Introduction Prehistoric humans believed that evil spirits, witchcraft, the full moon, or other supernatural forces caused mental disorders. In modern times, people have more naturalistic ideas. The models of abnormality can be divided into three types: medical, psychological, and cultural. Medical models hold that mental disorders take on a psychological appearance, but the underlying problems are physical in nature. Psychological models hold that mental disorders are caused and then maintained by a person’s past and present life experiences, which can result in inner conflicts, learned responses that are problematic, blocked efforts to grow and achieve self-actualization, or pessimistic, distorted thinking. Cultural models emphasize the sociocultural context of stress.
Medical Models of Abnormality Medical or biological models of abnormality
stem back to the Greek physician Hippocrates, who proposed that psychological disorders are caused by body-fluid imbalances. The Greeks believed that the uterus could move around a woman’s body, attaching itself at different places and causing the symptoms of hysteria, a disorder in which a person has physical symptoms without the usual organic causes.
The medical model gained support when people realized that some bizarre behaviors were due to brain damage and other identifiable physical causes. For example, people with scars in certain areas of the brain may have seizures. Also, people who contract the sexually transmitted disease syphilis, which is caused by microorganisms, can develop aberrant behavior ten to twenty years after the initial infection. Syphilis moves through the body and attacks different organs, sometimes the brain.
In modern times, biological researchers use modern research techniques to explore the brain chemistries of mentally disturbed people. They suspect that changes in the workings of neurotransmitters may contribute to many psychological disorders. For example, depression can be associated with abnormally low levels of norepinephrine and serotonin.
The medical model of abnormality is pervasive and can been seen in the language that is often used to describe mental problems. In this language, a patient is “diagnosed” with a mental disorder. This “illness” needs “treatment” that might include hospitalization and therapy to relieve symptoms and produce a cure.
The medical model ushered in humane treatment for people who hitherto had been persecuted as agents of the devil. Some of the resulting advances in treatment for psychological problems include antipsychotic medication, which can reduce hallucinations and help a person with schizophrenia avoid hospitalization; lithium, which can moderate the debilitating mood extremes of bipolar disorder; antidepressants, which can relieve the chronic pain of depression; and antianxiety drugs, which can relieve the acute stress of anxiety disorders. These kinds of advances help many people in their day-to-day lives.
Also, the medical model has focused research attention on the genetic inheritance of mental illness. One way to study the genetic basis of behavior is to compare identical twins and nontwins. An identical twin of a schizophrenic person who was adopted into an entirely different family and has never met the other twin is twice as likely to be schizophrenic as is a person identified randomly from the general population. Another way to study the genetic basis of behavior is to compare adopted children to their adoptive parents and to their biological parents. Using these types of research, scientists have implicated heredity in a number of mental disorders, including schizophrenia, depression, and alcoholism.
However, it may not be appropriate to view all psychological disorders in medical terms. Some disorders can be directly tied to life experiences. Also, the medical model has promoted the idea that people who behave abnormally are not responsible for their actions. They are mentally sick, therefore not in control of themselves. Some people disagree with this notion. In The Myth of Mental Illness (1961), American psychiatrist Thomas Szasz argued that mental illness is a socially defined, relative concept that is used to cast aside people who are different. In 1987, Szasz charged psychologists, psychiatrists, and other mental health professionals with being too quick to guard society’s norms and values and too slow to take care of the people who are in some way different. Further, Szasz claimed that the label “sick” invites those with problems to become passively dependent on doctors and drugs rather than relying on their own inner strengths.
Psychological Models of Abnormality The psychological model of abnormality also stems from ancient Greece. In the second century CE, the Greek physician Galen described a patient whose symptoms were caused either by an inflammation of the uterus or by something about which she was troubled but that she was not willing to discuss. He tested these two hypotheses and concluded that the patient’s problem was psychological in origin.
The psychological model gained support when French physician Jean-Martin Charcot used hypnosis to distinguish hysterical paralysis (that is, paralysis with no organic cause) from neurologically based paralysis. When Charcot hypnotized patients, those with hysterical paralysis were able to use their supposedly paralyzed body part. One of Charcot’s students, Austrian physician Sigmund Freud, expanded this approach. Freud and others believed that mental disorders usually begin with a traumatic event in childhood and can be treated with psychotherapy, a form of “talking cure.” Four main psychological models of abnormality evolved: psychoanalytic, behavioral, humanistic, and cognitive.
Psychoanalytic Model A psychoanalytic model, stemming from Freud’s work, emphasizes the role of parental influences, unconscious conflicts, guilt, frustration, and an array of defense mechanisms that people use, unconsciously, to ward off trauma. According to this view, people develop psychological problems when they have inner conflicts intense enough to overwhelm their normal defenses.
