1.5 SUMMING UP

The Three Criteria for Determining Psychological Disorders

• A psychological disorder is a pattern of thoughts, feelings, or behaviors that causes significant distress, impaired functioning in daily life, and/or risk of harm.
• The distress involved in a psychological disorder is usually out of proportion to the situation.
• Impairment in daily life may affect functioning at school, at work, at home, or in relationships. Moreover, people with a disorder are impaired to a greater degree than most people in a similar situation. A psychosis is a relatively identifiable type of impairment that includes hallucinations or delusions.
• A psychological disorder may lead to behaviors that create a significant risk of harm to the person or to others.
• Mental health clinicians and researchers recognize that context and culture in part determine whether a person’s state involves significant distress, impairment, or risk of harm.

Views of Psychological Disorders Before Science

• The oldest-known view of psychopathology is that it arose from supernatural forces, either magical or spiritual. Ancient and modern Chinese views of psychopathology consider its cause to be blocked or significantly imbalanced qi. The ancient Greeks attributed mental illness to an imbalance of bodily humors. The term medical model refers to Hippocrates’ view that illness (including psychological disorders) results from a biological disturbance.
• The Middle Ages saw a resurgence of the view that supernatural forces cause psychopathology: Mental illness was viewed as the result of demonic possession; witch hunts were frequent. By the end of the Renaissance, however, the mentally ill began to be treated more humanely.
• In the years immediately following the Renaissance, mental illnesses were thought to arise from irrational thinking, but this approach did not lead to consistent treatment.
• In the 1790s, Pinel championed humane treatment for those in asylums in France. In other European settings, patients were given moral treatment.
• In the United States, Benjamin Rush initiated the effort to treat the mentally ill more humanely; similarly, Dorothea Dix strove to ensure that the mentally ill were housed separately from criminals and treated humanely.

The Transition to Scientific Accounts of Psychological Disorders

• Freud played a major role in making the study of psychological disorders a science, largely by developing new methods for diagnosis and treatment; he also proposed an extensive theory of psychopathology. Freud’s methods included hypnosis and free association.
• According to Freud’s psychoanalytic theory, thoughts, feelings, and behaviors result from conscious and unconscious forces—such as sexual and aggressive urges. Moreover, he proposed that the mind is structured to function across three levels of consciousness: the conscious, the preconscious, and the unconscious.
• Freud proposed three psychic structures in the mind—id, ego, and superego—which are continually interacting and negotiating.
• According to Freud, each person passes through five psychosexual stages from infancy to adulthood, of which four involve particular erogenous zones. For healthy psychological development, each stage requires the successful completion of a key task.
• Various forms of psychodynamic therapy have been proposed, each drawing primarily on a different aspect of psychodynamic theory. A drawback of psychodynamic theory is that it has proven difficult to test scientifically.
• Humanistic psychologists such as Carl Rogers viewed psychodynamic theory as too mechanistic and opposed to free will. Rogers proposed that symptoms of distress and mental illness arise when a potential route to personal growth is blocked, as can occur when there is incongruence between the ideal and real selves. Rogers developed client-centered therapy to decrease incongruence in clients.

Scientific Accounts of Psychological Disorders

• Psychologists Edward Thorndike, John Watson, Clark Hull, and B. F. Skinner spearheaded behaviorism, focusing on directly observable behaviors rather than unobservable mental processes and mental contents. They investigated the association between a behavior and its consequence, and proposed scientifically testable mechanisms to explain how maladaptive behavior arises. Behaviorism helps explain how maladaptive behavior can arise from previous associations with an object, a situation, or an event.
• Pavlov discovered and investigated what is sometimes referred to as Pavlovian conditioning—the process whereby a reflexive behavior comes to be associated with a stimulus that precedes it. Pavlovian conditioning helps explain the severe fears and anxieties that are part of some psychological disorders.
• Cognitive psychology has led to the scientific investigation of mental processes and mental contents that affect how people pay attention to stimuli and develop biases in what they expect and remember. Such biases in turn can confirm the inaccurate views that perpetuate a psychological disorder. Aaron Beck and Albert Ellis each focused on how people’s irrational and inaccurate thoughts about themselves and the world can contribute to psychological disorders, and each developed a type of treatment to address the irrational and inaccurate thoughts.
• Social forces that help explain psychological disorders include difficulties with attachment and the role of relationships in buffering negative life events.
• Psychological disorders cannot be fully explained by any single type of factor or theory. One approach to integrating different factors is the diathesis–stress model, which proposes that if a person has a predisposition to a psychological disorder, stressors may trigger its occurrence.
• The biopsychosocial approach rests on the idea that both diathesis and stress can be grouped into three types of factors: biological, psychological, and social. Recent research allows investigators to begin to understand the role of the brain in psychological disorders and the feedback loops among the three types of factors. For these reasons, this book uses the term neuropsychosocial rather than biopsychosocial.