Lecture Notes For Abnormal Psychology, 18th Edition

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Instructor’sResourceManualForAbnormal PsychologyEighteenth EditionJill M. Hooley,Harvard UniversityMatthew K. Nock,Harvard UniversityJames N. Butcher,University of MinnesotaPrepared byDavid Lee,University ofCalifornia, IrvineRegina M. Hughes,Collin CollegeLinda Lockwood, Ph.D.,Metropolitan State University of Denver

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Abnormal Psychology18e, Hooley/Butcher1Chapter1:Abnormal Psychology:Overview and Research ApproachesLearning Objectives1.1 Explain how we define abnormality and classify mental disorders.1.2 Describe the advantages and disadvantages of classification.1.3Explain how culture affects what is considered abnormal, and describe two different culture-specific disorders.1.4 Distinguish between incidence and prevalence, and identify the most common and prevalentmental disorders.1.5 Discuss why abnormal psychology research can be conducted in almost any setting.1.6 Describe three different approaches used to gather information about mental disorders.1.7 Explain why a control (or comparison group) is necessary to adequately test a hypothesis.1.8 Discuss whycorrelational research designs are valuable, even though they cannot be used tomake causal inferences.1.9 Explain the key features of an experimental design.Chapter Overview/SummaryA precise definition ofabnormalityremains elusive. Elements that can be helpful in consideringwhether something is abnormal include subjective distress, maladaptiveness, statistical deviancy,violation of societal norms, social discomfort, irrationality and unpredictability, anddangerousness.TheDSMemploys a category type of classification similar to that used inmedicine. Disorders are regarded as discrete clinical entities, though not all clinical disordersmay be best considered in this way.Even though it is not without problems, theDSMprovides uswith working criteria that help clinicians and researchers identify and study specific difficultiesthat affect the lives of many people. It is far from a “finished product,” butfamiliarity with theDSMis essential to significant study of the field.Classifying disorders provides a common languageaswell as a communication shorthand. Italso allows us to structure information in an efficient manner and provides us with anorganizational framework. This facilitates research and treatment. In addition, classificationdefines the domain of what is considered to be pathological. From a practical perspective, itdelineates the types of psychological difficulties that warrant insurance reimbursement andidentifies the disorders that mental health professionals treat.When we classify, we lose detailedpersonal information about theindividualwith the disorder. Classification can also facilitate

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Abnormal Psychology18e, Hooley/Butcher2stigma, stereotyping, and labeling, although we should keep in mind that these problems are notcaused by the classification system itself. Fear of being viewed negatively or being discriminatedagainst may lead some people to avoid seeking treatment.Culture shapes the presentation of clinical disorders in some cases. Culture also provides thebackdrop against which we must evaluate whether a particular behavior is abnormal or not.Certain disorders appear to be highly culture specific.Taijin kyofushois an anxiety disorder thatis quite prevalent in Japan. It involvesthefear that one’s body, body parts, or body functionsmay offend, embarrass, or make others feel uncomfortable.Ataque de nerviosis anotherculturally rooted expression of distress. It is found in people of Latino descent, especially thosefrom the Caribbean. This condition does not have a clear counterpart in theDSM. Symptoms caninclude crying, trembling, fainting, uncontrollable screaming, and a general feeling of loss ofcontrol.Epidemiology involves the study of the distribution and frequency of disorders. Incidence isthe number ofnewcases that occur in a given period of time. Prevalence refers to the totalnumberofcases in a population during any specified period of time.Just under 50 percent ofpeople will experience some form of mental disorder during their lifetime. Mood disorders andanxiety disorders are particularly common.Studying and drawing inferences from past case studies alone often leads to erroneousthinking,as we often focus on data that confirm our ideas of how things are.Research preventsus from being misled by natural errors in thinking and can be conducted in clinics, hospitals,schools, prisons, and on the street. It is not the setting that determines whether a given researchproject may be undertaken. The importance lies in the researcher’s methodology.Information about mental disorders can be collected through case studies, self-report data,and observational approaches.Case studies can be a valuable source of new ideas and serve as astimulus for research. They also may provide insight into unusual clinical conditions that are toorare to be studied in a more systematic way.Self-report data allows us to study behavior in amore rigorous manner. This type of research often involves having research participantscomplete questionnaires of various types or conducting interviewswith them. When we collectinformation in a way that does not involve asking people directly, we are using some form ofobservational approach. Exactly how we go about this depends on what it is we seek tounderstand.Unless there is a control or comparison group, researchers cannot test their hypothesisadequately. The control group must be comparable in all major respects (e.g.,age, educationallevel, proportion of males and females) to the criterion group, except for the fact that they do notexhibit the disorder of interest. The control group could bemade up ofpsychologically healthypeople or people with a different disorder.Only when they are using a suitable control orcomparison group can researchers compare the two groups on the variables of interest to see ifthere are significant differences.Correlational research examines factors as they currently are, allowing us to identify factorsthat appear to be associated with certain disorders. Just because two variables are correlated doesnot mean that there is a causal relationship between them. Correlation does not equal causation.Thedirection of the relationshiporthepossibilities of a third variable bias arenot accounted forin correlational studies.Experimental research involves manipulating one variable (the independent variable) andobserving the effect this manipulation produces with regard to another variable (the dependentvariable). Because the experimenter is changing the experimental conditions, experimental

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Abnormal Psychology18e, Hooley/Butcher3research designs permit causal inferences to be made.Although most experiments involve thestudy of groups, single-case experimental designs (e.g., ABAB designs) may also be used tomake causal inferences in individual instances.DetailedChapterOutlineINTRODUCTION1.Abnormal psychologyis concerned with understanding the nature, causes, andtreatment of mental disorders.2.Family aggregationis whether a disorder runs in families.I.WHAT DO WE MEAN BY ABNORMALITY?Learning Objective1.1: Explain how we define abnormality and classify mentaldisorders.A.Indicators of Abnormality1.No one behavior or single indicator is enough to define abnormality. However,the morethatsomeone has difficulties in the following areas, the more likelyit isthatthey have some formofmental disorder:a.Subjective distress:If people suffer or experience psychological pain,we areinclined to consider this indicative of abnormality; however, althoughsubjective distress is an element of abnormality in many cases, it is neither asufficient condition nor even a necessary condition for us to considerthatsomethingisabnormal.b.Maladaptiveness:Any behavior that is maladaptive for the individual ortoward society (e.g., anorexia)is maladaptive.c.Statistical deviancy:The wordabnormalliterally means “away from thenormal.”Just because something is statistically common or uncommon,though,does not reflect abnormality (e.g., having an intellectual disability,which isstatistically rare, represents a deviation from the normal).d.Violation of the standards of society:All cultures have rules. Some of theseare formalized as laws; othersform the norms and moral standards that we aretaught to follow. When people fail to follow the conventional social and moralrules of their cultural group, we may consider theirbehaviorto be abnormal(e.g., the Amish of Pennsylvania not driving carsor watching television).