Freud thought that all people have some aspects of their personality that are innate and self-preserving (the id), some aspects of their personality that are learned rules or conscience (the superego), and some aspects of their personality that are realistic (the ego). For example, the id of a person who is hungry wants to eat immediately, in any manner, regardless of the time or social conventions. However, it may be time to meet with the supervisor for an important review. The superego insists on meeting with the supervisor right now, for as long as necessary. The ego may be able to balance personal needs and society’s requirements by, for example, bringing bagels for everyone to the meeting with the supervisor. People must somehow harmonize the instinctual and unreasoning desires of the id, the moral and restrictive demands of the superego, and the rational and realistic requirements of the ego.
Conflicts between the id, ego, and superego may lead to unpleasant and anxious feelings. People develop defense mechanisms to handle these feelings. Defense mechanisms can alleviate anxiety by staving off the conscious awareness of conflicts that would be too painful to acknowledge. A psychoanalytic view is that everyone uses defense mechanisms, and abnormality is simply the result of overblown defense mechanisms.
Some of the most prominent defense mechanisms are repression, regression, displacement, reaction formation, sublimation, and projection. In repression, an unconscious wish is prevented from being fulfilled and is instead channelled into the formation of a symptom, such as a tic or stutter. In regression, a person reverts to activities and feelings of a younger age. For example, a toddler who reclaims his old discarded bottle when a new baby sister comes on the scene is regressing. In displacement, a person has strong feelings toward one person but feels for some reason unable to express them. Subsequently, she finds herself expressing these feelings toward a safer person. For example, a person who is extremely angry with her boss at work may keep these feelings to herself until she gets home but then find herself angry with her husband, children, and pets.
In reaction formation, people have very strong feelings that are somehow unacceptable, and they react in the opposite way. For example, a person who is campaigning against adult bookstores in the community may be secretly fascinated with pornography. In sublimation, a person rechannels energy, typically sexual energy, into socially acceptable outlets. For example, a woman who is attracted to the young men in swimsuits at the pool may decide to swim one hundred laps. In projection, people notice in others traits or behaviors that are too painful to admit in themselves. For example, a person who is very irritated by his friend’s whining may have whining tendencies himself that he cannot admit. All defense mechanisms are unconscious ways to ward off mental trauma.
The psychoanalytic model opened up areas for discussion that were previously taboo and helped people understand that some of their motivations are outside their own awareness. For example, dissociative disorders
occur when a person’s thoughts and feelings are dissociated, or separated, from conscious awareness by memory loss or a change in identity. In dissociative identity disorder, formerly termed multiple personality disorder, the individual alternates between an original or primary personality and one or more secondary or subordinate personalities. A psychoanalytic model would see dissociative identity disorder as stemming from massive repression to ward off unacceptable impulses, particularly those of a sexual nature. These yearnings increase during adolescence and adulthood, until the person finally expresses them, often in a guilt-inducing sexual act. Then, normal forms of repression are ineffective in blocking out this guilt, so the person blocks the acts and related thoughts entirely from consciousness by developing a new identity for the dissociated bad part of self.
The psychoanalytic model views all human behavior as a product of mental or psychological causes, though the cause may not be obvious to an outside observer, or even to the person performing the behavior. Indeed, the model views all human behavior as abnormal to a greater or lesser extent. It emphasizes that abnormality is a question of degree and kind, rather than presence or absence, in the human psyche. Psychoanalytic influence on the modern perspective of abnormality has been enormous. Freudian concepts, such as Freudian slips and unconscious motivation, are so well known that they are now part of ordinary language and culture. However, the psychoanalytic model has been criticized because it is not verifiable, because it gives complex explanations when simple and straightforward ones are sufficient, because it cannot be proven wrong (lacks disconfirmability), and because it was based mainly on a relatively small number of upper-middle-class European patients and on Freud himself. Freud believed that the model was perfectly verifiable, however, because when the mental cause of a symptom was found and explained to a patient, the symptom disappeared. The fact that the model produced clinical results seemed to validate it—although, those results and the model itself may have been far more culturally specific than Freud was willing to admit.
Behavioral Model A behavioral, or social learning, model—stemming from the work of American psychologists such as John B. Watson and B. F. Skinner—emphasizes the role of environment in developing abnormal behavior. According to this model, people acquire abnormal behavior in the same ways they acquire normal behavior, by learning from rewards and punishments they either experience directly or observe happening to someone else. Their perceptions, expectations, values, and role models further influence what they learn. In this view, a person engaging in abnormal behavior has a different reinforcement
history from that of others.
