UNIT I

INTRODUCTION TO PSYCHOPATHOLOGY
a) Definition of psychopathology, mental health perspective of psychopathology,
b) Historical views of abnormal behaviour
c) Myths and facts;
d) Criteria of abnormality;
e) Approaches to understanding abnormal behaviour- biological approaches, psychological
approach, behavioural approach;
f) DSM and ICD classification of mental disorders.

DEFINITION OF PSYCHOPATHOLOGY, MENTAL HEALTH PERSPECTIVE OF PSYCHOPATHOLOGY,

1. Psychopathology: It is the scientific study of mental disorders including the theoretical

background, aetiology, progression, symptomology, diagnosis and treatment.
Psychopathology arises from the Greek words ‘psyche’ which means soul and ‘pathos’ which
means disorder.
2. The study of psychopathology arises from many fields of medicine, psychiatry,
biopsychology, neurology, biochemistry, pharmacology and even endocrinology.

HISTORICAL VIEWS OF ABNORMAL BEHAVIOUR

1. The evolutions of understanding abnormal behaviour are marked by changes in beliefs

practices, ideas and advancements in scientific study.
2. Demonology, gods and spirits: Earliest references to abnormal behaviours were made by
the Chinese, Hebrew and Egyptian scriptures that considered abnormal behaviour to result
from demonic possession or the work of evil spirits. Some beliefs considered abnormal
behaviour as punishments of angry gods.
3. Treatment for demonic possession was exorcism, where you coax evil spirits to leave the
body. Other techniques include trephination, operation where a circular section of the skull
is cut away to treat abnormal behaviour, prayer, magic, concoctions etc.
4. Early Medical concepts: During this period Hippocrates, known as the father of modern
medicine, gave his conclusions about abnormal behaviour. He said that abnormal behaviour
has its roots in brain dysfunction and that belief in deity and demonic possession hinders
appropriate treatment of mental disorders. Hippocrates classified diseases into three groups
– mania, melancholia and Phrenitis and gave detailed explanations for them. He also
explained personality in the form of the 4 humours – Black bile, yellow bile, phlegm and
blood.
5. Early Philosophical ideas: Greek philosopher Plato, believed that does who are not in
control of their actions should not be severely punished for their behaviour. He believed that
mental condition reflected one’s internal state and health of an individual. He also said that
behaviour is influenced by societal ideas and so there are individual differences in
intellectual abilities. He wanted those with mental disorders to receive hospital care and
promote their well-being. Plato’s student, Aristotle was known for is extensive work on
mental disorders and consciousness. He believed that directed thinking could help control
psychological pain. He also believed in Hippocrates’s view of temperament based on the
four humours.
6. Later Greek and Roman concepts: One of the most influential; Greek philosophers, Galen,
expanded Hippocrates’s view but then went on to make his original contributions in the
study of the nervous system and the classification of psychological disorders based on their
causes. Roman medicine also emphasised on the treatment of psychological conditions using
pleasant smelling baths and massages to ensure that the patients were comfortable.
7. Middle Ages: During the Middle Ages, the scientific aspects of Greek medicines survived in
the Islamic countries. The first mental hospital was established in Baghdad and then
followed in many other places. Avicenna of Persia, known as the ‘Prince of physicians,’
published one of the widely recognized works in the field of medicine known as ‘The Canon
of medicine’ that frequently refers to melancholia, hysteria, epilepsy and other such
disorders. On the other hand, In Europe, scientific enquiry of abnormal behaviour was
limited, but mental disorders became prevalent in the region. Mass madness was the
widespread occurrence of group behaviours of hysteria such as dancing, convulsions,
jumping etc. In Italy, this occurred in form of mass dancing called Tarantism, which then
later spread to Germany, called St. Vitus’s dance. In certain isolated rural areas, people
began showing lycanthropy, where they believe they are werewolves.
8. Exorcism and Witchcraft: In the ancient Europe, during the Middle Ages, the management
