Mar 27, 2013 — So, what is abnormal psychology and how do we determine that people are behaving in abnormal ways? Do we define abnormality by the number of
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Abnormal Behaviour 1Learning aims At the end of this chapter you should: Understand the complexity in distinguishing between abnormal and normal behaviour Understand the varmal behaviour Be familiar with the differences between deviance and dysfunction Comprehend the complexities of legy. INTRODUCTION CASE STUDY Matt is a 42-year-old construction worker. He has been married for 20 years, has two nearly grown children, served four years in the military and has been employed at the same construction company since he left military service. He is described as steady and reliable. Yet, there is one thing that 01-Ramsden-Ch-01.indd 127/03/2013 8:03:12 PM

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2Understanding Abnormal Psychology 2doesn’t seem quite right; he carries small brass bells with him wherever he goes. He has carried these bells since he was a child and will tell people that they are for luck. The reality is that Matt carries them to keep evil spirits away. He stopped telling people his real reason for carrying bells because people were less understanding than if he just said he carried them for luck. Matt’s beliefs do not interfere in his life, he has never been treated for a mental illness, and he doesn’t appear to use them to control anything else in his life. His behaviour has made him the butt of jokes. He has been called harsh names; he has been physically and mentally abused by others and yet he continues to carry his bells. Time has taught him to hide them in his clothing and he has taken to sewing them in the seams of his shirts and trousers. How would you describe Matt’s behaviour? Is Matt mentally ill? WHAT IS ABNORMAL BEHAVIOUR? What is abnormal behaviour? How do we define what is abnormal? We can identify behaviour that is ‘weird’ when we see it but how do we ‘define’ it. The majority of us avoid what we define for our- selves as ‘odd’ behaviour, for example we would probably choose not to sit next to someone acting in an odd fashion or dressed in odd clothing on a bus or train. We don’t like individuals who smell unclean and whenever possible stay away from them. On the whole, we would define abnormality as being outside the parameters of what is accepted in our society. But how is this defined and what does ‘normal parameters’ really mean? Who decides what is abnormal vs. normal? If normal behaviour is defined by a society, what is a society?A society is a collective of individuals who are defined by the language that is spoken, religious practices and ethnic diversity. Societies are fluid and constantly changing. What was the norm for a society one hundred years ago may not be the norm of the same society today. How an individual behaves within a group is defined by the constraints of the society. Rules and norms govern what are deemed to be normal parameters. If you lived a solitary existence, how you behaved would not be dictated by others as you would be free to do as you chose. Your behaviour would not impinge on anyone else. When an individual lives within a group, the definition of normal behaviour is usually classified by a consensus of what is considered to be normal for that group. Occasionally, certain groups of people can push the boundaries but even this has limitations. For example, many normal behaviours are classified by age ranges. A 16-year-old who chooses to dye their hair a bright lime green colour would probably not be classified as abnormal; perhaps unusual, but not extreme. We would probably agree that this behaviour is pushing the boundaries, but we would also define it as youthful behaviour and therefore acceptable. However, if a 70-year-old engages in the same behav- iour, our evaluation of this individual would be outside of normal boundaries. The norms that gov- ern behaviour at different age categories have unwritten rules that guide behaviour. Although it is certainly not illegal to dye hair any colour, at any age, certain colours would be governed by rules of what is considered age-appropriate behaviour and anyone acting outside these boundaries would probably be classified as behaving in an abnormal way. This is also complicated by the number of inappropriate behaviours. If the only behaviour that is outside of the norm, i.e. lime green hair, and 01-Ramsden-Ch-01.indd 227/03/2013 8:03:12 PM