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Abnormal Psychology18e, Hooley/Butcher4e.Social discomfort:Not all rules are explicit, andit doesn’t bother us whensomerules are violated. However, when someone breaks a social rule andthose around this individual experience a sense of discomfort or unease (e.g.,ifyou are sittingonan almost empty bus and someonegets onand sitsdirectly next to you), it may be considered an abnormal behavior.f.Irrationality and unpredictability:People are expected to behave in sociallyacceptable ways and abide by social rules. For example, if someone next toyou started screaming and yelling obscenities at nothing, this behavior wouldbe viewed as unpredictable, disorganized, and irrational.g.Dangerousness:Thisdescribessomeone who is clearly a danger to himself oranother person. Therapists are required to hospitalize suicidal clients,andifthey have a client who makes an explicit threat to harm another person, theyare required to contact both the police and the person who is the target of thethreat. But if we rely only on dangerousness as our sole feature ofabnormality, we will run into problems. For example, someone who engagesin high-risk sports such as free diving or base jumping is not immediatelyconsidered mentally ill.2.Decisions about abnormalityinvolvesocialjudgments. Therefore,cultureplays arole in determining what is abnormal.B.TheDSM-5and the Definition of Mental Disorder1.In the United States, the accepted standard for defining various types of mentaldisorders is the American Psychological Association’sDiagnostic and StatisticalManual of Mental Disorders.2.Commonly referred to asDSM, it is revised and updatedfrom time to time.Thecurrent version,DSM-5, was published in 2013; it contains a total of541diagnostic categories.3.The World Health Organization publishestheInternational Classification ofDiseasesfor use in countries outside the United States. The 11theditionis themostrecent.4.WithinDSM-5, a mental disorder is defined as a syndrome that is present in anindividual and involves clinically significant disturbance in behavior, emotionregulation, or cognitive functioning.These disturbances are thought to reflect adysfunction in biological, psychological, or developmental processes that arenecessary for mental functioning.5.DSM-5also recognizes that mental disorders are usually associated withsignificant distress or disability in key areas of functioning,such as social,occupational,andother activities.

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Abnormal Psychology18e, Hooley/Butcher5a.Predictable or culturally approved responses to common stressors or losses(such asthedeath of a loved one) are excluded.b.The dysfunctional pattern of behavior mustnot stem from social deviance orconflicts that the person has with society as a whole.c.This newDSM-5definition of mental illness was based on input from variousDSM-5work groups as well as other sources.d.Keep in mind that any definition of abnormality or mental disorder must besomewhat arbitrary.II.CLASSIFICATION AND DIAGNOSISLearning Objective 1.2: Describe the advantages and disadvantages of classification.1.At the most fundamental level, classification systems provide us with anomenclature(a naming system). This gives clinicians and researchers both acommon languageandshorthand termsfor complex clinical conditions.2.Classification systems enable us tostructure informationin a more helpfulmanner.Theyfacilitate research, which gives us more information and facilitatesgreater understanding about what causes various disorders and how they mightbest be treated.3.Defining the domainof what is considered pathological establishes the range ofproblems that the mental health professional can address, and thus delineateswhich types of psychological difficulties warrant insurance reimbursement andthe extent of such reimbursement.A.What Are the Disadvantages of Classification?1.Using any form ofshorthand inevitably leads to a loss of information.2.As we simplify through classification,we lose personal details about the actualindividualwith the disorder.3.Stigma,or disgrace,is still associated with having a psychiatric diagnosis.4.Stereotyping,orforming automatic beliefs about other people, may lead toincorrect inferences about those who havebeendiagnosed.a.We unavoidably learn stereotypes as a result of growing up in a particularculture (e.g., people who wear glasses are more intelligent; New Yorkers arerude).

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Abnormal Psychology18e, Hooley/Butcher65.A stigma could be perpetuated by the problem oflabeling.a.It is important to keep in mind that classification systems don’t classifypeople;they classify the disordersthat people have.6.When someone has an illness, we should take care not to definethemby thatillness. Respectful and appropriate language shouldbe usedinstead. For example,it wasoncequite common for mental health professionals to describe a patient as“a schizophrenic” or “a manic-depressive.” Now it is more widely acknowledgedthatitis more accurate and considerate to use“person-firstlanguage”—“a personwith schizophrenia” or “a person with bipolar disorder.”B.HowCanWeReducePrejudicialAttitudesTowardPeopleWhoAreMentallyIll?1.Prejudicial attitudesare common.2.The results of a study by Arthur andcolleagues (2010) suggest that stereotyping,labeling, and stigma toward people with mental illness are not restricted toindustrialized countries.3.For a long time,it was thought that educating people that mental illnesses were“real” brain disorders might be a solution, but sadlythisdoes not seem to be thecase.Increasesin the proportion of people who understand that mental disordershave neurological causes have not resulted in decreases in stigma.4.Stigma does seem to be reduced by having more contact with people in thestigmatized group. However, studies suggest that people may tend to avoid thosewith mental illness because of the psychophysiological arousal and distress theymay experience.III.CULTURE AND ABNORMALITYLearning Objective 1.3: Explain how culture affects what is considered abnormal, anddescribe twodifferent culture-specific disorders.1.There is considerable variation in the waythatdifferent cultures describepsychological distress.2.The way some disorders present themselves may depend on culturally sanctionedways of articulating distress.3.Culture can shape the clinical presentation of disorders like depression, which arepresent across cultures around the world.

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Abnormal Psychology18e, Hooley/Butcher74.Despite progressively increasing cultural awareness, we still know relatively littleconcerning cultural interpretation and expression of abnormal psychology.5.The vast majority of the psychiatric literature originates from Euro-Americancountries (i.e., Western Europe, North America, and Australia/New Zealand).6.Research published in languages other than English tends to be disregarded.7.Some types of psychopathology appear to be highlyculture-specific.For example,taijin kyofushoisan anxiety disorderthatis quite prevalent in Japan,andataque denervious, an “attack of nerves,”isfound in people of Latino descent.8.Certain unconventional actions and behaviors,such as hearing voices, laughing atnothing, defecating in public, drinking urine, and believing things that no one elsebelieves, are almost universally considered abnormal behaviors.IV.HOW COMMON ARE MENTAL DISORDERS?Learning Objective 1.4: Distinguish between incidence and prevalence, and identify themost common and prevalent mental disorders.1.How many and what sort of people have diagnosablepsychologicaldisordersis asignificant question. It is essential for planning and establishing mental healthservices, and it providesvaluable cues as tothe causes of these disorders.A.Prevalence and Incidence1.Epidemiologyisthe study of the distribution of diseases, disorders, or health-related behaviors in a given population.2.Prevalenceisthe number of active cases in a population during any given periodof time (i.e., the percentage of the population that has the disorder).3.Point prevalencerefers to the estimated proportion of actual, active cases of adisorder in a given population at a given point in time.4.1-year prevalencerefers to everyone who experienced a particular disorderthroughout an entire year.5.Lifetime prevalenceisan estimate of the number of people who have had aparticular disorder atsometime in their lives (even ifthey havenow recovered).Lifetime prevalenceestimates tend to be higher than other kinds of prevalenceestimates.6.Incidencerefers to the number of new cases that occur over a period of time(typically one year).

