C H A P T E R 1: Orientation to Medications Learning Outcomes 1-1 Define terms to understanding administration of medications. 1-2 List the major sources and uses of drugs. 1-3 Define drug standards, indicating how they are determined and why they are necessary. 1-4 List names by which drugs are known. 1-5 List drug references, explain how to use at least one, and make a drug card. 1-6 List the major drug laws and their main features. 1-7 List the federal agencies that enforce the drug laws and the importance of enforcing them. Chapter Outline Key Terms Introduction to Pharmacology Pharmacology Drug Sources Drug Uses Drug Standards Drug Names Drug References Preparing Your Own Drug Cards Drug Legislation You and the Law Chapter Summary Chapter 1 Review Teaching Strategies § Ask students to identify the key terms they are already familiar with. Discuss the definitions of all the terms and be certain that students are clear about the meanings. Point out any similarities that may be confusing to them and tell them to memorize those words to avoid confusion later on. Ask volunteers to share their methods of learning medical key terms. § Ask students to list the major sources of drugs and give examples of each. § If possible, obtain a film from the library or a pharmaceutical company explaining the process of drug trials. Show the film to the class. § Take a field trip to a pharmaceutical company in your area to observe the step-by-step process of manufacturing drugs. Ask students to summarize why, as health care workers, they should understand the drug manufacturing process. Discuss how the company followed drug legislation. § Invite a pharmacist into class (or visit a pharmacy) to discuss the process of testing for generic drugs. Ask students why it is important they understand this process. § Ask a pharmaceutical representative to speak to the class about how he or she can make a difference in patient care. § Visit a local pharmacy or invite a pharmacist into class to discuss what pharmacists teach patients when they dispense a drug. Ask for print material that is sometimes given to patients. Discuss in class how this material could be beneficial or harmful to the patient. § When students begin work in a health facility, ask them to make a list of all the drug references that are available to them in their work environment. Are the materials up-todate? Why are up-to-date references important to the patient and the health care worker? § Ask students to complete the Chapter 1 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with. § Administer and grade the Chapter 1 Test in this Instructor’s Manual. § Develop and administer a performance test for preparing a drug card.
Gauwitz, Administering Medications, 8e
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The Development of Biological Treatments Consequences of the Biological Tradition THE PSYCHOLOGICAL TRADITION Moral Therapy Asylum Reform and the Decline of Moral Therapy Psychoanalytic Theory Humanistic Theory The Behavioral Model THE PRESENT: THE SCIENTIFIC METHOD AND AN INTEGRATIVE APPROACH
DETAILED OUTLINE Understanding Psychopathology A psychological disorder is (1) a psychological dysfunction within an individual that is (2) associated with distress or impairment in functioning and (3) a response that is not typical or culturally expected. All three basic criteria must be met; no one criterion alone has yet been identified that defines the essence of abnormality.
DISCUSSION POINT: What are some behaviors that may be considered “abnormal” by the above definitions, but do not constitute a psychological disorder? DISCUSSION POINT: Do the words “abnormal” and “pathological” necessary mean the same thing? Can you be one without being the other? Is abnormality an “either-or” construct or is it better thought of as a continuum? The field of psychopathology is concerned with the scientific study of psychological disorders. Trained mental health professionals range from clinical and counseling psychologists to psychiatrists and psychiatric social workers and nurses. Each profession requires a specific type of training. Using scientific methods, mental health professionals can function as scientist-practitioners. They not only keep up with the latest findings but also use scientific data to evaluate their own work and often conduct research within their clinics or hospitals. Research about psychological disorders falls into three basic categories: clinical description (prevalence, incidence, course prognosis), causation (etiology), and treatment and outcomes. DISCUSSION POINT: What are some of the factors that may lead a person to have a psychological disorder, such as depression? Be sure to elicit answers involving biological, psychological, and social components. DISCUSSION POINT: Why do you think that two people can be diagnosed with the exact same psychological disorder while appearing to share none of the causative factors of that condition? The Supernatural, Biological, and Psychological Traditions Historically, there have been three prominent approaches to abnormal behavior. In the supernatural tradition, abnormal behavior is attributed to agents outside our bodies or social environment, such as demons, spirits, or the influence of the moon and stars; although still alive, this tradition has been largely replaced by biological and psychological perspectives. In the biological tradition, disorders are attributed to disease or biochemical imbalances; in the psychological tradition, abnormal behavior is attributed to faulty psychological development and to social context. It was from the psychological perspective that a renewed interest in the moral treatment of the mentally ill emerged, beginning in the last 1700s with Philippe Pinel. Each tradition has its own way of treating individuals who suffer from psychological disorders. Supernatural treatments include exorcism to rid the body of supernatural spirits. Biological treatments typically emphasize physical care and the search for medical cures, especially drugs. Psychological approaches use psychosocial treatments, beginning with moral therapy and including modern psychotherapy. Sigmund Freud, the founder of psychoanalytic therapy, offered an elaborate conception of the unconscious mind, much of which is still conjecture. In therapy, Freud focused on tapping into the mysteries of the unconscious through such techniques as catharsis, free association, and dream analysis. Although Freud’s followers steered from his path in many
ways, Freud’s influence can still be felt today. DISCUSSION POINT: How might Freudian theorists use the psychosexual stages to explain obsessive-compulsive disorder? DISCUSSION POINT: If you were to receive treatment for an episode of depression from a provider, from which perspective would you want him or her to operate? The psychoanalytic, humanistic, or behavioral perspective? Why? (If students fall into the trap of choosing just one, encourage them to consider an answer that introduces the concept of eclecticism.) One outgrowth of Freudian therapy is humanistic psychology, which focuses more on human potential and self-actualizing than on psychological disorders. Therapy that has evolved from this approach is known as person-centered therapy; the therapist shows almost unconditional positive regard for the client’s feelings and thoughts. The behavioral model moved psychology into the realm of science. Both research and therapy focus on things that are measurable, including such techniques as systematic desensitization, reinforcement, and shaping. The Present: The Scientific Method and an Integrative Approach With the increasing sophistication of our scientific tools, and new knowledge from cognitive science, behavioral science, and neuroscience, we now realize that no contribution to psychological disorders ever occurs in isolation. Our behavior, both normal and abnormal, is a product of a continual interaction of psychological, biological, and social influences.
