-12 of the prescribed book. • “How Common Are Mental Disorders”, page 12. • “Overcoming Social Stigma and Stereotypes”, pages 13-15. Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 11 Note how different perspectives and vantage points deepen your understanding and knowledge of the multifaceted nature of abnormal behaviour/mental disorders by generating a more comprehensive view of the subject matter. 1.3 STUDY UNIT: The Causes/Aetiology of Abnormal Behaviour Causes: Early Viewpoints The need to treat individuals who manifest abnormal behaviour leads to an exploration into the possible causes/beginnings/or the aetiology of abnormal behaviour. The organic or biological perspective tends to view abnormal behaviour as a mental disorder whose origin/cause/beginning/aetiology lies in the organic functioning of the brain, which means that organic malfunction results in psychological/mental/ behavioural malfunction. The psychological perspective tends to view abnormal behaviour as the result of emotional or cognitive processes, which means that emotional or cognitive malfunction results in mental/behavioural malfunction. In the early days of psychology around 1900 AD, either the biological, organic viewpoint or the psychological viewpoint was the preferred choice for explaining the aetiology of abnormal behaviour, although most people combined elements of both. Activity 1.3 In order to understand the multi-factorial nature of abnormal behaviour/mental disorders, you need to STUDY the following sections on pages 20 to 22 in your prescribed book: • “Causes of Mental Illness: Early Viewpoints” on page 20 • “The Biological Viewpoint” on page 20 • “The Psychological Viewpoint” on pages 21 to 22 • “Contemporary Trends in Abnormal Psychology” from page 22 to 30 ▪ The Influence of Multicultural Psychology ▪ Positive Psychology ▪ Recovery Movement ▪ Changes in the Therapeutic Landscape Activity 1.4 You are now ready to answer Focus Questions 1, 2, 3, 5, and 8, on page 4 of your prescribed book. Compare your answers with the answers in the Summary on pages 30-31 in your prescribed book. CONCLUSION With the increasing research outputs in consciousness and brain research, we have developed a more inclusive model of abnormal behaviour, which includes biological – organic, biochemical, physiological, genetic aspects in conjunction with psychological – emotional, cognitive, behavioural aspects in the context of social and cultural aspects, which will be the focus of attention in Chapter 2: “Perspectives/Models of Abnormal Behaviour”. REFERENCE American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association. Downloaded by Thomas Mboya () lOMoARcPSD| 12 Learning Unit 2: Prevention of Abnormal Behaviour Mrs Banti Mokgatlhe & Prof Christine Laidlaw Contents Page Overview 12 2.1 Study unit: Community Psychology 13 2.2 Study unit: Prevention of Psychopathology 13 Overview The 11th edition of the prescribed book does not contain this chapter entitled “Psychotherapeutic interventions”. It is, however, an important chapter; therefore please ensure that you know the sections on “Community Psychology” and “Prevention of Psychopathology” discussed in the Study Guide. The descriptions of various types of prevention are significant in the study and prevention of abnormal behaviour. The focus in this module is on community psychology; primary, secondary and tertiary prevention of abnormal behaviour. Community psychology as a sub-discipline of Psychology originated in the United States of America during the Boston Conference of 1965. The field of Clinical Psychology was increasingly being criticised for its availability to selected clients only, and the aim was to develop a conceptual orientation that would allow the professional to intervene in a social system on behalf of individuals requiring assistance. The concern of the early community psychologists was that psychotherapeutic models of helping were irrelevant to the needs of people who had little food and no education, jobs or decent housing. They questioned its selectivity in that it appeared to ignore the more serious and yet socially relevant problems such as substance abuse, crime, violence and women battering. Most psychologists who adopt the community perspective accept the broader society as it is and assume responsibility for creating or changing existing service organisations and other institutions into more effective agencies for achieving goals and providing more humane, effective care for those in need. They also take responsibility for enhancing human psychological growth and development. This entails intervention to improve the individual’s circumstances, emotional wellbeing and quality of life. Another major tenet of community psychology is its endeavour to identify and promote the strengths of a community rather than to diagnose problems on the basis of criteria determined by external sources (experts). Community psychology, for example, seeks to support health on the basis of the inherent strengths of the community rather than to prevent illness along the lines advocated by community mental health programmes. Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 13 Four theoretical models have been identified in the field of community psychology, namely: • The mental health model is based on the explicit intention of preventing mental illness and its disruption of usual living patterns. • The social action model also aims at prevention. It addresses the needs of the poor and attempts to equalise opportunities for upward social mobility. • The ecological model sees the community as an ecosystem consisting of relationships which operate in an environmental context. • The organisational model focuses on understanding and preventing mental disorders in organisations. It is seen as a method for facilitating change and development in people. The area to which community psychology applies is as wide as the interests and concerns of the community itself. Activity 2.1 Scan-read Learning Unit 2 in this Tutorial Letter 501, in order to familiarise yourself with the contents of this Learning Unit. 2.1 STUDY UNIT: Community Psychology In this study unit, we introduce you to the field of community psychology and, most importantly, the role of community psychologists in the prevention of psychopathology/abnormal behaviour. Community psychologists instigate community interventions to improve the quality of life of the entire community, whereas clinical psychologists work with individuals or groups to bring about psychological improvement. The community psychologist thus has a preventative orientation in contrast to the clinical psychologist’s curative orientation. Community interventions also tend to be of a more public nature and include the participation of nonprofessionals, volunteers and self-help support networks. Clinical interventions, in contrast, are essentially more private, are based on interpersonal contact and rarely involve non-professionals. In both instances, the focus is on the enhancement of mental health. Outcomes Once you have worked through Study Unit 2.1, you should be able to: • define community psychology • describe the role of community psychologists Study To be able to do the above, you will need to study the overview to this section in this Tutorial Letter 501 as well as study unit 2.1. 2.2 STUDY UNIT: Prevention of Psychopathology In this study unit, we introduce you to different forms of prevention. Preventing psychopathology is one of the most innovative functions of community psychology. Prevention programmes are attempts to maintain health rather than to treat sickness. The main emphasis is on reducing the number of new cases of mental disorders, the duration of disorders among afflicted people, and the disabling effects of disorders. These three areas of prevention have been called primary, secondary, and tertiary prevention. Downloaded by Thomas Mboya () lOMoARcPSD| 14 Primary Prevention Primary prevention is an effort to lower the incidence of new cases of behavioural disorders by strengthening or adding to resources that promote mental health and by eliminating community characteristics that threaten mental health. As an example of the former, Project Head Start was initiated in 1964, in the United States of America, with the goal of setting up a new and massive preschool program to help neglected or deprived children develop social, emotional, and intellectual skills. Examples of the latter are efforts to eliminate discrimination against members of minority groups to help them fulfil their potential. Both techniques – introducing new resources and eliminating causal factors – can be directed toward specific groups of people or the community as a whole. Munoz and colleagues (Munoz, Glish, Soo-Hoo & Robertson, 1982; Munoz et al., 1995) have been systematically attempting to prevent depression in a community-wide project and primary care patients. The project was particularly interesting. During a two-week period, nine televised programmes intended to prevent depression were broadcast in San Francisco. Each programme lasted for four minutes and showed viewers some coping skills, such as how to think positively, engage in rewarding activities, and deal with depression. Telephone interviews were conducted with 294 San Francisco residents. Some respondents were interviewed one week before the television segments were shown; others were interviewed one week after, and still, others were interviewed both before and after the segments. Information about respondents’ depression levels was collected during the interviews. (For those who were interviewed before and after the segments, the depression measure was administered twice). Respondents who were interviewed after the televised segments were also asked to indicate whether they had watched any of the segments. Results indicated that those who saw the segments exhibited a significantly lower level of depression than that found among the non-viewers. The results, however, held only for respondents who had some symptoms of depression, to begin with. Watching the television programmes did not change the depression levels of those who initially (before the segments) reported little depression. The results indicated that a community-wide prevention programme could be beneficial. A large proportion (approximately one-third) of the viewers had some symptoms of depression, and this group showed fewer symptoms after viewing the programs. The long-term effects of the programmes were not assessed. Another problem in the study was that those who benefited from the programmes had exhibited some initial symptoms. If they were clinically diagnosable as being depressed, the intervention might be considered secondary rather than primary prevention. (Secondary prevention is discussed in the next section.) Nevertheless, the San Francisco study demonstrated the effects of large-scale interventions that may help individuals who already exhibit disorders. Evidence