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Abnormal Psychology18e, Hooley/Butcher8B.Prevalence Estimates for Mental Disorders1.The most comprehensive source of prevalence estimatesfor adults in the UnitedStates diagnosed with mental disorders is the National Comorbidity SurveyReplication (NCS-R), which sampled the entire adult population using a numberof sophisticated methodological strategies.As indicated in Table 1.1, the study’sfindings included:a.Anxiety disorders have an estimated lifetime prevalence of 28.8percentanda1-year prevalence of 18.01percent.b.The lifetime prevalence forany mood disorder is 20.8percent,and the 1-yearprevalenceis 9.5percent.2.The lifetime prevalence of having anyDSM-IVdisorder is 46.4 percent,and the 1-year prevalence is 26.2percent.a.This may be an underestimate,as the NCS-R study did not assess forcertaindisorders, includingeating disorders, schizophrenia,andautism. It also did notinclude measures ofmost personality disorders.b.The most common individual disordersweremajor depressive disorder,alcohol abuse, and specific phobias (see Table 1.2).c.Although the lifetime and1-yearrates of mental disorders appear to be quitehigh, the duration ofan individual’sdisorder may be relatively brief. Also,many people who meet the criteriafor a disorderwill not be seriously affectedby it.d.Because the NCS-R is well over a decade old, another survey,the NationalSurvey on Drug Use and Health (NSDUH),is conducted every year.3.Comorbidityis thepresence of two or more disorders in the same person. Itisespeciallyhigh—50 percent—in people who have severe forms of mentaldisorders;thosewithmilder formshave only a7 percentrate.C.The Global Burden of Disease1.Worldwide, mental and substance use disorders account for over 7 percent of theglobal burden of disease.2.Because they are so common, anxietydisorders, depressive disorders, andsubstance use disorders together account for 184 million disability-adjusted yearsof life (DALYs), where one DALY can be thought ofasthe loss ofoneyear ofotherwise “healthy” life.

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Abnormal Psychology18e, Hooley/Butcher93.Depression accounts for more than 40 percent of DALYs.4.Estimatesindicate thatworldwide, mental disorders will cost$16 trillion—orabout 25 percent of global GDP in 2010—overthe next 20 years.Thisnumberdoes not include the costs oftreatment—or the personal,emotional costs thatliving with a mental disorder can causean individualandtheirfamily.5.Thereis a need to find better ways to provide mental health services, particularlyin developing countries.D.Treatment1.Althoughthere aremanyavailabletreatments for psychological disorders—frommedicationtopsychotherapy—not all people with disorders receive treatment.Some deny or minimize their problems; othersfear the stigma of diagnosis; andmany delay treatment, even if they recognize they need help(half ofthosewithdepression delay seeking treatment for6 to 8years; forthose withanxietydisorders, the delay ranges from 9to23 years).In addition, some are treated bytheir family physician rather than by a mental health specialist.2.Hospitalization and inpatient care are the preferred options for people who needmore intensive treatment than can be provided on an outpatient basis.3.Admissions to mental hospitals have decreased substantiallyoverthe past 45years, due in part totheincreaseddevelopment of medicationsthat controlsymptoms of severe disorders, budget cutsthathave forced many large state orcounty facilities to close, andhospital staysnotbeingauthorized by insurancecompanies, forcingpatientstoseek treatment elsewhere.4.Deinstitutionalization hashadmany unintended consequences, as described inChapter 2.E.Mental Health Professionals1.Whenindividualsreceive inpatient treatment, several different mental healthprofessionals often work as a team to provide the necessary care.A psychiatristmay prescribe medications and monitor the patient for side effects, a clinicalpsychologist may provide individual therapy, a clinical social worker may helpthe patient resolve family problems, and a psychiatric nurse may check in with thepatient on a daily basis to provide support.2.Patients treated in outpatient settings may also work with a team of professionals,but the number of mental health specialists involved is typically much smaller.For example, a patient might receive all treatment from a psychiatrist, who willprescribe medication and provide psychotherapy; or they may receive medications

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Abnormal Psychology18e, Hooley/Butcher10from a psychiatrist and see a psychologist or clinical social worker for regulartherapy sessions.V.RESEARCH APPROACHES IN ABNORMAL PSYCHOLOGYLearning Objective 1.5: Discuss why abnormal psychology research can be conductedin almostanysetting.1.We need to conduct research in order to study the characteristics, or nature,ofdisorder.2.Through research we can learn about the symptoms of a disorder, its prevalence,whether it tends to be eitheracute(short in duration) orchronic(long induration), and the problems and deficits that often accompany it.3.Research also allows us to further understand theetiology(or causes) ofdisorders.4.Abnormal psychology research can take place in clinics, hospitals, prisons, andhighly unstructured contexts, such as natural observations of homeless people onthe street.VI.SOURCES OF INFORMATIONLearning Objective1.6: Describe three different approaches used to gather informationabout mental disorders.A.Case Studies1.Much can be learned when skilled clinicians use thecase studymethod.a.PsychiatristsEmil Kraepelin and Eugen Bleulerprovided detailed accounts ofpatients whom researcherstodaywould easily recognize as having disorderssuch as schizophrenia and manic depression.b.Alois Alzheimer depicted a patient withanunusual clinical picture thatsubsequently became known as Alzheimer’s disease.c.Sigmund Freud published multiple clinical cases describing what we nowrecognize asphobia and obsessive-compulsive disorder.2.The information presented in case studies is subject tobiasbecause the writer ofthe case study selectswhichinformation to include and omit.3.Another concern is that the material in a case study is often relevant only to theindividual being described, meaningthatthe conclusionsdrawnhave low

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Abnormal Psychology18e, Hooley/Butcher11generalizability—that is, they cannot be used to draw conclusions about othercases when those cases involve people with a seemingly similar abnormality.B.Self-Report Data1.Self-report datamight involve having research participants completequestionnaires of various types. Or the data could originate ininterviews, wheretheresearcher asks a series of questions and records what the person says.2.Self-reports can be misleading becausetheyask abouttherater’s own subjectivestates of experiences.C.Observational Approaches1.When we collect information in a way that does not involve asking peopledirectly (self-report), we are using some form of observational approach.2.For example,Direct observationwould be used, for example,if you were tryingto observe aggression in children’s behavior. Observers would record the numberof times children hit, bit, pushed, punched, or kickedtheir playmates.Informationabout biological variables (e.g., heart rate and cortisol) might also be collected.3.Brain-imaging technology—such asfunctional magnetic resonance imaging(fMRI) and transcranial magnetic stimulation (TMS)—allows us to observe howthe brain works.4.In practice, much clinical research involves a mix of self-report and observationalmethodsVII.FORMING AND TESTING HYPOTHESESLearning Objective1.7: Explain why a control (or comparison group) is necessary toadequately test a hypothesis.1.Ahypothesisisan effort toexplain, predict, or explore something.2.Anecdotal accounts such as case studies can be very valuable in helping usdevelop hypotheses, although they are not well suited for testing the hypothesesthey may have inspired.3.Other sources ofhypotheses are unusual or unexpected research findings.4.Hypotheses are vital because they frequently determine the therapeuticapproaches used to treat a particular clinical problem.