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3mal Behaviour all other behaviours are age appropriate and considered normal, the unusual element may be clas-sified as odd or eccentric. The single behaviour displayed with all else being normal may not be defined as abnormal, although it would probably never be considered normal. The consequence of having ‘odd’ hair would probably result in those individuals within the same age range ostracizing the individual until they changed their hair back to an age-appropriate colour. So, what is abnormal psychology and how do we determine that people are behaving in abnormal ways? Do we define abnormality by the number of extreme behaviours? Efforts to define psychological abnormality typically raise as many questions as they answer. Ultimately, a society selects general criteria for defining abnormality and then utilizes that criterion to judge particular cases. Szasz (1960) believed that the entire idea of abnormality and mental illness was invalid and what society defines as abnormal are simply problems in living or finding a niche, not that something was wrong with the individual. Other researchers have believed that the concept of mental illness is used to control or change people whose unusual patterns of functioning upset or threaten the social order (Sarbin & Mancuso, 1980; Scheff, 1966). These viewpoints may seem extreme and hardly anyone would argue that the pressures of being successful and attaining one’s goals in society do not contribute to stress and dysfunctional behav- iour, but how do we define this contribution and more importantly, what can we do to change the pattern? Perhaps it is important to look at how the past has defined abnormal behaviour. History has pro- vided us with examples of behaviour that has been defined as abnormal for that society and that time and place. It may be important in our search for meaning to begin with earlier examples of what was defined as abnormal to help us understand how we classify abnormal behaviour today. society’sdefinitionIndividualself-conceptlack of fitin societythe result is mental illnessSzasz’s idea of abnormalityFigure 1.1 01-Ramsden-Ch-01.indd 327/03/2013 8:03:13 PM

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4Understanding Abnormal Psychology HISTORICAL PERSPECTIVES OF ABNORMAL BEHAVIOUR Ancient societies believed that events and people were controlled by the supernatural and when individuals in the community acted outside of what was considered ‘normal’ they were then placed at the mercy of evil spirits that could cause affliction, inhabit their bodies or cause terrible events to happen to family members. History is filled with stories of individuals who intentionally exchanged their souls in order to obtain wealth and power. Therefore, ancient societies looked for physical evidence of evil and found it in anything that deviated from the norm (Millon, 2004). Physically and mentally abnormalities were proof of demonic possession. Individuals were generally held to be responsible for their own ailments or had committed some act to place family members in danger. The treatments used by many early societies in order to purge the person from evil generally involved extreme physical measures in order to make the corporeal manifestation of the demon unpleasant and allow the evil spirit to leave the body. Unfortunately the extreme physical ‘treat- ment’ often proved fatal but nevertheless was considered a success as it kept the rest of the commu- nity safe from harm (Porter, 2002). The idea that evil spirits were responsible continued for thousands of years, until Hippocrates, a Greek physician, began to change the way illness was perceived. Hippocrates believed that imbal- ances and disorders were not the result of evil spirits and instead were problems within the brain and body. He relied on observations and explanations which would be the beginning of the scien- tific method. Hippocrates greatly influenced medicine by shifting the ideology from corporeal to tangible. He correctly assumed that the most important area of the body was the brain and that it was central to intellectual activity and abnormal behaviour was as a direct result of disease. Hippocrates introduced the theory of heredity and environmental factors into the concept of mental illness and developed more compassionate treatments which subjected individuals to less cruel and violent methods (Porter, 2002). Hippocrates was also the first to classify abnormal behaviour into three distinct categories; mania, melancholia and phrenitis, giving each detailed clinical descriptions. Others would follow the direc- tion that Hippocrates proposed. Plato continued the belief that abnormal behaviours occurred as a result of brain and body dysfunction and would insist that these individuals should be cared for by their families and not punished for their behaviour. Galen made major contributions with his sci- entific examination of the central nervous system and how this contributed to abnormal behaviour (Porter, 2002). Just as mankind appeared to be striding forward, they took a gigantic step backward with the rise of Christianity. Religious dogma reinstated the ancient ideas that abnormal behaviour was the result of supernatural contact; however instead of random, unnamed evil spirits the culprit was the devil. Scientific attempts to understand, classify and explain became less important than accepting disease and dysfunction as a manifestation of God’s will. The influence of Christianity did not promote science and instead actively discouraged it. Physicians were no longer allowed to conduct scientific experiments to determine the cause of death. Anyone who challenged Christian doctrine was denounced as a heretic and condemned. Initially, those who continued the teachings of Hippocrates and Plato were denounced and when 01-Ramsden-Ch-01.indd 427/03/2013 8:03:13 PM

