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Abnormal Psychology: An Integrative Approach, Third Canadian Edition

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Balancing biological, psychological, social, and cultural approaches, Barlow and Durand's groundbreaking integrative approach is the most modern, scientifically valid method for studying abnormal psychology. In this Third Canadian Edition of their proven ABNORMAL PSYCHOLOGY: AN INTEGRATIVE APPROACH, the authors successfully blend sophisticated research and an accessible writing style with the most widely recognized method of discussing psychopathology. Going beyond simply describing different schools of thought on psychological disorders, the authors explore the interactions of the various forces that contribute to psychopathology. A conversational writing style, consistent pedagogical elements, integrated case studies (95 percent from the authors' own files), and additional study tools (such as a website with video clips of clients) make this text the most complete learning resource available. For instructors, an Instructor's Resource Manual, Test Bank, and a wide selection of videos are available to use when teaching the course.
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Abnormal Psychology, Third Canadian
Edition
by David H. Barlow, V. Mark Durand, and
Sherry H. Stewart
COPYRIGHT © 2012, 2009 by
Nelson Education Ltd.
Adapted from Abnormal
Psychology, Sixth Edition, by
David H. Barlow and V. Mark
Durand, published by Wadsworth.
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Library and Archives Canada
Cataloguing in Publication
Barlow, David H.
Abnormal psychology : an
integrative approach / David H.
Barlow, V. Mark Durand, Sherry H.
Stewart. —3rd Canadian ed.
Includes bibliographical references
and index
ISBN-13: 978-0-17-650219-5
1. Psychology, Pathological—
Textbooks. I. Durand, Vincent
Mark II. Stewart, Sherry H. (Sherry
Heather), 1965- III. Title.
RC454.B36 2011 616.89
C2011-905709-3
ISBN-13: 978-0-17-650219-5
ISBN-10: 0-17-650219-X
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NEL
CHAPTER OUTLINE
JODY: The Boy Who Fainted at the Sight of Blood
What Is a Psychological Disorder?
Psychological Dysfunction
Personal Distress
Atypical or Not Culturally Expected
The Science of Psychopathology
The Scientist-Practitioner
Clinical Description
Causation, Treatment, and Outcomes
The Past: Historical Conceptions of Abnormal
Behaviour
The Supernatural Tradition
Demons and Witches
Stress and Melancholy
CHARLES VI: The Mad King
Treatments for Possession
The Moon and the Stars
Comments
The Biological Tradition
Hippocrates and Galen
The 19th Century
The Development of Biological Treatments
Consequences of the Biological Tradition
The Psychological Tradition
Moral Therapy
Asylum Reform and the Decline of Moral Therapy
Psychoanalytic Theory
Humanistic Theory
The Behavioural Model
The Present: The Scienti c Method and an
Integrative Approach
Abnormal Psychology Video
Roots of Behaviour Therapy
Abnormal Behaviour
inHistoricalContext
1
2
A clear and complete insight into the nature of
madness, a correct and distinct conception of what
constitutes the difference between the sane and the
insane has, as far as I know, not been found.
—Schopenhauer, The World as Will and Idea
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NEL
What Is a Psychological Disorder? 3
sodes were problematic for him and disruptive in school;
each time he fainted, the other students  ocked around him,
trying to help, and class was interrupted. Because no one
could  nd anything wrong with Jody, the principal  nally
concluded that he was being manipulative and suspended
him from school, even though he was an honour student.
Jody had what we now call blood-injury-injection phobia.
His reaction was quite severe, thereby meeting the criteria for
phobia, a psychological disorder characterized by marked
and persistent fear of an object or situation. But many people
have similar reactions that are not as severe when they
receive an injection or see someone who is injured, whether
or not blood is visible. For people who react as severely as
Jody, this phobia can be very disabling. They may avoid cer-
tain careers, such as medicine or nursing. If they are so afraid
of needles and injections that they avoid them even when
they are necessary, they put their health at risk.
What Is a Psychological Disorder?
Keeping in mind the real-life problems faced by Jody, let’s look
more closely at the de nition of a psychological disorder, or abnor-
mal behaviour: It is a psychological dysfunction within an individ-
ual associated with distress or impairment in functioning and a
response that is not typical or culturally expected ( Figure 1.1).
On the surface, these three criteria may seem obvious, but they
were not easily arrived at, and it is worth exploring what they
mean. You will see that no one criterion has yet been developed
that fully de nes abnormality.
Psychological Dysfunction
Psychological dysfunction refers to a breakdown in cognitive,
emotional, or behavioural functioning. For example, if you are out
on a date, it should be fun. If you experience severe fear all evening
and just want to go home, even though you have nothing to be
afraid of, and if the severe fear happens on every date, your
STUDENT LEARNING OUTCOMES*
Characterize the nature of psychology as a discipline. Explain why psychology is a science (APA SLO 1.1.a) (see textbook pages 6–9)
Demonstrate knowledge and understanding representing
appropriate breadth and depth in selected content areas of
psychology.
The history of psychology, including the evolution of methods of psychology, its
theoretical con icts, and its sociocultural contexts (APA SLO 1.2.b) (see textbook
pages 9–29)
Use the concepts, language, and major theories of the
discipline to account for psychological phenomena.
Use theories to explain and predict behaviour and mental processes (APA SLO
1.3.d) (see textbook pages 15–29)
Integrate theoretical perspectives to produce comprehensive and multifaceted
explanations (APA SLO 1.3.e) (see textbook page 27)
Explain major perspectives of psychology (e.g., behavioural,
biological, cognitive, evolutionary, humanistic, psychodynamic,
and sociocultural).
Explain major perspectives in psychology (APA SLO 1.4a) (see textbook
pages12–29)
* Portions of this chapter cover learning outcomes suggested by the American Psychological Association (2007) in their guidelines for the undergraduate psychology major. Chapter coverage of these
outcomes is identi ed above by APA Goal and APA Suggested Learning Outcome (SLO).
Today you may have gotten out of bed, had breakfast, gone to
class, studied, and at the end of the day, enjoyed the company of
your friends before falling asleep. It probably did not occur to you
that many physically healthy people are unable to do some or any
of these things. What they have in common is a psychological
disorder, a psychological dysfunction within an individual that is
associated with distress or impairment in functioning and a
response that is not typical or culturally expected. Before examin-
ing exactly what this means, let’s look at one individual’s
situation.
JODY The Boy Who Fainted at the Sight of
Blood
Jody, a 16-year-old boy, was referred to our anxiety disor-
ders clinic after increasing episodes of fainting. Jody
reported that he had always been somewhat queasy at the
sight of blood. About two years before coming to our clinic,
in his  rst biology class, the teacher showed a movie of a
frog dissection to illustrate various points about anatomy.
The  lm was particularly graphic, with vivid images of
blood, tissue, and muscle. About halfway through, Jody felt
a bit lightheaded and left the room, but the images did not
leave him. He continued to be bothered by them and occa-
sionally felt slightly queasy. He began to avoid situations in
which he might see blood or an injury. He stopped looking
at magazines that might have gory pictures. He found it
dif cult to look at raw meat, or even Band-Aids, because
they brought the feared images to mind. Eventually, any-
thing his friends or parents said that evoked an image of
blood or injury caused Jody to feel lightheaded. It became
so bad that if one of his friends exclaimed, “Cut it out!” he
felt faint. Beginning about six months before his visit to the
clinic, Jody actually fainted when he unavoidably encoun-
tered something bloody. His family physician could  nd
nothing wrong with him, nor could several other physicians.
By the time he was referred to our clinic, he was fainting
ve to ten times a week, often in class. Clearly, these epi-
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4 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
Atypical or Not Culturally Expected
Finally, the criterion that the response be atypical or not culturally
expected is important but also insuf cient to determine abnormality.
At times, something is considered abnormal because it occurs infre-
quently; it deviates from the average. The greater the deviation, the
more abnormal it is. You might say that someone is abnormally short
or abnormally tall, meaning that the person’s height deviates substan-
tially from average, but this obviously isn’t a de nition of disorder.
Many people are far from the average in their behaviour, but few
would be considered disordered. We might call them talented or
eccentric. Many artists, movie stars, and athletes fall into this
category. For example, it’s not normal to plan to have blood spurt
from your clothes, but when Lady Gaga did this while performing it
only enhanced her celebrity. The late novelist J. D. Salinger, who
wrote The Catcher in the Rye, retreated to a small town in New
Hampshire and refused to see any outsiders for years, but he
emotions are not functioning properly. However, if all your friends
agree that the person who asked you out is dangerous, then it would
not be “dysfunctional” for you to be fearful and avoid the date.
A dysfunction was present for Jody: he fainted at the sight of
blood. But many people experience a mild version of this reaction
(feeling queasy at the sight of blood) without meeting the criteria
for the disorder; knowing where to draw the line between normal
and abnormal dysfunction is often dif cult. For this reason, these
problems are often considered to exist on a continuum or as a
dimension, rather than as categories that are either present or
absent. This is one reason that just having a dysfunction is not
enough to meet the criteria for a psychological disorder.
Personal Distress
That the disorder or behaviour must be associated with distress
adds an important component and seems clear: the criterion is
satis ed if the individual is extremely upset. We can certainly say
that Jody was very distressed and even suffered with his phobia.
But remember, by itself this criterion does not de ne abnormal
behaviour. It is often quite normal to be distressed—for example,
if someone close to you dies. The human condition is such that
suffering and distress are very much part of life—and that is not
likely to change. Furthermore, for some disorders, by de nition,
suffering and distress are absent. Consider the person who feels
extremely elated and acts impulsively as part of a manic episode.
As we see in Chapter 7, one major dif culty with this problem is
that people enjoy the manic state so much they are reluctant to
begin treatment or stay in treatment very long. Thus, de ning
psychological disorder by distress alone doesn’t work, although
the concept of distress contributes to a good de nition. The
concept of impairment is useful, though it is not entirely satisfac-
tory. For example, many people consider themselves shy or lazy,
but this doesn’t mean that they’re abnormal. But if you are so shy
that you  nd it impossible to date or even interact with people,
and if you make every attempt to avoid interactions even though
you would like to have friends, then your social functioning is
impaired. Jody was clearly impaired by his phobia, but many
people with similar, less severe reactions are not impaired. This
difference again illustrates the important point that most psycho-
logical disorders are simply extreme expressions of otherwise
normal emotions, behaviours, and cognitive processes.
FIGURE 1.1 The criteria de ning a psychological disorder
Psychological
disorder
Psychological dysfunction
Distress or impairment
Atypical response
Distress and suffering are a natural part of life and do not in
themselves constitute a psychological disorder.
CP PHOTO/AP/Charles Rex Arbogast
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What Is a Psychological Disorder? 5
NEL
“So Rhoda,” I began laconically, “what do you suppose was wrong
with that woman?”
She looked at me as if I was mad.
“She is crazy.
“But how can you tell?”
“She’s crazy. Can’t you just see from how she acts?”
“But how do you decide that she is crazy? What did she do?”
“She killed that goat.”
“Oh,” I said with anthropological detachment, “but Masai kill
goats all the time.”
She looked at me as if I were an idiot. “Only the men kill
goats,” she said.
“Well, how else do you know that she is crazy?”
“She hears voices.
Again, I made a pain of myself. “Oh, but the Masai hear voices
sometimes.” (At ceremonies before long cattle drives, the Masai
trace-dance and claim to hear voices.) And in one sentence, Rhoda
summed up half of what anyone needs to know about cross-cultural
psychiatry. “But she hears voices at the wrong time.” (2002, p. 138)
However, a social standard of normal has been misused. Consider,
for example, the practice of committing political dissidents to mental
institutions, which was common in the former Soviet Union before
the fall of Communism. Although such dissident behaviour clearly
violates social norms, it should not alone be cause for commitment.
continued to write. Some male rock singers wear heavy makeup on
stage. These people are well paid and seem to enjoy their careers. In
most cases, the more productive you are in the eyes of society, the
more eccentricities society will tolerate. Therefore, “deviating from
the average” doesn’t work very well as a de nition.
Another view is that your behaviour is abnormal if you are violat-
ing social norms, even if some people are sympathetic to your point
of view. This de nition is very useful in considering important
cultural differences in psychological disorders. For example, to enter
a trance state and believe you are possessed would point to a psycho-
logical disorder in most Western cultures, but in many other societies
the behaviour is accepted and expected (see Chapter 6). (A cultural
perspective is an important point of reference throughout this book.)
An informative example of this view is provided by the prom-
inent neuroscientist Sapolsky (2002), who worked closely with
the Masai tribe in East Africa. One day Sapolsky’s Masai friend
Rhoda asked him to bring his jeep as quickly as possible to the
Masai village, where a woman had been acting very aggressively
and had been hearing voices. The woman had actually killed a
goat with her own hands. Sapolsky and several Masai were able
to subdue her and transport her to a local health centre. Realizing
that this was an opportunity to learn more of the Masai’s view of
psychological disorders, Sapolsky had the following discussion:
We accept extreme behaviours by entertainers, such as Lady
Gaga, that would not be tolerated in other members of our society.
Some religious behaviours may seem unusual to us but are
culturally or individually appropriate.
Concept Check 1.1
Check your understanding of the de nitions of abnormal
behaviour. Write the letter for any, all, or none of the following
de nitions in the blanks: (a) societal norm violation,
(b)impairment in functioning, (c) dysfunction, and (d) distress.
1. Jan’s neighbour collects aluminum cans and attaches
them to the inside walls of her house for decoration. She
has two rooms completely wallpapered with cans and
has started on a third. Jan knows of no one else who
engages in similar behaviour and, therefore, believes her
neighbour to be abnormal. Jan could be using one of two
de nitions of abnormality. Which, if any, are they?
______________
(continued)
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6 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
Some controversial  gures such as Thomas Szasz and George
Albee are highly critical of medical diagnoses being used in the
case of psychological disorders. In 1960, Szasz advanced his
position that mental illness is a myth and that the practice of
labelling mental illnesses should be abolished. For example,
Szasz (1960) argued that a fundamental difference exists between
the use of diagnoses for physical diseases and their use in mental
illnesses. The former uses objective criteria (e.g., results of blood
tests), but for mental illness, subjective judgments are required.
Albee (1998, 2000) has argued that the biggest mistake made by
the clinical psychology profession was uncritically accepting the
concept of “mental disease” and using the medical model and
associated diagnoses (e.g., the DSM system) in conceptualizing
abnormal behaviour. Even among the many proponents of the
DSM system, disagreement continues about how to de ne the
concept of “disorder.
As noted earlier, creation of the DSM-5 is in progress (Brown &
Barlow, 2005; Krueger, Watson, & Barlow, 2005; Regier, Narrow,
Kuhl, & Kupfer 2009), with publication due in May 2013. But the
basic de nition of psychological disorder will be largely
unchanged.
As a challenge, take the problem of de ning abnormal behav-
iour a step further and consider this: What if Jody passed out
repeatedly but regained consciousness so quickly that neither his
classmates nor his teachers even noticed? Furthermore, what if
Jody continued to get good grades? Would fainting all the time at
the mere thought of blood be a disorder? Would it be impairing?
Dysfunctional? Distressing? What do you think?
The Science of Psychopathology
Psychopathology is the scienti c study of psychological disor-
ders. Within this  eld are specially trained professionals, includ-
ing clinical and counselling psychologists, psychiatrists,
psychiatric social workers, psychiatric nurses, marriage and family
therapists, and mental health counsellors. Clinical psychologists
typically receive a Ph.D. (Doctor of Philosophy) following a
course of graduate-level study that lasts approximately  ve years.
