comerabpsych9e

Chapter Introduction

CHAPTER

Models of Abnormality

TOPIC OVERVIEW

The Biological Model

How Do Biological Theorists Explain Abnormal Behavior?

Biological Treatments

Assessing the Biological Model

The Psychodynamic Model

How Did Freud Explain Normal and Abnormal Functioning?

How Do Other Psychodynamic Explanations Differ from Freud’s?

Psychodynamic Therapies

Assessing the Psychodynamic Model

The Behavioral Model

How Do Behaviorists Explain Abnormal Functioning?

Behavioral Therapies

Assessing the Behavioral Model

The Cognitive Model

How Do Cognitive Theorists Explain Abnormal Functioning?

Cognitive Therapies

Assessing the Cognitive Model

The Humanistic-Existential Model

Rogers’ Humanistic Theory and Therapy

Gestalt Theory and Therapy

Spiritual Views and Interventions

Existential Theories and Therapy

Assessing the Humanistic-Existential Model

The Sociocultural Model: Family-Social and Multicultural Perspectives

How Do Family-Social Theorists Explain Abnormal Functioning?

Family-Social Treatments

How Do Multicultural Theorists Explain Abnormal Functioning?

Multicultural Treatments

Assessing the Sociocultural Model

Putting It Together: Integration of the Models

Philip Berman, a 25-year-old single unemployed former copy editor for a large publishing house … had been hospitalized after a suicide attempt in which he deeply gashed his wrist with a razor blade. He described [to the therapist] how he had sat on the bathroom floor and watched the blood drip into the bathtub for some time before he [contacted] his father at work for help. He and his father went to the hospital emergency room to have the gash stitched, but he convinced himself and the hospital physician that he did not need hospitalization. The next day when his father suggested he needed help, he knocked his dinner to the floor and angrily stormed to his room. When he was calm again, he allowed his father to take him back to the hospital.

The immediate precipitant for his suicide attempt was that he had run into one of his former girlfriends with her new boyfriend. The patient stated that they had a drink together, but all the while he was with them he could not help thinking that “they were dying to run off and jump in bed.” He experienced jealous rage, got up from the table, and walked out of the restaurant. He began to think about how he could “pay her back.”

Mr. Berman had felt frequently depressed for brief periods during the previous several years. He was especially critical of himself for his limited social life and his inability to have managed to have sexual intercourse with a woman even once in his life. As he related this to the therapist, he lifted his eyes from the floor and with a sarcastic smirk said, “I’m a 25-year-old virgin. Go ahead, you can laugh now.” He has had several girlfriends to date, whom he described as very attractive, but who he said had lost interest in him. On further questioning, however, it became apparent that Mr. Berman soon became very critical of them and demanded that they always meet his every need, often to their own detriment. The women then found the relationship very unrewarding and would soon find someone else.

During the past two years Mr. Berman had seen three psychiatrists briefly, one of whom had given him a drug, the name of which he could not remember, but that had precipitated some sort of unusual reaction for which he had to stay in a hospital overnight. … Concerning his hospitalization, the patient said that “It was a dump,” that the staff refused to listen to what he had to say or to respond to his needs, and that they, in fact, treated all the patients “sadistically.” The referring doctor corroborated that Mr. Berman was a difficult patient who demanded that he be treated as special, and yet was hostile to most staff members throughout his stay. After one angry exchange with an aide, he left the hospital without [permission], and subsequently signed out against medical advice.

Mr. Berman is one of two children of a middle-class family. His father is 55 years old and employed in a managerial position for an insurance company. He perceives his father as weak and ineffectual, completely dominated by the patient’s overbearing and cruel mother. He states that he hates his mother with “a passion I can barely control.” He claims that his mother used to call him names like “pervert” … when he was growing up, and that in an argument she once “kicked me in the balls.” Together, he sees his parents as rich, powerful, and selfish, and, in turn, thinks that they see him as lazy, irresponsible, and a behavior problem. When his parents called the therapist to discuss their son’s treatment, they stated that his problem began with the birth of his younger brother, Arnold, when Philip was 10 years old. After Arnold’s birth Philip apparently became [a disagreeable] child who cursed a lot and was difficult to discipline. Philip recalls this period only vaguely. He reports that his mother once was hospitalized for depression, but that now “she doesn’t believe in psychiatry.”