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Abnormal Psychology18e, Hooley/Butcher12A.Sampling and Generalization1.Studies that examine groups of people are valued over single cases.Group studiesmay identify multiple causes for disorders,and they cangeneralize results to othercases.2.Samplingis the careful selection of a subgroup that is representative of a largerpopulation for close study.3.The more representative the sample, the more able we are to generalize.Ideally,we would be able to use random sampling to avoid potential biases, as erroneousconclusions can emerge from faulty sampling.B.Internal and External Validity1.External validityisthe extent to which we can generalize our findings beyond thestudy itself.2.Internal validityreflects how confident we can be in the results of a given studyC.Criterion and Comparison Groups1.To test their hypotheses, researchers use acomparison group(sometimes calledacontrol group).This maybe defined as a group of people who do not exhibitthe disorder being studied but who are comparable in all other major respects tothe criterion group2.People with the disorder being studied are thecriterion group.VIII.CORRELATIONAL RESEARCH DESIGNSLearning Objective 1.8: Discuss why correlational research designs are valuable, eventhough they cannot be used to make causal inferences.1.Acorrelational research designinvolves studying the world as it is.2.Correlational research does notinvolve any manipulation of variables.3.Weusecorrelational design any time we study the differences betweenindividuals whodo and do nothave a particular disorder.A.Measuring Correlation1.The strength of acorrelationis measured by acorrelation coefficient, which isdenoted by the symbolr.A correlation runs from 0 to 1, with a number closer to 1

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Abnormal Psychology18e, Hooley/Butcher13representing a stronger association between the two variables.The + sign or–sign indicates the direction of the association between the two variables.2.Positive correlationis whenmeasures vary together in a direct, correspondingmanner.For example, higher scores on one variable are associated with higherscores on another variable.3.Withnegative correlation,there is an inverse correlation between the variablesof interest. For example,as scores on one variable go up, scores on the othervariable tend to go down.B.Statistical Significance1The notationp<.05 isan example ofhowthe level ofstatistical significanceisdepicted.This means that the probabilityofthe correlation occurringpurely bychance is less than 5 out of 100.Researchers consider correlations that havep<.05 to be statistically significant and worthy of attention.2.Statistical significance is influenced not only by the magnitude or size of thecorrelation between the two variables but also by the sample size.C.Effect Size1.Theeffect sizereflects the size of association between two variables,independentof the sample size.2.An effect size of zero meansthatthere is no association between the variables.D.Meta-Analysis1.Ameta-analysisisa statistical approach that calculates and then combines theeffect sizes fromnumerousstudies.2.Within a meta-analysis, eachseparate study can be thought of as being equivalentto an individual participant in a conventional research design.E.Correlations and Causality1.Correlation does not mean causation.2.A might cause B,or B might cause A; orA and B might both be caused by C.Aand B are involved in a complex web of relationships with other variables.3.Thethird variable problemiswhen some unknown,third variable might becausing both events to happen

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Abnormal Psychology18e, Hooley/Butcher14F.RetrospectiveVersus Prospective Strategies1.Aretrospectiveresearchstrategyinvolves looking back in time. Inother words,we would try to collect information about how the patients behavedearlierin theirlives,with the goal of identifying factors that might beassociated with what wentwrong later.2.Aprospectiveresearchstrategyinvolves looking ahead in time. Theidea is toidentify individuals who have a higher-than-average likelihood of becomingpsychologically disordered,and to focus research attention on them before adisorder manifests.3.A study with alongitudinaldesignfollows people over time and tries to identifyfactors that predate the onset of a disorderIX.THE EXPERIMENTAL METHOD IN ABNORMAL PSYCHOLOGYLearning Objective 1.9: Explain the key features of an experimental design.1.Correlational research does not allow us to draw any conclusions aboutdirectionality This is known as thedirection of effect problem.To drawconclusions about causality and resolve questions of directionality, anexperimental researchapproach must be used.In such studies, scientists controlall factors except one—the factor that could have an effect on a variable oroutcome of interest.2.Thefactor that is manipulated is referred to as theindependent variable.3.If the outcome of interest—thedependent variable—is observed to change as themanipulated factor changes, then that independent variable can be regarded as acause of the outcome.A.Studying the Efficacy of Therapy1.In treatment research, it is important that the treated and untreatedgroupsbe asequivalent as possible,except for the presence or absence of the proposed activetreatment.2.Patients are typically randomly assigned.Random assignmentmeans thateveryresearch participant has an equal chance of being placed in the treatment or theno-treatment condition.3.The ethics of withholding effective treatment may lead to an alternative researchdesign in whichtwo or more treatments are compared in differing yet comparablegroups.This is called astandard treatment comparison study.

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Abnormal Psychology18e, Hooley/Butcher154.In adouble-blindstudy,neither the subjects nor the experimenter working withthemknowswhoisreceivingthe genuine treatment.5.Placebo treatmentconditions enable experimenters to control for the possibilitythat simply believing one is getting an effective type of treatmentmayproducebenefits.B.Single-Case Experimental Designs1.Insingle-caseresearch designs,the same individual is studied over a period oftime.Behavior or performance at one point in time can then be compared tobehavior orperformance at a later time, after a specific intervention or treatmenthas been introduced.2.One of the most basic experimental designs in single-case research is theABABdesign.The letters refer to different phases of the intervention:The first A is thebaseline condition; the first B is the introduction of the treatment.C.Animal Research1.Using animal subjects, we are able to perform studies that would not be possibleto implement with humans.Nonetheless, ethical considerations still apply.2.One major assumption is that findings from animal studies can be generalized tohumans.Experiments of this kind are generally known asanalogue studies,wherewe study not the true item of interest but an approximation to it.3.Analogue studies may also involve humans (e.g., when we try to study depressionby studying healthy research participants whom we have made mildly andtransiently sad).4.Findings from animal researchhaveprovided impetus forthelearned helplessnessmodel ofdepression.