This education prepares them to conduct research into the causes
and treatment of psychological disorders and to diagnose, assess,
and treat these disorders. Instead of a Ph.D., clinical psychologists
sometimes receive a Psy.D. (Doctor of Psychology) degree for
which the training is similar to the Ph.D. but with more emphasis
on clinical practice and less on research training. No Psy.D.
programs currently exist in Canada; however, programs are
currently in development in Québec (Dobson, 2003; Hunsley &
Johnston, 2000). In Canada, regulation of the psychology profes-
sion is under the jurisdiction of the provinces and territories.
Depending on the jurisdiction, a psychologist may have either a
doctoral or a master’s degree (Hunsley & Johnston, 2000). For
example, within the province of Ontario, professional psycholo-
gists are regulated by the College of Psychologists of Ontario, as
outlined in the Regulated Health Professions Act (1991). Largely
to protect the public, but also in the interest of the profession
(Goodman, 2000), only those who are licensed or registered with
their provincial board or college are permitted to call themselves
“psychologists” (e.g., in advertising). Note that the labels
In a very thoughtful analysis of the matter, Wake eld (1992,
1999) uses the shorthand de nition “harmful dysfunction.” A related
concept that is also useful is to determine whether the behaviour is
beyond the individual’s control (something he or she doesn’t want to
do; Widiger & Sankis, 2000). Variants of these approaches are most
often used in current diagnostic practice, as outlined in the fourth
edition, text revision, of the Diagnostic and Statistical Manual
(DSM-IV-TR, American Psychiatric Association, 2000a), which
contains the current listing of criteria for psychological disorders.
These approaches, which are largely unchanged in the  fth edition
(DSM-5) based on recent drafts, guide our thinking in this book.
In conclusion, it is dif cult to de ne “normal” and “abnormal”
(Lilienfeld & Marino, 1995, 1999)—and the debate continues
(Clark, 1999; Klein, 1999; Spitzer, 1999). The most widely accepted
de nition used in the DSM-IV-TR (and drafts of the DSM-5)
describes behavioural, psychological, or biological dysfunctions
that are unexpected in their cultural context and associated with
present distress and impairment in functioning, or increased risk of
suffering, death, pain, or impairment. This de nition can be useful
across cultures and subcultures if we pay careful attention to what
is functional or dysfunctional (or out of control) in a given society.
But it is never easy to decide what represents dysfunction, and
some scholars have argued persuasively that the health professions
will never be able to satisfactorily de ne disease or disorder (see,
for example, Lilienfeld & Marino, 1995, 1999). Perhaps the best
we can do is consider how the apparent disease or disorder matches
a “typical” pro le of a disorder—for example, major depression or
schizophrenia—when most or all symptoms that experts agree are
part of the disorder are present. We call this typical pro le a proto-
type, and, as described in Chapter 3, the diagnostic criteria from
DSM-IV-TR as well as the emerging criteria for DSM-5 found
throughout this book are all prototypes. This means that the patient
may have only some features or symptoms of the disorder (a
minimum number) and still meet criteria for the disorder because
his or her set of symptoms is close to the prototype. This concept is
described more fully in Chapter 3, where the diagnosis of psycho-
logical disorder is discussed.
2. Miguel recently began feeling sad and lonely. Although
still able to function at work and ful ll his other respon-
sibilities, he  nds himself feeling down much of the time,
and he worries about what is happening to him. Which of
the de nitions of abnormality apply to Miguel’s situation?
______________
3. Three weeks ago, Tony, a 35-year-old business executive,
stopped showering, refused to leave his apartment, and
started watching television talk shows. Threats of being
red have failed to bring Tony back to reality, and he
continues to spend his days staring blankly at the tele-
vision screen. Which of the de nitions seem to describe
Tony’s situation? ______________
4. Jane is afraid to leave her home. She used to force herself
to go out to maintain contact with friends and relatives;
however, recently she refuses to go anywhere. Which def-
initions apply to this situation? ______________
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The Science of Psychopathology 7
NEL
their treatment. Many mental health professionals take a scienti c
approach to their clinical work and are therefore referred to as
scientist-practitioners (Barlow, Hayes, & Nelson, 1984; Hayes,
Barlow, & Nelson-Gray, 1999). Mental health practitioners may
function as scientist-practitioners at least one of three ways (see
Figure 1.2). First, they may keep up with the latest scienti c
developments in their  eld and therefore use the most current
diagnostic and treatment procedures. In this sense, they are
consumers of the science of psychopathology to the advantage of
their patients. Second, scientist-practitioners evaluate their own
assessments or treatment procedures to see whether they work.
They are accountable not only to their patients but also to the
government agencies and insurance companies that pay for the
treatments, so they must demonstrate clearly that their treatments
work. Third, scientist-practitioners might conduct research, often
in clinics or hospitals, that produces new information about disor-
ders or their treatment, thus becoming immune to the fads that
plague our  eld often at the expense of patients and their families.
For example, new “miracle cures” for psychological disorders
that are reported several times a year in the popular media would
not be used by a scientist-practitioner who did not have sound
scienti c data showing that they work. Such data  ow from
research that attempts three basic things: to describe psycho-
logical disorders, to determine their causes, and to treat them (see
Figure 1.3). These three categories compose an organizational
structure that recurs throughout this book and is formally evident
in the discussions of speci c disorders beginning in Chapter 5.
“psychotherapist” and “therapist” are not regulated by the provin-
cial and territorial psychology boards or colleges. Thus, in Canada,
the label of “psychologist” conveys information about the training
and quali cations of the professional, whereas the label of
“psychotherapist” does not. In addition, the terms “therapist” and
“psychotherapist” are not speci c to a particular profession. For
example, a social worker, a psychologist, and a psychiatrist can all
refer to themselves as “psychotherapists” if they provide therapy
services to members of the public around psychological issues.
Psychologists with other specialty training, such as experi-
mental and social psychologists, concentrate on investigating the
basic determinants of behaviour but do not assess or treat
psychological disorders. Although a great deal of overlap exists,
counselling psychologists (who can receive a Ph.D., Psy.D., or
Ed.D.—Doctor of Education) tend to study and treat adjustment
and vocational issues encountered by relatively healthy individ-
uals, whereas clinical psychologists usually concentrate on more
severe psychological disorders.
Psychiatrists rst earn an M.D. in medical school and then
specialize in psychiatry during a three-year to four-year residency
training program. Psychiatrists also investigate the nature and
causes of psychological disorders, often from a biological point
of view, make diagnoses, and offer treatments. Many psychiatrists
emphasize drugs or other biological treatments, although most
use psychosocial treatments as well.
Psychiatric social workers typically earn a master’s degree in
social work as they develop expertise in collecting information
relevant to the social and family situation of the individual with a
psychological disorder. Social workers also treat disorders, often
concentrating on family problems associated with them. Psychi-
atric nurses have advanced degrees, such as a master’s or a Ph.D.,
and specialize in the care and treatment of patients with psycho-
logical disorders, usually in hospitals as part of a treatment team.
Finally, marriage and family therapists and mental health coun-
sellors typically spend one to two years earning a master’s degree
and provide clinical services in hospitals or clinics, usually under
the supervision of a doctoral-level clinician. Table 1.1 shows the
number of each major category of mental health professionals
currently practising in Canada.
The Scientist-Practitioner
The most important recent development in the history of psycho-
pathology is the adoption of scienti c methods to learn more
about the nature of psychological disorders, their causes, and
TABLE 1.1 Mental Health Professionals Currently Practising
inCanada
Profession Number Currently Practising
Psychiatrists 3 600
Psychologists, master’s level, and
psychological associates
13 000
Psychiatric nurses 11 000
Psychiatric social workers thousands
Source: Adapted from Goering, Wasylenki, & Durbin, 2000.
FIGURE 1.2 Functioning as a scientist-practitioner
FIGURE 1.3 Three major categories compose the study and
discussion of psychological disorders
Consumer of science
Enhancing the practice
Evaluator of science
Determining the
effectiveness of the
practice
Creator of science
Conducting research
that leads to new
procedures useful
in practice
Scientist-
practioner
Studying
psychological
disorders
Focus
Clinical description
Causation (etiology)
Treatment and outcome
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8 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
The patient’s age may be a very important part of the clinical
description. A speci c psychological disorder occurring in child-
hood may present very differently from the same disorder in
adulthood or old age. Children experiencing severe anxiety and
panic often assume that they are physically ill because they have
dif culty understanding there is nothing physically wrong.
Because their thoughts and feelings are different from those
experienced by adults with anxiety and panic, children are often
misdiagnosed and treated for a medical disorder.
Causation, Treatment, and Outcomes
Etiology, or the study of origins, has to do with why a disorder
begins (what causes it) and includes biological, psychological,
and social dimensions. Because the etiology of psychological
disorders is so important to this  eld, we devote an entire chapter
to it (Chapter 2). Treatment is often important to the study of
psychological disorders. If a new drug or psychosocial treatment
is successful in treating a disorder, it may give us some hints
about the nature of the disorder and its causes. For example, if a
drug with a speci c known effect within the nervous system
alleviates a certain psychological disorder, we know that some-
thing in that part of the nervous system might be either causing
the disorder or helping maintain it. Similarly, if a psychosocial
treatment designed to help clients regain a sense of control over
their lives is effective with a certain disorder, a diminished sense
of control may be an important psychological component of the
disorder itself.
Ageneral overview of the categories now will give you a clearer
perspective on our efforts to understand abnormality.
Clinical Description
In hospitals and clinics we often say that a patient “presents”
with a speci c problem or set of problems, or we discuss the
presenting problem. Presents is a traditional shorthand way of
indicating why the person came to the clinic. Describing Jody’s
presenting problem is the  rst step in determining his clinical
description, which represents the unique combination of behav-
iours, thoughts, and feelings that make up a speci c disorder.
The word clinical refers both to the types of problems or disor-
ders you would  nd in a clinic or hospital and to the activities
connected with assessment and treatment. Throughout this text
are excerpts from many individual cases, most of them from our
personal  les.
Clearly, one important function of the clinical description is
to specify what makes the disorder different from normal
behaviour or from other disorders. Statistical data may also be
relevant. For example, how many people in the population as a
whole have the disorder? This  gure is called the prevalence of
the disorder. Statistics on how many new cases occur during a
given period, such as a year, represent the incidence of the
disorder. Other statistics include the sex ratio—that is, what
percentage of males and females have the disorder—and the
typical age of onset, which often differs from one disorder to
another.
In addition to having different symptoms, a different age of
onset, and possibly a different sex ratio and prevalence, most
disorders follow a somewhat individual pattern, or course. For
example, some disorders, such as schizophrenia (see Chapter 13),
follow a chronic course, meaning that they tend to last a long
time, sometimes a whole lifetime. Other disorders, like mood
disorders (see Chapter 7), follow an episodic course in which the
individual is likely to recover within a few months, only to have
a recurrence of the disorder later. This pattern may repeat
throughout a person’s life. Still other disorders may have a time-
limited course, meaning the disorder will improve without treat-
ment in a relatively short period.
Closely related to differences in the course of disorders are
differences in onset. Some disorders have an acute onset, mean-
ing that they begin suddenly; others develop gradually over an
extended time, which is sometimes called an insidious onset. It is
important to know the typical course of a disorder so that we
know what to expect and how best to deal with the problem. The
anticipated course is an important part of the clinical description.
For example, if someone has a mild disorder with acute onset that
we know is time limited, we might advise the individual to forgo
expensive treatment, because the problem will resolve soon
enough, like a common cold. However, if the disorder is likely to
last a long time (become chronic), the individual might want to
seek treatment and take other appropriate steps. The anticipated
course of a disorder is called the prognosis. So we might say, “the
prognosis is good,” meaning the individual will probably recover,
or “the prognosis is guarded,” meaning the probable outcome
doesn’t look good.
Children experience panic and anxiety differently from adults, so
their reactions may be mistaken for symptoms of physical illness.
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The Supernatural Tradition 9
NEL
treatment that allow us to function as scientist- practitioners. In
Chapters 5 through 15, we examine speci c disorders; our discus-
sion is organized in each case in the now familiar triad of descrip-
tion, cause, and treatment. Finally, in Chapter 16 we examine legal,
professional, and ethical issues that are relevant to psychological
disorders and their treatment in Canada today. With that interview
in mind, let us turn to the past.
The Past: Historical Conceptions of
Abnormal Behaviour
For thousands of years, humans have tried to explain and control
problematic behaviour. But our efforts always derive from the
theories or models of behaviour that are popular at the time. The
purpose of these models is to explain why someone is “acting like
that.” Three major models that have guided us date back to the
beginnings of civilization.
Humans have always supposed that certain agents outside our
bodies and environment in uence our behaviour, thinking, and
emotions. These agents, which might be divinities, demons, spirits,
or other phenomena such as magnetic  elds or the moon or the
stars, are the driving forces behind the supernatural model. In addi-
tion, since ancient Greece, the mind has often been called the soul
or the psyche and considered separate from the body. Although
many have thought that the mind can in uence the body and, in
turn, the body can in uence the mind, most philosophers looked
for causes of abnormal behaviour in one or the other. This split
gave rise to two traditions of thought about abnormal behaviour,
summarized as the biological model and the psychological model.
These three models—the supernatural, the biological, and the
psychological—are very old but still in use today.
The Supernatural Tradition
For much of our recorded history, deviant behaviour has been
considered a re ection of the battle between good and evil. When
confronted with unexplainable, irrational behaviour and by
suffering and upheaval, people perceived evil. A noted historian
chronicled the second half of the 14th century, a particularly dif -
cult time for humanity, in A Distant Mirror (Tuchman, 1978). She
very ably captures the con icting tides of opinion on the origins
and treatment of insanity during that bleak and tumultuous period.
Demons and Witches
One strong current of opinion put the causes and treatment of
psychological disorders squarely in the realm of the supernatural.
During the last quarter of the 14th century, religious and lay author-
ities supported these popular superstitions, and society as a whole
began to believe in the reality and power of demons and witches.
The Catholic Church had split, and a second centre, complete with
a pope, emerged in the south of France to compete with Rome. In
reaction to this schism, the Roman church fought back against the
evil in the world that must have been behind this heresy.
Concept Check 1.2
A clinical description includes the unique combination of
behaviours, thoughts, and feelings that compose a given
psychological disorder. Match the following words that are
used in clinical descriptions with their corresponding
examples: (a) presenting problem, (b) prevalence, (c) inci-
dence, (d) prognosis, (e) course, or (f) etiology.
1. Maria should recover quickly with no intervention neces-
sary. Without treatment, David will deteriorate rapidly.
______________
2. Three new cases of bulimia have been reported in this
county during the past month and only one in the next
county. ______________
3. Elizabeth visited the campus mental health centre
because of her increasing feelings of guilt and anxiety.
______________
4. Biological, psychological, and social in uences all con-
tribute to a variety of disorders. ______________
5. The pattern a disorder follows can be chronic, time lim-
ited, or episodic. ______________
6. How many people in the population as a whole have
obsessive-compulsive disorder? ______________
As we see in the next chapter, psychology is never that simple.
This is because the effect does not necessarily imply the cause. To
use a common example, you might take an aspirin to relieve a
tension headache that you developed during a gruelling day of
taking exams. If you then feel better, it does not mean the headache
was caused by a lack of aspirin in the  rst place. Nevertheless,
many people seek treatment for psychological disorders, and treat-
ment can provide interesting hints about the nature of the disorder.
