HCH 100: BEHAVIOURAL SCIENCES - MODULE 3 BEHAVIOUR CHANGE

UNIVERSITY OF NAIROBI

COLLEGE OF HEALTH SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PSYCHIATRY

HCH 100: BEHAVIOURAL SCIENCES

MODULE 3: BEHAVIOUR CHANGE

FOR

BACHELOR OF MEDICINE AND SURGERY STUDENTS

WRITER:

DR. MUTHONI A. MATHAI, MBCHB, MMED (PSYCH), Ph.D.

Copyright

Copyright

Behavioural Sciences Course to Undergraduate Students in the College of Health Sciences

by Distance Learning

Published by the University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

© 2015

The University of Nairobi (UoN)

College of Health Sciences (CHS), Department of Psychiatry

Lecture series: HCH 100: BEHAVIOURAL SCIENCES

Published by University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya

Printed by College of Health Sciences, University of Nairobi, 30197-00100, Nairobi, 2013

© University of Nairobi, 2013, all right reserved. No part of this Module may be reproduced in
any form or by any means without permission in writing from the Publisher.

Writer: Dr. Muthoni A. Mathai

Reviewer:

Chief Editor: Joshua M Orina

Technical Coordinator: Dr. Kefa Bosire and James Macharia

The University of Nairobi (UoN), College of Health Sciences wish to acknowledge the
contribution of the Department of Psychiatry and PRIME-K whose financial assistance made the
development of this e-learning course possible.

MODULE 3: BEHAVIOUR CHANGE

Welcome to this module on behaviour change. This module is a follow-up to module one and
two that cover, behavioural theories and personality theories. Knowledge acquired in the
previous module forms a good foundation for the current one. Disorders in health and wellbeing
are more often than not related to behaviour, either through negligence or through acquired
habits of unhealthy behaviour and life style. Although you are at the beginning of your career as
promoters of health and wellbeing, it is important that you start taking this role actively,
observing your surroundings from the perspective of the behavioural impact on wellbeing. It is
expected that during the practice of medicine you will continuously be trying to change the
behaviour of your individual patients or the community you are working in, in order to prevent
poor health and promote good health and wellbeing.

In this module we will be looking at psychosocial theories of behaviour as well as different

factors that influence it in a series of nine sections. The Module will start by addressing the basis
of human behaviour, which forms the foundation to understanding behavioural changes which
will be followed up with an appraisal of constitutional factors and behaviour including genetic
influence on behaviour with an additional section to address intelligence and psychological
disorders and gender differences in abnormal behaviour. We will move on to more sociological
aspects of behaviour to look at life events and their impact on behaviour, social attitudes and
their influence on behaviour and lastly iatrogenic disorders and behaviour. It is hoped that having
gone through this module your capacity to interact with colleagues and patients and to make
decisions relevant to the promotion of health will be positively influenced by knowledge you
have acquired.

3.2 Module objectives

At the end of this module, you should be able to:

1. <!--[if !supportLists]-->Discuss the Foundation of human behaviour

2. <!--[if !supportLists]-->Describe the Theories of behaviour change
3. <!--[if !supportLists]-->Evaluate the theories of Constitutional Factors and Behaviour<!--
[endif]-->
4. <!--[if !supportLists]-->Discuss genetic influence on behaviour<!--[endif]-->
5. <!--[if !supportLists]-->Describe genetic influence on Intelligence and psychological
disorders <!--[endif]-->
6. <!--[if !supportLists]-->Discuss Gender differences in Abnormal Behaviour <!--[endif]--
>
7. <!--[if !supportLists]-->Discuss Life Events and Abnormal behaviour<!--[endif]-->
8. <!--[if !supportLists]-->Discuss Social Attitudes and Behaviour<!--[endif]-->
9. Evaluate Iatrogenic Disorders and Behaviour

We shall now proceed to discuss the foundation of human behavior which makes the first section
of this module.

SECTION ONE: FOUNDATIONS OF HUMAN BEHAVIOUR

Welcome to this first section in this module on the theories of behavioural change and
behavioural models. From previous sections you will be familiar with some of the content in this
section. Psychology has been defined as the study of human behaviour and mental processes.
Behaviour is often implicated in health and wellbeing making behaviour change an important
vehicle in the prevention of ill health and promotion of wellbeing for health workers. As future
medical doctors and leaders in the promotion of health, this is priority area for your intervention.
This section is an overview on the scientific background of human behaviour, an important
preriquisite to unerstanding behaviour change We will look at a broad definition of behaviour,
describe the historical background in the study of human behaviour and review some of the
important theories in human behaviour from the perspective of history.

1.2 Section Objectives

At the end of the lecture you should be able to:

1. <!--[if !supportLists]-->Define and describe behaviour<!--[endif]-->

2. <!--[if !supportLists]-->Describe the Historical background in the study of human
behaviour,
 3. Discuss the different theories of human behaviour

1.3 Behaviour

In this section we hve discussed:

 behavior of living things

 behavior of human beings
 1.3.1 Behaviour in Living Things
 The most basic form of behaviour is that seen in unicellular organisms, in higher animals,
behavior is controlled by the endocorine system and the nervous system.
 The complexity of the behavior of an organism is related to the complexity of its nervous
system. The capacity to learn new responses to environmental triggers and adjust reaction
to these, increases with the complexity of the nervous system as shown in figure 1.


 Figure 1: Complexity of the Nervous System

 Source: Kolb & Whishaw, An Introduction to Brain and Behavior, 2nd Ed - Chapter 1
 1.3.2 Behaviour in Human Beings
 Human behaviour can be described as common, if it is a form of behaviour found the
majority of people in the community, it can also be said to be normal if within that
community it is within accepted norms. Other words such as usual or unusual, acceptable,
or unacceptable and abnormal are all used.

 In-Text Question 1.1



 What is abnormal behaviour?

 Abnormal behaviour is of interest to health workers and in particular to mental health
workers, and broadly refers to deviations from what is considered typical. Behaviour.
This deviation can be further be specified to qualitative abnormality- deviation from
culturally accepted standards or quantitive abnormal- behaviour that deviates from the
statistical average of a population.
  It must however be clear that normality is often relative and deviation may not be an
indication of a psychological disorder. However, because human beings are social
animals there are social norms that dictate behaviour and social control is used to regulate
behaviour.

 Activity 1.1
 In groups of two or four work on the following activity:
 Describe situations where abnomarlity in the form of deviation from social norms cannot
be termed psychological abnormality i.e. requiring intervention



 Figure 2: EEG evidence of brain activity
 What we see as behaviour are products of mental processes and Human behaviour cannot
be seen in isolation to the mental processes.

 Take Note 1.1

 Psychology is defined as the study of human behaviour and mental processes.

1.4 Historical background in the study of human behaviour,

We discuss:

 The Antic To Modern Times

 Nature vs Nurture
 1.4.1 The Antic To Modern Times
 An interest in human behaviour as far back as Plato and Aristotle in ancient greek. While
this consituted some of the important philosophical questions of ancient Greece, in the
middle ages around the 16th C. the questions of human behaviour had become the
preserve of church in Europe referred to as the study of the soul. The age of enlightment
around 19th C saw the return of free thinking and the question of human behaviour
returned back to the free thinking world of the then philosphical science. Psychology
became a scientific study of mental experiences and in the early 20th C- Modern
Psychology was born as the study of observable human behaviour.
 1.4.2 Nature vs Nurture
  One question has engaged the minds of philospohers and scientists through the ages from
ancient times to modern times and that is the the question as to whether human behaviour
is a product of biology as in inheritated or acquired through lifes experiences. This has
been referred to as the Nature vs Nurture or the role of the Biology (Hereditary) vs
Environment discourse.
 Aristotle-384-322 B.C. believed in sensory experience (what we perceive with our five
senses) as the source of knowledge that make us who we are- This has been referred as
empiricism. We are born without knowledge and life‘s experiences write on our ‚blank
slate‘.
 Plato (427-437 B.C.) on the other handbelieved that Human beings enter the world with
in-born knowledge of reality- referred to as Nativism/ Nature, he went on to add that
reasoning provided access to this knowledge.
 These have been called the two major schools of thought on the question of aetiology of
human behaviour-empiriscim and nativism. In other words those who believe that human
behaviour is a result of their experiences the empiricists – and who claimedlike John
Locke 1634-1704- Human mind is a‚tabula rasa‘ at birth- knowledge is acquired through
life experience, and those who believe that it is a result of biology or genetic endowment.
And in between are all the different grades of nature vs nurture in the sense of- both are
important but which one is more imprtoant than the other. An example of this is
Immanuel Kant (1724-1804) –who saw Nature and Nurture as sources of knowledge and
knowledge as a product of inborn faculties that interpret sensory input from environment.

1.5 Different theories of human behaviour

In this section we have discussed:

 Modern Rationalism and the Behaviourism

 Freud and Psychoanalysis
 Humanistic Theories of Behaviour
 Social Learning- Social Influences
 Cognitive Behavioral Theories
 Instincts, Basic Drives and Motives
 Psychobiological Basis of Behaviour in the “Post Modern”
 1.5.1 Modern Rationalism and the Behaviourism
  By the 19th C and the evolvement of modern science the question was not so much
whether knowledge was inheritated or acquired but the question was projected more to
personality and bheavioural traits. In favour of biology were the rationalists and in favour
of environment were now referred to as as behaviourists
 In support of the Biological influence were advances in sciences which saw:
 - The study of nerve impulses by Herman von Helmholtz (1821-1894)
 - The desription of Brain function research by Broca (1824- 1880)
 And the earth shattering controversial evolutionary theory that stated that natural
selection accounted for development of human abilities. With the survival of those with
most highly developed abilities propagated and hotly defended by Darwin-( 1809-1882)
and his cousin Sir Francis Galton.
 The environmentalist were also on the march and ‚Nurture‘ can be said to have reached
its peak in the science of Behaviourism- study of observable behaviour. No statement can
express the conviction of the behaviourist as that made by J. B. Watson (1878-1958) in
1946: „Give me a dozen healthy infants, well formed, and my own specified world to
bring them up and I‘ll gurantee to take any one at random and train him to become any
type of specialist I might select- doctor, lawyer, artist, merchant-chief and, yes, even
beggarman and thief, regardless of his talents, penchants, tendencies, abilities, vocations,
and race of his ancestors.“ (Watson, 1936)
 In other words Watson and his colleagues were convinced that it didnt really what genetic
material you were endowed with, you could under the right environment be trained or
molded to become anybody.
 Of particular interest in this movement was the learning theories developed by Ivan
Pavlov (1849- 1936), the classical conditioning and B.F. Skinner (1904-1990) the operant
conditioning.

1.5.1 Modern Rationalism and the Behaviourism

By the 19th C and the evolvement of modern science the question was not so much whether
knowledge was inheritated or acquired but the question was projected more to personality and
bheavioural traits. In favour of biology were the rationalists and in favour of environment were
now referred to as as behaviourists

In support of the Biological influence were advances in sciences which saw:

- The study of nerve impulses by Herman von Helmholtz (1821-1894)

- The desription of Brain function research by Broca (1824- 1880)

And the earth shattering controversial evolutionary theory that stated that natural selection
accounted for development of human abilities. With the survival of those with most highly
developed abilities propagated and hotly defended by Darwin-( 1809-1882) and his cousin Sir
Francis Galton.

The environmentalist were also on the march and ‚Nurture‘ can be said to have reached its peak
in the science of Behaviourism- study of observable behaviour. No statement can express the
conviction of the behaviourist as that made by J. B. Watson (1878-1958) in 1946: „Give me a
dozen healthy infants, well formed, and my own specified world to bring them up and I‘ll
gurantee to take any one at random and train him to become any type of specialist I might select-
doctor, lawyer, artist, merchant-chief and, yes, even beggarman and thief, regardless of his
talents, penchants, tendencies, abilities, vocations, and race of his ancestors.“ (Watson, 1936)

In other words Watson and his colleagues were convinced that it didnt really what genetic
material you were endowed with, you could under the right environment be trained or molded to
become anybody.

Of particular interest in this movement was the learning theories developed by Ivan Pavlov
(1849- 1936), the classical conditioning and B.F. Skinner (1904-1990) the operant conditioning.

1.5.2 Freud and Psychoanalysis

Sigmund Freud (1856- 1939) has a special place in mental health as the father of the modern
psychotherapy. Having started as a neurologist he moved on to become the founder of a new
discipline- psychoananlysis, with a heavy leaning towards environment as the basis of
psyhcological disorders or abnormal human behaviour.

According to the Psychoanalytical theory:

early childhood experiences play an important role in the developement of personality, and
experiences and conflicts during the first five year form the basis of psychosexual development.
Freud theorised that abnormal behaviour as in psychological disorders developed as a result of
unresolved childhood conflicts and trauma.

He also described the 3 instances of the psyche the id the ego and the super ego and the three
structure of the psyche -concious, subconcious and unconcious. Based on this theory he went on
to develop a therapy technique that aimed at resolving childhood conflicts.

