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Abnormal Psychology
Concepts of Normality
Abnormal Psychology
• Abnormal behavior is difficult to define
– Based on symptoms people exhibit or report
• Psychiatrists and psychologists use a diagnostic
manual (a standardized system) to help diagnose
correctly
– Still have errors
• Symptoms of the same disorder may vary between
individuals and groups
• Definition of abnormality can change over time
Deciding Abnormal Behavior
• How do you decide if someone’s behavior is
abnormal?
– A series of value judgments based on subjective
impressions
• There is a tendency to rely on the subjective
assessments of clinicians, in combination
with the diagnostic tools of classification
systems
Defining Normal
• Behavioral measures tend to be normally
distributed (bell-shaped curve)
– If behavior falls within this bell-curve, it’s normal
– Examples: Intelligence and short-term memory
• Other issues of abnormality are harder to apply to a
bell-shaped curve or statistics
– Obesity is statistically normal, but not desirable
– High IQ is statistically rare, but is not dysfunctional
Abnormality
• Abnormality: Subjective experience of feeling “not
normal”
– Feeling intense anxiety, unhappiness, distress
• Consider when behavior violates social norms or
makes others anxious
– Cultural diversity affects what people consider “normal
behavior”
– What may fit social norms in one culture may violate
social norms in another
Rosenhan and Seligman (1984)
• Seven criteria to decide normality:
1. Suffering
• Experiencing distress and discomfort?
1. Maladaptiveness
• Behaviors that make things difficult for themselves,
rather than helping themselves?
1. Irrationality
• Incomprehensible? Unable to communicate
reasonably?
Rosenhan and Seligman (1984)
4. Unpredictability
• Unexpected actions?
5. Vividness and unconventionality
• Different experiences than other people?
6. Observer discomfort
• Acting in a way that is difficult to watch? Upsets
others?
7. Violation of moral/ideal standards
• Habitually break the accepted ethical/moral
standards?
Rosenhan and Sligman (1984)
• Demonstrates focus on distress to the
individual
• Based on what is accepted in society
• Always comparing it to social norms is
problematic:
– Often don’t consider the diversity in how people
live their lives
– Different is not always bad or abnormal
Jahoda (1958)
• Six characteristics of mental health:
1. Efficient self-perception
2. Realistic self-esteem and acceptance
3. Voluntary control of behavior
4. True perception of the world
5. Sustaining relationships and giving affection
6. Self-direction and productivity
Jahoda (1958)
• Even normal people don’t meet all of these
mental health characteristics
• They are largely value judgments
• Not as easy to define psychological health as
it is physical health
• What is considered psychologically normal
varies between cultures
Changing Definition of Abnormality:
Homosexuality
• Older diagnostics saw homosexuality as an
abnormality
• DSM-III sees homosexuality as only abnormal if the
individual has negative feelings about the sexual
orientation
– DSM-IV: Persistent and marked distress about one’s
sexual orientation is abnormal
• Attitudes about homosexuality has changed so
cannot be considered abnormal
• Shows problems with set ideas of abnormality
Mental Illness Criterion
• Medical model: abnormal behavior is of
physiological origin
– i.e. disordered neurotransmission
– Treatment addresses the physiological problems
(primarily drugs)
• Psychopathology: Abnormal behavior
– Psychological illness based on the observed
symptoms of a patient
Medical Model
• Ethical concerns:
– Believes it is better to regard someone with a
mental disorder as sick rather than morally
defective to remove responsibility
– Model can be misused/interpreted incorrectly
• Due to cultural influences
• At times on purpose for personal gain (politics)
Mental Illness
• Use a classification system today
– Supposed to be objective
• Medical model is seen as reductionist
• Use a Biopsychosocial approach today to
combine all aspects
– Still not fool-proof
Tomasz Szasz (1962)
• Most mental disorders should be considered “problems in
living”
– Not all are diseases of the brain
• Strange behavior is not always caused by a brain disease
• Frude (1998): Relatively few psychological disorders can be
associated with identifiable organic pathology
• Today we have more evidence of brain diseases associated