also exists that early; primary prevention efforts can be successful in reducing the incidence of juvenile delinquency. Zigler, Taussig and Black (1992) noted that few treatment and rehabilitation programmes for children with conduct problems had had much effect. In their review of early intervention programmes aimed at children, they found evidence that these programmes intended to promote social and intellectual competence, have had an expected positive effect on preventing conduct problems in children. The investigators speculated that gaining competence may snowball to generate further success in other aspects of life and prevent conduct disorders. Although interest in primary prevention continues to grow, resistance to prevention is also strong. First, only through prospective and longitudinal research can developmental processes in primary prevention be uncovered (Lorion, 1990). Primary prevention is future-oriented, in that the benefits of the effort are not immediately apparent. Second, primary prevention competes with a traditional programme aimed at treating people who already show emotional disturbances. Third, prevention may require social and environmental changes so that stressors can be reduced or resources can be enhanced. Most mental health workers are unable to initiate such changes, and many others doubt that people have the ability to modify social structures. Fourth, funding for mental health programmes has traditionally been earmarked for treatment. Prevention efforts constitute a new demand on the funding system. Moreover, fifth, primary prevention requires a great deal of planning, work, and long-term evaluation. This effort alone may discourage many from becoming involved. Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 15 Secondary Prevention Secondary prevention is an attempt to shorten the duration of mental disorders and to reduce their impact. Suppose the presence of a disorder can be detected early, and effective treatment can be found. In that case it is possible to minimise the impact of the disorder or to prevent it from developing into a more serious and debilitating form. For example, classroom teachers can play an important role in secondary prevention by identifying children who are not adjusting to the school environment. Once identified, such children can be helped by teachers, parents, or school counsellors. In practice, there are a number of problems associated with secondary prevention. First, traditional diagnostic methods are often unreliable and provide little insight into which treatment procedures to use. It has been suggested that more specialised diagnostic techniques be used, perhaps focusing on certain behaviours or on demographic characteristics that may be related to psychopathology. Second, once a disorder is detected, it is often difficult to decide what form of treatment will be most effective with a particular patient. Third, prompt treatment is frequently unavailable because of the shortage of mental health personnel and the inaccessibility of services. Indeed, many mental health facilities have long lists of would-be patients who must wait months before receiving treatment. “Walk-in” clinics, crisis intervention facilities, and emergency telephone lines have been established in an attempt to provide immediate treatment. Tertiary Prevention The goal of tertiary prevention is to facilitate the readjustment of the person to community life after hospital treatment for a mental disorder. Tertiary prevention focuses on reversing the effects of institutionalisation and on providing a smooth transition to a productive life in the community. Several programmes have been developed to accomplish this goal. One involves the use of “passes,” whereby hospitalised patients are encouraged to leave the hospital for short periods of time. By spending gradually increasing periods of time in the community (and then returning each time to the hospital), the patients can slowly readjust to life away from the hospital while still benefiting from therapy. Psychologists can also ease readjustment to the community by educating the public about mental disorders. Public attitudes toward mental patients are often based on fears and stereotypes. Factual information can help modify these attitudes so that patients will be more graciously accepted. This help is especially important for the family, friends, and business associates of patients, who must interact frequently with them. A more difficult problem to deal with is the growing backlash against the discharge of former mental patients into nursing homes or rooming houses in the community. Many community members feel threatened when such patients live in their neighbourhoods. Again, education programmes can help dispel community members’ fears and stereotypes (Sue et al., 2006, pp. 589–592). Outcomes Once you have worked through Study Unit 2.2, you should be able to: • Distinguish between the various types of prevention, namely primary prevention, secondary prevention and tertiary prevention Study To be able to do the above, you will need to study the introduction to this section in this Tutorial Letter 501 as well as study unit 2.2. Activity 2.2 Contact a community worker in your area or community and ask him or her about the role of a community worker in the prevention of psychopathology. In carrying out this activity, you will enhance your understanding of the role of community workers in the prevention of psychopathology in your area. Downloaded by Thomas Mboya () lOMoARcPSD| 16 Additionally, an example of a national advocacy organisation that works towards the prevention of mental distress is the South African Depression and Anxiety Group. Explore their nationwide projects on their website: Activity 2.3 The following activity will help you to revise and summarise what you have studied in this Learning Unit: The learning outcomes of each of the three study units in this chapter were set out clearly in each of the study units. Make sure that you have acquired the necessary knowledge, skills and insights set out in these learning outcomes. Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 17 Learning Unit 3: Perspectives/Models of Abnormal Behaviour Dr Beate von Krosigk Contents Page Overview 17 3.1 Study unit: Models of Mental Disorders 18 Conclusion 19 Reference 19 Overview In general, the perspectives/models of abnormal behaviour fall into two distinct groups, which are based on the reasons these perspectives employ for finding explanations for the causes of abnormal behaviour. The biological, psychoanalytic, psychodynamic, behavioural, cognitive, humanistic, and existential perspectives/models are linear models which are based on cause and effect reasoning for explaining abnormal behaviour, while the general and family systems perspectives/models are circular models, which reason that circular causality can be observed or detected only in the present moment during an actual interaction, while all individuals who are involved in the reciprocal processes of verbal, non-verbal, and behavioural interactions are present. As PYC2601 (Personality Theories) is a set prerequisite for PYC3702, we assume that you have completed your studies of the different personality theories. These theories are exactly the same psychological theories/models or perspectives that we use in Abnormal Behaviour. In personality theory, the focus in teaching you these perspectives was on how these different theories/models/perspectives describe the development of the personality, whereas the focus on abnormal behaviour is on how these theories explain the development of abnormal behaviour (the aetiology of mental disorders). You will therefore use exactly the same knowledge regarding the different perspectives to explain the aetiology of mental disorders – using the same assumptions, principles, concepts and terminology as in personality theory – as the perspectives are the same and therefore applied in the same way, but for the shift in focus from personality development to the development of abnormal behaviour. You will see that different disorders have different explanations regarding their aetiology according to these different perspectives. Therefore, for this module (PYC3702), we assume you already know the assumptions, principles, concepts and terminology of these different psychological perspectives and therefore will not examine you on pure theoretical issues regarding these. We will, however examine you on the application of these different perspectives towards the explanation of the aetiology of specific mental disorders. Of course, the African perspective and the Multipath Model Downloaded by Thomas Mboya () lOMoARcPSD| 18 are new to this module. Therefore, we will examine pure knowledge/theoretical aspects as well as more application questions regarding these two perspectives. Your prescribed book utilises the Multipath Model for the explanation of the development of abnormal behaviour. This model is a meta-model meaning that the model attempts a holistic explanation for the development of abnormal behaviour by incorporating the different aetiological factors into four interrelated and reciprocal dimensions: • Dimension one: Biological Factors • Dimension two: Psychological Factors • Dimension three: Social Factors • Dimension four: Sociocultural Factors According to the Multipath Model, abnormal behaviour can very seldom be explained in full by one theoretical model. The proponents of the Multipath Model stress the roles and contributions of multiple pathways to and causes of mental disorders. They propose the consideration of combinations of interacting biological, psychological, social and sociocultural factors in explaining abnormal behaviour. At the beginning of chapter 2 of your prescribed book, you will find 7 “FOCUS QUESTIONS” on page 34. After having worked through this chapter, answer these questions, and compare your answers with the answers at the end of the chapter under the heading “SUMMARY”. Should your answers be incomplete, refer back to this study guide as well as the prescribed material in chapter 2, and again work through the parts you are required to study. 