In-Text Question 1.2

List the five stages of psychosexual development according to Freud.

Freud described the five stages of psychosexual development as the oral stage, the anal stage, the
phallic stage also referred to as the oedipal stage, the latent stage and the genital stage. Another
psychoanalyst- Erik Erikson went on to describe the 8 stages of Psychosocial development.

1.5.3 Humanistic Theories of Behaviour

Humanistic perspective- Abraham Maslow (1908-1970), theorised that human behaviour was
geared towards satisfaction of needs. He described the hierarchy of needs, starting with the most
basic to the highest as: Physical needs, Safety needs, Love needs, Aesthetic needs.

Carl Rogers (1902- 1987) on the other hand postulated that human beings have through free will
the capacity to overcome the influences of unconcious motive and environmental experiences.
Human beings have a natural tendency for self-actualisation (the attainment of one‘s potential).

1.5.4 Social Learning- Social Influences

The social learning theory postulates that as we grow and develop in our lives, we also develop
social attitudes which strongly influence our behavior. Children internalize the values of their
parents attitudes of the society and cultural expectations about how to behave- socialisation.

As we grow away from childhood into adolescence and beyond, there is a tendency to adapt
behavior in order to fit in with a particular group and peer influence and pressure form an
important aspect of social influences .

1.5.5 Cognitive Behavioral Theories

In the Cognitive Perspective (Gardner 1985), the brain has an active role in organising
perceptions, in processing information, and in interpreting experiences.

Jean Piaget (1896-1980) described the cognitive development as an important basis of behaviour.

The prevailing congitive theories postulate that thoughts shape emotions and behaviour and that
unwanted behaviour can be changed by changing the way we interpret our experiences forming
the basis of Cognitive behavioural therapy.

1.5.6 Instincts, Basic Drives and Motives

Earlier attempts to explain human behaviour on the basis of instincts as in other animals was
replaced by the drives theory and motivation. A Drive is described as a force originating from a
natural need, like thirst or hunger. Such a situation stimulates the organism to comply with the
need. This is complented by motivation corresponding to the state of an organism- to start or to
continue an act e.g. the type of food available or seen.

1.5.7 Psychobiological Basis of Behaviour in the “Post Modern”

The 21stcentury has seen major progress in the direction nature and hereditary factors, sometimes
being referred to as the age of the return to nature/ hereditary. This has been influenced by rapid
advances in the fields of: Behavioural genetics- based on increasing knowledge on the human
genom; Polygenic behaviour of human abilities and behaviour; Identification of genes related to
specific personality types and even disorders in psychiatry is on the move.
It is now accepted that psycho-biology- the nervous system, allows us to perceive, to interpret
and to respond to events from the environment. Hormones for example regulate human
behaviour as in quantities of food eaten, though not in choice of foods.

Closely related to behaviour are the complex psychobiological states referred to as emotions.
Emotions includes a wide range of observable behaviors, expressed feelings, and changes in the
body state, regulated to a large extent by hormones and other neurobiological chemicals .

Understanding of behaviour is undergoing modifications based on new understanding of the

brain, What Eric Kandel- (In search of memory) has been termed the emergence of a new
science of the mind. This has been facilitated be the emergence of modern investigation
techniques like the Functional Magnetic Resonance Imaging (fMRI) and the Positron Emission
Tomography (PET).

Take Note 1.2

 <!--[if !supportLists]--><!--[endif]-->Functional magnetic resonance imaging (fMRI) is a

neuro-imaging that procedure that measures brain activity by detecting associated
changes in blood flow.
 Positron emission tomography (PET) is an imaging technique that produces a three-
dimensional image of brain activity.

1.6 Summary

We have now come to the end of this lecture. Interest in human behaviour goes back to the
Antic. The nature vs nurture discourse that has characterised historical discussions from time
immemorial has tried to argue either for biological factors/hereditary factors or the
environmental/socialisation factors to explain human behaviour.

Human behaviour is complex and cannot be explained on the basis of any single theory. Both
hereditary factors and environmental factors play an important role and it is not a question of
either or. Recent advances in sceince however, continue to shed more light on the process of the
brain making possible to have a closer knowledge of the biological factors.

1.7 Suggestions for further readings

 1.7 Suggestions for further readings

1. <!--[if !supportLists]--><!--[endif]-->Introduction to Psychology: Clifford Thomas

Morgan, Richard Austin King, et.al
2. <!--[if !supportLists]--><!--[endif]-->Atkinson & Hilgard's Introduction to Psychology:
Susan Nolen-Hoeksema, et.al
3. <!--[if !supportLists]-->Psychology: Lester M. Sdorow
4. <!--[if !supportLists]-->Human Adjustment J.A. Simons; S. Kalichman; J.W. Santrock
5. <!--[if !supportLists]-->Social Psychology David G. Myers
6. Social Psychology Robert A. Baron & Donn Byrne

1.8 Review Questions

Review Questions
Abnormal human behaviour can be described using all the following except

Qualitative deviation from cultural norms

Quantitative deviations from society norms
Behaviour characterized by socio-occupation dysfunction
Behaviour based on different political opinion as the mainstream
eBehaviour characterized by personal distress

The historical discourse on Nature vs Nurture refers to:

The argument for or against science

The argument for hereditary factors vs environment to explain human behaviour
The argument for religion vs science
The argument for modern Tradition medicine vs modern medicine
The argument for ethnocentrism vs universalism

< !--[if !supportLists]--><!--[endif]-->Broca (1824-1880), the man who discovered the Broca
area in the brain was, with reference to the above discourse, a
 Psychoanalyst
environmentalist
a behavioralist
existentialist
rationalist

Sigmund Freud (1856-1939) theorised that abnormal behaviour and psychological disorders
developed as a result of unresolved childhood conflicts and founded a field of
psychology/psychotherapy referred to as

Humanism
Behaviouralism
Psychoanalysis
Existentialism
Rationalism

SUBMIT ANSWERS

SECTION TWO: THEORIES OF BEHAVIOUR CHANGE

Welcome to this second section in this module on the theories of behavioral change and
behavioral models. In the first section you looked at the basis of human behavior, including some
of the historical background that has formed the basis of our understanding of behavioral
changes. Behaviour change is an important vehicle in the prevention of ill health and promotion
of wellbeing by health workers. As future medical doctors and leaders in the promotion of
health, this is a priority area for you. You will need to understand behaviour change in order for
you to be efficent in the promotion of health. In this section we will look at 4 of the theories-
Classical and operant conditioning; Social cognitive theory; Theory of self efficacy and the
Reasoned action theory and two models that have evolved through the history of psychosocial
sciences to explain behaviour change and to promote changes in behaviour that would improve
the wellbeing of humans and their capacity to adapt to a rapidly changing envirnoment.

2.2 Section Objectives

At the end of the lecture you should be able to:

1. <!--[if !supportLists]-->Describe behavioral change theories

2. <!--[if !supportLists]-->Discuss observed health related behavior from the perspectives
models of behavior change <!--[endif]-->
3. Describe relevant areas of Application of behavioural change models

2.3 Behavioral change theories

Behavioural change theories and models are attempts to explain the reasons behind alterations
in individuals' behavioural patterns.

Behavioural theories cite environmental, personal, and behavioural characteristics as the

major factors in determining behaviour and behaviour change.

There are several theories and models on behaviour change, Each theory or model focuses on
different factors in attempting to explain behavioural change. There are, however a lot of
common elements among the different theories and they all fall under a broad category of
learning and social cognitive theories

Examples of behaviour change theories that are of particular relevance to health include:

a. Classical and Operant conditioning

b. Social cognitive learning Theory

c. Theory of self-efficacy

d. Reasoned action theory

Some of these have already been covered more extensively in the module on theories of
personality development so will be covered only briefly here.

2.3.1 Classical and Operant Conditioning

These learning theories presume that complex behavior is learned gradually through the
modification of simpler behavior. Secondly that Individuals learn by imitating behavior they
observe in others and rewards (reinforcement) ensure the repetition of desirable behavior. When
we think learning theories two behavioural scientists come to mind- Ivan Pavlov and B.F.
Skinner.

Pavlov described what he called classical conditioning based on a series of experiements with
dogs. He was able to show that although dogs do not normally respond to a bell as stimulus to
salivate, they can be trained to do so by coupling the bell with natural salivation-causing stimulus
- food (in this case a bone).

Pavlovs classical conditioning (Figure 3) has been used as a component of learning in different
setting both in humans and animals over the decades.

Figure 3: A diagrammatical representation of Pavlov's experiment

Source: http://www.getting-in.com/guide/gcse-psychology-learning-introduction-to-studies-and-
terminology/

Operant conditioning - B F. Skinner (1904-1990) went further to describe how the

consequences of behaviour can be used to strengthen newly introduced or existing behaviour or
abolish unwanted behaviour in a series of experiements involving rats. He called this new type of
learning operant conditioning and the consequences of behaviour that influence behaviour,
reinforcement either positive or negative as shown in figure 4, where a rat is rewarded when it
push e
s a panel with food pellets. But may also be punished with electric shock.

Figure 4: A diagrammatical representation of Skinner's experiment on operant conditioning

Source: http://www.simplypsychology.org/operant-conditioning.html

Skinner showed that new behaviour could be enhanced through rewards- positive reinforcement
and unwanted behaviour though punishment- negative reinforcement. The theory of Operant
conditioning has had a major impact on education, child rearing, therapy for disorders and
correction.

Activity 2.1

In groups of two or four work on the following activities:

Describe behaviours that are learned through operant conditioning in a given socio-cultural
content.

2.3.2 Social Cognitive Theory

Bandura (1986) described the basic reciprocal interactions between environmental, personaland
behavioural elements as key determinants of behavioural change- depicted in figure 5.

Figure 5: Basic reciprocal interactions as key determinants for behavioural change

Bandura went on to describe a more complex reciprocal interaction between thoughts, behaviour,
individual's characteristics and social environment.

Based on this theory there are three distinct components of interactions:

- An individual's thoughts affect their behaviour and an individual's characteristics elicit certain
responses from the social environment.

- Likewise, an individual's environment affects the development of personal characteristics as

well as the person's behaviour,

- Lastly an individual's behaviour may change their environment as well as the way the
individual thinks or feels.

These interactions have been further depicted in figure 6.

Figure 6: Complex reciprocal interactions as determinants for behavior change

Activity 2.2

Student Activities- in groups of upto 4 students-

1. Describe situations (as real as possible) in the Kenyan socio-cultural context in which:
2. <!--[if !supportLists]-->An individual’s thoughts affect their behaviour<!--[endif]-->
3. <!--[if !supportLists]-->An individual’s characteristics (personality traits) elicit certain
responses from the social environment. <!--[endif]-->
4. An individual’s characteristics (ethnic-lingual or racial) elicit certain responses from the
social environment
 5. An individual’s environment affects the development of personal characteristics as well
as the person’s behaviour
6. An individual’s behaviour may change their environment as well as the way the
individual thinks or feels.An individual’s behaviour may change the way the individual
thinks or feels.

< !--[if !supportLists]--><!--[endif]-->

< !--[endif]-->

One of the key concepts inherent in the Social cognitive theory is the Self-efficacy where Self-
efficacy refers to one’s confidence in the ability to take action and persist in action.

This person is not likely to engage in healthy lifestyle by engaging in the 25 km marathon.

Self-efficacy determines other important elements of behaviour change like:

1. the choice of activities in which people engage

2. how much energy they will expend on such activities and
3. the degree of persistence they demonstrate in the face of failure and/or adversity

2.1.3 Theory of reasoned Action-(Ajzen 1985)

This theory has its basis in the humanistic theory of behaviour and starts off by making an
assumption that humans are rational and individuals consider the consequences of a behaviour
before performing the particular behaviour. As a result, intentionis an important factor in
determining behaviour and behavioural change.

Secondly that intentions develop from an individual's perception of a behaviour as positive or

negativetogether with the individual's impression of the way their society perceivesthe same
behaviour.

 Thus, personal attitude and social pressure shape intention, which is essential to
performance of a behaviour and consequently behavioural change
 2.4 Models of Behavior change
 Models of change borrow from one or more theories of change to develop a
model/structure that can predict likely behaviour in specific situations.
 2.4.1 Transtheoretic/Stages of Change Model
 The transtheoretic Model by Prochaska and DiClemente (1986)of change also called the
stages of change model is a model that has often been used to predict the changes that
one is expected to go through in recovery from an addiction.
 Behavioural change under this model is a described as a five-step process between which
Individuals may oscillate up and down before achieving complete change. In addiction
medicine there is the time during which the individual doesn't acknowledge they have a
problem, or is in denial, referred to as precontemplationstage. In the Contemplation
stage- develops a desire to change, in Preparation- shows intention to change the
behaviour, in Action stage- begins to exhibit new behaviour consistently and in the
Maintenance stage- exhibits the new behaviour consistently for over six months.
 The Stages: are precontemplation, contemplation, preparation, action, and maintenance.
 Figure 7: Stages of change spiral
 Source: The Behaviour Change spiral ("What do they want us to do now?") AFAO 1996
 It is however important to note that behaviour change can only take place in the context
of an enabling or supportive environment. The relevant features of such a context include
social, cultural, ethical and spiritual, legal and political features and resources









 



 Figure 8: Stages of change and environmental features
 Source: The Behaviour Change spiral ("What do they want us to do now?") AFAO 1996
 In this model behavioural change occurs in a cyclical process that involves both progress
and periodic relapse. In successful behavioural change, while relapses to earlier stages
may occur, individuals never remain within the earlier stage to which they have
regressed, but rather, spiral upwards, until eventually they reach a state where most of
their time is spent in the maintenance stage.