KEY TERMS psychological disorder, 3 phobia, 4 abnormal behavior, 4 psychopathology, 6 scientist-practitioner, 7 presenting problem, 7 clinical description, 7 prevalence, 7 incidence, 7 course, 8 prognosis, 8 etiology, 8 exorcism, 10 psychosocial treatment, 16 moral therapy, 16 mental hygiene movement, 17 psychoanalysis, 18
psychosexual stages of development, 21 castration anxiety, 21 neurosis (plural neuroses), 22 ego psychology, 22 self-psychology, 22 object relations, 22 collective unconscious, 22 free association, 22 dream analysis, 22 psychoanalyst, 22 transference, 23 psychodynamic psychotherapy, 23 self-actualizing, 23 person-centered therapy, 24 unconditional positive regard, 24
behaviorism, 18 unconscious, 18 catharsis, 18 psychoanalytic model, 19 id, 19 ego, 20 superego, 20 intrapsychic conflicts, 20
behavioral model, 24 classical conditioning, 24 extinction, 25 introspection, 25 systematic desensitization, 25 behavior therapy, 26 reinforcement, 26 shaping, 26
IDEAS FOR INSTRUCTION 1.
Activity: Distinguishing Normal from Abnormal Behavior. An exercise that helps students recognize the difficulty of distinguishing normal from abnormal behavior is to begin by presenting a small amount of information about a case. If your class is large, break your students into groups of four or five. Instruct each group to list the top four questions they would want to know about a case to evaluate the behavior. For example, present the following information: Case #1: Tom is uncomfortable riding escalators. As a result, Tom avoids using them. After your students have explored the case, encourage them to ask the following types of questions: a. How old is Tom? Is it more "normal" for Tom to fear escalators if he is a child versus an adult? Discuss developmental issues. b. From what culture does Tom most likely come? Has he ever had exposure to an escalator? Cultural contexts must always be considered when evaluating abnormal behavior. c. How does Tom manage his fear? What symptoms does he have? d. To what extent does Tom avoid using escalators? Does his fear significantly interfere with his life? Also ask if your students would consider the behavior more abnormal if he had a fear of flying in airplanes versus escalators. In other words, at what point would the behavior be considered an abnormal fear versus a normal one? What if Tom is afraid of snow because he once saw it on television, but he lives in a climate where it never snows? Case #2: Rachel has been caught urinating in the corner of her bedroom. Is her behavior abnormal? What information will you need in order to make this assessment? Encourage students to ask the following types of questions: a. How old is Rachel? The clinical picture is very different if Rachel is 1 year old than if she is 13 years old. Discuss the importance of understanding developmental psychology. b. How many times has she engaged in the behavior? A pattern of behavior may be viewed differently than if it is a rare occurrence.
c. Does Rachel have a medical condition? Is she on any medications? Rachel may have a medical or organic condition that accounts for her behavior. Ask your students if identifying an organic condition would change their perception of Rachel. Discuss the implication of assigning less social stigma to medical versus psychiatric patients. d. Has Rachel experienced a recent trauma or is she exposed to unusual stressors? e. Has Rachel achieved urinary control in a developmentally expected way and has now lost that control, or has she never achieved it at all? f. How does Rachel feel about her behavior? How does she explain it? Examples such as these stimulate students to explore cases more fully before making snap judgments about people’s behavior and illustrate the complexity in teasing out normal from abnormal behavior. 2.
Activity: What is Normal vs. Abnormal? A similar exercise is to break students into groups and have them work with HANDOUT 1.1. Students should complete the handout on their own and then discuss their opinions.
3.
Activity: Examples of Conditioning in Everyday Life. To illustrate learning theory, ask your students to apply what they have learned about conditioning and behavior therapy to their own lives. Students may choose a behavior they would like to change or eliminate, or may identify a new behavior they would like to acquire. Ask them to keep a journal of the conditioning technique they are using and the exact procedure they are employing. For example, a student may want to stop texting on her cellphone when she is driving. She could keep a journal to describe if she is using a classical or operant procedure and monitor the progress (or success!) of the conditioning.
4.
Activity: The Blind Men and the Human Elephant. To illustrate the importance of taking an integrative, multidimensional approach and the dangers of scientific tunnel vision, read John G. Saxe’s (1963) poem “The Blind Men and the Elephant.” The poem is available from several websites (using the complete search phrase “Saxe’s Blind Men and the Elephant”), including http://www.wordinfo.info/words/index/info/view_unit/1/?letter=B&spage=3. Then have students discuss what behaving as one of the blind men would look like from a supernatural, biological, or psychological perspective (include psychoanalytic, behavioral, humanistic views). Use human behavior in place of the elephant illustrated in the poem. Try wearing a turban and a robe, or using other props while reading the poem as a means to elicit humor and to make the message stick. Be careful, however, not to do so if it risks offending any of your students.
