Not So Abnormal Psychology: A Pragmatic View of Mental Illness

258 Pages·2015·1.96 MB·English

by  Ronald B. Miller

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APA_NotSoAbnormal_Miller__title_APA Not So Abnormal Title 5/11/15 4:30 PM Page 2
Not So Abnormal
Psychology
A Pragmatic View
of Mental Illness
Ronald B. Miller
American Psychological Association
Washington, DC
Copyright © 2015 by the American Psychological Association. All rights reserved. Except
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prior written permission of the publisher.
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Psychological Association.
Library of Congress Cataloging-in-Publication Data
Miller, Ronald B., 1948- , author.
Not so abnormal psychology : a pragmatic view of mental illness / by Ronald B. Miller.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4338-2021-2 — ISBN 1-4338-2021-8
I. American Psychological Association, issuing body. II. Title.
[DNLM: 1. Mental Disorders. 2. Psychopathology—methods. WM 140]
RC454
616.89—dc23
2015007659
British Library Cataloguing-in-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America
First Edition
http://dx.doi.org/10.1037/14693-000
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CONTENTS
Preface ........................................................................................................ vii
Chapter 1. The Personal Allure of a Behavioral Science .................. 3
Chapter 2. T he Social, Political, Historical,
and Philosophical Context ............................................ 33
Chapter 3. T heoretical Models of Abnormal Psychology:
Approaches to Diagnosis, Assessment,
and Development ........................................................... 61
Chapter 4. Psychological Suffering in Childhood ........................... 95
Chapter 5. Anxiety and Related Forms of Suffering ...................... 121
Chapter 6. Depression, Suicide, and Anorexia .............................. 145
Chapter 7. Personality Patterns That Engender Suffering ............. 165
Chapter 8. Schizophrenia: Psychiatry’s Poster Child .................... 185
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Afterword ................................................................................................. 209
References ................................................................................................ 215
Index ........................................................................................................ 237
About the Author .................................................................................... 247
vi contents
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PREFACE
Traditionally, the abnormal psychology textbook is structured around
the diagnostic categories in the American Psychiatric Association’s diagnos-
tic reference work, the Diagnostic and Statistical Manual of Mental Disorders
(5th ed.; DSM–5; American Psychiatric Association, 2013). Chapters describe
and explain the various “mental disorders” and their treatment in terms of
the culturally dominant biomedical model, augmented by that theory from
contemporary clinical psychology that is also most consistent with cultur-
ally dominant views, namely, the cognitive–behavioral approach to diagnosis
and treatment. Humanistic, psychodynamic, community, and family systems
models for understanding and treating such disorders are introduced but rarely
mentioned after an introductory chapter on theories, because they are said to
have little traditional empirical support.
This is not a bad pedagological strategy if one wishes to train students
for careers doing research in abnormal/clinical psychology on the abstract
principles of developmental psychopathology or behavior change. However,
if one wants to prepare students to think effectively in the realm of clinical
practice, one has to start with the concepts and theories that have emerged
from the realm of clinical practice itself, augmented as necessary by the
work of pure theoreticians or scientists. In this book, I draw heavily on the
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concepts and theories in the clinical practice traditions in psychology that I
have found in almost 40 years of practice to have pragmatic value—namely,
the humanistic, psychodynamic, community, and family systems approaches
to clinical work. I have spent 3 decades immersed in various aspects of theo-
retical and philosophical psychology focusing on issues in the philosophy of
science, the moral judgments implicit in psychological theories, the role of
case studies in developing the knowledge base of clinical practice, and the
politics of mental health. In so doing, I have sought to understand why these
approaches that made so much sense to me came to be supplanted, broadly
within psychology, by the biomedical and cognitive–behavioral approaches
that are governed by scientific theory.
In Chapter 1, I acknowledge the literatures in these areas that have heav-
ily influenced my thinking, so much so that in writing this introductory text-
book, I have often been hard-pressed to identify which ideas and arguments
from these traditions are best attributed to which authors and which are part
of the intellectual climate in which I have operated for so long. I acknowl-
edge my indebtedness to these academic and intellectual communities and
hope those who may not have been cited will forgive any oversight on my
part and be pleased to see an introductory textbook in abnormal psychol-
ogy fairly representing points of view that undergraduate students have long
been denied access to. Because the predominant biomedical model cannot be
ignored, I have carefully reviewed the literature on the genetic, physiological,
and neuros cience aspects of mental disorders, and the effectiveness of treat-
ment with pharmaceutical drugs, looking particularly at the quality of research
rather than simply the frequency of citations in the literature.
One can take a traditional course in abnormal psychology without hav-
ing gained much practical knowledge about how to understand the psychologi-
cal difficulties in one’s own life or how to effectively address such difficulties in
the lives of one’s loved ones. This comes as no surprise when one understands
that often at large research universities, the individuals teaching such courses
have a purely theoretical interest in understanding such disorders and little
knowledge or interest in the practical task of actually being therapeutic
when working with such clients (patients). Attending to the immediate suf-
fering of “mental patients” or psychotherapy clients in the here and now is all