2.4.1 Transtheoretic/Stages of Change Model

Activity 2.3
Students activities- In agroup of upto 4 students- look at each of the features below and try to
describe how each of the features can apply to the recovery of an alcohol dependent student
going through the stages of change recovery

o Social features
o Cultural features
o Ethical and spiritual features
o Legal features
o Political features
o Resources

2.4.2 The Health Belief Model

The Health Belief Model (HBM) attempts to explain health-behaviour in terms of individual
decision-making based on attitudes and beliefs of the individual. It proposes that the likelihood
of a person adopting a given health-related behaviour is a function of that individual's
perception of a threat to their personal health, and their belief that the recommended behaviour
will reduce this threat. Thus, a person would be more likely to adopt a given behaviour if non-
adoption of that behaviour is perceived as a health threat and adoption is seen as reducing that
threat.

The Key variables of HBM include

a. Perceived Threat: Consists of two parts- Perceived Susceptibility: One's subjective

perception of the risk of contracting a health condition and Perceived Severity: Feelings
concerning the seriousness of contracting an illness or of leaving it untreated.

While a youth may perceive getting rained on as a risk factor in catching a cold, the seriousness
of the illness may not be considered severe enough to keep him from playing football in the rain.

b. Perceived Benefits: The believed effectiveness of strategies designed to reduce the threat
of illness.
c. Perceived Barriers: The potential negative consequences that may result from taking
particular health actions, including physical, psychological, and financial demands.
d. Cues to Action: Events, either bodily (e.g., physical symptoms of a health condition) or
environmental (e.g., media publicity)
e. Self efficacy: an individual's perceived ability to successfully carry out a "health"
strategy, such as using a condom consistently.

Activity 2.4

One of the most discussed form of behaviour change for prevention of HIV infection is the use
of the male codom.
In groups of upto 4 students- Discuss this from the perspective of the HBM

Taking into account

o Perceived Threat:
o Perceived Benefits:
o Perceived Barriers:
o Cues to Action:
o Self efficacy:

2.5 Applications of behavioral change theories and models

While behaviour change models have been applied in many situations, three areas have
dominated:

a. Health
b. Education
c. Criminology

1. Health

Promoting healthy lifestyle development- in explaining health-related behaviours providing

insight into methods that would encourage individuals to develop and maintain healthy lifestyles.

Specific health applications of behavioural change theories include the development of programs
promoting active lifestyles and programs reducing the spread of diseases like HIV/AIDS.

2. Education

Behavioural change theories can be used as guides in developing effective teaching methods.

Since the goal of much education is behavioural change, the understanding of behaviour afforded
by behavioural change theories provides insight into the formulation of effective teaching
methods that tap into the mechanisms of behavioural change.

In an era when education programs strive to reach large audiences with varying socioeconomic
statuses, the designers of such programs increasingly strive to understand the reasons behind
behavioural change in order to understand universal characteristics that may be crucial to
program design.

3. Criminology and correction

Theories of behavioural change suggest possible explanations to criminal behaviour and methods
of correcting deviant behaviour. Since deviant behaviour correction entails behavioural change,
understanding of behavioural change can facilitate the adoption of effective correctional methods
in policy-making.

Take Note 2.1

 No single theory can explain complex human behaviour

 Most Health projects are based on more than one theory of behaviour change

2.6 Summary

We have now come to the end of this lecture. Behavioural change is an important component of
preventing ill health and promoting good health and wellbeing. Theories of behaviour are
psychosocial theories that help us not only to understand behaviour but also to understand why
people engage in certain behaviour, undertake a form of behaviour change, or even sustain it.
Theories of behaviour change help health workers to formulate and designs programs to promote
and maintain a positive change in the individual as well as the community.

We hope you enjoyed the lecture. Before proceeding to the next lecture attempt the as self-
assessment test in section 1.8 to gauge how well you have understood the lecture.

2.7 Suggestions for further readings

2.7 Suggestions for further readings

1. <!--[if !supportLists]-->Introduction to Psychology: Clifford Thomas Morgan, Richard

Austin King, et.al<!--[endif]-->
2. <!--[if !supportLists]-->Atkinson & Hilgard's Introduction to Psychology: Susan Nolen-
Hoeksema, et.al
3. <!--[if !supportLists]-->Psychology: Lester M. Sdorow<!--[endif]-->
4. <!--[if !supportLists]-->4Human Adjustment J.A. Simons; S. Kalichman; J.W. Santrock
<!--[endif]-->
5. <!--[if !supportLists]-->Social Psychology David G. Myers <!--[endif]-->
6. Social Psychology Robert A. Baron & Donn Byrne

2.8 Review Questions

Pick the best answer

Which one of the following is true of classical conditioning in Pavlov’s experiment

Salivation to a bone only in the dog is a conditioned stimuli

A Bell is a an unconditioned reflex
A bell is an unconditioned stimuli
A bone is a conditioned reflex
A bone is a conditioned stimuli

Canning in schools is an education practice that is associated with

Classical conditioning
Health belief model
psychodynamic psychology
Permissive parenting
Operant conditioning

Which of the following is not associated with self-efficacy

Creativity
Persistence in an action
one’s confidence in the ability
Choice of activities
Amount of energy expended in an activity

Which one of these theories refers to the ancient Greek theory of Body types

Sheldon,s theory
Theory of Physiognomy
Kretchmer’ s theory
Somatotype theory
The Humoral theory

SUBMIT ANSWERS

SECTION THREE: CONSTITUTIONAL FACTORS AND HUMAN BEHAVIOUR

Welcome to this third section in the module on bio-psychological basis of behavior.
Constitutional factors refer to the components of the individual make-up which includes bodily
build, sex and temperament. We will be taking time to reflect on whether the way you look and
your bodily constitution determine your personality and we will look at several related theories
some of which have been discredited but continue to have some influence in the way behaviour
is interpreted both in professional circles and and in every day life. We will be looking at the
antic humoral theory, the later theories of body and behaviour and the more dicursive
sociocultural theories of behaviour.

Objectives

At the end of the lecture you should be able to:

1. Describe the humoural theory of behavior

2. Discuss the theories of body and human behaviour
3. Discuss Body culture and media

Take note

Personality- refers to your unique, relatively consistent pattern of thinking, feeling, and behaving

3.3 The humoural theory of behavior

The biological basis of personality and behaviour has been of interest since ancient times. The
Ancient Greeks- Hippocrates (460-377) B.C. And Galen (130-200 A.D.) hypothesized that
temperament, a person‘s predominant emotional state, reflects the relative level of body fluids
(called humours). The greeks described 4 type s of personalities based on the then known body
fluids

1. Blood- with cheerful, pleasure-seeking and sociable or sanguine temperament

2. Phlegm- with calm relaxed and quiet with phlegmatic temperament
3. Black bile- with a depressed, introverted and thoughtful, or melancholic temperament
4. Yellow bile- with irritable, ambitious and leader-like choleric temperament

Modern research has not found a humoral basis for personality but recognises the four
personality types, and you will come across these descriptions of personality types repeatedly
both in literature and every day life, though less professionally.

In-Text Questions 3.1

Match each emoticon to one of the four personality types described above:

<!--[if !vml]--><!--[endif]-->

3.4 The theories of body and human behaviour

These include:

 Phrenology and Pysiognomy

 Physique Body build and personality: Kretchmer Body Types
 Sheldon’s Constitutional Theory of Personality
 3.4.1 Phrenology and Pysiognomy
 In the 18th century the study of phrenology and physiognomy gained dominance. New
psychological specilisation was born, with the so called Phrenologists claiming that a
study of the contours of the skull could indicate the personality of a person. The bumps
on the skull determined the relative sizes of certain brain areas related to particular
personality charactersitcs-like-assertiveness, continuity, firmness etc.
 The study of physiognomy on the other hand claimed that personality was revealed in the
features of the face (i.e. size of nose or ears, shape of chin). After enjoying a period of
popularity phrenology gave way to the study of physique as a basis for personality
 However, some of the phrases have been retained in everyday language in description of
character.
  Activity 3.1


 In groups of two or four work on the following activity:

 Discuss the credibility of phrenology and physiognomy. You can palpate each other’s
scalp and try to prove this theory. However this will only be possible if you dont have
much hair on the head.


 A phrenology chart


3.4.2 Physique Body build and personality: Kretchmer Body Types

Ernst Kretchmer a German Psychiatrist (1888-1964), described four constitutional types:

a. The Pyknic
b. The Asthenic
c. The Athletic
d. The Displastic
1. The Pyknic- was described as a robust, well rounded figure with a tendency towards shortness
and stoutness. The trunk and body cavities are large, chest and shoulder are rounded. The neck
and limbs are short and stocky. The face is full and shield shaped

People with pyknic bodies were described as being talkative, uninhibited individuals who enjoy
social contacts. The pyknic individuals approach to problems was said to tend towards
practicality and realisism. They were people who were likely to express their emotions freely and
warmly but at times tended to become unduly elated or depressed.

Kretchmer found a third of manic - depressive patients to have a pyknic build.

2. The Asthenics - These were described as individuals with flat delicate physiques, they are
slender individuals with long, lean limbs and flat narrow chest with an elongated and the facial
features are sharp, they were also described as being frail and rather weak. People with this body
type tended to be shy, sensitive people who avoided social contacts and spent much of their time
day - dreaming.

3. The Athletics- build as the name suggests was said to be characterized by good muscular and
skeletal development including broad shoulders, large hands and long sturdy limbs.

4. The Displastics- were described as having mal-proportioned and atypical physique, with
features of abnormalities associated with endocrine dysfunction.

Kretchmer based his theory on the measurements of the physiques of 100 of mentally ill people.
He associated physique not only with personality types but with psychopathology. He however
concluded that a person's physique has nothing to do with whether he becomes psychotic or not.
But the physique merely influences the type of mental illness he would develop if he should
become psychotic. This theory has not been found to be valid in modern day psychiatry.

3.4.3 Sheldon’s Constitutional Theory of Personality

William Sheldon (American psychologist 1898-1977) working with thousands of photographs of

young men described 3 types of physiques which he called somatotypes

a. Endomorphy
b. Mesomorphy
c. Ectomorphy

After administering personality tests on his subjects he found that each somatoform was
associated to a particular temperament. Sheldon went on to describe 3 personality types related
to the body types as: Viscerotonia, cerebrotonia and somatotonia.

Reflection
In-Text Questions 3.3

Match each of the body types to a personality type.

In-Text Questions 3.3

Match each of the body types to a personality type.

1. Endomorph body type was described as - soft rounded, associated with relaxed, sociable,
easy going temperament he called viscerotonia. These types of personalities are characterized by
love of comfort and an interest in social gathering and food.

They express their feelings easily and are outgoing individuals.

2. Ectomorphs were described as thin frail physique- characterised by a shy restrained and
introspective temperament he called cerebrotonia. These personality types were found to be
very similar to the schizoid personality. Have inhibited feelings and favour solitude.

3. Mesomorphs were described as Muscular with strong physique- bold assertive and energetic
temperament he called somatotonia. These types are active, energetic and are self assertive,
aggressive and somewhat noisy. They are concerned with the affairs of the present and are doers
not thinkers.

Activity 3.2

In groups of two or four work on the following activity:

Discuss this excerpt from shakespeare and the implied physique and personality type.
Julius Caesar. Act 1 Scene 2

3.5 Body culture and media

Phrenology, Physiognomy and even Kretchmer‘s and Seldon's body type have faded more or less
from serious Psychology. Body types and the cultivation of certain body types in relation to
bheaviour and personality traits continues to be of great interest. This has become even more
prominent with the expansion of the media.

Activity 3.3

In groups of two or four work on the following activity:

Discuss the following.

1. How true is it that people of a certain body physique share some personality traits.
2. Is it true that tall people are more likely to be assertive and authoritative and small people
in leadership positions aggressive?
3. Are women with Sheldon,s endomorphic body types more likely to be more motherly?

Use examples from historical or known personalities. You can also look at this portrayal of body
in the media
The cultivation of body type is closely related to culture. In the african traditional culture an
example can be found in the fattening of girls in west Africa to endomorph body types. While
this body type has seen a lot of favour among women in several african socieites, there is a
strong move influenced from the west and media to cultivate an ectomorph body type for women
and a mesomorph body type for men.

