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1 Introduction to Abnormal Psychology Chapter Objectives After reading this chapter, you should be able to:

• Define abnormal behavior.

• Discuss the history of mental illness.

• Identify the major theorists and theoretical orientations in psychology.

• Discuss the DSM–5. Flirt/SuperStock get81325_01_c01.indd 1 12/5/13 3:59 PM Section 1.1 How Do We Define Abnormal Behavior? 1.1 How Do We Define Abnormal Behavior? One of the things we have discovered over the years is that if one were to poll a random sample of average people, most would say that they know abnormal behavio\ r when they see it. They might assess at-a-glance someone’s behavior as strange, \ odd, or sick, and they would quickly give you the reasons for their assessment. Let us look at an example of potentially odd behavior that will illustrate this.

You are walking in your neighborhood on a gorgeous summer afternoon, listening to your favorite songs on your iPod or smartphone. Suddenly, without warning, a man runs out from behind the bushes across the street. This wouldn’t normally catch your attention, but what really catches your eye is that this man has no clothes on. He is running frantically while trying to cover himself with his hands, all the while looking behi\ nd him. Before you know it, the man disappears around the corner. Was the man’s behavior abnormal? Do you think this man is likely to present a danger to himself or, more importantly, to other people? This is one of the goals that practicing psychologists have: to \ ascertain whether an individual’s behavior is abnormal or not, and to ascertain whether th\ eir behavior presents a danger to the individual or to others.

Does Abnormal Behavior Automatically Mean Psychopathology?

Psychopathology refers to the study of the causes and development of psychiatric disor- ders. Many in the mental health professions (psychologists, social workers, counselors, and psychiatrists, to name a few) agree that it is extremely difficult to arrive at a universal definition of abnormal behavior (Maddux & Winstead, 2007). They agree in general about what the term means, but they often use different perspectives to actually define it. Three perspectives commonly used by psychologists are the statistical frequency perspective (behavior is abnormal according to the statistics), the social norms perspective (behavior is abnormal according to the standards set by society), and the maladaptive perspective (behavior is abnormal because it interferes with the individual’s ability to function on a daily basis). Each perspective has its own usefulness and limitations, \ as discussed in the following sections.

The Statistical Frequency Perspective The statistical frequency perspective labels behavior as abnormal if the behaviors only exist (or are exhibited) by the minority of the population. A few presumptions here need to be examined. First, this perspective presumes that the general population’s behavior is considered to be normal. However, what is considered normal today wasn’t necessarily considered normal a hundred years ago, and what’s normal in New York City might not be considered all that normal in New Delhi. For example, consider the following rou - tine: Someone wakes up, eats breakfast, goes to work, has lunch, goes home, eats dinner, spends some time with family, watches television, and then goes to bed. This is a routine that many working adults in the United States follow on a daily basis. T\ herefore, the gen - eral population would consider this to be normal behavior.

So what would you then make of the following: Instead of going to work e\ very day and following the previously outlined routine, an individual goes to the beach at 8 a.m. and lies on a blanket until the sun sets, each and every day? Or what about \ this possibility: get81325_01_c01.indd 2 12/5/13 3:59 PM CHAPTER 1 Section 1.1 How Do We Define Abnormal Behavior? A man goes to the beach with a blanket and a guitar, sits on the boardwalk, strums away while singing folk songs, and has a sign asking for handouts as he has l\ ost his job due to a bad economy. Is this considered normal behavior based on current standards in the United States? Or is this behavior crossing over to abnormal behavior?

What about the man we described earlier who ran naked from behind bushes? Do people usually run through the streets naked anywhere in the United States? And if the statistical perspective tells us that this is extremely uncommon behavior, does that automatically mean that the individual must be pathological?

The Social Norms Perspective The social norms perspective states that behavior is abnormal if it devi\ ates greatly from accepted social standards, values, or norms. Norms are spoken and unspoken rules for proper conduct. These are established by a society over time and are subject to changes over time. Two types of norms used to assess whether behavior is abnormal are legal norms and psychological norms. Legal norms tend to dictate how an individual should behave in the realm of his civic surroundings and with regard to his friends and neigh - bors. In other words, this is a mandatory rule of social behavior that is established by the state. If someone is labeled a criminal, his behavior violates legal\ norms as deter - mined by that society. For example, the naked running man described earlier may be demonstrating abnormal behavior based on legal norms, since he could be \ arrested for indecent exposure.

Psychological norms are also determined by society, but are codified in the Diagnostic and Statistical Manual of Mental Dis- orders, Fifth Edition, published by the American Psychiatric Asso- ciation. Behaviors, thoughts, and emotions are considered to be abnormal if they violate the norms set out by psychologists.

For example, Michael Jackson was surely one of the most famous individuals in the world. How- ever, he demonstrated unusual, perhaps odd, and maybe even abnormal behaviors at times.

He often wore surgical masks when he was out in public. Per - haps more unusual was how he dressed his children when they went out. He would often cover his children’s faces or heads with blankets, Halloween-style masks, burqas, or disguises. Is this behavior abnor - mal? Most likely it is to the everyday individual. However, what if Jackson were germ- phobic, afraid of catching any kind of pathogen or cold? What if he had \ a compromised immune system and therefore needed to keep his face covered? Perhaps he covered his children’s faces to protect them against kidnappers, since he was an instantly recognizable © Olaf Selchow/dpa/Corbis Is this normal behavior? Michael Jackson would commonly cover his children’s faces and many considered this behavior to be abnormal. get81325_01_c01.indd 3 12/5/13 3:59 PM CHAPTER 1 Section 1.1 How Do We Define Abnormal Behavior? and very wealthy pop star. Do these latter explanations now make his behaviors more rational and therefore not abnormal? The psychological norms perspective would involve using diagnostic criteria in the DSM–5 to determine if the pattern of such behaviors is likely to point to a mental disorder.

The Maladaptive Perspective Finally, the maladaptive perspective views behavior as abnormal if it interferes with the individual’s ability to function in life or in society. By this we mean the ability to work, take care of oneself, and have normal social interactions. Do you think the nake\ d running man is able to function in everyday life? Can we even make these kinds o\ f judgments without knowing much about him? If nothing else, we can say that this naked individual appears to be somewhat unusual. However, is his behavior abnormal or indicative of mental illness? Let’s look at another example.

