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UNDERSTANDING PSYCHOPATHOLOGY

INTRODUCTION
Extraordinary People

Clifford Beers, A Mind That Found Itself

Clifford Beers was always an energetic child, moody, with little
selfcontrol. Still, he was intelligent and ambitious enough to do well in
school, and he graduated from college. However, Beers’s mood iness
increased with time, particularly after his brother Sam began to have
severe, convulsive seizures. In March 1890, as his brother lay dying in the
family home, Beers’s moodiness grew to despair, accompanied by deep
paranoia. He began contemplating suicide and eventually jumped out a
fourth-floor window, fortunately suffering only broken bones. Beers was
hospitalized, fi rst in a private mental hospital but later, when his family
ran out of money, in public mental hospitals. In the early 1900s, there
were no effective treatments for symptoms such as those Beers suffered.
He was given drugs that physicians thought might help, including
strychnine and arsenic tonics. He also was beaten, choked, put in a
straitjacket for up to 21 days, and locked away with no clothes for
long periods in dark, cold cells. Despite these experiences, Beers’s
symptoms ultimately subsided, and after spending 3 years in various
hospitals, he was declared recovered enough to be released.
These experiences inspired Beers to start a movement for the reform of
mental health treatment, which he called the mental hygiene
movement. After his release from the mental hospital, Beers wrote a
personal account of his time there, which was published in 1908 as A
Mind That Found Itself . This book forever changed how physicians and
the public viewed mental patients and hospitals (Nolen-Hoeksema, S.
2011).

The study of abnormal psychology is the

study of people, like Clifford Beers, who
suffer mental, emotional, and often physical

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pain, often referred to as psychopathology.

Sometimes the experiences of people with
psychopathology are as unusual. Sometimes,
however, people with psychopathology have
experiences that are familiar to many of us
but more extreme.
In this module, we explore the cases with
troubling psychological symptoms to
understand how they think, what they feel,
and how they behave. We investigate what is
known about the causes of and treatments
for various types of symptoms.
Thus, the purpose of this module is not
only to provide you with information, facts
and figures, theories, and research. It is
also to help you understand the experience
of people with psychological symptoms.

Lesson 1 Understanding Abnormal

Behavior: Its Key Concepts
Lesson 2 History of Mental Illness
Lesson 3 Research Methods in Abnormal
Psychology
Lesson 4 Models of Abnormality
Lesson 5 Clinical Assessments, Diagnosis
and Treatment

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MODULE I

UNDERSTANDING PSYCHOPATHOLOGY

INTRODUCTION

Cassie is an 18 year old female from suburban Seattle, WA. She was a
successful student in high school, graduating valedictorian and obtained a
National Merit Scholarship for her performance on the PSAT during her
junior year. She was accepted to a university on the far eastern side of the
state where she received additional scholarships which together, gives her a
free ride for her full four years of undergraduate education. Excited to start
this new chapter in her life, Cassie’s parents begin the 5 hour commute to
Pullman where they will leave their only daughter for the first time in her
life. The semester begins as it always does in late August. Cassie meets the
challenge head on and does well in all her classes for the first few weeks of
the semester, as expected. Sometime around Week 6 her friends notice she
is despondent, detached, and falling behind in her work. After being asked
about her condition she replies that she is “just a bit homesick.” Her friends
accept the answer as this is a typical response to leaving home and starting
college for many students. A month later her condition has not improved but
actually worsened. She now regularly shirks her responsibilities around her
apartment, in her classes, and on her job. Cassie does not hang out with
friends like she did when she first arrived for college and stays in bed most
of the day. Concerned, they contact Health and Wellness for help.
Cassie’s story, though hypothetical, is true of many Freshman leaving
home for the first time to earn a higher education, whether in rural
Washington state or urban areas such as Chicago and Dallas. Most students
recover from this depression and go on to be functional members of their
collegiate environment and accomplished scholars. Some learn to cope on
their own while others seek assistance from their university’s health and
wellness center or from friends who have already been through the same
ordeal. This is a normal reaction. But in Cassie’s case and that of other
students, the path to recovery is not as clear and instead of learning how to
cope, their depression increases until it reaches clinical levels and becomes
an impediment to success in multiple domains of life such as home, work,
school, and social circles.
In Module 1, we will explore what it means to display abnormal
behavior, what mental disorders are and how society views it both today
and has throughout history, and then we will overview research methods
used by psychologists in general and how they are adapted to study
abnormal behavior/mental disorders. We will conclude with an overview of
what mental health professionals do.

