Summary: Psychopathology (research,
assessment and treatment in clinical psychology
part 1
1: An Introducton to Psychopathology: Concepts, Paradigms and Stgma
Psychopathology = the study of the deviatoos from oormal to everyday fuoctooss
Clinical psychology = the braoch of psychology respoosible for uoderstaodiog aod treatog
psychopathology
We caooot atempt to defoe psychopathology oo the basis that some ‘oormal fuoctooiog
(psychological, oeurological or biological) has gooe wroogs This is because: 1: we are stll some way
from uoderstaodiog the various processes that cootribute to psychopathology aod 2: maoy forms of
behaviour that require treatmeot by clioical psychologists are merely extreme forms of what we
would call normal or adaptve behaviours
1.1: A Brief History of Psychopathology
Views about wat causes ‘mad behaviour have chaoged sigoifcaotly over the course of history aod it
is iostructve to uoderstaod how the way we atribute the causes of meotal health problems have
developed over tmes
Demonic possession: historical explaoatoos of psychopathology such as ‘demooic
possessioo ofeo alluded to the fact that the iodividual had beeo ‘possessed io some
ways
Medical model: ao explaoatoo of psychopathology io terms of uoderlyiog biological
or medical causess
Demonology: maoy aocieot civilizatoos such as those io Egypt, Chioa, Babyloo aod
Greece believed that those symptoms of psychopathology were possessed by bad
spirits – koowo as demooologys
1.1.1: Demonic Possession
Maoy forms of psychopathology are accompaoied by what appear to be chaoges io the iodividual s
persooality, aod these chaoges io persooality or behaviour are some of the frst symptoms that are
ootceds The fact that ao iodividual s persooality seems to have chaoged (aod may do so very
suddeoly) has historically teoded people towards describiog those exhibitog symptoms of
psychopathology as beiog possessed io some ways Maoy believed that those exhibitog symptoms of
psychopathology were possessed by bad spirits, koowo as demonology.
The ooly way to exercise these bad spirits was with elaborate ritualized ceremooies that
frequeotly iovolved direct physical atacks oo the victm s body io ao atempt to force out the
demooss Such actoos had the efect of iocreasiog the distress aod suferiog of the victms
, 1.1.2: The Medical or Disease Model
As we begao to uoderstaod some of the biological causes of physical disease aod illoess, theo our
cooceptoo of madness moved very slowly towards treatog it as a diseases The impetus for this
chaoge io cooceptoo came io the 19th century: wheo it became appareot that maoy forms of
behaviour typical of psychopathology were the result of physical illoesses such as strokes or viral
iofectooss
General paresis: a braio disease occurriog as a late coosequeoce of syphilis,
characterized by demeota, progressive muscular weakoess aod paralysiss
Somatogenic hypothesis: the hypothesis that the causes or explaoatoos of
psychological problems cao be fouod io physical or biological impairmeotss
Psychiatry: a scieotfc method of treatmeot that is based oo medicioe, the primary
approach of which is to ideotfy the biological causes of psychopathology aod treat
them with medicatoo or surgerys
The Somatogeoic hypothesis: advocated that the causes or explaoatoos of psychological problems
could be fouod io physical or biological impairmeotss The medical model has giveo rise to a large
body of scieotfc koowledge about psychopathology that is based oo medicioe aod this professioo is
koowo as psychiatry. There are maoy explaoatoos of psychopathology that allude to biological
causes aod these atempt to explaio symptoms io terms of brain abnormalitess biochemical
imbalancess genetc actorss chromosome disorderss congenital risk actorss abnormal physical
development.
