Understanding Psychopathology

Criteria for Psych Disorders (4Ds)

Psychological Dysfunction
Distress or Impairment
Deviance
Psychological Disorder
The Ds of Abnormality
Dangerousness (to others or self)
Psychopathology
Clinical Description
Presenting problem or presents
Prevalence
Incidence
Course
Onset
Prognosis
Etiology, Treatment, & Etiology Outcomes
Etiology
Treatment
Ancient Views & Treatment
Beliefs in Prehistoric Societies
Interpretation of Abnormal Behavior
Trephination
Later Societies
Ancient China
Greek and Roman Views
Hippocrates
Hippocrates' Humors
Hippocrates and Hysteria
Europe in the Middle Ages
Power of the Clergy
Outbreaks of Mass Madness
Tarantism / Saint Vitus’s Dance
Lycanthropy
Revival of Exorcisms
The Renaissance & the Rise of Asylums
The Rise of Asylums
Bedlam, 1547
Reform and Moral Treatment
Philippe Pinel
William Tuke
Benjamin Rush
Dorothea Dix
The Decline of Moral Treatment
The Early 20th Century
Somatogenic Perspective
Psychogenic Perspective
Somatogenic Perspective
Emil Kraepelin

Understanding Psychopathology 1
 Syphilis
Development of Biological Treatments
Psychogenic Perspective
Hypnotism
Josef Breuer
Sigmund Freud
Recent Decades & Current Trends
Psychotropic Medications
Antipsychotic drugs
Antidepressant drugs
Antianxiety drugs
Deinstitutionalization
Outpatient Care and Community Mental Health Approach
Preventing Disorders & Promoting Mental Health
Positive psychology - The study and enhancement of positive feelings, traits, and group-
directed virtues.

Criteria for Psych Disorders (4Ds)

Psychological Dysfunction
A breakdown in cognitive, emotional, or behavioral functioning (not working
properly)

Example: Being severely anxious during a date; being afraid of seemingly safe
things like dogs

Distress or Impairment
Distress – The status of being extremely upset, having negative and unpleasant
mood, or suffering

Impairment – Whether daily tasks (e.g., interacting with people, working, studying)
are affected

Deviance
Atypical or not culturally expected

Violating social norms

Psychological Disorder
The most widely accepted definition describes psychological disorders as the

“Behavioral, psychological, or biological dysfunctions that are

unexpected in their cultural context and associated with present distress
and impairment in functioning, or increased risk of suffering, death, pain,
or impairment (DSM 5).”

The Ds of Abnormality
Dysfunction (psychological dysfunction)

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 Distress (and/or impairment)

Deviance (from the cultural context)

Dangerousness (to others or self)

Psychopathology
The scientific study of psychological disorders.

Includes specially trained professionals like:

Clinical psychologists

Psychometricians

Psychiatrists

Clinical Description
Presenting problem or presents
Why the person came to the clinic.

Represents the unique combination of behaviors, thoughts, and feelings that make
up a specific disorder.

Prevalence
The number of people in the population as a whole who have the disorder.

Incidence
Statistics on the number of new cases that occurred during a given period (e.g., a
year).

Course
Individual pattern of the disorder.

Chronic course – tends to last for a long time or even a lifetime (e.g.,
schizophrenia).

Episodic course – likely to recover within a few months, only to suffer a recurrence
of the disorder at a later time (e.g., depression).

Time-limited course – likely to improve without treatment in a relatively short period

with little or no risk of recurrence.

Onset
The beginning of the psychological disorder.

Sudden/Acute onset – begins suddenly.

Insidious onset – comes slowly and does not have obvious symptoms at first.

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 Prognosis
The anticipated course of a disorder.

Good prognosis – the individual will probably recover.

Guarded prognosis – the probable outcome does not look good.

Etiology, Treatment, & Etiology Outcomes

Etiology
The study of origins, focusing on the causes of disorders.

Includes biological, psychological, and social dimensions.

Treatment
Crucial in psychopathology.

Success of a new drug or treatment may offer clues about the nature and causes of
a disorder.

Unfortunately, in psychopathology, the effect of treatment does not necessarily

indicate the cause.

Ancient Views & Treatment

Beliefs in Prehistoric Societies
People believed events were influenced by magical, sometimes sinister beings.

Viewed the human body and mind as a battleground between external forces of
good and evil.

Interpretation of Abnormal Behavior

Abnormal behavior seen as a victory by evil spirits.

Cure involved forcing demons from the victim's body.

Trephination
A process using a stone instrument (trephine) to cut away a circular section of the
skull.

Purpose: To release evil spirits causing the problem.

Later Societies

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 Explained abnormal behavior as possession by demons.

Treatment often involved exorcism to coax evil spirits to leave or make the person's
body an uncomfortable place.

Ancient China
Focus on the movement of air or "wind" in the body.

Unexplained mental disorders attributed to blockages of wind or the presence of

cold, dark wind (yin) versus warm, life-sustaining wind (yang).

Treatment involved restoring proper wind flow through methods like acupuncture.

Greek and Roman Views

Hippocrates
Taught that illnesses had natural causes.

Saw abnormal behaviors as diseases arising from internal physical problems.

Believed brain pathology was the culprit, resulting from an imbalance of four fluids,
or humors, flowing through the body.

Hippocrates' Humors
Blood (heart) - insomnia and delirium

Black bile (spleen) - causes depression (melancholia)

Phlegm (brain) - apathy and sluggishness

Yellow bile (liver) - hot-tempered

Diseases resulted from too much or too little of one of the humors.

