Abnormal Behavior and Psychopathology


I.                 What is “mental illness”?


A.       Historical progression


1.    Spiritual and religious views – e.g., abnormal behavior as “demonic possession”

2.    Gradual movement to more “scientific” and humane views of mental illness during the Renaissance and Enlightenment

a.   Estabishment of asylums – e.g., the monastery of St. Mary of Bethlehem in London became the notorious “Bedlam”

b.  La Bicêtre hospital in Paris – patients in chains and shackles, poorly fed, in dark, in uncleaned and unheated cells

c.   Pinel’s reforms in France in 1792, after the French Revolution – removing the chains and creating decent conditions for the mentally ill


3.    The development of the “medical model” of mental illness

a.   assumption: mental illnesses have physical, biological causes like physical diseases

b.  The distinction between “symptoms” and underlying disease

c.   “General paresis” – a kind of dementia caused by syphilis; in the late 1800s a Viennese psychiatrist, Richard von Krafft-Ebing, showed a link between syphilis and general paresis when he showed that inoculating patients suffering from general paresis with fluids from syphilitic sores did not lead to secondary symptoms of syphilis – this implied that paretic patients had already been infected with syphilis

d.  Emil Kraepelin (1856-1926) –Swiss psychiatrist who created the first modern classification system, or taxonomy of mental illness; the forerunner of the Diagnostic Statistical Manual of the American Psychiatric Association


4.    The development of modern psychotherapy and the fragmentation of approaches to abnormal behavior in the late 19th and 20th centuries

a.   Freud, the psychoanalytic perspective, and the development of psychoanalysis

b.  The behavioral perspective on mental illness – abnormal behavior as learned, maladaptive behavior

c.   The genetic-biological perspective and the “diathesis-stress” model – “diathesis” is a biological or genetic predisposition to an illness; “stress” refers to the environmental pressures that trigger actual illness

d.  The humanistic/cultural/normative perspective:  Mental illness as culturally relative and non-normative behavior: Examples: homosexuality, “acting out” behavior in teenagers; links to existential philosophy


B.        Three common-sense criteria of psychopathology

1.    Is behavior maladaptive? --  that is, does behavior interfere with one’s happiness and pursuit of common life goals (such as intimacy, close personal relationships, meaningful work, achievement, physical health and well-being)

2.    Is behavior injurious and destructive, either to others or to self.  Examples: alcoholism and drug abuse, depression and suicide, sociopathic or antisocial personality traits

3.    Is behavior “deviant,” in the sense that it is statistically abnormal in a negative or maladaptive direction; does behavior break social rules of proper behavior (Examples: adults who have conversations with imaginary 6-foot-tall rabbits, people who exhibit their genitals in public places, people who don’t groom and clean themselves in “normal” ways)


C.        Classifying and diagnosing mental illness – DSM: The Diagnostic Statistical Manual of the American Psychiatric Association


1.    The five axes of DSM – five dimensions of information or classification that are important in diagnosing mental illness

a.   Axis 1: Specific clinical syndromes or conditions; these are specific kinds of “mental illness” that have clusters of symptoms and often have a definite time of onset.  Examples: schizophrenia, depression, panic attacks and their related symptoms

b.  Axis 2: Personality disorders and long-term disorders like retardation; these are long-term, trait-like disorders that affect individuals in very broad ways.  Examples: antisocial, borderline, and schizoid personality disorder; some of these can be conceptualized as extreme version of Big Five traits

c.   Axis 3: General medical condition, particularly as it relates to psychological conditions.  Examples: chronic disease or pain and its relation to depression; arterial disease, medication, and impotence; diabetes, thyroid disorders, and mood changes

d.  Axis 4: Environmental problems and stressors.  Examples: family, job, and economic problems.  Distinction between a “reactive depression” and an “endogenous depression” – Is the depression in response to traumatic events?

e.   Axis 5: Global assessment of function and current level of adjustment.  Example: Given that you are depressed, are you still managing to work, go to school, and have relations with friends and family?





