Perspectives in Abnormal Behavior

541 Pages·1974·10.06 MB·English

by  Richard J. Morris (Eds.)

Perspectives in Abnormal Behavior
Edited by
RICHARD J. MORRIS
Department of Psychology
Syracuse University
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Copyright © 1974, Pergamon Press Inc.
Library of Congress Cataloging in Publication Data
Morris, Richard J comp.
Perspectives in abnormal behavior.
(Pergamon general psychology series, PGPS-37)
Includes bibliographies.
1. Psychiatry-Addresses, essays, lectures.
I. Title. [DNLM: 1. Psychopathology-Collected
works. WM100 M877p 1974]
RC458.M63 1974 616.8'9 73-7975
ISBN 0-08-017738-7
ISBN 0-08-017739-5 (pbk.)
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Printed in the United States of America
To my mother and in memory of my father
Preface
There have been many changes in the field of abnormal psychology over the past 20 years.
Changes in treatment have ranged from a general disenchantment with insight oriented
psychotherapy to treatment techniques based on learning theory, and to encounter groups.
Changes with respect to when treatment should be initiated have also occurred, giving rise
to the community mental health movement with its emphasis on prevention and the
handling of everyday "problems in living." In addition, there have been changes in terms of
the focus of therapy. Instead of treating the individual in vacuo, many therapists have
begun to modify the individual's environment as well as his maladaptive behavior within
that environment.
Moreover, the recent emphasis in abnormal psychology on the role of social, environ-
mental, cultural, genetic, and biochemical factors as contributing variables to the develop-
ment and maintenance of maladaptive behavior has led many professionals into disciplines
with which they were previously little concerned. Thus, within the last 20 years we find a
movement in the field of abnormal psychology away from the strict psychological theoriz-
ing of the pre-1950s and toward an interdisciplinary approach to the understanding and
treatment of maladaptive behavior.
This is not to say that mental health professionals have totally abandoned such
psychological theorizing as psychoanalysis to understand their fellow man, but that within
the last decade or so they have begun to realize that there are factors other than the
individual's psyche that are contributing to the development and maintenance of his
maladaptive behavior.
Just as Freud's position in the early 1900s was considered to be revolutionary, so must
the developments in abnormal psychology since 1950. One cannot deny the research
findings that have consistently demonstrated the effects of non-psychological variables as
contributors to the development, maintenance, and treatment of maladaptive behavior. Nor
can one overlook the importance of the exponentially increasing research that has evolved
from the learning theories of Hull and Skinner as well as Pavlov and social-learning theory.
This research, with little exception, has shown that behavior can be modified by its
consequences.
Before 1950, most psychotherapists viewed insight oriented psychotherapy as the
method of choice for the treatment of various behavior disorders, the emphasis being on
the medical model. However, over the last 20 years, the literature has shown that techni-
ques derived from other models are as effective and perhaps more efficient in the treatment
of many of the same maladaptive behaviors.
There have been changes in abnormal psychology in addition to those concerned with
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xii Preface
etiology, treatment, and prevention. Particularly noteworthy over the last decade has been
the development among clinicians of a feeling of disillusionment with psychiatric labels and
diagnoses—reflecting the growing body of research which has demonstrated the question-
able reliability of psychiatric diagnoses. Intimately tied to this development is the concern
by most professionals with the stigma attached to those people who have been labeled men-
tally ill. This concern is reflected in the number of articles that appeared recently, in the
professional literature on the consequences of being labeled mentally ill.
It was because of these various changes in the area of abnormal psychology that a
decision was made to compile a book of readings which would communicate these changes
to students. In order to present this material in a balanced manner, articles were chosen
which reflected the major perspectives now subscribed to in abnormal psychology.
Two main criteria were used in the selection of material. First, the article had to be
readable, wihout a technical orientation, and had to maintain the tenets of scientific rigor.
Second, the article had to reflect the present direction(s) of the particular area covered and
suggest further avenues of investigation. The intent was to present a compelling compila-
tion of challenging and informative articles from various perspectives in the area of
abnormal psychology.
As is the case with any book, but especially with a book of readings, many people
deserve acknowledgment and thanks. I would like to thank the authors and publishers who
permitted their material to be reprinted, and many of my students who were interested
enough to discuss critically the issues covered in the book. A number of people worked
behind the scenes to ready this book for publication. Among them, appreciation is notably
due Donna Petta and Ellen Kasher, Catherine LaPlante, Michael Dolker, and Kenneth Suc-
kerman for their assistance in the preparation of the manuscript. I also thank my colleague
and friend, Dr. Mark Sherman, for reviewing the manuscript and offering comments. The
major typing of the manuscript and the letters of permission was expertly done by Vera
Richardson who donated a significant amount of her time to this project. I thank her very
much.
I also wish to express my gratitude to Dr. Arnold P. Goldstein, consulting editor at
Pergamon Press, for his support and many helpful suggestions concerning the manuscript.
Finally, special thanks are due my wife, Vinnie, for her editorial assistance as well as her
everpresent encouragement and support from the formulation to the completion of this
book.