There is a woman in your neighborhood that you see often. She works a regular 9-to-5 job, but you notice that it takes her a while to leave for work. You have noticed that she engages in some rather “unusual” yet regular routines before she finally heads off. She locks her door then returns at least four more times to make sure it’s locked. You also notice that it takes her a long time to leave the house. She goes back i\ nside at least five or six times, disappears for a few minutes, and then returns outside. When she finally gets in her car, she drives off, then she returns a few minutes later to ensure the garage door is closed. You also notice that when she finally leaves for good, the time is 10 a.m\ . Based on the maladaptive perspective, this woman’s behaviors interfere with her everyday life. She is able to function, but her daily rituals make her late for work every day. She has extreme difficulty leaving the house until she is absolutely certain that all the d\ oors are locked and that her gas oven and range are turned off (we will discuss behaviors like this in more detail when we discuss obsessive-compulsive and related disorders).

Other Considerations Let us consider several other factors that we use to classify abnormal b\ ehavior. First, is the individual’s behavior causing danger to him/herself or to other p\ eople? Often this is not the case. The idea that individuals who have a mental illness are dangerous or violent people like Jeffrey Dahmer or Charles Manson is simply not true. Most individuals with a mental illness are not dangerous, and of those who are, most are more likely to pose a threat to themselves than to others.

Another consideration is whether the individual’s behavior is causing him or her distress.

Not all abnormal behavior causes stress to the individual. In many cases, the individual’s family or loved ones are more distressed than the individual themselves. This makes it espe- cially important for the family to be involved in as many aspects of treatment as possible.

Finally, we must consider factors such as the duration, the age of onset, and the intensity of the behavior(s). By duration, we mean the length of time the troublesome behaviors have existed. By age of onset, we mean the age at which the troublesome behaviors first become noticeable. This is especially important, since some mental illne\ sses cannot be diagnosed until an individual has reached a certain age, or cannot be diagnosed once an get81325_01_c01.indd 4 12/5/13 3:59 PM CHAPTER 1 Section 1.1 How Do We Define Abnormal Behavior? individual has passed a certain age. By intensity, we mean how extreme the behaviors in question are. So, where does our naked running man fit? Let us see if more information about him helps to clear up the picture. This man is a sophomore at a major university in the United States. He is a psychology major and has made the Dean’s L\ ist, a status granted only to the best students. When you looked more closely at the man, you saw that he was only wearing sneakers, which let him run faster. The sneakers had the university’s logo on the sides. Is this enough to make a determination?

Psychologists often have to make judgments based on what they see on the\ surface or in an individual’s overt behaviors. These are behaviors that are open and detectable by who - ever observes them (Reber & Reber, 2001, p. 500). In other words, these are behaviors that we can see on the surface and therefore measure. Let’s look at some other facts about the naked running man. He was running because he was “discovered.” He was discovered by the house’s owners who saw him skinny-dipping in their pool. He also \ had a camcorder set up recording his escapades. Does this help?

Now do you think this man’s behavior is abnormal based on the aforementioned perspec - tives? Is skinny-dipping in someone else’s pool statistically frequent? Does it conform to social norms? Do you think it interferes with the man’s ability to function at his univer - sity? Does the man’s skinny-dipping in a stranger ’s pool present a danger to him or to others? Perhaps a bit more information would help. The man was skinny-dipping and recording his feat because he was pledging a fraternity at his university. This was part of a “hazing” ritual. The man had to prove he performed his escapade and therefore filmed it. As you learn more about the man, you discover that he is extremely reserved, painfully shy, and generally withdrawn in many social situations.

Perhaps he is just what David Weeks and Jamie James (1995) call an eccentric. Eccentrics have odd or unusual habits but do not have a mental illness.

Weeks and James published a work called Eccen- trics: A Study of Sanity and Strangeness , in which they examined eccentrics throughout history.

They concluded that the eccentrics’ thought pat - terns are not disrupted and their behavior doesn’t typically cause them distress; in fact, most eccen- trics may take pleasure in being an “original.” Perhaps you yourself have some odd or unusual habits, or perhaps you know someone who does.

Albert Einstein could be classified as an eccentric.

He picked up and smoked discarded cigarette butts off the street in order to circumvent his doc - tor ’s ban on buying tobacco for his pipe. He also would use his sailboat on windless days because he enjoyed a challenge. Oscar Wilde, the famous novelist, was another famous eccentric. While studying at Oxford University, Wilde would walk through the streets with a lobster on a leash, in addition to engaging in other odd behaviors. AP Photo Eccentrics exhibit odd or unusual habits, yet do not have a mental illness. Albert Einstein may be considered an eccentric or an “original” for displaying peculiar habits. get81325_01_c01.indd 5 12/5/13 3:59 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories 1.2 A History of Abnormal Behavior Theories Imagine this: It is a few thousand years ago, and your friend is planning to attend a regularly occurring event that he is eagerly anticipating. Your friend talks about looking forward to the occasion, as it is a form of socialization for him. The governm\ ent sanc- tions the event and supports it as a way of pleasing its citizens and gi\ ving back to them.

Your friend then mentions that he would like you to come along to see how\ exciting the event is. You arrive and see that the arena contains at least 80,000 screaming people.

You naturally wonder why everyone is yelling and why they seem so excited\ . All of the people are standing. You even see a “royal box” where dignitaries are sitting. At the end of the event your friend asks you, “Well, what did you think?” You reply that you have never seen anything like it and love what you saw. You then ask when you can attend the next performance.

Does any of this seem unusual or abnormal? What if you now knew that you were in ancient Rome attending gladiator fights and seeing prisoners being torn to pieces by lions? These events were considered to be a normal form of entertainment in ancient Rome, but if we tried to stage such an event in the United States in 2014, you can imagine the consequences and outrage.

Thus, what constitutes abnor - mal behavior is partially depen - dent on society’s definitions of what is normal, which can change over the course of time.

Humans have demonstrated abnormal behavior for at least, by this author ’s account, a few thousand years. The gladi - ator fights were not considered unusual in their time, but they are now considered to be unusual and, by many, repulsive.

