Fundamentals of Abnormal Psychology

196 Pages·2004·3.94 MB·English

by  Ronald J. Comer

art to come
C H A P T E R
1 Abnormal Psychology:
Past and Present
Topic Overview Alexandra cries herself to sleep every night. She is certain that the future
holds nothing but misery. Indeed, this is the only thing she does feel certain
about. “I’m going to die and my daughters are going to die. We’re doomed.
what is psychological
abnormality? The world is ugly. I now detest every moment of my life.” She has great trou-
ble sleeping. She is afraid to close her eyes, afraid that she will never wake
Deviance
up, and what will happen to her daughters then? When she does drift off to
Distress sleep, her dreams are nightmares filled with blood, dismembered bodies,
Dysfunction thunder, decay, death, destruction.
Danger
One morning Alexandra even has trouble getting out of bed. The thought of
The Elusive Nature of Abnormality facing another day frightens and overwhelms her. She wishes that she and
what is treatment? her daughters were dead. “Get it over with. We’d all be better off.” She feels
paralyzed by her depression and anxiety, too tired to move and too afraid to
how was abnormality leave her house. She decides to stay home and to keep her daughters with
viewed and treated in the her. She makes sure that all shades of the apartment are drawn and that every
past?
conceivable entrance is secured. She is afraid of the world and afraid of life.
Ancient Views and Treatments
Greek and Roman Views and During the past year Brad has been hearing mysterious voices that tell him
Treatments
to quit his job, leave his family, and prepare for the coming invasion. These
Europe in the Middle Ages: voices have brought tremendous confusion and emotional turmoil to Brad’s life.
Demonology Returns
He believes that they come from beings in distant parts of the universe who are
The Renaissance and the Rise of somehow wired to him. Although it gives him a sense of purpose and special-
Asylums
ness to be the chosen target of their communications, they also make him tense
The Nineteenth Century: Reform and anxious. He dreads the coming invasion. When he refuses an order, the
and Moral Treatment voices insult and threaten him and turn his days into a waking nightmare.
The Early Twentieth Century: The
Brad has put himself on a sparse diet against the possibility that his enemies
Somatogenic and Psychogenic
Perspectives may be contaminating his food. He has found a quiet apartment far from his
old haunts where he has laid in a good stock of arms and ammunition. His
current trends
family and friends have tried to reach out to Brad, to understand his prob-
How Are People with Severe lems, and to dissuade him from the disturbing course he is taking. Every day,
Disturbances Cared For? however, he retreats further into his world of mysterious voices and imagined
How Are People with Less Severe dangers.
Disturbances Treated?
A Growing Emphasis on
Preventing Disorders and
Promoting Mental Health Most of us would probably consider Alexandra’s and Brad’s emotions,
The Growing Influence of thoughts, and behavior psychologically abnormal, the result of a state
Insurance Coverage sometimes called psychopathology, maladjustment, emotional disturbance, or
mental illness (see Box 1–1 on page 4). These terms have been applied to
What Are Today’s Leading
Theories and Professions? the many problems that seem closely tied to the human brain or mind.
Psychological abnormality affects the famous and the obscure, the rich
crossroads: a work in
and the poor, the upright and the perverse. Politicians, actors, writers, and
progress
other public figures of the present and the past have struggled with it.
Psychological problems can bring great suffering, but they can also be the
source of inspiration and energy.
Because they are so common and so personal, these problems capture
the interest of us all. Hundreds of novels, plays, films, and television
programs have explored what many people see as the dark side of human
2 chapter 1
mages
Getty I
ures/
Pict
Universal
A
C
M
A Beautiful Mind Psychological disorders are a
popular subject in today’s movies, novels, and
television shows. The film A Beautiful Mind,for
example, which portrayed the struggles against
schizophrenia of Nobel Prize winner John Nash,
received the Academy Award for best picture of
the year in 2001.
nature, and self-help books flood the market. Mental health experts are popular
guests on both television and radio, and some even have their own shows.
The field devoted to the scientific study of the problems we find so fascinating
is usually called abnormal psychology. As in any science, workers in this field,
called clinical scientists, gather information systematically so that they may de-
scribe, predict, and explain the phenomena they study. The knowledge that they
acquire is then used by clinical practitioners, whose role is to detect, assess, and
treat abnormal patterns of functioning.
