Last part of Abnormal Behaviour in Historical Context.

blogger ate up my previous post apparently. thank goodness i saved my post..
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As seen from the previous post, the psychoanalytic theory is indeed very broad. Whatever that was mentioned was probably only 10% of his entire theory. Go read Freud’s book if you are interested to know the other 90%. :X

Now we veer from the vague and unimaginable to something more logical and acceptable. The humanistic theory was the one of the main basis for Jung and Adler, the ex-followers of Freud. As personality theorists, they believed in the positive and optimistic side of human nature and that human being is innately geared towards self-actualization – the process in which people strive to achieve the highest potential against difficult life experiences. One of the underlying assumptions in this belief is that all of us have the freedom and free will to grow. Such an assumption, nevertheless, remains highly controversial and debatable (HEY Socrates, Plato and Aristotle!! Do we really have free will?!). Hence, to the humanists, psychological disorders are a result of road blocks and obstacles that impede our desire and behaviour to self-actualise.

Abraham Maslow postulated a hierarchy of needs, in describing the structure of personality. It follows a rough order of basic needs (at the bottom) for food and sex, social needs (friendship etc.), and then self actualization, love and self-esteem (at the top). He hypothesized that we cannot move up the hierarchy without satisfying the needs of the lower.

The most common humanistic therapy used today is the person-centered therapy, in which the client, rather than the therapist, primarily directs the course of discussion, seeking self-discovery and self-responsibility. The therapist gives unconditional positive regard for the client in which he/she completely accepts most of the client’s feelings and actions and empathises greatly with the client, understanding the individual’s particular view of the world. To the humanists, these are essential features to work effectively towards growth.

This therapy hinges on the importance of therapeutic relationships between therapist and client in facilitating human growth. Nonetheless, Maslow noted that such therapy is only more applicable among individuals without psychological disorders.

Lastly, we look into the behavioural model, which by far, is the most fascinating to me. Tonnes of experiments performed with respect to this model, which resulted in various ethical issues as well regarding the morality of the experiments (Then again, this is one of the biggest issues facing psychologists. Indeed, experiments to test and discover the human nature may seem immoral and unethical in many ways. However, if not for these unethical experiments, we wouldn’t have been enlightened with the various discoveries and theories associated with the mental process and behaviour and the field of psychology wouldn’t have developed thus far. Psychologist’s dilemma?).

The behavioural model gained a foothold with Ivan Pavlov’s classical conditioning. It involves the repeated pairing of a neutral stimulus (NS) with a unconditioned response (UCR). Afterwhich, the neutral stimulus becomes a conditioned stimulus (CS), which can elicit the same response, which is now the conditioned response (CR). Playing piano to a cow? Let’s go into Pavlov’s actual experiment.

1) Food was presented to a dog. Dog salivated.
Food – Normal stimulus
Salivation – Unconditioned response (UCR)

2) Food was presented to the dog, this time, accompanied by a bell ring. Dog salivated again.
Bell – Neutral Stimulus (NR)
Salivation – Unconditioned response (UCR)

3) (2) was done repeatedly. After some time, no food was presented to the dog, only the ringing of the bell. Dog SALIVATED!
Bell – Conditioned stimulus (CS)
Salivation – Conditioned Response (CR)

When the ringing of bell was repeated WITHOUT presenting the food (pairing removed), after some time, the dog learned that the bell means nothing and hence, eliminates its conditioned response. This process is called extinction.

In conditioning, a phenomenon known as stimulus generalization can arise. For instance, you fall head over heels for kueh lapis (like me). But on a fateful day, you suffered from diarrhea after eating a few slices of it. You vomited and felt totally sick. From then on, the sight of kueh lapis makes you sick and nauseas. Whenever you see food that comes in layers (like tiramisu), you feel sick, because it resembles the kueh lapis. Even anything that looks yellow or brown can start making you sick. You begin to attribute kueh lapis and anything that looks, tastes, smells like it to the response of puking and feeling sick. Hence, stimulus generalization.

There are many other famous (and evil) experiments on classical conditioning, like John B. Watson and little Albert, and Mary Cover Jones and 2-year-old Peter, all of which contributed to the school of behaviourism. No time to type them out. If you’re really interested, try googling them or ask call, email, sms me. :X

Such an approach to the study of psychology is known as introspection, which involves systematic attempts to report thoughts and feelings that specific stimuli evoked.

