ABPSYCH CHAPTER 1: PSYCHOPATHOLOGY IN considered disordered.

We might call them talented or

HISTORICAL CONTEXT eccentric.
PSYCHOLOGICAL DISORDER - a psychological In most cases, the more productive you are in the eyes of
dysfunction within an individual associated with distress or society, the more eccentricities society will tolerate.
impairment in functioning and a response that is not typical Therefore, “deviating from the average” doesn’t work
or culturally expected. well as a definition for problematic abnormal behavior.
CRITERIA OF PSYCHOLOGICAL DISORDER Behavior is disordered if you are violating social norms,
even if a number of people are sympathetic to your point of
1. PSYCHOLOGICAL DYSFUNCTION
view. This definition is useful in considering important
2. DISTRESS OR IMPAIRMENT
cultural differences in psychological disorders. For
3. ATYPICAL RESPONSE
example, to enter a trance state and believe you are
PHOBIA – a psychological disorder characterized by possessed reflects a psychological disorder in most Western
marked and persistent fear of an object or situation. cultures but not in many other societies, where the behavior
is accepted and expected.
BLOOD–INJECTION–INJURY PHOBIA
Jerome Wakefield (1999, 2009) in a thoughtful analysis of
ABNORMAL BEHAVIOR - It is a psychological the matter, uses the shorthand definition of harmful
dysfunction within an individual that is associated with dysfunction. However, this definition assumes that we
distress or impairment in functioning and a response that is know what the evolutionary function of a behavior is, which
not typical or culturally expected. is often not the case. Another possibility is to determine
PSYCHOLOGICAL DYSFUNCTION refers to a whether the behavior is out of the individual’s control
breakdown in cognitive, emotional, or behavioral (something the person doesn’t want to do).
functioning. AN ACCEPTED DEFINITION
Just having a dysfunction is not enough to meet the criteria The most widely accepted definition used in the Diagnostic
for a psychological disorder. and Statistical Manual of Mental Disorders, fifth edition
DISTRESS OR IMPAIRMENT – The behavior must be (DSM-5) (American Psychiatric Association, 2013)
associated with distress to be classified as a disorder. The describes behavioral, psychological, or biological
criterion is satisfied if the individual is extremely upset. dysfunctions that are unexpected in their cultural context
and associated with present distress and impairment in
The human condition is such that suffering and distress are functioning, or increased risk of suffering, death, pain, or
very much part of life. Furthermore, for some disorders, by impairment. This definition can be useful across cultures
definition, suffering and distress are absent. Consider the and subcultures if we pay careful attention to what is
person who feels extremely elated and may act impulsively functional or dysfunctional (or out of control) in a given
as part of a manic episode. One of the major difficulties society.
with this problem is that some people enjoy the manic state
so much they are reluctant to begin treatment or stay long The best we may be able to do is to consider how the
in treatment. Defining psychological disorder by distress apparent disease or disorder matches a “typical” profile of
alone doesn’t work, although the concept of distress a disorder—for example, major depression or
contributes to a good definition. Most psychological schizophrenia—when most or all symptoms that experts
disorders are simply extreme expressions of otherwise would agree are part of the disorder are present. We call this
normal emotions, behaviors, and cognitive processes. typical profile a prototype the diagnostic criteria from
DSM-5 found throughout this book are all prototypes. This
ATYPICAL or NOT CULTURALLY EXPECTED – the means that patients may have only some features or
criterion that the response be atypical or not culturally symptoms of the disorder (a minimum number) and still
expected is important but also insufficient to determine if a meet criteria for the disorder because their set of symptoms
disorder is present by itself. is close to the prototype.
At times, something is considered abnormal because it THE SCIENCE OF PSYCHOPATHOLOGY
occurs infrequently; it deviates from the average. The
greater the deviation, the more abnormal it is. Many people PSYCHOPATHOLOGY is the scientific study of
are far from the average in their behavior, but few would be psychological disorders.
Within this field are specially trained professionals, provide clinical services by hospitals or clinics, usually
including clinical and counseling psychologists, under the supervision of a doctoral-level clinician.
psychiatrists, psychiatric social workers, and psychiatric
The most important development in the recent history of
nurses, as well as marriage and family therapists and mental
psychopathology is the adoption of scientific methods to
health counselors.
learn more about the nature of psychological disorders, their
CLINICAL PSYCHOLOGISTS and COUNSELING causes, and their treatment. Many mental health
PSYCHOLOGISTS receive the Ph.D., doctor of professionals take a scientific approach to their clinical
philosophy, degree (or sometimes an Ed.D., doctor of work and therefore are called SCIENTIST-
education, or Psy.D., doctor of psychology) and follow a PRACTITIONERS.
course of graduate-level study lasting approximately 5
Mental health practitioners may function as scientist-
years, which prepares them to conduct research into the
practitioners in one or more of three ways.
causes and treatment of psychological disorders and to
diagnose, assess, and treat these disorders. 1. First, they may keep up with the latest scientific
developments in their field and therefore use the most
COUNSELING PSYCHOLOGISTS tend to study and
current diagnostic and treatment procedures. In this
treat adjustment and vocational issues encountered by
sense, they are consumers of the science of
relatively healthy individuals.
psychopathology to the advantage of their patients.
CLINICAL PSYCHOLOGISTS concentrate on more 2. Second, scientist-practitioners evaluate their own
severe psychological disorders. assessments or treatment procedures to see whether
they work. They are accountable not only to their
Programs in professional schools of psychology, where the
patients but also to the government agencies and
degree is often a Psy.D., focus on clinical training and
insurance companies that pay for the treatments, so
deemphasize or eliminate research training.
they must demonstrate clearly whether their
In contrast, Ph.D. programs in universities integrate clinical treatments are effective or not.
and research training. Psychologists with other specialty 3. Third, scientist-practitioners might conduct research,
training, such as experimental and social psychologists, often in clinics or hospitals, that produces new
concentrate on investigating the basic determinants of information about disorders or their treatment, thus
behavior but do not assess or treat psychological disorders. becoming immune to the fads that plague our field,
often at the expense of patients and their families.
PSYCHIATRISTS first earn an M.D. degree in medical
school and then specialize in psychiatry during residency For example, new “miracle cures” for psychological
training that lasts 3 to 4 years. Psychiatrists also investigate disorders that are reported several times a year in popular
the nature and causes of psychological disorders, often from media would not be used by a scientist-practitioner if there
a biological point of view; make diagnoses; and offer were no sound scientific data showing that they work. Such
treatments. Many psychiatrists emphasize drugs or other data flow from research that attempts three basic things: to
biological treatments, although most use psychosocial describe psychological disorders, to determine their causes,
treatments as well. and to treat them.