of mentally disturbed individuals were left to the clergy. Here, people resorted back to the
practices of prayers, holy water and exorcism. People who had mental disorders were
labelled as witches and either punished or killed.
9. Re-emergence of scientific enquiry in Europe: With the beginning of the Renaissance
movement, people began questioning the practices of the Middle Ages. Physician
Paracelsus, said that dancing mania was a disease and not a form of demonic possession.
Even though he rejected demonology, he believed that mental illness arises due to the astral
energy that affects human beings. He believed that the position of the moon (Luna) had an
influence over the brain. Another physician, Johann Weyer was so disturbed by the ill-
treatment of the mental ill patients that he wrote a book ‘On the Deceits of Demons,’ that
rebutted the practices against the those who were sick, but his works were banned by the
Church. He was one of the first physicians to specialize in mental disorders.
10. Early Asylums: The establishment of early asylum were meant as refuge for those people
who were unable to care for themselves. These places were referred to as ‘madhouses’ and
the conditions of those in the hospitals were very poor. But this began to reform and people
started receiving more humane treatment.
11. Humanitarian Reform: Philip Pinel worked towards more humanitarian treatment of mental
illness patients by removing their chain, clearing their filth, treating them with kindness and
compassion, all that proved to be helpful in turn in regulating their behaviour. Like Pinel’s
reforms, William Tuke, introduced compassion for those with mental disorder and
employed trained practitioners at asylums, which improved the care that the patients
received abut also changed the attitude of people regarding mental illness. Stemming from
these changes, a Moral Management Movement has begun where they would focus on the
patients social, occupational and individual need. In United States, these reforms were led
by Benjamin Rush who advocated the humane treatment of people. The moral management
movement then transformed to the Mental Hygiene Movement where the focus was on the
physical well-being of the hospitalized persons. Dorothy Dix, was an instrumental figure in
spreading the mental hygiene movement across America, where she is credited to
establishing 32 mental hospitals. The military also became lucrative in its efforts to work for
mental health, where they treated causalities but also produced psychiatrists who worked in
the field of mental health.
 12. 19th and 20th Century: In the early 19th century, professional or ‘alienists’ in the field of
psychology had little role play in the treatment and so the treatment of patients was rather
inhumane. But later, these alienists gained control and then began being influential in bring
out good mental health treatment. These alienists then believed that emotional problems
arise due to exhaustion of body energies. Mental disorders or shattered nerves resulted
from using up nerve energy known as ‘neurasthenia,’ a condition that depicts low mood and
lack of energy. Another physician, Clifford Beers used his own experiences to explain the
nature of inhumane treatment he faced at mental institution and how he recovered from his
condition only in presence of care and compassion. His description was helpful in
enlightening public about the treatment of the ill. Another physician, Franz Anton Mesmer,
was working on hypnosis and mental disorders, was highly influenced by the planets and
how they contributed to our states of mind. According to him, planets influenced the
universal magnetic fluid in our body, the distribution of this fluid is what led to mental
diseases. His study in this field is what is known today as – Mesmerism.
13. 20th Century: Emil Kraepelin was one of the first to bring out the foundations for the
classification of mental disorders and later went on to become the forerunner for the DSM.
Mary Jane Ward’s book ‘The Snake Pit,’ became influential in bringing attention to the poor
conditions of metal asylums. In 1946, the National Institutes of Mental Health was
organised and began providing training for those working in the field. Changing laws and
attitudes towards mental illnesses, people began establishing more clinics and institutions to
house the mentally unwell.

MYTHS AND FACTS;