One of the most successful and prevalent behaviour therapies is that of systematic desensitization. It aims at diminishing fear and hopefully eliminate phobias by gradual exposure to the feared stimulus paired with a positive coping experience, usually relaxation. A possible therapy I could try on my mum. People who know me would know what a cleanliness freak my mum is. So I could try to expose my mum to dirt and dust first, and ultimately, an outrageously dirty environment, preferably within home. And while she stares in horror and trauma, at every stage, I would then teach her relaxation exercises. By right, after some time, she should feel relaxed upon seeing dust and dirt (But seriously, do you really think it will work on my mum?? Benefit of doubt maybe).

Following classical conditioning was B. F. Skinner’s operant conditioning, which is a type of learning where behaviour changes as a function of what follows the behaviour (layman: giving incentives or not). Skinner’s theory was influenced by Thorndike’s law of effect, which states that behaviour is either strengthened or weakened depending on the consequences of that behaviour. He believed that the most effective way of developing a new behaviour is to positively reinforce desired behaviour, usually by means of a reward. For instance, my tutee is motivated to work hard for her psle this year because her mum promised her a handphone if she does well. Thus, her mum is practicing positive reinforcement here. On the contrary, punishment, in Skinner’s opinion, is ineffective in the long term.

Ever wondered how the parrots in the bird park could do mathematics and perform tricks? Credit goes to the process of shaping, which operates on the principle of operant conditioning. It is a process of reinforcing successive approximations to a final behaviour or set of behaviours. For example, if you want to make a parrot kick a ball, you guide it towards the ball by rewarding it with food whenever it takes a step closer towards the ball, till you get the desired act finally.

The behavioural model, though fascinating, is in itself, incomplete. It fails to account for biological, developmental (changes through life-span) and the subconscious factors that may cause a psychological disorder.

I think the last point of the summary in the textbook summarises it all nicely:

With the increasing sophistication of our scientific tools. And new knowledge from cognitive science, behavioural science and neuroscience, we now realize that no contribution of psychological disorders ever occurs in isolation. Our behaviour, both normal and abnormal, is a product of a continual interaction of psychological, biological and social influences.

Part 2 of Abnormal Behaviour in Historical Context.

The historical context of psychopathology is supported by 3 main traditions: Supernatural, Biological and Psychological.

The supernatural tradition sounds very much like the superstitions we would think of today. In this tradition, deviant behaviour mirrors the battle between good and evil. Hence, characters such as demons and witches come into play. One with a psychological disorder was thought to be possessed by evil spirits and so, exorcism [their (in)famous treatment method] was commonly used extricate the evil spirits. People then also held a strong (warped) view that insanity was a natural phenomenon. (Try googling King Charles VI of France, aptly known as the “Mad King”).

There was also the belief that movements of the moon and stars affected people’s psychological functioning (which was how the term “lunatic” came about, with “luna” being moon in Latin).

In my (and many others, I hope) opinion, this is absolute trash. I don’t think I should have even bothered typing those out. But I digress…

The biological tradition then paved its way (thank goodness) thanks to Greek physician Hippocrates (father of modern medicine) and Roman physician Galen. Hippocrates believed that genetics played a role in psychological disorders and that the brain logically houses the disorders since he considered it to be “the seat of wisdom, consciousness, intelligence and emotion”. Galen adopted and developed on Hippocrates’ ideas, giving birth to the Hippocratic-Galenic approach which includes the humoral theory of disorders. In this theory, abnormality is linked with brain and chemical imbalances.

American psychiatrist John P. Grey believed that insanity was always due to physical causes and thus, mentally ill people should be treated as physically ill.

One of the interesting developments of biological treatments is that of the shock treatment. It was observed by Joseph von Meduna that schizophrenia was rare in epileptics and so his followers thought that brain seizures could, perhaps cure schizophrenia. They sent 6 small shocks into the brain of a depressed patient which resulted in convulsions. Afterwhich, the patient recovered. With some modifications, this shock treatment is now known as electroconvulsive therapy (ECT).

Drug therapy is also one of the key features of biological treatments. Nevertheless, the use of drug may have limited success and very often carry side effects with them.

Lastly, the psychological tradition is probably the most dominant. There are various approaches to this tradition, namely moral therapy, psychoanalysis (HUGE CHUNK OF IT!), humanistic, and behaviourism. This tradition was a precursor to modern psychosocial approaches, which focus on psychological as well as social and cultural factors.

Moral therapy began in the 19th century, which was a treatment that involved treating mental patients as normally as possible in normal environments. In other words, they are placed in a setting where normal social interaction is encouraged and reinforced. However, moral therapy faced a decline in the mid 19th century due to various reasons (which I don’t think is really important :X). After laying dormant for some time, its ideas began resurfacing in psychoanalysis and behaviorism.