PSYCHIATRIC SOCIAL WORKERS typically earn a Research about psychological disorders falls into three
master’s degree in social work as they develop expertise in basic categories: description, causation, and treatment and
collecting information relevant to the social and family outcomes.
situation of the individual with a psychological disorder.
CLINICAL DESCRIPTION - In hospitals and clinics, we
Social workers also treat disorders, often concentrating on
often say that a patient “presents” with a specific problem
family problems associated with them.
or set of problems or we discuss the presenting problem.
PSYCHIATRIC NURSES have advanced degrees, such Presents is a traditional shorthand way of indicating why
as a master’s or even a Ph.D., and specialize in the care and the person came to the clinic.
treatment of patients with psychological disorders, usually
CLINICAL DESCRIPTION represents the unique
in hospitals as part of a treatment team.
combination of behaviors, thoughts, and feelings that make
MARRIAGE AND FAMILY THERAPISTS AND up a specific disorder. The word clinical refers both to the
MENTAL HEALTH COUNSELORS typically spend 1 types of problems or disorders that you would find in a
to 2 years earning a master’s degree and are employed to clinic or hospital and to the activities connected with
assessment and treatment.
One important function of the clinical description is to guarded,” meaning the probable outcome doesn’t look
specify what makes the disorder different from normal good.
behavior or from other disorders. Statistical data may also
The patient’s age may be an important part of the clinical
be relevant.
description. A specific psychological disorder occurring in
For example: How many people in the population as a childhood may present differently from the same disorder
whole have the disorder? in adulthood or old age. Children experiencing severe
anxiety and panic often assume that they are physically ill
This figure is called the prevalence of the disorder.
because they have difficulty understanding that there is
Statistics on how many new cases occur during a given
nothing physically wrong. Because their thoughts and
period, such as a year, represent the incidence of the
feelings are different from those experienced by adults with
disorder.
anxiety and panic, children are often misdiagnosed and
Other statistics include the sex ratio—that is, what treated for a medical disorder.
percentage of women and men have the disorder
Developmental psychology – the study of changes in
(unfortunately, this traditional term does not consider
behavior over time.
nonbinary gender identity)—and the typical age of onset,
which often differs from one disorder to another. Developmental psychopathology – the study of changes in
abnormal behavior.
In addition to having different symptoms, age of onset, and
possibly a different sex ratio and prevalence, most Life-span developmental psychopathology – study of
disorders follow a somewhat individual pattern, or course. abnormal behavior across the entire age span.
Schizophrenia, follow a chronic course – they tend to last CAUSATION, TREATMENT, AND ETIOLOGY
a long time, sometimes a lifetime. OUTCOMES
Mood disorders, follow an episodic course – the Etiology – the study of origins, has to do with why a
individual is likely to recover within a few months, only to disorder begins (what causes it) and includes biological,
suffer a recurrence of the disorder at a later time. This psychological, and social dimensions.
pattern may repeat throughout a person’s life.
The question of causality is deeply philosophical. Just
Other disorders may have a time-limited course – the because two events co-occur does not mean that they are in
disorder will improve without treatment in a relatively short any way causally related: Correlation does not imply
period with little or no risk of recurrence. causality. Statisticians often use the term Granger causality
to describe when a series of events temporally predict
Closely related to differences in course of disorders are
another series of events. But even if events are related, it is
differences in onset.
often difficult if not impossible to pinpoint a single cause of
Some disorders have an acute onset, meaning that they something, especially if many factors contribute to it.
begin suddenly; others develop gradually over an extended
Treatment, also, is often important to the study of
period, which is sometimes called an insidious onset.
psychological disorders. If a new drug or psychosocial
It is important to know the typical course of a disorder so treatment is successful in treating a disorder, it may give us
that we can know what to expect in the future and how best some hints about the nature of the disorder and its causes.
to deal with the problem. This is an important part of the For example, if a drug with a specific known effect within
clinical description. the nervous system alleviates a certain psychological
disorder, we know that something in that part of the nervous
For example, if someone is suffering from a mild disorder system might either be causing the disorder or helping
with acute onset that we know is time limited, we might maintain it. Similarly, if a psychological treatment designed
advise the individual not to bother with expensive treatment to help clients regain a sense of control over their lives is
because the problem will be over soon enough, like a effective with a certain disorder, a diminished sense of
common cold. If the disorder is likely to last a long time control may be an important psychological component of
(become chronic), however, the individual might want to the disorder itself.
seek treatment and take other appropriate steps.
The effect does not necessarily imply the cause.
The anticipated course of a disorder is called the prognosis.
So, we might say, “the prognosis is good,” meaning the
individual will probably recover, or “the prognosis is
 HISTORICAL CONCEPTIONS OF ABNORMAL back against the evil in the world that it believed must have
BEHAVIOR been behind this heresy.
For thousands of years, humans have tried to explain and People increasingly turned to magic and sorcery to solve
control problematic behavior. But our efforts always derive their problems. During these turbulent times, the bizarre
from the theories or models of behavior popular at the time. behavior of people afflicted with psychological disorders
The purpose of these models is to explain why someone is was seen as the work of the devil and witches. It followed
“acting like that.” that individuals possessed by evil spirits were probably
responsible for any misfortune experienced by people in the
Three major models that have guided us date back to the
local community, which inspired drastic action against the
beginnings of civilization.
possessed. Treatments included exorcism, in which various
• Supernatural Model religious rituals were performed in an effort to rid the victim
• Biological Model of evil spirits. Other approaches included shaving the
• Psychological Model pattern of a cross in the hair of the victim’s head and
securing sufferers to a wall near the front of a church so that
Humans have always supposed that agents outside our they might benefit from hearing Mass.
bodies and environment influence our behavior, thinking,
and emotions. These agents—which might be divinities, The conviction that sorcery and witches are causes of
demons, spirits, or other phenomena such as magnetic fields madness and other evils continued into the 15th century,
or the moon or the stars—are the driving forces behind the and evil continued to be blamed for unexplainable behavior,
Supernatural model. even after the founding of the United States, as evidenced
by the Salem, Massachusetts, witch trials in the late 17th
In addition, since the era of ancient Greece, the mind has century, which resulted in the hanging deaths of 20 innocent
often been called the soul or the psyche and considered people.