Hippocrates and Hysteria

Coined the term hysteria (now somatic symptom disorders).

Physical symptoms seemed related to a medical problem with no apparent physical

cause.

Hysteria believed to occur only in women; attributed to the empty uterus wandering
in search of conception.

Europe in the Middle Ages

Power of the Clergy

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 Increased during this period.

Religious beliefs dominated life and were highly superstitious and demonological.

Deviant behavior, especially psychological abnormality, was seen as evidence of

Satan’s influence.

Outbreaks of Mass Madness

Instances of mass madness where large numbers of people shared delusions and
hallucinations (shared psychosis).

Tarantism / Saint Vitus’s Dance

Mass hysteria in Europe where groups of people would suddenly jump, dance, and
go into convulsions.

Lycanthropy
People believed they were possessed by wolves or other animals.

Acted wolflike and imagined fur was growing all over their bodies.

Revival of Exorcisms
Clergymen, in charge of treatment, would perform exorcisms, pleading, chanting, or
praying to the devil or evil spirits.

The Renaissance & the Rise of Asylums

Improvement in the care of people with mental disorders during the Renaissance.

In England, individuals might be kept at home with financial aid from the local
parish.

The Rise of Asylums

Government officials found private homes and community residences insufficient for
those with severe mental disorders.

Converted hospitals and monasteries into asylums, institutions primarily for caring
for people with mental illness.

Bedlam, 1547
St. Mary of Bethlehem Hospital.

Originally for confining the mentally ill.

Patients in chains cried out; the hospital became a tourist attraction.

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 Reform and Moral Treatment
Philippe Pinel
Advocated treating mentally ill patients with sympathy and kindness, rejecting
chains and beatings.

William Tuke
Followed Pinel's lead, introduced moral treatment in England.

Founded country houses where patients received care through rest, talk, prayer,
and manual work.

Benjamin Rush
Introduced moral treatment in the United States.

Required intelligent and sensitive attendants for close interaction with patients,
including reading, talking, and walks.

Dorothea Dix
Campaigned for reform in the treatment of insanity, founded the mental hygiene
movement.

Improved care standards and advocated for care accessibility.

The Decline of Moral Treatment

Early 20th century: The moral treatment movement declined in the United States
and Europe.

Public mental hospitals provided only custodial care and ineffective medical
treatments, becoming overcrowded.

Long-term hospitalization became the norm once again.

The Early 20th Century

Somatogenic Perspective
View that abnormal functioning has physical causes.

Psychogenic Perspective
View that the chief causes of abnormal functioning are psychological.

Somatogenic Perspective

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 Emil Kraepelin
Taught that physical factors like fatigue are responsible for mental dysfunction
(1883).

Developed the first modern system for classifying abnormal behavior, listing
physical causes and discussing their expected course.

Syphilis
Scientists discovered that syphilis led to general paresis.

General Paresis - an irreversible disorder with mental symptoms like delusions of

grandeur and physical ones like paralysis.

Development of Biological Treatments

1930s - Physical interventions like electric shock and brain surgery were used,
discovered by accident (e.g., insulin shock therapy, electroconvulsive therapy).

Psychogenic Perspective
Friedrich Anton Mesmer and Hypnotism

Treated patients with hysterical disorders with a procedure called mesmerism,

believed to be helped by it.

Mesmer believed problems were caused by "animal magnetism," a fluid in living

organisms, which could become blocked.

He "cured" this through hypnosis and was later regarded as the father of
hypnosis.

Hypnotism
A procedure in which a person is placed in a trancelike mental state during which
they become extremely suggestible.

Josef Breuer
Studied the effects of hypnotism on hysterical disorders.

Discovered patients sometimes awoke free of symptoms after speaking candidly

under hypnosis about upsetting events.

Precursor to free association.

Sigmund Freud
Working with Breuer led him to develop psychoanalysis, the theory that many forms
of abnormal and normal functioning are psychogenic.

Believed unconscious psychological processes are at the root of such functioning.

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 Developed the technique of psychoanalysis to help people gain insight into their
unconscious psychological processes.

Recent Decades & Current Trends

In the past decade, significant changes have occurred in how clinicians understand
and treat abnormal functioning.

More theories, types of treatment, research studies, and information have led to
more disagreements about abnormal functioning than ever before.

Psychotropic Medications
By the 1950s, researchers discovered several new psychotropic medications -
drugs that primarily affect the brain and reduce symptoms of mental dysfunction.

Antipsychotic drugs
Correct extremely confused and distorted thinking.

Antidepressant drugs
Lift the mood of depressed individuals.

Antianxiety drugs
Reduce tension and worry.

Deinstitutionalization
Releasing hundreds of thousands of patients from public mental hospitals.

Outpatient Care and Community Mental Health

Approach
Outpatient care is now the primary treatment mode for people with severe
psychological disturbances and moderate problems.

Focus on community mental health emphasizes community care for those with
severe psychological disturbances.

Preventing Disorders & Promoting Mental Health

Growing emphasis on prevention in recent years.

Community programs aim to correct social conditions underlying psychological

problems and help individuals at risk of developing emotional problems.

Prevention programs energized by increasing interest in positive psychology.

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 Positive psychology - The study and enhancement of positive
feelings, traits, and group-directed virtues.

Understanding Psychopathology 10