Activity 3.4

In groups of two or four work on the following activity:

Discuss the role of the media and the fashion industry in relation to the pictures below:

Reflection

In-Text Question 3.4

Normality, fashion or disorder?

<!--[if !vml]--> <!--[endif]-->

3.6 Summary and conclusion

We have now come to the end of this lecture:

The Ancients Greeks associated personality types with 4 body fluids referred to as humours:

 Blood- sanguine temperament

 Phlegm- phlegmatic temperament
 Black bile- melancholic temperament
 Yellow bile- choleric temperament

Kretchmer, and Sheldon maintained that there is a close relationship between physique and
temperament and between physique and psychosis- with ectomorphic component predominating
in certain types of schizophrenic patients and with the greater majority of manic -depressive
patients exhibiting a endomorphic traits

Sheldon's three body types correspond approximately with the pyknic, asthenic and athletic types
by Kretchmer,

According to sheldon and others- a persons somatotype might affect the persons sense of self and
their behaviour and the behaviour of others towards them.

While later research has not found an association between body types and mental illness

 The impact of body type and self awareness and environmental influence has been
observed.- Physically imposing people may be more self assured, assertive, more
confident and expected to lead.
  Gender and cultural expectations of different somatypes no doubt plays important roles in
this theory

3.7 Suggestions for further readings

3.7 Suggestions for further readings

1. Introduction to Psychology: Clifford Thomas Morgan, Richard Austin King, et.al

2. Atkinson & Hilgard's Introduction to Psychology: Susan Nolen-Hoeksema, et.al
3. Psychology: Lester M. Sdorow
4. Human Adjustment J.A. Simons; S. Kalichman; J.W. Santrock
5. Social Psychology David G. Myers
6. Social Psychology Robert A. Baron & Donn Byrne
7. American Psychiatric Association DSM IV Tr

3.8 Model Exam Questions

SCORM Quiz
Which one of these theories refers to the ancient Greek theory of Body types

Sheldon,s theory
Theory of Physiognomy
Kretchmer’ s theory
Somatotype theory
The Humoral theory

The sample group that Ernst Kretchmer used to develop his theory of physique Body build and
personality came from a population of

High school students

Mentally ill patients
Ford factory workers
Photographs of young men
Randomly sampled adults

SUBMIT ANSWERS
 Essay Questions

1. <!--[if !supportLists]-->Write a short essay discussing gender and the cultural cultivation
of body types
2. Write a short essay discussing the implications of modern cultivation of body types on
health and wellbeing

SECTION FOUR: GENETIC INFLUENCE AND BEHAVIOUR

Welcome to this fourth section in this module on bio-psychological basis of behavior. In this
section we will be looking at one of the most interesting areas of human behavior. We will be
looking at what determines some of our observable traits and whether these are predetermined at
conception. We will briefly look at hereditary factors in behaviour and the study of behavioural
genetics. We will review parentings outcomes, individual choices and preferences in life from
the perspective of genes and environment. The study of Genetics is still-the new, to be explored,
horizon.

4.2 Section Objectives

At the end of the section you should be able to:

1. <!--[if !supportLists]-->Describe the link between genes and behavior<!--[endif]-->

2. Discuss Studies in behavioral genetics

4.3 Genes and Behaviour

Human variation in behaviourand susceptibility to mental illness, risk taking and performance
on intelligence tests, and other traits can partly be answered by behavioural genetics. Studies
seem to indicate a connection between genes and particular behaviours. This link however does
not mean there is a gene that makes some prefer football to cycling or mathematics to languages
or blue to green clothes the same way there are genes that explain eye colour, height, skin colour.

A gene or even several genes cannot make you act in any particular way in day to day life
because behaviour is a manifestation of the play of genetics on the body's development and
physiology in response to the environment. We do inherit our genes, we do not inherit
behavior traits in any fixed sense. The effect of our inherited set of genes on our behavior is
entirely dependent upon the context of our life as it unfolds day to day.

The way genes relate to behavior is complex, indirect, and closely related to variable events like
internal environment and external environment
Figure 9: External and Internal Environment

Environment in genetic terms means all influences other than inherited factors.

The External environment encomapsses family and friends, home and workplace, and specific
experiences from everyday life.

The Internal environment comprises of factors belonging to the internal, biological world:
nutrients,hormones, viruses, bacteria, toxins, and other products that affect the body during
prenatal development and throughout life.

Behaviour is explained as the outcome of an interaction between inherited factors and

environmental factors: Gene/environment interaction is the complex exchange of reciprocating
influence that goes beyond nature vs nurture. The two act upon and with each other. The same
genotype (underlying genetic structure) in different environments may lead to similar or
different phenotypes (observable traits). The same environment operating upon different
genotypes may also lead to similar or different phenotypes.

It all depends upon interactions.

Take Note 4.1

Heritability is the proportion of phenotypic variation in a population that is due to genetic
variation.

Behavior is also shaped by gene/environment correlation. A gene/environment correlation occurs

when individuals endowed with certain hereditary traits live in environments that support
expression of the trait.
 In-Text Questions 4.1

<!--[if !vml]--> <!--[endif]-->

Can gene-environment correlation be used to explain the picture above- discuss

4.4 Studies in behavioural genetics

For centuries behavioural scientists have tried to understand human behaviour in terms of
biological and hereditary factors-postulating that some aspects of complex human behaviour in
inherited first and foremost as a species but also from the closer ancestral lineage.

An interesting way to reflect on the role of behaviour and genetics is to look at our closest
„cousins" (if you believe in evolution that is):

Figure 10: Similarities in Man and Chimpanzee

The similarities in man and chimpanzee is depicted in this figure

 Activity 4.1

Discuss this in groups of 4 to 5.

What makes us different?

I hope you have had an interesting discussion and in case you have never heard of her, this is a
good time to also look at the work of Jane Goodall. Studies across species seem to indicate that:

< !--[if !supportLists]--> Human beings are characterised by 99% genetic similarity<!--[endif]-->

< !--[if !supportLists]--> Surprisingly Humans and chimpanzees share 98% genetic similarity<!--
[endif]-->

Behavioural genetists are interested in the less than 1% of the human genome that varies.
Behavioural genetists look at behaviour from the perspective of hereditary factors, by studying
similarities in behaviour among people who share genetic material by virtue of being
biologically related to each other. Most of what is currently known about the role of genes and
behaviour is based on such studies.

4.4.1 Sibling Differences in Behaviour

Biological siblings are half alike genetically, on average, and twins are fully alike genetically and
yet still turn out differently in many ways. Children growing up together may have a shared or
non shared environment. The shared environment e.g parents socioeconomic status may make
them similar while the non shared environment-illnesses, friends, teachers etc. may make them
different.

The importance of environment is emphasised strongly in some organisms in which internal

environmental factors influence biological developement as in our very very distant relative (if
you believe in evolution that is) the bee.

Take Note 4.2

  An interesting but simplistic example of the impact of the environment on genetic
endowment can be seen in the social insects like the honey bee

 In any honeybee colony, there is only one queen. She is much larger than than the worker
and her function is to lay the eggs. The worker bee has clearly other functions.

All grow from the same eggs gentically fed on different diets.

4.4.2 Family studies in behavioural genetics

Behavioural genetics study specific traits and try to determine the roles of both the environment
and the genes.

In a family study there is the key subject- the proband who posses of the trait to be studied

The trait is sought in:

 First degree relatives- parents, siblings, and children

 Second-degree relatives- aunts, uncles, grandchildren, grandparents, and nephews or
nieces.
Figure 11: Sign of Twins in a Car

Some of the most important contributions in our understanding of behavioural genetics have
come from twin studies.

Twin studies can be done on identical/ monozygotic twins (MZ), fraternal /dizygotic twins (DZ),
twins reared apart or together. Twin studies rely on the fact that MZ twins have essentially the
same set of genes while DZ twins have, a half-identical set. A basic assumption in these studies
is that reared together MZ twins and DZ twins get the same share of environmental influences-
equal environmental opportunities. What makes identical twins more alike compared to fraternal
twins is their greater genetic similarity.

Concordance rates: If Data from many twin pairs are collected and the rates of similarity for
MZ and DZ pairs compared- for discrete traits (traits that are either present or absent, such as a
disease) we say that concordance rates are - the proportion of the twin pairs that both have the
trait under study.

Co-relation coefficient: If Data from many twin pairs are collected and the rates of similarity for
MZ and DZ pairs compared continous traits ( traits that are documented as a range like, height,
weight, intelligence etc), we do statisitcal calculations for co-relation coeffcient.

Genetic influence is indicated when the concordance rate or correlation coefficient for identical
twins exceeds that for fraternal twins.

Shared environmental influences are indicated when the similarity for both types of twins are
quite close and Non-shared environmental influences are indicated when identical twins are
dissimilar for a trait.

To further illustrate this I have taken an imaginary study on Polydactyl (a discrete trait) depicted
in Figure 12 and answer the In-text question 4.2
Figure 12: Polydactyl

4.4.2 Family studies in behavioural genetics

In-Text Question 4.2

Calculate the concordance rate for Polydactyl (Extra digits ED) in the following imaginary study

Astudy sample of 100 MZ twins and 100 DZ twins

Findings-

 <!--[if !supportLists]--> In 80 pairs of MZ twins both have ED while in 20 pairs only one
has ED. <!--[endif]-->
 30 pairs of DZ twins both have ED while in 70 pairs only one twin has ED

< !--[if !supportLists]--><!--[endif]-->

1. <!--[if !supportLists]-->What is the concordance rate in MZ twins for trait ED- ??<!--
[endif]-->
2. <!--[if !supportLists]-->What is the concordance rate in DZ twins for trait ED -?<!--
[endif]-->
3. What does this tell us about the Genetic influence for trait ED?

4.4.3 Adoption Studies

Adoption creates an environment in which children are raised in families other than their
biological families. This give behavioural sceintists an opportunity to assess genetic vs
environemental influence. Adoption studies looks at biologically related people who have been
reared apart. In twin adoption studies, MZ twins separated at birth for adoption are compared. It
is assumed that the different environments shape them differently so that similarities in traits can
be attributed, at least in part, to genetic effects.

In child/parent adoption studies children adopted at birth are compared to both their biological
and adoptive parents. Evidence for partial genetic influence on a trait is indicated when adoptees
are more similar for the trait to their biological parents than to their adoptive parents. Evidence
for some environmental influence is found when the adoptee is more like his or her adoptive
parents than the biological parents.

Adopted children are also compared to other biological offsprings of adoptee parents, similarity
found is pressumed to be indicative of shared environment, while dissimilarity would suggest
genetic effects or non shared environement.

4.5 Summary

Behaviour is explained as the outcome of an interaction between inherited factors and

environmental factors. Studies seem to indicate a connection between genes and particular
behaviours.

Behaviour is a manifestation of the play of genetics on the body's development and physiology in
response to the environment.

The way genes relate to behavior is complex, indirect, and closely related to variable events like
internal environment and external environment

Behavioural genetics study specific traits and try to determine the roles of both the environment
and the genes. Family studies are apopular method used. In a family study the key subject who
posses of the trait to be studied is the proband while the first degree relatives are parents,
siblings, and children; and the second-degree relatives are aunts, uncles, grandchildren,
grandparents, and nepwhile hews or nieces.

Some of the most important contributions in our understanding of behavioural genetics have
come from twin studies

Conclusion: We do inherit our genes, we do not inherit behavior traits in any fixed sense.

4.6 Suggestions for further readings

Activity

1. Behavioral Genetics: An introduction to how genes and environments interact through

development to shape differences in mood, personality, and intelligence: Cat h e r i n e B
aker
2. Companion to psychiatric studies third edition- R. E: kendell and A. K. Zealey
3. DSM IV-TR
 4. The personality Puzzle: David C. Funder. Published by W.W. Norton & company Inc.
New York. 5th edition. 2010

4.7 Review Questions

Choose the best answer

Environmental influence on Behaviour normally refers to influence from one of the following:

Genetic endowment
Climatic conditions
Physiognomy
Life events
Hereditary factors

Which of the following statements is not true of behavioural genetics?