separate from the body. Although many have thought that
the mind can influence the body and, in turn, the body can STRESS AND MELANCHOLY
influence the mind, most philosophers looked for causes of An equally strong opinion, even during this period,
abnormal behavior in one or the other. This split gave rise reflected the enlightened view that insanity was a natural
to two traditions of thought about abnormal behavior, phenomenon, caused by mental or emotional stress, and that
summarized as the biological model and the psychological it was curable. Mental depression and anxiety were
model. recognized as illnesses, although symptoms such as despair
The Supernatural Tradition and lethargy were often identified by the church with the
sin of acedia, or sloth. Common treatments were rest,
For much of our recorded history, deviant behavior has sleep, and a healthy and happy environment. Other
been considered a reflection of the battle between good and treatments included baths, ointments, and various potions.
evil. When confronted with unexplainable, irrational Indeed, during the 14th and 15th centuries, people with
behavior and by suffering and upheaval, people have insanity, along with those with physical deformities or
perceived evil. In fact, in the great Persian empire from 900 disabilities, were often moved from house to house in
to 600 B.C., all physical and mental disorders were medieval villages as neighbors took turns caring for them.
considered the work of the devil. Barbara Tuchman, a noted We now know that this medieval practice of keeping people
historian, chronicled the second half of the 14th century, a who have psychological disturbances in their own
particularly difficult time for humanity, in A Distant Mirror community is beneficial.
(1978). She ably captures the conflicting tides of opinion on
the origins and treatment of insanity during that bleak and In the 14th century, one of the chief advisers to the king of
tumultuous period. France, a bishop and philosopher named Nicholas Oresme,
also suggested that the disease of melancholy (depression)
DEMONS AND WITCHES was the source of some bizarre behavior, rather than
demons. Oresme pointed out that much of the evidence for
During the last quarter of the 14th century, religious and lay
the existence of sorcery and witchcraft, particularly among
authorities supported these popular superstitions, and
those considered insane, was obtained from people who
society as a whole began to believe more strongly in the
were tortured and who, quite understandably, confessed to
existence and power of demons and witches. The Catholic
anything.
Church had split, and a second center, complete with a
pope, emerged in the south of France to compete with These conflicting crosscurrents of natural and supernatural
Rome. In reaction to this schism, the Roman Church fought explanations for mental disorders are represented more or
less strongly in various historical works, depending on the MASS HYSTERIA
sources consulted by historians. Some assumed that
Another fascinating phenomenon is characterized by large-
demonic influences were the predominant explanations of
scale outbreaks of bizarre behavior. To this day, these
abnormal behavior during the Middle Ages, others believed
episodes puzzle historians and mental health practitioners.
that the supernatural had little or no influence. As in the
During the Middle Ages, they lent support to the notion of
handling of the severe psychological disorder experienced
possession by the devil. In Europe, whole groups of people
by late-14th-century King Charles VI of France, both
were simultaneously compelled to run out in the streets,
influences were strong, sometimes alternating in the
dance, shout, rave, and jump around in patterns as if they
treatment of the same case.
were at a particularly wild party late at night (still called a
TREATMENTS FOR POSSESSION rave today, but with music). This behavior was known by
several names, including Saint Vitus’s Dance and
With a perceived connection between evil deeds and sin on
tarantism. It is most interesting that many people behaved
the one hand and psychological disorders on the other, it is
in this strange way at once. In an attempt to explain the
logical to conclude that the sufferer is largely responsible
inexplicable, several reasons were offered in addition to
for the disorder, which might well be a punishment for evil
possession. One reasonable guess was reaction to insect
deeds.
bites. Another possibility was what we now call mass
The acquired immune deficiency syndrome (AIDS) hysteria.
epidemic was associated with a similar belief among some
MODERN MASS HYSTERIA
people, particularly in the late 1980s and early 1990s.
Because the human immunodeficiency virus (HIV) is, in One Friday afternoon, an alarm sounded over the public
Western societies, still quite prevalent among the gay address system of a community hospital, calling all
community, many people believed it was a divine physicians to the emergency room immediately. Arriving
punishment for what they considered immoral behavior. from a local school in a fleet of ambulances were 17
This view became less common as the AIDS virus spread students and 4 teachers who reported dizziness, headache,
to other segments of the population, yet some people still nausea, and stomach pains. Some were vomiting; most were
hold on to this belief. hyperventilating.
Possession, however, is not always connected with sin but In hydrotherapy, patients were shocked back to their senses
may be seen as involuntary and the possessed individual as by applications of ice-cold water.
blameless. Furthermore, exorcisms at least have the virtue
All the students and teachers had been in four classrooms,
of being relatively painless. They sometimes work, as do
two on each side of the hallway. The incident began when
other forms of faith healing, for reasons we explore in
a 14-year-old young woman reported a funny smell that
subsequent chapters. But what if they did not? In the Middle
seemed to be coming from a vent. She fell to the floor,
Ages, if exorcism failed, some authorities thought that steps
crying and complaining that her stomach hurt and her eyes
were necessary to make the body uninhabitable by evil
stung. Soon, many of the students and most of the teachers
spirits, and many people were subjected to confinement,
in the four adjoining classrooms, who could see and hear
beatings, and other forms of torture.
what was happening, experienced similar symptoms. Of 86
Somewhere along the way, a creative “therapist” decided susceptible people (82 students and 4 teachers in the four
that hanging people over a pit full of poisonous snakes classrooms), 21 patients (17 students and 4 teachers)
might scare the evil spirits right out of their bodies (to say experienced symptoms severe enough to be evaluated at the
nothing of terrifying the people themselves). This approach hospital. Inspection of the school building by public health
sometimes worked; that is, the most disturbed, oddly authorities revealed no apparent cause for the reactions, and
behaving individuals would suddenly come to their senses physical examinations by teams of physicians revealed no
and experience relief from their symptoms, if only physical abnormalities. All the patients were sent home and
temporarily. Naturally, this was reinforcing to the therapist, quickly recovered.
so snake pits were built in many institutions. Although these
Mass hysteria may simply demonstrate the phenomenon of
torture procedures seemed temporarily effective, these
emotion contagion, in which the experience of an emotion
“treatments” are not the kinds of approaches we want to use
seems to spread to those around us. If someone nearby
because there is no good theoretical (or ethical) reason for
becomes frightened or sad, chances are that, for the
using them.
moment, you also will feel fear or sadness. When this kind
of experience escalates into full-blown panic, whole
communities are affected. People are also suggestible when
they are in states of high emotion. Therefore, if one person “disease” because they believed that psychological
identifies a “cause” of the problem, others will probably disorders might also be caused by brain pathology or head
assume that their own reactions have the same source. In trauma and could be influenced by heredity (genetics).
popular language, this shared response is sometimes These are remarkably astute deductions for the time, and
referred to as mob psychology. Until recently, it was they have been supported in recent years. Hippocrates
assumed that victims had to be in contact with each other considered the brain to be the seat of wisdom,
for the contagion to occur, as were the young women consciousness, intelligence, and emotion. Therefore,
described above in the adjacent classrooms. But lately there disorders involving these functions would logically be
are documented cases of emotion contagion occurring located in the brain. Hippocrates also recognized the
across social networks, raising the possibility that episodes importance of psychological and interpersonal
of mass hysteria may increase. contributions to psychopathology, such as the sometimes-
negative effects of family stress; on some occasions, he
Emotions are contagious and can escalate into mass
removed patients from their families.
hysteria.