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OBJECTIVES
After studying the module, you should be able to:

1. Explain what it means to display abnormal behavior.

2. Clarify the manner in which mental health professionals classify
mental disorders.
3. Outline the history of mental illness.
4. Describe research methods used to study abnormal behavior and
mental illness.
5. Describe Clinical Assessments, diagnosis and treatment
used to study abnormal behavior and mental illness.

DIRECTIONS/ MODULE ORGANIZER

There are five (5) lessons in the module outlined as follows:

1. Understanding Abnormal Behavior: Its Key Concepts
2. History of Mental Illness
3. Research Methods in Abnormal Psychology
4. Models of Abnormality
5. Clinical Assessments, Diagnosis and Treatment

Read each lesson carefully then answer the exercises/activities to find out
how much you have benefited from it. Work on these exercises carefully and
submit your output to your tutor.

In case you encounter difficulty, discuss this with your tutor during
the face-to-face meeting. If not contact your tutor at the College of Arts
and Sciences, Psych Dept Faculty Room.

Good luck and happy reading!!!

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Lesson 1

UNDERSTANDING
ABNORMAL BEHAVIOR:
ITS KEY CONCEPTS

Consider these behaviors:

1. A man kissing another man
2. A man driving a nail through his hand
3. A woman refusing to eat for several days
4. A man barking like a dog and crawling on
the floor on his hands and knees
5. A woman building a shrine to her dead husband in her living room and
leaving food and gifts for him at the altar
Do you think these behaviors are abnormal?
You may reply, “It depends.” Several of these behaviors are accepted in
certain circumstances. In many European cultures, for example, men
commonly greet other men with a kiss. In many religious traditions, refusing
to eat for a period, or fasting, is a common ritual of cleansing and
penitence. You might expect that some of the other behaviors listed, such
as driving a nail through one’s hand or barking like a dog, are abnormal in
all circumstances, yet even these behaviors are accepted in certain
situations. In Mexico, some Christians have themselves nailed to crosses on
Good Friday to commemorate the crucifixion of Jesus. Among the Yoruba of
Africa, traditional healers act like dogs during healing rituals. Shinto and
Buddhist customs include building altars to dead loved ones, offering them
food and gifts, and speaking with them as if they were in the room . Thus,
the context, or circumstances, surrounding a behavior influences whether
the behavior is viewed as abnormal.
A number of criteria in addition to context have been used over the
years to draw the line between normal and abnormal.
What might be considered normal behavior is difficult to define.
Equally difficult is understanding what abnormal behavior is which may be
surprising to you. The American Psychiatric Association, in its publication
which you will become intimately familiar with throughout this module, the
Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5 for
short), states that though “no definition can capture all aspects of all
disorders in the range contained in the DSM-5” certain aspects are required.