4. Activity: The Designer’s Guide to Gestalt Psychology. Read Igor Ovsyannykov’s blog1 and think about how basic design principles are grounded in the contrast of “normal” and “abnormal.” For example, the principle of closure allows creativity in design by leaving something to the imagination. Ask students to use their mobile devices to look for examples of closure and other Gestalt Principles from the blog. Discuss how these 1
https://creativemarket.com/blog/the-designers-guide-to-gestalt-psychology
designs are appealing using a psychoanalytic, behavioral, or humanistic viewpoint). (If students need a hint to get started, show pictures of the World Wildlife Fund or NBC logos). 5.
Activity: Myths, Magic, & Placebos: What Do They Have to Do with Having Rocks in Your Head? When you discuss material dealing with treatment of the mentally ill during the Middle Ages, see whether students know where the phrase “rocks in your head” originated. It actually originated during the Middle Ages, when city street vendors would commonly perform pseudosurgery on street corners. Troubled people with symptoms associated with mental illness would often frequent these vendors for relief. The vendors, in turn, would make a minor incision on the skull, while an accomplice would sneak the surgeon a few small stones. The surgeon would then pretend to have taken the stones from the patient’s head. The stones were claimed to be the cause of the person’s problems and that the person was now cured. A similar variant on this theme is quite popular with modern magicians and some faith healers who purport to painlessly remove diseased organs from the bodies of their subjects. The procedure involves an elaborate ritual, accompanied by chicken or beef blood and associated meat parts. The magic rests in the illusion of the magician’s arm twisting and turning into the bloodcovered exposed belly of the subject and the slow removal of what appears to look like a body part. Ask students to think about other examples of modern-day cures that they have heard about or maybe experienced themselves. This is a good place to tie in the concept of the placebo effect and perhaps open up a discussion about the role of beliefs and expectancies in producing and alleviating medical and psychological forms of distress and suffering.
6.
Activity: Course Journal. At the beginning of your class, ask students to keep a journal regarding their experiences in learning about abnormal psychology. One suggested format would be to have them answer, on a weekly basis, the following questions: o What is the most significant fact that I learned about abnormal psychology this week? o What did I learn this week about the field of abnormal psychology that changed my existing perceptions (e.g., what “myth” did I once believe that I now see differently)? o One idea I had for a research study in abnormal psychology this week is _______. You can have the students turn in this journal at the end of the course or to reflect on their experiences completing the journal in a small paper. If you are going to assign and collect the journals, don’t forget to remind students that they should only disclose information that they are comfortable with you reading! You may also introduce the topic of “Psychology Student Syndrome” here and ask them to track how often they feel that the topics discussed in class remind them of themselves, and discuss the normalcy of such perceptions.
7.
Rosenhan’s “On Being Sane in Insane Places.” Open your lecture on what is abnormal with the article “On Being Sane in Insane Places.” You can mention that one of the pseudopatients was a professional artist, and the staff interpreted her work in terms of her illness and recovery. As the pseudopatients took notes about their experience, staff members referred to the note-taking as schizophrenic writing. Ask students for any other types of behavior that they can think of that would be misinterpreted in a mental hospital setting. Use http://facstaff.bloomu.edu/jleitzel/classes/introabnormal/Spitzer_1975.pdf or see “On Being Sane in Insane Places”, Science, 1973, 179, pp. 250-257 to develop your lecture. (Be aware that the hyperlink of this article may warn you that the link may have viruses or harm your computer. Be assured this is a safe link)
8.
Invite a guest speaker from campus mental health/counseling services to discuss the range of services offered. This should reduce the fear and stigma of seeking any type of personal counseling services on campus. Additionally, it will let students know where to seek help should any personal issues arise during the semester. With the stress of student life, many students can and should use these services. You may also consider inviting a colleague who is a clinician if your institution does not have a counseling center or if the staff there are not available. This may also be an opportunity for a psychology student group (e.g., Psychology club, Psi Chi, etc.) to have a social event that focuses on the topic.
Uh Oh! Plan B Although instructors are skilled professionals in creating classroom experiences, things don’t always go as planned. The chapter-related lecture and activity suggestions in this section are for instances when your planned lecture or activity idea do not go as planned. Implement these to recover student interest and enhance student reading. 1. Fall Back on Didactic Lecture. Unfortunately mental health continues to carry a stigma and students may feel uncomfortable discussing “abnormality,” even in the abstract. The lecture suggestions here rely heavily on discussion. If your first class is quieter than you would like, don’t hesitate to provide more information. This gives you an opportunity to model a high level of comfort with the material and the students a chance to feel more comfortable with the topic. 2. Get up and MOVE. There are many ways in which to stimulate a discussion. If your setting permits, you can post signs around the room, forcing students to answer the question with their bodily presence and their voice. For example, most discussion questions can be answered from a Supernatural, Biological, and Psychological Tradition. Ask the students to move to one sign. Then, ask the groups to explain the phenomenon given their chosen perspective. For example, “depression” can be explained by the Supernatural group as being infected by evil spirits, whereas the Biological group can identify the phenomenon by chemical markers in the brain, etc.