Ancient Times The earliest explanations for mental illness seem to have been that the \ afflicted were pos - sessed by evil spirits or demons (an idea that some people still believ\ e today). Skulls dat - ing back to 6500 BCE have been discovered with holes bored into them (see Figure 1.1), which are an indication of trepanning (also known as trephination). The belief seems to have been that the holes would allow the evil spirits to leave the “p\ ossessed” person. In later medieval societies exorcisms were performed, usually by a priest. This was a nonin - vasive way to drive the evil spirits out from the possessed individual. These became more common in the 1600s. Exorcisms, although rare, are still performed today. © Heritage Images/Corbis In ancient Roman times, attending gladiator fights was a common form of entertainment. get81325_01_c01.indd 6 12/5/13 3:59 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories Figure 1.1: Trepanning Skull Trephine Hole made by trepanning Note the holes bored into the skull.

The first physiology-based explanations for mental illness were provided in ancient Greece by Hippocrates (460–377 BCE), the father of modern medicine. H\ ippocrates viewed abnormal behavior—and physical illnesses in general—as havi\ ng internal causes.

Specifically, he believed that the body contained four fluids, or humors (yellow bile, black bile, blood, and phlegm), that must be kept in adequate balance to maintain health (it must be noted that the theory was wrong about the cause of diseases). His prescriptions for the ill included rest, proper diet, sobriety, and exercise, strategies that are still recom - mended today. Hippocrates also believed that if you took care of your body, your mind would stay well.

Two Important Mental Health Reformers: 1700s–1800s Philippe Pinel (1745–1826) was one of the early reformers in the proper treatment of indi - viduals with mental illnesses. Pinel, a Frenchman, advocated that they be treated with sympathy, compassion, and empathy and not with beatings and torture. Dorothea Dix get81325_01_c01.indd 7 12/5/13 3:59 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories (1802–1887) helped to establish many state mental hospitals in the United States during her nation- wide campaign to reform treatments of the men - tally ill. She was directly responsible for laws that aimed to reform treatment of this population.

Psychoanalytic Theory: 1890s–1930s While trephination dates back thousands of years, the history of abnormal psychology realistically dates back to 1895, when Sigmund Freud (1856– 1939), in collaboration with Josef Breuer (1842– 1925), published his first book, Studies in Hysteria.

(The first book Freud wrote alone was The Inter- pretation of Dreams, published in 1900.) Sigmund Freud was initially a researcher who studied the reproductive systems of eels. In 1885, just before he got married, he obtained a grant to go to Paris to see the famous neurologist Jean Martin Charcot (1825–1893). Charcot specialized in the study of hysteria and susceptibility to hypnosis. From his time with Charcot, Freud realized the power that the mind could have over the body, and he returned from Paris determined to make a name for himself in the field of hypnosis.\ After experimenting with hypnosis on his patients, Freud abandoned this form of treatment as it proved ineffective for many of them. He favored treatment where the patient talked through his or her problems, which he termed psychoanalysis.

Josef Breuer, a Viennese physician, treated patients who suffered from hysteria. Breuer ’s patients told him that they had physical illnesses. However, after examination, he discovered that they had no physical symptoms. Breuer discovered that in some cases his patients’ symptoms eased or dis - appeared once they discussed the past with him in a safe environment without censure and while under hypnosis. Breuer and Freud discussed their ideas, and Freud expanded on them and created psychoanalytic theory, thus leading to an entire movement that is still popular today. Freud’s basic tenet was as follows: that unconscious pro - cesses, motives, and urges are at the core of all of our behaviors and difficulties.

How did Freud view abnormal behavior? Freud saw adult human behavior as resulting from a combination of the components of what he termed the psyche, which consisted of three parts: the id, the ego, and the superego (see Figure 1.2). The id Everett Collection Published in 1895, Studies in Hysteria by Sigmund Freud and Josef Breuer marks the history of abnormal psychology. iStockphoto/Thinkstock Josef Breuer discovered many of his patients claimed to have a physical illness, yet all symptoms disappeared once the patients discussed their ailments in a safe environment and were under hypnosis. get81325_01_c01.indd 8 12/5/13 3:59 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories is the primitive part of the personality that houses our unconscious desires, wishes, and basic innate drives such as sex and aggression. If these drives are not satisfied, or if the unconscious desires come into consciousness, anxiety can result. The id is the only piece of the psyche that is present at birth. The ego, which is partially conscious and is the second part of the psyche, does its best to control the id by trying to “convince” it to delay gratifica- tion until a reasonable solution to the drive reduction is found. The id does not listen, as it needs to be satisfied immediately regardless of the consequences. The ego develops when a child is between 1½ and 3 years old. Eventually the superego, the final part of the psyche, develops when a child is between 3 and 6 years old and enables the indiv\ idual to feel guilt and have a conscience. The superego is also partially conscious, and it helps the ego to control the id’s desires. Even if the id’s urges are controlled by the ego and the superego, its desires still exist, driving behavior. Because these desires are so strong, they cause anxiety if they are unmet. According to psychoanalytic theory, this can lead to abnormal behavior.

Figure 1.2: A schematic illustration of the personality Id Unconscious Preconscious Conscious Ego Superego Freud compared personality to an iceberg. A very small part is conscious, a somewhat larger part is preconscious (available to conscious awareness with some mental effort), and the largest part of personality is unconscious (unavailable to the individual without massive psychoanalytic effort).