What Is Psychological Abnormality?
Although their general goals are similar to those of other scientific professionals,
clinical scientists and practitioners face problems that make their work especially
difficult. One of the most troubling is that psychological abnormality is very hard
to define. Consider once again Alexandra and Brad. Why are we so ready to call
their responses abnormal?
Although many definitions of abnormality have been proposed over the years,
none is universally accepted (Woolfolk, 2001). Still, most of the definitions have
certain features in common, often called “the four D’s”: deviance, distress, dys-
function, and danger. That is, patterns of psychological abnormality are typically
deviant (different, extreme, unusual, perhaps even bizarre); distressing (unpleas-
ant and upsetting to the person); dysfunctional(interfering with the person’s abil-
ity to conduct daily activities in a constructive way); and possibly dangerous. These
criteria offer a useful starting point from which to explore the phenomena of psy-
>>BY THE NUMBERS
chological abnormality. As we shall see, however, they have key limitations.
Deviance
39% People who confess to snooping in Deviance
their hosts’medicine cabinets<<
Abnormal psychological functioning is deviant, but deviant from what?
27% Those who admit taking more than the Alexandra’s and Brad’s behaviors, thoughts, and emotions are different from
maximum number of items through a those that are considered normal in our place and time. We do not expect people
supermarket express line<<
to cry themselves to sleep each night, wish themselves dead, or obey voices that
23% Those who confess to not flushing the no one else hears.
toilet all the time<< In short, behavior, thoughts, and emotions are deemed abnormal when they
10% Those who believe they have seen a violate a society’s ideas about proper functioning. Each society establishes norms—
ghost<< explicit and implicit rules for proper conduct. Behavior that violates legal norms
is called criminal. Behavior, thoughts, and emotions that violate norms of psy-
5% Those who have sunbathed nude<<
chological functioning are called abnormal.
(Kanner, 1995) Judgments of abnormality vary from society to society. A society’s norms grow
from its particular culture—its history, values, institutions, habits, skills, tech-
Abnormal Psychology: Past and Present 3
Carol Beckwith Gardin Stringer/AP
Patrick
Deviance and abnormality Along the Niger River, men of the
Wodaabe tribe put on elaborate makeup and costumes to attract
women. In Western society, the same behavior would break
behavioral norms and probably be judged abnormal.
Changing times Two decades ago, a woman’s love for bullfighting would
have been considered strange, perhaps even abnormal. Today Cristina
Sánchez is one of Spain’s finest matadors and is considered a role model.
nology, and arts. A society that values competition and assertiveness may accept
aggressive behavior, whereas one that emphasizes cooperation and gentleness may
consider aggressive behavior unacceptable and even abnormal. A society’s values
may also change over time, causing its views of what is psychologically abnormal
to change as well. In Western society, for example, a woman’s participation in the
business world was widely considered inappropriate and strange a hundred years
ago. Today the same behavior is valued.
Judgments of abnormality depend on specific circumstances as well as on cul-
tural norms. What if, for example, we were to learn that the fears and desperate
unhappiness of Alexandra were in fact occurring in the days following the deadly
terrorist attack on the World Trade Center on September 11, 2001—an attack that
killed her husband as he was at work on the 94th floor of the North Tower and
wrecked the family’s nearby apartment, shattering the secure and happy life they
had all once known? In the ensuing weeks, as the horror and losses settled in, as
she came to the conclusion that her missing husband must indeed be dead, as she
and her daughters moved from one temporary location to another, Alexandra
stopped expecting anything except more of the same. In this light, Alexandra’s re-
actions do not seem quite so inappropriate. If anything is abnormal here, it is her
situation. Many painful human experiences produce intense reactions—large-
scale catastrophes and disasters, rape, child abuse, war, terminal illness, chronic
pain (Resick, 2000; Ursano et al., 1999). Is there an “appropriate” way to react to
such things? Should we ever call reactions to them abnormal?