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Abnormal Psychology18e, Hooley/Butcher16Key TermsABAB designabnormal psychologyacuteanalogue studiesbiascase studychroniccomorbiditycomparison or control groupcorrelationcorrelation coefficientcorrelational researchcriterion groupdependent variabledirectobservationdouble-blind studyeffect sizeepidemiologyetiologyexperimental researchexternal validityfamily aggregationgeneralizabilityhypothesisincidenceindependent variableinternal validitylabelinglifetime prevalencelongitudinal designmeta-analysisnegative correlationnomenclature1-year prevalenceplacebo treatmentpoint prevalencepositive correlationprevalenceprospective researchrandom assignmentretrospective researchsamplingself-report datasingle-case research designstatistical significancestereotypingstigmathird variable problemLecture Suggestionsand ActivitiesLearning Objective 1.1:Explain how we define abnormality and classify mental disorders.LECTURE SUGGESTIONSWhyAreYouTakingThisCourse?Students taking abnormal psychology often have a variety of reasons for doing so. These rangefrom satisfying a degree requirement to a desire for enhanced personal insight. The expectations ofthe students regarding the course, and what they may or may not get out of it, are interesting issuesto explore at the very outset. Students should be encouraged to volunteer their reasons for enrollingin the course. Common answers that usually arise include: to learn more about my own behavior,to understand others, and to learn about the different mental health professions. Hearing otherpeoples’ answers to this question can also help students expand their ambitions in the coursebeyond the ones they originally held. This discussion can also provide a good opportunity topresent the rationale behind studying abnormal psychology and how the scientific tradition assists

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Abnormal Psychology18e, Hooley/Butcher17in increasing our understanding of behavior and its determinants. After this discussion, studentsshould have a clear understanding of the demands and expectations of this course and how theirexpectations fit into the course design. Students can also write one reason anonymously on a pieceof paper and designate a couple of students or the professor to read them aloud.TheVariousWaysAbnormalityIsDefinedBegin the in-class discussionwiththe various ways in which abnormal behavior is defined andclassified so that researchers and mental health professionals can communicate with each otherabout the people they see. Again, as a reminder, the textbook defines abnormal behavior asencompassing subjective distress, maladaptiveness, statistical deviancy, violation of thestandards of society, social discomfort, irrationality and unpredictability, and dangerousness.Evolutionary PsychologyIf you have a background that includes evolutionary psychology, you may want to discussadaptive value and ask students to generate possible reasons why we would see maladaptivebehaviors not die out. Because one of the main tenets of evolutionary psychology is thatbehaviors that persist must in some way be or have been adaptive, how does this explain thedisorders we see today? One example can be built on the example above on the “adaptive value”of schizophrenia. Ask students if someone lived in a remote tribe in South America or Africa andthey reported talking to God, how would their village receive them? Could there be othersituations with other disorders where some of these behaviors are actually adaptive in some way?EvolvingConceptualizations of HomosexualityPrior to the publication ofDSM-IIIin 1980, homosexuality was considered a mental illness. InDSM-IIIit was considered a disorder only if the homosexual person was emotionally troubled byit—that is, only if it wasego-dystonic. InDSM-IIIR(1987) it moved into a general category ofsexual disorders “not otherwise specified,” where it was recast as “persistent and marked distressabout one’s sexual orientation,” for ego-dystonicheterosexuality as well as homosexuality.These transitions were not driven by scientific research but by evolving societal norms andpolitical pressure. Evolving conceptualizations of homosexuality provide interesting material fordiscussing diagnosis, science, and politics. It is also sometimes quite interesting to discuss thekinds of research that could be conducted to establish the diagnostic status of behaviors,including homosexuality. Are there data that would certify behaviors as abnormal, or are societalvalues absolutely necessary?ACTIVITYDefining AbnormalityTo initiate a class discussion of abnormality, ask students the following question: “How wouldyou define abnormal behavior?” A number of different answers will be generated, and theseshould be recorded on theblackboard. The instructor should challenge each of the answers inorder to illustrate the concepts expressed in the text. The responses generated by the students canthen be categorized into the different areas identified in Chapter 1—for example, the view thatabnormality is always dangerous or that mental disorder is something to be scorned. Through thecourse of the discussion, students should come to appreciate the problem in defining abnormalbehavior and gain an insight into factors affecting the labeling of abnormality.

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Abnormal Psychology18e, Hooley/Butcher18Learning Objective 1.2: Describe the advantages and disadvantages of classification.LECTURE SUGGESTIONInviteaStudentwith aDisabilityYou may want to consider asking students with disabilities to come in andparticipate in a shortdiscussion on what it is like for many of the students on your campus with disabilities. Thediscussion of labeling and stereotyping lends itself well to more general discussions on labelingof all forms. Many students in abnormal psychology classes, more so than other classes, oftenself-disclose diagnoses and other forms of personal information. This discussion may makestudents more sensitive to others in the class who have been “labeled” and how that in and ofitself has affected them.ACTIVITIESHospitalizationUsing a PowerPoint slideora whiteboard, write the following question and answer choices:“Your city is planning to create a half-way house for adult men who have been hospitalized forparanoid schizophrenia. Where would be the best place to put this home? A. Next door to yourhome; B. In your neighborhood; C. Anywhere in town would be fine; D. In the next town.”Asking students to answer privately on their own paper prior to beginning any discussion of thistopic is typically necessary.Stereotypes in the MediaStereotypes and stigma often originate in media portrayals of both the mentally ill and theprofessionals who treat and study them. Television and the movies consistently usepsychological labels to describe unpleasant and dangerous characters. The written medialikewise often use lurid descriptions of crimes, including psychological diagnoses and terms.Most students in the class will be able to cite examples of such portrayals from their ownexperience. An excellent way to combat erroneous beliefs about abnormal psychology is to rebutthese salient portrayals. Asking students to bring examples to class can readily accomplish this.Each student can be required to bring at least one newspaper or magazine article, video clip, oreven Web site portraying some aspect of abnormal psychology. The class can be asked tocomment on these materials before the instructor points out what is generally representative andaccurate, given the scientific literature on the topic, versus what is not representative or eveninaccurate. For instance, a student might bring a clip fromA Beautiful Mind, which providesvivid images of visual hallucinations, even though these are much less common in schizophreniathan auditory hallucinations. This film also provides a good opportunity to discuss medicationsand the prospects for overcoming schizophrenia through mere effort of will. Large classes can bebroken into groups that can compile materials and present their observations and questions to therest of the class.