YouTube Video Clips: Chapter 1 Introduction: Watch as the United States Centers for Disease Control redefines Attention Deficit/Hyperactivity Disorder (ADHD) and Tourette’s Syndrome as a “journey” rather than a mental health problem to be “fixed.” The Centers for Disease Control (2014). Children’s Mental Health Disorders: A Journey for Parents and Children. May 5, 2014. https://www.youtube.com/watch?v=ewbD2Dw0NLo The Supernatural Tradition: The American Culture is riddled with conflations of supernatural explanations of mental health disorders. This Michael Jackson classic is particularly poignant when you consider the lyrics: “They’re out to get you/there’s demons closing in on every side. They will possess you unless you change the number on your dial.” Belle, B., Riley, T., Temperton, R. Jackson, M. (1982). Thriller https://www.youtube.com/watch?v=sOnqjkJTMaA The Biological Tradition: What new depression cures are on the frontier? This one-hour lecture by National Institutes of Health scientist Carlos Zarate discusses the biological basis of depression and potential biologically-based ways to address it. Zerate, C. (2015). Relief from Severe Depression and Suicidal Ideation within Hours: From Synapses to Symptoms. November 4, 2015. https://www.youtube.com/watch?v=PiUhbbIvENg The Present: The Scientific Method and an Integrative Approach: Need an (educated) class laugh that reviews the scientific method in a clear straightforward way? Check out this campy classic made by two science professors and their students. Tunes2Teach (2012). December 20, 2012. https://www.youtube.com/watch?v=bUa-ilQqEv0 The Scientific Method Rap.
SUGGESTED VIDEOS Abnormal behavior: A mental hospital. (CRM/McGraw-Hill Films). Portrays life in a modern mental hospital, including views of schizophrenics and of a patient receiving ECT. (28 min) Adlerian therapy. (Insight Media). Dr. Jon Carlson examines and demonstrates Adlerian therapy (also known as individual psychology). (100 min) B. F. Skinner and behavior change: Research, practice, and promise. (Research Press). Features a discussion with B. F. Skinner and addresses some controversial issues related to behavioral psychology. (45 min) Carl Rogers. (Insight Media). Carl Rogers discusses the humanistic model of personality as well as his views on encounter groups, education, and other issues facing psychologists. (Two programs, each 50 min) Freud: The hidden nature of man. (Insight Media). Explores the concepts of psychoanalysis through interviews with Sigmund Freud himself. (29 min) Is mental illness a myth? (NMAC-T 2031). Debates whether mental illness is a physical disease or a collection of socially learned behaviors. Panelists include Thomas Szasz, Nathan Kline, and F. C. Redlich. (29 min) Keltie’s beard: A woman’s story. About a woman with heavy facial hair that she chooses not to cut. Useful in discussing the criteria for abnormal behavior. (9 min) Man facing southeast. Fascinating Argentine film about a man with no identity who shows up at a psychiatric hospital claiming to be from another planet. Neither the hospital staff nor the film’s audience ever figure out exactly what is happening. Out of sight. (PBS). Discusses the development of institutions for the mentally ill and traces custodial care practices of the mentally disturbed. (60 min) Pavlov: The conditioned reflex. (Films for the Humanities and Sciences). Documentary focusing on the classic work of Ivan Pavlov; includes rare footage of his investigations on the conditioned reflex. (25 min) The dark side of the moon. (Fanlight Productions). Chronicles the lives of three men with mental disorders, from living on the streets to becoming useful members of society. They now work to help other people in similar situations. (25 min) To define true madness. (PBS). Examines mental illness through history and considers the progress made to understand psychological disorders. (60 min)
ONLINE RESOURCES American Psychiatric Association http://www.psych.org/ APA’s website contains psychology-related links, information on legal cases that have affected psychiatry, continuing education for therapists, and much more. Clinically Psyched http://www.clinicallypsyched.com/ Collection of articles relevant to abnormal psychology, many of which are in the form of press releases, so you may want to track down the original sources. The topics covered span the discipline of abnormal psychology. Internet Mental Health http://www.mentalhealth.com/ This comprehensive site contains information related to the assessment, diagnosis, and treatment of mental illness. National Alliance for the Mentally Ill http://www.nami.org/ Links, membership information, and searchable indexes of mental disorders are all included on this site. Personality Theories http://www.ship.edu/~cgboeree/perscontents.html Electronic textbook (e-text) created for undergraduate and graduate courses in personality theory. The History of Psychology Website http://academic.udayton.edu/gregelvers/hop/welcome.asp Links to many psychology-related webpages on the Internet. The National Institute of Mental Health http://www.nimh.nih.gov The NIMH website offers information about diagnosis and treatment of several mental health disorders. Today in the History of Psychology http://www.cwu.edu/~warren/today.html The American Psychological Association created this website, which allows the user to access information on the history of psychology by selecting a date on the calendar.