The psychoanalytic theory was pioneered by this interesting (weird and sexist) psychologist, Sigmund Freud (this was where “Freudian slips” came about). His most groundbreaking research and discovery was that of the unconscious mind. Freud (and Breuer) also discovered that it is therapeutic to recall and relive emotional trauma that has been made unconscious and to release the accompanying tension, known as catharsis. It promotes a fuller understanding of the relationship between current emotions and earlier events known as insight.

Psychoanalytic theory has three major facets: the structure of the mind, defense mechanisms and stages of early psychosexual development.

The structure of the mind consists of 3 major parts/functions: the id, ego and superego. Id represents our basic drives at birth, including eating, sleeping and even strong sexual and aggressive feelings or energies. The energy or drive within the id is the libido. When left totally unchecked, the id would turn us into rapists, killers and even barbarians. It operates in accordance to the pleasure principle which aims to maximize pleasure and eliminate any associated tension or conflicts. Its characteristic way of processing information is known as the primary process.

The superego or conscience represents the moral principles instilled in us by our parents and our own culture. It serves to counteract the potential aggressive and sexual drives of the id, which then forms the basis for conflict of the id and superego.

When 2 parties quarrel, a mediator is often needed, hence, the role of the ego. The ego is responsible for finding realistic and practical ways to satisfy the id drives. If it mediates successfully, we can proceed to higher intellectual and creative pursuits of life. Otherwise, the id or superego overwhelms and result in psychological disorders.

These conflicts are known as intrapsychic conflicts, since they all occur within the mind.

The ego can perform defense mechanisms in its attempt to mediate. Defense mechanisms are common patterns of behaviour, often adaptive coping styles when they occur in moderation, observed in response to particular situations. Catch no ball? Read on.

A few examples of defense mechanisms can be found in the DSM-IV-TR. Namely:

Denial: refusal to acknowledge some aspect of objective reality or subjective experience that is apparent to others (this is obvious).

Displacement: transferring a feeling about or a response to, an object that causes discomfort onto another, usually less threatening, object or person. Analogy: Your tutor gave you shit grades for an essay you drained yourself over. You are angry, but you know that confronting your tutor is probably the stupidest thing to do unless you are prepared to get more shit grades. So you go home and “displace” your anger at your stress ball (cps stress ball!) by whacking it up down left right on your wall.

Projection: falsely attributing own unacceptable feelings, impulses or thoughts to another individual or object. Analogy: Jac jac is pissed off because she got nagged at by her mum. So when she met up with peace-loving gabby, she suddenly yells at him, “WHY ARE YOU PISSED OFF WITH ME!?!!?!!!#$#$#%$^^%^#!!!@@” and gabby’s jaw drops as he does some soul searching but couldn’t find his soul…ahem. I mean anything wrong. And he says to himself, “jac jac must be having pms.”

Rationalization: Conceals true motivations for actions, thoughts or feelings through elaborate reassuring or self-serving but incorrect explanations (layman: cook up some excuse to make yourself feel better).

Reaction formation: substituting behaviour, thoughts or feelings that are the direct opposite of unacceptable ones. Analogy: You the tendencies of a compulsive gambler but due to certain obligations to avoid it, you condemn gamblers as a result.

Repression: blockage of disturbing wishes, thoughts or experiences from conscious awareness. (layman: forcing yourself to forget traumatic experiences).

Sublimation: directing potentially maladaptive feelings or impulses into socially acceptable behaviour. Analogy: when I feel stressed out or pissed off, I go running to relief tension.

Psychosexual stages of development is the part of Freud’s theory which I think is the most absurd and unimaginable. It includes the oral, anal, phallic, latency and genital stages.

Oral stage: at roughly 2 years old, characterized by the need for food. Sucking, lips, mouth, tongue become focus of libidinal drives. When not appropriately gratified (fixation), it might result in excessive thumb sucking and oral stimulation through eating, biting nails etc when they grow older.

Phallic stage: the most unacceptable stages of all to me. :X It involves the weird intrapsychic known as the Oedipus complex: young boys at the certain time will begin to fall in love with their mothers and hope to have sexual interactions with them. At the same time, they feel angry towards their father because they are jealous of him. However, knowing that their father is far more powerful and might cut off their penises as a punishment for their lust (castration anxiety), they control their lust (out of respect and love maybe) and model themselves upon their fathers and parental love from their mothers are enough. The female version would be the Elektra complex, where young girls fall in love with their fathers and want to possess them. On top of that, they have a strong desire for a penis (penis envy). Nevertheless, the conflict is resolved when girls look toward healthy heterosexual relationships and anticipation for a baby as a substitute for having a penis. (warped right!?)

Freud termed psychological disorders resulting from unconscious conflicts and anxiety they cause as neurosis (plural: neuroses).