Distress abnormal psychology
The scientific
study of abnormal behavior in order to de-
Even functioning that is considered unusual does not necessarily qualify as ab-
scribe, predict, explain, and change abnor-
normal. According to many clinical theorists, behavior, ideas, or emotions usually mal patterns of functioning.
have to cause distress before they can be labeled abnormal. Consider the Ice
norms
A society’s stated and unstated
Breakers, a group of people in Michigan who go swimming in lakes throughout
rules for proper conduct.
the state every weekend from November through February. The colder the
culture
A people’s common history, val-
weather, the better they like it. One man, a member of the group for 17 years, says
ues, institutions, habits, skills, technology,
he loves the challenge. Man against the elements. A 37-year-old lawyer believes and arts.
that the weekly shock is good for her health. “It cleanses me,” she says. “It perks
4 chapter 1
B O X 1–1
Verbal Debuts
W
e use words like “abnormal” and similar words (including slang
and “mental disorder” so often terms) make their debut in print as ex-
that it is easy to forget that there was pressions of psychological dysfunc-
a time not that long ago when these tioning? The Oxford English Dictionary
terms did not exist. When did these offers the following dates.
abnormal
insanity psychopathology
distressed psychiatric
unstable disturbed unbalanced maladjustment
1200 1300 1400 1500 1600 1700 1800 1900 2000
madness “crazy” “nuts” mental
dysfunctional
(slang) (slang) illness
psychological mentally
handicapped
deviant
me up and gives me strength.” Another Ice Breaker likes the special bond the
group members share. “When we get together, we know we’ve done something
special, something no one else understands. I can’t even tell most of the people I
know that I’m an Ice Breaker.”
Certainly these people are different from most of us, but is their behavior ab-
normal? Far from experiencing distress, they feel energized and challenged. Their
positive feelings must cause us to hesitate before we decide that they are func-
tioning abnormally.
A spiritual experience In the Val d’Isère, Should we conclude, then, that feelings of distress must always be present be-
France, students bury themselves in snow up to fore a person’s functioning can be considered abnormal? Not necessarily. Some
their necks. Far from experiencing distress or
people who function abnormally maintain a positive frame of mind. What if this
displaying abnormality, they are engaging in a
were the case with Brad, the young man who hears mysterious voices? Brad does
Japanese practice designed to open their hearts
and enlarge their spirits. experience severe distress over the coming invasion and the life changes he feels
forced to make. But what if he enjoyed listening to the voices, felt
ma Liaison hShoonuolrdend’ tt ow eb es ticlhl oresgeanr,d a hnids fluonokcteido nfionrgw aarsd a bton osramvianlg? Aths ew we oshrladl?l
m
Ga discover in Chapter 8, people whose behaviors are described as
mande/ manic often feel just wonderful, yet still they are diagnosed as psy-
Alle chologically disturbed. Indeed, in many cases it is their euphoria
Catherine adnatdesd fiospr rtohpios rdtiiaognnaotes iss.ense of well-being that make them candi-
Dysfunction
Abnormal behavior tends to be dysfunctional; that is, it interferes
with daily functioning. It so upsets, distracts, or confuses people
that they cannot care for themselves properly, participate in ordi-
nary social interactions, or work productively. Brad, for example,
has quit his job, left his family, and prepared to withdraw from the
productive life he once led.
Here again one’s culture plays a role in the definition of abnor-
mality. Our society holds that it is important to carry out daily ac-
tivities in an effective, self-enhancing manner. Thus Brad’s behavior
is likely to be regarded as abnormal and undesirable, whereas that
Abnormal Psychology: Past and Present 5
of the Ice Breakers, who continue to perform well in their jobs and enjoy fulfill-
ing relationships, would probably be considered simply unusual. >>IN THEIR WORDS
Then again, dysfunction alone does not necessarily indicate psychological ab- Mental Dysfunction
normality. Some people (Gandhi or César Chávez, for example) fast or in other
“The only difference between me and a mad-
ways deprive themselves of things they need as a means of protesting social in-
man is that I am not mad.”<<
justice. Far from receiving a clinical label of some kind, they are widely viewed as
Salvador Dali
admirable people—caring, sacrificing, even heroic.