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5mal Behaviour this proved an ineffective deterrent they were executed by the church and all their papers and books were seized and burned. Scientific thought was in conflict with church doctrine and reli- gious leaders found it abhorrent to mutilate the dead when clearly the death was at God’s will (Porter, 2002). Illness, whether physical or mental, was now seen as punishment for sin. The sick person was guilty by the hand of God for wrongdoing and relief could only come from repentance. The treatment of individuals at this time was imbalanced; some individuals were treated with compassion while others were subjected to cruel punishments designed to elicit confessions. The downward decline of positive treatment continued and individuals displaying abnormal behaviour, mental and physical ill- nesses were subject to prayers, curses, flogging, starvation and immersion in hot water. Church lead- ers deemed what was abnormal behaviour and corrected the inconsistencies (Foucault, 2006).During the fifteenth and sixteenth centuries religious leaders were constantly battling social and religious reforms. In an effort to quash protests which threatened the Church’s power, the Church claimed that these insurrections were the acts of the devil and began to actively endorse demonic possession and witches (Eghigian, 2010).In 1484 Pope Innocent VIII issued a decree calling on the clergy to identify and exterminate any- one thought to be in league with the devil. This resulted in the publication of the malleus malefi-carum (the witches’ hammer). The document acted to confirm the existence of witches and also outlined various ways of detecting them (Alexander & Selesnick, 1966).An individual displaying any behaviour that was deemed to be abnormal in any way was sus- pected of witchcraft. It is probable that anyone with any type of mental illness would certainly have been condemned as being a witch. Individuals behaving outside of traditional norms were seen by the Church as being undesirable or uncooperative and were tortured in order to obtain confes- sions, with thousands of individuals being burned alive and mutilated in the name of the Church (Alexander & Selesnick, 1966).Ancient societiesmental illness caused by demonic possession three distinct categories of mental illnessmania, melancholia and phrenitisHippocratesPlatoabnormal behaviour is the result of brain and body dysfunction scientific examination of the central nervous system GalenFigure 1.2 01-Ramsden-Ch-01.indd 527/03/2013 8:03:13 PM

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6Understanding Abnormal Psychology A change in attitudes came with the Renaissance period, which is defined as the fourteenth through sixteenth century. This saw a resurgence of rational and scientific inquiry which led to great advances in the sciences. The humanistic movement also originated during this time frame and emphasized human welfare and the worth and uniqueness of the individual. The Renaissance period allowed individuals to understand that acting outside of norms would not lead to total anar- chy, rather it led to a period of prosperity and growth. These changes in attitude of allowing individ- uals the freedom to express themselves slightly outside of the norm leads us to the next element of defining abnormality (Bewley, 2008). Previously held explanations of mental illness began to lose support and favour and in 1563 a German physician named Johann Weyer published a book which challenged the foundation of witchcraft and alleged that many of the people who had been tortured, imprisoned and burned as witches were instead mentally disturbed. Although the practices of cruelty toward the mentally ill had somewhat subsided, the ideology was still very much active and present. Weyer’s book was immediately banned by both church and state and the author was emotionally and physically pun- ished for speaking out against the long held belief of witchcraft and demonology (Bewley, 2008). However, instead of stifling the information, many began to believe and eventually the beliefs stated by Weyer became the forerunner of the humanitarian perspective towards the mentally ill. The care of people with mental illnesses began to improve and instead of the inhuman treatment of punishment, abandonment and death, people were kept at home and cared for by family members with the help of their friends and neighbours and the financial support of the local parish. During this period, all across Europe religious shrines were devoted to the humane treatment of people with mental disorders (Van Walsum, 2004; Airing, 1975). The mid-sixteenth century continued to bring positive changes to the care of the mentally ill. Private homes and small communities could only help a small number of mentally ill individuals. Large cities had difficulty housing all the individuals who needed this type of care. The