A proband is the person who has the traits you want to study
A first degree relative is the mother, the father and siblings
Monozygotic twins share the same genome
Study of dizygotic twins reared together is a good source of shared environment
Study of monozygotic twins reared apart is a good source of shared environment

SUBMIT ANSWERS

SECTION FIVE: GENETIC INFLUENCE ON INTELLIGENCE AND PSYCHOLOGICAL DISORDERS

Welcome to this fifth section in the module on bio-psychological basis of behaviour. In this
section we will be looking at some of the controversial areas in the study of genetics and
behaviour including the influence of genetics on intelligence and some of the psychological
disorders that are also categorized under psychiatric disorders. We will look at disorders related
to single gene defects as well as polygenic the aetiology of psychiatric disorders. We will try to
explain whether genetics can explain why some people score higher on IQ tests, why some
families seem to be predisposed to alcohol dependence syndrome and why some psychiatric
disorders run in families. Behavioural genetics is of particular interest in psychiatry in as far as it
contributes to an understanding of abnormal behaviour. The role of Behavioral genetics in
mental disease, personality, intelligence remain controversial.
 5.2 Section Objectives

At the end of the section you should be able to:

1. Discuss intelligence and behavioral genetics

2. Defects in the human genome and behavior

5.3 Intelligence and behavioural genetics

Intelligence is a complex general capacity of the Brain- the ability to reason, to think abstractly,
to draw conclusions, to solve problems, to learn from experience, and to remember what has
been learned. It also has to do with how the mind makes use of sensory information and how it
takes cues from emotions (our own and others'). Intelligence very clearly correlates with
successes in school and work settings.

Intelligence theorists claim an underlying ability to learn that feeds into all cognitive
performance- general cognitive Ability (g).

A theory of multiple intelligences proposed (Howard Gardner in 1983) holds that humans have
eight forms of intelligence:

 Linguistic,
 Logical-Mathematical,
 Spatial,
 Kinesthetic,
 Musical,
 Intrapersonal,
 Interpersonal
 Naturalist

Take Note 5.1

 A great many quantitative studies have shown that IQ correlation increases as genetic
similarity increases.
 Quantitative studies also provide evidence of environmental influences on intelligence

Most quantitative studies of intelligence measuring modern Western populations have produced
heritability estimates ranging broadly around 0.50- suggesting that genetics and environment
are roughly equivalent in their influence on the variation in IQ.
This means that highly intelligent people have multiple superior genes for general cognitive
abilities. They may also have experienced favorable nutritional and nurturing conditions and may
have been raised in an intellectually stimulating environment.

5.4 Defects in the human genome and

One alteration in a gene is sufficient to produce some medical disorders, however the vast
majority of mental disorders are believed to be polygenic- arising out of multiple gene. And
multifactorial implying that environmental factors (internal or external) are involved.

The more recent method of research is studying the human genome for defects or particularities
in relation to specific traits. The discovery of epigenetic tags has made important contributiions
to the understanding of how internal environmental factors influence genetics in the new science
of Epigenetics.Differences in MZ twins with a shared environment can now partly be explained
through epigenetics.

Take Note 5.2

 The environment impacts on genetics through epigenetic process

 Epigenetic tags are chemical mechanisms that can express (suppress or activate) genes to
different degrees

5.4.1 Simple single gene defects

As mentioned above, even alteration in a single gene is sufficient to produce some medical
disorders. Such genes are relatively easy to find, compared to the genes that contribute to
complex disorders or behaviour. Listed here is a group of Single gene defect disorders with
added implications on mental well being.

1. Cystic fibrosis- Chromosome 7

2. Huntington's disease- Chromosome 4
3. PKU- phenylalanine hydroxylase Chromosome 12
4. Fragile X syndrome is an X- linked disorder that expressed in Boys with Autisim and
learning disability

Take Note 5.3

1. Cystic fibrosis is an autosomal recessive affecting lungs pancreas, intestine abnormal

mucous production and fibrosis and scarring
2. Hutington's disease- progressive degeneration of nerve cells in the brain resulting in
impairment of movement, cognitive abilities and psychiatric symptoms.
 3. PKU- phenylalanine hydroxylase is an autosomal recessive metabolic disorder- affecting
the enzyme Phenlyallanine hydroxylase- learning disability and seizures

In-Text Question 5.2

 What is an autosomal recessive disorder?

 What is an autosomal dominant disorder?

5.4.2 Polygenic gene involvement and Psychiatric disorders

The vast majority of mental disorders are believed to be polygenic- multiple gene involvement.
Most mental disorders are also multifactorial- multiple environmental and genetic factors are
operating in an intricate fashion to distabilise the stable development and functioning of cells of
the CNS. A polygenic disorder results only when all of the pertinent genetic and environmental
factors are in place, and the extent of disorder depends on when those factors occur and how they
affect each other.

Examples of a polygenic disorders, related to impaired neurotransmitter production and functions

are schizophrenia and bipolar mood disorders

The 1st degree relatives of schizophrenia have 10 times greater risk of schizophrenia as the
general population.

In-Text Question 5.3

 X and Y are monozygotic twins. X is diagnosed with schizophrenia at the age of 16 years
what are the chances that Y will also develop Schizophrenia?
 X and Y have a younger sister Z, what are the chances that she will develop
schizophrenia
 Who has the highest risk of getting schizophrenia Y or Z?

The concordance rate of schizophrenia are higher in MZ as in DZ twins.

The relative influence of environment to genetic influence is not clear- but indicated by the the
existence of substantial discordance in MZ twins (less than 50% concordance).

Important environmental factors thought to be intrauterine and perinatal infections

particularly viral infections.
 Take Note 5.3
The genes implicated in the aetiology of schizophenia are not yet known studies are ongoing and
there are indications that these will be identified with the ongoing mapping of the human genome
making this statement invalid.

In Alcohol dependence syndrome it is estimated that 40-60% of the variance of risk of alcohol
dependence is explained by genetic influences. The risk of alochol dependence is 3 to 4 times
higher in first degree relatives of alcohol depandants.

Impulsive disorders and novelty seeking is abehavioural feature found in several psychiatric
disorders like- Attention Deficit Hyperactive Disorder (ADHD), intermittent explosive
disorder (the loss of control over impulses toward aggression), kleptomania (the impulse to
steal unneeded objects), pyromania (the impulse to set objects on fire), and antisocial
personality disorder.

Associated to novelty seekers-people who thrive on new experiences and heightened sensations,
like skydiving, mountain climbing, travel to exotic locations etc. by genetic behavioral
researchers.

It is presummed that the similar groups of genes working through neurotransmitter pathways are
responsible for impulsive disorders and novelty seeking.

The expression of the genes into socially acceptable or unaccepatable behaviour depending on
environmental factors and context such as living in deprived urban neighbourhoods and might be
a deciding factor in future outcome- motor cross or pyromania.

Take Note 5.5

 In the past, research in behavioral genetics has been used to support- hateful prejudices
and violations of human rights as in eugenics.
 Eugenics is the movement/philosophy of improving the human population by advocating
the promotion of breeding the "desired traits" or out-breeding "undesired traits".

5.5 Summary

Genes have an influence on human behaviour and of particular interest is genetic involvement in
intelligence and psychiatric disorders. However, based on your genes, no one can say what kind
of human being you will turn out to be or what you will do in life. Your genetic endowment can
be positively supplemented by internal and external environmental factors. Human beings still
have room to make choices.
„Genes cannot cause anybody to do anything, anymore than you can live in the blue print of your
house."Funder D. C. 2010. pg 335.

5.6 Suggestions for further readings

5.6 Suggestions for further readings

1. Behavioral Genetics: An introduction to how genes and environments interact through

development to shape differences in mood, personality, and intelligence: Cat h e r i n e B
aker
2. Companion to psychiatric studies third edition- R. E: kendell and A. K. Zealey
3. DSM IV-TR
4. The personality Puzzle: David C. Funder. Published by W.W. Norton & company Inc.
New York. 5th edition. 2010

5.7 Review Questions

Choose the best answer

The following are true about the aetiology of schizophrenia except

Schizophrenia is a polygenic disorders related to impaired neurotransmitter production and

functions
The 1st degree relatives of schizophrenia have 10 times greater risk of schizophrenia as the
general population
The concordance rate of schizophrenia is higher in MZ as in DZ twins
The concordance rate of schizophrenia is higher in DZ as in MZ twins
Intrauterine and perinatal viral infections are thought to be important environmental factors

Which of the following is true of psychiatric disorders in childhood and adolescence?

The prevalence of psychological disorders is higher in girls as compared to boys

There is a higher prevalence of learning disabilities in girls
There is an excess of boys among children with emotional disorders
Girls are more likely to display truancy as compared to boys

SUBMIT ANSWERS
 SECTION SIX: SEX AND GENDER DIFFERENCES IN ABNORMAL BEHAVIOUR

Welcome to this sixth section in this unit on bio-psychological basis of behavior. In this section
we will be looking at the influence of gender on behaviour. As a preliminary to this we will first
define abnormal behaviour and then look at gender in relation to psychological disorders and
gender differences in common psychiatric disorders in adults and children.

6.2 Section Objectives

At the end of the section you should be able to:

1. Discuss Sex gender and behaviour

2. Describe Gender differences in Psychiatric disorders

6.3 Sex gender and behavior

In-Text Questions 6.1

What is gender?

While sex is a biological diagnosis Gender is defined as a social construction, that assigns
individuals roles and characteristics that are based on the presumed biological sex. Consequently
it also refers to an individual's self-conception as being male or female, as distinguished from
actual biological sex.
 In-Text Question 6.2

Why do we say presumed sex?

Think about cases you may have read about where the biological sex of an individual was not
clear or was wrong

Figure 13: Different Colours Depending on Gender

In many parts of the world babies are dressed in different colours depending on gender as
depicted in figure 13.

Activity 6.1

In groups of two or four work on the following activity:

Look at the picture below and discuss the signficance of pink and blue colours

There are gender differences in normal behaviour, these include behaviour like mate selection as
in what women look for in a mate and what do men look for in a mate. Other difference include,
mating strategies as in commitment, variation in number of partners, desire for monogamy.
There are also gender differences in career choice

Activity 6.2

In groups of two or four work on the following activity:

Discuss the possible reasons for observed gender differences in:

 Mate selection
 Mating strategies
  Career choice
 Conflict resolution

Our focus here however is on abnormal behaviour. Behaviour can be said to be those actions
that are overt and directly observable- social interactions, speech, motor activity, however
private experiences and processes are often included in the psychological study of behaviour.

Abnormal behaviour refers to deviations from what is considered typical behaviour and this
can be either:

 Qualitative abnormality- deviation from culturally accepted standards

 Quantitive abnormal- behaviour that deviates from the statistical average

Abnormal behaviour however is not always an indicator of psychological disorder,

people who achieve rare accomplishments may be abnormal (not typical) but not psychological
disordered. Even qualitatively abnormal behaviour- depends on context- if you observe the
aggresive Handwashing of a surgeon vs the hand washing in compulsive disorder you arrive at
different interpretation: Good surgeon vs obssessive compulsive disorder.

When psychological abnormality is determined by atypical behaviour alone then we have abuse
of psychiatry as has been observed in the past where Non conformists and political dissidents
who refuse to accept the status quo are are incacereted in Psychiatric hopsitals as psychologically
disordered-colonial policy or the communist policy in former USSR and China.

Take Note 6.1

 It is not bad to be different

Evolution of species depends on individual differences- „For a species to remain viable it must
include diversity.“ Nettle 2006

In psychological disorders, Abnormality is only one of the 3 basic elements that comprises
psychological disorders. Abnormality here refers to -Pattern of moods, thoughts, perception
and behaviour. The other two criteria are- maladaptiveness and personal distress.

Maldapativeness is behaviour that seriously disrupts your social occupational functioning.

Personal distress is a subjective feeling of anxiety, depression or other unpleasant emotions.

The combination of abnormality, maladptiveness and personal distress to determine

psychological abnormality varies with different disorders.
6.4 Gender differences in Psychiatric disorders

Gender differences in several psychiatric disorders have been recorded. However, before we
discuss these, a quick look at the different psychiatric disorders is important see table 1.

Table 1: Major Psychiatric disorders: DSM IV Tr

 Anxiety disorders
 Somatoform disorders
 Disorders usually first diagnosed in  Factitious disorders
infancy, childhood, and adolescence  Dissociative disorders
 Delirium, dementia, and amnestic and  Sexual and gender identity disorders
other cognitive disorders  Eating disorders
 Mental disorders due to general  Sleep disorders
medical conditions  Impulse control disorders
 Substance-related disorders  Personality disorders
 Schizophrenia and other psychotic  Other conditions that may be a focus of
disorders clinical attention
 Mood disorders

The biopsychosocial model is an important key to understanding gender differences in abnormal

behaviour:

o Bio- Biological differences particularly hormonal

o Psycho- Differences in psychological development
o Social-Gender differences due to environmental influences

While gender differences in psychiatric disorders are still under study, addressed here are 11
disorders in which gender differences in prevalence have been reported.

1. Disorders in children and Adolescence

Boys are often more disturbed than girls at a ration of 2:1 or even 2.5:1

Boys tend to display aggresive behaviour while girls tend to more emotionaldisorders.

There is a higher prevalence of developmental disorders (Mental retardation, learning

disabilities etc) in boys.

There is an excess of boys among children with conduct disorders that cannot be accounted for
solely by the higher frequency of developmental disorders in boys.

Take Note 6.2

Conduct disorders are disorders characterized by aggression to people and animals, destruction
of property, deceitfulness or theft, and serious violation of rule.

Apart from biological factors, male socialisation to aggression has been implicated in the
aetiology, Similarly Girls may tend to model the care givers who are predominantly women
whereas male role models are often remote at this age.