1. Abnormal behaviour was always considered to be bizarre, which is not true as abnormal
behaviour does show patterns different from normal behaviour, but need not always be
bizarre.
2. Normal and abnormal behaviour are different in kind, whereas behaviour that is classified as
normal is only based on the social approval and overt nature of it. Those with abnormal
behaviour may be feeling immense turmoil on the inside but may not show it on the outside,
and people may classify it as normal, even though the dissonance between the feeling and
behaviour is abnormal.
3. People with mental disorders are dangerous, not all mental illness are dangerous in nature
and so even its applicability as a criterion for judging abnormal behaviour does not stand
valid.
4. Once a person has a mental disorder it can never be changed. Even though mental illness
results from a cascade of events that takes place of a certain amount of tine, with the
correct support an intervention the people can be brought back into normalcy.
5. Mental disorder is something to be ashamed. Just as physical disorder that may occur
throughout our lives, mental disorders can have a possibility of occurring when people put
through difficult periods in their lives. Just as we consulting a doctor for physical disorder is
normal, consulting a professional for a mental disorder is also normal.
6. Abnormal behaviour is result of some personal deficiency. Though some abnormal
behaviour may arise from underlying issues in the person, not all of them occur due to some
personal deficiency.

CRITERIA OF ABNORMALITY;
There is no single indicator to abnormality, however there are certain behaviour that can be
categorized as abnormal.

1. Subjective Distress: If people suffer or experience psychological pain. But this not a
sufficient (all that is needed) or necessary (a feature required for all cases of abnormality)
condition for some behaviour to be considered abnormal.
2. Maladaptive Ness: Behaviour that is maladaptive in nature., such as a person with anorexia
restricting their diet. Maladaptive behaviour interferes with the well-being if the individual
and their ability to enjoy their life and relationships.
3. Statistical deviancy: Statistically rare and uncommon behaviours that are undesirable are
abnormal than those that are desirable. Ex. Intellectual disability is an abnormality while
intellectual giftedness is not, even though both are statistically rare.
4. Violation of the standards of society: Each society has its own norms and formalized laws
that are meant to be followed by the individual of the communities. People are also
expected to act along certain moral standards and those who deviate from these are
labelled as abnormal. Abnormality is also dependent of the statistical magnitude of the
behaviour. Ex. Parking illegally is against the formalized law but because of the magnitude of
the people who indulging in it, it not considered as a behavioural abnormality.
5. Social discomfort: Not all rules are explicit or written. When certain implicit rules are
violated, it leads to feelings of discomfort and uneasiness.
6. Irrationality and unpredictability: Behaviours that have no reasoning ex. Delusion s of
schizophrenic person and are unpredictable ex. Sudden screaming, are usually associated
with manic episodes in individuals and so they are considered as an abnormality. Another
important factor that is used to classify the behaviour as abnormal is whether the individual
can control it or not.
7. Dangerousness: If the person is a source of danger to themselves or towards others, then
the behaviour can be labelled as psychologically abnormal.

APPROACHES TO UNDERSTANDING ABNORMAL BEHAVIOUR- BIOLOGICAL APPROACHES,

PSYCHOLOGICAL APPROACH, BEHAVIOURAL APPROACH;

Aetiology of Abnormal Behaviour: (causal factors) Necessary Conditions – characteristics that need
to exist for disorder to occur. Sufficient Conditions – Conditions that guarantees the disorder.
Contributary causes – Other factors that mind have also contributed to development of disease.
Risk factors – The predisposing factors that make the person vulnerable to developing the disorder.
Reinforcement – any behaviour or factor that increases the studied behaviour.

