Theme 1: Introduction to psychopathology
Ch. 1: An introduction to psychopathology: concepts, paradigms and stigma (pp. 3 - 37)
1.1 A BRIEF HISTORY OF PSYCHOPATHOLOGY
Throughout history, societies have explained “mad” or distressing behaviour in very different ways —
from supernatural possession, to medical illness, to psychological and social models. Each era’s view
shaped how individuals with mental health problems were treated.
Supernatural explanations: Demonic Possession
• Early civilizations (e.g., Egypt, Babylon, Greece) saw mental disturbance as caused by evil spirits.
(Anneliese Michel was special because these treatments were used in 18th sentury, and she
lived in 1952-1976)
• Behavioural changes (withdrawal, aggression, mood swings) were seen as signs of possession.
• Treatments: exorcism, prayer, starvation, flogging.
• This linked madness with moral failure rather than illness.
• Even today, in some cultures (e.g., Ugandan child soldiers; Neuner et al., 2012), “spirit
possession” may reflect trauma-related dissociation, showing that context shapes
interpretation.
Biological explanations: The Medical or Disease model
• Emerged in the 17th–18th centuries with the rise of science.
• Mental disorders viewed as illnesses of the brain or body, not supernatural forces.
• Descartes and later scientists emphasized biological dysfunction (e.g., genetics,
neurotransmitters, brain abnormalities).
• Psychiatry became a medical discipline focused on diagnosis and treatment (e.g., medication,
rest, later ECT).
• Criticism: too reductionist — ignores social and psychological context and reinforces stigma by
implying people are “broken.”
Humanitarian Reform: Moral Treatment (18th–19th Century)
• Reformers like Philippe Pinel (France) and William Tuke (UK) rejected cruelty in asylums.
• Introduced moral treatment based on kindness, dignity, and daily structure.
• Focused on self-control, work, and social responsibility to aid recovery.
• Represented the first psychosocial approach to mental illness.
Institutionalization – The Rise of Asylums
• 19th-century expansion of state psychiatric hospitals.
• Intended as refuge but became overcrowded and custodial rather than therapeutic.
• People with mental illness were often isolated from society — leading to stigma and exclusion.
Deinstitutionalization – From Asylums to Community Care (20th Century)
• 1950s–1970s: movement towards community-based treatment.
, • Laws like the Community Mental Health Act (1963, US) promoted outpatient care and
multidisciplinary teams (CMHTs).
• Milieu therapy: structured hospital life promoting self-respect, responsibility, and
independence.
• Token economy: behavioural reinforcement system (Ayllon & Azrin, 1968) rewarding adaptive
behaviours (e.g., communication, self-care).
• Assertive Outreach Teams began supporting individuals in their own communities, aiming to
prevent relapse and hospitalization.
Modern Approach – The Recovery Model
• Focus on empowerment, inclusion, and autonomy, not just symptom reduction.
• Recognizes social factors like education, work, and community participation as essential for
recovery.
• Emphasizes hope, self-direction, and personal meaning rather than viewing people as
“broken.”
1.2 DEFINING PSYCHOPATHOLOGY
Defining psychopathology—the study of mental health problems—is complex. Unlike physical illness,
psychological problems rarely have clear biological causes, and many definitions carry ethical and
social implications. Therefore, multiple perspectives are used to decide what counts as a “mental
disorder.”
The Challenge of Definition
• Real-life examples (Joan, Peter, Jo, Erica) show that distressing experiences vary widely.
• Psychopathology cannot be defined solely by biological dysfunction since many mental
disorders lack identifiable physical causes.
• Terms like abnormal psychology have been used, but “abnormal” implies deviation from
normality and reinforces stigma—suggesting inferiority or “less than normal.”
• Modern approaches emphasize reducing stigma and focusing on individual needs and
functioning, not moral judgement.
,Approaches to Defining Psychopathology
a. Deviation from the Statistical Norm
• Based on measurable traits (e.g., IQ, anxiety level).
• Individuals far from the population mean are labelled “abnormal.”
o Example: IQ < 70 → intellectual disability.
• Advantage: objective, quantifiable.
• Limitations:
o Rare traits aren’t always pathological (e.g., genius).
o Most emotions (e.g., anxiety, sadness) are statistically common yet clinically relevant
only when distressing or impairing.
b. Deviation from Social and Political Norms
• Abnormality defined by behaviour that violates societal expectations.
• What counts as “normal” depends on culture, politics, and context.
o Example: during the Soviet Union, political dissidents were misdiagnosed with
schizophrenia.
• Psychopathology and culture:
o Disorders can be culture-bound (expressed differently across societies).
o Examples:
▪ Ataque de nervios (Caribbean/Latin America): episodes of intense emotional
distress, screaming, and loss of control.