Figure 14: Aggression

Activity 6.3

In groups of two or four work on the following activity:

Discuss critically the role of socialisation in the aetiology of agression among boys in different
Kenyan communities.

1. Substance related disorders

Substance abuse is commoner in males than females

Misuse and dependence on sedatives and tranquilisers has been found to be commoner in
middle aged women

There has been an increase in prevalence of alcohol abuse in women as women enter and work
more in the male environment out of the family circles

Alcohol dependency in women develops faster and on lower quantities of alcohol

2. Anxiety disorders
Have been shown to be slightly more commoner in women than men this is particularly so for
Generalised Anxiety Disorders and phobias

3. Somatoform disorders

Among common somatoform disorders are: Somatization characterized by multiple physical

complaints and found more commonly in women and Conversion disorder, previously referred
to as "hysteria" which is 2-10 times more common in women than men

4. Affective disorders

The prevalence of depression is twice as high in women as in men-independent of cultur and

ethnie while The M:F ratio in Bipolar disorders (also referred to as Manic Depressive
Psychosis) is 1:1.

The rate of suicide in depressive illness which has been est. At 10- 15% is higher in males than
females. The rate of para-suicide on the other hand(attempted suicide) is higher in females.
Males tend to use more violent methods of suicide than females.

5. Schizophrenia

Schizophrenia which is one of the most devasatating psychiatric disorders affects about 1% of
general population globally in the the male:female ration of 1:1.

6. Eating disorders

Anorexia- and bulimia nervosa occur almost predominantly in young white women and rarely
in males.

7. Sleep disorders

Are Commoner in women and elderly going by the increased use of sedatives in women.

8. Sexual disorders

Gender difference in sexual disorders are related to the different anatomical and physiological
functions of bilogical males and females and are therefore predominantly gender specific
disorders.

While men complain predominantly of erectile failure and premature ejaculation women
complain more of arousal and orgasmic problems.

9. Impulse disorders Impulse control disorder.

Refer to is a group of psychiatric disorders characterized by impulsivity - failure to resist a

temptation, urge or impulse that may harm oneself or others.
 a. Intermittent explosive disorder, characterized by recurrent, significant outbursts of
aggression is commoner in men than women
b. Kleptomania characterized by repetitive, uncontrollable stealing of items not needed for
personal use has been found to be commoner in women.
c. Pyromania characterized by repetitive purposeful fire setting and fascination with fire,
and pathological gambling repetitive by persistent and recurrent maladaptive patterns of
gambling behavior has been found to be commoner in men

10. Personality disorders

Gender differences in Personlity disorders are closely related to the specific types of disorders.

Antisocial personality (previously referred to as Psychopathy) is commoner in men.

6.5 Summary

We have now come to the end of this lecture. While sex is determined by biology XX or XY,
Gender is a social construction that assigns individuals roles and characteristics and consequently
evolves into an individual's self-conception as being male or female. There are gender
differences in normal behaviour and abnormal behaviour. In abnormal behaviour we refer here to
abnormal patterns of moods, thoughts, perception and behaviour in addition to maladaptiveness
and personal distress, as opposed to socio-cultural deviations from the norm.

The biopsychosocial model looks at the aetiology of disorders from a biological, psychological
perspective and is an important key to understanding gender differences in abnormal behaviour.

There are gender differences in psychiatric disorders in childhood, adolescence and adulthood.
Your biological sex XX or XY may have implications on your behaviour, this however is not
always based on biology but is also strongly influenced by the process of gender specific
socialisation.

6.5 Summary

We have now come to the end of this lecture. While sex is determined by biology XX or XY,
Gender is a social construction that assigns individuals roles and characteristics and consequently
evolves into an individual's self-conception as being male or female. There are gender
differences in normal behaviour and abnormal behaviour. In abnormal behaviour we refer here to
abnormal patterns of moods, thoughts, perception and behaviour in addition to maladaptiveness
and personal distress, as opposed to socio-cultural deviations from the norm.
The biopsychosocial model looks at the aetiology of disorders from a biological, psychological
perspective and is an important key to understanding gender differences in abnormal behaviour.

There are gender differences in psychiatric disorders in childhood, adolescence and adulthood.
Your biological sex XX or XY may have implications on your behaviour, this however is not
always based on biology but is also strongly influenced by the process of gender specific
socialisation.

6.6 Suggestions for further readings

Activity

1. <!--[if !supportLists]--> Introduction to Psychology: Clifford Thomas Morgan, Richard

Austin King, et.al<!--[endif]-->
2. <!--[if !supportLists]-->Atkinson & Hilgard's Introduction to Psychology: Susan Nolen-
Hoeksema, et.al<!--[endif]-->
3. <!--[if !supportLists]-->Psychology: Lester M. Sdorow<!--[endif]-->
4. <!--[if !supportLists]-->Human Adjustment J.A. Simons; S. Kalichman; J.W. Santrock
<!--[endif]-->
5. <!--[if !supportLists]-->American Psychiatric Association DSM IV Tr <!--[endif]-->
6. <!--[if !supportLists]-->Social Psychology Robert A. Baron & Donn Byrne <!--[endif]-->
7. <!--[if !supportLists]-->Understanding Human Sexuality Hyde DeLamater <!--[endif]-->
8. <!--[if !supportLists]-->Human Sexuality: diversity in contemporary America B. Strong;
C. Devault; B. Sayad; W. Yerber <!--[endif]-->

6.7 Review Questions

Answer all questions

Which of the following is true of psychiatric disorders in childhood and adolescence?

The prevalence of psychological disorders is higher in girls as compared to boys

There is a higher prevalence of learning disabilities in girls
There is an excess of boys among children with emotional disorders
Girls are more likely to display truancy as compared to boys

The following are factors that contribute significantly to gender differences in Psychiatric
disorders except
 Differences in Socio-economic status
Differences in Physiognomy
Differences in psychological development
Biological differences particularly hormonal

Which of the following statements is true about gender variation in behaviour?

Boys are often more disturbed than girls at a ration of 5:1

Boys tend to display more withdrawn behaviour in early childhood as compared to
adolescence girls
Girls tend to display more emotional disorders than boys
Mental retardation and learning disabilities are commoner in girls in early childhood
Aggressive behaviour in girls is rare

SUBMIT ANSWERS

SECTION SEVEN: SOCIAL ATTITUDES AND BEHAVIOUR

Welcome to this seventh section in this unit on bio-psychological basis of behavior. In this
section we will be looking at the interactions between attitudes and behavior. Attitudes and
behaviour are an important aspect of health care, particularly primary health care, where Health
Professionals try to change peoples behaviour- from unhealthy to healthy.

Assessing for (Knowledge, Attitude and Practice (KAP) or Knowledge, Attitude and Behaviour
(KAB) is an important excercise in public health and primary health care as it generates baseline
data in communities where there is a desire to initiate change. In this section we will define the
terms attitude and behavior. We will then address external factors and how they influence
personal attitudes, address the predictability of behavior based on attitude, look at passive and
active behavior, the influence of behavior on attitude and conclude with the sociological theories
of action on behavior.

7.2 Section Objectives

At the end of the section you should be able to:

1. Define Attitude and behavior

2. Describe passive and active attitude
3. Describe the sociological theories of behaviour to attitude
7.3 Attitude and Behavior

Attitude is defined as a predisposition to classify objects and events and to react to them with
some degree of evaluative consistency. Attitudes can also be said to be Beliefs and feelings
about others or about events and the inclination to act.

In-Text Question 7.1

When we perceive a scenario our brains quickly work out what/who/why/when/how etc.

< !--[if !supportLists]-->o With reference to the picture above note down your first impression
using the what/who/why/when/how questions?<!--[endif]-->

Now go back to your noted impressions and indicate what information you used to arrive at your
conclusions

Attitudes influence how we perceive and interpret events.

7.3.1 The influence of attitude on behavior

Attitudes inhabit the realms of our thoughts- in other words they are inferred either from
behavior or verbal communication. Ideally one would assume that attitudes particularly verbally
expressed are a predictor of behaviour. The highly advanced human brain is however capable of
many forms of deception even self-deception. Public Health workers have realized that asking
women what they feed their babies, they may receive answers unrelated to what the women feed
their babies depending on what the women have learned from other health workers. Attitudes do
not always determine behaviour and what we are inside (our beliefs and feelings) may not
always be related to who we are outside (what we do or our public behaviour).

Activity 7.1

Do and a small survey in your class- sample size 20 to 50 using the following questions:

1. Do you think it is wrong to cheat in an exam ?

2. Have you ever cheated in an exam ?
3. If you haven’t read for a exam would you accept a friend’s offer to sit next to him/her and
copy their answers ?
Evaluate your survey and answer the question:
Is a student‘s attitude towards cheating a good predictor of likelyhood to cheat in exams?

If you haven‘t prepared for an exam there is a high likelyhood you will fail. So What! If you fail
an important exam you might have to repeat a class. The consequences of this would be; anger
from parents, cost, separation from friends- these can be called external factors. And then there
are the internal factors- loss of face and shame. So even if you believe that cheating in exams is
wrong- this is weighed against the external and internal infleunces. If on the other hand you
decide to cheat- you risk getting caught and the consequences and if you are lucky and dont get
caught there might still be the uncomfortable feelings of guilt (internal influence).

When all this is added and subtracted- Our expressed attitude may not always predict behaviour
because both our attitudes and our behaviour are subject to other internaland external
influences.

Whatever we say, whatever we do in public is being observed and interpreted according to social
rules of behaviour and the expectations of others

 We sometimes say what we think others want to hear

 We sometimes do what others expect us to do

A good reason for the secret ballot.

7.3.2 Predictability of behaviour from attitude

From the above it would seem like attitude is a not always a good predictor for behaviour. This is
particularly true if observation is over a short period of time. The effects of attitude on behaviour
becomes more reliable when one considers behaviour over a long period of time
Minimising on external influences will increase prediction of behaviour from attitude- that is
why the secret ballot is one of the most commonly used methods of voting globally and an
anonymous questionnaire more likely to produce desired results.
Attitude predicts behaviour when the attitude is more pertinent to behaviour- eg. A belief that
running is a good way to increase fittness has better predictability for jogging as opposed to
general concept of ‚healthy living‘ and eating plenty of fruits and vegetable better than eating
health food for an overweight person.
Attitude predicts behaviour when it is potent- present in the concious- ‚thought out‘.
However not all behaviour is thought out- Some behaviour is based on scripts- common daily
behaviour-If you are closing the road you don‘t have to think- „look left look right then look left
again“ like you learned in Kindergarten. In reponse to questions such as- how are you?,- fine;
how was school?-Ok Behaviour and verbal reponses that are repeated often becomes
automatized. In the abscence of a script behaviour is less automatic has to be thought out.

Activity 7.2
In groups of two or four work on the following activity:

List some of the behaviour/ verbal responses that are based on scripts

Figure 15: Mercy of a Mob

Figure 15 depicts a man at the mercy of a mob, a not uncommon sight in Kenya.

Take Note 7.1

Self conciousness and self awareness is being in tune with your attitudes- people with little self
awareness are more likely to be influenced by mobs
“To thine own self be true““- Shakespeare”

Behaviour that is not thought out is driven by unconscious attitudes as in following a mob.
Our planet is characterised by diversity in life forms. Racial and ethnic diversity is a rich
characteristic of humans but also a cause of major conflicts- "us vs them"
Ethnic prejudice is one of the areas strongly governed by unconciously held attitudes.
Unconcious attitudes can also influence spontaneuos behaviour- walking thru‘ a dark alley.

7.3.3 Passive or active attitudes

Attitudes acquired through experience are more potent and more predictive of behaviour-people
who have been directly involved in a crisis are more likely to sign pettitions to change things as
opposed to those who know about the crisis theoretically. A student in Nairobi who closes a busy
road every day to get to college is more likely to sign a petition on the construction of a flyover
as compared to a student at Narok University.

Take Note 7.2

Behavior related to unconscious attitudes may have/have had a survival function in the social
evolution

While attitudes influence behaviour, taking into account internal and external influences, how
does behaviour influence attitude. This is particularly pertinent in consideration of unconcious
attitudes. The power of self persuasion is one of the explanations advanced to explain how
people explain behaviour based on unconcious attitudes by inventing a reason for our behaviour
which sounds reasonable.

In another scenarion acting into a role can be seen as behaviour that infleunces attitude, e.g. the
career you choose will affect not only what you do on the job but also your attitudes -internalised
roles

A third scenario is the power of the word or verbal affirmations to a cause- We believe what we
say and the more we say it the more we believe it- ‚Saying is believing‘

7.4 Passive and Active Attitudes

In-Text Question 7.2

We stand up for what we believe in but do we also believe in what we stand up for?

While attitudes influence behaviour, taking into account internal and external influences, how
does behaviour influence attitude. This is particularly pertinent in consideration of unconcious
attitudes. The power of self persuasion is one of the explanations advanced to explain how
people explain behaviour based on unconcious attitudes by inventing a reason for our behaviour
which sounds reasonable.