SUPPLEMENTARY READING MATERIAL Additional Readings: Bjork, D. W. (1993). B.F. Skinner: A life. New York: Basic. Bolles, R. C. (1993). The story of psychology: A thematic history. Pacific Grove, CA: Brooks/Cole. Grob, G. (1994). The mad among us: A history of the care of America’s mentally ill. New York: MacMillan. Hatfield, A. B., & Lefley, H. P. (1993). Surviving mental illness. New York: Guilford. Hunt, M. M. (1993). The story of psychology. New York: Doubleday. Rosen, G. (1975). Madness in society: Chapters in the historical sociology of mental illness. New York: Anchor Books. Rosenhan, D. (1973). On being sane in insane places. Science, 179, p. 253. Spanos, N. P. (1978). Witchcraft in the histories of psychiatry: A critical appraisal and an alternative conceptualization. Psychological Bulletin, 35, 417–439. Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15, 113–118. Watson, R. I. (1991). The great psychologists: A history of psychological thought. (5th ed.). Reading, MA: Addison Wesley Longman. Weitz, R. D. (1992). A half century of psychological practice. Professional Psychology: Research and Practice, 23, 448-452.
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HANDOUT 1.1 WHAT IS ABNORMAL? Consider the following situations. Most people would consider at least some of the actions of the people involved to be abnormal. What do you think? Think about each one as you read through the list. Then, talk with your group about your judgments. When you are through talking about each, elect a group spokesperson who will take notes on the reasons that the group members come up with as to why you did or did not consider each situation to be abnormal. You will have to “dig” mentally to put some of these reasons into words.
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1.
Your uncle consumes a quart of whiskey per day; he has trouble remembering the names of those around him.
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Your grandmother believes that part of her body is missing and cries out about this missing part all day long. You show her that the part she thinks is missing actually is not, but she refuses to acknowledge this contradictory information.
3.
Your neighbor has vague physical complaints and sees two or three doctors weekly.
4.
Your neighbor sweeps, washes, and scrubs his driveway daily.
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Your cousin is pregnant, and is dieting (800 calories per day) so that she will not get “too fat” with the pregnancy. She has had this type of behavioral response since she was 13 years old.
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A woman’s husband died within the past year. The widow appears to talk to herself in the yard, doesn’t wash herself or dress in clean clothes, and appears to have lost a lot of weight.
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A 10-year-old wants to have his entire body tattooed.
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A 23-year-old female smokes marijuana every day, is a straight-A student in college, has a successful job, and is in a solid long-term relationship.
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A person experiences several unexpected panic attacks each week, but is otherwise happily married, functions well at work, and leads an active recreational lifestyle.
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A 35-year-old happily married man enjoys wearing women’s clothes and underwear on the weekends when he and his wife go out on the town.
WARNING SIGNS FOR PSYCHOLOGICAL DISORDERS IN ADULTS Confused thinking Prolonged depression (sadness or irritability) Feelings of extreme highs and lows Excessive fears, worries, and anxieties Social withdrawal or isolation Dramatic changes in eating or sleeping habits Strong feelings of anger Delusions or hallucinations Growing inability to cope with daily problems and activities Suicidal thoughts Denial of obvious problems Numerous unexplained physical ailments Substance abuse
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WARNING SIGNS FOR PSYCHOLOGICAL DISORDERS IN YOUNGER CHILDREN Changes in school performance Poor grades despite strong efforts Excessive worry or anxiety (i.e., refusing to go to bed or school) Hyperactivity Persistent nightmares Persistent disobedience or aggression Frequent temper tantrums Unexplained physical injuries or wounds
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WARNING SIGNS FOR PSYCHOLOGICAL DISORDERS IN OLDER CHILDREN AND PRE-ADOLESCENTS Substance abuse Inability to cope with problems and daily activities Change in sleeping and/or eating habits Excessive complaints of physical ailments Defiance of authority, truancy, theft, and/or vandalism Intense fear of weight gain Lack of or decrease in interest in engaging with peers or friends Prolonged negative mood, accompanied by poor appetite or thoughts of death Frequent outbursts of anger .
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CHAPTER 2 AN INTEGRATIVE APPROACH TO PSYCHOPATHOLOGY CHAPTER OVERVIEW This chapter outlines the primary components of a multidimensional model of psychopathology. The multidimensional model considers genetic contributions, the role of the nervous system, behavioral and cognitive processes, emotional influences, cultural, social and interpersonal influences, and developmental factors in explaining the causes of—and even the factors that maintain—psychological disorders. This chapter describes these areas of influence as well as their interaction in producing mental disorder.
CHAPTER OUTLINE ONE-DIMENSIONAL VERSUS MULTIDIMENSIONAL MODELS What Caused Judy’s Phobia? Outcome and Comments GENETIC CONTRIBUTIONS TO PSYCHOPATHOLOGY The Nature of Genes New Developments in the Study of Genes and Behavior The Interaction of Genes and the Environment Epigenetics and the Nongenomic “Inheritance” of Behavior NEUROSCIENCE AND ITS CONTRIBUTIONS TO PSYCHOPATHOLOGY The Central Nervous System The Structure of the Brain The Peripheral Nervous System Neurotransmitters Implications for Psychopathology Psychosocial Influences on Brain Structure and Function
Interactions of Psychosocial Factors and Neurotransmitter Systems Psychosocial Effects on the Development of Brain Structure and Function Comments BEHAVIORAL AND COGNITIVE PSYCHOLOGY Conditioning and Cognitive Processes Learned Helplessness Social Learning Prepared Learning Cognitive Science and the Unconscious EMOTIONS The Physiology and Purpose of Fear Emotional Phenomena The Components of Emotion Anger and Your Heart Emotions and Psychopathology CULTURAL, SOCIAL, AND INTERPERSONAL FACTORS Voodoo, the Evil Eye, and Other Fears Gender Social Effects on Health and Behavior Global Incidence of Psychological Disorders
DETAILED OUTLINE One-Dimensional versus Multidimensional Models The causes of abnormal behavior are complex and fascinating. You can say that psychological disorders are caused by nature (biology) and by nurture (psychosocial factors), and you would be right on both counts—but also wrong on both counts. To identify the causes of various psychological disorders, we must consider the interaction of all relevant dimensions: genetic contributions, the role of the nervous system, behavioral and cognitive processes, emotional influences, social and interpersonal influences, and developmental factors. Thus, we have arrived at a multidimensional integrative approach to the causes of psychological disorders. .