The behavioral model of abnormality stresses classical conditioning, operant conditioning, and modeling. In classical conditioning, a child might hear a very loud sound immediately after entering the elevator. Thereafter, this child might develop a phobia of elevators and other enclosed spaces. In operant conditioning, a mother might give the child a cookie to keep him quiet. Soon, the child will notice that when he is noisy and bothersome, his mother gives him cookies and will develop a pattern of temper tantrums and other conduct disorders. In modeling, the person might notice that her mother is very afraid of spiders. Soon, she might develop a phobia of spiders and other small creatures.
The behavioral model advocates a careful investigation of the environmental conditions in which people display abnormal behavior. Behaviorists pay special attention to situational stimuli, or triggers, that elicit abnormal behavior and to the typical consequences that follow abnormal behavior. Behaviorists search for factors that reinforce or encourage the repetition of abnormal behaviors.
The behavioral model helped people realize how fears become associated with specific situations and the role that reinforcement plays in the origin and maintenance of inappropriate behaviors. However, this model ignores the evidence of genetic and biological factors playing a role in some disorders. Further, many people find it difficult to accept the view of human behavior as simply a set of responses to environmental stimuli. They argue that human beings have free will and the ability to choose their situations, as well as how they will react.
Humanistic Model A humanistic model, stemming from the work of American psychologist Carl R. Rogers and others, emphasizes that mental disorders arise when people are blocked in their efforts to grow and achieve self-actualization. According to this view, the self-concept
is all-important, and people have personal responsibility for their actions and the power to plan and choose their behaviors and feelings.
The humanistic model stresses that humans are basically good and have tremendous potential for personal growth. Left to their own devices, people will strive for self-actualization. However, people can run into roadblocks. Problems will arise if people are prevented from satisfying their basic needs or are forced to live up to the expectations of others. When this happens, people lose sight of their own goals and develop distorted self-perceptions. They feel threatened and insecure and are unable to accept their own feelings and experiences.
In this model, losing touch with one’s own feelings, goals, and perceptions forms the basis of abnormality. For example, parents may withhold their love and approval unless a young person conforms to their standards. In this case, the parents are offering conditional positive regard. This causes children to worry about such things as, “What if I do not do as well on the next test?” “What if I do not score in the next game?” and “What if I forget to clean my room?” In this example, the child may develop generalized anxiety disorder, which includes chronically high levels of anxiety. What the child needs for full development of maximum potential, according to the humanistic view, is unconditional positive regard.
American psychologist Abraham Maslow and other humanistic theorists stress that all human activity is normal, natural, rational, and sensible when viewed from the perspective of the person who is performing the behavior. According to this model, abnormality is a myth. All abnormal behavior would make sense if it the world could be seen through the eyes of the person behaving abnormally.
The humanistic model has made useful contributions to the practice of psychotherapy and to the study of consciousness. However, the humanistic model restricts attention to immediate conscious experience, failing to recognize the importance of unconscious motivation, reinforcement contingencies, future expectations, biological and genetic factors, and situational influences. Further, contrary to the optimistic, self-actualizing view of people, much of human history has been marked by wars, violence, and individual repression.
Cognitive Model A cognitive model, stemming from the work of American psychologists Albert Ellis and Donald Meichenbaum, American psychiatrist Aaron T. Beck, and others, finds the roots of abnormal behavior in the way people think about and perceive the world. People who distort or misinterpret their experiences, the intentions of those around them, and the kind of world where they live are bound to act abnormally.
The cognitive model views human beings as thinking organisms that decide how to behave, so abnormal behavior is based on false assumptions or unrealistic views of situations. For example, Sally Smith might react to getting fired from work by actively searching for a new job. Sue Smith, in contrast, might react to getting fired from work by believing that this tragedy is the worst possible thing that could have happened, something that is really awful. Sue is more likely than Sally to become anxious, not because of the event that happened but because of what she believes about this event. In the cognitive model of abnormality, Sue’s irrational thinking about the event (getting fired), not the event itself, caused her abnormal behavior.
Beck proposed that depressed people have negative schemas about themselves and life events. Their reasoning errors cause cognitive distortions. One cognitive distortion is drawing conclusions out of context, while ignoring other relevant information. Another cognitive distortion is overgeneralizing, drawing a general rule from one or just a few isolated incidents and applying the conclusion broadly to unrelated situations. A third cognitive distortion is dwelling on negative details while ignoring positive aspects. A fourth cognitive distortion is thinking in an “all-or-nothing” way. People who think this way categorize experiences as either completely good or completely bad, rather than somewhere in between the two extremes. A fifth cognitive distortion is having automatic thoughts, negative ideas that emerge quickly, spontaneously, and seemingly without voluntary control.
The cognitive and behavioral models are sometimes linked and have stimulated a wealth of empirical knowledge. The cognitive model has been criticized for focusing too much on cognitive processes and not enough on root causes. Some also see it as too mechanistic.