“Insanity: doing the same thing over and over
again and expecting different results.”<<
Danger
Albert Einstein
Perhaps the ultimate in psychological dysfunctioning is behavior that becomes
“Insanity—a perfectly rational adjustment to
dangerousto oneself or others. Individuals whose behavior is consistently careless, an insane world.”<<
hostile, or confused may be placing themselves or those around them at risk. R. D. Laing
Brad, for example, seems to be endangering himself by his diet and others by his
“The distance between insanity and genius is
buildup of arms and ammunition.
measured only by success.”<<
Although danger is often cited as a feature of abnormal psychological func-
James Bond in Tomorrow Never Dies
tioning, research suggests that it is actually the exception rather than the rule
(Monahan, 2001, 1993, 1992; Linaker, 2000). Despite popular misconceptions, “One of the symptoms of an approaching ner-
vous breakdown is the belief that one’s work
most people struggling with anxiety, depression, and even bizarre thinking pose
is terribly important.”<<
no immediate danger to themselves or to anyone else.
Bertrand Russell
The Elusive Nature of Abnormality
If the concept of abnormality depends so heavily on social norms and values, it is
no wonder that efforts to define psychological abnormality typically raise as many
questions as they answer. Ultimately, each society selects general criteria for defin-
ing abnormality and then uses those criteria to judge particular cases.
Noting society’s role in this process, one clinical theorist, Thomas Szasz (2000,
1997, 1970), argues that the whole concept of mental illness is invalid, a myth of
sorts. According to Szasz, the deviations that society calls abnormal are simply
“problems in living,” not signs of something wrong within the person. Societies,
he is convinced, invent the concept of mental illness so that they can better con-
trol or change people whose unusual patterns of functioning upset or threaten the
social order.
Even if we assume that psychological abnormality is a valid concept and that
it can indeed be defined, we may be unable to apply our definition consistently. If
a behavior—excessive use of alcohol among college students, say—is familiar
enough, the society may fail to recognize that it is deviant, distressful, dysfunc-
tional, and dangerous. Thousands of college students throughout the United
States are so dependent on alcohol that it interferes with their personal and aca-
demic lives, causes them great discomfort, jeopardizes their health, and often en-
dangers them and the people around them. Yet their problem often goes
unnoticed, certainly undiagnosed, by college administrators, other students, and
health professionals. Alcohol is so much a part of the college subculture that it is
easy to overlook drinking behavior that has become abnormal.
Conversely, a society may have trouble distinguishing between an abnormality
that requires intervention and an eccentricity,or marked individuality, with which
others have no right to interfere. From time to time we see or hear about people
who behave in ways we consider strange, such as a man who lives alone with two
dozen cats and rarely talks to other people. The behavior of such people is deviant,
and it may well be distressful and dysfunctional, yet many professionals think of
it as eccentric rather than abnormal (see Box 1–2 on the next page).
In short, while we may agree to define psychological abnormalities as patterns
of functioning that are deviant, distressful, dysfunctional, and sometimes dan-
gerous, we should be clear that these criteria are often vague and subjective. When
is a pattern of behavior deviant, distressful, dysfunctional, and dangerous enough
to be considered abnormal? The question may be impossible to answer. Few of the
current categories of abnormality that we will meet in this book are as clear-cut
as they may seem, and most continue to be debated by clinicians.
6 chapter 1
B O X 1–2
Marching to a Different Drummer: Eccentrics
Gary Holloway, an environmental reviews seem to have started the ball many as 1 in 5,000 persons may be
planner in San Francisco, keeps a veri- rolling (Pickover, 1998; Weeks & “classic, full-time eccentrics.” Men and
table stable of hobbyhorses. He is also James, 1995). women seem equally prone to such
fascinated by Martin Van Buren. . . . He For example, the researcher David patterns.
discovered that Van Buren was the only Weeks studied 1,000 eccentrics over a Weeks suggests that eccentrics do
U.S. president not to have a society
10-year period and was able to pin- not typically suffer from mental disor-
dedicated to his memory, so he
point 15 characteristics common to ders. Whereas the unusual behavior of
promptly founded the Van Buren Fan
them. Altogether, he estimates that as persons with mental disorders is thrust
Club. Holloway is a lifelong devotee of
St. Francis of Assisi, and frequently
dresses in the habit of a Franciscan
monk. “It’s comfortable, fun to wear,
awneda rI ilti,k” eh teh eex rpelsapinosn.s “eP eI ogpelte w ahlwena yIs of- ma Liaison
fer me a seat on the bus.” Gam
(WEEKS & JAMES, 1995, PP. 29, 36–37)
T
he dictionary defines an eccen-
tric as a person who deviates
from common behavior patterns or Eccentricity takes a break
Gene Pool, a 37-year-old
displays odd or whimsical behavior.
carpenter, journeys repeatedly
But how can we separate a psycholog-
around New York City wearing
ically healthy person who has unusual an outfit made of 500 empty
habits from a person whose oddness cans. The reason? To make a
statement about the need for
is a symptom of psychopathology? For
recycling and to be noticed.
years, little research was done on ec- Here he rests for a while on a
centrics, but some recent studies and city park bench.
