Abnormal Psychology

30 CHAPTER 1

Summary of The Three

Criteria for Defi ning

Diagnosing Psychological Disorders

A psychological disorder is a pattern of

thoughts, feelings, or behaviors that causes

significant distress, impaired functioning in

daily life, and/or risk of harm. The distress

involved in a psychological disorder is out of

proportion to the situation.

Impairment in daily life may be evident

in functioning at school, at work, at home,

or in relationships. Moreover, people with

a psychological disorder are impaired to a

greater degree than most people in a similar

situation. A psychosis is a relatively easily

identifi able type of impairment that includes

hallucinations or delusions. A psychological

disorder may lead to behaviors that create

a signifi cant risk of harm to the person or to

others.

Mental health clinicians and researchers

recognize that context and culture in part de-

termine whether a person’s state involves sig-

nifi cant distress, impairment, or risk of harm.

In particular, people from different cultures

may express distress differently, and some

sets of symptoms, such as those of posses-

sion trance, may, in fact, not be a disorder in

certain cultures.

Thinking like a clinician

Suppose Pietro was hearing the voice of a

deceased relative, and he was from a culture

where such experiences were considered

normal—or at least not abnormal. But he

was distressed about hearing the voice, to

the point where he was having a hard time

doing his job. Should Pietro be considered

to have a psychological disorder? If so, why?

If not, why not? What additional information

would you want to help you decide, if you

weren’t sure?

Summary of Views of

Psychological Disorders

Before Science

The oldest known view of psychopathology

is that it arose from supernatural (magical

or spiritual) forces. Treatment included exor-

cism. The ancient Greeks attributed mental

illness to an imbalance of bodily humors. The

term medical model refers to Hippocrates’

view that illness (including psychological dis-

orders) arises from a biological disturbance.

The Middle Ages saw a resurgence of

the view that supernatural forces cause

psychopathology. This view persisted into the

Ren aissance, when mental illness was viewed

as the result of demonic possession, and

witches were thought to be possessed by, or in

league with, the devil. Treatment of the men-

tally ill consisted of exorcism. By the end of the

Renaissance, however, the mentally ill began

to be treated more humanely, and asylums

were built throughout Europe; over time, how-

ever, these asylums became a place to keep

the mentally ill poor off the street, which led to

overcrowded facilities.

In the years immediately following the Re-

naissance, mental illnesses were thought to

arise from irrational thinking, but this approach

did not lead to consistent cures.

Beginning in the 1790s, Pinel champi-

oned humane treatment for those in asylums

in France. Based on careful observation, he

proposed that there were different types of

madness. In other European settings, patients

were given moral treatment, which centered

on having them live and work within a com-

munity in the countryside.

In the United States, Benjamin Rush initi-

ated the effort to treat the mentally ill more

humanely; similarly, Dorothea Dix strove to

ensure that the mentally ill were housed sepa-

rately from criminals and treated humanely.

However, public institutions for the mentally

ill became overcrowded and underfunded.

By the end of the 19th century in Europe and

North America, “madness” was generally

viewed as caused by a medical abnormality.

Thinking like a clinician

Why might explanations of mental illness as

arising from supernatural forces have been

popular for so long? How does prevailing

treatment of abnormality follow from beliefs

about the cause of mental illness? Use spe-

cifi c examples.

Summary of The

Transition to Scientifi c

Accounts of Psychological

Disorders

Freud played a major role in making the study

of psychological disorders a science, largely

by developing new methods for diagnosis and

treatment; he also proposed an extensive the-

ory of psychopathology. According to Freud’s

psychoanalytic theory, thoughts, feelings,

and behaviors are a result of conscious and

unconscious forces—such as sexual and ag-

gressive urges—continually interacting in the

mind. Moreover, he proposed that the mind is

structured so as to function across three levels

of consciousness: the conscious, the precon-

scious, and the unconscious. Freud stressed

that many mental processes occur outside

our awareness but nonetheless influence

thoughts, feelings, and behaviors. Unaccept-

able urges are banished to the unconscious,

where they inevitably gain strength and even-

tually demand release.

Freud proposed three psychic structures

in the mind—id, ego, and superego—which

are continually interacting and negotiating.

According to Freud, each individual passes

through five psychosexual stages from in-

fancy to adulthood, of which four involve

particular erogenous zones. For healthy psy-

chological development, each stage requires

the successful completion of a key task. Freud

also proposed that parents’ interactions with

their child are central in forming the child’s

personality.

Freud’s followers focused on a variety of

issues related to the development of the self

and of the ego, the role of motivation, the

possibility of unconscious archetypes, and

the ways moment-to-moment interactions

between child and parent can contribute to

psychological disorders. A drawback of psy-

chodynamic theory is that it has proven diffi -

cult to test scientifi cally.

Humanistic psychologists such as Carl

Rogers viewed psychodynamic theory as too

mechanistic and opposed to free will. Rogers

proposed that symptoms of distress and men-

tal illness arise when a potential route to per-

sonal growth is blocked, as can occur when

the ideal and real selves are incongruent.

Rogers developed client-centered therapy to

decrease incongruence in clients.

Lasting contributions of psychodynamic

theory include the focus on mental processes

and mental contents and the concept that

such processes and contents can be hidden

from awareness.

Thinking like a clinician

Based on what you have read, why do you

think Freud’s theory has diminished in

influence? Why have certain aspects of psy-

chodynamic theory continued to influence

modern perspectives?

Summary of Scientifi c

Accounts of Psychological

Disorders

Psychologists Edward Thorndike, John Watson,

Clark Hull, and B. F. Skinner spearheaded

behaviorism, which focused on directly

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