3.1 STUDY UNIT: Models of Mental Disorders Begin by reading the case study on Steven V at the beginning of chapter 2 in the prescribed book. While you are doing so, become aware of your own underlying presuppositions on which your reasoning is based for understanding Steven V’s abnormal behaviour and family situation. Are you able to identify the perspective(s)/ model(s) you use in order to explain Steven V’s abnormal behaviour? Write down your observations and retain them for later. Activity 3.1 You are now ready to STUDY the following sections in your prescribed book: • “One-Dimensional Models of Mental Disorders”, page 36 • “A Multipath Model of Mental Disorders”, page 37 As you were studying the abovementioned sections, you may have realised that the “One-Dimensional Models of Mental Disorders” refer to the way in which psychologists use a particular personality theory to the exclusion of others in their attempt to explain abnormal behaviour. The “Multipath Model of Mental Disorders” on the other hand, integrates different perspectives/models on a number of different dimensions. Explanations from the biological dimension (Bio) can include an array of biological aspects of human functioning, which can be referred to as supportive evidence for the explanation of the presence of abnormal behaviour. These biological aspects include genetic factors, chemical imbalances in the brain, metabolic dysfunction, abnormalities in the neurological structures, and organ malfunction. Activity 3.2 You can now STUDY the following sections in your prescribed book for a deeper understanding of the four dimensions of the multipath model: • “Dimension One: Biological Factors”, page 42 • “Dimension Two: Psychological Factors”, page 52 • “Dimension Three: Social Factors”, page 63 • “Dimension Four: Socio-cultural Factors”, page 65 Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 19 Did you recognise that to a large extent, these four dimensions were a revision from your Basic Psychology, Developmental Psychology and Personality Theory modules? Activity 3.3 Revision We will now return to your initial reading of Steven V’s story, and the observations you made. Has your understanding changed? Do you now see the basis of your reasoning for explaining Steven V’s abnormal behaviour, differently? Are you able to identify the perspective(s)/model(s) you used in order to explain Steven V’s abnormal behaviour? And have they changed? Has your basis for your reasoning changed now that you have gained more knowledge/facts about the different perspectives/models? Would you use different perspectives/models now than you used before for explaining abnormal behaviour? We will now return to the beginning of chapter 2 of your prescribed book. Answer the 7 “focus questions” on pages 34 and compare your answers with the answers at the end of the chapter under the heading “summary” on page 75. Should your answers be incomplete, refer back to this study guide as well as the prescribed material in chapter 2, and again work through the sections you are required to study. Pay particular attention to the aspects you misunderstood, misrepresented, or simply forgot. Ensure that you know the new terminology as well as all the other words that you do not understand. CONCLUSION We have now come to the end of revising Western perspectives/models of abnormal behaviour/mental disorders/psychopathology and will now look at the African perspective of explaining abnormal behaviour. REFERENCE American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association. Downloaded by Thomas Mboya () lOMoARcPSD| 20 Learning Unit 4: Psychopathology from an African Perspective Mrs Banti Mokgatlhe Contents Page Overview 20 4.1 Study unit: The African perspective 22 4.2 Study unit: Approaches to understanding culture and mental health 24 4.3 Study unit: The cultural context of psychopathology 26 4.4 Study unit: The African worldview versus the Western worldview 27 4.5 Study unit: Traditional African perspective on psychopathology 31 4.6 Study unit: Culture-specific syndromes 34 Conclusion 39 References 40 Overview The 12th edition of the prescribed book does not contain a chapter entitled “Psychopathology from an African Perspective”. It is, however, an important Learning Unit, so please ensure that you know the content below thoroughly. A point of caution before reading this Learning Unit; the author acknowledges the fact that most societies have evolved over time. As a result, the general views on Western and African worldviews on most of the issues discussed in this chapter may not be applicable to everyone. As Africans would say, “re inele matsogo metsing”, in other words, please accept our apologies if you find any of the material somewhat offensive. In a multicultural society such as South Africa, the challenge facing many therapists is how to work with people from diverse cultural backgrounds. As mainstream psychology is based on Western philosophy and principles, how would you as a Western-trained therapist treat a culturally different client who believes that (a) his or her mental problems are due to spirit possession, (b) only a traditional healer with supernatural powers can deal with the problem, and (c) a cure can be effected via formal ritual and a journey into the spirit world? Therapists who have little experience of indigenous methods of treatment often have great difficulty in working effectively with clients with an indigenous orientation. It is, therefore, important that therapists and scholars of psychology should be open to alternative worldviews and, as such, become culturally Downloaded by Thomas Mboya () lOMoARcPSD| PYC3702/501/3/2022 21 sensitive to clients’ diverse contexts, develop an understanding of the latter and, as a result, avoid equating differences with deviance. The debate on the relevance of the psychology practised and taught in South Africa has evolved along with socio-political movements in the country. There is a growing consciousness of the absence of comprehensive theories and treatment models for human problems in a culturally plural society. In this module, we expose you to an African worldview as an alternative approach to psychopathology. A lot still has to be learned about this topic, which has often been overlooked by research in