idea of the state providing accommodation and care began with converting hospitals and monasteries into asy-lums where the insane were to be sheltered from a hostile world, kept from harming themselves or others and given help and treatment. As these began to fill, the government began to build special hospitals specifically designated for the care of the mentally disturbed, many of which were built in secluded areas and surrounded by high walls with locked gates. These hospitals, now called asy- lums, quickly became overcrowded and what began with good intentions for treatment and care became filthy conditions where the patients began to be physically restrained rather than receiving treatment. Patients became inmates and they were locked in boxes or crates, chained to walls and floors, given bare sustenance, beaten and mistreated, with many dying of starvation and physical ill- ness. The Bethlem Royal Hospital in London (also called Bedlam) became one of these infamous places and was well known for its inhumane treatment of patients. It housed people in such deplor- able states and was in such a state of chaos that it became a public spectacle and members of the general public would pay to stare at the various patients chained and locked in their cells, and laugh at their antics. It became so well known that the name entered the English language and is used to describe chaos and confusion. Gradually the general public began to see the mentally ill as a men- ace and security became more important than treatment (Arnold, 2009).The reform movement of the eighteenth and nineteenth centuries came about with the influence of two men, Philippe Pinel and William Tuke. Pinel was a physician in France and had been placed 01-Ramsden-Ch-01.indd 627/03/2013 8:03:13 PM

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8Understanding Abnormal Psychology psychological perspective. This ideology held that psychological processes were the reason for mental illness (Kent, 2003). The early 1900s saw a reversal of the moral treatment movement. Several factors were respon-sible; severe money and staffing shortages, decline in recovery rates, and a new wave of prejudice and fear from the public (Bockoven, 1963). Quickly public mental hospitals were back to provid- ing custodial care and became filled to over-capacity. With the overcrowding came poor treatment and abuse of the patients. Although many mental health reforms had been passed and hospitals attempted to put humane practices into place, the sheer numbers of individuals with mental illness often made these practices unrealistic. Additionally the humane practices were not sufficient for all cases (those that were dangerous or endangered others) and clearly something more was needed. Psychological treatment was available but was generally only accessible to individuals who had the means to pay for this type of intervention. Individuals who could not afford psychological therapies and private care were relegated to the public mental hospitals (Kent, 2003). In 1949 the Australian psychiatrist John Cade reported on the success of giving lithium to long- term hospitalized manic patients that calmed them enough for them to be released. In 1950 the drug thorazine was synthesized, which was extremely effective in the treatment of psychotic patients. It has been claimed that this drug alone has been responsible for the single greatest advances in the twentieth century (Andreasen, 1984; Lickey & Gordon, 1991). Suddenly long-term hospitalized patients were able to be released. A new class of drug, the psychotropic medications came in three Sanguine − impulsive and pleasure- seekers Phlegmatic − consistent- relaxed/calm Melancholic − introverted- thoughtful Choleric − aggressive- passionate BloodYellow bile Black BilePhlegmFigure 1.4 The four humours and associated temperaments – kept in balance, allowed the person to be physically as well as mentally healthy 01-Ramsden-Ch-01.indd 827/03/2013 8:03:14 PM

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9mal Behaviour basic classes. The first category were antipsychotic drugs, to correct disordered thinking and hal- lucinations, the second were antidepressant drugs to lift the moods of those individuals who were depressed and the third class were anti-anxiety drugs to reduce tension and worry (Sweet, Rozensky & Tovian, 1991). Many of the patients who were provided with these drugs dramatically improved and were able to be discharged from hospital care. The new drugs created a different system of caring for the men- tally ill and a phase of deinstitutionalization occurred. Patients were now being discharged into community care and outpatient care, which solved many of the overcrowding problems at mental institutions. They in turn were able to begin implementing many of the principles that had begun with Pinel and his moral treatment movement, as well as provide psychological therapies that had only once been accessible to the wealthy (Barham, 1997). In spite of the new drug therapies and deinstitutionalization, many believed that the inhumane physical practices of the past that