In the past, textbooks emphasized treatment approaches in a
very general sense, with little attention to the disorder being
treated. For example, a mental health professional might be
thoroughly trained in a single theoretical approach, such as
psychoanalysis or behaviour therapy (both described later in the
chapter), and then use that approach on every disorder. More
recently, as our science has advanced, we have developed speci c
effective treatments that do not always adhere neatly to one theor-
etical approach but that have grown out of a deeper understanding
of the disorder in question. For this reason, this book does not
have separate chapters on such types of treatment approaches as
psychodynamic, cognitive behavioural, or humanistic. Rather, the
latest and most effective drug and psychosocial treatments are
described in the context of speci c disorders, in keeping with our
integrative multidimensional perspective.
We now survey many early attempts to describe and treat abnor-
mal behaviour, and more still to comprehend its causes, which will
give you a better perspective on current approaches. In Chapter 2,
we examine contemporary views of causation and treatment. In
Chapter 3, we discuss efforts to describe, or classify, abnormal
behaviour. In Chapter 4, we review research methods—our system-
atic efforts to discover the truths underlying description, cause, and
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10 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
during the 14th and 15th centuries, people
with mental illnesses, along with people who
had physical deformities or disabilities, were
often moved from house to house in medieval
villages, as neighbours took turns caring for
them. We now know that this medieval prac-
tice of keeping people who have psycho-
logical disturbances in their own community
is bene cial (see Chapter 13). (We return to
this subject when we discuss biological and
psychological models later in this chapter.)
One of the chief advisers to the king of
France, a bishop and philosopher named
Nicholas Oresme, also suggested that the
disease of melancholy (depression), rather
than demons, was the source of some
bizarre behaviour. Oresme pointed out that
much of the evidence for the existence of
sorcery and witchcraft, particularly among
people with psychological disorders, was
obtained from people who were tortured
and who, quite understandably, confessed
to anything.
These con icting crosscurrents of natural
and supernatural explanations for mental
disorders are represented more or less
strongly in various historical works, depending on the sources
consulted by historians. Some assume that demonic in uences
were the predominant explanations of abnormal behaviour
during the Middle Ages (e.g., Zilboorg & Henry, 1941); others
believe the supernatural had little or no in uence. As we see in
the handling of the severe psychological disorder experienced by
King Charles VI of France in the late 14th century, both in u-
ences were strong, sometimes alternating in the treatment of the
same case.
CHARLES VI The Mad King
In the summer of 1392, King Charles VI of France was under a
great deal of stress, in part because of the division of the Cath-
olic Church. As he rode with his army to the province of Brit-
tany, a nearby aide dropped his lance with a loud clatter and
the king, thinking he was under attack, turned on his own army,
killing several prominent knights before being subdued from
behind. The army immediately marched back to Paris. The
king’s lieutenants and advisers concluded that he was mad.
During the following years, at his worst the king hid in
a corner of his castle, believing he was made of glass, or
roamed the corridors howling like a wolf. At other times he
couldn’t remember who or what he was. He became fearful
and enraged whenever he saw his own royal coat of arms
and would try to destroy it if it were brought near him.
The people of Paris were devastated by their leader’s
apparent madness. Some thought it re ected God’s anger,
because the king had failed to take up arms to end the
schism in the Catholic Church; others thought it was God’s
People turned increasingly to magic and sorcery to solve
their problems. During these turbulent times, the bizarre behav-
iour of people af icted with psychological disorders was seen as
the work of the devil and witches. It followed that individuals
possessed by evil spirits were probably responsible for any
misfortune experienced by the townspeople, which inspired
drastic action against the possessed. Treatments included exor-
cism, in which various religious rituals were performed to rid
the victim of evil spirits. Other approaches included shaving the
pattern of a cross in the victims’ hair and securing them to a wall
near the front of a church so that they might bene t from hear-
ing mass.
The conviction that sorcery and witches were causes of
madness and other evils continued into the 15th century. Evil
continued to be blamed for unexplainable behaviour, even after
the European founding of the New World, as evidenced by the
1692 Salem witch trials. This event involved an outbreak of
accusations of witchcraft alleged toward women in a Massachu-
setts village community (Boyer & Nissenbaum, 1974).
Stress and Melancholy
An equally strong opinion, even during this period, re ected the
enlightened view that insanity was a natural phenomenon,
caused by mental or emotional stress, and that it was curable
(Alexander & Selesnick, 1966; Maher & Maher, 1985a). Mental
depression and anxiety were recognized as illnesses (Kemp,
1990; Schoeneman, 1977), although symptoms such as despair
and lethargy were often identi ed by the church with the sin of
acedia, or sloth (Tuchman, 1978). Common treatments were
rest, sleep, and a healthy and happy environment. Other treat-
ments included baths, ointments, and various potions. Indeed,
During the Middle Ages, individuals with psychological disorders were sometimes
thought to be possessed by evil spirits that had to be exorcised through rituals.
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The Supernatural Tradition 11
NEL
(AIDS) epidemic re ects a very similar belief among some
people. Because the human immunode ciency virus (HIV) is, in
Western societies, most prevalent among practising homosexuals,
some people believe it is a divine punishment for what they
consider abhorrent behaviour. This view is slowly dissipating as
the AIDS virus spreads to other “less sinful” segments of the
population, but it still persists. Possession, however, is not always
connected with sin and may be seen as involuntary and the
possessed individual as blameless. Furthermore, exorcisms at
least have the virtue of being relatively painless. Interestingly,
they sometimes work, as do other forms of faith healing, for
reasons we explore in subsequent chapters. But what if they did
not? In the Middle Ages, if exorcism failed, some authorities
thought that steps were necessary to make the body uninhabitable
by evil spirits, and many people were subjected to con nement,
beatings, and other forms of torture (Kemp, 1990).
Somewhere along the way, a creative “therapist” decided that
hanging people over a pit full of poisonous snakes might scare the
evil spirits right out of their bodies (to say nothing of terrifying
the people themselves). Strangely, this approach sometimes
worked; that is, the most disturbed, oddly behaving individuals
would suddenly come to their senses and experience relief from
their symptoms, if only temporarily. Naturally, this was reinfor-
cing to the therapist, and, so, snake pits were built in many institu-
tions. Many other treatments based on the hypothesized
therapeutic element of shock were developed, including dunkings
in ice-cold water.
The Moon and the Stars
Paracelsus, a Swiss physician who lived from 1493 to 1541,
rejected notions of possession by the devil, suggesting instead
that the movements of the moon and stars had profound effects on
people’s psychological functioning. This in uential theory
inspired the word lunatic, which is derived from the Latin word
for moon, luna. You might hear some of your friends explain
something crazy they did last night by saying, “It must have been
the full moon.” The belief that heavenly bodies affect human
behaviour still exists, although no scienti c evidence supports it.
Despite much ridicule, millions of people around the world are
convinced that their behaviour is in uenced by the stages of the
moon or the position of the stars. This belief is most noticeable
today in followers of astrology, who hold that their behaviour and
the major events in their lives can be predicted by their day-to-day
relationship to the position of the planets. However, no serious
evidence has ever con rmed such a connection.
Comments
The supernatural tradition in psychopathology is alive and well,
although it is relegated, for the most part, to some cultures outside
North America and to small religious sects within North America.
Members of organized religions in most parts of the world look to
psychology and medical science for help with major psychological
disorders; in fact, the Roman Catholic Church requires that all
health care resources be exhausted before spiritual solutions such
as exorcism can be considered. Nonetheless, miraculous cures are
sometimes achieved by exorcism, magic potions, rituals, and other
warning against taking up
arms; still others thought it
was divine punishment for
heavy taxes (a conclusion
some people might make
today). But most thought
the king’s madness was
caused by sorcery, a belief
strengthened by a great
drought that dried up the
ponds and rivers, causing
cattle to die of thirst.
Merchants claimed their
worst losses in 20 years.
Naturally, the king was given the best care available. The
most famous healer in the land was a 92-year-old physician
whose treatment program included moving the king to one
of his residences in the country where the air was thought
to be the cleanest in the land. The physician prescribed rest,
relaxation, and recreation. After some time, the king seemed
to recover. The physician recommended that the king not be
burdened with the responsibilities of running the kingdom,
claiming that if he had few worries or irritations, his mind
would gradually strengthen and further improve.
Unfortunately, the physician died and the insanity of King
Charles VI returned more seriously than before. This time,
however, he came under the in uence of the con icting
crosscurrent of supernatural causation. “An unkempt evil-
eyed charlatan and pseudo-mystic named Arnaut Guilhem
was allowed to treat Charles on his claim of possessing a
book given by God to Adam by means of which man could
overcome all af iction resulting from original sin” (Tuchman,
1978, p. 514). Guilhem insisted that the king’s malady was
caused by sorcery, but his treatments failed to effect a cure.
A variety of remedies and rituals of all kinds were tried
but none worked. High-ranking of cials and doctors of the
university called for the “sorcerers” to be discovered and
punished. “On one occasion, two Augustinian friars, after
getting no results from magic incantations and a liquid made
from powdered pearls, proposed to cut incisions in the king’s
head. When this was not allowed by the king’s council, the
friars accused those who opposed their recommendation of
sorcery” (Tuchman, 1978, p. 514). Even the king himself,
during his lucid moments, came to believe the source of
madness was evil and sorcery. “In the name of Jesus Christ,”
he cried weeping in his agony, “if there is any one of you
who is an accomplice in this evil I suffer, I beg him to torture
me no longer but let me die!” ( Tuchman,1978, p. 515).
Treatments for Possession
With a perceived connection between evil deeds and sin on the
one hand, and psychological disorders on the other, it is logical to
conclude that the person is largely responsible for his or her own
disorder, which might well be a punishment for evil deeds. Does
this sound familiar? The acquired immune de ciency syndrome
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12 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
within the biological tradition that extended
well into the 19th century. One of the more
interesting and in uential legacies of the
Hippocratic-Galenic approach is the humoral
theory of disorders. Hippocrates assumed
that normal brain functioning was related to
four bodily  uids, or humors: blood, black
bile, yellow bile, and phlegm. Blood came
from the heart, black bile from the spleen,
phlegm from the brain, and choler or yellow
bile from the liver. Physicians believed that
disease resulted from too much or too little
of one of the humors; for example, too much
black bile was thought to cause melancholia
(depression). In fact, the term melancholer,
which means black bile, is still used today in
its derivative form melancholy to refer to
aspects of depression. The humoral theory
was, perhaps, the  rst example of associat-
ing psychological disorders with chemical
imbalance, an approach that is widespread
today.
The four humors were related to the Greeks’ conception of the
four basic qualities: heat, dryness, moisture, and cold. Each
humor was associated with one of these qualities. Terms derived
from the four humors are still sometimes applied to personality
traits. For example, sanguine (red, like blood) describes someone
who is ruddy in complexion—presumably from copious blood
owing through the body—and cheerful and optimistic, though
insomnia and delirium were thought to be caused by excessive
blood in the brain. Melancholic, of course, refers to a depressive
personality (depression was thought to be caused by black bile
ooding the brain). A phlegmatic personality (from the humor
phlegm) indicates apathy and sluggishness but can also mean
being calm under stress. A choleric person (from yellow bile or
choler) is hot tempered (Maher & Maher, 1985a).
Excesses of one or more humors were treated by regulating the
environment to increase or decrease heat, dryness, moisture, or
cold, depending on which humor was out of balance. One reason
King Charles VI’s physician moved him to the less stressful
countryside was to restore the balance in his humors (Kemp,
1990). In addition to rest, good nutrition, and exercise, two treat-
ments were developed. In bleeding or bloodletting, a carefully
measured amount of blood was removed from the body, often
with leeches. In the other, vomiting was induced; indeed, in a
well-known treatise on depression published in 1621, Anatomy of
Melancholy, Burton recommended eating tobacco and a half-
boiled cabbage to induce vomiting (Burton, 1621/1977). Three
hundred years ago, under the in uence of early biological trad-
itions, Jody might have been diagnosed with an illness, a brain
disorder, or some other physical problem and given the proper
medical treatments of the day, including bed rest, a healthful diet,
exercise, and other ministrations as indicated.
Hippocrates also coined the word hysteria to describe a concept
he learned about from the Egyptians, who had identi ed what we
now call the somatoform disorders (see Chapter 6). In these disor-
ders, the physical symptoms appear to be the result of an organic
pathology for which no organic cause can be found, such as
methods that seem to have little connection with modern science.
It is fascinating to explore them when they do occur, and we return
to this topic in subsequent chapters. But such cases are relatively
rare, and almost no one would advocate supernatural treatment for
severe psychological disorders except, perhaps, as a last resort.
The Biological Tradition
Physical causes of mental disorders have been sought since early
in history. Important to the biological tradition are a man, Hippoc-
rates; a disease, syphilis; and the early consequences of believing
that psychological disorders are biologically caused.
Hippocrates and Galen
The Greek physician Hippocrates (460–377 ...) is considered
the father of modern medicine. He and his associates left a body of
work called the Hippocratic Corpus, written between 450 ...
and 350 ... (Maher & Maher, 1985a), in which they suggested
that psychological disorders could be treated like any other disease.
They did not limit their search for the causes of psychopathology
to the general area of “disease,” because they believed that psycho-
logical disorders might also be caused by brain pathology or head
trauma and could be in uenced by heredity (genetics). These were
remarkably astute deductions for the time, and they have been
supported in recent years. Hippocrates considered the brain to be
the seat of wisdom, consciousness, intelligence, and emotion.
Therefore, disorders involving these functions would logically be
located in the brain. Hippocrates also recognized the importance of
psychological and interpersonal contributions to psychopathology,
such as the sometimes negative effects of family stress; on some
occasions, he removed patients from their families.
The Roman physician Galen (ca. 129–198 ..) later adopted
the ideas of Hippocrates and his associates and developed them
further, creating a powerful and in uential school of thought
In hydrotherapy, patients were shocked back to their senses by being submerged in
ice-cold water.
Culver Pictures
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The Biological Tradition 13
NEL
19thcentury by two factors: the discovery of the nature and cause
of syphilis, and strong support from the well-respected American
psychiatrist John P. Grey.
Syphilis
Behavioural and cognitive symptoms of what we now know as
advanced syphilis include believing that everyone is plotting
against you (delusion of persecution) or that you are God (delu-
sion of grandeur), as well as other bizarre behaviours. Although
these symptoms are very similar to those of psychosis, research-
ers recognized that a subgroup of apparently psychotic patients
deteriorated steadily, becoming paralyzed and dying within  ve
years of onset. This course of events contrasted with that of most
psychotic patients, who remained fairly stable. In 1825, the
condition was designated a disease, general paresis, because it
had consistent symptoms (presentation) and a consistent course
that resulted in death. The relationship between general paresis
and syphilis was only gradually established. Louis Pasteur’s germ
theory of disease, around 1870, facilitated the identi cation of the
speci c bacterial micro-organism that caused syphilis. Pasteur
stated that all the symptoms of a disease were caused by a germ
(bacterium) that had invaded the body.
Of equal importance was the discovery of a cure for general
paresis. Physicians observed a surprising recovery in patients who
had contracted malaria and deliberately injected others with
blood from a soldier who was ill with malaria. Many recovered,
because the high fever “burned out” the syphilis bacteria.
Obviously, this type of experiment would not be ethically possible
today. Ultimately, clinical investigators discovered that penicillin
cures syphilis, but the malaria cure convinced many for the  rst
time that “madness” and associated behavioural and cognitive
symptoms could be traced directly to a curable infection. Many
mental health professionals then assumed that comparable causes
and cures might be discovered for all psychological disorders.
paralysis and some kinds of blindness. Because these disorders
occurred primarily in women, the Egyptians (and Hippocrates)
mistakenly assumed that they were restricted
to women. They also presumed a cause: The
empty uterus wandered to various parts of
the body in search of conception (the Greek
for “uterus” is hysteron). Numerous physical
symptoms re ected the location of the
wandering uterus. The prescribed cure might
be marriage or, occasionally, fumigation of
the vagina to lure the uterus back to its
natural location (Alexander & Selesnick,
1966). Knowledge of physiology eventually
disproved the wandering uterus theory;
however, the tendency to stigmatize dramatic
women as “hysterical” continued unabated
well into the 1970s, when mental health
professionals became sensitive to the preju-
dicial stereotype the term implied.