Mr. Berman had graduated from college with average grades. Since graduating he had worked at three different publishing houses, but at none of them for more than one year. He always found some justification for quitting. He usually sat around his house doing very little for two or three months after quitting a job, until his parents prodded him into getting a new one. He described innumerable interactions in his life with teachers, friends, and employers in which he felt offended or unfairly treated … and frequent arguments that left him feeling bitter … and [he] spent most of his time alone, “bored.” He was unable to commit himself to any person, he held no strong convictions, and he felt no allegiance to any group.

The patient appeared as a very thin, bearded … young man with pale skin who maintained little eye contact with the therapist and who had an air of angry bitterness about him. Although he complained of depression, he denied other symptoms of the depressive syndrome. He seemed preoccupied with his rage at his parents, and seemed particularly invested in conveying a despicable image of himself….

Spitzer et al., 1983, pp. 59–61

BETWEEN THE LINES

In Their Words

“Help! I’m being held prisoner by my heredity and environment.”

Dennis Allen

Philip Berman is clearly a troubled person, but how did he come to be that way? How do we explain and correct his many problems? To answer these questions, we must first look at the wide range of complaints we are trying to understand: Philip’s depression and anger, his social failures, his lack of employment, his distrust of those around him, and the problems within his family. Then we must sort through all kinds of potential causes—internal and external, biological and interpersonal, past and present.

Although we may not realize it, we all use theoretical frameworks as we read about Philip. Over the course of our lives, each of us has developed a perspective that helps us make sense of the things other people say and do. In science, the perspectives used to explain events are known as models, or paradigms. Each model spells out the scientist’s basic assumptions, gives order to the field under study, and sets guidelines for its investigation (Kuhn, 1962). It influences what the investigators observe as well as the questions they ask, the information they seek, and how they interpret this information (Prochaska & Norcross, 2013). To understand how a clinician explains or treats a specific set of symptoms, such as Philip’s, we must know his or her preferred model of abnormal functioning.

model A set of assumptions and concepts that help scientists explain and interpret observations. Also called a paradigm.

Until recently, clinical scientists of a given place and time tended to agree on a single model of abnormality—a model greatly influenced by the beliefs of their culture. The demonological model that was used to explain abnormal functioning during the Middle Ages, for example, borrowed heavily from medieval society’s concerns with religion, superstition, and warfare. Medieval practitioners would have seen the devil’s guiding hand in Philip Berman’s efforts to commit suicide and his feelings of depression, rage, jealousy, and hatred. Similarly, their treatments for him—from prayers to whippings—would have sought to drive foreign spirits from his body.

Today several models are used to explain and treat abnormal functioning. This variety has resulted both from shifts in values and beliefs over the past half-century and from improvements in clinical research. At one end of the spectrum is the biological model, which sees physical processes as key to human behavior. In the middle are four models that focus on more psychological and personal aspects of human functioning: The psychodynamic model looks at people’s unconscious internal processes and conflicts, the behavioral model emphasizes behavior and the ways in which it is learned, the cognitive model concentrates on the thinking that underlies behavior, and the humanistic-existential model stresses the role of values and choices. At the far end of the spectrum is the sociocultural model, which looks to social and cultural forces as the keys to human functioning. This model includes the family-social perspective, which focuses on an individual’s family and social interactions, and the multicultural perspective, which emphasizes an individual’s culture and the shared beliefs, values, and history of that culture.

Given their different assumptions and principles, the models are sometimes in conflict. Those who follow one perspective often scoff at the “naïve” interpretations, investigations, and treatment efforts of the others. Yet none of the models is complete in itself. Each focuses mainly on one aspect of human functioning, and none can explain all aspects of abnormality.