with abnormalities, but we still don’t know whether Szasz is
absolutely right or wrong
Diagnosing Psychological Disorders
• Psychiatrist has to rely upon patient’s subjective
description of a problem
• Formal standardized clinical interview with a
checklist of questions to ask
• Klienmuts (1967) sees flaws in this process:
– Information exchange can be blocked due to the
relationship between patient and clinician
– Patient’s intense anxiety or preoccupation could hinder
the process
– Clinician’s style, experience, and beliefs/theories will
affect the diagnosis
Methods of Diagnosing
• Formal standardized clinical interview
• Direct observation of behavior
• Brain-scanning techniques (CAT and PET)
• Psychological testing
– Like personality tests and IQ tests
Symptoms of a Disorder: ABC’s
• Affective symptoms: emotional elements
– Fear, sadness, anger
• Behavioral symptoms: observational behaviors
– Crying, pacing, physical withdrawal/space
• Cognitive symptoms: ways of thinking
– Pessimism, personalization, self-image
• Somatic symptoms: physical symptoms
– Facial twitching, stomach cramping, amenorrhea
Classification Systems
• DSM: Diagnostic and Statistical Manual of
Mental Disorders
– Some argue it is gender/culturally biased
• ICD: International Classification of Diseases
• Based largely on abnormal experiences and
beliefs reported by patients and professional
agreement
– Criteria changes overtime as new editions are
published due to new information or professional
agreements
Validity and Reliability of Diagnosis
• Reliability:
– Classification system should make it possible for
different clinicians to arrive at the same
diagnosis
• Validity:
– Should be able to classify a real pattern of
symptoms which can lead to an effective
treatment
– However: The system is descriptive and does not
identify any specific cause
Rosenhan (1973)
• Aim: Test the reliability of psychiatric diagnoses
• Study 1: Researchers pretended to hear voices
(all but 1 diagnosed with schizophrenia) and
stayed in hospital approx 19 days; considered
abnormal
• Study 2: Warned hospital that normal people
would be pretending to be abnormal; not true;
hospital mistook abnormal people to be normal
people faking it
Rosenhan (1973)
• Conclusion: It is not possible to distinguish
between sane and insane in psychiatric
hospitals
• Medical diagnoses can be maid with a lack
of scientific evidence
– Ethical issue: Are treatments properly justified?
Unreliable
• Diagnostic systems have been accused of
being unreliable
• With the same manual, two psychiatrists
could diagnose the same patient with two
different disorders
• Beck et al. (1962): Agreement on diagnosis
for 153 participants between two
psychiatrists was only 54%
Unreliable
• Cooper et al. (1972): New York and London
psychiatrists shown the same videotaped
clinical interviews
– New York psychiatrists were twice as likely to
diagnose schizophrenia than London
psychiatrists
– London psychiatrists were twice as likely to
diagnose mania or depression than New York
psychiatrists
Lipton and Simon (1985)
• 131 patients in New York hospital were
reassessed
• Only 16 of the 89 originally diagnosed with
schizophrenia were diagnosed again
• 50 were diagnosed with a mood disorder;
however, only 15 had been diagnosed with
this previously
Unreliable
• There must be a lack of validity if there’s a 50:50
chance of reaching the same conclusion
• Probably due to a bias in diagnosis
• Diagnosis may be influenced by the
attitudes/prejudices of the psychiatrists
• Overpathologization: When a specific group is
consistently assumed to be diagnosed with a
certain diagnosis
• May expect a certain type of person to be depressed (for example)
so evaluates them with bias based on culture/clothing/etc
Ethical Considerations
• Stigmatization brought on by the diagnosis
• Labeling anyone as abnormal is iffy because
it can be a life-long label
– Even if symptoms are no longer shown
• Scheff (1966) Self-fulfilling prophecy: people
may begin to act as they think they are
expected to
– i.e. Someone diagnosed with depression starts
to have suicidal thoughts after the diagnosis
Langer and Abelson (1974)
• Videotape of a younger man telling an older man
about his job experience
• When viewers were told he was applying for a job,
they said he was attractive and conventional-
looking (average/positive)
• When told he was a patient, they said he was tight,
defensive, dependent, frightened of his own
aggressive tendencies (negative)
• Power of schema processing!
