LEARNING OBJECTIVES
After reading and studying this chapter and participating in lecture and discussion, students should be able to:
1. Distinguish between normal but unusual behavior and between unusual but abnormal behavior.
2. Understand how explanations of abnormal behavior have changed through time.
3. Describe the facets of modern mental health care.
4. Describe the scientific method.
5. Describe types of research studies.
CHAPTER OUTLINE
I. Abnormality Along the Continuum (continuum model of abnormality; psychopathology)
A. Extraordinary People
II. Defining Abnormality
A. Mental illness
B. Cultural Norms (cultural relativism)
C. The Four D’s of Abnormality
1. Shades of Gray
III. Historical Perspectives on Abnormality (biological theories, supernatural theories, psychological theories)
A. Ancient Theories
1. Driving Away Evil Spirits (trephination)
2. Ancient China: Balancing Yin and Yang
3. Ancient Egypt, Greece, and Rome: Biological Theories Dominate
B. Medieval Views
1. Witchcraft
2. Psychic Epidemics
C. The Spread of Asylums
D. Moral Treatment in the Eighteenth Century (mental hygiene movement, moral treatment)
III. The Emergence of Modern Perspectives
A. The Beginnings of Modern Biological Perspectives (general paresis)
B. The Psychoanalytic Perspective (mesmerism; psychoanalysis)
C. The Roots of Behaviorism (classical conditioning, behaviorism)
D. The Cognitive Revolution (cognitions, self-efficacy beliefs)
IV. Modern Mental Health Care
A. Deinstitutionalization (patients’ rights movement, deinstitutionalization, community mental health movement, community mental health centers, halfway houses, day treatment centers)
B. Managed Care
1. Case Study
C. Professions Within Abnormal Psychology
V. Chapter Integration
A. Shades of Gray Discussion
ACTIVITIES AVAILABLE IN CONNECT
Connect is a teaching and learning platform designed to boost performance.
Connect offers:
• one destination for all course content
• assignment and quiz banks
• deep insights into student performance
• recommendations for students to improve
• adaptive learning features that customize the student experience
The following are a selection of the resources available in Connect for this course:
Chapter Resource Name Resource Type
1 Abnormality Concept Clip
1 Thinking Critically: Defining Abnormality Critical Thinking
1 NewsFlash: Working with Mental Illness NewsFlash
1 NewsFlash: Expert on Mental Illness Reveals her own Fight NewsFlash
1 NewsFlash: Myth vs. Fact: Sorting Out Mental Illness, Violence Relationship NewsFlash
Suggestion: LearnSmart is an invaluable tool in helping students to integrate the content. While many are drawn to Abnormal Psychology (which they equate with the whole field of psychology) they find it difficult to internalize the respective theoretical orientations for conceptualizations and treatment. LearnSmart facilitates this by allowing them to practice their knowledge. Faces – Interactive (available with some of the chapters) are very helpful, and students like adopting the clinician role.
POLLING QUESTIONS
1. Approximately how many adults in the U.S. experience a mental illness in a given year?
a. 1 in 2
b. 1 in 3
c. 1 in 5 (*)
d. 1 in 10
2. What is the percentage of homeless adults who experience mental illness or substance use disorders?
a. 26% (*)
b. 46%
c. 60%
d. 85%
3. What percentage of adults needing mental health care receives it?
a. 10%
b. 25%
c. 41% (*)
d. 66%
All questions and answers derived from the NAMI website:
https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
LECTURE SUGGESTIONS
1. General Questions and Concerns Related to Defining Abnormality
The first or second meeting of the course is an optimal point to discuss concerns, experiences, misconceptions, and understandings of abnormal psychology and/or behavior. The study of abnormal psychology is the study of people whose behavior and experiences may range from the bizarre and unusual to the familiar. Many of the students will be related to or acquainted with a person experiencing one of the disorders to be addressed in the course, and some of the students may experience one of these disorders themselves. The instructor might wish to invite a community spokesperson to address the class – for example, someone from a local chapter of the National Alliance for the Mentally Ill or a local support group for persons with bipolar disorder. Prior to any such guest presentation, it is imperative that the instructor discusses issues of confidentiality and privacy.
At some point during discussion of the iniquitousness of abnormal behavior, the instructor might consider addressing the possibility that the presentation of bizarre or unusual behaviors may provoke laughter. It is suggested that laughter is a common and understandable way of responding to the unexpected (that's what makes a joke a joke), and that laughter is often a way of distancing ourselves from material that might otherwise make us feel uncomfortable. Students need not be admonished for finding humor in some of the unusual phenomena to be discussed in the course, but a social norm prohibiting put-downs and ridicule of persons with psychological disorders might be established early in the course. One can be compassionate while appreciating the humorous side of the sometimes-painful human condition. For example, discussion might be generated around various colloquial terms for concepts associated with psychological disorders, for example, "crazy," "nuts," "loony bin," and so on. This is also an opportunity to consider the social constructions of disorders and the influence of stigma.