In another scenarion acting into a role can be seen as behaviour that infleunces attitude, e.g. the
career you choose will affect not only what you do on the job but also your attitudes –
internalised roles
A third scenario is the power of the word or verbal affirmations to a cause- We believe what we
say and the more we say it the more we believe it- ‚Saying is believing‘

7.4.1 A foot in the door phenomenon

There is a story of a camel on a cold night in the desert that asked his master if he could not put
just his nose into the tent for a bit of warmth------. The foot in the door phenomenon or should
we call it the nose in the door phnomenon is a strategy that influences behaviour by introducing
it step by step.

Small changes make way for bigger changes- immunising in small doses. When people commit
themselves voluntarily to social action they tend to believe in what they are doing.

This phenomenon is used actively to get people involved:

1. Time and participation

2. Sales and marketing
3. Petitions and fundraising
4. Dating

7.4.2 Influence of Immoral behaviour, acts of aggression and attitude

People tend not only to hurt those they believe are bad but alo to believe and say they hate
people they hurt, to justify acts of agression.

Nazi regime atrocities- were often explained by the perpetrators as being because they hated jews
even when they had never had prior contact. The more one commits attrocities the easier it gets.
Giving a drerogatory name to your victim makes it easier to commit attrocities to them. The
victims are seen as having traits that justify the action taken against them.

Take Note 7.3

Evil acts are not only a reflection of the self they shape the self.

The reverse can be said of moral acts- Moral action when chosen affects moral thinking. Doing
something good out of choice, having thought about, it has a longer lasting impact on the way
you behave than being threatened to do a good thing.

Activity 7.3

In groups of two or four work on the following activity:

  Discuss the ongoing debate on female genital cutting and critically discuss the following
question:

Should Kenya wait for attitudes to change- through public education or is it justified to force
behaviour through legislation that criminalises Female genital Cutting/mulitation to protect
children

Actions feed attitudes- even positive behaviour towards someone fosters liking for that person.

That Actions feed attitude can also be observed in social political movements- one step to getting
a person to support your team is to cloth them in the team colours. Political socialisation and
building patriotism is promoted through actions like raising flag, singing a national anthem, party
symbols.

Repeated verbal affirmations are a strong weapon in changing attitudes and consequently
behaviour- psychic equilibrium is achieved by believing what you are saying.

Take Note 7.4

Believing what you are made to say repeatedly is also called Brain washing or thought control-
as described in the literary classic „Brave New World“
"Alpha children wear grey. They work much harder than we do, because they are frightfully
clever. I’m really awfully glad I’m a beta, because I don’t work so hard. And then we are much
better than the Gammas and Deltas. Gammas are stupid. They are wear green and Delta children
wear Khaki. Oh no, I don’t want to play with Delta children and Epsilons are still worse. They
are too stupid to be able to read or write. Besides, they wear Black, which is such a beastly
colour. I am so glad I’m a Beta.”- Aldous Huxley. Brave New World (1931)

7.5 Action to Attitude theories

Social psychologists explain the effect of actions on attitude using 3 main theories:

1. Self presentation theories- assumes that we express attitudes that make us appear
consistent
2. Cognitive disonance theory assumes that to reduce discomfort we justify our actions to
ourselves
3. Self perception theory assumes that our actions are self revealing- we look at our
actions/ behaviour and explain our feelings and beliefs on this basis the same way we do
for other people
7.7 Summary

Social psychologists explain the effect of actions on attitude using 3 main theories:

1. Self presentation theories- assumes that we express attitudes that make us appear
consistent
2. Cognitive disonance theory assumes that to reduce discomfort we justify our actions to
ourselves
3. 3Self perception theory assumes that our actions are self revealing- we look at our
actions/ behaviour and explain our feelings and beliefs on this basis the same way we do
for other people

7.8 Suggestions for further readings

7.7 Suggestions for further readings

1. David G. Myers- Social psychology- 4th edition, McGraw- Hill Inc 1983
2. Lester M. Sdorow- Psychology- 2nd edition, Brown and Benchmark 1993
3. Social Psychology Robert A. Baron & Donn Byrne

7.9 Review Questions

Anwer all questions

Assessment of knowledge attitudes and practice

Refers to anthropological studies in traditional communities

Is an academic exercise that has little relevance in practice
Has no relevance in modern health practices
Is can be good indicator of how communities are reacting to health messages
Can only have relevance in literate communities

Attitudes

Can never be used to predict behaviour

Are internalized before the age 2years
Can easily be measured through school performance
Influence how people perceive and interpret events
 Are a good indicator of success in life

Predictability of behaviour from attitude

Can be increased by minimizing on external influences

Can be increased by increasing internal influences
Can be enhanced through a cross sectional survey
Corresponds to religious beliefs
Cannot be improved

Self presentation theories.

Assume that people justify their behaviour to reduce internal discomfort.

Assume that we express attitudes that make us appear consistent
Assume that we look at our behaviour from outside ourselves
Assume that people justify their actions to continue doing them
Assume that people are strictly speaking not responsible for their actions

SUBMIT ANSWERS

SECTION EIGHT: LIFE EVENTS AND ABNORMAL BEHAVIOUR

Welcome to this eighth section in this module on bio-psychological basis of behaviour. In this
section we will be looking at the impact of life events on behaviour and particularly stress and
other psychological disorders that are characterized by behavioural change. We will start of by
defining life events and outlining some of the common major life events. We will then describe
events in relation to life span starting with the early years and ending with late adulthood. We
will then look at bereavement an event that can occur through all the cycles and end our journey
with major traumatic life events.

8.2 Section Objectives

At the end of the lecture you should be able to:
Define life events
Describe major life events across the lifespan
Discuss losses across the lifespan
Discuss major traumatic life events

8.3 Life events

The life span of human beings is characterised by milestones also referred to as life events.
These are events that have a major impact on the individual. Life events are external
environmental influences that have an impact on Human beings and which may be experienced
as negative (divorce) or positive (marriage). Life events can function as stressors and when many
life events occur in a short period of time, the level of stress can rise to impact on both Physical
and mental health. Poorly adjusted individuals are more likely to succumb to mental disorders
after a major life event.

Activity 8.1
In a small group of four or five- spend five minutes each to outline some major life events in
your life.

Various definitions have been used to describe life events:

1. Events that cause physiological stress reactions.
2. Events that task the individuals coping resources triggering a stress response.
Stress may range from mild deviation from the norm like mild disturbance- like sleep
disturbance to major disturbance like psychosis or may provoke the onset of a psychiatric
disorder, or the relapse or deterioration of a previously diagnosed disorder. On the other hand,
psychiatric illness can also cause life events for example a schizophrenic breakdown may lead to
the loss of a job triggering a major life event. However individuals do not react to similar events
in the same way because aattitudes influence how we perceive and interpret events.

In-Text Question 8.1

Describe two events in your life that caused you stress and compare them with the list of events
in 1.4.

Below is a list of some major life events as experienced by people worldwide? Reactions to these
and others may vary from one individual to another and from one community to the other and
may not follow the same sequence or priority:

a. Entry into school

b. Birth of a sibling

c. Exams

d. Moving house or migration

e. Adolescent crisis

f. Initiation*(in traditional societies)

g. Adolescent pregnancy
h. Divorce, separation or death of parent(s) or siblings and other significant relatives

i. Marriage

j. Birth of a child

k. Loss of job

l. Change of job

m. homelessness

n. Separation, Divorce, or loss of spouse

o. A significant change in health (self or spouse)

p. retirement

In-Text Question 8.2

Does your community practice a right of passage?
If yes what is the significance of this ritual?
If not give an example of such a ritual that you know about.

8.4 Major life events across the lifespan

These include:

 Early life events

 Life Events in adolescence and early adulthood
 Life events in Middle and late adulthood
 8.4.1 Early life events
 Early life events revolve around separation and loss and include separation from
mother/mothering person for reasons like - illness and admission to hospital of either
child or mother. The birth of a sibling may be perceived as loss of previous position as
mother‘s baby and expressed as sibling rivarly. The beginning of school may be
perceived both as separation from mothering person and familiar surrounding. Moving
house or migration is similarly experienced as loss of familiar environment and friends.
The impact of early life events on child depends on the level of development and prior
attachment with poorly attached children having more problems with separation.
Symptoms may range from regression, depressive symptoms, withdrawal, aggression,
conduct disorders in older children and school refusal

 Activity 8.3
 What is attachment and why do you think poorly attached children have more problems
with separation? You may need to read the theories of attachment to answer this question.
 

8.4.2 Life Events in adolescence and early adulthood

The Normal stressful changes of adolescence make adolescents particularly vulnerable to

negative life events. Stressful events include- school change and entry into boarding schools,
separation/abandonment,bereavement, rejection by contemporaries and failure at school,
loss of physical health that impair the adolescent from active participation in activities.

While all adolescents undergo biological or physical changes like the onset of menarche,
development of secondary sexual characteristics and rapid physical changes, not all are prepared
for these changes and some may be viewed negatively particularly if the occur earlier or later
relative to the peer group. One of the most important events in the life of an adolescent is the
initiation of sex. This may be complicated by unpreparedness, ignorance, coercion, orientation
confusion and socio-cultural and religious factors with associated guilt and shame. Sexual
initiation may also result in premature pregnancy and abortion, which in our country may be
unsafe with serious to severe medical implications.

Reactions to life events during adolescence include: depression, anxiety, avoidancedisorders,

obsessive - compulsive disorders and phobias, school refusal and truancy. Conduct disorders
are common in boys and manifest as delinquency (crimes of violence, serious vandalism and
criminality linked to drug abuse, truancy and vagrancy).

Substance use and abuse is a common reaction to stress in adolescence, but may also result in
major life events- like severe punishment, expulsion from school or home etc.

Eating disorders are more common in girls. Anorexia nervosa is still relatively rare in our
communities but a common disorder of young white females. Others in include bulimia nervosa,
adiposita (obesity) not so uncommon in modern Kenya. Sleep disorders are also common.

The prevalence of suicide and attempted suicide also increases in adolescence. In school
systems where exams start early like in KCPE- the level of stress may become unbearable
leading to psychiatric symptoms- depression, somatisation, psychosomatic disorders, anxiety
disorders like- panic attacks, generalised anxiety disorders, conversion disorders.

Poor performance in exams may even lead to attempted suicide and suicide.

Events in early adulthoodrevolve around intimate relationships, leaving home, job marriage and
childbirth and not necessarily in that order. Among these childbirth is probably one of the most
significant for women so that most women are able to say that life is never the same again.

While the birth of a child is often a joyous event for women, Pregnancy and childbirth can
however be associated with biological changes and psychosocial stressors that predispose to
psychiatric disorders.
Women who are unable cope with childbirth for various reasons may suffer maternal blues, post-
natal depression and post-partum psychosis.

Common Stress factors in child birth include:

 Lack of social support

 Young motherhood
 Unplanned pregnancy
 Single motherhood etc.
 Physiological changes
 Marital disharmony

Women with a genetic predisposition to Mental illness are more likely to succumb. As in: Family
history of depression or other mental illness.

While ideally marriage is a positive event, poorly adjusted people may have problems dealing
with the changed circumstances or even just the stress of organising a wedding.

Changes in employment life can also be a stressful event. These may range from new job, loss or
change of jobs, promotion and demotion and while these events may be negative or positive as in
promotion- some people may not be able to cope with the changes involved or demands.

Stressors include:

 Adjusting to a new job, and new working colleagues

 Climbing up the ladder may come with new challenges, conflicts and group dynamics

Demotion is frustrating and demoralizing and may come with reduced income.

The loss of a job may happen as early as early adulthood but experienced more severely in
middle adulthood.

Reactions to major life events include: Depression, anxiety disorders, somatic disorders and
substance abuse, conduct disorders in children and relapses or worsening of previously
diagnosed mental disorders.

8.4.3 Life events in Middle and late adulthood

In-Text Question 8.4

From what age is middle adulthood?

Describe some of the characteristics of middle adulthood

Menopause and Midlife crisis constitue major changes in midlle adulthood. Menopause is
closely related to other major life events creating the midlife crisis. Events related to midlife
crisis include - loss of gainful employment through retirement, loss of own parents, loss of
children to the world (empty nest syndrome), diminishing physical health and physical
attractiveness.

Life change events have been found to be more important for the development of psychological
symptoms than the biological changes of menopause.

In-Text Question 8.5

What are the characteristics of menopause?

Although men don't have a clear cut biological change as in menopause, a change referred to as
andropause and a psychosocial crisis ‘midlife crisis' has been described in men.

Middle adulthood progresses to late adulthood and retirement which may be experienced as a
negative event to the individual because:

a) It represents major losses in income and in social status, purpose and role

b) It is a period characterized by monotony, boredom, and decline.