The Roman physician Galen (approximately A.D. 129–
THE MOON AND THE STARS
198) later adopted the ideas of Hippocrates and his
Paracelsus, a Swiss physician who lived from 1493 to associates and developed them further, creating a powerful
1541, rejected notions of possession by the devil, and influential school of thought within the biological
suggesting instead that the movements of the moon and tradition that extended well into the 19th century. One of
stars had profound effects on people’s psychological the more interesting and influential legacies of the
functioning. Echoing similar thinking in ancient Greece, Hippocratic-Galenic approach is the humoral theory of
Paracelsus speculated that the gravitational effects of the disorders. Hippocrates assumed that normal brain
moon on bodily fluids might be a possible cause of mental functioning was related to four bodily fluids or humors:
disorders. This influential theory inspired the word lunatic, blood, black bile, yellow bile, and phlegm.
which is derived from the Latin word luna, meaning
• Blood came from the heart
“moon.” You might hear some of your friends explain
• Black bile from the spleen
something crazy they did one night by saying, “It must have
• Phlegm from the brain
been the full moon.” The belief that heavenly bodies affect
human behavior still exists, although there is no scientific • Choler or Yellow bile from the liver
evidence to support it. Despite much ridicule, millions of Physicians believed that disease resulted from too much or
people around the world are convinced that their behavior too little of one of the humors; for example, too much black
is influenced by the stages of the moon or the positions of bile was thought to cause melancholia (depression). In fact,
the stars. This belief is most noticeable today in followers the term melancholer, which means “black bile,” is still
of astrology, who hold that their behavior and the major used today in its derivative form melancholy to refer to
events in their lives can be predicted by their day-to-day aspects of depression. The humoral theory was, perhaps, the
relationship to the position of the planets. No serious first example of associating psychological disorders with a
evidence has ever confirmed such a connection. “chemical imbalance,”.
THE BIOLOGICAL TRADITION The four humors were related to the Greeks’ conception of
Physical causes of mental disorders have been sought since the four basic qualities: heat, dryness, moisture, and cold.
early in history. Important to the biological tradition are an Each humor was associated with one of these qualities.
ancient Greek physician, Hippocrates; a disease, syphilis; Terms derived from the four humors are still sometimes
and the early consequences of believing that psychological applied to personality traits.
disorders are biologically caused. Sanguine (literal meaning “red, like blood”) describes
HIPPOCRATES AND GALEN someone who is ruddy in complexion, presumably from
copious blood flowing through the body, and cheerful and
The Greek physician Hippocrates (460–377 B.C.) is optimistic, although insomnia and delirium were thought to
considered to be the father of modern Western medicine. He be caused by excessive blood in the brain.
and his associates left a body of work called the
Hippocratic Corpus, written between 450 and 350 B.C., in Melancholic means depressive (depression was thought to
which they suggested that psychological disorders could be be caused by black bile flooding the brain). A phlegmatic
treated like any other disease. They did not limit their search personality (from the humor phlegm) indicates apathy and
for the causes of psychopathology to the general area of sluggishness but can also mean being calm under stress.
Choleric person (from yellow bile or choler) is hot SYPHILIS
tempered.
Behavioral and cognitive symptoms of what we now know
Excesses of one or more humors were treated by regulating as advanced syphilis, a sexually transmitted disease caused
the environment to increase or decrease heat, dryness, by a bacterial microorganism entering the brain, include
moisture, or cold, depending on which humor was out of believing that everyone is plotting against you (delusion of
balance. One reason King Charles VI’s physician moved persecution) or that you are God (delusion of grandeur),
him to the less stressful countryside was to restore the as well as other bizarre behaviors. Although these
balance in his humors. In addition to rest, good nutrition, symptoms are similar to those of psychosis, researchers
and exercise, two treatments were developed. In one, recognized that a subgroup of apparently psychotic patients
bleeding or bloodletting, a carefully measured amount of deteriorated steadily, becoming paralyzed and dying within
blood was removed from the body, often with leeches. The 5 years of onset.
other was to induce vomiting; indeed, in a well-known
Psychosis— psychological disorders characterized in part
treatise on depression published in 1621, Anatomy of
by beliefs that are not based in reality (delusions),
Melancholy, Robert Burton recommended eating tobacco
perceptions that are not based in reality (hallucinations), or
and a half-boiled cabbage to induce vomiting.
both
BLOODLETTING – the extraction of blood from patients,
In 1825, the condition was designated a disease, general
was intended to restore the balance of humors in the body.
paresis, because it had consistent symptoms (presentation)
In ancient China and throughout Asia, a similar idea and a consistent course that resulted in death. The
existed. The Chinese focused on the movement of air or relationship between general paresis and syphilis was only
“wind” throughout the body. Unexplained mental disorders gradually established. Louis Pasteur’s germ theory of
were caused by blockages of wind or the presence of cold, disease, developed in about 1870, facilitated the
dark wind (yin) as opposed to warm, life-sustaining wind identification of the specific bacterial microorganism that
(yang). Treatment involved restoring proper flow of wind caused syphilis.
through various methods, including acupuncture.
Of equal importance was the discovery of a cure for general
Hippocrates also coined the word hysteria to describe a paresis. Physicians observed a surprising recovery in
concept he learned about from the Egyptians, which what patients with general paresis who had contracted malaria,
we now call the somatic symptom disorders. In these so they deliberately injected other patients with blood from
disorders, the physical symptoms appear to be the result of a soldier who was ill with malaria. Many of those who
a medical problem for which no physical cause can be survived this treatment recovered because the high fever
found, such as paralysis and some kinds of blindness. “burned out” the syphilis bacteria. Obviously, this type of
Because these disorders occurred primarily in women, the experiment would not be ethically possible today.