consisted of chaining individuals who were suffering from men- tal illnesses to beds, walls and chairs have only been replaced by chaining their minds. Although the new drug therapies appeared to be a significant improvement, the side effects that accompany the drug therapy are considerable (Breggin, 2001). It is not uncommon for individuals to exchange damaged minds for damaged bodies in the form of lowered life expectancy, extrapyramidal effects on motor control, lowered white blood cell count, tardive dyskinesia, sexual dysfunction and tardive psychosis. These have a potential for permanent chemical dependence leading to psychosis that can be even more debilitating than before the drug was administered (Keshavan, 2004).EVALUATION IN CONTEXT Abnormal behaviour must be evaluated in its context. All behaviour must be evaluated in terms of its time frame, social norms and rules that govern behaviour. We have expectations of how peo- ple should behave at public places. For example our expectation at a train station is that people should be orderly, fairly well dressed, clean and to wait patiently for the departure or arrival of their train. Anyone whose behaviour is outside of these norms becomes suspect. We would avoid dirty, unkempt individuals who push and shove and yell, in loud obnoxious tones. However at a three-day outdoor music festival someone in a three piece suit would be totally out of place; the norm for this venue is grimy, dirty and dishevelled. In fact many people at these festi- vals wear mud caked all over their bodies as if they are badges of honour. Generally, the more out- rageous the behaviour, the more the surrounding people find this to be entertaining. Individuals who push and shove and yell in loud obnoxious tones are welcomed and cheered. However, even this venue has limits; it is considered outside the norm to attack other people or to cause bodily harm to others. At what point does amusing behaviour become abnormal? It is difficult to describe in detail where the line is drawn – but generally those of us living in a society can readily identify when the behaviour becomes extreme and unwanted. Abnormal behaviour must always be evaluated with regard to a specific time frame, social norms and expectations of behaviour for that venue/place and it must be judged against what is ‘normal behaviour’ and normal expectations. 01-Ramsden-Ch-01.indd 927/03/2013 8:03:14 PM

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10Understanding Abnormal Psychology GENDEROur gender plays a major role in our perceptions and how we define ourselves. Being male or female affects the way our parents raise us, our role in life, the way other people respond to us and the way we are treated by society. It has historically also been used to determine normal and abnormal behaviour. Gender defines the range of behaviour that is considered appropriate and permissible and generally the range is narrower for women than for males. Women who do not conform to the current defined roles of femininity are more likely to be labelled as mentally ill (Scheff, 1966). Until relatively recently it was widely accepted that the only desirable roles for a woman were those of wife and mother and that a woman’s entire life should revolve around these roles. Even today in the UK archaic remnants of masculine/feminine social definitions continue to exist, e.g. if a woman hasn’t married before the age of 25 she is deemed a spinster by the UK Registrar’s Office. In com- parison, there are no offensive terms for an unmarried man of any age. Traditional roles form the basis for social behaviour. If we as a society determine that there are certain traditional roles for a group of people, anyone acting outside of these roles would be behav- ing in abnormal ways. We continue to be influenced by traditional roles that determine that certain types of jobs and careers are preferable to others. A female wanting to work in non-traditional roles is no longer considered abnormal but she is still far from the norm. For example, a female plumber may have a difficult time securing jobs independently as many would feel that only a male plumber would provide good service. In the past 30 years women were denied opportunities to many different types of professions such as: accountancy, engineering, politics, medical and legal careers although this is slowly changing and women are being trained and securing jobs in these professions. Unfortunately these changes did not occur without a great deal of discord and women were forced to fight for their rights. Many became pioneers and had to break down barriers in order to overcome gender discrimination. Various studies have documented how boys and girls are socialized into traditional sex roles. Witt (1997) found that children learn at a very young age what the difference in gender means and through a variety of activities, opportunities and positive and negative reinforcement, experience the process of gender role socialization. Sandtrock (1994) found that as children develop they internalize the process of gender roles and these become firmly entrenched