the past. In this module, we give you a brief and by no means complete picture of some of the important issues in African cultures. For pragmatic reasons, we do not cover all African cultures in this module. This does not imply that the cultures not covered are less significant or relevant within the South African context. In the past, psychology addressed mainly the problems arising from the Western way of life, but today there is no conceivable reason to maintain the status quo. There are two views in this debate: those in favour of the status quo and who profess a universalist approach, and those who advocate new theories and the development of treatment models based on cultural relativism. A third view proposes a synthesis of the two. A more detailed discussion of these approaches will follow in Learning Unit 4. Also, the fact that western conceptions of normality and abnormality have been exported to Africa to explain the African client has resulted in a lack of development of a theory of abnormal behaviour from a purely African perspective. Activity 4.1 Scan-read Learning Unit 4 in the Tutorial Letter, in order to familiarise yourself with the contents of this unit. Activity 4.2 Read a book on traditional healing or attend a cultural event or activity of a culturally different group from your own in your community. Such an experience could help you to personalise your theoretical understanding through an experiential exercise. Suggested texts: Bodibe, R.C. (1992). Traditional healing: An indigenous approach to mental health problems. In J. Uys (ed.), Psychological counselling in the South African context (p. 156). Cape Town, South Africa: Pan Books. Botha, K., Moletsane, M., Makhubela, M & Burke, A. (2019). Origins and causes of Psychopathology. In Burke, A (3rd ed.), Understanding Psychopathology: South African perspectives (pp. 22- 23). Cape Town, South Africa: Oxford University Press An understanding and knowledge of the African perspective will enable you to: • address issues relating to diversity and difference in traditional psychology theories, models and philosophies • address issues relating to diversity and differences in traditional psychology theories, models and philosophies. • study psychology from an alternative worldview. Traditional psychology is presented from a limited perspective, and this does injustice to one of the greatest attributes of people: the individual and collective diversity in thought, feeling and behaviour. Furthermore, traditional psychology is not generalisable to people of diverse cultural contexts. • raise questions about traditional mainstream knowledge in psychology. • understand and be sensitive to people from diverse cultural backgrounds. Downloaded by Thomas Mboya () lOMoARcPSD| 22 • understand the cultural context and belief systems of African people in order to deliver an effective service as a health care worker. Societal thinking in South Africa has shifted from the concept of this country as a "melting pot" of different races and cultures to the idea of a conglomeration of many different microcultures. This changing societal emphasis makes the focus on diversity imperative. 4.1 STUDY UNIT: The African Perspective In defining abnormal behaviour, psychologists usually adopt one of several approaches. The aim of this chapter is to give you an overview of psychopathology from an African perspective. There is no single theory or model to explain the African perspective on psychopathology. The system is basically intuitive and subjective, with differing views as to what constitutes psychopathology from diverse cultural contexts. The pioneering work of Vera Buhrmann (1977, 1979, 1984 & 1987) is a case in point of studies done on pathological behaviour from an indigenous African perspective. The anthropologist Hammond-Tooke’s (1975 & 1989) studies of various African tribes also contributed to the awareness that Western diagnostic categories are not applicable to African patients. Outcomes Once you have worked through study unit 4.1, you should be able to: • discuss the development of the African perspective on psychopathology • define culture • define ethnocentrism • define stereotypes Study To be able to do the above you have to study the following sections in this Study Guide: • The introduction to the section on “The African Perspective” • The section on “Approaches to understanding culture and mental health” • Universalism • Relativism • The section on the “cultural context of Psychopathology” Activity 4.3 STUDY the following section in this Tutorial Letter 501: The concept of psychopathology within the traditional African worldview has evolved through the years to incorporate both traditional African and Western biomedical views. There is sufficient evidence in contemporary society to incorporate both views. This also illustrates the shift that is taking place in the lives of Africans from a traditional to a more modern way of life. South African psychology has its origins in American and European philosophies, theories, constructs and social systems (Bhana, cited in Mogale, 1999). Its theories, constructs and methods are, therefore, based on Western philosophies and values. We can, therefore, argue that although people from all cultures are more similar than different and in this way identify many psychological constructs and skills applicable in all cultures, it would be invalid to overgeneralise and accept that Western psychology is applicable to Africa in all its aspects.