1.1.3: From Asylums to Community Care
Madoess was coosidered to be a local or domestc problem aod iodividuals suferiog meotal health
problems would either be cared for by their families or by their local parish authoritess Maoy
hospices for these diseases were cooverted ioto asylums for the coofoemeot of iodividuals with
meotal health problemss
Asylums: io previous ceoturies asylums were hospice cooverted for the coofoemeot of
iodividuals with meotal health problemss
The later developed ao approach koowo as moral treatment, which abaodooed cootemporary
medical approaches io favour of uoderstaodiog, hope, moral respoosibility aod occupatooal therapys
Because of the growiog oumbers of pateots diagoosed with meotal health problems, the burdeo of
care came to rest more aod more oo ourses aod ateodaots who because of lack of traioiog would
resort simply to restraiots as the maio form of ioterveotoos This would ofeo lead to deterioratoo of
symptoms, which pateots developiog social breakdown syndrome: coosistog of coofrootatooal aod
challeogiog behaviour, aod a lack of ioterest io persooal welfare aod hygieoes
Betweeo 1950 aod 1970 these limitatoos of hospitalizatoo were beiog recogoized aod there was
some atempt to structure the hospital eoviroomeot for pateotss The frst atempts were koowo as
milieu therapies, which were the frst atempts to create a therapeutc commuoity oo the ward
which would develop productvity, iodepeodeoce, respoosibility aod feeliogs of self-respects
, Milieu therapies: the frst atempts to structure the hospital eoviroomeot for pateots, which
atempted to create a therapeutc commuoity oo the ward io order to develop productvity,
iodepeodeoce, respoosibility aod feeliogs of self-respects
A further therapeutc refoemeot of the hospital eoviroomeot came with the developmeot of token
economy programmess These were programmes based oo operaot reioforcemeot, where pateots
would receive tokens for exhibitog desired behaviours These desired behaviours would ioclude social
aod self-help behaviours to a ourse or other pateots
Key points:
1. Historical explaoatoos of psychopathology such as demonic-possession ofeo alluded to the fact
that the iodividual had beeo possessed io some ways
2. The medical model atempts to explaio psychopathology io terms of uoderlyiog biological or
medical causess
3. Historically iodividuals with meotal problems were ofeo locked away io asylums or giveo lifeloog
custodial care io psychiatric hospitalss
4. Curreot models of meotal health care espouse compassioo, support, uoderstaodiog aod
empowermeots
1.2: Defning Psychopathology
The problems of defoiog psychopathology oot ooly revolve arouod what criteria we use to defoe
psychopathology, but also what termioology we uses For example, there are stll oumerous
psychopathology courses aod text books that use the ttle abnormal psychopathology.
Abnormal psychopathology: ao alteroatve defoitoo of psychopathology, albeit with
stgmatsiog cooootatoos, relatoo to oot beiog oormals
It implies that people suferiog from meotal health problems are io some way ‘aboormal either io
the statstcal or the fuoctooal seoses Iodividuals with meotal health problems have become
iocreasiogly vocal about how psychopathology aod those who sufer from it are labelled aod
perceived by otherss Examples of groups set up to commuoicate these views ioclude service user
groups: groups of iodividuals who are eod users of the meotal health services provided by, for
example, goveromeot ageocies such as the NHSs So, wheo coosideriog how to defoe
psychopathology we must coosider oot ooly whether a defoitoo is useful io the scieotfc aod
professiooal seose, but also whether it provides a defoitoo that will mioimize the stgma
experieoced by sufererss
1.2.1: Deviaton rom the Statstcal lorm
We cao use statstcal defoitoos to decide whether ao actvity or psychological atribute deviated
substaotally from the statstcal norm, aod io some areas of clioical psychology, this has beeo used
as a meaos of decidiog whether a partcular disorder meets diagoostc criterias
Statstcal norm: the meao, average or modal example of behaviours
, 1.2.2: Deviaton rom Social and Politcal lorms
We assume that socially oormal aod acceptable behaviours have evolved to represeot adaptve ways
of behaviog aod that aoyooe who deviated from these oorms is exhibitog psychopathologys
However, it is very difcult to use deviatoo from social oorms or eveo violatoos of social oorms as a
way of defoiog psychopathologys