I.                 Description of the disorder

A.    Kraeplin's description of dementia praecox – early or “precocious” dementia

B.    Swiss psychiatrist, Eugen Bleuler, invented the term, schizophrenia -- a "split" in the sense of disorganized thought processes, a split between thought and emotion, a splitting off from reality

C.    Prevalence and characteristics of sufferers

1.    During any year, approximately 1% of adults in the U.S. suffer from schizophrenia

2.    This disorder accounts for nearly 40% of admissions to state mental hospitals

3.    Typically, the onset occurs during late teens to twenties; males tend to have a somewhat earlier onset than females

D.    Symptoms and clinical description

1.    Positive symptoms (e.g., hallucinations, delusions, agitation) vs. negative symptoms (lack of expressiveness, emotion, speech, responsiveness to environment); negative symptoms are associated with worse prognosis

2.    Disordered thought: "cognitive slippage," "word salad" and thinking through associations; delusions (or false beliefs); hallucinations (or false perceptions)

3.    Emotional disorders: blunted affect, ahedonia (inability to experience pleasure), inappropriate affect

4.    Disrupted care of self: inappropriate grooming or cleanliness; incontinence

5.    Retreat to inner world: most evident in catatonic schizophrenia

6.    Bizarre movements and motor behaviors: Manic behaviors, grimacing, strange rituals such as rocking movements

E.     Subtypes of schizophrenia

1.    Paranoid: delusions, hallucinations; may involve delusions of grandeur or of persecution

2.    Catatonic: extreme withdrawal in some cases; zombie-like behavior and "waxy immobility"; may alternate with extremely agitated and manic states

3.    Disorganized (formerly called "hebephrenic"): occurs at earlier age than others; emotional distortion and blunting; silliness, laughter, peculiar mannerisms

4.    Undifferentiated: rapidly changing pattern of many of the primary symptoms of schizophrenia; these symptoms may occur at onset of disorder before more stable patterns have settled in


II.             The strange and tragic case of the Genain quads  -- four identical quadruplet girls who were born in the 1930s, each of whom developed schizophrenia by her mid-20s


A.    Question: How important was nature vs. nurture in the development and onset of the disorder, the treatment, and the prognosis for these four sisters?

B.    The disturbed Genain parents

C.    The disturbed childhood of the Genain quads: exploitation, hounding, and sexual abuse

D.    Nora and Myra were treated better by parents; Hester and Iris were considered "inferior" and they were mistreated the most

E.     Adolescence and breakdowns: Hester at 18, Nora at 20, Iris at 22, and Myra at 24

F.      Treatment at NIMH (the source of the sisters' pseudonyms)

G.    Prognosis and outcomes for the four sisters

III. Causes of schizophrenia (etiology -- the study of factors that influence the development of a disease)

A. Biological factors

1.    Genetic factors -- some facts: Offspring of two schizophrenic parents have a 46% chance of developing schizophrenia; offspring of one schizophrenic parent has a 17% chance; siblings of a schizophrenic person have a 9% chance; grandchildren of schizophrenic person have a 5% chance; nieces and nephews of schizophrenic person have a 4% chance; first cousins have a 2% chance; Twin studies find a higher rate of concordance for identical twins (about 28%) than for fraternal twins (6%), which suggests genetic factors; one adoption study found that 17% of adopted-away children born to schizophrenic mothers also developed schizophrenia

2.    Neurotransmitters and the dopamine hypothesis: Early antischizophrenic drugs (called neuroleptics) seemed to work by blocking neural circuits mediated by the neurotransmitter dopamine.  Actually, these drugs lower dompamine to abnormally low levels

3.    Schizophrenics show strange eye movement patterns – the inability to smoothly track moving objects visually; these and similar findings suggest neurological deficits, which are also seen in brain waves and reflex tests

4.    Schizophrenics are over-represented among people who were premature at birth or who suffered from obstetrical complications

5.    Brain abnormalities: enlargement of ventricles (fluid-filled spaces in the brain), enlarged sulci (fissures); suggests progressive degeneration and atrophy of parts of the brain

6.    Schizophrenics more like to be born in winter and early spring months; could be related to prenatal infectious diseases