From: Steven Schwartz and James Johnson, Psychopathology of childhood: A clinical-experimental approach , p. 13, Pergamon Press, 1985. Reprinted by permission. get81325_01_c01.indd 9 12/5/13 3:59 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories Freud and his followers also looked at abnormal behavior in other ways. For example, Freud saw depression as anger turned inward. He maintained that we all have self-destructive tenden- cies, but that they usually remain repressed. Repression is an ego defense mechanism that oper- ates unconsciously. Repression keeps certain ideas, impulses, and memories from reaching consciousness. If these ideas were to surface, they would produce anxiety and guilt, among other feelings. However, when indi - viduals are unable to express their anger appropriately and turn it inward as a form of self-punishment, this can lead to depression. Behaviorism: 1910s–1940s Freud’s explanations for abnormal behavior varied somewhat according to an individu - al’s diagnosis; however, the explanations of two American psychologists, John B. Watson (1878–1958) and B. F. Skinner (1904–1990), stayed the same regardless of the individual or the diagnosis. These two posited that something in the environment is always reinforcing an individual’s aberrant behavior(s). In other words, the causal factors are outside of the individual. Behaviorists believe that only observable and scientifically measurable behav - iors are worth studying and investigating. Some behaviorists go to more of an extreme, stating that only physiological responses matter; consciousness and any mental states are not worth examining as they do not exist. (They have often been called \ radical behaviorists.) Let’s consider an example: A child is often disruptive in class, screaming and throwing objects. That child is usually sent to the principal’s office for subsequent punishment. It turns out that the child loves the attention he gets when he is removed from class, as he has no friends and is also ignored at home by his father. His acting out is reinforced by the attention he gets in the classroom and by getting sent to the principal’s office. Perhaps you can think of some celebrities whose behaviors are reinforced by environmental actions (gaining more attention and notoriety). Effective treatment, therefore, always relies on the manipulation of the environment in order to change the individual’s behavior. In the case of someone suffering from depression, for example, Skinner would try to discover what environmental factors were sustaining the depressive symptoms and then help the patient to eliminate those reinforcers, with little to no emphasis on the person’s thoughts, unconscious desires, and so on. Kablonk/SuperStock According to Freud, depression was a result of unrepressed anger trapped inside rather than expressed outwardly. get81325_01_c01.indd 10 12/5/13 4:00 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories Cognitive Behaviorism: 1950s–1970s Cognitive behaviorism is a psychotherapeutic method that alters distorted attitudes by identifying and replacing negative and inaccurate thoughts, which will therefore lead to behavioral changes. Albert Ellis (1913–2007) took a somewhat unique approach to defin - ing and treating abnormal behavior. He believed that we get depressed and develop other mental illnesses because of our faulty thinking. For example, Ellis says\ that some people set themselves up to fail because of “musterbation.” This means th\ at you create a series of mental “musts” that are virtually impossible to satisfy, such as “I must always do well in all of my performances and always win the praise and approval of others. If not, I’m a failure.” This is an unrealistic expectation, and when it’s not met, the individual gets depressed and anxious or develops other problems. Ellis defined an ABC model that refers to the three components of how we experience and interpret events in either a faulty or a healthy manner. In this model, A is the activating event or adversity, B is the belief that follows, and C is the consequence. For example, let’s look at a \ man who receives a negative work evaluation (this is the A, activating event or adversity). He then believes that he is a failure (the B, or belief). The end result (or C, consequence) is that the man now feels anxious and depressed. Ellis created Rational Emotive Behavior Therapy (REBT) to treat people with problems resulting from such faulty thinking. It works by helping patients to replace their irrational responses to events (the B or belief) with a more healthy and ratio - nal interpretation (such as, in the case of the poor job review, “I tried my best” or “I’m still learning and will get better.”) REBT works well with anxi - ety disorders and some mood disorders (such as some depressive disorders); it does not work well with lower-functioning individuals or with those who are not very verbal (or verbally astute).

Albert Bandura (b. 1925) created social learning theory, also known as modeling. Bandura postu - lated that we could learn by observing the behav - ior of others—whether in real life, on television, or in the movies—and then copying, or model - ing, those behaviors. Modeling is a very power - ful form of learning. How did you learn to read, ride a bicycle, or use a computer? Likely through modeling! Therefore, abnormal behavior is easy to explain from a modeling perspective. The indi - vidual sees a model demonstrate a behavior and either get rewarded for it or not, or get punished for it. If the model is rewarded for the behavior, the observer may think, “Hmm, he got rewarded, maybe I should do the same.” Then the observer copies what she sees and demonstrates the behav - ior. Of course this seems (and is, to a degree) rather Hemera/Thinkstock Bandura’s theory of modeling posits that we learn behavior by observing the behavior of others. The child pictured here is learning how to ride a bicycle by modeling the behaviors of his father. get81325_01_c01.indd 11 12/5/13 4:00 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories simplistic, but, in addition to biological factors, this might help to e\ xplain why certain behaviors run in families. For example, if an individual was abused as a child, he \ or she is more likely to be an abuser as an adult.

Aaron Beck (b. 1921) developed the cognitive perspective theory to examine the causes of unipolar depression, known just as depression to most people; this depression has one “pole” or dysfunctional mood state. These individuals have no \ history of mania and revert to a normal mood state when the depression lifts. Bipolar disorder has two poles and two dysfunctional mood states—a manic state and depression. The cognitive per - spective attributes abnormal behavior to faulty thinking—that is, to seeing life’s events in a negative fashion. Having these negative thoughts will lead to negative behavior, which can lead to developing unipolar depression. According to Beck, depression develops in childhood and adolescence because of what he calls negative schemas, or the tendency to see the world pessimistically or negatively. A schema is defined as the fundamental way in which people process information, typically about themselves (Gonca & Savasir, 2001).

Individuals acquire these negative schemas for a variety of reasons: for example, the death of a parent, repeated social rejection of peers, or one tragedy after another. These schemas are activated whenever the individual experiences a new situation that is \ similar to the conditions in which the negative schemas were learned. Beck also notes that these indi - viduals are prone to misinterpreting reality. Thus, they think irrationally and may believe that they are responsible for all of their family’s ills, that they are totally worthless, and so on. They may end up seeing themselves as hopeless and their chances of f\ uture success as limited or nonexistent.

These negative schemas and their accompanying cognitive distortions supp\ ort the nega- tive triad. Beck explained this in the following fashion: First, the person maintains a nega - tive view of him- or herself (“Everything I touch is ruined.”). The person also maintains a negative view of the environment (“No one could possibly get along with these room - mates.”). Finally, the person has a negative view of the future and sees things as hopeless (“No matter what I do, things will always turn out bad for me, so it\ is really hopeless to even try.”). Individuals who follow this triad set themselves up for failure and most likely depression by adopting these schemas. If they experience stress or disappointment, the likelihood of becoming depressed increases. In effect, the individual’s negative thoughts lead to negative behaviors (Beck, 1976; Beck, Rush, Shaw, & Emery, 1979).