Egyptians (and Hippocrates) mistakenly assumed that they Ultimately, clinical investigators discovered that penicillin
were restricted to women. They also presumed a cause: The cures syphilis, but with the malaria cure, “madness” and
empty uterus wandered to various parts of the body in associated behavioral and cognitive symptoms for the first
search of conception (the Greek word for “uterus” is time were traced directly to a curable infection. Many
hysteron). Numerous physical symptoms reflected the mental health professionals then assumed that comparable
location of the wandering uterus. The prescribed cure might causes and cures might be discovered for all psychological
be marriage or, occasionally, fumigation of the vagina to disorders.
lure the uterus back to its natural location. Knowledge of
JOHN P. GREY
physiology eventually disproved the wandering uterus
theory; however, the tendency to stigmatize dramatic The champion of the biological tradition in the United
women as hysterical continued unabated well into the States was the most influential American psychiatrist of the
1970s, when mental health professionals became sensitive time, John P. Grey. In 1854, Grey was appointed
to the prejudicial stereotype the term implied. Somatic superintendent of the Utica State Hospital in New York, the
symptom disorders (and the traits associated with them) are largest in the country. He also became editor of the
not limited to any one sex. American Journal of Insanity, the precursor of the current
American Journal of Psychiatry, the flagship publication of
THE 19TH CENTURY
the American Psychiatric Association (APA). Grey’s
the discovery of the nature and cause of syphilis and strong position was that the causes of insanity were always
support from the well-respected American psychiatrist physical. Therefore, the mentally ill patient should be
John P. Grey. treated as physically ill. The emphasis was again on rest,
diet, and proper room temperature and ventilation, physician who was a friend and colleague of Franklin tried
approaches used for centuries by previous therapists in the it on himself and discovered that the shock also made him
biological tradition. Grey even invented the rotary fan to “strangely elated” and wondered if it might be a useful
ventilate his large hospital. treatment for depression.
Under Grey’s leadership, the conditions in hospitals greatly Independently in the 1920s, Hungarian psychiatrist Joseph
improved, and they became more humane, livable von Meduna observed that schizophrenia was rarely found
institutions. But in subsequent years, they also became so in individuals with epilepsy (which ultimately did not prove
large and impersonal that individual attention was not to be true). Some of his followers concluded that induced
possible. brain seizures might cure schizophrenia. Following
suggestions on the possible benefits of applying electric
In fact, leaders in psychiatry at the end of the 19th century
shock directly to the brain—notably, by two Italian
were alarmed at the increasing size and impersonality of
physicians, Ugo Cerletti and Lucio Bini, in 1938—a
mental hospitals and recommended that they be downsized.
surgeon in London treated a depressed patient by sending
It was almost 100 years before the community mental health
six small shocks directly through his brain, producing
movement was successful in reducing the population of
convulsions. The patient recovered. Although greatly
mental hospitals with the controversial policy of
modified, shock treatment is still with us today. The
deinstitutionalization, in which patients were released into
controversial modern uses of electroconvulsive therapy. It
their communities. Unfortunately, this practice has as many
is interesting that even now we have little knowledge of
negative consequences as positive ones, including a large
how it works.
increase in the number of chronically disabled patients
experiencing homelessness on the streets of our cities. During the 1950s, the first effective drugs for severe
psychotic disorders were developed in a systematic way.
In the 19th century, psychological disorders were attributed
Before that time, a number of medicinal substances,
to mental or emotional stress, so patients were often treated
including opium (derived from poppies), had been used as
sympathetically in a restful and hygienic environment.
sedatives, along with countless herbs and folk remedies.
THE DEVELOPMENT OF BIOLOGICAL With the discovery of Rauwolfia serpentine (later renamed
TREATMENTS reserpine) and another class of drugs called neuroleptics
(major tranquilizers), for the first time hallucinatory and
On the positive side, renewed interest in the biological delusional thought processes could be diminished in some
origin of psychological disorders led, ultimately, to greatly patients; these drugs also controlled agitation and
increased understanding of biological contributions to aggressiveness.
psychopathology and to the development of new
treatments. In the 1930s, the physical interventions of Other discoveries included benzodiazepines (minor
electric shock and brain surgery were often used. Their tranquilizers), which seemed to reduce anxiety. By the
effects, and the effects of new drugs, were discovered quite 1970s, the benzodiazepines (known by such brand names as
by accident. For example, insulin was occasionally given to Valium and Librium) were among the most widely
stimulate appetite in psychotic patients who were not prescribed drugs in the world. As drawbacks and side
eating, but it also seemed to calm them down. In 1927, a effects of tranquilizers became apparent, along with their
Viennese physician, Manfred Sakel, began using limited effectiveness, prescriptions decreased somewhat.
increasingly higher dosages until, finally, patients
Throughout the centuries, as Alexander and Selesnick point
convulsed and became temporarily comatose. Some
out, “The general pattern of drug therapy for mental illness
actually recovered their mental health, much to the surprise
has been one of initial enthusiasm followed by
of everybody, and their recovery was attributed to the
disappointment”. For example, bromides, a class of
convulsions. The procedure became known as insulin
sedating drugs, were used at the end of the 19th century and
shock therapy, but it was abandoned because it was too
beginning of the 20th century to treat anxiety and other
dangerous, often resulting in prolonged coma or even death.
psychological disorders. By the 1920s, they were reported
Other methods of producing convulsions were needed.
as being effective for many serious psychological and
Benjamin Franklin made numerous discoveries during his emotional symptoms. By 1928, one of every five
life with which we are familiar, but most people don’t know prescriptions in the United States was for bromides. When
that he discovered accidentally, and then confirmed their side effects, including various undesirable physical
experimentally in the 1750s, that a mild and modest electric symptoms, became widely known, and experience began to
shock to the head produced a brief convulsion and memory show that their overall effectiveness was relatively modest,
loss (amnesia) but otherwise did little harm. A Dutch bromides largely disappeared from the scene.