7.    One study analyzed home movies of pre-schizophrenic children; they were already abnormal in their emotions and motor patterns, suggesting early neurological problems

B. Psychological and social factors

1.    Schizophrenogenic (schizophrenia-producing) parents: Research suggests that families with disorganized communication patterns more likely to produce schizophrenic offspring; families with intrusive, critical, overly emotional communication patterns more likely to trigger schizophrenic breakdowns in offspring

2.    Correlation between social class and schizophrenia, with higher rates in lower classes?  Cause and effect could go in both directions: Lower-class status is stressful and triggers schizophrenia, or schizophrenic or pre-schizophrenic symptoms lead people to a downward spiral in terms of social class


III.         Treatments and outcomes

A.    Anti-psychotic drugs discovered in the 1950s.  The first – reserpine – was based on an East Indian folk remedy.  These drugs had a dramatic effect on hospitalized schizophrenics.  Newer and better drugs have been developed since.

1.  First-time hospitalized patient has a better than 80% chance of being released within a relatively short period of time, after drug therapy; however 10% don’t respond to treatment and may end up permanently hospitalized

2.  Although drugs may treat “florid,” positive symptoms, often patents don’t show “social recovery” – the ability to maintain normal social and work relationships

B.    Psychosocial approaches

1.  Family therapy – assessing dysfunctional family communication patterns and intervening; while not a cure for schizophrenia, this can increase family support and decrease chances of remission

2.  Individual therapy: Again, while not a cure, this can help patient to learn coping strategies and to manage emotions and face everyday problems; social skills training; monitoring medication and its side effects



Mood Disorders


I.                 What are mood disorders?


A.       Two kinds of abnormal and extreme moods are: mania (unrealistic excitement, euphoria, and hyperactivity) and depression (extreme and debilitating sadness and dejection)

B.        Unipolar ("one-directional") mood disorders are much more common and are characterized by depression; Bipolar ("two-directional") mood disorders are less common and are characterized by both manic and depressive states; in the past, sometimes called manic-depressive disorder

C.        Prevalence:  One recent survey suggested that over the course of their lives, nearly 13% of males and 21% of females will suffer from a major depression; for bipolar disorder, the lifetime risk estimates range from .4 to 1.6%, with no sex difference;  depression has sometimes been called the "common cold" of mental illness because it is so common


II.             Depression: Varieties, Symptoms, Causes, and Treatments

A.    Depression can come in different varieties: Dysthymia is chronic depressed mood for at least 2 years; dysthymics can have normal days; not as profound as clinical depression;

Major depressive disorder is more profound than dysthymia -- more persistent and not mixed with "good days"; characterized by loss of pleasure and depressed mood and at least 4 of the following symptoms: fatigue or loss of energy, sleep disturbances (insomnia or hypersomnia), appetite disturbance and weight loss, mental sluggishness or agitation, decreased ability to think and concentrate, intense feelings of worthless and guilt, thoughts of death and suicide

B.    Causes of depression

1.    Genetics and hereditary factors: Evidence from 5 twin studies is that, if one twin suffers from major depression, the chances that the other twin will also suffer from depression is 2 to 4 times greater for identical than for fraternal twins; this suggests a genetic component to depression;  heritability estimates for depression range from 33% to 45%; Adoption studies also suggest genetic effects -- one study found that having a biological relative with depression increased one's chances of developing depression 7-fold

2.    Biochemical factors:

a.   Research focus has been on the neurotransmitters norephinephrine, dopamine, and serotonin; antidepressant drugs seemed to have their effects on these neurotransmitters or on their release or uptake at synapses;  research evidence is complex, however

b.  Additional research has focused on hypothalamus, pituitary, and thyroid hormones; thyroid disorders can mimic depression

c.   Recent brain imaging studies suggest that depressed people have lower activity in frontal lobes, particularly on the right side of the brain; consistent with this is evidence that damage to right prefrontal regions of the brain can lead to depression

d.  Depressed people have abnormal sleep patterns: Depressed people enter REM (rapid eye movement) sleep sooner and have more REM sleep earlier in the night than non-depressed people do; suggests possible disturbances to sleep-wake cycles and circadian (daily) rhythms; some of these sleep pattern abnormalities remain even after depression lifts