Biological Processes

1. Biological perspective of abnormal behaviour claims that behaviour has in roots in biology of
the body and the brain. In this perspective, abnormal behaviour is accounted for genetical
abnormality, structural dysfunction, improper functioning of neurons and hormones.
2. Genetic predisposition: Genes are molecules of Deoxyribonucleic acid that carry genetic
information that is inherited from parents to offspring. Though genes alone cannot result in
genetic disorders, studies show that genes do play an important role in predisposition
towards a disorder. Genetic changes along with environmental stressors can result in the
onset or trigger of mental disorders. Passive effect of genes is where the environment plays
an important role in shaping the offspring’s character. Evocative effect is where the genes
may have some role to play in determining behaviour and Active effect is where the genes
actively play a role in determining and shaping the environment. Gene related illnesses may
 be resulted due to improper hormone production, changes in brain chemistry and even
structural abnormality. Various methods are employed for the study of the correlation
between genetics and mental disorders – Twin studies, family influences and adoption
studies aim to understand how genes play a role in behaviour within a family and to address
the nature Vs. nurture question. Linkage studies and Association studies are employed to
identify the location of genes that result in mental disorders.
3. Brain dysfunction and neural plasticity: Neural plasticity refers to the brains’ structural and
functional capacity to reorganize itself in responses to changes in diet, emotional and
structural defects, drug use etc. Studies have recognised that positive prenatal experiences
can affect the brain’s structural development in the offspring more positively. It also effects
the neural development of connection especially in infants, whereas similar changes did not
elicit a dramatic effect in the adult brain. Scientists are now exploring the developmental
systems approach where, genetic affects the neural development, which in turn effects your
behaviour towards the environment. But it also believed that this process is bi directional in
nature.
4. Neurotransmitters and functions: neurotransmitter play a very important role in regulating
behaviour. Acetylcholine is a neurotransmitter that is responsible for muscle contractions
and formation memories. Dopamine is also responsible for regulation of muscle
contractions, learning, memory and emotions. Poor dopamine production can result in
depression and anxiety. Serotonin, is responsible for mood states, sleep irregularities. Gama
amino butyric acid (GABA), secreted in low levels can also result in development of
Generalised anxiety disorder. Non epinephrine secreted by the adrenal gland is responsible
for the body arousal in a flight or fight situation. When a neuron transmits an impulse,
presynaptic neurons releases neurotransmitters into the synapse. These neurotransmitters
bring about changes in the post synaptic neuron so that the impulse can be carried. If
excess, neurotransmitter is released, then the presynaptic nerve reuptakes the excess or an
enzyme monoamine oxidase, destroys the remaining neurotransmitters. If this process
doesn’t take place appropriately, it leads to continuous firing of neurons, that can result
abnormal behaviour. Highly sensitive or insensitive post synaptic neuron can also result in
behavioural changes.
5. Temperament: It refers to the person’s reactivity and characteristic ways of self -regulation,
which is believed to be biologically pre-programmed. These behaviours also affected by
many other factors such as environmental influences, developmental patterns etc. Early
personality can be explained in terms of its five dimensions: fearfulness,
frustration/irritability, positive affect, activity level, attention perception and effort control.
In adult personality the three important dimensions are: Neuroticism and negative
emotionality, extraversion and positive emotionality, and constrain (conscientiousness,
agreeableness).

Psychological Approaches

1. Psychological approach aims to understand human behaviour in form of desires, motives,

perceptions and more than just their biological processes. Freud’s psychoanalysis
emphasized on the importance of the unconscious desires in regulating our behaviour.
These desires may be expressed in form of fantasize, dreams and can be brought to the
conscious by psychotherapy.
2. Psychosexual stages of development given by Freud, depict the interpsychic conflict
between the id, ego and superego throughout the development of the child. For the proper
development to take place, the child must be able resolve the conflict or need at each of the
 stages or else it may lead to fixation at any one of the stages. Freud believed that
psychological disorders that arise from unresolved childhood conflicts that are buried in the
unconscious. In some cases, these underlying conflicts overcomes the barriers of ego and
results in a condition known as psychosis. Psychosis is characterised by hallucinations, faulty
perceptions and bizarre behaviours. Psychotherapy helps people to recognise these
underlying issues and deal with them.
3. Neo- Freudian theories: Ego psychology by Anna Freud emphasizes on the central role of
the ego in personality development and when faced with conflicts. According to her theory,
ego played a very important role in dealing with interpsychic conflicts and psychopathology
develops if the ego -defence mechanisms are not appropriately used in dealing with them.
Object relations theory by Klein and Mahler, talks about children who symbolically
represent the other people in the environment as ‘Objects’ in their head and then by
introjection they symbolically incorporate the object’s characteristics on to themselves.
These objects go onto influence the child’s future behaviour and their self-esteem. Alfred
Adler’s interpersonal perspective, focused on how social aspects also shapes
psychopathology development of the individual and that interpersonal relations have an
important role in determining the type of tendencies we have, adaptive or maladaptive.
Karen Horney and Eric Fromm, both spoke about how social factors along with the
psychological forces affect behaviour. Erik Erikson based on the interpersonal factors that
affect psychanalytical theory, proposed the psychosocial stages of development that occurs
during the lifespan of the individual, where each stage was marked by a stage related
conflict resolution which determines how the person would develop in future. Carl Jung,
believed that people were driven by an inferiority complex and not by sexual instinct as
proposed by Freud. He said that it was the inferiority complex that encouraged them to seek
superiority and dominance in their life, that fuels behaviour. In healthy personalities, this
drive to achieve dominance is kept in check by the need to help other people.
4. Prominent areas of Freuds studies are his projective techniques that are used to understand
unconscious desire in people. This therapeutic techniques like dream analysis and free
association are used to understand both the conscious and unconscious mind. His
understanding of normal and abnormal behaviour as reactions of the ego, towards problems
in life showed a changed attitude towards the understanding of mental disorders. But his
theory over the years has also faced a lot of criticism for the lack of scientific basis, focus on
the sexual causes than the social causes of behaviour and for the demeaning view of
women.