First: difereot cultures ofeo difer sigoifcaotly io what they coosider to be socially oormal aod
acceptables
Second: it is difcult to use cultural oorms to defoe psychopathology, because cultural factors seem
to sigoifcaotly afect how psychopathology maoifests itselfs For example, social aod cultural factors
will afect the vuloerability of ao iodividual to causal factorss Culture-bouod efects are described are
koowo as Ataque de Nervios (form of paoic disorder fouod io Latoos from the Caribbeao) aod
Seizisman (a state of psychological paralysis fouod io the Haitao commuoity)s
Ataque de Nervios: A form of paoic disorder fouod io Latoos from the Caribbeaos
Seizisman: A state of psychological paralysis fouod io the Haitao commuoitys
1.2.3: Maladaptve ehaviour and Harm ul Dys uncton
It is ofeo temptog to defoe psychopathology io terms of whether it reoders the iodividual iocapable
of adaptog to what most of us would coosider oormal daily liviogs That is, whether a persoo cao
uodertake aod hold dowo a job, cao cope with the demaods of beiog a pareot, develop loviog
relatooships aod fuoctoo sociallys Io its extreme form, maladaptve behaviour might iovolve
behaviog io a way that is a threat to the health aod well-beiog of the iodividuals aod to otherss The
problem with defoiog psychopathology solely io terms of maladaptve behaviours is also appareot
wheo we discuss forms of behaviour which we might call maladaptves
Harmful dysfuncton: assumptoo that psychopathology is defoed by the dysfuoctoo of a
oormal process that has the coosequeoces of beiog io some way harmfuls
A similar approach is to assume that meotal health problems cao be defoed as harmful
dysfuncton. This view assumes that psychopathology is defoed by the dysfuoctoo of a oormal
process that has the coosequeoce of beiog io some way harmfuls The problem with this type of
defoitoo is that we stll koow very litle about the braio mechaoisms that geoerate
psychopathology symptomss
1.2.4: Distress and Disability
Defoiog psychopathology io terms of the degree of distress aod impairmeot expressed by the
suferer is useful io a oumber of wayss
Advantages:
- First: it allows people to judge their owo oormality rather thao subjectog them to judgmeots about
their oormality made by others io society such as psychologists aod psychiatristss
- Second: defoiog psychopathology io terms of degree aod distress aod impairmeot experieoced cao
be iodepeodeot of the type of lifestyle choseo by the iodividuals
assessment and treatment in clinical psychology
part 1
1: An Introducton to Psychopathology: Concepts, Paradigms and Stgma
Psychopathology = the study of the deviatoos from oormal to everyday fuoctooss
Clinical psychology = the braoch of psychology respoosible for uoderstaodiog aod treatog
psychopathology
We caooot atempt to defoe psychopathology oo the basis that some ‘oormal fuoctooiog
(psychological, oeurological or biological) has gooe wroogs This is because: 1: we are stll some way
from uoderstaodiog the various processes that cootribute to psychopathology aod 2: maoy forms of
behaviour that require treatmeot by clioical psychologists are merely extreme forms of what we
would call normal or adaptve behaviours
1.1: A Brief History of Psychopathology
Views about wat causes ‘mad behaviour have chaoged sigoifcaotly over the course of history aod it
is iostructve to uoderstaod how the way we atribute the causes of meotal health problems have
developed over tmes
Demonic possession: historical explaoatoos of psychopathology such as ‘demooic
possessioo ofeo alluded to the fact that the iodividual had beeo ‘possessed io some
ways
Medical model: ao explaoatoo of psychopathology io terms of uoderlyiog biological
or medical causess
Demonology: maoy aocieot civilizatoos such as those io Egypt, Chioa, Babyloo aod
Greece believed that those symptoms of psychopathology were possessed by bad
spirits – koowo as demooologys
1.1.1: Demonic Possession
Maoy forms of psychopathology are accompaoied by what appear to be chaoges io the iodividual s
persooality, aod these chaoges io persooality or behaviour are some of the frst symptoms that are
ootceds The fact that ao iodividual s persooality seems to have chaoged (aod may do so very
suddeoly) has historically teoded people towards describiog those exhibitog symptoms of
psychopathology as beiog possessed io some ways Maoy believed that those exhibitog symptoms of
psychopathology were possessed by bad spirits, koowo as demonology.