DISCUSSION POINT: Discuss the causes of Judy’s phobia, or another case example of your choosing, in the context of a multidimensional vs. unidimensional framework (behavioral, biological, emotional, social, and developmental causes). DISCUSSION POINT: Can you think of any cases of psychopathology that would have a unidimensional explanation? (Instructor should be prepared to play counterpoint, and repeated uses of this question will help to build an arsenal of appropriate responses.) Genetic Contributions to Psychopathology The genetic influence on much of our development and most of our behavior, personality, and even IQ score is polygenic—that is, influenced by many genes. This is assumed to be the case in abnormal behavior as well, although research is beginning to identify specific small groups of genes that relate to some major psychological disorders. In studying causal relationships in psychopathology, researchers look at the interactions of genetic and environmental effects. In the diathesis-stress model, individuals are assumed to inherit certain vulnerabilities that make them susceptible to a disorder when the right kind of stressor comes along. In the reciprocal gene-environment or gene-environment correlation model the individual’s genetic vulnerability toward a certain disorder may make it more likely that the person will experience the stressor that, in turn, triggers the genetic vulnerability and thus the disorder. In epigenetics, the immediate effects of the environment (such as early stressful experiences) impact cells that turn certain genes on or off. This effect may be passed down through several generations. Neuroscience and Its Contributions to Psychopathology The field of neuroscience promises much as we try to unravel the mysteries of psychopathology. Within the nervous system, levels of neurotransmitter and neuroendocrine activity interact in complex ways to modulate and regulate emotions and behavior and contribute to psychological disorders. DISCUSSION POINT: What are some disorders that students believe to be primarily biological in their origins? Discuss findings for disorders such as schizophrenia and bipolar disorder in which interactions between biology and environment determine outcome. Critical to our understanding of psychopathology are the neurotransmitter currents called brain circuits. Of the neurotransmitters that may play a key role, we investigated five: serotonin, gamma-aminobutyric acid (GABA), glutamate, norepinephrine, and dopamine. DISCUSSION POINT: What do recent findings about the interaction of psychosocial factors with brain structure and function indicate regarding future research directions in abnormal psychology?
Behavioral and Cognitive Psychology The relatively new field of cognitive psychology provides a valuable perspective on how behavioral and cognitive influences affect the learning and adaptation each of us experience throughout life. Clearly, such influences not only contribute to psychological disorders but also may directly modify brain functioning, brain structure, and even genetic expression. We examined some research in this field by looking at learned helplessness, social learning, prepared learning, and implicit memory. DISCUSSION POINT: What are some examples of a situation where a person may develop pathological thoughts or actions based on learned helplessness? Based on maladaptive modeling? Emotions Emotions have a direct and dramatic impact on our functioning and play a central role in many disorders. Mood, a persistent period of emotionality, is often evident in psychological disorders. Some moods, such as fear and anger, are often regarded as unhealthy; however, there are clearly adaptive functions of moods, even when they don’t make people feel particularly happy. Research has clearly illuminated the fact that some emotions have the potential to be harmful not just mentally but also physically. A consistent finding is that chronically elevated levels of anger are negatively correlated with heart health. DISCUSSION POINT: What are some ways in which suppression of an emotion might lead to a negative health outcome? Have students generate examples. Cultural, Social, and Interpersonal Factors Social and interpersonal influences profoundly affect both psychological disorders and biology. The existence of cultural disorders shows us how one’s cultural setting is related to definitions of pathology, as well as the emergence of specific illness symptoms. Such factors are also related to the treatment of mental symptoms. Lifespan Development In considering a multidimensional integrative approach to psychopathology, it is important to remember the principle of equifinality, which reminds us that we must consider the various paths to a particular outcome, not just the result. .
KEY TERMS multidimensional integrative approach, 33 genes, 36 diathesis-stress model, 38 vulnerability, 38 gene-environment correlation model, 40 epigenetics, 42 neuroscience, 42 neuron, 43 synaptic cleft, 43 neurotransmitters, 43 hormone, 47 brain circuits, 49 agonist, 50 antagonist, 50 inverse agonist, 50 reuptake 50
glutamate, 50 gamma-aminobutyric acid (GABA), 50 serotonin, 51 norepinephrine (also noradrenaline), 52 dopamine, 53 cognitive science, 58 learned helplessness, 59 modeling (also observational learning), 60 prepared learning, 60 implicit memory, 61 fight or flight response, 62 emotion, 62 mood, 63 affect, 63 equifinality, 70
IDEAS FOR INSTRUCTION 1.