Behavioural Approach

1. Behavioural approach focuses on the understanding of learning because of experience.

Behaviourists focused on how the learning occurs and the environmental factors that affect
the learning – which could deem it as adaptive or maladaptive.
2. Classical Conditioning: In classical conditioning, specific stimuli elicit a conditioned response
due to the association of the stimuli with the response. It is very important in understanding
abnormal psychology, as many physiological responses are associated with certain stimuli
due to the strong association between the stimuli presented simultaneously. Ex. Fear
towards the dark can be learned, while fear towards dangerous situation is an inherent
physiological response. Therefore, we if we associate darkness and danger, over time we
learn to fear the dark.
3. Operant conditioning: here, the behaviour is learned by reinforcing the behaviour with
some form of reward or removal of negative consequence. In instrumental conditioning,
 high rates of reinforcement are required to elicit the required behaviour. Continuous
reinforcement may lead to decrease in the behavioural response, whereas intermittent
reinforcement is more likely to elicit response for longer periods. Through the course of
development, instrumental conditioning becomes important in identifying behaviour that
will prove to be rewarding or unrewarding. This may encourage us to seek out behaviours in
which we achieve rewards very easily even though they may be maladaptive in nature. Ex.
Substance abuse as an escape from life stress.
4. Observational learning: Learning in this case occurs by modelling or imitating behaviour of
others, without experiencing the situation or stimulus. Children acquire traits by observing
their parents behave. If the parent’s show fear towards a particular object, then they learn
to fear the object, by reacting in a similar manner. Children who grow up in aggressive
environment pick up on the aggression and act in similar ways. Similarly, maladaptive and
adaptive behaviours can be observed and incorporated into people’s behaviour both
consciously or unconsciously.
5. Cognitive Behavioural approach is an extension to the behavioural approach with
importance given to the underlying mental schemas and perceptions which in turn effect our
behaviour. Those with maladaptive behaviour, usually have faulty perceptions of themselves
and their environment. These false perceptions alter their thinking and what they feel about
themselves and therefore, manifesting in form of maladaptive behaviour.
6. Treating maladaptive behaviour, could be by providing negative reinforcement to reduce
deviant behaviour, systematic desensitisation along with relaxation techniques are used for
treating phobias and fears.

DSM AND ICD CLASSIFICATION OF MENTAL DISORDERS.

1. During the early 20th century, there was an increase in number of causalities due to the
World War, which effected both the military and those outside of it bot physically and
mentally. There was a sudden requirement for psychologists and mental health practitioners
to meet the demands on an increasing number of patients suffering from various mental
disorders. It was in the wake of this, that the requirement to classify disorders came about.
2. Classification provided people with a common language and shortened terms for dealing
with the mental health conditions. It helped to structure wide range of information and
categorise disorders of similar characteristics. It would facilitate research and treatment
techniques of the various mental conditions.
3. The Diagnostic and Statistical Manual of disorders was given inn 1952 by the American
psychiatric association.