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These include:
Dysfunction – includes “clinically significant disturbance in an
individual’s cognition, emotion regulation, or behavior that reflects a
dysfunction in the psychological, biological, or developmental processes
underlying mental functioning”. Abnormal behavior, therefore, has the
capacity to make our well-being difficult to obtain and can be assessed by
looking at an individual’s current performance and comparing it to what is
expected in general or how the person has performed in the past. As such, a
good employee who suddenly demonstrates poor performance may be
experiencing an environmental demand leading to stress and ineffective
coping mechanisms. Once the demand resolves itself the person’s
performance should return to normal according to this principle.
Distress – When the person experiences a disabling condition “in
social, occupational, or other important activities”. Distress can take the
form of psychological or physical pain, or both concurrently. Alone though,
distress is not sufficient enough to describe behavior as abnormal. The loss
of a loved one would cause even the most “normally” functioning individual
pain. An athlete who experiences a career ending injury would display
distress as well.
Deviance – Closer examination of the word abnormal shows that it
indicates a move away from what is normal, or the mean (i.e. what would
be considered average and in this case in relation to behavior), and so is
behavior that occurs infrequently (sort of an outlier in our data). Our
culture, or the totality of socially transmitted behaviors, customs, values,
technology, attitudes, beliefs, art, and other products that are particular to
a group, determines what is normal and so a person is said to be deviant
when he or she fails to follow the stated and unstated rules of society,
called social norms. Finally, consider that statistically deviant behavior is
not necessarily negative. Being a genius is an example of behavior that is
not the norm.
Though not part of the DSM conceptualization of what abnormal
behavior is, many clinicians add dangerousness to this list, or when
behavior represents a threat to the safety of the person or others. It is
important to note that having a mental disorder does not mean you are also
automatically dangerous. The depressed or anxious individual is often no
more a threat than someone who is not depressed (dangerousness is more
the exception than the rule). Still, mental health professionals have a duty
to report to law enforcement when a mentally disordered individual
expresses intent to harm another person or themselves. It is important to
point out that people seen as dangerous are also not automatically mentally
ill.
In conclusion, though there is no one behavior that we can use to
classify people as abnormal, most clinical practitioners agree that any
behavior that strays from what is considered the norm or is unexpected, and
has the potential to harm others or the individual, is abnormal behavior.

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THINK!

Shades of Abnormality
1. Bob is a very intelligent, 25 year old member of a religious organization
that is based on Buddhism. Bob's working for this organization caused
considerable conflict between him and his parents, who are devout
Catholics. Recently Bob experiences acute spells of nausea and fatigue
that prevent him from working and which have forced him to return home
to live with his parents. Various medical tests are being conducted, but as
yet no physical causes of his problems have been found.
2. Jim was vice president of the freshman class at a local college and
played on the school's football team. Later that year he dropped out of
these activities and gradually became more and more withdrawn from
friends and family. Neglecting to shave and shower, he began to look dirty
and unhealthy. He spent most of his time alone in his room and sometimes
complained to his parents that he heard voices in the curtains and in the
closet. In his sophomore year he dropped out of school entirely. With
increasing anxiety and agitation, he began to worry that the "Nazis" were
plotting to kill his family and kidnap him.
3. Mary is a 30 year old musician who is very dedicated and successful in
her work as a teacher in a local high school and as a part-time member of
local musical groups. Since her marriage five years ago, which ended in
divorce after six months, she has dated very few men. She often worries
that her time is "running out" for establishing a good relationship with a
man, getting married, and raising a family. Her friends tell her that she
gets way too anxious around men, and that she needs to relax a little in
general.
4. Larry, a homosexual who has lived for three years with a man he met in
graduate school, works as a psychologist in a large hospital. Although
competent in his work, he often feels strained by the pressures of his
demanding position. An added source of tension on the job is his not being
able to confide in all his co-workers about his private life. Most of his
leisure activities are with good friends who belong to the gay subculture.
RATE each of these people using the following scale and explain your
rating:
1 = Basically O.K.
2 = Mild disturbance.
3 = Significant disturbance.
4 = Severe disturbance. Hospitalize!