Activity: Brain Areas & Their Function. To teach your students neuroanatomy and the contributions of neuroscience to psychopathology, prepare two sets of index cards. On one set, write the brain structures discussed in the text. The second set of cards should list the functions of these structures. For example, your cards could include the following: STRUCTURE Central nervous system Medulla and pons Cerebellum Midbrain Reticular activating system Limbic system Caudate nucleus Cerebral cortex Left hemisphere Right hemisphere Temporal lobe Parietal lobe Occipital lobe Frontal lobe Peripheral nervous system Somatic nervous system Autonomic nervous system Endocrine system Sympathetic nervous system Parasympathetic nervous system Pituitary gland
FUNCTION Consists of the brain and spinal cord Breathing, pumping of heart, digestion Motor coordination Coordinates movement with sensory input Processes of arousal and tension Emotional experiences/basic drives of sex, aggression, hunger, and thirst Controls motor behavior Contains over 80% of neurons in the central nervous system Verbal and other cognitive processes Perceiving surrounding events and creating images Recognizing various sights and sounds Recognizing various sensations of touch Integrates various visual input Thinking and reasoning abilities Coordination with brain stem to ensure body is working properly Controls our muscles Regulates the cardiovascular system and endocrine system Releases hormones into the bloodstream Mobilizes body during times of stress Renormalizes body after arousal states Master or coordinator of endocrine system
The goal of this quick activity is to have students match various structures of the brain with their respective functions. Divide the class in half and distribute one set of index cards to each group of students. Each student should receive one card. Instruct students to find the match for their structure/function, and tell them to do the activity without talking. The above terms and simple descriptions can also easily be converted into various “game” type activities. Students may enjoy a Jeopardy! format as a classroom activity or review session.
2.
Activity: The Ubiquity of Emotion & Conditioning. Conditioning is so ubiquitous in everyday experience that it is often hard to see. Have students come up with examples of classically conditioned emotional/evaluative responses and use such examples to illustrate that most conditioning is quite adaptive. If students have trouble coming up with examples, you may start with conditioned taste aversions, objects or events that students fear, or words/images that elicit an emotional response (e.g., fear, anger, disgust; seeing flashing blue lights in your rearview mirror and getting caught for speeding). Have students talk about the dimensions that are involved in the conditioned responses in keeping with the text description of emotion as involving cognition, behavior, and physiology. As a trick, you may ask students whether they have ever felt that an exam they had taken was unfair. Don’t ask for a show of hands. Most students will raise their hands. You can then ask, “Why did you all raise your hands?” Use this example to illustrate the role of experience and socialization in learning and behavior (in this case, automatically raising one’s hand in response to a question in the classroom without being asked to do so).
3.
Activity: Susan Mineka’s Work on Vicarious Learning of Fear in Primates. Susan Mineka and her colleagues have performed some interesting experiments demonstrating vicarious learning of fear in lab-reared monkeys. Her work to date represents the most compelling evidence for observational learning of fear. Many students find the description of her classic studies interesting in itself.
4.
The Effects of Alcohol on Students in Social Situations. Ask the students to form small groups and have them develop an explanation for alcohol abuse and dependence using behavioral and cognitive theory. Have the groups write a summary of the group discussion to be shared with the entire class. This is a serious subject in colleges and universities, where every year there are many alcohol-related deaths often due to binge drinking.
Uh Oh! Plan B Although instructors are skilled professionals in creating classroom experiences, things don’t always go as planned. The chapter-related lecture and activity suggestions in this section are for instances when your planned lecture or activity idea do not go as planned. Implement these to recover student interest and enhance student reading. 1.
Big picture/Small picture—The brain and its organization are extremely complicated and the detail can easily overwhelm students. The question of “why” is missing from many psychopathology lectures. Including “the big picture” of why a particular region or function of the brain is important (even providing examples as you see fit) will help the information “stick!”
2. Using Art as an In-Class Visual—Encourage your students to bring colored pencils to class and label/color the parts of the brain as you discuss them. Research1 has suggested that color and the act of color can lead to better memory of the material.
Dzulkifli, M. A., & Mustafar, M. F. (2013). The Influence of Colour on Memory Performance: A Review. The Malaysian Journal of Medical Sciences : MJMS, 20(2), 3–9. 1
YouTube Video Clips: Chapter 2 What does it mean to be multidimensional? The concept is interdisciplinary. Watch how Michio Kaku defines the 10 dimensions of our universe. Excerpted from Michio Kaku (2014) "The Future of the Mind" https://www.youtube.com/watch?v=p4Gotl9vRGs (10:59) How is mental health biological, cultural, social, and interpersonal? This lecture details specific examples of genetic research on behavior and mental illness. Crespi, B. (2012). "Where Darwin meets Freud: Molecular Genetics, Evolution, and Psychopathology of the Social Brain". Simon Fraser University. https://www.youtube.com/watch?v=pAoueFNsvVg (1:12: 01) Our emotions can both inhibit and enhance our health and well-being. Watch Oprah Winfrey interview Gavin de Becker, author of the classic book, The Gift of Fear: And Other Survival Signals that Protect us From Violence. Dell Publishing. 1998. https://www.youtube.com/watch?v=bBProrposzc (4:24)
SUGGESTED VIDEOS Discovering psychology: The responsive brain. (Annenburg/CPB Collection). Examines the interaction of the brain, behavior, and the environment. Also shows how brain structure and function are influenced by behavioral and environmental factors. (30 min) Episode One: Reality Check. (Showtime). The first episode of the This American Life series features the story of “Second Chance,” a cloned bull version of a beloved pet. It demonstrates that despite identical genetics to its predecessor, behavioral differences exist. (29 min) Inside information: The brain and how it works. (Films for the Humanities and Sciences:). This videotape describes how the many areas of the brain function and includes interviews with researchers in the field of neuroscience. (58 min) The brain, mind, and behavior. (PBS). This series focuses on the nature and function of the human brain, consciousness, and the effects of the brain and hormones on behavior. (8 parts, 60 min each) The enchanted loom: Processing sensory information. (Films for the Humanities and Sciences). Discusses how the brain is capable of sorting through vast sensory information and interpreting it on the basis of past experience and expectations. (60 min) The human brain. (Insight Media). Investigators discuss how the brain’s abilities can be enhanced through the proper environment. Also presents the case of a man who improves his condition after a serious brain injury. (25 min) The mind. (PBS). This series focuses on mental development in the context of normal and abnormal development.