3.    Psychological and social causes

a.    Stressful life events contribute can trigger depression;  Examples: events that threaten self-esteem (failing, being fired), threatening and chronic diseases, death of loved one, breakup of important relationship, loss of job

b.   According to one classic study (Brown & Harris, 1978) four factors buffered women against depression: having an intimate relationship, have 3 or fewer children at home, having work outside of home, and having serious religious commitment; one common thread here may be the importance of social support

c.    Certain personality traits place one at more or less risk for depression: People high on Neuroticism are more vulnerable, whereas people high on Extraversion are less vulnerable; recall that these two Big Five traits are mood-related -- Neuroticism is "negative affectivity" and Extraversion is "positive affectivity"; people who are pessimistic and who attribute negative events to stable, internal causes ("I am stupid," "I am boring") are more prone to depression

d.   A number of studies suggest that early parental loss -- through death or separation -- is a risk factor for depression; also disturbed, unhappy family relationships can be a risk factor

e.    Aaron Beck's cognitive theory sees depression as caused by dysfunction, unrealistic beliefs learned from parents and teachers early in life; he describes the "negative cognitive triad" of depressed people: 1) negative thoughts about self ("I'm ugly and worthless"), 2) negative thoughts about others and one's social environment ("no one loves me"), and 3) negative thoughts about the future ("I'll always be a failure"); an unresolved question: are such thoughts and beliefs causes or consequences of depression?

f.      The learned helplessness model of depression: animal research by Martin Seligman and his colleagues suggested that when animals are exposed to uncontrolled punishments, they develop symptoms and behaviors much like human depression

g.    Attibutional models (Abramson, Seligman, and Teasdale, 1978) combine learned helplessness and cognitive processes to explain human depression; when people are exposed to uncontrollable negative events they make attributions (i.e., try to mentally explain the events); depressed people are prone to explain negative events in internal, global, and stable terms

h.   Sex differences in depression: biological (genetic, hormonal) theories have been offered but found unsatisfactory;  sex differences emerge in adolescence; one hypothesis is that women engage in more ruminative strategies whereas men engage more in distraction strategies when facing problems; many girls experience bodily dissatisfaction in adolescent and sex-role conflicts; also women may face more societal stresses such as lower status, high workloads in family life, and greater physical and sexual abuse


C.    Treatments

1.    Drugs: since 1960s tricyclics have been used; they are often effective, but can have unpleasant side effects such as dry mouth, constipation, sexual dysfunction, and weight gain; in the past decade or so, selective serotonin reuptake inhibitors (SSRIs such as Prozac and Paxil) have frequently been prescribed (and some would argue, over-prescribed) for depression; have fewer side effects; antidepressant drugs can sometimes take weeks to build up in the bloodstream and take effect; patients may be tempted to stop taking drugs prematurely

2.    Electroconvulsive shock therapy: used in acute cases where patients are suicidal; Remission of symptoms usually occurs after 6 to 12 treatments; although effective, shock therapy is usually augmented by drugs

3.    Cognitive-behavioral therapies train people to identify their depressive beliefs and automatic self-defeating thoughts, to recognize them as distortions of reality, to challenge them, and to replace them with more positive thoughts; many studies have shown that such therapy can be quite effective in treating depression


III.         Bipolar disorder: Varieties, Symptoms, Causes, and treatment

A.    Varieties and symptoms

1.  Bipolar disorders can be confused with depression, particularly if the bipolar patient suffers the depressive stage first

2.  In "Bipolar I disorder" person has full-blown manic episodes; in "Bipolar II disorder" the mania is more muted

3.  In manic stages, bipolar person may be full of energy and have thoughts and ideas racing through brain; person may be brash and place self in compromising situations (e.g., engage in promiscuous and risky sexual behavior); symptoms of depressed stage are like those of unipolar depression

4.  Some bipolar people show "rapid cycling" with many manic and depressive cycles in one year; others cycle over a much longer time; The composer Robert Schumann, who suffered from bipolar disorder, had three depressions and two manic episodes from 1833 to 1856; his greatest musical productivity was during the manic periods; in his final depression he was committed to an insane asylum, where he committed suicide by self-starvation


B.    Causes

1.    Genetics and heredity: Evidence for genetic factors is stronger for bipolar disorder than for depression; A recent summary found that 9% of first degree relatives of people with bipolar disorder will also have it, which is about 9 times the rate in the general population;  twin studies show that 67% of identical twins but only 20% of fraternal twins are concordant (the same) for bipolar disorder; this suggests a heritability of around 80% or more.