The 19th Century
The biological tradition waxed and waned
during the centuries after Hippocrates and
Galen, but was reinvigorated in the
Bloodletting, the extraction of blood from patients, was intended to
restore the balance of humors in the body.
In the 19th century, psychological disorders were attributed to mental or emotional stress,
so patients were often treated sympathetically in a restful and hygienic environment.
National Library of Medicine
National Library of Medicine
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14 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
During the 1950s, the  rst effective drugs for severe psychotic
disorders were developed in a systematic way, and they were
introduced to Canada by psychiatrist Heinz Lehman. Before that
time, a number of medicinal substances, including opium (derived
from poppies), had been used as sedatives, along with countless
herbs and folk remedies (Alexander & Selesnick, 1966). With the
discovery of Rauwol a serpentina (later renamed reserpine) and
another class of drugs called neuroleptics (major tranquilizers),
for the  rst time hallucinatory and delusional thought processes
could be diminished; these drugs also controlled agitation and
aggressiveness. Other discoveries included benzodiazepines
(minor tranquilizers), which seemed to reduce anxiety. By the
1970s, the benzodiazepines (known by such brand names as
Valium and Librium) were among the most widely prescribed
drugs in the world. As drawbacks and side effects of tranquilizers
became apparent, along with their limited effectiveness, the
number of prescriptions decreased somewhat (we discuss the
benzodiazepines in more detail in Chapters 5 and 11).
Throughout the centuries, as Alexander and Selesnick (1966,
p.287) point out, “The general pattern of drug therapy for mental
illness has been one of initial enthusiasm followed by disappoint-
ment.” For example, bromides, a class of sedating drugs, were used
at the end of the 19th and the beginning of the 20th centuries to treat
anxiety and other psychological disorders. By the 1920s they were
reported as being effective for many serious psychological and
emotional symptoms. By 1928, one of every  ve prescriptions in the
United States was for bromides. When their side effects, including
various undesirable physical symptoms, became widely known, and
experience began to show that their overall effectiveness was rela-
tively modest, bromides largely disappeared from the scene.
Neuroleptics were also used less when attention focused on
their many side effects, such as tremors and shaking. However, the
positive effects of these drugs on some patients’ psychotic symp-
toms of hallucinations, delusions, and agitation revitalized both
the search for biological contributions to psychological disorders
and the search for new and more powerful drugs, a search that has
paid many dividends, as documented in later chapters.
Consequences of the Biological Tradition
In the late 19th century, John P. Grey and his colleagues, ironic-
ally, reduced or eliminated interest in treating patients with mental
illnesses because they thought mental disorders were dueto some
as yet undiscovered brain pathology and were therefore incurable.
The only available course of action was to hospitalize these
patients. In fact, around the turn of the 20th century, somenurses
documented clinical success in treating mental patients with
psychological methods but were prevented from treating others for
fear of raising hopes of a cure among family members. In place of
treatment, interest centred on diagnosis, legal questions concern-
ing the responsibility of patients for their actions during periods of
insanity, and the study of brain pathology itself.
Emil Kraepelin (1856–1926) was the dominant  gure during
this period and one of the founding fathers of modern psychiatry.
He was extremely in uential in advocating the major ideas of the
biological tradition, but he was little involved in treatment,
re ecting the belief that disorders were due to brain pathology.
His lasting contribution was in the area of diagnosis and
John P. Grey
The champion of the biological tradition in North America was a
very in uential psychiatrist named John P. Grey, who was appointed
superintendent of a large hospital in New York in 1854 (Bockoven,
1963). Grey also became editor of the American Journal of Insan-
ity, the precursor of the current American Journal of Psychiatry,
and the  agship publication of the American Psychiatric Associa-
tion. Grey’s position was that insanity always has physical causes.
Therefore, the mentally ill patient should be treated as physically ill.
The emphasis was once again on rest, diet, and proper room
temperature and ventilation, approaches used for centuries by previ-
ous therapists in the biological tradition. Grey even invented the
rotary fan in order to ventilate his large hospital.
Under Grey’s leadership, the conditions in hospitals greatly
improved, and they became more humane, livable institutions.
But in subsequent years they also became so large and impersonal
that individual attention was not possible.
In fact, leaders in psychiatry at the end of the 19th century
were alarmed at the increasing size and impersonality of mental
hospitals and recommended that they be downsized. It was almost
100 years before the community mental health movement was
successful in reducing the population of mental hospitals with the
very controversial policy of deinstitutionalization, in which
patients were released into their communities. Unfortunately, this
practice had as many negative consequences as positive ones,
including a large increase in the number of patients with chronic
disabilities left homeless on the streets of our cities.
The Development of Biological Treatments
On the positive side, renewed interest in the biological origin of
psychological disorders led, ultimately, to an increased understanding
of the biological contributions to psychopathology and to the develop-
ment of new treatments. In the 1930s, the physical interventions of
electric shock and brain surgery were often used. Their effects, and the
effects of new drugs, were discovered quite by accident. For example,
insulin was occasionally given to stimulate appetite in psychotic
patients who were not eating, but it also seemed to calm them down.
In 1927, a Viennese physician, Manfred Sakel, began using higher and
higher dosages until,  nally, patients convulsed and became temporar-
ily comatose (Sakel, 1958). Some actually recovered their mental
health, much to the surprise of everybody, and their recovery was
attributed to the convulsions. The procedure became known as insulin
shock therapy, but it was abandoned because it was too dangerous,
often resulting in prolonged coma or even death. Other methods of
producing convulsions had to be found.
In the 1920s, Joseph von Meduna observed that schizophrenia
was very rarely found in epileptics (which ultimately did not prove
to be true). Some of his followers concluded that induced brain seiz-
ures might cure schizophrenia. Following suggestions on the possible
bene ts of applying electric shock directly to the brain—notably, by
two Italian physicians, Cerletti and Bini, in 1938—a surgeon in
London treated a depressed patient by sending six small shocks
directly through his brain, producing convulsions (Hunt, 1980). The
patient recovered. Though greatly modi ed, shock treatment is still
with us today. The controversial modern uses of electroconvulsive
therapy (ECT) are described in Chapter 7. It is interesting that even
now we have very little knowledge of how ECT works.
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The Psychological Tradition 15
NEL
psychological factors but also on social and cultural ones. Other
well-known early philosophers, including Aristotle, also empha-
sized the in uence of the social environment and early learning
on later psychopathology. These philosophers wrote about the
importance of fantasies, dreams, and cognitions and thus antici-
pated, to some extent, later developments in psychoanalytic
thought and cognitive science. They also advocated humane and
responsible care for people with psychological disturbances.
Moral Therapy
During the  rst half of the 18th century, a strong psychosocial
approach to mental disorders called moral therapy became in u-
ential (Taubes, 1998). The term moral really meant “emotional”
or “psychological” rather than a code of conduct. Its basic tenets
included treating institutionalized patients as normally as possible
in a setting that encouraged and reinforced normal social inter-
action (Bockoven, 1963; Taubes, 1998), thus providing them with
many opportunities for appropriate social and interpersonal
contact. Relationships were carefully nurtured. Individual atten-
tion clearly emphasized positive consequences for appropriate
interactions and behaviour; the staff made a point of modelling
this behaviour. Lectures on various interesting subjects were
provided, and restraint and seclusion were eliminated.
Once again, these are old ideas. The principles of moral ther-
apy date back to Plato and beyond. But moral therapy as a system
originated with the well-known French psychiatrist Philippe Pinel
(1745–1826; Zilboorg & Henry, 1941). A former patient, Pussin,
long since recovered, was working in the Parisian hospital La
Bicêtre when Pinel took over. Pussin had already instituted
remarkable reforms, remembering, perhaps, being shackled as a
patient himself. Pussin persuaded Pinel to go along with the
classi cation, which we discuss in detail in Chapter 3. Kraepelin
(1913) was one of the  rst to distinguish among various psycho-
logical disorders, seeing that each may have a different age of
onset and course, with somewhat different clusters of presenting
symptoms and probably a different cause. Many of his descrip-
tions of schizophrenic disorders are still useful today.
By the end of the 19th century, a scienti c approach to psycho-
logical disorders and their classi cation had begun with the search
for biological causes. Furthermore, treatment was based on humane
principles. However, there were many drawbacks, the most
unfortunate being that active intervention and treatment were all
but eliminated in some settings, despite the fact that some very
effective approaches were available. It is to these that we now turn.
Concept Check 1.3
For thousands of years, humans have tried to understand
and control abnormal behaviour. Check your understanding
of these historical theories and match them to the treatments
used to “cure” abnormal behaviour: (a) marriage; fumiga-
tion of the vagina; (b) hypnosis; (c) bloodletting; induced
vomiting; (d) patient placed in socially facilitative environ-
ments; and (e) exorcism; burning at the stake.
1. Supernatural causes; evil demons took over the victims’
bodies and controlled their behaviours. ________________
2. The humoral theory re ected the belief that normal func-
tioning of the brain required a balance of four bodily
uids, or humors. ________________
3. Maladaptive behaviour was caused by poor social and cul-
tural in uences within the environment. ________________
The Psychological
Tradition
It is a long leap from evil spirits to brain
pathology as causes of psychological disor-
ders. In the intervening centuries, where
was the body of thought that put psycho-
logical development, both normal and
abnormal, in an interpersonal and social
context? In fact, this approach has a long
and distinguished tradition. Plato, for
example, thought that the two causes of
maladaptive behaviour were the social and
cultural in uences in a person’s life and the
learning that took place in that environment.
If something was wrong in the environment,
such as abusive parents, a person’s impulses
and emotions would overcome reason. The
best treatment was to reeducate the individual
through rational discussion so that the power
of reason would predominate (Maher &
Maher, 1985a). This approach was very
much a precursor to modern psychosocial
approaches, which focus not only on Patients with psychological disorders were freed from chains and shackles as a result of the
in uence of Philippe Pinel (1745–1826), a pioneer in making mental institutions more humane.
Stock Montage
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16 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
institution was 200 or fewer,
allowing for a great deal of indi-
vidual attention. However,
patient loads in existing hospi-
tals increased to 1000, 2000,
and more with the enormous
waves of immigrants arriving in
North America at the time.
A second reason for the
decline of moral therapy has
an unlikely source. The great
crusader Dorothea Dix (1802–
1887) campaigned endlessly
for reform in the treatment of
the insane throughout Canada
and the United States. A school-
teacher who had worked in
various institutions, she had
rsthand knowledge of the
deplorable conditions imposed
on people with mental
disorders, and she made it her
life’s work to inform the public and their leaders of these abuses.
Her work became known as the mental hygiene movement.
According to Hurd, Drewry, Dewey, Pilgrim, Blumer, and
Burgess (1916), Dix visited Canada in 1843 and 1844 and discov-
ered appalling conditions involving the incarceration of “lunatics”
at Beauport in Québec and in the Toronto Jail. She was involved
in the construction of the asylum in St. John’s, Newfoundland, in
1854. Probably most notable of her contributions to the mental
hygiene movement in Canada was her appeal to the Nova Scotia
Legislature in January 1850, when she described the deplorable
conditions for people with mental illnesses at the time and argued
for the development of an asylum in Nova Scotia:
In imagination, for a short time, place yourselves in their stead:
enter the horrid, noisome cell, invest yourselves with the foul,
tattered garments which scantily serve the purposes of decent
protection; cast yourselves upon the loathsome pile of  lthy straw;
nd companionship in your own cries and groans, or in the
wailings and gibberings of wretches miserable like yourselves; call
changes. Much to Pinel’s credit, he did,  rst at La Bicêtre and
then at the women’s hospital Salpétrière (Maher & Maher, 1985b;
Weiner, 1979), where a humane, socially facilitative atmosphere
produced “miraculous” results.
After William Tuke (1732–1822) followed Pinel’s lead in
England, Benjamin Rush (1745–1813), often considered the founder
of North American psychiatry, introduced moral therapy to the New
World. It then became the treatment of choice in the leading hospi-
tals. Asylums had appeared in the 16th century in Europe, with the
intent of providing places of refuge for the con nement and care of
people with mental illnesses. However, these early asylums were
more like prisons than hospitals. Many housed beggars as well as
people with a variety of mental illnesses, conditions were often
deplorable, and little was provided to patients in the way of treat-
ment regimens. It was the rise of moral therapy in Europe and North
America that made institutions habitable and even therapeutic.
Sussman (1998) provides a description of the history of the
development of asylums in Canada in the 19th century. He notes
that institutionalizing people with mental illnesses in Canada
began with humane intentions, to relieve the suffering and neglect
of these individuals who had previously been placed in jails or
poorhouses, or left to care for themselves in the community. The
provinces proceeded relatively independently to develop separate
and more adequate provisions for people with mental illness in
the form of mental hospitals or “asylums” (see Table 1.2 for a
summary). Asylum development in most provinces was in u-
enced to a great extent by systems and movements in Great
Britain and to a lesser extent by those in the United States. The
involvement of religious orders in the care of people with mental
illnesses in Québec was in uenced by practices occurring in
France. According to Sussman (1998), the development of
asylums through the moral therapy movement did bring some
relief to many people with mental illnesses.
Asylum Reform and the Decline
ofMoralTherapy
Unfortunately, after the mid-19th century, humane treatment declined
because of a convergence of factors. First, it was widely recognized
that moral therapy worked best when the number of patients in an
Dorothea Dix (1802–1887)
began the mental hygiene
movement and spent much of
her life campaigning in the
United States and Canada for
reform in the treatment of
people with mental illnesses.
TABLE 1.2 Development of the First Asylums in Canada
Province Date Notes
Québec 1845 Beauport, or the Québec Lunatic Asylum, was opened.
New Brunswick 1847 The Provincial Lunatic Asylum was erected.
Ontario 1850 The Provincial Lunatic Asylum in Toronto admitted patients.
Newfoundland 1854 An asylum was erected and admitted its  rst patients.
Nova Scotia 1857 The  rst patients were admitted to the Provincial Hospital for the Insane.
Prince Edward Island 1877 The Prince Edward Island Hospital for the Insane was built.
Manitoba 1886 The Selkirk Lunatic Asylum admitted patients.
Saskatchewan 1911 The Saskatchewan Provincial Hospital admitted its  rst patients.
Alberta 1914 The Insane Asylum in Ponoka was opened.
Library of Congress Prints and Photographs Division Washington, D.C.
20540 USA
Source: Adapted from Table 1 of: Sussman, S. “The First Asylums in Canada: A Response to Neglectful Community Care and Current Trends.” Canadian Journal of
Psychiatry 1998; 43(3):260-264.
Vintage Postcards of Hamilton, Ontario by Janet
Forjan-Freedman www.hamiltonpostcards.com
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The Psychological Tradition 17
NEL
A  nal blow to the practice
of moral therapy, mentioned
earlier, was the decision, in
the middle of the 19th century,
that mental illness was caused
by brain pathology and, there-
fore, was incurable.
The psychological tradition
lay dormant for a time, only
to reemerge in several very
different schools of thought
in the 20th century. The  rst
major approach was psycho-
analysis, based on Sigmund
Freud’s (1856–1939) elaborate
theory of the structure of the
mind and the role of uncon-
scious processes in determin-
ing behaviour. The second was
behaviourism, associated with
John B. Watson, Ivan Pavlov,
and B. F. Skinner, which
focuses on how learning and adaptation affect the development of
psychopathology.
