Abnormal Psychology The Science and Treatment of Psychological Disorders, 15th Edition, Ann M Kring, by TBtutors

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Solution Manual

Resource:

Abnormal Psychology The Science and Treatment of Psychological Disorders

Edition:

15th Edition

Author(s):

Ann M. Kring Sheri L. Johnson

Kring/Johnson, Abnormal Psychology 15th Edition

CHAPTER 1 INTRODUCTION AND HISTORICAL OVERVIEW

LEARNING GOALS 1. Explain the meaning of stigma as it applies to people with psychological disorders. 2. Understand the characteristics that define psychological disorder. 3. Understand how the causes and treatments of psychological disorders have changed over the course of history. 4. Describe the historical forces that have helped to shape our current view of psychological disorders, including biological and psychological views. 5. Understand what we have (and have not) learned from history. 6. Describe the different mental health professions, including the training involved and the expertise developed. The Learning Goals are inherent in both the Lecture Launchers and Discussion Stimulators below. Please note the Discussion Questions at the end of this chapter.

INTRODUCTION TO THE DSM-5 This Instructor’s Manual provides instructors with a comprehensive overview of material contained in the text. Each chapter of the Instructor’s Manual contains a chapter synopsis, a review of the learning goals and key terms, a series of Lecture Launchers, a compilation of Discussion Stimulators, and a list of relevant instructional films. Additionally, the manual contains criteria for disorders contained in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

CHAPTER SYNOPSIS

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The study of psychopathology is a search for the reasons why people behave, think, and feel in unexpected, sometimes odd, and possibly self-defeating ways. The focus of this book will be on the description, causes, and treatments of a number of different mental disorders. It is important to note at the outset that the personal impact of our subject matter requires us to make a conscious, determined effort to remain objective. Stigma remains a central problem in the field of psychopathology. Stigma has four components that involve the labels for mental illness and their uses (see Figure 1.1). 1. 2. 3. 4.

Distinguishing label is applied. Label refers to undesirable attributes. People with the label are seen as different. People with the label are discriminated against.

Even the use of everyday language terms such as crazy or schizo can contribute to the stigmatization of the mentally ill. Despite advances, many frontiers of discrimination persist.

Defining Mental Disorder A number of different definitions of mental disorder have been offered, but none can entirely account for the full range of disorders. The DSM-5 definition includes a variety of important characteristics (see Figure 1.2). 1. Personal Distress: Whether or not a behavior causes personal distress can be a characteristic of mental disorder. But not all behavior that we consider to be part of mental disorders causes distress. 2. Disability and Dysfunction: Behaviors that cause a disability or impair a person’s functioning at work, home, school, and/or in social situations can be considered part of mental disorder. However, disability and dysfunction alone cannot account for mental disorders. 3. Violation of Social Norms: Behavior that violates social norms can also be considered part of a mental disorder. However, not all such behavior is considered part of a mental disorder, and some behaviors that are part of mental disorders do not necessarily violate social norms. Taken together, each definition of mental disorder has something helpful to offer in the study of psychopathology. The DSM-5 definitions include all of these characteristics.

Early History of Psychopathology Since the beginning of scientific inquiry into mental illness, supernatural, biological, and psychological points of view have vied for attention. Early concepts of mental illness included demonology (possession by demons) but also biological approaches as evidenced by the ideas of Hippocrates, who believed that mental illness was caused by a disturbance of the humors—for example, that melancholy or depression was caused by excessive amounts of sticky thick black bile and that schizophrenia arose from too much cold mucus. During the Dark Ages, some people with mental illness were cared for in monasteries, but many simply roamed the countryside. Some were persecuted as witches, but this was relatively rare. (Later analyses indicated that many of the people accused of being witches were not mentally ill.) Treatments for people with mental illness have changed over time, though not always for the better. Instructors Manual

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Exorcisms did not do much good. Treatments in asylums could also be cruel and unhelpful, but pioneering work by Pinel, Dix, and others made asylums more humane places for treatment, ushering in an era known for moral treatment. Unfortunately, their good ideas did not last, as the mental hospitals became overcrowded and understaffed. For a more intensive history of how views of psychopathology have evolved over time, here is a link to a time link: http://www.zeepedia.com/read.php?psychopathology_in_historical_context_supernatural_model_biologi cal_model_abnormal_psychology&b=83&c=3.