2.    Like research on depression, research on bipolar disorder has focused on neurotransmitters and hormones; evidence is mixed; one recent hypothesis focuses on disorder with the "biological clock" that regulates circadian and longer body rhythms

3.    Like unipolar depression, bipolar episodes can be triggered by stressful life events

C.    Treatment

1. Drugs: lithium salts often help people with bipolar disorders; such drugs are termed mood stabilizers; even if lithium does not completely prevent relapses, it leads to fewer episodes; unfortunately lithium can have unpleasant side effects such as lethargy, decreased muscular coordination, diarrhea, digestive upset; also, lithium drugs can be toxic and lead to kidney damage; thus blood levels must be carefully monitored; more recently anticonvulsant drugs have been used to treat bipolar disorder, and they may help patients who don't respond to lithium or who have unacceptable side effects


Approaches to Psychotherapy


I.                 Biological approaches

A.    Electroconvulsive shock therapy – begun in 1938 by Italian doctors, Cerletti and Bini

1.    Used to treat depression and mania; can be effective, although the way it works is still not understood

2.    Bilateral ECT sends current across entire brain; ECT would cause convulsions and loss of consciousness; today anesthesia and muscle relaxant drugs are used; patient usually awakens within several minutes; may experience amnesia; repeated treatments are usually required

3.    Unilateral ECT sends current across only one side of brain; this can lessen side effects

B.    Psychosurgery

1.    Prefrontal lobotomy – tissue in the frontal lobe of brain is lesioned (i.e., destroyed); first used in 1935 by Portuguese physician, Antonio Moniz; practiced extensively in the U.S. during 1940s and 1950s; use declined with advent of antipsychotic drugs

2.     Lobotomy had many devastating side effects, including dullness, inability to control impulses, lack of feelings; today this surgery is generally considered unethical and is not used except in extreme cases (intractable psychosis or in case of severe pain)

3.    Tragic real-life case: Rosemary Kennedy, sister of President John Kennedy

C.    Drug treatments

1.    Antipsychotic drugs; most work by blocking dopamine receptors in brain

2.    Antidrepressant drugs; 1) monoamine oxidase inhibitors (originally discovered as a treatment for depression after being used for treatment of tuberculosis) – these drugs work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters like serotonin and norepenephrine in synapses; 2) Tricyclic antidepressants; operate by inhibiting re-uptake of serotonin and norepinephrine in synapses; may have side effects such as fatigue, dizziness, blurred vision, constipation, and sexual dysfunction; 3) Selective serotonin reuptake inhibitors (SSRIs); best known example is Prozac

3.    Antianxiety drugs (tranquilizers); barbiturates and benzodiazepenes (e.g., Valium, Xanax); can produce drousiness and lethargy; can be habit forming; these drugs probably have their effects by stimulating the neurotransmitter GABA

4.    Lithium and other drugs used to stabilize moods; lithium first used by Australian, John Cade, in the late 1940s; can be toxic and blood levels must be carefully monitored; can have unpleasant side effects such as gastrointestinal upset, lethargy, coordination problems, and weight gain


II.             Psychodynamic therapies

A.    Classic Freudian techniques: Free association, dream analysis, analysis of resistance; Goal: to make conscious what was formerly unconscious, to “dig up” repressed material and expose earlier traumas to the light of conscious reflection

B.    Transference and counter-transference: Patient may “project” other relationships and emotional syndromes onto patient-therapist relationship; therapist may do the same and engage in counter-transference