RICHARD J. MORRIS
Syracuse, New York
About the Author
Richard J. Morris (Ph.D., Arizona State University) is presently Associate
Professor of Psychology, Syracuse University, and a member of the Clinical
Faculty, Department of Pediatrics, State University of New York, Upstate
Medical Center. He has also taught at Arizona State University. Dr. Morris is
a member of several professional associations and serves as a Consulting
Editor for Rehabilitation Psychology and as a Consultant for the Veterans
Administration Hospitals. His published works and papers are in the areas of
behavior therapy and experimental personality.
UNIT I
Issues in Identifying Abnormal Behavior
INTRODUCTION
The assumption that has been made traditionally by most clinicians is that it is
necessary to diagnose and classify a person's abnormal behavior before treatment
can take place. This assumption is based on the procedure followed in medicine
regarding when people with physical illnesses are treated. Mental health profes-
sionals who use this approach generally believe that once the basic cause, or
underlying malady, has been diagnosed from a patient's symptoms (maladaptive
behaviors), then the best possible treatment procedure can be prescribed. They
further point out that since a patient's symptoms are signs of an underlying
psychological disorder or neurological defect direct treatment of these symptoms
would not be appropriate. Rather, they feel that the underlying disorder should be
the focus of treatment. The use of this approach in the diagnosis and treatment of
abnormal behavior is known as the medical model.
According to this model, before techniques can be developed to successfully
treat various abnormal behaviors, a system must be developed whereby these be-
haviors can be identified and classified. One of the first systematic attempts to
classify abnormal behavior was performed by Emil Kraepelin in the last half of
the nineteenth century. He defined two major categories of mental illness—manic-
depressive psychosis and dementia praecox (later called schizophrenia). These
categories were used, with some modification, by mental health professionals until
the classification system was completely revised in the early 1950s by a committee
of the American Psychiatric Association. This revision resulted in the publication
in 1952 of a new and more elaborate classification system called the Diagnostic
and Statistical Manual of Mental Disorders (DSM-I). In 1968, this manual was
revised by a similar committee of the American Psychiatric Association resulting
in the publication of the new classification system, also called the Diagnostic and
Statistical Manual of Mental Disorders (DSM-II). This revised system is the one
currently in use in psychiatric settings.
In recent years the validity of the medical model approach has been questioned
by an increasing number of professionals in the field of mental health (e.g., Ull-
mann & Krasner, 1965). They point out that because there may be an underlying
basis to the symptoms of a patient with a particular physical illness, it does not
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2 Perspectives in Abnormal Behavior
necessarily follow that there must also be an underlying cause for the symptoms
of a patient with a mental health problem. They further maintain that the maladap-
tive behaviors (symptoms) a patient shows are, in fact, his psychological disorder,
that is, there is no underlying cause to these behaviors. This view implies that the
clinician should direct his efforts toward the treatment of maladaptive behaviors
and not the treatment of a presumed underlying cause. For example, if a patient
has a fear of driving over bridges, a fear of flying, a fear of elevators, and a fear of
becoming interpersonally close to another person, the psychologist or psychiatrist
should consider these maladaptive behaviors as the patient's disorder and treat
these problems directly (either separately or all at one time), instead of trying to
find the underlying problem causing each of these behaviors.
One prominent person who has questioned the appropriateness of the medical
model is Thomas S. Szasz, author of Article 1. He views mental illness as a myth;
that is, he feels that there are no underlying neurological causes to mental illness.
He points out that the construct "mental illness" has led mental health profession-
als away from the very problems they should be treating, namely, the patient's
maladaptive behaviors. Thus, this construct should either be redefined in terms of
maladaptive behaviors that can be observed or be removed from the language of
the mental health professions. Szasz also suggests that the symptoms that clini-
cians observe in patients represent nothing more than "problems in living," or
deviations from the social norm, and he reiterates his point that such deviations
are what constitute the mental illness.
A similar position is taken by Thomas J. Scheff, author of Article 2, who directs
his discussion to that diagnostic category called schizophrenia, the diagnosis given
to the majority of individuals who are hospitalized for psychiatric problems. Mak-
ing use of labeling theory, he states that schizophrenia is a label applied by people
in our society (and by societies who share our values) to those individuals who
break the established social rules of acceptable conduct. Since behaviors that
deviate from the social customs of a society are not usually tolerated by members
of that society, and since these unacceptable modes of behavior do not fit into
conventional categories such as crime, drunkenness, prostitution, etc., members
of the society utilize a socially acceptable approach in dealing with people who
show these unacceptable modes of behavior. Specifically, the society makes use
of a residual category that involves labeling these people as mentally ill (e.g., as
schizophrenic) and thus enables society to maintain what Scheff refers to as the
"public order."