The cognitive model proposes that maladaptive thinking causes psychological disorders. In contrast, the psychoanalytic model proposes that unconscious conflicts cause psychological disorders; the humanistic model proposes that blocking of full development causes psychological disorders; and the behavioral model proposes that inappropriate conditioning causes psychological disorders. These psychological models of abnormality stress the psychological variables that play a role in abnormal behavior.
Sociocultural Models of Abnormality A sociocultural model of abnormality emphasizes the social and cultural context, going so far as to suggest that abnormality is a direct function of society’s criteria and definitions for appropriate behavior. In this model, abnormality is social, not medical or psychological. For example, the early Greeks revered people who heard voices that no one else heard, because they interpreted this phenomenon as evidence of divine prophecy. In the Middle Ages, some Europeans tortured or killed people who heard voices, because they interpreted this same proclivity as evidence of demonic possession or witchcraft. In modern Western culture, doctors treat those who hear voices with medicine and psychotherapy, because the phenomenon is viewed as a symptom of schizophrenia.
Social and cultural context can influence the kinds of stresses people experience, the kinds of disorders they are likely to develop, and the treatment they are likely to receive.
Particularly impressive evidence for a social perspective is a well-known 1973 study by American psychologist David L. Rosenhan. Rosenhan arranged for eight normal people, including himself, to arrive at eight different psychiatric hospitals under assumed names and to complain of hearing voices repeating innocuous words such as “empty,” “meaningless,” and “thud.” These pseudopatients responded truthfully to all other questions except their names. Because of this single symptom, the hospital staff diagnosed all eight as schizophrenic or manic-depressive and hospitalized them.
Although the pseudopatients immediately ceased reporting that they heard voices and asked to be released, the hospitals kept them from seven to fifty-two days, with an average of nineteen days. When discharged, seven of the eight were diagnosed with schizophrenia “in remission,” which implies that they were still schizophrenic but simply did not show signs of the illness at the time of release. The hospital staff, noticing that these people took notes, wrote hospital chart entries such as “engages in writing behaviors.” No staff member detected that the pseudopatients were normal people, though many regular patients suspected as much. The context in which these pseudopatients behaved (a psychiatric hospital) controlled the way in which others interpreted their behavior.
Particularly impressive evidence for acultural perspective comes from the fact that different types of disorders appear in different cultures. Bulimia nervosa, which involves binge eating followed by purging, primarily strikes middle- and upper-class women in Western cultures. In such cultures, women may feel particular pressure to be thin and have negatively distorted images of their own bodies. Amok, a brief period of brooding followed by a violent outburst that often results in murder, strikes Navajo men and men in Malaysia, Papua New Guinea, the Philippines, Polynesia, and Puerto Rico. In these cultures, this disorder is frequently triggered by a perceived insult.
Pibloktoq, a brief period of extreme excitement that is often followed by seizures and coma lasting up to twelve hours, strikes people in Arctic and Subarctic Eskimo communities. The person may tear off his or her clothing, break furniture, shout obscenities, eat feces, and engage in other acts that are later forgotten. As researchers examine the frequency and types of disorders that occur in different societies, they note some sharp differences not only between societies but also within societies as a function of the decade being examined and the age and gender of the individuals being studied.
The sociocultural model of abnormality points out that other models fail to take into account cultural variations in accepted behavior patterns. Understanding cross-cultural perspectives on abnormality helps in better framing questions about human behavior and interpretations of data. Poverty and discrimination can cause psychological problems. Understanding the context of the abnormal behavior is essential.
The medical, psychological, and sociocultural models of abnormality represent profoundly different ways of explaining and thus treating people’s problems. They cannot be combined in a simple way, because they often contradict one another. For example, a biological model asserts that depression is due to biochemistry. The treatment, therefore, is medicine to correct the imbalance. In contrast, a behavioral model asserts that depression is learned. The treatment, therefore, is changing the rewards and punishments in the environment, so the person unlearns old, bad habits and learns new, healthy habits.
One attempt to integrate the different models of abnormality is called the diathesis-stress model of abnormality. It proposes that people develop disorders if they have a biological weakness (diathesis) that predisposes them to the disorder when they encounter certain environmental conditions (stress). The diathesis-stress approach is often used to explain the development of some forms of cancer, which also seem to be caused by a biological predisposition coupled with certain environmental conditions. According to this model, some people have a predisposition that makes them vulnerable to a disorder such as schizophrenia. They do not develop schizophrenia, however, unless they experience particularly stressful environmental conditions.
It is unlikely that any single model can explain all disorders. It is more probable that each of the modern perspectives explains certain disorders and that any single abnormal behavior has multiple causes.
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