C.    Modern focus on relationships and “object relations”; trying to reeducate client about relationships


III.         Behavioral therapies

A.    Overview:  Much more of a focus on the “here and now” than Freudian therapies; Behavior problems are seen a resulting from maladaptive learning; client needs to “relearn” behaviors, or extinguish maladaptive emotions or behaviors

B.    Examples:  1) Systematic desensitization – training a person to relax in the presence of an anxiety-producing stimulus; used to treat phobias,  2) “Flooding” and “implosion” --in vivo (real-life) vs. in vitro (imagined) exposure to anxiety-provoking or phobic stimuli; shows people they can manage anxiety, 3) Aversion therapies – punishing behavior or pairing it with aversive stimuli; Antabuse as a treatment of alcohol abuse


IV.       Cognitive therapies

A.    Albert Ellis’s rational emotive therapy: attempts to challenge client’s maladaptive thought processes, such as “Everyone must like me” or “I must be well-informed about everything”; often such thoughts are expressed in terms of “I should” or “I ought” or “I must….”; therapist may challenge irrational beliefs and give “homework assignments” for reinforcing new beliefs

B.    Aaron Beck’s cognitive therapy for depression: clients taught to identify automatic depressive thoughts (e.g., “my presentation was a disaster”) and how they            1) selectively perceive evidence, 2) overgeneralize negative information, 3) magnify negative events and “catastrophize,” and 4) engage in black-and-white kinds of thinking; therapist may help client plan events and resume pleasurable activities; this approach works on both beliefs and behavior


V.           Humanistic and existential therapies

A.    Roger’s client-centered (or person-centered_therapy: Goal is to become aware of “true self,” others’ expectations, and how we give up the “true self” to gain others’ esteem.  Client-centered therapists engage in “unconditional positive regard” and strive to be authentic; therapist reflects back client’s concerns and feelings but does not play an authoritarian role or impose interpretations on client

B.    Existential therapies (e.g., May, Yalom): Core issues of life are: 1) death, 2) meaningless and meaning,              3) aloneness, 4) choice and responsibility.  These therapies have a link to the views of existential philosophers such as Sartre and Camus;  distinguishing between “authentic” and “inauthentic” ways of dealing with the existential dilemmas that all people face


VI.       Some common goals, themes, and cores to all therapies

A.    Forming a nurturing, open relationship with a nonjudgmental person; finding social support for change

B.    Committing to change: The very fact of seeing a therapist – particularly if one freely chooses to do so – commits a person to reevaluate life and seek change

C.    Gaining feedback about one’s life and behavior; engaging in reflection and self-examination; learning that one is not alone or the only one in the world with a given problem

D.    Obtaining instruction for possible new behaviors, thought processes, and relationship patterns; using the therapeutic relationship to “try out” new patterns of thinking and relating to others


Schools of Psychology and Human Nature


I.                 Four perspectives

A.       Behavioral/Learning

B.        Biological/Genetic/Darwinian

C.        Freudian/Psychodynamic

D.       Humanistic/Existential


II.             Some basic philosophical questions about human nature

A.       Human beings: basically good, neutral, or evil?

B.        Determinism and free will: Do people choose their behavior, or is their behavior determined by biological and environmental factors?  Related question: Do people passively respond to the environment, or can they actively change themselves and their surroundings?

C.        Malleability:  Can people change, or is our nature (our personality, our abilities, our behavior) fixed and set?

III.  Each perspective’s answers to the three philosophical questions

D.        Behavioral/Learning: Neutral, determined, malleable

E.        Biological/Genetic/Darwinian: Mixed, determined, fixed

F.         Freudian/Psychodynamic: Evil, determined, fixed

G.       Humanistic/Existential: Neutral or good, people have choice, malleable


IV. Views of mental health

A.Adaptive behavior that brings rewards and avoids pain and punishment

B.  to be physically healthy, to survive and reproduce

C.  to be aware of unconscious motives and earlier traumas; Freud’s “love and work”; to employ positive rather than negative defenses

D.to grow, to love, to be authentic; to strive for complete actualization; to find liberating alternatives to social constraints