Martin Seligman (b. 1942), a professor of psychology at the University of Pennsylvania (where Beck also taught), was inspired by Beck’s work and developed a theory of learned helplessness as it applies to depression. Again, keep in mind that even though we are specifically discussing depression, these theories can explain other mental illnesses, but not all. Seligman sees individuals developing depression, or perhaps anxiety disorders, because they see themselves as helpless to control the reinforcers in their environment, and therefore the environment itself; they cannot make positive changes in their lives. If individuals are consistently experiencing bad incidents (for example, they might say \ that they are having a bad month), Seligman would say that eventually the individua\ ls will resign themselves to the negativity as “fate.” Avoidance and escape behaviors then disap - pear and individuals see themselves as helpless to escape, prisoners of \ their environments and of their situations. Seligman and his colleagues later revised this theory and renamed it the reformulated helplessness theory. get81325_01_c01.indd 12 12/5/13 4:00 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories The initial theory had two major problems. First, the original the- ory does not distinguish between cases in which outcomes are uncontrollable for all people (called universal helplessness) and cases in which they are uncon- trollable only for some people (called personal helplessness). Sec- ond, the theory does not explain when helplessness is general and when it is specific, or when it is chronic and when it is acute.

The reformulation was based on a revised concept of attribution theory (Abramson, Seligman, & Teasdale, 1987; Taube-Schiff & Lau, 2008). According to this revision, once people perceive that they lack control over outcomes, they attribute their helplessness to a cause. This cause can be stable or unstable, global or specific, and internal or external.\ Humanism: 1950s Carl Rogers (1902–1987) created the client- or person-centered approach. Rogers believed in the innate goodness of all people, and in the ability of all people t\ o grow and to lead constructive lives. Rogers theorized that dys - function begins in infancy. Children who receive unconditional positive regard—when one person is completely accepting toward another person— from their parents early in life will grow up to become constructive and productive adults, even though they will have flaws. They will realize that they and their contributions are valued even with these flaws. In Rogerian therapy, clients attempt to look at themselves as being valuable worthwhile human beings. Those who have low self-esteem may be seen as being incongruent, or experiencing a mismatch between their idealized self-image and their true self-image. When this occurs anxiety and other issues result, and it is the therapist’s job, first, to be a model of congru - ence and empathize with the client. Then, the therapist will help the individual become con- gruent and to effectively feel better about him- or herself.

For a summary of all of the main theories and theo - rists in psychology’s history, see Table 1.1. RubberBall/SuperStock Children who receive unconditional positive regard from their parents early in life will grow up to become constructive and productive adults, even though they will have flaws. SuperStock According to the reformulated helplessness theory, some individuals develop depression or anxiety because they see themselves as prisoners of fate, unable to control their negative situations or environment. get81325_01_c01.indd 13 12/5/13 4:00 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories Table 1.1: The main theories and theorists in psychology’s history PsychologistTheory Explanation Sigmund Freud (1856–1939)Psychoanalytic Theory Individuals develop neuroses because of their unresolved conflicts (repressed id impulses surfacing and overwhelming the ego and superego) and because of problems occurring during childhood.

Albert Bandura (1925–) Social Learning Theory (Modeling) Individuals learn based on what they observe others (models) do in the world.

Albert Ellis (1913–2007) Rational Emotive Behavior Therapy Individuals develop disorders because of faulty thinking.

Aaron Beck (1921–) Cognitive Perspective Individuals develop depression in childhood and adolescence because of the tendency to see the world negatively.

Martin Seligman (1942–) Theory of Learned Helplessness Individuals develop disorders because they see themselves as helpless to control the environment around them. They therefore “give up” trying to change their situation and “grin and bear it.” Carl Rogers (1902–1987) Humanism Dysfunction begins in infancy. Children who receive unconditional positive regard —when one person is completely accepting toward another person—from their parents early in life will grow up to become constructive and productive adults, even though they will have flaws.

The Diathesis-Stress Model Next we will look at a model that straddles the two categories of cognit\ ive and biological theories. The diathesis-stress model contends that behaviors are a product of both genetics (biology) and environmental stressors. This is an interactionist model, which means that it views abnormal behavior as originating from a combination of genetic predisposition(s) (the diathesis) set off, or “turned on” (like a light switch), by environmental stressors (Holmes & Rahe, 1967).

We can examine this more closely by using an example. Many psychologists accept that schizophrenia runs in families and, therefore, that it has a genetic component. However, this does not guarantee that individuals born into a family with a histo\ ry of mental illness will have the disorder; it just means that they are more vulnerable to developing it, or per - haps another mental illness. They are essentially born with this gene “switched off,” and stress from the environment may or may not eventually “turn on” the gene. For example, \ let’s look at a young adult with a genetic predisposition for schizophrenia who uses illicit substances such as marijuana and heroin. Soon after the drugs’ effects have worn off, she get81325_01_c01.indd 14 12/5/13 4:00 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories begins to demonstrate schizo- phrenic behaviors and thoughts.

This demonstrates how the environment (the stress) turns on the diathesis (the genetic pre - disposition). If this individual has strong support systems, the diathesis is less likely to trigger the switch, and the illness is less likely to be expressed. This is a useful theory for the following reason: It removes some of the responsibility from individuals for contracting their illnesses.

It is not their fault, not a char - acter flaw; it is just the fact that they were born with this genetic predisposition. Biological Models: 1950s–Present The field of psychology reached a major milestone in the early 1950s when Henry Laborit (1914–1955) introduced a drug, Thorazine (generically known as chlorpromazine). This medication was initially used to tranquilize surgical patients, but Laborit noticed that it also managed to calm patients without putting them to sleep. Since patients with schizo - phrenia often exhibit perpetual agitated behavior, Laborit proposed using the drug to treat schizophrenic disorders. Many psychiatrists thought that his idea had no merit and stood by the practices of using electroshock therapy or psychotherapy to treat serious mental ill - nesses. However, a fellow surgeon informed his brother-in-law, the psychiatrist Pierre Deniker, about this possible use of Thorazine.

Deniker became interested and ordered some to try on his most agitated, uncontrollable patients.