▪ Seizisman (Haiti): paralysis-like reactions linked to trauma and spiritual
beliefs.
• Limitation: norms vary over time and across groups, so this approach risks political misuse
and cultural bias.
c. Maladaptive Behaviour and Harmful Dysfunction
• Focuses on whether behaviour interferes with normal functioning (work, relationships, daily
life).
• Example: severe anxiety preventing someone from leaving home.
• Yet, maladaptive ≠ always psychopathological.
o Some harmful acts (e.g., terrorism) are not mental disorders.
o Some “abnormal” behaviours (e.g., phobias) can be adaptive if they protect against
threat.
• The harmful dysfunction model (Wakefield, 1997):
o A disorder exists when (1) there is a dysfunction of a mental process and (2) this
causes harm judged by social standards.
o Balances biological dysfunction and subjective distress.
• Limitation: we still lack clear knowledge of what constitutes dysfunction.
, d. Distress and Disability
• One of the most widely used criteria (DSM-5).
• A disorder involves clinically significant distress or impairment in social, occupational, or
academic functioning.
• This focuses on the individual’s experience rather than societal judgement.
• However:
o Not all who suffer distress have a disorder (e.g., grief).
o Some disorders (e.g., antisocial personality disorder) cause harm to others, not
distress to the self.
o Diagnosis doesn’t always require self-reported distress.
1.3 EXPLANATORY APPROACHES TO PSYCHOPATHOLOGY
Psychopathology can be explained through different paradigms—biological, psychological, and
sociocultural. Each focuses on distinct but complementary aspects of mental disorders.
This section outlines the five major explanatory models: Biological, Psychoanalytical, Behavioural,
Cognitive, and Humanist-Existential.
1.3.1 Biological Models
The biological model explains psychopathology as a result of genetic, neuroanatomical, or
neurochemical abnormalities in the brain or nervous system. It focuses on how biological factors
influence behaviour, emotion, and cognition, often interacting with environmental stressors.
Genetics
• Genetics is the study of heredity and variation in inherited traits.
• Mental disorders are often partly genetic, meaning people inherit biological predispositions
that influence their vulnerability to psychopathology.
• The Human Genome Project has identified genes linked to psychological traits and disorders.
• The degree to which genes influence behaviour varies:
o High influence: Huntington’s disease (dominant single gene).
o Moderate influence: schizophrenia, bipolar disorder.
o Low or nonspecific influence: depression and anxiety, where environment matters
more.
Ch. 1: An introduction to psychopathology: concepts, paradigms and stigma (pp. 3 - 37)
1.1 A BRIEF HISTORY OF PSYCHOPATHOLOGY
Throughout history, societies have explained “mad” or distressing behaviour in very different ways —
from supernatural possession, to medical illness, to psychological and social models. Each era’s view
shaped how individuals with mental health problems were treated.
Supernatural explanations: Demonic Possession
• Early civilizations (e.g., Egypt, Babylon, Greece) saw mental disturbance as caused by evil spirits.
(Anneliese Michel was special because these treatments were used in 18th sentury, and she
lived in 1952-1976)
• Behavioural changes (withdrawal, aggression, mood swings) were seen as signs of possession.
• Treatments: exorcism, prayer, starvation, flogging.
• This linked madness with moral failure rather than illness.
• Even today, in some cultures (e.g., Ugandan child soldiers; Neuner et al., 2012), “spirit
possession” may reflect trauma-related dissociation, showing that context shapes
interpretation.
Biological explanations: The Medical or Disease model
• Emerged in the 17th–18th centuries with the rise of science.
• Mental disorders viewed as illnesses of the brain or body, not supernatural forces.
• Descartes and later scientists emphasized biological dysfunction (e.g., genetics,
neurotransmitters, brain abnormalities).
• Psychiatry became a medical discipline focused on diagnosis and treatment (e.g., medication,
rest, later ECT).
• Criticism: too reductionist — ignores social and psychological context and reinforces stigma by
implying people are “broken.”
Humanitarian Reform: Moral Treatment (18th–19th Century)
• Reformers like Philippe Pinel (France) and William Tuke (UK) rejected cruelty in asylums.
• Introduced moral treatment based on kindness, dignity, and daily structure.
• Focused on self-control, work, and social responsibility to aid recovery.
• Represented the first psychosocial approach to mental illness.
Institutionalization – The Rise of Asylums
• 19th-century expansion of state psychiatric hospitals.
• Intended as refuge but became overcrowded and custodial rather than therapeutic.
• People with mental illness were often isolated from society — leading to stigma and exclusion.
Deinstitutionalization – From Asylums to Community Care (20th Century)
• 1950s–1970s: movement towards community-based treatment.
, • Laws like the Community Mental Health Act (1963, US) promoted outpatient care and
multidisciplinary teams (CMHTs).