The Evolution of Contemporary Thought: Biological and Psychological Approaches Early systems of classifying mental disorders led to a reemergence of the biological perspective in the eighteenth and nineteenth centuries. Developments outside the field of psychopathology, such as the germ theory of disease and the discovery of the cause of general paresis via syphilis, illustrated how the brain and behavior were linked. Early investigations into the genetics of mental illness led to a tragic emphasis on eugenics and the enforced sterilization of many thousands of people with mental illness. Such biological approaches to treatment as induced insulin coma, electroconvulsive therapy (ECT), and lobotomy eventually gave way to drug treatments. Psychological approaches to psychopathology evolved from Mesmer’s manipulation of “animal magnetism” to treat hysteria (late 18th century) through Charcot’s interest in psychological aspects of hysteria and Breuer’s conceptualization of the cathartic method in his treatment of Anna O. (late 19th century) and culminated in Freud’s psychodynamic theories and treatment techniques (early 20th century). Freud’s theory posited a three-part psyche made up of the id, ego, and superego. He further emphasized stages of psychosexual development and the importance of unconscious processes, such as repression and defense mechanisms, with the suggestion that people can fixate at an early stage, and that all of this is traceable to early-childhood conflicts. Therapeutic interventions based on psychodynamic theory (psychoanalytic therapy) make use of techniques such as free association and the analysis of transference in attempting to overcome repressions so that patients can confront and understand their conflicts and find healthier ways of dealing with them. Jung and Adler took Freud’s basic ideas in a variety of different directions. Those who developed ego analysis maintained that the ego has energies of its own that are just as important as id energies and that it is important to focus on a person’s current living situation as well as his or her social interactions. Freud’s theorizing, though often criticized, introduced a number of concepts that are still discussed today, including defense mechanisms and the importance of the early environment in the development of psychological problems. Behaviorism began its ascendancy in the 1920s and continues to be an important part of various psychotherapies. John Watson built on the work of Ivan Pavlov in showing how some behaviors can be conditioned, with the conditioned stimulus (CS) coming to elicit the conditioned response, or CR, via its repeated pairing with an unconditioned stimulus (UCS). B. F. Skinner, building on the work of Edward Thorndike, emphasized the contingencies associated with behavior, showing how positive and negative Instructors Manual

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reinforcement could shape behavior. Research on modeling helped to explain how people can learn even when no obvious reinforcers are present. Early behavior therapy techniques included systematic desensitization, aversion therapy, and modeling. Behaviorism did not account for emotions and thoughts and consequently, cognitive approaches became prominent in the 1960s. Cognitive therapy was developed based on the ideas that people not only behave, but they also think and feel. Cognitive therapies focus on changing maladaptive thoughts so that they will act differently and feel better. Here is a definition from the National Association of Cognitive-Behavioral Therapists: http://www.nacbt.org/whatiscbt-htm/.

The Mental Health Professions There are a number of different mental health professions, including clinical and counseling psychologist (Ph.D., Psy.D.), psychiatrist (M.D.), psychiatric nurse (R.N., L.P.N.), social worker (M.S.W.), mental health counselor (L.P.C., L.C.S.W.), and marriage and family therapist (M.F.T., Ph.D.). Each involves different training programs of different lengths and with different emphasis on research, psychological assessment, psychotherapy, and psychopharmacology. Mental Health America lists 13 mental health professions with a brief description of each and the role the play in mental health: http://www.mentalhealthamerica.net/types-mental-health-professionals.

KEY TERMS anal stage

defense mechanism

analytical psychology

demonology

individual psychology

asylums

ego

interpretation

aversive conditioning

ego analysis

latency period

behaviorism

electroconvulsive therapy (ECT)

law of effect

behavior therapy cathartic method classical conditioning clinical psychologist collective unconscious conditioned response (CR) conditioned stimulus (CS) counseling psychologist

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exorcism extinction fixation free association general paresis genital stage harmful dysfunction

libido marriage and family therapist mental disorder modeling moral treatment negative reinforcement operant conditioning oral stage