The results stunned Deniker and his colleagues, as patients who needed to be restrained or who were uncommunicative were now open to communication and could be left unsupervised. The field of psychopharmacology (the study of the effect of drugs on the mind and behavior) was unofficially born, and the nature of mental illness treatment was changed forever. Universal Images Group/SuperStock In the diathesis-stress model, stressors like the pressure to perform and the tendency to binge drink in college can trigger the genetic predisposition to become an alcoholic. Peter Sickles/SuperStock Research in the early 1950s revealed that drugs commonly used during medical procedures could also be used to treat mental illness. get81325_01_c01.indd 15 12/5/13 4:00 PM CHAPTER 1 Section 1.2 A History of Abnormal Behavior Theories How do these psychotropic medications generally work? They increase or decrease levels of various neurotransmitters, brain chemicals that are presumed to be either at subnormal or supernormal levels in an individual with a mental illness (see Table 1.2 for a list of com- mon neurotransmitters). Most frequently, psychotropic medications are used to increase levels of the neurotransmitters serotonin and norepinephrine, which have been implicated in a variety of mental illnesses. For example, serotonin deficiencies have been implicated in depression as well as in bulimia nervosa, and high dopamine levels have been\ tied to schizophrenia. We’ll discuss these associations in more detail in Chapters 6, 7, and 8, respectively.

Table 1.2: Some common neurotransmitters Acetylcholine (ACH): Triggers muscle contractions; involved with muscle movement, memory, anger, and aggression.

Dopamine : Involved with muscle movement, mood, motivation, and reward-seeking behavior; also involved with Parkinson’s disease; hypothesized to be involved with schizophrenia and bipolar disorder.

Gamma-Amino Butyric Acid (GABA): Involved with movement and anxiety; involved with anxiety disorders (too little causes anxiety) and seizure disorder.

Glutamate: Involved with memory and learning; hypothesized to be involved with schizophrenia and some substance-related disorders.

Norepinephrine: Involved with stress, alertness, arousal, and reward-seeking behavior; hypothesized to be involved with anxiety and mood disorders.

Serotonin : Regulates mood, sex drive, appetite, body temperature, and sleep; involved with depression, eating disorders; may be involved with schizophrenia, bipolar disorder, and anxiety disorders.

The advent of psychotropic medications also led to some other changes in treatment for the mentally ill. For example, some of these individuals could now be released from inpa - tient units and be treated on an outpatient basis, freeing up facility beds and allowing the patients to lead more normal lives.

Today, a number of mental illnesses are treated with a combination of talk therapy and medications. Medications work well (for some) in alleviating the symptoms of some men- tal illnesses, but they do not eliminate all of the concerns that bring someone in for treat - ment. They also can produce side effects, some of which are quite significant, and some classes of medications have addictive potential. Therefore, medications should not be viewed as panaceas or be used as the sole treatment for a mentally ill person; neverthe - less, they should be used when advisable in conjunction with therapy. get81325_01_c01.indd 16 12/5/13 4:00 PM CHAPTER 1 Section 1.3 The DSM–5 Highlight: Do I Have a Mental Illness?

Have you ever felt sad or lonely and sat down in front of the television with a pint of ice cream to make yourself feel better? Did you feel like throwing up afterwards? Does this mean that you have bulimia nervosa? Does it mean you are depressed? If you are like many students, you may be tempted to self-diagnose your own behaviors as you learn about the disorders that will be described in the remainder of this book.

It may be that you are neither bulimic nor depressed, but you may have another condition: medical student syndrome (sometimes called medical school syndrome), wherein medical students often begin to believe that they are suffering from the disease they are studying. Consider that everyone overeats at some point in their lives, and everyone has days, perhaps many in a row, where they feel blue or depressed. We are all human and, like all humans, we have good days and bad days, and the bad days may sometimes include behaviors that could be mistaken for mental illness symptoms. However, rest assured that the diagnostic criteria in the DSM–5 (American Psychiatric Association [APA], 2013) require, in most instances, a duration of several months to at least two years before any diagnosis can be made.

If your behaviors are brief and occur only occasionally, you are probably acting “normally” and have little to worry about. You will learn more about symptoms and diagnosis of disorders in later chapters. If after reading more, you still think you may be suffering from mental illness, by all means, we encourage you to seek help. (One resource is the National Alliance on Mental Illness: http://www.nami.org/ ).

1.3 The DSM–5 The classification system to which psychologists and other helping professionals refer when making diagnoses concerning mental health issues is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5; APA, 2013). This manual has always been published by the American Psychiatric Association (APA) and covers all defined mental illnesses in both children and adults that were known at the time of publication. The book lists symptoms and signs that can help categorize the various illnesses.\ Symptoms are the patient’s subjective description of the complaints that they may have, while signs are gen- erally objective observations made by the diagnostician, either from an interview or some type of test that is given to the patient.

The Evolution of the DSM The DSM was first published in 1952 and has undergone several revisions since that time.

The sole purpose of the DSM was to classify and provide a descriptive explanation for all known mental disorders. The first version was 132 pages long, listed 106 disorders, and offered concise descriptions of major psychiatric diagnoses. This inventory w\ as an impor - tant advancement in the field of psychology and led to greater reliability of mental illness diagnoses because all researchers began to use the same criteria. The second edition was published in 1968 and included 182 disorders, yet it was quite similar to the DSM–I. Both the DSM–I and DSM–II emphasized the psychodynamic (Freudian) perspective, yet the DSM–II included sociological and biological knowledge about each disorder as well. get81325_01_c01.indd 17 12/5/13 4:00 PM CHAPTER 1 Section 1.3 The DSM–5 The third edition of the DSM was published in 1980 and was 494 pages long—quite a bit longer than the first edition. This edition included many important changes. For exam - ple, it addressed the fact that the first two editions neglected extraneous factors,\ such as medical conditions, environmental concerns, and life stressors, that may play a part in the development of mental illnesses. The DSM–III, unlike the DSM–I and DSM–II, was based on scientific evidence. Its reliability was improved with the addition of explicit diagnostic criteria. In short, the third edition acknowledged that many disorders do not have a single cause but are triggered by the cumulative effect of multiple factors (Mayes & Horwitz, 2005).

The third edition also introduced a new multiaxial system where disorders were evalu - ated on five different axes. Many of the disorders that are listed in the DSM–III have a high level of co-occurrence with other disorders. This is called co-morbidity (Fowler, O’Donohue & Lilienfeld, 2007). However, the idea of co-morbidity may not be accurate according to Drake and Wallach (2007) who feel that, rather than distinct conditions, many disorders could be a variation of a single underlying disorder.