The nervous system. (Insight Media). Explores the function of neurons as well as the central, peripheral, and autonomic nervous systems. (25 min)
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ONLINE RESOURCES Intro to the Brain https://www.youtube.com/watch?v=iTrQwJyxU8U Shows different parts of the brain and introduces concept of disease-related dementia History of Neuroscience http://faculty.washington.edu/chudler/hist.html Lists some of the most important events that occurred in neuroscience and psychology in chronological order, dating back to 4000 B.C. Neuropsychology Central http://www.neuropsychologycentral.com/resources.html Links to online sources on neuropsychological assessment, treatments, software, and newsgroups, just to name a few. The Whole Brain Atlas http://www.med.harvard.edu/AANLIB/home.html An excellent site reviewing the structure and function of the human brain. Many of the links are quite advanced, but students with a real interest in this topic may spend hours perusing the various resources. APA http://www.apa.org The homepage for The American Psychological Association. The Albert Ellis Institute http://www.rebt.org/ The site for rational-emotive therapy, where you can find additional information on Ellis’s technique. American Psychoanalytic Association http://www.apsa.org The American Psychoanalytic Association’s webpage.
SUPPLEMENTARY READING MATERIAL Additional Readings: Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall. Beck, A. T., & Clark, D. A. (1988). Anxiety and depression: An information processing perspective. Anxiety Research, 1, 23-36. Blatt, S. J., & Lerner, H. (1991). Psychodynamic perspectives on personality theory. In M. Hersen, A. E. Kazdin, & A. S. Bellack (Eds.) The clinical psychology handbook (2nd ed.). New York: Pergamon, 147-169.
Damasio, A. R. (1995). Descartes’ error: Emotion, reason, and the human brain. New York: Avon Books. Ellis, A., & Harper, R. A. (1976). A guide to rational living. North Hollywood, CA: Wilshire Book Company. Gross, C. G. (1998). Brain, vision, memory: Tales in the history of neuroscience. Cambridge: MIT Press. Hundert, E. (1991). A synthetic approach to psychiatry’s nature-nurture debate. Integrative Psychiatry, 7, 76-83. Kihlstrom, J. F. (1987). The cognitive unconscious. Science, 237, 1445-1452. Marshall, L. H., & Magoun, H. W. (Eds) (1998). Discoveries in the human brain: Neuroscience prehistory, brain structure, and function. Totowa, NJ: Humana Press. Mineka, S., Davidson, M., Cook, M., & Keir, R. (1984). Observational conditioning of snake fear in rhesus monkeys. Journal of Abnormal Psychology, 93, 355-372. Ramachandran, V. S., & Blakeslee, S. (1998). Phantoms in the brain: Probing the histories of the human mind. New York: William Morrow & Company. Rosenhan, D. (1973). On being sane in insane places. Science, 179, p. 253
Sacks, O. (1985). The man who mistook his wife for a hat and other clinical tales. New York: Summit Books.
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Anatomic Features of the Human Spinal Cord
Anatomic Features: Spinal nerves and internal organization of the spinal cord (gray and white matter) Function: Relays information to and from the brain; responsible for simple reflexive behavior
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Anatomic Features of the Human Skull
Anatomic Features: A fused connection of bony plates covering the brain Function: Protection of the brain
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Anatomic Features Protective Meninges of the CNS
Anatomic Features: Dura mater, arachnoid membrane, and pia mater Function: Protective covering of the central nervous system (CNS), location of venous drainage, and cerebrospinal fluid absorption
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Anatomic Features of the Ventricular System
Anatomic Features: Lateral (1st and 2nd), 3rd, and 4th ventricles, choroids plexus, cerebral aqueduct, and arachnoid granulations Function: Balancing intracranial pressure, cerebrospinal fluid production, and circulation
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Anatomic Features of the Brain’s Vascular System
Anatomic Features: Arteries, veins, circle of Willis Function: Arteries provide nourishment, oxygen, and other nutrients to the brain; the veins carry away waste products
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Anatomic Features of the Lower Brain Stem
Anatomic Features: Hindbrain contains the medulla oblongata (myelencephalon), and pons (metencephalon); midbrain contains the tectum and tegmentum, cranial nerves, reticular activating system Function: Relays information to and from the brain; responsible for simple reflexive behavior
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Anatomic Features of the Cranial Nerves
Anatomic Features: Located within the brain stem Function: Conducts specific motor and sensory information
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Anatomic Features of the Reticular Formation
Anatomic Features: Neural network within the lower brain stem connecting the medulla and the midbrain Function: Nonspecific arousal and activation, sleep and wakefulness