What Is Treatment?
Once clinicians decide that a person is indeed suffering from some form of psy-
chological abnormality, they seek to treat it. Treatment,or therapy,is a procedure
designed to change abnormal behavior into more normal behavior; it, too, re-
quires careful definition (Compas & Gotlib, 2002). For clinical scientists, the
problem is closely related to defining abnormality. Consider the case of Bill:
February:He cannot leave the house; Bill knows that for a fact. Home is the only
place where he feels safe—safe from humiliation, danger, even ruin. If he were
to go to work, his co-workers would somehow reveal their contempt for him. A
pointed remark, a quizzical look—that’s all it would take for him to get the mes-
sage. If he were to go shopping at the store, before long everyone would be star-
ing at him. Surely others would see his dark mood and thoughts; he wouldn’t be
able to hide them. He dare not even go for a walk alone in the woods—his heart
would probably start racing again, bringing him to his knees and leaving him
breathless, incoherent, and unable to get home. No, he’s much better off staying
in his room, trying to get through another evening of this curse called life.
treatment A procedure designed to help July:Bill’s life revolves around his circle of friends: Bob and Jack, whom he
change abnormal behavior into more nor- knows from the office, where he was recently promoted to director of customer
mal behavior. Also called therapy. relations, and Frank and Tim, his weekend tennis partners. The gang meets for
Abnormal Psychology: Past and Present 7
upon them and usually causes them trics. The first 5 are the most defini- Famous Eccentrics
suffering, eccentricity is chosen freely tive, but possessing any 10 may ✣ James Joyce always carried a tiny
and provides pleasure. In short, qualify a person as an eccentric. pair of lady’s bloomers, which he
“Eccentrics know they’re different and ✣ Nonconforming waved in the air to show approval.
glory in it” (Weeks & James, 1995, ✣ Creative ✣ Emily Dickinson always wore
p. 14). Similarly, the thought processes
white, never left her room, and hid
of eccentrics are not severely dis- ✣ Strongly curious her poems in tiny boxes.
rupted, and they do not leave the per-
✣ Idealistic ✣ Benjamin Franklin took “air baths”
son dysfunctional.
In fact, Weeks found that ec- ✣ Happily obsessed with a hobby (of- for his health, sitting naked in
ten more than one) front of an open window.
centrics actually had fewer emotional
problems than the general population. ✣ Aware from early childhood of be- ✣ President John Quincy Adams
Perhaps being an “original” is good for ing different from others swam nude in the Potomac River
mental health. The eccentrics in his ✣ Intelligent each morning.
study also seemed physically healthier ✣ Alexander Graham Bell covered
✣ Opinionated and outspoken
than others, visiting a doctor only the windows of his house to keep
once every eight years on average. ✣ Noncompetitive out the rays of the full moon. He
Weeks concludes that most eccentrics, ✣ Unusual eating or living habits also tried to teach his dog how to
despite their deviant behavior— talk.
perhaps even because of it—are happy, ✣ Not interested in the opinions or ✣ The writer D. H. Lawrence enjoyed
company of others
well-adjusted, and joyful people. removing his clothes and climbing
✣ Mischievous sense of humor mulberry trees.
Are You Eccentric?
✣ Single (ASIMOV, 1997; WEEKS & JAMES, 1995)
According to Weeks, the following 15
✣ Eldest or only child
qualities (in descending order of im-
portance) are characteristic of eccen- ✣ Bad speller
dinner every week at someone’s house, and they chat about life, politics, and
their jobs. Particularly special in Bill’s life is Janice. They go to movies, restau-
rants, and shows together. She thinks Bill’s just terrific, and Bill finds himself
beaming whenever she’s around. Bill looks forward to work each day and his
one-on-one dealings with customers. He is enjoying life and basking in the glow
of his many activities and relationships.