Anna Freud developed his father’s ideas and came up with the object-relations theory, which states that children incorporate images, memories and values of a person who was important to them and to whom they were/are emotionally attached. Object refers to people and the process of incorporation is introjection. According to the theory, you tend to see the world through the eyes of the person incorporated into your self.

Carl Jung and Alfred Adler were students of Freud, but broke off from him to develop their own school of thoughts. Unlike Freud, they believed that human nature is positive and there is a strong drive toward self-actualization, very similar to the humanistic theory. While acknowledging the presence of the subconscious mind, they focus on the influence of culture and society on personality as well.

Psychoanalytic psychotherapy includes free association which explores threatening material repressed into the unconscious. The patient is instructed to say whatever comes to mind without censoring. Another technique is dream analysis, where dream contents are examined as symbolic of id impulses and intrapsychic conflicts (for example, if you dream of a snake, it symbolizes the penis. Erps.)

Between the therapist and the patient, there can be a relationship of transference, where patients come to relate the therapist as they to do important authority figures, like their parents and feel accordingly to the therapist (either resent or fall in love with the therapist). There can also be a relationship of counter transference where the therapist project his/her personal issues and feelings onto the patient.

Psychodynamic theory and therapy is the contemporary version of psychoanalysis. On the whole, there is little efficacy for this theory because it is not testable and hence, unscientific.
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Right. It’s 4am now and I’m kind of tired. To be continued…

Abnormal Behaviour in Historical Context (PL3236)

yes i took almost 3 weeks to trot back here from my textbook. :X thanks to test on monday. :( ANYWAY.
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There are 3 main components attributing to a psychological disorder. Firstly, there has to be psychological dysfunction, ie. a breakdown in cognitive, emotional or behavioural functioning (layman: you think, feel and act weirdly). These dysfunctions are not simply present or absent, but rather vary along a continuum. Secondly, the disorder/behaviour has to result in personal distress (layman: upsets you). Lastly, the response is atypical or culturally unexpected (layman: deviating from average). This last attribute tends to be rather vague and controversial because what is unusual or unacceptable to one may not be so to others. An issue of relativity again. Hence, the diagnosis of psychological disorder is often ambiguous (so stop thinking that all psychologists own a crystal ball).

In sum, the accepted definition of a psychological disorder from the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, the bible of all psychopathologists :X) is behavioural, emotional or cognitive dysfunctions that are unexpected in their cultural context and associated with personal distress or substantial impairment in functioning.

Psychopathology is the study of psychological disorders, commonly referred to as clinical psychology. Associated fields of occupation are clinical and counseling psychologists, as well as psychiatrists and psychiatric social workers. The main difference between a psychologist and psychiatrist is that the latter goes through medical school first before specializing psychiatry as post-grad. The latter is also more concerned with the biological view of psychological disorders and treatments. Psychiatric social workers earn a social work degree and focus more on disorders related to family problems.

Mental health professionals adopt a scientist-practitioner model. As a scientist, they have to be updated with the latest developments on diagnosis and treatment, evaluate the effectiveness of their own methods and produce their own research to discover new information on disorders and treatments. In practice, they describe psychological disorders, determine their causes and treat them.

A clinical description, which is the unique combination of behaviours, thoughts and feelings that form a specific disorder, begins with the presenting problem. The primary function of a clinical description is to distinguish clinically significant dysfunction from common human experience (layman: depression/sadness is common in everyone so how do we determine if they are actually symptoms of a disorder?). Statistical data come in useful in terms of prevalence, ie how many people in the entire population have the disorder, and incidence, ie the number of new cases that occur during a given period. Sex ratio and age of onset can be useful as well.

Identifying the course (layman: individual pattern) of the disorder is also important. Disorders can follow a chronic course, which is long lasting; episodic course, which recovery is rather quick but relapse(s) may occur later on; time-limited course, where the disorder improves without treatment within a short period.

Similarly, there are also differences in onset. Acute onset refers to a sudden attack while an insidious onset refers to a gradual one over an extended period. Knowing the typical course and onset of a disorder, one can then be prepared and deal with the problem appropriately.

The anticipated course of a disorder is known as the prognosis. If it is “good”, chances of recovery is high. If it is “guarded”, outcome is probably not too optimistic.

Etiology is the study of origins of a disorder, which includes biological, psychological and social aspects. Treatment then becomes crucial since if a new drug or treatment successfully treats a disorder, it may suggest the nature and causes of the disorder. However, it is not always the case, because effect does not always imply cause. For instance, you may take charcoal pills to relief your diarrhea after eating too much trash. But when you feel better, it does not mean that the diarrhea was caused by a lack of charcoal pill intake.

Ok I need a break.