Psychoanalytic Theory
Have you ever felt as if someone had cast a spell on you? Have
you ever been mesmerized by a look across a room from an
attractive woman or man, or a stare from a rock musician as you
sat in front at a concert? If so, you have something in common
with the patients of Austrian physician Anton Mesmer (1734–
1815) and with millions of people since his time who have been
hypnotized. Mesmer suggested to his patients that their problem
was due to an undetectable  uid found in all living organisms
called “animal magnetism” that could become blocked. Mesmer
had his patients sit in a dark room around a large vat of chemicals
with rods extending from it and touching the patients. Dressed in
owing robes, he might then identify and tap various areas of
their bodies where their animal magnetism was blocked while
suggesting strongly that they were being cured. Because of his
rather unusual techniques, Mesmer was considered an oddity and
maybe a charlatan and was strongly opposed by the medical
establishment (Winter, 1998).
Benjamin Franklin put animal magnetism to the test by
conducting a brilliant experiment in which patients received
either magnetized water or nonmagnetized water with strong
suggestions that they would get better. Neither the patient nor the
therapist knew which water was which, making it a “double-
blind” experiment (see Chapter 4). When both groups got better,
Franklin concluded that animal magnetism, or mesmerism, was
nothing more than strong suggestion (Gould, 1990; McNally,
1999). Nevertheless, Mesmer is widely regarded as the father of
hypnosis, a state in which suggestible subjects sometimes appear
to be in a trance.
Many distinguished scientists and physicians were very
interested in Mesmer’s powerful methods of suggestion. One
of the best known, Jean Charcot (1825–1893), was head of the
for help and release, for blessed words or soothing and kind of ces
of care, till the dull walls are weary in sending back the echo of
your moans; then, if self-possession is not overwhelmed under the
imaginary miseries of what are the actual distresses of the insane,
return to the consciousness of your sound intellectual health, and
answer if you will longer refuse or delay to make adequate
appropriations for the establishment of a provincial hospital for
those who are deprived of reason, and thereby of all that gladdens
life or makes existence a blessing. (Hurd et al., 1916, p. 493)
In addition to improving the standards of care, Dix worked
hard to make sure that everyone who needed care received it,
including homeless people. Through her efforts, humane treat-
ment became more widely available in North American institu-
tions. As her career drew to a close, she was rightly acknowledged
as a hero of the 19th century.
Unfortunately, an unforeseen consequence of Dix’s heroic
efforts was a substantial increase in the number of mental
patients. This in ux led to a rapid transition from moral therapy
to custodial care because hospitals were inadequately staffed. Dix
reformed asylums and single-handedly inspired the construction
of numerous new institutions. But even her tireless efforts and
advocacy could not ensure suf cient staf ng to allow the individ-
ual attention necessary for effective moral therapy. Unfortunately,
institutionalization in Canada eventually “became a synonym for
an inhumane response to mentally ill people” (Sussman, 1998,
p. 262), often because resources were insuf cient to provide
adequate care.
An important mental health reformer and crusader who
followed Dix’s example was Clarence Hincks, a University of
Toronto medical school graduate who cofounded the Canadian
Committee for Mental Hygiene in 1918. Early in his career, he
toured mental institutions throughout Manitoba. In his unpublished
autobiography and his report to the Manitoba government, Hincks
documented continued appalling conditions for the people with
mental illnesses in these institutions (Grif n, 1989; Roland,
1990). Hincks often found that those working in institutions—
including the superintendents—had no special psychiatric
training. In one case there was only one doctor in charge of 700
patients, and he also acted as the superintendent. In one institution
in Portage La Prairie, Hincks encountered a woman who had
been left in a closet for two years, and had only been allowed out
once, and then within the con nes of a cage. Hincks noted that
some of the institutions were not even meant for those with
mental illness, but had come to house them anyway despite
having no methods for caring for them. At another Manitoban
institution, he discovered that mentally ill patients were locked
into cof n-like boxes at night to sleep, and in another, “mentally
defective” children were rolled in long strips of cotton at night,
with their arms and legs bound, and then placed on shelves to
sleep. Hincks had himself experienced and recovered from a bout
of major depression while in university. His personal experience
in recovering from depression led him to advocate for the idea
that mental illness was treatable. Hincks’s position stood in
contrast to the prevailing view at the time that mental illness was
incurable. In fact, one Manitoba institution that Hincks visited in
1918 in Portage La Prairie was named the “Home for Incurables”
(Roland 1990).
Clarence Hincks (1885–1964)
was an early crusader for the
mental hygiene movement in
Canada. He cofounded the
Canadian National Committee
for Mental Hygiene in 1918—a
precursor to today’s Canadian
Mental Health Association.
From In Search of Sanity: A Chronicle of the Canadian Mental Health
Association 1918-1988 by John D. Grif n MD, MA, DPM(E), FRCP(C).
Reprinted with permission of the Canadian Mental Health Association
01_Ch01.indd 1701_Ch01.indd 17 23/12/11 12:42 PM23/12/11 12:42 PM
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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18 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
problems, con icts, and fears
in as much detail as they could.
Breuer observed two extremely
important phenomena during
this process. First, patients
often became extremely emo-
tional as they talked and felt
quite relieved and improved
after emerging from the
hypnotic state. Second, seldom
would patients have gained an
understanding of the relation-
ship between their emotional
problems and their psycho-
logical disorder. In fact, it was
dif cult or impossible for
them to recall some of the
details they had described
under hypnosis. In other words,
the material seemed to be beyond the awareness of the patient.
With this observation, Breuer and Freud had “discovered” the
unconscious mind and its apparent in uence on the production
of psychological disorders. This discovery is one of the
most important developments in the history of psychology as a
whole.
A close second was their discovery that recalling and reliv-
ing emotional trauma that has been made unconscious and
releasing the accompanying tension is therapeutic—a process
that became known as catharsis. A fuller understanding of the
relationship between current emotions and earlier events is
called insight. As we see throughout this book, particularly in
Chapters 5 and 6 on anxiety and somatoform disorders, the
existence of unconscious memories and feelings and the
importance of processing emotion-laden information have been
veri ed and reaf rmed.
Freud and Breuer’s theories were based
on systematic case observations. An excel-
lent example is Breuer’s classic description
of his treatment of “hysterical” symptoms in
Anna O. in 1895 (Breuer & Freud, 1957).
Anna O. was a young woman who was
perfectly healthy until she turned 21. Shortly
before her problems began, her father
developed a serious chronic illness that led
to his death. Throughout his illness, Anna O.
had cared for him, spending hours at his
bedside. Five months after her father became
ill, Anna noticed that during the day her
vision blurred and periodically she had dif -
culty moving her right arm and both legs.
Soon, she began to experience some dif -
culty speaking, and her behaviour became
very erratic. Shortly thereafter, she consulted
Breuer.
In a series of treatment sessions, Breuer
dealt with one symptom at a time through
hypnosis and subsequent “talking through,”
tracing each symptom to its hypothetical
Salpétrière Hospital in Paris, where Philippe Pinel had intro-
duced psychological treatments several generations earlier. A
distinguished neurologist, Charcot demonstrated that some of
the techniques of mesmerism were effective with several
psychological disorders, and he did much to legitimize the
edgling practice of hypnosis while doing away with the  ow-
ing robes and chemicals. Signi cantly, in 1885 a young man
named Sigmund Freud came from Vienna to study with
Charcot.
After returning from France, Freud teamed up with Josef Breuer
(1842–1925), who had experimented with a somewhat different
hypnotic procedure. While his patients were in the highly
suggestible state of hypnosis, Breuer asked them to describe their
Anton Mesmer (1734–1815) and other early therapists used strong
suggestions to cure their patients, who were often hypnotized.
Jean Charcot (1825–1893) studied hypnosis and in uenced Sigmund Freud to consider
psychosocial approaches to psychological disorders.
Josef Breuer (1842–1925)
worked on the celebrated case
of Anna O. and, with Freud,
developed the theory of
psychoanalysis.
Mary Evans Picture Library
Erich Lessing/Art Resource, NY
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The Psychological Tradition 19
NEL
be fully aware of their mean-
ing. The id is the source of our
strong sexual and aggressive
energies or our instinctual
drives—the “animal” within
us. The positive energy or drive
within the id is the libido. Even
today some people explain low
sex drive as an absence of
libido. A less important source
of energy is the death instinct,
or thanatos. Much like matter
and antimatter, these two basic
drives toward life and domin-
ance and ful llment on the one
hand, and death and destruc-
tion on the other, are continu-
ally in opposition.
The id operates according to the pleasure principle, with an
overriding goal of maximizing pleasure and eliminating any asso-
ciated tension or con icts. The goal of pleasure, which is particu-
larly prominent in childhood, often con icts with social rules and
regulations, as we see later. The id has its own characteristic way
of processing information; referred to as primary process, this type
of thinking is very emotional, irrational, illogical, led with fanta-
sies, and preoccupied with sex, aggression, sel shness, and envy.
Fortunately for all of us, in Freud’s view, the id’s sel sh and
sometimes dangerous drives do not go unchecked. In fact, only a
few months into life, we know we must adapt our basic demands to
the real world; we must  nd ways to meet our basic needs without
offending everyone around us. The part of our mind that ensures we
act realistically is called the ego, and it operates according to the
reality principle instead of the pleasure principle. The cognitive
operations or thinking styles of the ego, characterized by logic and
reason, are referred to as the secondary process, as opposed to the
illogical and irrational primary process of the id.
The third important structure within the mind, the superego, or
what we might call the conscience, represents the moral principles
instilled in us by our parents and our culture. It is the voice within
us that nags at us when we know we’re
doing something wrong. Because the
purpose of the superego is to counteract the
aggressive and sexual drives of the id that
are potentially dangerous, the basis for
con ict is readily apparent.
The role of the ego is to mediate con ict
between the id and the superego, juggling
their demands with the realities of the world.
The ego is often called the executive or
manager of our minds. If it mediates success-
fully, we can go on to the higher intellectual
and creative pursuits of life. If it is unsuccess-
ful, and the id or the superego becomes too
strong, con ict will overtake us and psycho-
logical disorders will develop. Because these
con icts are all within the mind, they are
called intrapsychic con icts. Finally, Freud
believed the id and the superego are almost
causation in circumstances
surrounding the death of
Anna’s father. One at a time
her “hysterical” ailments
disappeared, but only after
treatment was administered to
each respective behaviour.
This process of treating one
behaviour at a time ful lls a
basic requirement for drawing
scienti c conclusions about
the effects of treatment in an
individual case study, as we
see in Chapter 4.
Freud took these basic obser-
vations and expanded them into
the psychoanalytic model, the
most comprehensive theory yet
constructed on the development
and structure of our personal-
ities. He also speculated on
where this development could
go wrong and produce psycho-
logical disorders.
Although most of it remains unproven, psychoanalytic theory
has had a strong in uence, and it is important to be familiar with
its basic ideas; what follows is a brief outline of the theory. We
focus on its three major facets: (1) the structure of the mind and
the distinct functions of personality that sometimes clash with
one another; (2) the defence mechanisms with which the mind
defends itself from these clashes or con icts; and (3) the stages of
early psychosexual development that provide grist for the mill of
our inner con icts.
The Structure of the Mind
The mind, according to Freud, has three major parts or functions:
the id, ego, and superego (see Figure 1.4). These terms, like many
from psychoanalysis, have found their way into our common
vocabulary, and although you may have heard them, you may not
Bertha Pappenheim (1859–
1936), famous as Anna O., was
described as “hysterical” by
Breuer.
Sigmund Freud (1856–1939)
is considered the founder of
psychoanalysis.
Mary Evans Picture Library
Bettmann/Corbis Canada
FIGURE 1.4 Freud’s structure of the mind
Go to www.abnormalpsych3e.nelson.com to access an interactive version
of this  gure.
Illogical;
emotional;
irrational
Logical;
rational
Conscience Moral
principles
Reality
principle
Pleasure
principle
Type of thinking Driven by
Intrapsychic
conflicts
Superego
Ego
Mediator
Id
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20 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
Vaillant, 1986). For example, different psychological disorders
seem to be associated with different defence mechanisms (Pollack
& Andrews, 1989), which might be important in planning treat-
ment. Vaillant (1976) noted that healthy defence mechanisms,
such as humour and sublimation, were correlated with psycho-
logical health. Thus, the concept of defence mechanisms—
“coping styles,” in contemporary terminology—continues to be
important to the study of psychopathology.
Psychosexual Stages of Development
Freud also theorized that during infancy and early childhood, we
pass through several psychosexual stages of development that
have a profound and lasting impact, thus providing the  rst
developmental perspective on abnormal behaviour. The stages—
oral, anal, phallic, latency, and genital—represent distinctive
patterns of gratifying our basic needs and satisfying our drive for
physical pleasure. For example, the oral stage, typically extending
for approximately two years from birth, is characterized by a
central focus on the need for food. In the act of sucking, necessary
for feeding, the lips, tongue, and mouth become the focus of libid-
inal drives and, therefore, the principal source of pleasure. Freud
hypothesized that, if we did not receive appropriate grati cation
during a speci c stage or if a speci c stage left a particularly strong
impression (which he termed xation), an individual’s personality
would re ect the stage throughout adult life. For example,  xation
at the oral stage might result in excessive thumb sucking and
emphasis on oral stimulation through eating, chewing pencils, or
biting  ngernails. Adult personality characteristics theoretically
associated with oral  xation include dependency and passivity or,
in reaction to these tendencies, rebelliousness and cynicism.
One of the more controversial and frequently mentioned
psychosexual con icts occurs during the phallic stage (from age
three to age  ve or six), which is characterized by early genital
self-stimulation. This con ict is the subject of the Greek tragedy
Oedipus Rex, in which Oedipus is fated to kill his father and,
unknowingly, to marry his mother. Freud asserted that all young
boys relive this fantasy when genital self-stimulation is accom-
panied by images of sexual interactions with their mothers. These
fantasies, in turn, are accompanied by strong feelings of envy and
perhaps anger toward their fathers, with whom they identify but
whose place they want to take. Furthermore, strong fears develop
that the father may punish that lust by removing the son’s penis—
thus, the phenomenon of castration anxiety. This fear helps the
boy keep his lustful impulses toward his mother in check. The
battle of the lustful impulses on the one hand and castration
anxiety on the other creates a con ict that is internal, or intra-
psychic, called the Oedipus complex. The phallic stage passes
uneventfully only if several things happen. First, the child must
resolve his ambivalent relationship with his parents and reconcile
the simultaneous anger and love he has for his father. If this
happens, he may go on to channel his libidinal impulses into
heterosexual relationships while retaining harmless affection for
his mother. Development of the superego is another consequence
of successfully resolving this con ict.
The counterpart con ict in girls, called the Electra complex, is
even more controversial. Freud viewed the young girl as wanting
to replace her mother and possess her father. Central to this
possession is the girl’s desire for a penis, so as to be more like her
entirely unconscious. We are fully aware only of the secondary
processes of the ego, which is a relatively small part of the mind.
Defence Mechanisms
The ego  ghts a continual battle to stay on top of the warring id
and superego. Occasionally, their con icts produce anxiety that
threatens to overwhelm the ego. The anxiety is a signal that alerts
the ego to marshal defence mechanisms, unconscious protective
processes that keep primitive emotions associated with con icts
in check so the ego can continue its coordinating function.
Although Freud  rst conceptualized defence mechanisms, it was
his daughter, Anna Freud, who developed the ideas more fully.