Biases that Affect Diagnoses
• Racial/ethnic:
– Jenkins-Hall and Sacco (1991)
– 4 women
• Two European American women; 1 with depression; 1
without depression
• Two African American women; 1 with depression; 1
without depression
– African American and European American non-
depressed women were rated the same
– African American depressed woman was rated with
more negative terms and seen as less socially
competent than the Euro Amer depressed woman
Biases that Affect Diagnoses
• Confirmation Bias:
– Clinicians have expectations about the people
who consult them
– Assume if the patient is there in the first place
there must be something abnormal
– May overreact and see abnormality where ever
they look because that’s their job!
• Example: Rosenhan’s study (1973)
Assessment Techniques
• Kahneman and Tversky (1973): Using a
greater amount of assessment techniques
does not improve the accuracy of a
diagnosis
Institutionalization
• If mis-diagnosed, it is very difficult to
convince medical staff it’s wrong
• Once diagnosed, all behavior is perceived as
being a symptom of the illness
– Illustrated by Rosenhan (1973) where it took a
participant 52 days to convince the ward he was
not really schizophrenic and that it was a test
Biases that Affect Diagnoses
• Powerlessness and depersonalization:
– Lack of rights, constructive activity, choice, and
privacy in institutions
– Some attendants even face verbal and physical
abuse
Cultural Considerations in Diagnosis
• Concepts of abnormality vary between cultures
• Culture-bound syndromes: disorders that are
thought to be culturally specific
– Neurasthenia is common in China, but not even listed in
the Western DSM-IV
• These culture-bound syndromes are now included
in a special section of the DSM
• Maybe these are frequent in Western civilizations
too!
– The mindset that these are bound to other cultures can
lead to faults in diagnosis; they aren’t considered
Reporting Bias
• The way in which patients report their
symptoms/issues to doctors
– What they include/exclude
• Rack (1982):
– Asians more likely to consult doctors for physical
issues
– Deal with their emotional issues personally with
their family
Cultural Outlooks
• Cohen (1988) Indian mentally ill people are cursed
and looked down on
• Rack (1982) Chinese only label individuals out of
contact with reality as mentally ill because of the
stigma
• Studying cultures based on mental hospital
admission rates can therefore be very misleading
– Some don’t have access to hospitals as well
Cultural Differences
• Marsella (2003) Depression takes a primarily
affective form in individualistic cultures
– Feelings of loneliness and isolation dominate these
cultures
• Somatic symptoms are more dominant in
collectivist cultures
• Depressive symptom patterns differ across
cultures because of cultural variation in sources
of stress and resources for coping
Kleinman (1984)
• It is impossible to compare depression
cross-culturally because it may be
experienced with substantially different
symptoms or behaviors
– Chinese patients feel headaches/back pain
– Western patients feel guilt and anxiety
• Difficult to accurately diagnose
• Hard to classify disorder’s symptoms
Culture Blindness
• Cultural blindness: the problem of identifying
symptoms of a psychological disorder if they
are not the norm in the clinician’s own
culture
• Cochrane and Sashidharan (1995): White
people are considered the norm; if ethnic
groups differ in their behaviors, they’re seen
as abnormal
How to Avoid Cultural Bias
• Make efforts to learn about the culture of the
people being assessed
• Bilingual patients should be assessed in both
languages
– Could use second language as a form of resistance
to avoid emotional responses
• Be sure the patient understands the
requirements of the task when diagnosing
• Symptoms of disorders should be discussed
with practitioners of that culture

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Abnormal Psychology: Concepts of Normality

  • 2. Abnormal Psychology • Abnormal behavior is difficult to define – Based on symptoms people exhibit or report • Psychiatrists and psychologists use a diagnostic manual (a standardized system) to help diagnose correctly – Still have errors • Symptoms of the same disorder may vary between individuals and groups • Definition of abnormality can change over time