too often of little interest or import.
This is a tremendous squandering of psychology’s resources. It is also a
tragic lost opportunity to improve the lives of the million or more college stu-
dents each year who take a course in abnormal psychology and who ought to
emerge from this course with a pragmatic understanding of themselves and
how to cope with the psychological stressors and problems so typical of late
adolescence and young adulthood. This is a critical developmental period
during which those students who are overwhelmed with new responsibilities,
viii preface
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environments, and work demands often are at increased risk of depression,
anxiety, substance abuse, self-harm, and first psychotic breaks.
The goal of this volume is to be such a text—to provide undergraduate
students (and other interested readers) with an introduction to abnormal
psychology that is theoretically grounded and historically informed, while at
the same time promoting the understanding of self and others that is critical
to emotional health and well-being. To this end, I freely discuss the kind of
personal struggles I have encountered both as a child and later as an aspiring
psychologist, and I have integrated case studies into each chapter as a way of
acknowledging that the subject matter of the book is the challenge all of
us face as we attempt to make a life for ourselves, care for those we love,
and navigate the complex physical and social environments that we inhabit.
Deeply troubling states of mind, emotions, and behavior patterns are
not abstract scientific entities, but are instead the lived experiences of
human suffering. My unabashed goal is for readers to both know more about
abnormal psychology as a subdiscipline of psychology proper and to know
more about themselves and the people they care about in a manner that
eases some of the pain of human existence, especially that of being a young
or emerging adult in our highly stressful society. Consequently, I have focused
the case studies whenever possible on college students to illustrate the appli-
cation of concepts and strategies that are applicable across the life span.
I am indebted to the good people of Saint Michael’s College for the
opportunity to teach and write on topics related to this book over a period
of 30 years. The department of psychology’s administrative assistant, Diana
Hoppe, provided technical support and kept the master’s program in clinical
psychology that I direct functioning smoothly while I was preoccupied at times
with this project. In those times when the preoccupation became burdensome,
the encouragement of my longtime colleague Dr. Susan Kuntz proved invalu-
able, as did that of Tara Arcury, assistant to the president, who also offered
technical assistance with the manuscript. The following graduate students pro-
vided assistance in reviewing scientific and clinical literature for this project:
Meaghan Pilling, Kristin Robideau, Jennifer Moore, Monica Lawson, Jennifer
Signet, Frank Huseman, and Griffin Thayer. More recently, as I began using
the book’s chapters in my abnormal psychology course, I appreciate the efforts
of more than 100 of my recent undergraduate students at Saint Michael’s
College who provided useful critical feedback to the author of their textbook.
I have learned a great deal from the many individuals and families who
bestowed their trust in me over the past 40 years in my role as a clinical prac-
titioner. In addition to the tremendous meaning that clinical work brings
into my life, I have drawn on these experiences heavily in authoring this
textbook, though always with an eye to the critical centrality of confidential-
ity in the therapeutic process. Cases of my own discussed in this book have
preface ix
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been heavily disguised to conceal the identity of the individuals and families
involved. This has been done in a manner to preserve the clinical integrity
of a case so that no essential psychological process or outcome that would
affect the reader’s judgment of the case has been altered. In some instances,
similar elements from the life histories of several case subjects were combined
to provide the necessary level of detail while preserving confidentiality.
One learns a great deal from listening to the life histories of one’s cli-
ents, but even more if one has trusted colleagues with whom one can consult
on how to understand and improve the therapeutic relationship. I have been
truly blessed in this regard to have had the opportunity to work with a mar-
velously talented clinical social worker and play therapist, Naomi P. Shapiro,
LICSW, with whom I have shared not only a practice but also a life. Much
of the clinical perspective presented in this volume has evolved in the con-
text of our relationship—practicing, teaching, and raising a family together.
The chapter on psychological suffering in childhood is largely a result of
what I have learned from her about the amazing power of play therapy when
practiced by a person who truly loves children and loves life. We have been
blessed with two wonderful children of our own, Ari Shapiro-Miller and
Maya Shapiro-Miller, now grown into adulthood and pursuing careers in the
educational and mental health worlds. I have relied on their love and sup-
port as I endeavored to complete this project. As the member of the family
who had most recently been a college student, Maya provided feedback on
how accessible a student taking a first course in abnormal psychology would
find the material. I counted on her for the unvarnished truth, and she never
let me down.
Thanks too, are due to my friend Craig Lawrence, for his encouragement
and incisive editorial suggestions, and to Bertram P. Karon, a mentor and
friend these last 30 years who took time from his arduous schedule to review
the entire manuscript, and whose professional and personal courage and
generosity have inspired several generations of clinical psychology stu-
dents and colleagues. Finally, I am appreciative of the diligent efforts of the
American Psychological Association staff, Mary Lynn Skutley, Linda Malnasi
McCarter, and Tyler Aune, as well as the several anonymous reviewers who
provided excellent feedback on an earlier draft. I believe the book was greatly
improved because of their collective efforts. Of course, in all instances where
I benefited from the writings and feedback of others in this process, I both
gratefully acknowledge their assistance and take full responsibility for the
interpretations of the literature and views expressed here.
x preface
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