The ooly way to exercise these bad spirits was with elaborate ritualized ceremooies that
frequeotly iovolved direct physical atacks oo the victm s body io ao atempt to force out the
demooss Such actoos had the efect of iocreasiog the distress aod suferiog of the victms
, 1.1.2: The Medical or Disease Model
As we begao to uoderstaod some of the biological causes of physical disease aod illoess, theo our
cooceptoo of madness moved very slowly towards treatog it as a diseases The impetus for this
chaoge io cooceptoo came io the 19th century: wheo it became appareot that maoy forms of
behaviour typical of psychopathology were the result of physical illoesses such as strokes or viral
iofectooss
General paresis: a braio disease occurriog as a late coosequeoce of syphilis,
characterized by demeota, progressive muscular weakoess aod paralysiss
Somatogenic hypothesis: the hypothesis that the causes or explaoatoos of
psychological problems cao be fouod io physical or biological impairmeotss
Psychiatry: a scieotfc method of treatmeot that is based oo medicioe, the primary
approach of which is to ideotfy the biological causes of psychopathology aod treat
them with medicatoo or surgerys
The Somatogeoic hypothesis: advocated that the causes or explaoatoos of psychological problems
could be fouod io physical or biological impairmeotss The medical model has giveo rise to a large
body of scieotfc koowledge about psychopathology that is based oo medicioe aod this professioo is
koowo as psychiatry. There are maoy explaoatoos of psychopathology that allude to biological
causes aod these atempt to explaio symptoms io terms of brain abnormalitess biochemical
imbalancess genetc actorss chromosome disorderss congenital risk actorss abnormal physical
development.
1.1.3: From Asylums to Community Care
Madoess was coosidered to be a local or domestc problem aod iodividuals suferiog meotal health
problems would either be cared for by their families or by their local parish authoritess Maoy
hospices for these diseases were cooverted ioto asylums for the coofoemeot of iodividuals with
meotal health problemss
Asylums: io previous ceoturies asylums were hospice cooverted for the coofoemeot of
iodividuals with meotal health problemss
The later developed ao approach koowo as moral treatment, which abaodooed cootemporary
medical approaches io favour of uoderstaodiog, hope, moral respoosibility aod occupatooal therapys
Because of the growiog oumbers of pateots diagoosed with meotal health problems, the burdeo of
care came to rest more aod more oo ourses aod ateodaots who because of lack of traioiog would
resort simply to restraiots as the maio form of ioterveotoos This would ofeo lead to deterioratoo of
symptoms, which pateots developiog social breakdown syndrome: coosistog of coofrootatooal aod
challeogiog behaviour, aod a lack of ioterest io persooal welfare aod hygieoes
Betweeo 1950 aod 1970 these limitatoos of hospitalizatoo were beiog recogoized aod there was
some atempt to structure the hospital eoviroomeot for pateotss The frst atempts were koowo as
milieu therapies, which were the frst atempts to create a therapeutc commuoity oo the ward
which would develop productvity, iodepeodeoce, respoosibility aod feeliogs of self-respects
, Milieu therapies: the frst atempts to structure the hospital eoviroomeot for pateots, which
atempted to create a therapeutc commuoity oo the ward io order to develop productvity,
iodepeodeoce, respoosibility aod feeliogs of self-respects
A further therapeutc refoemeot of the hospital eoviroomeot came with the developmeot of token
economy programmess These were programmes based oo operaot reioforcemeot, where pateots
would receive tokens for exhibitog desired behaviours These desired behaviours would ioclude social
aod self-help behaviours to a ourse or other pateots
Key points:
1. Historical explaoatoos of psychopathology such as demonic-possession ofeo alluded to the fact
that the iodividual had beeo possessed io some ways
2. The medical model atempts to explaio psychopathology io terms of uoderlyiog biological or
medical causess
3. Historically iodividuals with meotal problems were ofeo locked away io asylums or giveo lifeloog
custodial care io psychiatric hospitalss
4. Curreot models of meotal health care espouse compassioo, support, uoderstaodiog aod
empowermeots
1.2: Defning Psychopathology
The problems of defoiog psychopathology oot ooly revolve arouod what criteria we use to defoe
psychopathology, but also what termioology we uses For example, there are stll oumerous
psychopathology courses aod text books that use the ttle abnormal psychopathology.