In addition to questioning the validity of the medical model, some researchers
have taken a critical look at the reliability of the diagnostic classification system
used in the mental health field. They are particularly interested in discovering the
extent to which clinicians agree on the diagnosis given to a person in a psychiatric
setting. The general findings of this research, based on a large number of studies
published since 1950, have shown that the reliability of specific psychiatric diag-
noses is not impressive. Article 3, by Edward Zigler and Leslie Phillips, is
addressed to the issue of the reliability of psychiatric diagnoses, and discusses the
Issues in Identifying Abnormal Behavior 3
advantages and disadvantages of these diagnoses. Zigler and Phillips' review of
the diagnostic system shows that the degree of agreement among professionals re-
garding such general and inclusive psychiatric categories as psychosis, neurosis,
or character disorders is at an acceptable level; however, as the classification sys-
tem narrows to specific diagnoses within these general categories (e.g., anxiety
state neurosis or paranoid schizophrenia), the level of agreement decreases. The
authors also discuss reasons why many professionals have questioned the utility of
psychiatric diagnoses—for example, one reason relates to the lack of clarity
regarding which symptoms are associated with each diagnostic category. They
conclude that there is merit in the use of psychiatric diagnoses providing that their
use is solely descriptive, that they are based on empirically derived behavior
correlates, and that they are not used for purposes of inferring cause.
Article 4 by Frederick H. Kanfer and George Saslow, extends the discussion of
psychiatric diagnoses an additional step. The authors reject the use of the be-
havioral correlate approach to diagnoses since they feel that this approach is not
reliable, is of limited prognostic value, and does not differentially determine which
type of treatment a particular patient should receive. They feel that the clinician
should use a classification system that will help him in the planning of a treatment
approach for his particular patient. As an alternative to the current diagnostic
practice, these authors suggest that the clinician should undertake a behavior
analysis of each patient. Such an analysis would include an extensive interview
with the patient, as well as the gathering of information about the patient from
various people with whom he interacts, the observation of his interactions with
others, and a review of the results of his psychological tests. This differs from
traditional diagnostic approaches, but the authors feel that once all the informa-
tion from this behavior analysis is processed and organized the therapist will be in
a position to determine the best treatment procedure for the patient. This ap-
proach to diagnosis follows quite closely from Kanfer and Saslow's theoretical
position concerning the conduct of therapy. Commonly called behavior modifica-
tion, or behavior therapy, their position utilizes techniques based on various
theories of learning. It also rejects the use of labels to summarize a patient's be-
havior and favors the clinician's detailed description of the patient's behavior.
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington,
D.C.: American Psychiatric Association, 1952.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. (2nd ed.)
Washington, D.C.: American Psychiatric Association, 1968.
Ullman, L., & Krasner, L. Case studies in behavior modification. New York: Holt, Rinehart &
Winston, 1965.
1
The Myth of Mental Illness*
THOMAS S. SZASZ
My aim in this essay is to raise the question "Is there such a thing as mental ill-
ness?" and to argue that there is not. Since the notion of mental illness is extremely
widely used nowadays, inquiry into the ways in which this term is employed would seem to
be especially indicated. Mental illness, of course, is not literally a "thing"—or physical
object—and hence it can "exist" only in the same sort of way in which other theoretical
concepts exist. Yet, familiar theories are in the habit of posing, sooner or later—at least to
those who come to believe in them—as "objective truths" (or "facts"). During certain his-
torical periods, explanatory conceptions such as deities, witches, and microorganisms ap-
peared not only as theories but as self-evident causes of a vast number of events. I submit
that today mental illness is widely regarded in a somewhat similar fashion, that is, as the
cause of innumerable diverse happenings. As an antidote to the complacent use of the
notion of mental illness—whether as a self-evident phenomenon, theory, or cause—let us
ask this question: What is meant when it is asserted that someone is mentally ill?
In what follows I shall describe briefly the main uses to which the concept of mental
illness has been put. I shall argue that this notion has outlived whatever usefulness it might
have had and that it now functions merely as a convenient myth.
MENTAL ILLNESS AS A SIGN OF BRAIN DISEASE
The notion of mental illness derives its main support from such phenomena as syphilis
of the brain or delirious conditions—intoxications, for instance—in which persons are
known to manifest various peculiarities or disorders of thinking and behavior. Correctly
speaking, however, these are diseases of the brain, not of the mind. According to one
school of thought, all so-called mental illness is of this type. The assumption is made that
some neurological defect, perhaps a very subtle one, will ultimately be found for all the
disorders of thinking and behavior. Many contemporary psychiatrists, physicians, and
other scientists hold this view. This position implies that people cannot have
troubles—expressed in what are now called "mental illnesses"—because of differences in
personal needs, opinions, social aspirations, values, and so on. All problems in living are
attributed to physicochemical processes which in due time will be discovered by medical
research.
"Mental illnesses" are thus regarded as basically no different than all other diseases (that
is, of the body). The only difference, in this view, between mental and bodily diseases is
that the former, affecting the brain, manifest themselves by means of mental symptoms;
whereas the latter, affecting other organ systems (for example, the skin, liver, etc.), mani-
•Frorn Szasz, T. S., "The myth of mental illness," American Psychologist, 1960, 15, 113-118.
Copyright © 1960 by the American Psychological Association, and reproduced by permission.
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