  • 3. Deciding Abnormal Behavior • How do you decide if someone’s behavior is abnormal? – A series of value judgments based on subjective impressions • There is a tendency to rely on the subjective assessments of clinicians, in combination with the diagnostic tools of classification systems
  • 4. Defining Normal • Behavioral measures tend to be normally distributed (bell-shaped curve) – If behavior falls within this bell-curve, it’s normal – Examples: Intelligence and short-term memory • Other issues of abnormality are harder to apply to a bell-shaped curve or statistics – Obesity is statistically normal, but not desirable – High IQ is statistically rare, but is not dysfunctional
  • 5. Abnormality • Abnormality: Subjective experience of feeling “not normal” – Feeling intense anxiety, unhappiness, distress • Consider when behavior violates social norms or makes others anxious – Cultural diversity affects what people consider “normal behavior” – What may fit social norms in one culture may violate social norms in another
  • 6. Rosenhan and Seligman (1984) • Seven criteria to decide normality: 1. Suffering • Experiencing distress and discomfort? 1. Maladaptiveness • Behaviors that make things difficult for themselves, rather than helping themselves? 1. Irrationality • Incomprehensible? Unable to communicate reasonably?
  • 7. Rosenhan and Seligman (1984) 4. Unpredictability • Unexpected actions? 5. Vividness and unconventionality • Different experiences than other people? 6. Observer discomfort • Acting in a way that is difficult to watch? Upsets others? 7. Violation of moral/ideal standards • Habitually break the accepted ethical/moral standards?
  • 8. Rosenhan and Sligman (1984) • Demonstrates focus on distress to the individual • Based on what is accepted in society • Always comparing it to social norms is problematic: – Often don’t consider the diversity in how people live their lives – Different is not always bad or abnormal
  • 9. Jahoda (1958) • Six characteristics of mental health: 1. Efficient self-perception 2. Realistic self-esteem and acceptance 3. Voluntary control of behavior 4. True perception of the world 5. Sustaining relationships and giving affection 6. Self-direction and productivity
  • 10. Jahoda (1958) • Even normal people don’t meet all of these mental health characteristics • They are largely value judgments • Not as easy to define psychological health as it is physical health • What is considered psychologically normal varies between cultures
  • 11. Changing Definition of Abnormality: Homosexuality • Older diagnostics saw homosexuality as an abnormality • DSM-III sees homosexuality as only abnormal if the individual has negative feelings about the sexual orientation – DSM-IV: Persistent and marked distress about one’s sexual orientation is abnormal • Attitudes about homosexuality has changed so cannot be considered abnormal • Shows problems with set ideas of abnormality
  • 12. Mental Illness Criterion • Medical model: abnormal behavior is of physiological origin – i.e. disordered neurotransmission – Treatment addresses the physiological problems (primarily drugs) • Psychopathology: Abnormal behavior – Psychological illness based on the observed symptoms of a patient
  • 13. Medical Model • Ethical concerns: – Believes it is better to regard someone with a mental disorder as sick rather than morally defective to remove responsibility – Model can be misused/interpreted incorrectly • Due to cultural influences • At times on purpose for personal gain (politics)
  • 14. Mental Illness • Use a classification system today – Supposed to be objective • Medical model is seen as reductionist • Use a Biopsychosocial approach today to combine all aspects – Still not fool-proof
  • 15. Tomasz Szasz (1962) • Most mental disorders should be considered “problems in living” – Not all are diseases of the brain • Strange behavior is not always caused by a brain disease • Frude (1998): Relatively few psychological disorders can be associated with identifiable organic pathology • Today we have more evidence of brain diseases associated with abnormalities, but we still don’t know whether Szasz is absolutely right or wrong