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Abnormal Psychology18e, Hooley/Butcher19Learning Objective 1.3:Explain how cultureaffectswhat is considered abnormal, anddescribe two different culture-specific disorders.LECTURE SUGGESTIONSWhat’s Your Frame of Reference?The concept of social labeling provides an excellent topic for alecture/discussion session. Anynumber of cultural groups can be used as examples to provide contrasts in how societies labelpathology. Students can be asked to generate their own examples of social labeling, usingexperiences with subcultural groups. The behaviors found among different age groups are oftenlabeled as abnormal by the dominant age group in our society. For instance, street slang may beevaluated as maladaptive by the school system, yet it provides rich communication in its ownsubcultural context. The behavior of adolescents may be labeled as pathological by adults whosee the behavior as maladaptive (e.g., body piercing or tattooing). Students should find thediscussion of social labeling an interesting one, because they can contribute experiences fromtheir own subcultural group. In-class lecture can illustrate that, although social labeling can be apowerful process, some behaviors (such as depression) are generally assumed to be maladaptivein all subcultures and societies. Students can be asked to identify other behaviors whosemaladaptiveness transcends cultural boundaries. An easy way to begin a discussion of this typemight be to ask students the number of piercings that they have. Tally the number of studentswho report 0, 1, 2, 3, 4, 5 or more piercings, and talk about how the acceptance of piercing haschanged in the past few years in our culture.Cultural RelativityStudents sometimes view stigma, cultural relativity, and social causation as rather weakcompared tobiological factors and cultural universals. The force of cultural and socialphenomena can be established experientially by assigning students to violate an innocuous normin a way that would be inconsequential elsewhere. Caution them to avoid illegal activities orones that infringe on the rights of others. For instance, if social and interpersonal forces areinnocuous, it should be inconsequential to wear a football helmet all day or to carry around ahouseplant adorned with Christmas ornaments.ACTIVITYResearchingCulture-Bound SyndromesHave students work in groups to conduct online research on a culture-bound syndrome found inadifferent country or regionof the world. For each syndrome,studentscan present the syndromeand why it might be present in that region but notconsideredabnormal in the United States.

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Abnormal Psychology18e, Hooley/Butcher20Learning Objective 1.4: Distinguish between incidence and prevalence, and identify themost common and prevalent mental disorders.LECTURE SUGGESTIONRates of IncidenceHere youmay want to again discuss the issue of rates of incidence with students. Do they feelthese numbers include everyone? What about gender differences? Do they think one gender maybe diagnosed more? Why or why not? Perhaps one sex is more likely to seek help? What aboutdisorders like substance abuse? Will everyone be represented in the data?ACTIVITIESExploring PrevalenceRates OnlineHave students guess what the most prevalent psychological disordersare. Then havethemconductonline research onprevalence numbers. Have them compare and contrast 1-yearprevalence and point prevalence. They could also contrast the prevalence numbers by region andethnicity. Finally, have students discuss why the statistics vary by source.Handout: WhatIsAbnormal?Foreach of the behaviorslisted, indicate whether you think it would be considereddistressful,maladaptive,deviant, a violation of the standards of society, socially uncomfortable, irrational,and/or dangerous. You may select none or more than one for each.DistressfulMaladaptiveDeviantViolation ofSocietyStandardsSociallyUncomfortableIrrationalDangerousA man talking tohimselfas hewalksdown the streetA strongpreferencefor yellow socksOwning 25 catsWashing hands over50 times a dayA man tellingyouthat God has askedhim to help youHavingto sit in thesame seat in everyclass you takeBelievingthat allyour neighbors areplotting against youNot eating solidfoods for one weekBecoming extremelytense and jitterybefore an examCreated by:David Lee, Universityof California, Irvine. No third-party material included.

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Abnormal Psychology18e, Hooley/Butcher21Learning Objective 1.5: Discuss why abnormal psychology research can be conducted inalmostanysetting.LECTURE SUGGESTIONSOn Being Sane in Insane PlacesRosenhan (1973) published a classic abnormal psychology study in the extremely high-profilejournalScience(vol.179, pp. 250–258). This study raises many interesting questions aboutresearch methods, definitions of abnormality, and the ability of mental health professionals todistinguish actual from feigned mental illness. In this study, eight healthy volunteers, several ofthem psychologists and psychiatrists, went to mental hospitals and complained of hearing voicessaying “empty,” “hollow,” or “thud.” These pseudo-patients acted normally in every way exceptfor the reported auditory hallucinations. As soon as they were admitted, they stoppedcomplaining of these symptoms. Although many of the real hospitalized patients suspected thepseudo-patients were faking, none of the hospital staff apparently did. All pseudo-patients werelabeled schizophrenic and their stays ranged from 7 to 52 days, with an average stay of 19 days.Originally, this was taken as evidence of how important labels and expectations affectinterpretations of people’s behavior. However, it is worth envisioning a control group of pseudo-patients who report equally severe physical symptoms to physicians. Indeed, people with somekinds of somatoform disorder (Chapter 8) succeed in getting fairly dramatic treatments,including surgery, in the absence of genuine organic pathology. It is also worth noting that manypseudo-patients were diagnosed with atypical subtypes of schizophrenia, suggesting that thehospital staff recognized that there was something quite different about these patients. TheRosenhan study also raises questions about securing informed consent from researchparticipants, draining precious treatment resources, and how long it is reasonable to observe anapparently recovered psychotic person to ensure that relapse is not imminent. These, and otherdesign, ethical, and statistical matters, many of which were published in a subsequent issue ofScience(1973, vol. 180, pp. 1116–1122), qualify the interpretation of this classic reportsubstantially.Sampling Issues in Abnormal PsychologyDiscuss with students where the data in this area comes from. Is it from Intro to Psych studentslike data in Social? Is it from schools and education data clearinghouses like Developmental?Here you are generally looking at what sample? Who’s included? Who’s excluded? By gettingstudents to think about where the data comes from and if it excludes many people, studentsshould be able to think about how good is the data in this area and if there are ways to get betterdata.Ethics in Scientific ResearchThis is a great time to discuss the ethical treatment of subjects, both human and animal. Point outto students that drug studies, for example, involve both humans and animals.Regardless of thelong-term pay off, the cost to a subject can be high; where should the line be drawn?

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Abnormal Psychology18e, Hooley/Butcher22ACTIVITYCreating a SurveyHave students create a 15-item survey/questionnaire to assess depression or anxiety symptoms inadolescents.Thenhave students discuss which questions can provide insightas towhether asymptom is chronicor acute.Also ask students to include questions that mightprovideinformation aboutthe etiology of the disorder. Finally, discuss anyquestions that might causeethical concerns.Learning Objective 1.6: Describe three different approaches used to gather informationabout mental disorders.LECTURE SUGGESTIONIssues with Case StudiesThis is a good time to point out the problems with case studies. Forexample, Alex the Africanparrot.Despite many attempts, researchers have never replicated these results. Keep in mind,although case studies can be dead on (e.g., early descriptions of schizophrenia, the role of theamygdale in Phineas Gage’s uncontrolled emotions, Piaget’s observations of his children), theycan also be very wrong (e.g., Alex the African parrot, some of Freud’s assumptions based on hiscase studies). Also, remind students that although there are significant limitations to case studies,many times it is the only way, for example, when only a handful of people have a condition, or incases of brain damage.ACTIVITYPros and Cons of Research ApproachesAfter discussing the three approaches to gathering information—case study,self-report, andobservation—have students discuss the pros and cons of eachone. Then have students conductresearch to find studies illustratingeach type of approach.Either individually or in groups,students can conduct online research to browse recent issues ofJournal of Abnormal Psychology,Journal of Consulting and Clinical Psychology, Archives of General Psychiatry,andAmericanJournal of Psychiatryto find at least one article of interest.Learning Objective 1.7: Explain why a control (orcomparison group) is necessary toadequately test a hypothesis.LECTURE SUGGESTIONThe Importance of a Control GroupDiscuss the many different types of control in the experimental method. Discuss the advantagesand disadvantagesof a placebo-group(active)controlversusa passive control groupstudy.Also