We all use defence mechanisms at times—sometimes they are
adaptive and sometimes they are maladaptive. For example, have you
ever done poorly on a test because the professor was unfair in the
grading? And then when you got home, you yelled at your brother or
perhaps at your dog? This is an example of the defence mechanism of
displacement. The ego adaptively “decides” that expressing primitive
anger at your professor might not be in your best interest. Because
your brother and your dog don’t have the authority to affect you in an
adverse way, your anger is displaced to one of them. Indeed, the
DSM-IV-TR includes an axis of defence mechanisms in the appendix.
Here are some examples of defence mechanisms (adapted from the
DSM-IV-TR, American Psychiatric Association, 2000a):
Denial: Refuses to acknowledge some aspect of objective
reality or subjective experience that is apparent to others (e.g.,
a person not facing the fact that a romantic relationship is
over).
Displacement: Transfers a feeling about, or a response to, an
object that causes discomfort onto another, usually less threat-
ening, object or person (e.g., kicking the dog when actually
angry with a teacher).
Projection: Falsely attributes own unacceptable feelings,
impulses, or thoughts to another individual or object (e.g., a
man with sexual feelings toward a certain woman thinks that
woman is “coming on” to him).
Rationalization: Conceals the true motivations for actions,
thoughts, or feelings through elaborate reassuring or self-
serving but incorrect explanations (e.g., after not getting into a
certain graduate school, an aspiring graduate student decides
that school was not really where she wanted to study after all).
Reaction formation: Substitutes behaviour, thoughts, or feel-
ings that are the direct opposite of unacceptable ones (e.g., a
man with sexual feelings toward children crusades against
child pornography).
Repression: Blocks disturbing wishes, thoughts, or experi-
ences from conscious awareness (e.g., a person “forgets” about
an embarrassing experience).
Sublimation: Directs potentially maladaptive feelings or impulses
into socially acceptable behaviour (e.g., redirecting energy from
underlying con ict into artistic expression and achievement).
Defence mechanisms have actually been subjected to scienti c
study, and some evidence indicates they may be of potential
importance in the study of psychopathology and health
(MacGregor, Davidson, Rowan, Barksdale, & MacLean, 2003;
McGregor, Zanna, Holmes, & Spencer, 2001; Vaillant, Bond, &
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The Psychological Tradition 21
NEL
eld of ego psychology or self-psychology. Her book Ego and
the Mechanisms of Defense (1946) is still in uential. According
to Anna Freud, the individual slowly accumulates adaptational
capacities, skill in reality testing, and defences. Abnormal behav-
iour develops when the ego is de cient in regulating such func-
tions as delaying and controlling impulses, or in marshalling
appropriate normal defences to strong internal con icts.
A related area that is quite popular today is referred to as object
relations. In this school of thought are theorists Melanie Klein and
Otto Kernberg. Kernberg’s work on borderline personality disor-
der, in which some behaviour borders on being out of touch
with reality and thus psychotic, has been widely applied (see
Chapter12). Object relations is the study of how children incor-
porate the images, memories, and sometimes the values of a
person who was very important to them and to whom they were
(or are) emotionally attached. Object in this sense refers to these
important people, and the process of incorporation is called intro-
jection. Introjected objects can become an integrated part of the
ego or may assume con icting roles in determining the identity, or
self. For example, your parents may have con icting views on
relationships or careers, which, in turn, may be different from
your own partly developed point of view. To the extent that these
varying positions have been incorporated, the potential for con ict
arises. One day you may feel one way about your career direction,
and the next day you may feel quite differently. According to
object relations theory, you tend to see the world through the eyes
of the person incorporated into your self. Object relations theor-
ists focus on how these disparate images come together to make
up a person’s identity, and on the con icts that may emerge.
Carl Jung (1875–1961) and Alfred Adler (1870–1937) were
students of Freud who came to reject his ideas and form their own
schools of thought. Unlike Freud, both Jung and Adler believed
that the basic quality of human nature is positive and that people
have a strong drive toward self-actualization. Jung and Adler
believed by removing barriers to both internal and external
growth, the individual would naturally improve and  ourish.
Others took psychoanalytical theorizing in different directions,
emphasizing development over the life span and the in uence of
culture and society on personality. Karen Horney (1885–1952),
Erich Fromm (1900–1980), and Erik Erikson (1902–1994) are
associated with these ideas. For example, Horney reanalyzed
Freud’s male-oriented views of women’s psychological develop-
ment, and developed her own feminine psychology in which she
recognized the in uences of societal factors (e.g., Horney, 1967).
Erikson’s greatest contribution was his theory of development
across the life span, in which he described in some detail the
crises and con icts that accompany eight speci c psychosocial
stages. For example, in the last of these stages, the mature age,
beginning at about age 65, individuals review their lives and
attempt to make sense of them, experiencing both the satisfaction
of having completed some lifelong goals and despair at having
failed at others. Scienti c developments have borne out the
wisdom of considering psychopathology from a developmental
point of view.
Psychoanalytic Psychotherapy
Many techniques of psychoanalytic psychotherapy, or psycho-
analysis, are designed to reveal the nature of unconscious mental
father and brothers—hence the term penis envy. According to
Freud, the con ict is partially resolved when females develop
healthy heterosexual relationships and look forward to having a
baby, which he viewed as a healthy substitute for having a penis.
It is the partial resolution of the Electra complex, resulting in a
less highly developed superego, that makes females (in Freud’s
theory) less highly developed psychologically than are males.
Needless to say, this particular theory has provoked marked
consternation over the years as being sexist and demeaning. It is
important to remember that it is theory, not fact; no systematic
research exists to support it.
In Freud’s view, all nonpsychotic psychological disorders
resulted from underlying unconscious con icts, the anxiety that
resulted from those con icts, and the implementation of ego
defence mechanisms. Freud called such disorders neuroses, or
neurotic disorders, from an old term referring to disorders of the
nervous system.
Later Developments in Psychoanalytic Thought
Freud’s original psychoanalytic theories have been greatly modi-
ed and developed in many different directions, mostly by his
students or followers.
Anna Freud (1895–1982), Freud’s daughter, concentrated on
the way in which the defensive reactions of the ego determine our
behaviour. In so doing, she was the  rst proponent of the modern
Anna Freud (1895–1982), here with her father, contributed the
concept of defence mechanisms to the  eld of psychoanalysis.
Hulton-Deutsch Collection/Corbis Canada
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22 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
and efforts are made to identify trauma and active defence mech-
anisms, therapists use an eclectic mixture of tactics, with a social
and interpersonal focus. Seven tactics that characterize psycho-
dynamic psychotherapy include (1) a focus on affect and the
expression of patients’ emotions, (2) an exploration of patients’
attempts to avoid topics or engage in activities that hinder the
progress of therapy, (3) the identi cation of patterns in patients’
actions, thoughts, feelings, experiences, and relationships, (4) an
emphasis on past experiences, (5) a focus on patients’ inter-
personal experiences, (6) an emphasis on the therapeutic relation-
ship, and (7) an exploration of patients’ wishes, dreams, or
fantasies (Blagys & Hilsenroth, 2000). Two additional features
characterize psychodynamic psychotherapy. First, it is signi -
cantly briefer than classical psychoanalysis. Second, psycho-
dynamic therapists de-emphasize the goal of personality
reconstruction, focusing instead on relieving the suffering associ-
ated with psychological disorders. Some forms of psychodynamic
psychotherapy have strong scienti c evidence for their effective-
ness, such as interpersonal therapy (IPT) in the treatment of
depression (see Chapter 7).
Comments
Pure psychoanalysis is of historical more than current interest,
and classical psychoanalysis as a treatment has been diminishing
in popularity for years (Robins, Gosling, & Craik, 1999). In 1980,
the term neurosis, which speci cally implied a psychoanalytic
view of the causes of psychological disorders, was dropped from
the DSM, the of cial diagnostic system of the American Psychi-
atric Association.
A major criticism of psychoanalysis is that it is basically
unscienti c, relying on reports by the patient of events that
happened years ago. These events have been  ltered through the
experience of the observer and then interpreted by the psycho-
analyst in ways that certainly could be questioned and might
differ from one analyst to the next. Finally, there has been no
careful measurement of any of these psychological phenomena
and no obvious way to prove or disprove the basic hypotheses of
psychoanalysis. This fact is important, because measurement and
the ability to prove or disprove a theory are the foundations of the
scienti c approach.
Nevertheless, psychoanalytic concepts and observations have
been very valuable, not only to the study of psychopathology and
psychodynamic psychotherapy but also to the history of ideas in
Western civilization. Careful scienti c studies of psycho-
pathology have supported the observation of unconscious mental
processes, that is, the notion that basic emotional responses are
often triggered by hidden or symbolic cues and the understanding
that memories of events in our lives can be repressed and other-
wise avoided in a variety of ingenious ways. The relationship of
the therapist and the patient, called the therapeutic alliance, is an
important area of study across most therapeutic strategies. These
concepts, along with the importance of various coping styles or
defence mechanisms, appear repeatedly throughout this book.
Freud’s revolutionary idea that pathological anxiety emerges
in connection with some of our deepest and darkest instincts
brought us a long way from witch trials and incurable brain path-
ology. Before Freud, the source of good and evil and of urges and
prohibitions was conceived as external and spiritual, usually in
processes and con icts through catharsis and insight. Freud
developed techniques of free association, in which patients are
instructed to say whatever comes to mind without the usual
socially mandated censoring. Free association is intended to
reveal emotionally charged material that may be repressed
because it is too painful or threatening to bring into conscious-
ness. Freud’s patients lay on a couch, and he sat behind them so
they would not be distracted. This method is how the couch
became the symbol of psychotherapy. Other techniques include
dream analysis (still quite popular today), in which the content
of dreams, supposedly re ecting the primary process thinking of
the id, is systematically related to symbolic aspects of uncon-
scious con icts. The therapist interprets the patient’s thoughts and
feelings from free association and the content of dreams and
relates them to various unconscious con icts. This procedure is
often dif cult because the patient may resist the efforts of the
therapist to uncover repressed and sensitive con icts and may
deny the interpretations. The goal of this stage of therapy is to
help the patient gain insight into the nature of the con icts.
The relationship between the therapist, called the psychoanalyst,
and the patient is very important. In the context of this relationship
as it evolves, the therapist may discover the nature of the patient’s
intrapsychic con ict: In a phenomenon called transference,
patients come to relate to the therapist very much as they did
toward important  gures in their childhood, particularly their
parents. Patients who resent the therapist but can verbalize no
good reason for it may be reenacting childhood resentment
toward a parent. More often, the patient falls deeply in love with
the therapist, which re ects strong positive feelings that existed
earlier for a parent. In the phenomenon of countertransference,
therapists project some of their own personal issues and feelings,
often positive, onto the patient. Therapists are trained to deal with
their own feelings as well as their patients’, whatever the mode of
therapy, and it is strictly against all ethical canons of the mental
health professions to accept overtures from patients that might
lead to relationships outside therapy.
Classical psychoanalysis requires therapy four to  ve times a
week for two to  ve years to analyze unconscious con icts,
resolve them, and restructure the personality to put the ego back
in charge. A recent study by Norman Doidge at the Canadian
Institute of Psychoanalysis in Toronto showed that the mean
length of treatment for patients undergoing psychoanalysis in
Canada is 4.8 years, compared to 5.7 years in the United States
and 6.6 years in Australia (Doidge et al., 2002). In psychoanaly-
sis, reduction of symptoms (overt manifestations of psychological
disorders) is seen as relatively inconsequential, because they are
only expressions of underlying intrapsychic con icts that arise
from psychosexual developmental stages. Thus, eliminating a
phobia or depressive episode would be of little use unless the
underlying con ict was dealt with adequately, because another set
of symptoms would almost certainly emerge (symptom substitu-
tion). Because of the extraordinary expense of psychoanalysis,
and the lack of evidence that it is effective in alleviating psycho-
logical disorders, this approach is seldom used today.
Classical psychoanalysis is still practised, particularly in some
large cities, but many psychotherapists employ a loosely related
set of approaches referred to as psychodynamic psychotherapy.
Although con icts and unconscious processes are still emphasized,
01_Ch01.indd 2201_Ch01.indd 22 23/12/11 12:42 PM23/12/11 12:42 PM
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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The Psychological Tradition 23
NEL
the relationship as a means to an end (transference), humanistic
therapists believed relationships, including the therapeutic rela-
tionship, were the single most positive in uence in facilitating
human growth. In fact, Rogers made substantial contributions to
the scienti c study of therapist–client relationships. And research
by W. H. Coons and colleagues at the Ontario Hospital in Hamil-
ton (Coons, 1957, 1967; Coons & Peacock, 1970) provided
evidence for the importance of the humanistic concept of empathy
or “the opportunity for interpersonal interaction in a consistently
warm and accepting social environment” (Coons, 1957, p. 1) in
explaining the success of psychotherapy. Proponents of the
humanistic model stress the unique, nonquanti able experiences
of the individual, emphasizing that people are more different than
alike. Thus, it does not come as a surprise that many humanistic
model proponents have not been much interested in doing
research that would discover or create new knowledge. A major
exception is Carl Rogers himself, who conducted important work
on understanding how psychotherapy works, an area known today
as “psychotherapy process” research.
Frederich (Fritz) Perls developed a therapy known as Gestalt
therapy that has humanistic elements (Levitsky & Perls, 1970;
Perls, 1969). Like the person-centred therapy approach, Gestalt
therapy focuses on people’s positive and creative potentials.
Gestalt therapy helps clients to develop an awareness of their
desires and needs, and to understand how they might be blocking
themselves from reaching their potential. Unlike psychoanalytic
therapy, Gestalt therapy does not involve delving into past experi-
ences—instead, it is very focused on the present. Relative to
person-centred therapy, which does not emphasize technique,
Gestalt therapists are trained in the use of speci c techniques.
These include “I language,” in which the therapist encourages the
client to refer to “I” rather than to “it” to take more responsibility
for emotions and behaviour, and the use of metaphor, in which the
therapist uses stories or scenarios to illustrate and make a problem
clearer to a client.
Where is the humanistic movement today? As Maslow noted,
traditional person-centred therapy found its greatest application
among individuals without psychological disorders. The applica-
tion of person-centred therapy to more severe psychological
disorders has decreased substantially over the decades, although
certain variations have periodically arisen in some areas of
psychopathology. For example, Les Greenberg and his colleagues
at York University in Toronto have developed experiential and
emotion-focused therapies that have their roots in both person-
centred and Gestalt approaches (Goldman, Greenberg, & Angus,
2006; Greenberg, 2004; Greenberg, Elliott, & Lietaer, 2003;
Greenberg & Watson, 2005). These variations of traditional
humanistic therapy are well researched and have demonstrated
effectiveness in treating certain forms of psychopathology, such
as certain mood and anxiety disorders (see Chapters 5 and 7).
The Behavioural Model
As psychoanalysis swept the world at the beginning of the 20th
century, events in Russia and North America eventually provided
an alternative psychological model that was just as powerful. The
behavioural model brought the systematic development of a more
scienti c approach to psychological aspects of psychopathology.
the guise of demons confronting the forces of good. Since Freud,
we ourselves have become the battleground for these forces, and
we are inexorably caught up in the battle, sometimes for better
and sometimes for worse.
Humanistic Theory
We have already seen that Jung and Adler broke sharply with
Freud. Their fundamental disagreement concerned the very nature
of humanity. Freud portrayed life as a battleground where we are
continually in danger of being overwhelmed by our darkest
forces. Jung and Adler, by contrast, emphasized the positive, opti-
mistic side of human nature. Jung talked about setting goals,
looking toward the future, and realizing our fullest potential.
Adler believed that human nature reaches its fullest potential
when we contribute to other individuals and to society as a whole.