• Milieu therapy: structured hospital life promoting self-respect, responsibility, and
independence.
• Token economy: behavioural reinforcement system (Ayllon & Azrin, 1968) rewarding adaptive
behaviours (e.g., communication, self-care).
• Assertive Outreach Teams began supporting individuals in their own communities, aiming to
prevent relapse and hospitalization.
Modern Approach – The Recovery Model
• Focus on empowerment, inclusion, and autonomy, not just symptom reduction.
• Recognizes social factors like education, work, and community participation as essential for
recovery.
• Emphasizes hope, self-direction, and personal meaning rather than viewing people as
“broken.”
1.2 DEFINING PSYCHOPATHOLOGY
Defining psychopathology—the study of mental health problems—is complex. Unlike physical illness,
psychological problems rarely have clear biological causes, and many definitions carry ethical and
social implications. Therefore, multiple perspectives are used to decide what counts as a “mental
disorder.”
The Challenge of Definition
• Real-life examples (Joan, Peter, Jo, Erica) show that distressing experiences vary widely.
• Psychopathology cannot be defined solely by biological dysfunction since many mental
disorders lack identifiable physical causes.
• Terms like abnormal psychology have been used, but “abnormal” implies deviation from
normality and reinforces stigma—suggesting inferiority or “less than normal.”
• Modern approaches emphasize reducing stigma and focusing on individual needs and
functioning, not moral judgement.
,Approaches to Defining Psychopathology
a. Deviation from the Statistical Norm
• Based on measurable traits (e.g., IQ, anxiety level).
• Individuals far from the population mean are labelled “abnormal.”
o Example: IQ < 70 → intellectual disability.
• Advantage: objective, quantifiable.
• Limitations:
o Rare traits aren’t always pathological (e.g., genius).
o Most emotions (e.g., anxiety, sadness) are statistically common yet clinically relevant
only when distressing or impairing.
b. Deviation from Social and Political Norms
• Abnormality defined by behaviour that violates societal expectations.
• What counts as “normal” depends on culture, politics, and context.
o Example: during the Soviet Union, political dissidents were misdiagnosed with
schizophrenia.
• Psychopathology and culture:
o Disorders can be culture-bound (expressed differently across societies).
o Examples:
▪ Ataque de nervios (Caribbean/Latin America): episodes of intense emotional
distress, screaming, and loss of control.
▪ Seizisman (Haiti): paralysis-like reactions linked to trauma and spiritual
beliefs.
• Limitation: norms vary over time and across groups, so this approach risks political misuse
and cultural bias.
c. Maladaptive Behaviour and Harmful Dysfunction
• Focuses on whether behaviour interferes with normal functioning (work, relationships, daily
life).
• Example: severe anxiety preventing someone from leaving home.
• Yet, maladaptive ≠ always psychopathological.
o Some harmful acts (e.g., terrorism) are not mental disorders.
o Some “abnormal” behaviours (e.g., phobias) can be adaptive if they protect against
threat.
• The harmful dysfunction model (Wakefield, 1997):
o A disorder exists when (1) there is a dysfunction of a mental process and (2) this
causes harm judged by social standards.
o Balances biological dysfunction and subjective distress.
• Limitation: we still lack clear knowledge of what constitutes dysfunction.
, d. Distress and Disability
• One of the most widely used criteria (DSM-5).
• A disorder involves clinically significant distress or impairment in social, occupational, or
academic functioning.
• This focuses on the individual’s experience rather than societal judgement.
• However:
o Not all who suffer distress have a disorder (e.g., grief).
o Some disorders (e.g., antisocial personality disorder) cause harm to others, not
distress to the self.
o Diagnosis doesn’t always require self-reported distress.
1.3 EXPLANATORY APPROACHES TO PSYCHOPATHOLOGY
Psychopathology can be explained through different paradigms—biological, psychological, and
sociocultural. Each focuses on distinct but complementary aspects of mental disorders.
This section outlines the five major explanatory models: Biological, Psychoanalytical, Behavioural,
Cognitive, and Humanist-Existential.
1.3.1 Biological Models
The biological model explains psychopathology as a result of genetic, neuroanatomical, or
neurochemical abnormalities in the brain or nervous system. It focuses on how biological factors
influence behaviour, emotion, and cognition, often interacting with environmental stressors.
Genetics
• Genetics is the study of heredity and variation in inherited traits.
• Mental disorders are often partly genetic, meaning people inherit biological predispositions
that influence their vulnerability to psychopathology.
• The Human Genome Project has identified genes linked to psychological traits and disorders.
• The degree to which genes influence behaviour varies:
o High influence: Huntington’s disease (dominant single gene).
o Moderate influence: schizophrenia, bipolar disorder.
o Low or nonspecific influence: depression and anxiety, where environment matters
more.