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Abnormal Psychology18e, Hooley/Butcher23discuss the advantagesand disadvantagesof repeated designs,such as ABAB,versuscomparingtwo independent groups. Factors to discuss might include time, attrition, cost, and control ofconfounding variables.ACTIVITYDifferent Methods of ControlHave students designa study examining theeffectiveness of a psychotherapy treatment methodfor anxiety. How many groups should they compare? Will they use an active or a passive controlgroup? Thenhavethemdesign a study examining the effectiveness of a medical treatment foranxiety. How many groups should they compare? Will they use an active or a passive controlgroup?Is there a difference in the waytheywould design control groupsfor medication studiescompared to psychotherapy studies?Learning Objective 1.8: Discuss whycorrelationalresearchdesigns are valuable, eventhough they cannot be used to make causal inferences.LECTURE SUGGESTIONCorrelationIsNotCausationStudents often assume that a correlation can be interpreted as a causal relationship. Provideexamples of alternativeexplanations forstrong correlations. For example, you can discuss thestrong positivecorrelationbetweenicecreamsales anddrowningdeathsto discuss the thirdvariable bias.Or you can discuss the directionproblem inthe relationship between self-esteemand achievement.ACTIVITYJournal BrowsingStudents can gain a greater appreciation for scientific approaches to the study of abnormalpsychology by perusing current issues of some of the more rigorous journals in the field. Eitherindividually or in groups, studentscan conduct online researchto browse recent issues ofJournal of Abnormal Psychology, Journal of Consulting and Clinical Psychology, Archives ofGeneral Psychiatry,andAmerican Journal of Psychiatryto find at least one article of interest.They can then be asked to present this article to the class, summarizing its purpose and mainfindings. It can also be instructive to ask that students make some general classifications of theresearch design. Is the selected study correlational or experimental? Retrospective orprospective? What diagnosis is under consideration? Does the article address etiology,descriptive psychopathology, or treatment? Is there a control group? A historical perspective canbe encouraged by randomly assigning students to study articles from various decades

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Abnormal Psychology18e, Hooley/Butcher24Learning Objective 1.9: Explain thekeyfeatures ofan experimentaldesign.LECTURE SUGGESTIONThe Experimental DesignManipulation and control are key features of the experimental design. Using a concrete example,such as a clinical drug trial studyfor depression, discuss and identify the independent anddependent variables in the study. Have students help with the manipulation process by formingthe comparison groups for the independent variable. Discuss the importance of placebo groupsand of having an active, rather than passive, control group. Finally, emphasize the significance ofrandom assignment in eliminating confounding variables.ACTIVITYSingle-Case Experimental DesignJames Carr and John Austin (1997) developed a demonstration of single-case experimentaldesign that can easily be used in a classroom setting. Students are instructed on how to take theirown pulse rate and record these data for five, 1-minute intervals. This constitutes baseline. Thetreatment phase then begins by asking students to stand up and do jumping jacks for 20 seconds.The students then sit and take their pulse rate again for one minute. Students repeat the treatmentphase four additional times. Following the collection of the five pulse rates during “treatment,”the students once again sit and record five resting pulse rates in 1-minute intervals. Studentscould repeat the treatment phase if the instructor wishes to demonstrate an ABAB design. Oncethe data is collected, each student could draw a graph of his or her results and attempt to drawsome conclusions regarding how “treatment” impacted heart rate.Revel VideosWhat Does It Mean to Have a Mental Disorder?Case StudiesSelf-Report DataCorrelational and Experimental Research Designs

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Abnormal Psychology18e, Hooley/Butcher1Chapter 2: Earliest Views ofAbnormal BehaviorLearning Objectives2.1 Explain the first views of mental disorders.2.2 Describe the effect that scientific thinking had on views of abnormal psychology and the riseof earlyasylums.2.3 Describe the historical development of humanitarian reform.2.4 Describe the changes in social attitudes that led to changes in how we think about and treatmental disorders.2.5 Identify developments that led to the contemporary view ofabnormal psychology.Chapter Overview/SummaryUnderstanding of abnormal behavior has not evolved smoothly or uniformly over the centuries.Thesteps have been uneven, with great gaps in between, and unusual—even bizarre—views orbeliefs have oftensidetracked researchers and theorists.The dominant social, economic, andreligious views of the times have had a profound influence over how people have viewedabnormal behavior.In the ancient world, superstitious explanations for mental disorders were followed by theemergence of medical concepts in many places,such as Egypt and Greece; many of theseconcepts were developed and refined by Roman physicians. After the fall of Rome,near the endof the fifth century, superstitious views dominated popular thinking about mental disorders forover 1,000 years. In the fifteenth and sixteenth centuries, it was still widely believed, even byscholars, that some of the people experiencing mental disturbances were possessed by a devil.Great strides have been made in our understanding of abnormal behavior. For example,during the latter part of the Middle Ages and the early Renaissance, a spirit of scientificquestioning reappeared in Europe, and several noted physicians spoke out against inhumanetreatments. There was a general movement away from superstitions and “magic” towardreasoned, scientific studies.With recognition of a need for the special treatment of people with mental illness came thefounding of various “asylums” toward the end of the sixteenth century. However,institutionalization led to the isolation and maltreatment of patients. Slowly,this situation wasrecognized, and in the eighteenth century further efforts were made to help afflicted individuals