Bill’s thoughts, feelings, and behavior interfered with all aspects of his life in
February. Yet most of his symptoms had disappeared by July. All sorts of factors
may have contributed to Bill’s improvement. Friends and family members may
have offered support or advice. A new job or vacation may have lifted his spirits.
Perhaps he changed his diet or started to exercise. Any or all of these things may
have been useful to Bill, but they could not be considered treatment, or therapy.
Those terms are usually reserved for special, systematic procedures that are de-
signed to help people overcome their psychological difficulties. According to the
clinical theorist Jerome Frank, all forms of therapy have three essential features:
1. A sufferer who seeks relief from the healer.
2. A trained, socially accepted healer, whose expertise is accepted by the
sufferer and his or her social group.
8 chapter 1
3. A series of contacts between the healer and the sufferer, through which
the healer, often with the aid of a group, tries to produce certain
changes in the sufferer’s emotional state, attitudes, and behavior.
(Frank, 1973, pp. 2–3)
Frank’s definition seems straightforward enough, yet clinicians argue about
how to apply it. Carl Rogers, a pioneer in the modern clinical field whom we will
meet in Chapter 3, noted that “therapists are not in agreement as to their goals
or aims. . . . They are not in agreement as to what constitutes a successful out-
come of their work. They cannot agree as to what constitutes a failure. It seems
as though the field is completely chaotic and divided.”
Some clinicians view abnormality as an illness and so consider therapy a pro-
cedure that helps cure the illness. Others see abnormality as a problem in living
and therapists as teachers of more functional behavior and thought. Clinicians
even differ on what to call the person undergoing therapy: those who see abnor-
mality as an illness speak of the “patient,” while those who view it as a problem
in living refer to the “client.” Because both terms are so common, this book will
use them interchangeably.
Despite their differences, most clinicians do agree that large numbers of peo-
ple need therapy of one kind or another. Later we shall encounter evidence that
therapy is indeed often helpful (Clements, 2002; Chambless & Ollendick, 2001).
How Was Abnormality Viewed and
Treated in the Past?
In any given year as many as 30 percent of the adults and 20 percent of the chil-
dren and adolescents in the United States display serious psychological distur-
bances and are in need of clinical treatment (Narrow et al., 2002; Kessler et al.,
2001, 1994; Kazdin, 2000). It is estimated that up to 19 of every 100 adults have
a significant anxiety disorder, 10 suffer from profound depression, 5 display a per-
sonality disorder (inflexible and maladaptive personality traits), 1 has schizo-
phrenia (loses touch with reality for an extended period of time), 1 experiences
the brain deterioration of Alzheimer’s disease, and 11 abuse alcohol or other
drugs. Add to these figures as many as 600,000 suicide attempts, 500,000 rapes,
and 3 million cases of child abuse each year, and it becomes apparent that ab-
normal psychological functioning is a pervasive problem in this country. The
numbers and rates in other countries are similarly high. Furthermore, most peo-
ple go through periods of extreme tension, demoralization, or other forms of psy-
chological discomfort in their lives and at such times experience at least some of
the distress associated with psychological disorders.
It is tempting to conclude that unique characteristics of the modern world are
responsible for these numerous emotional problems—perhaps rapid technological
change, the growing threats of terrorism, or a decline in religious, family, or other
support systems (Schumaker, 2001). Although the special pressures of modern
life probably do contribute to psychological dysfunctioning, they are hardly its pri-
mary cause. Historical records demonstrate that every society, past and present,
trephination
An ancient operation in has witnessed psychological abnormality. Perhaps, then, the proper place to begin
which a stone instrument was used to cut our examination of abnormal behavior and treatment is in the past.
away a circular section of the skull, perhaps
As we look back, we can see how each society has struggled to understand and
to treat abnormal behavior.
treat psychological problems, and we can observe that many present-day ideas and
exorcism
The practice in early societies
treatments have roots in the past. A look backward makes it clear that progress in
of treating abnormality by coaxing evil spir-
the understanding and treatment of mental disorders has hardly been a steady
its to leave the person’s body.
movement forward. In fact, many of the inadequacies and controversies that
humors
According to Greek and Roman
mark the clinical field today parallel those of the past. At the same time, looking
physicians, bodily chemicals that influence
mental and physical functioning. back can help us to appreciate the significance of recent breakthroughs and the
importance of the journey that lies ahead.