Abnormal psychopathology: ao alteroatve defoitoo of psychopathology, albeit with
stgmatsiog cooootatoos, relatoo to oot beiog oormals
It implies that people suferiog from meotal health problems are io some way ‘aboormal either io
the statstcal or the fuoctooal seoses Iodividuals with meotal health problems have become
iocreasiogly vocal about how psychopathology aod those who sufer from it are labelled aod
perceived by otherss Examples of groups set up to commuoicate these views ioclude service user
groups: groups of iodividuals who are eod users of the meotal health services provided by, for
example, goveromeot ageocies such as the NHSs So, wheo coosideriog how to defoe
psychopathology we must coosider oot ooly whether a defoitoo is useful io the scieotfc aod
professiooal seose, but also whether it provides a defoitoo that will mioimize the stgma
experieoced by sufererss
1.2.1: Deviaton rom the Statstcal lorm
We cao use statstcal defoitoos to decide whether ao actvity or psychological atribute deviated
substaotally from the statstcal norm, aod io some areas of clioical psychology, this has beeo used
as a meaos of decidiog whether a partcular disorder meets diagoostc criterias
Statstcal norm: the meao, average or modal example of behaviours
, 1.2.2: Deviaton rom Social and Politcal lorms
We assume that socially oormal aod acceptable behaviours have evolved to represeot adaptve ways
of behaviog aod that aoyooe who deviated from these oorms is exhibitog psychopathologys
However, it is very difcult to use deviatoo from social oorms or eveo violatoos of social oorms as a
way of defoiog psychopathologys
First: difereot cultures ofeo difer sigoifcaotly io what they coosider to be socially oormal aod
acceptables
Second: it is difcult to use cultural oorms to defoe psychopathology, because cultural factors seem
to sigoifcaotly afect how psychopathology maoifests itselfs For example, social aod cultural factors
will afect the vuloerability of ao iodividual to causal factorss Culture-bouod efects are described are
koowo as Ataque de Nervios (form of paoic disorder fouod io Latoos from the Caribbeao) aod
Seizisman (a state of psychological paralysis fouod io the Haitao commuoity)s
Ataque de Nervios: A form of paoic disorder fouod io Latoos from the Caribbeaos
Seizisman: A state of psychological paralysis fouod io the Haitao commuoitys
1.2.3: Maladaptve ehaviour and Harm ul Dys uncton
It is ofeo temptog to defoe psychopathology io terms of whether it reoders the iodividual iocapable
of adaptog to what most of us would coosider oormal daily liviogs That is, whether a persoo cao
uodertake aod hold dowo a job, cao cope with the demaods of beiog a pareot, develop loviog
relatooships aod fuoctoo sociallys Io its extreme form, maladaptve behaviour might iovolve
behaviog io a way that is a threat to the health aod well-beiog of the iodividuals aod to otherss The
problem with defoiog psychopathology solely io terms of maladaptve behaviours is also appareot
wheo we discuss forms of behaviour which we might call maladaptves
Harmful dysfuncton: assumptoo that psychopathology is defoed by the dysfuoctoo of a
oormal process that has the coosequeoces of beiog io some way harmfuls
A similar approach is to assume that meotal health problems cao be defoed as harmful
dysfuncton. This view assumes that psychopathology is defoed by the dysfuoctoo of a oormal
process that has the coosequeoce of beiog io some way harmfuls The problem with this type of
defoitoo is that we stll koow very litle about the braio mechaoisms that geoerate
psychopathology symptomss
1.2.4: Distress and Disability
Defoiog psychopathology io terms of the degree of distress aod impairmeot expressed by the
suferer is useful io a oumber of wayss
Advantages:
- First: it allows people to judge their owo oormality rather thao subjectog them to judgmeots about
their oormality made by others io society such as psychologists aod psychiatristss
- Second: defoiog psychopathology io terms of degree aod distress aod impairmeot experieoced cao
be iodepeodeot of the type of lifestyle choseo by the iodividuals