Neuroleptics have also been used less as attention has has a long and distinguished tradition. Plato, for example,
focused on their many side effects, such as chronic tremors thought that the two causes of maladaptive behavior were
and shaking. However, the positive effects of these drugs the social and cultural influences in one’s life and the
on some patients’ psychotic symptoms of hallucinations, learning that took place in that environment. If something
delusions, and agitation revitalized both the search for was wrong in the environment, such as abusive parents,
biological contributions to psychological disorders and the one’s impulses and emotions would overcome reason. The
search for new and more powerful drugs, a search that has best treatment was to reeducate the individual through
paid many dividends. rational discussion so that the power of reason would
predominate. This was very much a precursor to modern
CONSEQUENCES OF THE BIOLOGICAL
psychosocial treatment approaches to the causation of
TRADITION
psychopathology, which focus not only on psychological
In the late 19th century, Grey and his colleagues ironically factors but also on social and cultural ones. Other well-
reduced or eliminated interest in treating mental patients known early philosophers, including Aristotle, also
because they thought that mental disorders were the result emphasized the influence of social environment and early
of some as-yet-undiscovered brain pathology and were learning on later psychopathology. These philosophers
therefore incurable. The only available course of action was wrote about the importance of fantasies, dreams, and
to hospitalize these patients. Around the turn of the century, cognitions and thus anticipated, to some extent, later
some nurses documented clinical success in treating mental developments in psychoanalytic thought and cognitive
patients but were prevented from treating others for fear of science. They also advocated humane and responsible care
raising hopes of a cure among family members. In place of for individuals with psychological disturbances.
treatment, interest centered on diagnosis, legal questions
MORAL THERAPY
concerning the responsibility of patients for their actions
during periods of insanity, and the study of brain pathology During the first half of the 19th century, a strong
itself. psychosocial approach to mental disorders called moral
therapy became influential. The term moral actually
The German physician Emil Kraepelin (1856–1926) was
referred more to emotional or psychological factors rather
the dominant figure during this period and one of the
than to a code of conduct. Its basic tenets included treating
founding fathers of modern psychiatry. He was extremely
institutionalized patients as normally as possible in a setting
influential in advocating the major ideas of the biological
that encouraged and reinforced normal social interaction,
tradition, but he was little involved in treatment. As a
thus providing them with many opportunities for
student of Wilhelm Wundt, his lasting contribution was in
appropriate social and interpersonal contact. Relationships
the area of diagnosis and classification. Kraepelin (1913)
were carefully nurtured. Individual attention clearly
was one of the first to distinguish among various
emphasized positive consequences for appropriate
psychological disorders, seeing that each may have a
interactions and behavior, and restraint and seclusion were
different age of onset and time course, with somewhat
eliminated.
different clusters of presenting symptoms, and probably a
different cause. Many of his descriptions of schizophrenic As with the biological tradition, the principles of moral
disorders are still useful today. therapy date back to Plato and beyond. For example, the
Greek Asclepiad Temples of the 6th century B.C. housed
By the end of the 1800s, a scientific approach to
the chronically ill, including those with psychological
psychological disorders and their classification had begun
disorders. Here, patients were well cared for, massaged, and
with the search for biological causes. Furthermore,
provided with soothing music. Similar enlightened
treatment was based on humane principles. There were
practices were evident in Muslim countries in the Middle
many drawbacks, however, the most unfortunate being that
East. But moral therapy as a system originated with the
active intervention and treatment were all but eliminated in
well-known French psychiatrist Philippe Pinel (1745–
some settings, despite the availability of some effective
1826) and his close associate Jean-Baptiste Pussin (1746–
approaches. It is to these that we now turn.
1811), who was the superintendent of the Parisian hospital
THE PSYCHOLOGICAL TRADITION La Bicêtre.

It is a long leap from evil spirits to brain pathology as the When Pinel arrived in 1791, Pussin had already instituted
cause of psychological disorders. In the intervening remarkable reforms by removing all chains used to restrain
centuries, where was the body of thought that put patients and instituting humane and positive psychological
psychological development, both normal and abnormal, in interventions. Pussin persuaded Pinel to go along with the
an interpersonal and social context? In fact, this approach changes. Much to Pinel’s credit, he did, first at La Bicêtre
and then at the women’s hospital Salpétrière, where he In addition to improving the standards of care, Dix worked
invited Pussin to join him. Here again, they instituted a hard to make sure that everyone who needed care received
humane and socially facilitative atmosphere that produced it, including people who experienced homelessness.
“miraculous” results. After William Tuke (1732–1822) Through her efforts, humane treatment became more
followed Pinel’s lead in England, Benjamin Rush (1745– widely available in U.S. institutions. As her career drew to
1813), often considered the founder of U.S. psychiatry, a close, she was rightly acknowledged as a hero of the 19th
introduced moral therapy in his early work at Pennsylvania century.
Hospital. It then became the treatment of choice in the
Unfortunately, an unforeseen consequence of Dix’s heroic
leading hospitals. Asylums had appeared in the 16th
efforts was a substantial increase in the number of mental
century, but they were more like prisons than hospitals. It
patients. This influx led to a rapid transition from moral
was the rise of moral therapy in Europe and the United
therapy to custodial care because hospitals were
States that made asylums habitable and even therapeutic.
inadequately staffed. Dix reformed our asylums and single-
In 1833, Horace Mann, chair of the board of trustees of the handedly inspired the construction of numerous new
Worcester State Hospital, reported on 32 patients who had institutions here and abroad. But even her tireless efforts
been given up as incurable. These patients were treated with and advocacy could not ensure sufficient staffing to allow
moral therapy, cured, and released to their families. Of 100 the individual attention necessary to moral therapy. A final
patients who were viciously assaultive before treatment, no blow to the practice of moral therapy was the decision, in
more than 12 continued to be violent a year after beginning the middle of the 19th century, that mental illness was
treatment. Before treatment, 40 patients had routinely torn caused by brain pathology and, therefore, was incurable.
off any new clothes provided by attendants; only 8
The psychological tradition lay dormant for a time, only to
continued this behavior after a period of treatment. These
reemerge in several different schools of thought in the 20th
were remarkable statistics then and would be remarkable
century. The first major approach was psychoanalysis,
even today.
based on Sigmund Freud’s (1856–1939) elaborate theory
ASYLUM REFORM AND THE DECLINE OF of the structure of the mind and the role of unconscious
MORAL THERAPY processes in determining behavior. The second was
behaviorism, associated with John B. Watson, Ivan
Unfortunately, after the mid-19th century, humane
Pavlov, and B. F. Skinner, which focuses on how learning
treatment declined because of a convergence of factors.
and adaptation affect the development of psychopathology.
First, it was widely recognized that moral therapy worked
best when the number of patients in an institution was 200 PSYCHOANALYTIC THEORY
or fewer, allowing for a great deal of individual attention.
The patients of Franz Anton Mesmer (1734–1815) and
After the Civil War, enormous waves of immigrants arrived
millions of people since his time have been hypnotized.
in the United States, yielding their own populations of
Mesmer suggested to his patients that their problem was
mentally ill. Patient loads in existing hospitals increased to
caused by an undetectable fluid found in all living
1,000 or 2,000, and even more. Because immigrant groups
organisms called “animal magnetism,” which could
were thought not to deserve the same privileges as “native”
become blocked.