Because of some inconsistencies in the criteria of some disorders, the APA issued a revi - sion of the DSM–III in 1987 and named it the DSM–III–R. This edition increased the cov - erage of psychopathologies. The next major revision of the DSM took place in 1994 with the publication of the DSM–IV, which had 943 pages and covered 373 different diagnoses (APA, 2000). Additional revisions were published in 2000 that included some corrections and updates to the content; this was called the DSM–IV–TR (Text Revision). The latest major revision is called the DSM-5 (APA, 2013). Table 1.3 summarizes the DSM series up to and including the DSM-IV-TR. To give you an idea how diagnostic criteria appear in the DSM–5, refer to Table 1.4, which shows the diagnostic criteria for bulimia nervosa.

Highlight: Removing Disorders From the DSM Did you know that until the DSM–III was published in 1980, homosexuality was considered to be a mental illness/mental disorder? The DSM task force decided to eliminate homosexuality in December 1973; this took place with the seventh printing of the DSM–II (1974). Technically, however, homosexu- ality was not completely removed (i.e., not mentioned at all) until the DSM–III was published. Also, did you know that Asperger’s syndrome (a pervasive developmental disorder that is a higher function- ing form of autism) has now been reclassified as an Autism Spectrum Disorder? If nothing else, these changes show how our views of what constitutes mental illness, how it is defined, and what each diagnosis entails, have changed over the years. What are your views on this? get81325_01_c01.indd 18 12/5/13 4:00 PM CHAPTER 1 Section 1.3 The DSM–5 Table 1.3: Summary of the DSM series from DSM-I through DSM-IV-TR VersionYear Published Length/# of Diagnoses Description/Changes DSM–I1952 132 pages/106 diagnoses Concise descriptions of major psychiatric diagnoses DSM–II 1968 136 pages/182 diagnoses Increased attention given to problems of children and adolescents with addition of Behavior Disorders of Childhood-Adolescence DSM–III 1980 494 pages/265 diagnoses Addressed the role of extraneous factors, such as medical conditions and life stressors, that may play a role in mental illness; introduced the new multiaxial system DSM–III–R 1987 567 pages/ 292 diagnoses Increased coverage of psychopathologies DSM–IV 1994 943 pages/373 diagnoses Included new clinically significant criteria in almost half the categories DSM–IV–TR 2000 943 pages/373 diagnoses Some information updated Source: Adapted from Andreasen and Black (2006). get81325_01_c01.indd 19 12/5/13 4:00 PM CHAPTER 1 Section 1.3 The DSM–5 Table 1.4: How the DSM–5 summary table appears for bulimia nervosa DSM–5 Diagnostic Criteria for Bulimia Nervosa (307.51) A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self- induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa. Specify if:

In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time.

In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Specify current severity: The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.

Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week. Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week. Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week. Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week. Source: American Psychiatric Association (APA, 2013, p. 345) How Do We Use the DSM–5?

The DSM–5 describes mental disorders and their symptoms and gives statistics and gen - der breakdowns for each disorder. This common diagnostic and classification system pro - vides a way for mental health professionals to communicate with each other about spe - cific disorders. The DSM–5 gives psychologists and other helping professionals a common communication system, where mental disorders and diagnostic criteria remain the same regardless of specialty area. Communicating a diagnosis about a patient to another mental health professional in a succinct manner is important in trying to get the patien\ t the help that he/she needs (Blashfield & Burgess, 2007). Using a standardized method of diagnosis leads to a better understanding of disorders and, as a consequence, better treatment. get81325_01_c01.indd 20 12/5/13 4:00 PM CHAPTER 1 Section 1.3 The DSM–5 There must be a high degree of reliability when a standardized classification system is used. Reliability refers to the consistency of the diagnostic system. Interrater reliability means that a test will have the same or similar results when used by different people.

The validity of a classification system, that is, the measurement or accuracy of the informa - tion in the diagnostic categories, is also clearly important. In other words, does the test measure or predict what it is supposed to? If it does, then we can say that the assessment technique is valid. For example, does an intelligence test really measure intelligence? It may measure “book smarts” but not “street smarts,” which is a type of intelligence.

The number of disorders now listed in the DSM–5 may make it easier to diagnose more individuals as having disorders. Although this results in several more types of mental illnesses, they are more distinct from each other now than they were several years ago.

Nevertheless, the problem remains: How do you diagnose someone who meets only three of the four required symptoms of a disorder? For example, someone who is anx - ious also commonly suffers from depression. That means that this particular individual will now have two different diagnostic labels—not just a single one that may encompass both aspects of the individual’s disorder.

The Medical Model All mental illnesses described in the DSM–5 are seen as having similar symptoms in common within each diagnostic category and subcategory. For example, all individuals suffering from bulimia nervosa will demonstrate binging behaviors as well as recurrent inappropriate compensatory behaviors (self-induced vomiting, abuse of laxatives, fasting, and so on). The mental illnesses listed in the DSM–5 are seen as being similar to physical diseases (i.e., all influenzas have the same general symptoms, all bronchial pneumonias have similar symptoms), hence the term medical model. In addition there is thought to be a physiological basis or cause for the individual’s problem(s). Those who endorse the medical model consider symptoms to be visible signs of the physical diso\ rder. Therefore if symptoms are grouped together and classified into a disorder such as bulimia nervosa, the true cause can eventually be discovered and appropriate physical treatment admin - istered. The behaviors that one demonstrates (hallucinations, depressed mood, fear of heights, and so on) are considered to be symptoms of a mental illness. The symptoms are clustered together to define various mental illnesses. Therefore, when psychologists attempt to diagnose a new patient, they will look at symptoms and see in\ to which DSM–5 category the symptoms fit. This is critical because it allows the helpin\ g professions to have a common language in which to communicate.