  • 16. Diagnosing Psychological Disorders • Psychiatrist has to rely upon patient’s subjective description of a problem • Formal standardized clinical interview with a checklist of questions to ask • Klienmuts (1967) sees flaws in this process: – Information exchange can be blocked due to the relationship between patient and clinician – Patient’s intense anxiety or preoccupation could hinder the process – Clinician’s style, experience, and beliefs/theories will affect the diagnosis
  • 17. Methods of Diagnosing • Formal standardized clinical interview • Direct observation of behavior • Brain-scanning techniques (CAT and PET) • Psychological testing – Like personality tests and IQ tests
  • 18. Symptoms of a Disorder: ABC’s • Affective symptoms: emotional elements – Fear, sadness, anger • Behavioral symptoms: observational behaviors – Crying, pacing, physical withdrawal/space • Cognitive symptoms: ways of thinking – Pessimism, personalization, self-image • Somatic symptoms: physical symptoms – Facial twitching, stomach cramping, amenorrhea
  • 19. Classification Systems • DSM: Diagnostic and Statistical Manual of Mental Disorders – Some argue it is gender/culturally biased • ICD: International Classification of Diseases • Based largely on abnormal experiences and beliefs reported by patients and professional agreement – Criteria changes overtime as new editions are published due to new information or professional agreements
  • 20. Validity and Reliability of Diagnosis • Reliability: – Classification system should make it possible for different clinicians to arrive at the same diagnosis • Validity: – Should be able to classify a real pattern of symptoms which can lead to an effective treatment – However: The system is descriptive and does not identify any specific cause
  • 21. Rosenhan (1973) • Aim: Test the reliability of psychiatric diagnoses • Study 1: Researchers pretended to hear voices (all but 1 diagnosed with schizophrenia) and stayed in hospital approx 19 days; considered abnormal • Study 2: Warned hospital that normal people would be pretending to be abnormal; not true; hospital mistook abnormal people to be normal people faking it
  • 22. Rosenhan (1973) • Conclusion: It is not possible to distinguish between sane and insane in psychiatric hospitals • Medical diagnoses can be maid with a lack of scientific evidence – Ethical issue: Are treatments properly justified?
  • 23. Unreliable • Diagnostic systems have been accused of being unreliable • With the same manual, two psychiatrists could diagnose the same patient with two different disorders • Beck et al. (1962): Agreement on diagnosis for 153 participants between two psychiatrists was only 54%
  • 24. Unreliable • Cooper et al. (1972): New York and London psychiatrists shown the same videotaped clinical interviews – New York psychiatrists were twice as likely to diagnose schizophrenia than London psychiatrists – London psychiatrists were twice as likely to diagnose mania or depression than New York psychiatrists
  • 25. Lipton and Simon (1985) • 131 patients in New York hospital were reassessed • Only 16 of the 89 originally diagnosed with schizophrenia were diagnosed again • 50 were diagnosed with a mood disorder; however, only 15 had been diagnosed with this previously
  • 26. Unreliable • There must be a lack of validity if there’s a 50:50 chance of reaching the same conclusion • Probably due to a bias in diagnosis • Diagnosis may be influenced by the attitudes/prejudices of the psychiatrists • Overpathologization: When a specific group is consistently assumed to be diagnosed with a certain diagnosis • May expect a certain type of person to be depressed (for example) so evaluates them with bias based on culture/clothing/etc
  • 27. Ethical Considerations • Stigmatization brought on by the diagnosis • Labeling anyone as abnormal is iffy because it can be a life-long label – Even if symptoms are no longer shown • Scheff (1966) Self-fulfilling prophecy: people may begin to act as they think they are expected to – i.e. Someone diagnosed with depression starts to have suicidal thoughts after the diagnosis
  • 28. Langer and Abelson (1974) • Videotape of a younger man telling an older man about his job experience • When viewers were told he was applying for a job, they said he was attractive and conventional- looking (average/positive) • When told he was a patient, they said he was tight, defensive, dependent, frightened of his own aggressive tendencies (negative) • Power of schema processing!