Americans (whose ancestors had immigrated perhaps only
50 or 100 years earlier!), they were not given moral FRANZ ANTON MESMER (1734–1815) and other early
treatments even when there were sufficient hospital therapists often used hypnosis and/or strong suggestions to
personnel. cure their patients.
A second reason for the decline of moral therapy has an Mesmer had his patients sit in a dark room around a large
unlikely source. The great crusader Dorothea Dix (1802– vat of chemicals with rods extending from it and touching
1887) campaigned endlessly for reform in the treatment of them. Dressed in flowing robes, he might then identify and
insanity. A schoolteacher who had worked in various tap various areas of their bodies where their animal
institutions, she had firsthand knowledge of the deplorable magnetism was blocked while suggesting strongly that they
conditions imposed on patients with insanity, and she made were being cured. Because of his rather unusual techniques,
it her life’s work to inform the American public and their Mesmer was considered an oddity and maybe a charlatan,
leaders of these abuses. Her work became known as the strongly opposed by the medical establishment (Winter,
mental hygiene movement. 1998). In fact, none less than Benjamin Franklin put
animal magnetism to the test by conducting a brilliant
DOROTHEA DIX (1802–1887) began the mental hygiene
experiment in which patients received either magnetized
movement and spent much of her life campaigning for
water or nonmagnetized water with strong suggestions that
reform in the treatment of the mentally ill.
they would get better. Neither the patient nor the therapist A fuller understanding of the relationship between current
knew which water was which, making it a double-blind emotions and earlier events is referred to as insight. On
experiment. When both groups got better, Franklin anxiety and somatic symptom disorders, the existence of
concluded that animal magnetism, or mesmerism, was “unconscious” memories and feelings and the importance
nothing more than strong suggestion. Nevertheless, of processing emotion-filled information have been verified
Mesmer is widely regarded as the father of hypnosis, a state and reaffirmed.
in which extremely suggestible subjects sometimes appear
Freud and Breuer’s ideas were based on case observations,
to be in a trance.
some of which were made in a surprisingly systematic way
Many distinguished scientists and physicians were for those times. An excellent example is Breuer’s classic
interested in Mesmer’s powerful methods of suggestion. description of his treatment of “hysterical” symptoms in
One of the best known, Jean-Martin Charcot (1825– Anna O. in 1895 (Breuer & Freud, 1895/1957).
1893), was head of the Salpétrière Hospital in Paris, where
Anna O. was a bright young woman who was perfectly
Philippe Pinel had introduced psychological treatments
healthy until she reached 21 years of age. Shortly before her
several generations earlier. A distinguished neurologist,
problems began, her father developed a serious chronic
Charcot demonstrated that some techniques of mesmerism
illness that led to his death. Throughout his illness, Anna O.
were effective with a number of psychological disorders,
had cared for him; she felt it necessary to spend endless
and he did much to legitimize the fledgling practice of
hours at his bedside. Five months after her father became
hypnosis. Significantly, in 1885 a young man named
ill, Anna noticed that during the day her vision blurred and
Sigmund Freud came from Vienna to study with Charcot.
that from time to time she had difficulty moving her right
JEAN CHARCOT (1825–1893) studied hypnosis and arm and both legs. Soon, additional symptoms appeared.
influenced Sigmund Freud to consider psychosocial She began to experience some difficulty speaking, and her
approaches to psychological disorders. behavior became unpredictable. Shortly thereafter, she
consulted Breuer.
After returning from France, Freud teamed up with Josef
Breuer (1842–1925), who had experimented with a In a series of treatment sessions, Breuer dealt with one
somewhat different hypnotic procedure. symptom at a time through hypnosis and subsequent
“talking through,” tracing each symptom to its hypothetical
JOSEF BREUER (1842–1925) worked on the celebrated
causation in circumstances surrounding the death of Anna’s
case of Anna O. and, with Sigmund Freud, developed the
father. One at a time, her “hysterical” ailments
theory of psychoanalysis.
disappeared, but only after treatment was administered for
While his patients were in the highly suggestible state of each respective behavior. This process of treating one
hypnosis, Breuer asked them to describe their problems, behavior at a time fulfills a basic requirement for drawing
conflicts, and fears in as much detail as they could. Breuer scientific conclusions about the effects of treatment in an
observed two extremely important phenomena during this individual case study.
process. First, patients often became extremely emotional
Freud took these basic observations and expanded them into
as they talked and felt quite relieved and improved after
the psychoanalytic model, the most comprehensive theory
emerging from the hypnotic state. Second, seldom would
yet constructed on the development and structure of our
they have gained an understanding of the relationship
personalities. He also speculated on where this
between their emotional problems and their psychological
development could go wrong and produce psychological
disorder. In fact, it was difficult or impossible for them to
disorders. Although many of Freud’s views changed over
recall some details they had described under hypnosis. In
time, the basic principles of mental functioning that he
other words, the material seemed to be beyond the
originally proposed remained constant through his writings
awareness of the patient. With this observation, Breuer and
and are still applied by psychoanalysts today.
Freud believed that they had “discovered” the unconscious
mind and its apparent influence on the production of Although most of it turned out to be incorrect or remains
psychological disorders. This is one of the most important unproven, psychoanalytic theory has had a strong influence,
developments in the history of psychopathology and, and it is still important to be familiar with its basic ideas;
indeed, of psychology as a whole. what follows is a brief outline of the theory. We focus on
its three major facets:
A close second was their discovery that it is therapeutic to
recall and relive emotional trauma that has been made (1) the structure of the mind and the distinct functions of
unconscious and to release the accompanying tension. This personality that sometimes clash with one another;
release of emotional material became known as catharsis.
(2) the defense mechanisms with which the mind defends dangerous aggressive and sexual drives of the id, the basis
itself from these clashes, or conflicts; for conflict is readily apparent.