We would like to conclude with this thought: Many students, when they fir\ st encoun - ter the DSM–5, have the following reaction, “Well, where does this book tell me how to treat this complicated disorder?” The DSM–5 does not include treatment information; it is only, as its title states, a diagnostic manual that describes the disorders. Psychologists and others in the helping professions learn how to treat mental illnesses by direct practice, classwork, and, of course, studying and reading. We will discuss how to treat the most commonly presented mental illnesses in the remainder of this book. get81325_01_c01.indd 21 12/5/13 4:00 PM CHAPTER 1 Chapter Summary Chapter Summary How Do We Define Abnormal Behavior? • The statistical frequency perspective labels behavior as abnormal if it occurs rarely in relation to the behavior of the general population. • The social norms perspective considers behavior to be abnormal if the be\ havior deviates greatly from accepted social standards, values, or norms. • The maladaptive perspective views behavior as abnormal if it interferes with the individual’s ability to function in life or in society. A History of Abnormal Behavior Theories • During ancient times, mental illness was explained as the presence of “evil spir - its” within the body of the ill person. One method for treating mental illness was trepanning, in which a small instrument was used to bore holes in the skull to allow the evil spirits to leave the “possessed” person. • Hippocrates noted a connection between abnormal behavior and internal, p\ hysi - ological causes. • Sigmund Freud and Josef Breuer noticed that some of their patients presented physiological symptoms while having no physiological problems. Freud realized that one way to help these individuals was via psychoanalysis, or talk t\ herapy. • Freud’s theory includes the ideas of repression and the psyche, which consists of the id, ego, and superego; this theory emphasizes the importance of examining people’s unconscious minds. • B. F. Skinner and John Watson believed that abnormal behavior was environ - mentally caused, as an individual’s behavior was reinforced in the environment, therefore making it more likely to recur. • Albert Ellis, Albert Bandura, Aaron Beck, and Martin Seligman believed that a person’s thoughts (irrational, maladaptive, or otherwise) lead to\ , or cause, a person’s aberrant or abnormal behaviors. Bandura believed that a pers\ on learns abnormal behaviors by watching others perform them, and then the individ\ ual reproduces (or “models”) what he or she sees. • Carl Rogers believed that all humans are innately good and that problems arise when an individual is incongruent, that is, experiencing a mismatch between their idealized self-image and their true self-image. • The diathesis-stress model posits that abnormal behavior originates from a com - bination of genetic factors (the diathesis) triggered or “turned on” (like a light switch) by environmental stressors. • Biological models view mental illness as having biological origins, spec\ ifically neurotransmitter levels being too low or too high. Medications are often used to treat mental illnesses in this model. The DSM–5 • The DSM–5 describes mental disorders, their signs and symptoms, and gives statistics and gender breakdowns for each disorder. • The medical model views all mental illnesses described in the DSM–5 as having similar symptoms in common within each diagnostic category and subcatego\ ry. get81325_01_c01.indd 22 12/5/13 4:00 PM CHAPTER 1 Key Terms Critical Thinking Questions 1. What criteria would you use to determine whether someone’s behavior i\ s abnor - mal or not? 2. Discuss whether social norms should be used to determine/diagnose mental\ illness. 3. Behaviorists like Skinner focus on the present, not on the past or on a person’s upbringing. How successful would this approach be in psychotherapy, and why? 4. Which of the theories mentioned in this chapter do you think best explai\ ns the origins of mental illness? Why? 5. What are your views on Rogers’s concept of innate goodness? Do you think people are innately good or bad? 6. What are the pros and cons of using medications to treat mental illnesses? Key Terms ABC model A model of three components of how we experience and interpret events:

A, the activating event or adversity; B, the belief that follows; and C, the consequence. age of onset The age at which the trouble- some behaviors first become noticeable. behaviorists Psychologists who believe that only observable and scientifically measurable behaviors are worth studying and investigating. bipolar disorder A disorder with two poles and two dysfunctional mood states— a manic state and a depressed state. cognitive behaviorism A psychotherapeu - tic method that alters distorted attitudes by identifying and replacing negative and inaccurate thoughts, which will therefore lead to behavioral changes. cognitive perspective theory Aaron Beck’s theory that abnormal behavior is caused by faulty thinking such as viewing life events in a negative fashion. diathesis-stress model A model that contends behaviors are a product of both genetics (biology) and environmental stressors. duration The length of time the trouble- some behaviors have existed for a patient. eccentric Individuals who have odd or unusual habits but do not have a mental illness. ego A partially conscious part of the psyche (which develops when an infant is between 1½ and 3 years old) that seeks to control the id by “convincing” it to delay gratification until a reasonable solution to the drive reduction is found. id The primitive part of the personality, present from birth, that houses our uncon- scious desires, wishes, and our basic innate drives such as sex and aggression. intensity How extreme the behaviors in question are. learned helplessness Seligman’s theory that individuals develop depression or anxiety disorders because they see themselves as helpless to control their environments. legal norms Rules for behavior based on society’s laws. get81325_01_c01.indd 23 12/5/13 4:00 PM CHAPTER 1 Key Terms maladaptive perspective Behavior is deemed abnormal if it interferes with the individual’s ability to function. medical student syndrome Syndrome where medical students begin to believe they are suffering from the disease they are studying. modeling The idea that we can learn by observing the behavior of others. negative schema A view of the world that is negative or pessimistic. Beck believed this to be the cause of depression. neurotransmitters Brain chemicals; they are presumed to be at subnormal or super - normal levels in individuals with mental disorders. norms Spoken and unspoken rules for proper conduct that are established by a society over time and of course are subject to changes over time. overt behaviors Behaviors that are on the surface or clearly visible to others. psyche In Freudian theory, this consists of three parts: the id, the ego, and the superego. psychoanalytic theory The set of concepts that state individuals develop neuroses because of their unresolved conflicts, repressed id impulses surfacing and overwhelming the ego and superego, and problems that occurred during childhood. psychological norms Rules for behavior as codified in the DSM–5. psychopathology The study of the causes and development of psychiatric disorders. psychopharmacology The study of the treatment of mental illnesses with drugs and medication. reformulated helplessness theory Revised version of the helplessness theory that differentiates between universal and personal helplessness, as well as between helplessness that is general or specific. repression An ego defense mechanism that operates unconsciously to keep certain ideas, impulses, and memories from reach- ing consciousness. social norms perspective Behavior is deemed abnormal according to the stan- dards set by society statistical frequency perspective Behav- ior is deemed abnormal because it occurs rarely or in only a small minority of the population. superego The final part of the psyche; it develops when a child is between 3 and 6 years old and enables the individual to feel guilt and have a conscience. The superego is partially conscious and helps the ego to control the id’s desires. trepanning A process in which a small instrument is used to bore holes into the skull; the purpose may have been to release evil spirits from an afflicted person. unconditional positive regard When one person is completely accepting toward another person. Carl Rogers believed that people who receive unconditional posi- tive regard from their parents early in life will grow up to become constructive and productive adults. unipolar depression Known just as depression to most people; this depres- sion has one “pole” or dysfunctional mood state. get81325_01_c01.indd 24 12/5/13 4:00 PM CHAPTER 1