  • 29. Biases that Affect Diagnoses • Racial/ethnic: – Jenkins-Hall and Sacco (1991) – 4 women • Two European American women; 1 with depression; 1 without depression • Two African American women; 1 with depression; 1 without depression – African American and European American non- depressed women were rated the same – African American depressed woman was rated with more negative terms and seen as less socially competent than the Euro Amer depressed woman
  • 30. Biases that Affect Diagnoses • Confirmation Bias: – Clinicians have expectations about the people who consult them – Assume if the patient is there in the first place there must be something abnormal – May overreact and see abnormality where ever they look because that’s their job! • Example: Rosenhan’s study (1973)
  • 31. Assessment Techniques • Kahneman and Tversky (1973): Using a greater amount of assessment techniques does not improve the accuracy of a diagnosis
  • 32. Institutionalization • If mis-diagnosed, it is very difficult to convince medical staff it’s wrong • Once diagnosed, all behavior is perceived as being a symptom of the illness – Illustrated by Rosenhan (1973) where it took a participant 52 days to convince the ward he was not really schizophrenic and that it was a test
  • 33. Biases that Affect Diagnoses • Powerlessness and depersonalization: – Lack of rights, constructive activity, choice, and privacy in institutions – Some attendants even face verbal and physical abuse
  • 34. Cultural Considerations in Diagnosis • Concepts of abnormality vary between cultures • Culture-bound syndromes: disorders that are thought to be culturally specific – Neurasthenia is common in China, but not even listed in the Western DSM-IV • These culture-bound syndromes are now included in a special section of the DSM • Maybe these are frequent in Western civilizations too! – The mindset that these are bound to other cultures can lead to faults in diagnosis; they aren’t considered
  • 35. Reporting Bias • The way in which patients report their symptoms/issues to doctors – What they include/exclude • Rack (1982): – Asians more likely to consult doctors for physical issues – Deal with their emotional issues personally with their family
  • 36. Cultural Outlooks • Cohen (1988) Indian mentally ill people are cursed and looked down on • Rack (1982) Chinese only label individuals out of contact with reality as mentally ill because of the stigma • Studying cultures based on mental hospital admission rates can therefore be very misleading – Some don’t have access to hospitals as well
  • 37. Cultural Differences • Marsella (2003) Depression takes a primarily affective form in individualistic cultures – Feelings of loneliness and isolation dominate these cultures • Somatic symptoms are more dominant in collectivist cultures • Depressive symptom patterns differ across cultures because of cultural variation in sources of stress and resources for coping
  • 38. Kleinman (1984) • It is impossible to compare depression cross-culturally because it may be experienced with substantially different symptoms or behaviors – Chinese patients feel headaches/back pain – Western patients feel guilt and anxiety • Difficult to accurately diagnose • Hard to classify disorder’s symptoms
  • 39. Culture Blindness • Cultural blindness: the problem of identifying symptoms of a psychological disorder if they are not the norm in the clinician’s own culture • Cochrane and Sashidharan (1995): White people are considered the norm; if ethnic groups differ in their behaviors, they’re seen as abnormal
  • 40. How to Avoid Cultural Bias • Make efforts to learn about the culture of the people being assessed • Bilingual patients should be assessed in both languages – Could use second language as a form of resistance to avoid emotional responses • Be sure the patient understands the requirements of the task when diagnosing • Symptoms of disorders should be discussed with practitioners of that culture