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Abnormal Psychology18e, Hooley/Butcher2by providing them with better living conditions and humane treatment, although theseimprovements were the exception rather than the rule.The nineteenth and early twentieth centuries witnessed a number of scientific andhumanitarian advances. The work of Philippe Pinel in France, William Tuke in England, andBenjamin Rush and Dorothea Dix in the United States prepared the way for several importantdevelopments in contemporary abnormal psychology.Among these were the gradual acceptanceof patients with mental illness as afflicted individuals who need and deserve professionalattention; the successful application of biomedical methods to disorders; and the growth ofscientific research into the biological, psychological, and sociocultural roots of abnormalbehavior.The reform of mental hospitals continued into the twentieth century, but duringitslast fourdecades, there was a strong movement to close mental hospitals and release people into thecommunity. Thisdeinstitutionalizationmovement remains controversial intothe early part of thetwenty-first century.In the nineteenth century, great technological discoveries and scientific advancements thatwere made in the biological sciences enhanced the understanding and treatment of individualswith mental illness. One major biomedical breakthrough came with the discovery of the organicfactors underlying general paresis—syphilis of the brain—one of the most serious mentalillnesses of the day.Beginning in the early part of the eighteenth century, knowledge of anatomy, physiology,neurology, chemistry, and general medicine increased rapidly. These advances led to theidentification of the biological, or organic, pathology underlying many physical ailments.The development of a psychiatric classification system by Kraepelin played a dominant rolein the early development of the biological viewpoint. Kraepelin’s work (a forerunner to theDSMsystem) helped to establish the importance of brain pathology in mental disorders and madeseveral related contributions that helped establish this viewpoint.The first major steps toward understanding psychological factors in mental disordersoccurred with mesmerism, followed by the work of Sigmund Freud. During five decades ofobservation, treatment, and writing, he developed a theory of psychopathology known aspsychoanalysis,whichemphasized the inner dynamics of unconscious motives. During the pasthalfcentury, other clinicians have modified and revised Freud’s theory, which has thus evolvedinto new psychodynamic perspectives.Scientific investigation into psychological factors and human behavior began to makeprogress in the latter part of the nineteenth century. The end of the nineteenth century and earlytwentieth century saw experimental psychology evolve into clinical psychology with thedevelopment of clinics to study, as well as intervene in, abnormal behavior.Understanding the history of psychopathology—its forward steps and missteps alike—helpsus understand the emergence of modern concepts of abnormal behavior.

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Abnormal Psychology18e, Hooley/Butcher3Detailed Chapter OutlineI.THE FIRST VIEWS OF MENTAL DISORDERSLearning Objective2.1: Explain the firstviews ofmentaldisorders.A.Demonology, Gods, and Magic1.Abnormal behaviorwasattributed topossession by a demon or a god. Whetherthe “possession” was assumed toinvolve good or evil spirits typically dependedon the individual’s symptoms (if they appeared to have a religious or mysticalsignificance, it was usually thought that good spirits or a god were involved).Most possessions, however, were considered the work of an angry god or an evilspirit.2.The primary treatment for demonic possession wasexorcism,which includedtechniques for casting evil spirits out. These techniques includedmagic, prayer,incantation, noisemaking, andtheuse of horrible-tasting concoctions.B.Hippocrates’ Early Medical Concepts1.Around 400B.C.,there wasa shiftinfocus away from the supernatural toproblems in the human body.2.Hippocrates insistedthatmental disordersweredue to natural causes. Hebelievedthat thebrain was the central organ of intellectual activity and that mentaldisorders were due to brain pathology. Healso emphasized the importance ofheredity and predisposition, andpointed out that injuries to the head could causesensory and motordisorders.3.Hippocratesclassified all mental disorders into three general categories,based ondetailed clinical observations:mania, melancholia, and phrenitis (brain fever).4.The best known of the earlier paradigms for explaining personality ortemperament is the doctrine of the four humors, associated with Hippocrates andlater with the Roman physician Galen.a.Thefour essential fluidsof the body were blood (sanguis), phlegm, bile(choler), and black bile (melancholer), .b.Aperson’s temperament was determined by which of the humors wasdominant.5.Hippocrates considered dreams to be important in understanding a patient’spersonality.

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Abnormal Psychology18e, Hooley/Butcher46.Herecommended varioustreatments,includinga regular and tranquil life,sobriety and abstinence from all excesses, a vegetable diet, celibacy, exerciseshort of fatigue, and bleeding if indicated.He also emphasized the importance ofenvironment and promoted the removal of patients from their families ifnecessary.7.Hippocrates believedthathysteria was restricted to women and caused by awandering uterus and pining for a child, and he believed thatthe cure wasmarriage.C.Early PhilosophicalConceptualizations of Abnormal Behavior1.Plato (429–347 B.C.)was aGreekphilosopher who studied individuals withmental disturbances who had committed criminal acts and how to deal with them.Henoted that such persons were, in some “obvious” sense, not responsible fortheir acts and should not receive punishment in the same way as normal persons.a.Plato emphasized inThe Republicthe importance of individual differences inintellectual and other abilities and took into account sociocultural influencesin shaping thinking and behavior.b.He recommended “hospital” care for those who developed beliefs counter tothe broader social order.c.Despitethese modern ideas,Platobelieved that mental disorders were in partdivinely caused.2.Aristotle (384–322 B.C.)was apupil of Plato. His most lasting contributions topsychology are his descriptions of consciousness.a.Aristotle held the view that“thinking” as directed would eliminate pain andhelp attain pleasure.b.He generally subscribed totheHippocratic theory of disturbances in the bile.3.Galen (A.D. 130–200)was aGreek physicianwho took a scientific approach tomental health and divided the causes into physical and mental categories.D.Early Chinese Conceptualizations of Abnormal Behavior1.Chinese medicine was based ona belief in natural rather than supernatural causesof illnesses.2.Around A.D. 200, Chung Ching, called the Hippocrates of China, wrote twomedical works that implicated organ pathologies as primary causes of mentaldisorders.

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Abnormal Psychology18e, Hooley/Butcher53.From the latter part of the second century through the early part of the ninthcentury, Chinese views regressed to a beliefin supernatural forces such as ghostsand devils as causal agents of mental disorders.4.During the past 50 years, China has beenexperiencinga broadeningof ideas inmentalhealth services and incorporating many ideas from Western psychiatry.E.Viewsof Abnormality During the Middle Ages1.During the Middle Ages (about 500 to 1500), the more scientific aspects of Greekmedicine survived in the Islamic countries of the Middle East.a.The first mental hospital was established in Baghdad in 792, where theyprovidedhumane treatment.b.Referred to as the “prince of physicians,” Avicenna from Persia(c. 980–1037)authoredThe Canon of Medicine.2.The Middle Ages inEurope were largely devoid of scientific thinking andhumanetreatment for those with mental illnesses.a.Management of those who were mentally disturbed was left largely to theclergy.b.Some monasteries practiced combining exorcisms with vaguely understoodmedical treatments.3.Some recent interpretationshavequestionedthe long-held notionthatduring theMiddle Ages, many people with mental disturbances were accused of beingwitches and killed.The confusion between witchcraft and mentalillness may bedue,in part,to misunderstandings about demonic possession.II.VIEWS OF ABNORMAL BEHAVIOR IN THE 1500SAND 1600SLearning Objective 2.2: Describe the effect that scientific thinking had on views ofabnormal psychology and the rise of early asylums.1.During the latter part of the Middle Ages and the early Renaissance, scientificquestioning reemerged,and a movement emphasizinghuman interests andconcerns, referred to ashumanism,began.2.The superstitious belief that had hindered the understanding of therapeutictreatment began to be challenged.

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