2. The Meaning of Abnormality
A logical place to start in a class on abnormal psychology is with a discussion of what is meant by the terms "abnormal," "abnormality," and "abnormal behavior." The text begins by placing the label within the framework of context, noting that elements such as time, place, tradition, culture, purpose, and gender are among the important variables in determining whether a particular behavior or set of behaviors is normal.
A seminal study on the contextual interpretation of behavior was that of David Rosenhan (1973), who embarrassed the mental health community when the eight participants in his research, having presented themselves to twelve different mental institutions in five different states with the symptoms of having heard voices say "empty," "hollow," and "thud" (but otherwise presenting no unusual behaviors) were all admitted, usually with the diagnosis of schizophrenia. Each of these "pseudopatients" had to "work" his way out (Dr. Rosenhan himself was one of the pseudopatients), which they began doing immediately upon admission in part by acting completely "normal." Although the real patients all seemed to know that these participants were not "insane," the staff not only believed they were suffering from mental disorders, but labeled their behaviors within that context (those who took notes about their experiences had the notation of "note taking behavior" listed on their charts). When each of these participants was finally released from hospitalization, rather than indicate that there was no disorder in the first place, each was listed as having their symptoms "in remission." With respect to our author's recognizing the importance of context in a determination of what is seen as "normal" or "abnormal," recall that Rosenhan noted, "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meanings of behavior can easily be misunderstood" (p. 257).
Rosenhan's (1973) criticisms were considerably more kind (although perhaps not intentionally so) than those of Kate Millett, feminist author of Sexual Politics. Millett (1990) wrote of her experiences with bipolar disorder in The Loony Bin Trip. Her book is an indictment of a whole society that labels people with a disorder and then interprets all of their behavior within the context of that disorder.
Understanding the power of context, whether situational or personal, what exactly is abnormality? Understanding that this is a difficult term to define, our author explores a variety of criteria, including cultural relativism, deviant, distress (i.e., of the person suffering the disorder, not the people around him or her), and mental illness. Finally, Nolen-Hoeksema set out four behavioral characteristics that psychologists have determined to be important (although constrained in part by societal norms). They are:
1. somewhat unusual for the social context
2. distressing to the individual
3. interfering with social or occupational functioning
4. dangerous (p. 3)
3. Diagnosis as Social Construction and a Form of Social Control
To highlight the phenomenon in which diagnosis has been used as a means of social control, I draw students' attention to the historical use of the labels drapetomania (a "sickness" that caused black slaves to desire their freedom) and dysaesthesia Aethiopis (the refusal to work for one's master) (referenced on p. 6). Lest students remain complacent in the belief that such atrocities could not possibly be repeated in modern society, I cite several examples of diagnosis in the service of social control that have occurred in the twentieth century. [For these, I borrow extensively from Brown (1990; see references).]
First, research into the archives of the Boston Psychiatric Hospital, during the years 1912-1921, reveals that psychiatrists used the term psychopathic to diagnose the "hypersexual behavior" of sexually active working class women. These "patients" were typically women who lived economically independent lifestyles and had chosen to forgo or delay marriage or who were widows or divorced. Another contemporary example of pathologizing behavior as a means of social control occurred in the 1960s, and implicates Bruno Bettelheim, then famous as an authority on childhood autism and operator of the private Orthogenic School for severely disturbed children in Chicago. In testimony presented to the House Special Subcommittee on education on March 20, 1969, Bettelheim told the U.S. Congress that student antiwar protesters at the University of Chicago had no serious political agenda. Instead, he testified that they were acting out unresolved Oedipal conflicts by attacking the university as a surrogate father.
4. Advantages and Limitations of the Various Criteria for Defining Abnormality
To convey comparisons and contrasts between the various criteria for defining abnormality, I ask students to consider who might be inadvertently and unjustifiably included or excluded by each criterion. This provides student-generated examples of instances that define the boundaries of each criterion and illustrates their practical utility. For example, when considering the unusualness criterion, I query students for examples of behaviors that might be misguidedly included according to this criterion and those behaviors that we might agree should be labeled as abnormal, but are excluded by this criterion. Students are typically able to offer examples, such as left-handedness or homosexuality, of behaviors that are statistically rare but not justifying the label of abnormal, and examples, such as depression or anxiety, of behaviors that are statistically common but should be labeled as abnormal when decisions about helpful interventions are made. This similar process can be applied to each criterion in turn and is a very good illustration of the advantages and limitations of each definition, as well as showing that no single definition is adequate.
5. Applying Evolutionary Psychology
If you have a background that includes evolutionary psychology you may want to discuss adaptive value and ask students to generate possible reasons why we would see maladaptive behaviors not die out. One of the main tenets of Evolutionary Psychology is that behaviors that persist must in some way be, or have been, adaptive. How could this explain disorders we see today?
One example can be built on the example above on the “adaptive value” of schizophrenia. Ask students if someone lived in a remote tribe in South America or Africa and they reported talking to God, how would their village receive them? Now if someone in their class started speaking to God, or speaking in “tongues” as Pentecostals do, would they perceive that as “abnormal”? Could there be other situations with other disorders where some of these behaviors are actually adaptive in some way?
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