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phallic stage

psychodynamic theory

superego

pleasure principle

psychopathology

systematic desensitization

positive reinforcement

psychotherapy

transference

psyche

reality principle

psychiatric nurse

repression

unconditioned response (UCR)

psychiatrist

shaping

psychoactive medications

social worker

psychoanalysis

stigma

unconditioned stimulus (UCS) unconscious

LECTURE LAUNCHERS 1. Careers in Mental Health Many students enroll in Abnormal Psychology classes because of an interest in entering the field or a curiosity about abnormal behavior. An interesting class discussion could focus on a more detailed review of the various mental health professions and work settings (e.g., psychology department, academic medical center, hospital, community clinic, forensic settings, etc.). Each profession can be listed on the board and compared on various dimensions, such as years of training required, difficulty of acceptance into training programs, criteria for acceptance (courses, grades, national exams, outside activities), focus of academic training, and career possibilities. Students are also likely to be interested in comparisons such as opinions that each profession holds of each other, inter-professional conflicts, lines of authority and power structure, salaries (the $125+ hourly rate for highly trained professionals amazes most students), and similar “insider” information. Current topics of interest in the mental health field might be discussed, such as: 1. Should clinical psychologists be allowed “admitting privileges” at psychiatric hospitals? 2. Which professionals should be eligible to receive Medicare payments for their services? 3. Should professionals other than psychiatrists be allowed to prescribe psychotropic medications? (see Discussion Stimulator) 4. Should training of clinical psychologists focus on clinical or research training, or both? 5. How are career goals affected by managed care? An article in American Psychologist (Purdy, J. E., Reinehr, R. C., & Swarx, J. D., 1989, 44, 960–961) reported on results of a survey of 106 graduate programs in experimental, clinical, and counseling psychology regarding their admissions criteria. Students might be interested in hearing the conclusions: The ideal graduate school applicant has a high GRE combined score, strong letters of recommendation, some research experience (particularly for Ph.D. programs), and a high overall GPA (with particularly high grades for the final two Instructors Manual

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years). For applicants for a clinical or counseling program, previous clinical experience is desirable. Undergraduate coursework would include statistics, experimental methods, and at least some laboratory experience (e.g., directed study). Since the publication of this article by Purdy, Reinehr and Swarx, later studies have confirmed their conclusions. See for example the article in the American Psychologist (Norcross, J. C., Kohout, J. L., & Wicherski, M. (2005). Graduate Study in Psychology: 1971-2004. American Psychologist, 60(9), 959– 975).

2. HANDOUT: Hypnosis Because of its central role in the development of psychogenic theories of psychopathology, hypnosis is worth considering in more detail. A good place to start is with the question what exactly is hypnosis? Given how often psychologists and psychiatrists use the term, it is sobering to realize how much controversy there is about its nature. Hilgard (1979) suggests the following characteristics: 1. Increased suggestibility. Hypnotized subjects seem much more open to suggestions from the hypnotist than they would be in a waking state. 2. Enhanced imagery and imagination. Hypnotized subjects are able to imagine vividly the sensory experiences suggested to them and also report that they are able to retrieve images, sometimes from childhood, with great clarity. 3. Disinclination to plan. The hypnotized subject loses initiative and instead looks to the hypnotist as a source of direction. Indeed, many hypnotized subjects become annoyed when asked to do some planning on their own. 4. Reduction in reality testing. Many hypnotized subjects readily accept all kinds of perceptual distortions that they would not tolerate when awake. Thus hypnotized subjects may accept suggestions that an animal is talking to them or that someone is present in the room when no one is actually there. The logic that operates during a hypnotic trance, allowing a person to perceive the world in a way remarkably different from how he or she regards it when awake, has been called “trance logic” (Orne, 1959). These are what many mental health workers regard as characteristics of hypnotized subjects. As in all aspects of human behavior, not all people manifest all these characteristics in the same way, and it is indeed possible for subjects who otherwise appear to be deeply hypnotized not to give all these noticeable indications at any one time. An excellent review of the characteristics and therapeutic processes can be found in Varga, K., Józsa, E., & Kekecs, Z. (2014). Comparative analysis of phenomenological patterns of hypnotists and subjects: An interactional perspective. Psychology of Consciousness: Theory, Research, and Practice, 1(3), 308. Our historical review mentions Mesmer’s therapy for hysterical disabilities and subsequent work by Charcot, Janet, and Breuer. During the same period of time, surgeons were “mesmerizing” patients to block pain. For example, in 1842 a British physician, W. S. Ward, amputated the leg of a patient after hypnotizing him. Apparently the patient felt nothing during what would otherwise have been an excruciatingly painful operation. In 1849 a mesmeric infirmary was opened in

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