He believed we all strive to reach superior levels of intellectual
and moral development. Nevertheless, both Jung and Adler
retained many of the principles of psychodynamic thought. Their
general philosophies were adopted in the middle of the 20th
century by personality theorists and became known as humanistic
psychology.
Self-actualizing was the watchword for this movement. The
underlying assumption is that all of us can reach our highest
potential, in all areas of functioning, if only we have the freedom
to grow. Inevitably, a variety of conditions may block our actual-
ization. Because every person is basically good and whole, most
blocks originate outside the individual. Dif cult living conditions
or stressful life or interpersonal experiences may move you away
from your true self. Abraham Maslow (1908–1970) was most
systematic in describing the structure of personality. He postu-
lated a hierarchy of needs, beginning with our most basic physical
needs for food and sex and ranging upward to our needs for self-
actualization, love, and self-esteem. Social needs such as friend-
ship fall somewhere in between. Maslow hypothesized that we
cannot progress up the hierarchy until we have satis ed the needs
at lower levels.
Carl Rogers (1902–1987) is, from the point of view of therapy,
the most in uential humanist. Rogers originated client-centred
therapy, later known as person-centred therapy (Rogers, 1961).
In this approach, the therapist takes a passive role, making as few
interpretations as possible. The point is to give the individual a
chance to develop during the course of therapy, unfettered by
threats to the self. Humanist theorists have great faith in the abil-
ity of human relations to foster this growth. Unconditional
positive regard, the complete and almost unquali ed acceptance
of most of the client’s feelings and actions, is critical to the
humanistic approach. Empathy is the sympathetic understanding
of the individual’s particular view of the world. The hoped-for
result of person-centred therapy is that clients will be more
straightforward and honest with themselves and will access their
innate tendencies toward growth.
Like psychoanalysis, the humanistic approach has had a
substantial effect on theories of interpersonal relationships. For
example, the human potential movements so popular in the 1960s
and 1970s were a direct result of humanistic theorizing. This
approach also emphasized the importance of the therapeutic rela-
tionship in a way quite different from Freud’s. Rather than seeing
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24 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
Whether the stimulus is food, as in Pavlov’s laboratory, or
chemotherapy, the classical conditioning process begins with a
stimulus that elicits a response in almost anyone and requires no
learning; no conditions must be present for the response to occur.
For these reasons, the food or chemotherapy is called the uncon-
ditioned stimulus (UCS). The natural or unlearned response to
this stimulus—in these cases, salivation or nausea—is called the
unconditioned response (UCR). Now the learning comes in. As
we have already seen, any person or object associated with the
unconditioned stimulus (food or chemotherapy) acquires the
power to elicit the same response, but now the response, because
it was elicited by the conditional or conditioned stimuli (CS), is
termed a conditioned response (CR). Thus, the nurse associated
with the chemotherapy becomes a conditioned stimulus. The
nausea, which is almost the same as that experienced during
chemotherapy, becomes the conditioned response.
With unconditioned stimuli as powerful as chemotherapy, a
conditioned response can be learned in one trial. However, most
learning of this type requires repeated pairing of the unconditioned
stimulus (e.g., chemotherapy) and the conditioned stimulus (e.g.,
nurses’ uniforms or hospital equipment). When Pavlov began to
investigate this phenomenon, he substituted a metronome for the
footsteps of his laboratory assistants so he could quantify the
stimulus more accurately and, therefore, study the approach more
precisely. What he also learned is that presentation of the CS
(e.g., the metronome) without the food for a long enough period
would eventually eliminate the conditioned response to the food.
In other words, the dog learned that the metronome no longer
meant that a meal might be on the way. This process was called
extinction.
Because Pavlov was a physiologist, it was quite natural for him
to study these processes in a laboratory and to be quite scienti c
about it. This method required precision in measuring and observ-
ing relationships and in ruling out alternative explanations.
Although this approach is common in biology, it was not at all
common in psychology at that time. For example, it was impos-
sible for psychoanalysts to measure unconscious con icts
precisely, or even to observe them. Early experimental psycholo-
gists such as Edward Titchener (1867–1927) emphasized the
study of introspection. Subjects simply reported on their inner
thoughts and feelings after experiencing certain stimuli, but the
results of this armchair psychology were inconsistent and discour-
aging to many experimental psychologists.
Watson and the Rise of Behaviourism
An early American psychologist, John B. Watson (1878–1958), is
considered the founder of behaviourism. Strongly in uenced by
the work of Pavlov, Watson decided that to base psychology on
introspection was to head in the wrong direction, that psychology
could be made as scienti c as physiology, and that psychology no
more needed introspection or other nonquanti able methods than
did chemistry and physics (Watson, 1913). This point of view is
re ected in a famous quotation from a seminal article published
by Watson in 1913: “Psychology, as the behaviorist views it, is a
purely objective experimental branch of natural science. Its theor-
etical goal is the prediction and control of behavior. Introspection
forms no essential part of its methods” (p. 158). This, then, was
the beginning of behaviourism and, like most revolutionaries,
The behavioural model is more commonly referred to today as the
cognitive-behavioural (e.g., Meichenbaum, 1995) or social learn-
ing model (e.g., Bandura, 1973, 1986), given the greater emphasis
today on cognitive and social factors involved in learning. These
more recent developments to the traditional behavioural model are
described in Chapter 2.
Pavlov and Classical Conditioning
In his classic study of the salivation response in dogs, physiolo-
gist Ivan Petrovich Pavlov (1849–1936) of St. Petersburg,
Russia, learned why dogs salivate before the presentation of
food. This classic experiment initiated the study of classical
conditioning, a type of learning in which a neutral stimulus is
paired with a response until it elicits that response. The word
conditioning (or conditioned response) resulted from an acci-
dent in translation from the original Russian. Pavlov was really
talking about a response that occurred only on the “condition”
of the presence of a particular event or situation (stimulus)—in
this case, the footsteps of the laboratory assistant at feeding
time. Thus, “conditional response” would have been more
accurate. Conditioning is one way we acquire new information,
particularly information that is somewhat emotional in nature.
This process is not as simple as it  rst seems, and we continue
to uncover many more facts about its complexity (Bouton,
Mineka, & Barlow, 2001; Rescorla, 1988). But it can be quite
automatic. Let’s look at a powerful contemporary example.
Psychologists working in oncology units have studied a phenom-
enon well known to many cancer patients, their nurses and physicians,
and their families. Chemotherapy, a common treatment for some
forms of cancer, has side effects that include severe nausea and
vomiting. But as documented in the research of Patricia Dobkin at
the University of Montréal and others, these patients often
experience severe nausea and, occasionally, vomiting, when they
merely see the medical personnel who administer the chemotherapy
or any equipment associated with the treatment itself, even on
days when their treatment is not delivered (Morrow & Dobkin,
1988). For some patients, this reactionbecomes associated with a
wide variety of stimuli that evoke people or things present
during chemotherapy—anybody in a nurse’s uniform or even the
sight of the hospital itself. The
strength of the response to simi-
lar objects or people is usually a
function of how similar these
objects or people are. This
phenomenon is called stimulus
generalization because the
response “generalizes” to simi-
lar stimuli. In any case, this
particular reaction, obviously, is
very distressing and uncomfort-
able, particularly if it is associ-
ated with a wide variety of
objects or s ituations. Psychol-
ogists have had to develop
speci c treatments to overcome
this response (Redd & Andryko-
wski, 1982); they are described
more fully in Chapter 9.
Ivan Pavlov (1849–1936)
identi ed the process of
classical conditioning, which is
important to many emotional
disorders.
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The Psychological Tradition 25
NEL
The Beginnings of Behaviour Therapy
The implications of Jones’s research were largely ignored for
two decades, given the fervour associated with more psycho-
analytic conceptions of the development of fear. But in the late
1940s and early 1950s, Joseph Wolpe (1915–1997), a pioneer-
ing psychiatrist from South Africa, became dissatis ed with
prevailing psychoanalytic interpretations of psychopathology
and began looking for something else. He turned to the work of
Pavlov and became familiar with the wider  eld of behavioural
psychology. He developed a variety of behavioural procedures
for treating his patients, many of whom have phobias. His best-
known technique was termed systematic desensitization. In
principle, it was really very similar to Jones’s treatment of little
Peter. Individuals were gradually introduced to the objects or
situations they feared so their fear could extinguish; that is,
they could test reality and see that nothing bad really happened
in the presence of the phobic object or scene. Wolpe added
another element by having his patients do something that was
incompatible with fear while they were in the presence of the
dreaded object or situation. Because he could not always repro-
duce the phobic object in his of ce, Wolpe had his patients
carefully and systematically imagine the phobic scene, and the
response he chose was relaxation, because it was convenient.
For example, Wolpe treated a young man with a phobia of dogs
by training him  rst to relax deeply and then imagine he was
looking at a dog across the park. Gradually, he could imagine
the dog across the park and remain relaxed, experiencing little
or no fear, and Wolpe then had him imagine he was closer to the
dog. Eventually the young man imagined he was actually
touching the dog while maintaining a very relaxed, almost
trance-like state.
Wolpe reported success with systematic desensitization, one of
the  rst wide-scale applications of the new science of behaviour-
ism to psychopathology. Wolpe, working with fellow pioneers
Hans Eysenck and Stanley J. Rachman in London, called this
approach behaviour therapy. Wolpe eventually moved to the
United States and Rachman to Canada, while Eysenck remained
in the United Kingdom, which contributed to the dissemination of
behaviour therapy knowledge and techniques throughout North
America and Europe.
B. F. Skinner and Operant
Conditioning
Sigmund Freud’s in uence
extended far beyond psycho-
pathology into many aspects
of our cultural and intellectual
history. Only one other behav-
ioural scientist has made a
similar impact, Burrhus Fred-
eric (B. F.) Skinner (1904–
1990). In 1938, he published
The Behavior of Organisms,
in which he laid out, in a
comprehensive manner, the
principles of operant condi-
tioning, a type of learning in
Watson took his cause to extremes. For example, he wrote that
“thinking,” for purposes of science, could be equated with
subvocal talking and that one need only measure movements
around the larynx to study this process objectively.
Most of Watson’s time was spent developing behavioural
psychology as a radical empirical science, but he did dabble brie y
in the study of psychopathology. In 1920, he and a student, Rosalie
Rayner, presented an 11-month-old boy named Albert with a
harmless  uffy white rat to play with. Albert was not afraid of the
small animal and enjoyed playing with it. However, every time
Albert reached for the rat, the experimenters made a loud noise
behind him. After only  ve trials, Albert showed the  rst signs of
fear if the white rat came near. The experimenters then determined
that Albert displayed mild fear of any similar white furry object,
even a Santa Claus mask with a white fuzzy beard. You may not
think this is surprising, but keep in mind that this was one of the
rst examples ever recorded in a laboratory of actually producing
fear of an object not previously feared. Of course, this experiment
would be considered unethical by today’s standards. For example,
Watson and Rayner’s failure to remove (or “recondition”) Albert’s
fear before the end of the experiment, and their insuf cient follow-
up of the child’s fears after the experiment, would be criticized on
ethical grounds today (Harris, 1979).
Another student of Watson’s, Mary Cover Jones, thought that
if fear could be learned or classically conditioned in this way,
perhaps it could also be unlearned or extinguished. She worked
with a boy named Peter, who at two years, ten months old was
already quite afraid of furry objects. Jones decided to bring a
white rabbit into the room where Peter was playing for a short
time each day. She also arranged for other children, whom she
knew did not fear rabbits, to be in the same room. She noted that
Peter’s fear gradually diminished. Each time it diminished, she
brought the rabbit closer. Eventually Peter was touching and even
playing with the rabbit (Jones, 1924a, 1924b), and years later the
fear had not returned.
Mary Cover Jones (1896–1987) was one of the  rst psychologists
to use behavioural techniques to free a patient from a phobia.
Stanley J. Rachman, recently
retired from the University of
British Columbia, is one of the
original founders of the
behaviour therapy approach.
Archives of the History of American Psychology
Courtesy of Jack Rachman
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26 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
governed to some degree by reinforcement, which can be arranged
in an endless variety of ways, in schedules of reinforcement.
Skinner wrote a book on different schedules of reinforcement
(Ferster & Skinner, 1957). He also believed that using punish-
ment as a consequence is relatively ineffective in the long run and
that the primary way to develop new behaviour is to positively
reinforce desired behaviour. Much like Watson, Skinner did not
see the need to go beyond the observable and quanti able to
establish a satisfactory science of behaviour. He did not deny the
in uence of biology or the existence of subjective states of
emotion or cognition; he simply explained these phenomena as
relatively inconsequential side effects of a particular history of
reinforcement.
The subjects of Skinner’s research were usually animals,
mostly pigeons and rats. Using his new principles, Skinner and his
disciples actually taught the animals a variety of tricks, including
dancing, playing Ping-Pong, and playing a toy piano. To do this,
he used a procedure called shaping, a process of reinforcing
successive approximations to a  nal behaviour or set of behav-
iours. If you want a pigeon to play Ping-Pong,  rst you provide it
with a pellet of food every time it moves its head slightly toward
a Ping-Pong ball tossed in its direction. Gradually you require the
pigeon to move its head ever closer to the Ping-Pong ball until it
touches it. Finally, receiving the food pellet is contingent on the
pigeon’s actually hitting the ball back with its head. Pavlov,
Watson, and Skinner contributed signi cantly to behaviour ther-
apy (e.g., Wolpe, 1958), in which scienti c principles of psychol-
ogy are applied to clinical problems. Many psychologists and
other mental health professionals quickly picked up on behaviour
therapy techniques and began applying them with their patients in
the 1950s and 1960s. For example, in an early application of these
principles at the Lakeshore Psychiatric Hospital in Toronto,
Richard Steffy and his colleagues describe how they used operant
conditioning techniques to modify the behaviour of a ward of
severely aggressive female patients. These researchers docu-
mented how reinforcements could be used by staff to decrease
these patients’ violent activity and to improve their self-care and
social responsiveness (Steffy, Hart, Craw, Torney, & Marlett,
1969). Similar results were reported by Teodoro Ayllon and Jack
Michael (1959) from a study conducted at the Saskatchewan
Hospital in Weyburn, showing that the use of reinforcements by
nursing staff could produce substantial reductions in psychiatric
patients’ undesirable behaviour and increases in patients’ desir-
able behaviour. The ideas of Pavlov, Watson, and Skinner have
continued to contribute substantially to current psychosocial treat-
ments, and so we refer to them repeatedly in this book.
Comments
The behavioural model has contributed greatly to the understand-
ing and treatment of psychopathology, as will be apparent in the
chapters that follow. Nevertheless, this model is incomplete in
itself and inadequate to account for what we now know about
psychopathology. In the past, behaviourism had little or no room
for biology, because disorders were considered, for the most part,
environmentally determined reactions. The model also fails to
account for development of psychopathology across the life span.
Recent advances in our knowledge of how information is
which behaviour changes as a
function of what follows the
behaviour. Skinner observed
early on that a large part of our
behaviour is not automatically
elicited by an unconditioned
stimulus (UCS) and we must
account for this. In the ensu-
ing years, Skinner did not
con ne his ideas to the labora-
tories of experimental psych-
ology. He ranged broadly in
his writings, describing, for
example, the potential appli-
cations of a science of behav-
iour to our culture. Some of
the best-known examples of
his ideas are in the novel
Walden Two (Skinner, 1948), in which he depicts a  ctional soci-
ety run on the principles of operant conditioning. In another well-
known work, Beyond Freedom and Dignity (1971), Skinner lays
out a broader statement of the problems facing our culture and
suggests solutions based on his own view of a science of
behaviour.