Retirement may be accompanied by depression and anxiety and even suicide

Late adulthood is a time of many losses-parents, friends, and spouse. It is also the time of
increasing physical disabilities and may even culminate in the loss of mobility. It is however the
loss of a long term spouse that has been found to be most striking.

8.5 Losses across the lifespan

Some life events know no age. The loss of a loved one is probably one of the most devastating
life events across the lifespan, death of a family member or death of a loved one is very painful
and a source of heightened stress for the bereaved.

Bereavement may provoke any of the psychiatric symptoms- particularly depression and anxiety
disorders. Abnormal reaction to death may warrant a special diagnosis of „bereavement“ or
„abnormal grief reaction“.

Several factors both individual and related to the kind of death determine how death is
experienced. Some breakdown and others come through the experience after normal mourning.
The following are factors that determine reaction to death include:

 Sudden death

 Traumatic death

 Strong attachment to a particular person

 Close relationship with the bereaved

 Multiple bereavements

 8.6 Major traumatic Life events

 In addition to life events related to the normal milestones of life, traumatic life events are
major unexpected life events, defined as an event that is experienced as life-threatening
or includes a danger of injury so severe that the person is horrified, feels helpless, and
experiences a psychophysiological alarm response during and shortly after the
experience. These include- severe road traffic accidents, personal violence, wars and
other conflicts, and natural catastophies.
 The reactions may be any form of psychiatric disorder- particularly major depressive and
anxiety disorders and substance use disorder, however reaction to trauma may warrant a
special diagnosis of „Acute stress disorder" or„Post Traumatic Stress Disorder" -
syndromes characterised by pathological reactions to a specific or multiple traumatic
experiences.

 Activity 8.2

In a small group compile a list of major disasters that have affected Kenyans in different
part of the country in the last 10 years.


 8.7 Summary and conclusion

 Most Life events are specific to the stage in the life span. Loss is a major theme in most
major negative life events and although th reactions may be developmental age specific
anxiety disorders and depression and the use of substances are common reactions across
board after childhood. Major life evenst however can triger the onset or exercerbation of
any mental disorder. Bereavement can result in abnormal grief reaction and major
traumatic life events are more likely to cause Post traumatic stress disorders.
 Conclusion: Our journey through life is characterised by mile stones, without which we
would not be able to say we have lived. They influence our behaviour and shape who we
are. Similarly we experience life events and react to them and modify their impact on us
from a specific unique position- who we are.
 8.7 Summary and conclusion
  Most Life events are specific to the stage in the life span. Loss is a major theme in most
major negative life events and although th reactions may be developmental age specific
anxiety disorders and depression and the use of substances are common reactions across
board after childhood. Major life evenst however can triger the onset or exercerbation of
any mental disorder. Bereavement can result in abnormal grief reaction and major
traumatic life events are more likely to cause Post traumatic stress disorders.
 Conclusion: Our journey through life is characterised by mile stones, without which we
would not be able to say we have lived. They influence our behaviour and shape who we
are. Similarly we experience life events and react to them and modify their impact on us
from a specific unique position- who we are.

8.8 Suggestions for further readings

8.9 Suggestions for further readings

1. David G. Myers- Social psychology- 4th edition, McGraw- Hill Inc 1983
2. Lester M. Sdorow- Psychology- 2nd edition, Brown and Benchmark 1993
3. Social Psychology Robert A. Baron & Donn Byrne

8.9 Review Questions

Answer all questions

Assessment of knowledge attitudes and practice

Refers to anthropological studies in traditional communities

Is an academic exercise that has little relevance in practice
Has no relevance in modern health practices
Is can be good indicator of how communities are reacting to health messages
Can only have relevance in literate communities

Attitudes

Can never be used to predict behaviour

Are internalized before the age 2years
Can easily be measured through school performance
Influence how people perceive and interpret events
Are a good indicator of success in life
Predictability of behaviour from attitude

Can be increased by minimizing on external influences

Can be increased by increasing internal influences
Can be enhanced through a cross sectional survey
Corresponds to religious beliefs
Cannot be improved

Self presentation theories.

Assume that people justify their behaviour to reduce internal discomfort.

Assume that we express attitudes that make us appear consistent
Assume that we look at our behaviour from outside ourselves
Assume that people justify their actions to continue doing them
Assume that people are strictly speaking not responsible for their actions

SUBMIT ANSWERS

SECTION NINE: IATROGENIC DISORDERS AND BEHAVIOUR

Welcome to this eighth and last section in this unit on bio-psychological basis of behaviour. In
this section we will be looking at abnormal behaviour that is related to the interaction between
patients and health workers. Health workers and health systems are dedicated to promotion of
health and health care, however there are instances when they cause disease, create disabilities or
cause the health of those in their care to deteroriate. We will begin by giving a broad definition
of iatrogenic disorders, we will then look at the causes of such diosorders and give examples of
common ones. We will adress misdiagnosis, creation of dependency on psychotropic drugs,
reinforcement and medicalization of deviant behaviour and end up with institutionalization.

I hope you have enjoyed this module and have learned enough to prepare you on your journey as
a health worker who will not only have to understand and interpret the behaviour of your patients
and treat them accordingly but will also be looked up to by society to provide answers and
direction when behaviour of members deviates from the norm.

9.2 Section Objectives

At the end of the section you should be able to:
Define iatrogenic disorders
Describe the causes of iatrogenic disorders
Discuss the Creation of dependency to psychotropic drugs
Discuss the reinforcement and medicalization of deviant behaviour
Discuss institutionalization

9.3 Iatrogenic disorders

Iatrogenic disorders are disorders caused by doctors and other health workers or health care
system and are present in all branches of medicine.Iatrogenic disorders arise as the result of
the health worker:

1. Making Incorrect or incomplete clinical assessment (physical , behavioral, psychosocial

and psychological)
2. Making Inappropriate diagnostic and treatment interventions
3. Making False attribution to the etiology of the problems
4. Failing to recognize and reinforcing dysfunctional behavior
5. Failing to promote function and effective return to work

Activity 9.1
In a small group discuss and asnwer the following questions based on your life experience.
Are there cases that you know of where health workers have been responsible for causing
disease, created disabilities or caused the health of those in their care to deteroriate?

9.4 Causes of Iatrogenic disorders

As mentioned above, iatrogenic disorders can be said to arise by errors in diagnosis and
management of patients at different levels of patient/healthworker interaction.

9.4.1 Misdiagnosis in Psychiatry

Conversion disorders are often misdiagnosed as epilepsy and patients treated for years on
antiepileptics- sudden withdrawal of which causing seizures.

Patients with endocrine conditions like Hyperthyroidism or hyperthyroidism, cardiovascualr

disorders and other organic conditions may first present with psychological symptoms, failure
to diagnose these conditions may be life threatening, additionally they may often be treated with
antipsychotics exposing them to severe side effects.

Failure to recognise the side effects of drugs and either withdraw or reduce dosage of
medication. This is particulary common with Phenothiazines and Antidepressants. A commonly
hidden sde effect is sexual dysfunction which the patients may not report.

9.4.2 Misdiagnosis in Clinical Medicine/Surgery and related

Misdiagnosis in medicine of life threatening conditions may create psychiatric conditions
particularly Anxiety disorders and Depression. Common misdiagnosis include

 Misdiagnosis with cancer, or hiv/aids etc- may lead to stress depression and even suicide
 Patients correctly diagnosed with life threatening conditions may develop adjustment
disorders due to poor counselling skills among clinicians

9.4.3 Medicalization of psychological disorders

Many Psychological disorders present with physical symptoms, failure of a clinician to take a
comprehensive history, examination and investigations may lead to medicalization- Invocation
of a medical diagnosis to explain physical discomfort that is not caused by organic disease and
application of a medical intervention to treat it as in:

 Manchausen‘s syndrome
 Anxiety disorders
 pain disorders
 Body dysmorphic syndrome
 Conversion disorders

9.5 Creating dependency on Psychotropic drugs

Figure 16: Sample of Drugs

It is not unusual to find patients with several prescription drugs as above particulary elderly
patients.
Figure 17: MJ Singing
Source:
The legendary Michael Jackson.

Activity 9.2
In a small group discuss Critically the events leading to the death of Michael Jackson.

A common problem among both psychiatric and medical health workers is the innapropriate use
of psychotropic drugs creating a problem of substance abuse and subsequent dependency.

Some of the most commonly prescribed and over the counter drugs are sedatives/tranquilisers
(benzodiazepines, barbiturates) and pain killers (opiates)

In many cases the use of these drugs is initiated by doctors

Patients continue using the drugs because they are poorly informed about the long term addiction
potentials or because they become addicted due to prolonged prescriptions

9.6 Reinforcing and medicalization of deviant behaviour

Reinforcing deviant behaviour- Certain forms of deviant behaviour which do not require
medical intervention are reinforced through misdiagnosis or clinicians conviction that they
should be treated using medication.

Deviation from the cultural norms of a society is not necessarily a medical or psychiatric
condition. Medicalization and labelling of deviant behaviour of political dissidents as metally ill
deserving treatment has a long history propagated by political systems in collussion with doctors
in various parts of the world.

9.6.1 Hypochondriasis and Autistic Spectrum disorders

Hypochondriasis is a well recognized condition in psychiatry, a condition in which the patient
believes they suffer from a major life threatening disorder and seek help from various doctors.
Failure to make a quick diagnosis and continuous investigation of such patients reinforces the
patients belief that they are suffering from a terminal illness.

Increased tendency to medicalise deviant behaviour and providing treatment- has particularly
affected children. Children who do not fit into the school system are quickly inappropiately
diagnosed and treated for disorders ranging from ADHD to autism. This has created a global
controversy particularly with highly gifted children. Some have argued that pharmaceutical
companies have a role in this trend.

In-Text Question 9.1

What is labeling?
Can labelling of deviant behaviour as mental illness- be seen as a cause of mental illness ?

9.6.2 Labelling

Labelling of deviant behaviour- assigning the behaviour a medical or psychiatric diagnosis is a

major cause of stigma worldwide. Psychosociological theories also claim that people/society
reacts differently to labelled people this may cause the labelled individual to behave in the
manner expected of his label. Children and people of lower intelligence are particulary prone to
adapt labels.
Sexual behaviour covers a wide range of behaviour determined by both by individual and
cultural factors. When deviation from the social norms is diagnosed as mental illness- potential
for the developement of other psychological disorders like depression, anxiety and even suicidal
behaviour- example homosexuality.

9.6.3 Controversial diagnosis in Psychiatry

Some disorders are so controversial in psychiatry that diagnosis and inclusion in diagnostic
criteria has often been labelled as creating iatrogenic disorders. Among these are the dissociative
disorders particularly- Multiple personality disorder, which is more commonly found in fictional
literature than in textbooks and Borderline personality disorder.

Activity 9.3
In groups of two or four work discuss critically the follwoing questions:
What is homosexuality?
Is homosexuality a psychiatric or medical disorder?

9.6 Institutionalisation
Prolonged admission of patients into psychiatric institutions creates a dependency on care and
institutions that makes it difficult for the patient to reintegrate into society. The situation may be
excerbated by a failure promote function and effective return to work. Patients suffering from
schizophrenia are particularly prone to this problem. Institutionalisation is usually supported by
the family and the community who wish to rid themselves of the responsibilty of the care of the
patient and abandonment is common.

9.7 Summary

Iatrogenic disorders are disorders caused by doctors and other health workers or health care
system and are present in all branches of medicine. These disorders are the result of
misdiagnosis, inappropriate use of psychotropic drugs, reinforcement and labelling of deviant
behaviour and institutionalization.

9.8 Suggestions for further readings

9.8 Suggestions for further readings

1. Introduction to Psychology: Clifford Thomas Morgan, Richard Austin King, et.al

2. Psychology: Lester M. Sdorow
3. American Psychiatric Association DSM IV Tr
4. Social Psychology Robert A. Baron & Donn Byrne
5. Understanding Human Sexuality Hyde DeLamater
6. Human Sexuality: diversity in contemporary America B. Strong; C. Devault; B. Sayad;
W. Yerber

9.9 Review Questions

Answer all questions

Iatrogenic disorders are

Disorders unique to Psychiatry

Are disorders which are found in urban settings
Are caused by health professionals
Are anxiety disorders
Are caused by neglectful relatives

Iatrogenic Substance use dependency is

 Is a problem commonly associated with Antidepressants
Is related to prolonged prescriptions of benzodiazepines
Is associated with self diagnosis and treatment
Is associated with minor ailments
Is related to prolonged use of paracetamol

A patient is most likely to present to a medical doctor with a conviction of a terminal illness if
he/she has

Generalised Anxiety disorder

Major depressive disorder
Schizophrenia
Hypochondriasis
Body dysmorphic disorder

An iatrogenic disorder can arise from all the following except

Living with a spouse who is mentally ill.

Being misdiagnosed with HIV
Being admitted for a long time in a psychiatric ward
Being misdiagnosed for cancer
Being given a two month prescription for Diazepam

SUBMIT ANSWERS