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KEY CONCEPTS in the

STUDY OF
ABNORMAL
PSYCHOLOGY

Our discussion so far has concerned what is normal and abnormal

behavior. The scientific study of abnormal behavior, with the intent to be
able to reliably predict, explain, diagnose, identify the causes of, and treat
maladaptive behavior is what we refer to as abnormal psychology.
Abnormal behavior can become pathological in nature and so leads to the
scientific study of psychological disorders, or psychopathology. This begs the
question of what the accepted definition of a psychological or mental
disorder is. From our previous discussion we can fashion the following
definition – mental disorders are characterized by psychological dysfunction
which causes physical and/or psychological distress or impaired functioning
and is not an expected behavior according to societal or cultural standards.
Other key concepts in the study of abnormal behavior include the
following:
Classification is the way in which things are organized or categorized.
It is useful to do classify abnormal behavior and classification provides us
with a nomenclature, or naming system, to structure our understanding of
mental disorders in a meaningful way.
Epidemiology is the scientific study of the frequency and causes of
diseases and other health-related states in specific populations such as a
school, neighborhood, a city, country, and the world. Psychiatric or mental
health epidemiology refers to the occurrence of mental disorders in a
population. In mental health facilities, we say that a patient presents with a
specific problem, or the presenting problem, and we give a clinical
description of it which includes information about the thoughts, feelings,
and behaviors that constitute that mental disorder. We also seek to gain
information about the occurrence of the disorder, its cause, course, and
treatment possibilities.
Occurrence can be investigated in several ways. First, prevalence is
the percentage of people in a population that has a mental disorder or can
be viewed as the number of cases per some number of people. For instance,
if 20 people out of 100 have bipolar disorder, then the prevalence rate is
20%. Prevalence can be measured in several ways:
Point prevalence indicates the proportion of a population that has
the characteristic at a specific point in time. In other words, it is the
number of active cases.
Period prevalence indicates the proportion of a population that has
the characteristic at any point during a given period of time, typically the
past year.
Lifetime prevalence indicates the proportion of a population that
has had the characteristic at any time during their lives.

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Incidence indicates the number of new cases in a population over a

specific period of time. This measure is usually lower since it does not
include existing cases as prevalence does. If you wish to know the number of
new cases of social phobia during the past year (going from say Aug 21, 2019
to Aug 20, 2020), you would only count cases that began during this time
and ignore cases before the start date, even if people are currently afflicted
with the mental disorder. Incidence is often studied by medical and public
health officials so that causes can be identified and future cases prevented.
Comorbidity describes when two or more mental disorders are
occurring at the same time and in the same person.
The etiology is the cause of the disorder. There may be social,
biological, or psychological explanations for the disorders beginning which
need to be understood in order to identify the appropriate treatment.
Likewise, the effectiveness of a treatment may give some hint at the cause
of the mental disorder. ( More on this later ☺ )
The course of the disorder is its particular pattern. A disorder may be
acute meaning that it lasts a short period of time, or chronic, meaning it
lasts a long period of time. It can also be classified as time-limited,
meaning that recovery will occur in a short period of time regardless of
whether any treatment occurs.
Prognosis is the anticipated course the mental disorder will take. A
key factor in determining the course is age, with some disorders presenting
differently in childhood than adulthood.
Finally, we will discuss several treatment strategies in relation to
specific disorders. Treatment is any procedure intended to modify abnormal
behavior into normal behavior. The person suffering from the mental
disorder seeks the assistance of a trained professional to provide some
degree of relief over a series of therapy sessions. The trained mental health
professional may prescribe medication or utilize psychotherapy to bring
about this change. Treatment may be sought from the primary care
provider, in an outpatient fashion, or through inpatient care or
hospitalization at a mental hospital or psychiatric unit of a general hospital.

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Match the following words that are used in clinical descriptions

with their corresponding examples: (a) presenting problem,
(b) prevalence, (c) incidence, (d) prognosis, (e) course, and (f)
etiology.

1. Maria should recover quickly with no intervention necessary.

Without treatment, John 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 center because of
her increasing feelings of guilt and anxiety.
4. Biological, psychological, and social influences all contribute to a
variety of disorders.
5. The pattern a disorder follows can be chronic, time limited, or
episodic.
6. How many people in the population as a whole suffer from
obsessive-compulsive disorder?

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References:
American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders. (5th ed.). Arlington, VA: American
Psychiatric Publishing.
David H Barlow, Durand. Abnormal psychology : an integrative approach,
Boston, MA : Cengage Learning, [2018].
Ronald Comer, Abnormal Psychology, 9th ed. Worth Publishers, Inc.
Published: 2015.
James Morrison. DSM5 Made Easy:The Clinician,s Guide to Diagnosis 1st
ed. THE GUILFORD PRESS: New York.

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