Abnormal Psychology: Past and Present 9
Ancient Views and Treatments
Mbaosesdt oofn o uinr fkenreonwcleesd mgea odfe pfrreohmis taorrcihc aseooclioetgiiecsa lh adsis bceoevner aiecsq.u Hiriesdto irnidanirse cstclryu atnindi zies Verano
W.
tchluee su ntoe aprethoepdle ’bso cnuesst,o amrtsw aonrdk , baenlide fso.t hAenry rceomnncalunstiso nosf aarnec iaetn bt essotc tieentiteast itvoe fainndd John
are always subject to revision in the face of new discoveries.
Thus our knowledge of how ancient societies viewed and treated people with
mental disturbances is limited. Most historians believe that prehistoric societies
regarded abnormal behavior as the work of evil spirits. These early societies ap-
parently explained all phenomena as resulting from the actions of magical, some-
times sinister beings who controlled the world. In particular, they viewed the
human body and mind as a battleground between external forces of good and evil.
Abnormal behavior was typically interpreted as a victory by evil spirits, and the
cure for such behavior was to force the demons from a victim’s body.
This supernatural view of abnormality may have begun as far back as the Stone
Age, a half-million years ago. Some skulls from that period recovered in Europe
and South America show evidence of an operation called trephination,in which
a stone instrument, or trephine, was used to cut away a circular section of the
skull. Historians surmise that this operation was performed as a treatment for se-
vere abnormal behavior—either hallucinations, in which people saw or heard
things not actually present, or melancholia, characterized by extreme sadness and
immobility. The purpose of opening the skull was to release the evil spirits that
were supposedly causing the problem (Selling, 1940). Expelling evil spirits The two holes in this skull
In recent decades, some historians have questioned whether Stone Age people recovered from ancient times indicate that the
actually believed that evil spirits caused abnormal behavior. Trephination may in- person underwent trephination, possibly for the
purpose of releasing evil spirits and curing
stead have been used to remove bone splinters or blood clots caused by stone
mental dysfunctioning.
weapons during tribal warfare (Maher & Maher, 1985). Either way, later societies
clearly did attribute abnormal behavior to possession by demons. Egyptian,
Chinese, and Hebrew writings all account for psychological deviance this way. The
Bible, for example, describes how an evil spirit from the Lord affected King Saul
and how David feigned madness in order to convince his enemies that he was vis-
ited by divine forces.
The treatment for abnormality in these early societies was often exorcism.
The idea was to coax the evil spirits to leave or to make the person’s body an un-
comfortable place in which to live. A shaman,or priest, might recite prayers, plead
with the evil spirits, insult them, perform magic, make loud noises, or have the
person drink bitter potions. If these techniques failed, the shaman performed a
more extreme form of exorcism, such as whipping or starving the person.
Greek and Roman Views and Treatments
In the years from roughly 500 B.C. to A.D. 500, in the flourishing Greek and
Roman civilizations, philosophers and physicians identified a number of mental
disorders. Heading the list were melancholia, a condition marked by unshakable
sadness; mania, a state of euphoria and frenzied activity; dementia, a general in-
tellectual decline; hysteria, the presence of a physical ailment with no apparent
physical cause; delusions,blatantly false beliefs; and hallucinations,the experience
of imagined sights or sounds as if they were real. Although demonological inter-
pretations of mental and physical illness were still widespread, philosophers and
physicians began to offer alternative explanations during this period.
Hippocrates (460–377 B.C.), often called the father of modern medicine, taught
that illnesses had natural causes. He saw abnormal behavior as a disease arising
from internal physical problems. Specifically, he believed that some form of brain
pathology was the culprit and that it resulted—like all other forms of disease, in
his view—from an imbalance of four fluids, or humors, that flowed through
the body: yellow bile, black bile, blood, and phlegm. An excess of yellow bile, for ex-
ample, caused mania; an excess of black bile was the source of melancholia. To
treat psychological dysfunctioning, Hippocrates sought to correct the underlying