and part of a child’s self-concept. Rubin, Provenzano and Luria (1974) found that parents have different expectations of sons and daughters as early as 24 hours after birth. Further studies have documented that a child internalizes the parental messages regarding gender at a very early age and their defined self-identity and self-concepts of gender come from parents (Lauer & Lauer, 1994; Santrock & Warshak, 1979; Kaplan, 1991). Hoffman (1977) found that reasons given by women for preferring a son over a daughter were to please their husbands, carry on the family name and to be a companion for their husband. Reasons for wanting a daughter included having a companion for themselves and to have fun dressing a girl and doing her hair. Stereotyping is defined as attaching an usually unfavourable and inaccurate perception to a group of people. Stereotypes often make it easier to justify unequal treatment of the stereotyped person or group. Among the traditional stereotypes of women is the belief that they are naturally passive, domestic and weak. However unrealistic and inaccurate these stereotypes may be, many 01-Ramsden-Ch-01.indd 1027/03/2013 8:03:14 PM

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11mal Behaviour individuals in society believe them to be true. One of the unfortunate effects of stereotyping is that even people who are victimized by these labels tend to believe that they are true. They become self-fulfilling prophecies, i.e., if a woman believes that being a car mechanic is an occupation that women are incapable of doing because they are not strong enough, she will not take her car to a female car mechanic, believing her to be incapable, nor will she consider the idea of becoming a car mechanic herself or encourage female children to consider that occupation. Goldberg (1972) found that women value professional work that they think was done by a man more highly than the same work if they think it was done by a woman. Horner (1970) found that many women were motivated to avoid success, fearing that the more ambitious and successful they became, the less feminine they would be. The norms of a society are an important source of prejudice and discrimination. Anyone outside of these norms will subject themselves to a variety of conforming social pressures and when these do not work, can be labelled as abnormal and even insane. If an entire society believes that women are less valuable, more mentally unstable, emotional and weak, these definitions will be accepted by most members as being accurate. In early civilization women were equal partners and revered as the bringers of life and fertil-ity (Eisler, 1988). This ideology began to change with the origin of the patriarchal structure most associated with warfare (Brown & Harris, 1978). With warfare, invasions and destruction became the norm and male dominance and enslavement of women became common. Engels (1983) fur- ther stated that the changing status of women also came with the beginning of private ownership of land that coincided with warfare. Society moved from a transient state to a static phase where land ownership, social class and patrilineal inheritance became important. As a result of these changes, women have been dominated by men in every aspect of their lives including reproductive rights and sexual freedom.Chastity and fidelity became important societal virtues and in order for men to ensure that women remained ‘pure’ and that they retained control they designed chastity belts. These devices first appeared in Europe in the fifteenth century and were used until the late 1800s, first by fathers and then by husbands. They enabled men to have complete sexual and reproductive control which included the prevention of masturbation. The most important role for a woman to have was as wife and mother. Any woman who chose a life outside of these roles was considered abnormal. Working- class women were expected to work until they had children. These women tended to have more chil- dren than upper- and middle-class wives. In the middle of the nineteenth century, the average married woman gave birth to six children. Over 35 percent of all married women had eight or more children. It wasn’t until the early 1900s that women began advocating for changes in reproductive rights. Marie Stopes in 1918 wrote a guide for women concerning contraception which caused turmoil with the leaders of the Church of England and the Pope, who believed that the use of birth con- trol was wrong and condemned all forms of contraception. Again, the idea that a woman should be allowed to choose outside of the traditional roles and deny her husband children was considered abnormal behaviour and anyone participating in this behaviour was reprimanded by society as well as the religious organization they were associated with. The first pharmaceutical form of birth control became available in 1957 and for the first time in history women gained control of their reproductive rights as they no longer were required to have 01-Ramsden-Ch-01.indd 1127/03/2013 8:03:14 PM

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