Skinner was strongly in uenced by Watson’s conviction that a
science of human behaviour must be based on observable events
and relationships among those events. The work of psychologist
Edward L. Thorndike (1874–1949) also in uenced Skinner.
Thorndike is best known for the law of effect, which states that
behaviour is either strengthened (likely to be repeated more
frequently) or weakened (likely to occur less frequently)
depending on the consequences of that behaviour. Skinner took
the very simple notions that Thorndike had tested in the animal
laboratories, using food as a reinforcer, and developed them in a
variety of complex ways to apply to much of our behaviour. For
example, if a  ve-year-old boy starts shouting at the top of his
lungs in McDonald’s, much to the annoyance of the people
around him, it is unlikely his behaviour was automatically elicited
by an unconditioned stimulus (UCS). Also, he will be less likely
to do it in the future if his parents scold him, take him out to the
car to sit for a bit, or consistently reinforce more appropriate
behaviour. Then again, if the parents think his behaviour is cute
and laugh, chances are he will do it again.
Skinner coined the term operant conditioning because behav-
iour “operates” on the environment and changes it in some way.
For example, the boy’s behaviour affects his parents’ behaviour
and probably the behaviour of other customers as well. Therefore,
he changes his environment. Most things we do socially provide
the context for other people to respond to us in one way or
another, thereby providing consequences for our behaviour. The
same is true of our physical environment, although the conse-
quences may be long term (polluting the air eventually will
poison us). Skinner preferred the term reinforcement to reward
because it connotes the effect on the behaviour. Skinner once said
that he found himself a bit embarrassed to be talking continually
about reinforcement, much as Marxists used to see class struggle
everywhere. But he pointed out that all of our behaviour is
B. F. Skinner (1904–1990)
studied operant conditioning, a
form of learning that is central to
psychopathology.
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NEL
The Present: The Scienti c Method and an Integrative Approach 27
in uence—biological, behavioural, cognitive, emotional, or
social—ever occurs in isolation. Every time we think, feel, or do
something, the brain and the rest of the body are hard at work.
Perhaps not as obvious, however, is the fact that our thoughts,
feelings, and actions inevitably in uence the function and even
the structure of the brain, sometimes permanently. In other words,
our behaviour, both normal and abnormal, is the product of the
continual interaction of psychological, biological, and social
in uences.
The view that psychopathology is multiply determined had its
early adherents. Perhaps the most notable was psychiatrist Adolf
Meyer (1866–1950). Whereas most professionals during the  rst
half of the 20th century held narrow views of the cause of psycho-
pathology, Meyer steadfastly emphasized the equal contributions
of biological, psychological, and sociocultural determinism.
Although Meyer had some proponents, it was a century before the
wisdom of his advice was fully recognized in the  eld.
By 2000, a veritable explosion of knowledge about psycho-
pathology had occurred. The young  elds of cognitive science and
neuroscience began to grow exponentially as we learned more
about the brain and about how we process, remember, and use
information. At the same time, startling new  ndings from behav-
ioural science revealed the importance of early experience in
determining later development. It was clear that a new model was
needed that would consider biological, psychological, and social
in uences on behaviour. This approach to psychopathology would
combine  ndings from all areas with our rapidly growing under-
standing of how we experience life during different develop-
mental periods, from infancy to old age. In 2010, the National
Institute of Mental Health (NIMH) instituted a strategic plan to
support further research and development on the interrelationship
of these factors with the aim of translating research  ndings to
front-line treatment settings (Insel, 2009). In the remainder of this
book, we explore the reciprocal in uences among neuroscience,
cognitive science, behaviour science, and developmental science
and demonstrate that the only currently valid model of psycho-
pathology is multidimensional and integrative.
Concept Check 1.4
Match the treatment with the corresponding psychological
theory of behaviour: (a) behavioural model, (b) moral
therapy, (c) psychoanalytic theory, and (d) humanistic
theory.
1. Treating institutionalized patients as normally as possible
and encouraging social interaction and relationship
development. ____________
2. Hypnosis, psychoanalysis-like free association and
dream analysis, and balance of the id, ego, and superego.
____________
3. Person-centred therapy with unconditional positive
regard. ____________
4. Classical conditioning, systematic desensitization, and
operant conditioning. ____________
processed, both consciously and subconsciously, have added a
layer of complexity. We also now know that learning can occur
indirectly or vicariously through observing others in social inter-
actions (Bandura, Jeffery, & Bachicha, 1974; Bandura & McDon-
ald, 1963; Bandura, Ross, & Ross, 1963). Integrating all these
dimensions requires a new model of psychopathology.
The Present: The Scienti c Method and
an Integrative Approach
As Shakespeare wrote, “What’s past is prologue.” We have just
reviewed three different traditions or ways of thinking about
causes of psychopathology: the supernatural, the biological, and
the psychological (further subdivided into two major historical
components: psychoanalytic and behavioural).
Supernatural explanations of psychopathology are still with
us. Superstitions prevail, including beliefs in the effects of the
moon and the stars on our behaviour. However, this tradition has
little in uence on scientists and other professionals. Biological,
psychoanalytic, and behavioural models, by contrast, continue to
further our knowledge of psychopathology, as we see in the next
chapter. Even with the many advances in our understanding of
mental disorders, no blood test exists for mental illness, and no
speci c known cure, as is often the case with physical illness.
This fact helps explain why there are many, sometimes compet-
ing, models for mental disorders today.
Despite the fact that the biological, psychoanalytic, and behav-
ioural models continue to improve our understanding of the vari-
ous forms of psychopathology, each tradition has failed in at least
one important way. First, scienti c methods were not often
applied to the theories and treatments within a tradition, mostly
because methods that would have produced the evidence neces-
sary to con rm or discon rm the theories and treatments had not
been developed. Lacking such evidence, various fads and super-
stitions were widely accepted that ultimately proved untrue or
useless. New fads often superseded truly useful theories and treat-
ment procedures. This trend was at work in the so-called discov-
ery of the drug reserpine, which, in fact, had been around for
thousands of years. King Charles VI was subjected to a variety of
procedures, some of which have since been proved useful and
others that were mere fads or even harmful. How we use scienti c
methods to con rm or discon rm  ndings in psychopathology is
described in Chapter 4. Second, health professionals tend to look
at psychological disorders very narrowly, from their own point of
view alone. John Grey assumed psychological disorders are the
result of brain disease and that other factors have no in uence
whatsoever. John Watson assumed that all behaviours, including
disordered behaviour, are the result of psychological and social
in uences and that the contribution of biological factors is
inconsequential.
In the 1990s, two developments came together as never before
to shed light on the nature of psychopathology: (1) the increasing
sophistication of scienti c tools and methodology (e.g., more
sophisticated medical technology methods such as neuro-
imaging—see Chapter 3), and (2) the realization that no one
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28 Chapter 1 Abnormal Behaviour inHistoricalContext NEL
psychosocial, 15
reinforcement, 26
scientist-practitioner, 7
self-actualizing, 23
shaping, 26
superego, 19
systematic desensitization, 25
transference, 22
unconditional positive
regard, 23
unconscious, 18
presenting problem, 8
prevalence, 8
prognosis, 8
psychoanalysis, 17
psychoanalyst, 22
psychoanalytic model, 19
psychodynamic
psychotherapy, 22
psychological disorder, 3
psychopathology, 6
psychosexual stages of
development, 20
extinction, 24
free association, 22
id, 19
incidence, 8
intrapsychic con icts, 19
introspection, 24
mental hygiene movement, 16
moral therapy, 15
neurosis (neuroses plural), 21
object relations, 21
person-centred therapy, 23
phobia, 3
behaviour therapy, 25
behavioural model, 23
behaviourism, 17
catharsis, 18
classical conditioning, 24
clinical description, 8
course, 8
defence mechanisms, 20
dream analysis, 22
ego, 19
ego psychology, 21
etiology, 8
Key Terms
Each tradition has its own way of treating individuals who
have psychological disorders. Supernatural treatments
include exorcism to rid the body of the supernatural
spirits. Biological treatments typically emphasize physical
care and the search for medical cures, especially drugs.
Psychological approaches use psychosocial treatments,
beginning with moral therapy and including modern
psychotherapy.
Sigmund Freud, the founder of psychoanalytic therapy, offered
an elaborate conception of the unconscious mind, much of
which is still conjecture. In therapy, Freud focused on tapping
into the mysteries of the unconscious through such techniques
as catharsis, free association, and dream analysis. Though
Freud’s followers veered from his path in many ways, Freud’s
in uence can still be felt today.
One outgrowth of Freudian therapy is humanistic psychology,
which focuses more on human potential and self-actualizing
than on psychological disorders. Therapy that has evolved
from this approach is known as person-centred therapy; the
therapist shows almost unconditional positive regard for the
client’s feelings and thoughts.
The behavioural model moved psychology into the realm of
science, with an emphasis on  ndings from the laboratories of
psychology as applied to human behaviour. Therapeutic tech-
niques derived from this model include systematic desensitiza-
tion, reinforcement, and shaping.
The Present: The Scienti c Method and the
Integrative Approach
With the increasing sophistication of our scienti c tools and
new knowledge from cognitive science, behavioural science,
and neuroscience, we now realize that no contribution to
psychological disorders ever occurs in isolation. Our behav-
iour, both normal and abnormal, is a product of a continual
interaction of psychological, biological, and social in uences.
What Is a Psychological Disorder?
A psychological disorder is (1) a psychological dysfunction or
dyscontrol within an individual that is (2) associated with dis-
tress or impairment in functioning and (3) a response that is
not typical or culturally expected. Although this de nition is
the most popular, no one description has yet been identi ed
that de nes the essence of abnormality.
The Science of Psychopathology
The  eld of psychopathology is concerned with the scienti c
study of psychological disorders. Trained mental health pro-
fessionals range from clinical and counselling psychologists to
psychiatrists and psychiatric social workers and nurses. Each
profession requires a speci c type of training.
Using scienti c methods, mental health professionals can function
as scientist-practitioners. They not only keep up with the latest
ndings but also use scienti c data to evaluate their own work, and
they often conduct research within their clinics or hospitals.
Research about psychological disorders falls into three basic
categories: description, causation, and treatment and out-
comes.
The Supernatural, Biological, and Psychological
Traditions
Historically, three prominent approaches to abnormal behav-
iour have been used. In the supernatural tradition, abnormal
behaviour is attributed to agents outside our bodies or social
environment, such as demons or spirits, or the in uence of the
moon and stars; though still alive, this tradition has been
largely replaced by biological and psychological perspectives.
In the biological tradition, disorders are attributed to disease or
biochemical imbalances; in the psychological tradition,
abnormal behaviour is attributed to faulty psychological
development and to social context.
SUMMARY
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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Summary 29
NEL
1.4
1. b 2. c 3. d 4. a
Media Resources
Access an integrated eBook, Abnormal Psychology Videos (formerly Abnormal Psych Live
CD-ROM), chapter-speci c interactive learning tools ( ashcards, quizzes, learning modules),
and more in your Psychology CourseMate, available at www.abnormalpsych3ce.nelson.com.
Abnormal Psychology Video
Free Abnormal Psychology videos can be viewed on the website www.abnormalpsych3ce
.nelson.com.
Roots of Behaviour Therapy: This combined clip shows the historical progression
ofclassical conditioning and the behavioural model from Pavlov through Watson
andSkinner.
Video Concept Reviews
CourseMate also contains Mark Durand’s Video Concept Reviews on these challenging
topics:
Concept Check—Abnormality
Psychopathology
Mental Health Professions
The Scientist-Practitioner
Presenting Problem
Prevalence
Incidence
Course
1.3
1. e 2. c 3. d 4. a
1.2
1. d 2. c 3. a 4. f 5. e 6. b
1.1
1. a, c 2. d 3. b, c 4. b
Answers to Concept Checks
Prognosis
Supernatural Views—Historical
Supernatural Views—Current
Emotion Contagion
Hippocrates
Moral Therapy
Concept Check—Integrative Approach
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Licensed to:
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1930–1968
1500s: Paracelsus suggests
that the moon and the stars
affect people’s psychological
functioning, rather than pos-
session by the devil.
1300s: Superstition runs ram-
pant and mental disorders are
blamed on demons and witch-
es; exorcisms are performed
to rid victims of evil spirits.
1400s: Enlightened view that
insanity is caused by mental
or emotional stress gains
momentum, and depression
and anxiety are again regard-
ed by some as disorders.
1400–1800: Bloodletting and
leeches are used to rid the
body of unhealthy uids and
restore chemical balance.
1793: Philippe Pinel introduc-
es moral therapy and makes
French mental institutions
more humane.
1825–1875: Syphilis is dif-
ferentiated from other types of
psychosis in that it is caused
by a specic bacterium; ulti-
mately, penicillin is found to
cure syphilis.
200 B.C.E.: Galen suggests that
normal and abnormal behaviour
are related to four bodily u-
ids, or humors.
400 B.C.E.: Hippocrates sug-
gests that psychological disor-
ders have both biological and
psychological causes.
400 B.C.E.–1875
400 B.C.E. 1500s 1825–18751300s
1968: DSM-II is published.
1938: B. F. Skinner publishes
The Behavior of Organisms,
which describes the principles
of operant conditioning.
1930: Insulin shock therapy,
electric shock treatments, and
brain surgery begin to be used
to treat psychopathology.
1958: Joseph Wolpe effec-
tively treats patients with pho-
bias using systematic desen-
sitization based on principles
of behavioural science.
1952: The rst edition of the
Diagnostic and Statistical
Manual (DSM-I) is published.
1950: The rst effective drugs
for severe psychotic disorders
are developed. Humanistic
psychology (based on ideas
of Carl Jung, Alfred Adler,
and Carl Rogers) gains some
acceptance.
1946:
Ego and the Mechanisms of
Defense.
1943: The Minnesota
Multiphasic Personality
Inventory is published.
1930 1943 1950 1968
Mary Evans Picture Library
National Library of Medicine
Stock Montage
Bettmann/Corbis Canada
Imagno/Hulton Archive /Getty Images
Anna Freud publishes
Timeline of Significant Events
NEL
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Licensed to:
CengageBrain User
1848–1920
1980–2000
1990s: Increasingly sophisticat-
ed research methods are devel-
oped; no one inuence—biologi-
cal or environmental—is found
to cause psychological disorders
in isolation from the other. 2000: DSM-IV-TR is published.
1994: DSM-IV is published.
1987: DSM-III-R is published.
1980: DSM-III is published.
1904: Ivan Pavlov receives the
Nobel Prize for his work on
the physiology of digestion,
which leads him to identify
conditioned reexes in dogs.
1848: Dorothea Dix suc-
cessfully campaigns for
more humane treatment in
American mental institutions.
1854: John P. Grey, head of
New York’s Utica Hospital,
believes that insanity is the
result of physical causes, thus
de-emphasizing psychological
treatments.
1870: Louis Pasteur develops
his germ theory of disease,
which helps identify the bac-
terium that causes syphilis.
1913: Emil Kraepelin classies
various psychological disorders
from a biological point of view
and publishes work on diagnosis.
1920: John B. Watson experi-
ments with conditioned fear in
Little Albert using a white rat.
1895: Josef Breuer treats the
“hysterical” Anna O., leading
to Freud’s development of
psychoanalytic theory.
1900: Sigmund Freud pub-
lishes The Interpretation of
Dreams.
1848 1920
1980
1870
1990s 2000
1900
Library of Congress Prints and
Photographs Division Washington,
D.C. 20540 USA
Bettmann/Corbis Canada
Munchener Medizinische
Wochenschrift (1926)
Mary Evans Picture Library
Bettmann/Corbis Canada
FPO
NEL
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
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