(3) the stages of early psychosexual development that The role of the ego is to mediate conflict between the id and
provide grist for the mill of our inner conflicts. the superego, juggling their demands with the realities of
the world. The ego is often referred to as the executive or
THE STRUCTURE OF THE MIND
manager of our minds. If it mediates successfully, we can
The mind, according to Freud, has three major parts or go on to the higher intellectual and creative pursuits of life.
functions: the id, the ego, and the super-ego. These terms, If it is unsuccessful and the id or superego becomes too
like many from psycho-analysis, have found their way into strong, conflict will overtake us, and psychological
our common vocabulary, but although you may have heard disorders will develop. Because these conflicts are all
them, you may not be aware of their meaning. within the mind, they are referred to as intrapsychic
conflicts. Now think back to the case of Anna O., in which
The id is the source of our strong sexual and aggressive Breuer observed that patients cannot always remember
feelings or energies. It is, basically, the animal within important but unpleasant emotional events. From these and
people; if totally unchecked, it could make someone a rapist other observations, Freud conceptualized the mental
or a killer. The energy or drive within the id is the libido. structures described in this section to explain unconscious
Even today, some people explain low sex drive as an processes. He believed that the id and the superego are
absence of libido. A less important source of energy, not as almost entirely unconscious. We are fully aware only of the
well conceptualized by Freud, is the death instinct, or secondary processes of the ego, which is a relatively small
thanatos. These two basic drives, toward life and fulfillment part of the mind.
on the one hand and death and destruction on the other, are
continually in opposition. SIGMUND FREUD (1856–1939) is considered the
founder of psychoanalysis.
The id operates according to the pleasure principle, with an
overriding goal of maximizing pleasure and eliminating any DEFENSE MECHANISMS
associated tension or conflicts. The goal of pleasure, which
The ego fights a continual battle to stay on top of the
is particularly prominent in childhood, often conflicts with
warring id and superego. Occasionally, their conflicts
social rules and regulations, as you shall see later. The id
produce anxiety that threatens to overwhelm the ego. The
has its own characteristic way of processing information;
anxiety is a signal that alerts the ego to marshal defense
referred to as the primary process, this type of thinking is
mechanisms, unconscious protective processes that keep
emotional, irrational, illogical, filled with fantasies, and
primitive emotions associated with conflicts in check so
preoccupied with sex, aggression, selfishness, and envy.
that the ego can continue its coordinating function.
Fortunately for all of us, in Freud’s view, the id’s selfish Although Freud first conceptualized defense mechanisms,
and sometimes dangerous drives do not go unchecked. In it was his daughter, Anna Freud, who developed the ideas
fact, only a few months into life, we know we must adapt more fully.
our basic demands to the real world. In other words, we
We all use defense mechanisms at times: They are
must find ways to meet our basic needs without offending
sometimes adaptive and at other times maladaptive. For
everyone around us. Put yet another way, we must act
example, have you ever done poorly on a test because the
realistically.
professor was unfair in the grading? And then you go to a
The part of our mind that ensures that we act realistically is store and you start an argument with a store clerk because
called the ego, and it operates according to the reality you can’t find an item? This is an example of the defense
principle instead of the pleasure principle. The cognitive mechanism of displacement. The ego adaptively decides
operations or thinking styles of the ego are characterized by that expressing primitive anger at your professor might not
logic and reason and are referred to as the secondary be in your best interest. Because that store clerk doesn’t
process, as opposed to the illogical and irrational primary have the authority to affect you in an adverse way, your
process of the id. anger is displaced to them. Some people may redirect
energy from conflict or underlying anxiety into a more
The super-ego, or what we might call conscience, constructive outlet such as work, where they may be more
represents the moral principles instilled in us by our parents efficient because of the redirection. This process is called
and our culture. It is the voice within us that nags at us when sublimation.
we know we’re doing something wrong. Because the
purpose of the superego is to counteract the potentially More severe internal conflicts that produce a lot of anxiety
or other emotions can trigger self-defeating defensive
processes or symptoms. Phobic and obsessive symptoms and mouth become the focus of libidinal drives and,
are especially common self-defeating defensive reactions therefore, the principal source of pleasure. Freud
that, according to Freud, reflect an inadequate attempt to hypothesized that if we did not receive appropriate
deal with an internally dangerous situation. Phobic gratification during a specific stage or if a specific stage left
symptoms typically incorporate elements of the danger. For a particularly strong impression (which he termed fixation),
example, a dog phobia may be connected to an infantile fear an individual’s personality would reflect the stage
of castration; that is, a man’s internal conflict involves a throughout adult life. For example, fixation at the oral stage
fear of being attacked and castrated, a fear that is might result in excessive thumb sucking and emphasis on
consciously expressed as a fear of being attacked and bitten oral stimulation through eating, chewing pencils, or biting
by a dog, even if he knows the dog is harmless. fingernails. Adult personality characteristics theoretically
associated with oral fixation include dependency and
Defense mechanisms have been subjected to scientific
passivity or, in reaction to these tendencies, rebelliousness
study, and there is some evidence that they may be of
and cynicism.
potential import in the study of psychopathology. For
example, Perry and Bond noted that reduction in Phallic stage (from age 3 to age 5 or 6), which is
unadaptive defense mechanisms, and strengthening of characterized by early genital self-stimulation. This
adaptive mechanisms such as humor and sublimation, conflict is the subject of the Greek tragedy Oedipus Rex,
correlated with psychological health. in which Oedipus is fated to kill his father and,
unknowingly, to marry his mother. Freud asserted that all
Denial: Refuses to acknowledge some aspect of objective
young boys relive this fantasy when genital self-stimulation
reality or subjective experience that is apparent to others
is accompanied by images of sexual interactions with their
Displacement: Transfers a feeling about or a response to mothers. These fantasies, in turn, are accompanied by
an object that causes discomfort onto another, usually less strong feelings of envy and perhaps anger toward their
threatening, object or person fathers, with whom they identify but whose place they wish
to take. Furthermore, strong fears develop that the father
Projection: Falsely attributes own unacceptable feelings, may punish that lust by removing the son’s penis—thus, the
impulses, or thoughts to another individual or object phenomenon of castration anxiety. This fear helps the boy
Rationalization: Conceals the true motivations for actions, keep his lustful impulses toward his mother in check. The
thoughts, or feelings through elaborate reassuring or self- battle of the lustful impulses on the one hand and castration
serving but incorrect explanations anxiety on the other creates a conflict that is internal, or
intrapsychic, called the Oedipus complex. The phallic stage
Reaction formation: Substitutes behavior, thoughts, or passes uneventfully only if several things happen. First, the
feelings that are the direct opposite of unacceptable ones child must resolve his ambivalent relationship with his
parents and reconcile the simultaneous anger and love he
Repression: Blocks disturbing wishes, thoughts, or
has for his father. If this happens, he may go on to channel
experiences from conscious awareness
his libidinal impulses into heterosexual relationships while
Sublimation: Directs potentially maladaptive feelings or retaining harmless affection for his mother.
impulses into socially acceptable behavior
The counterpart conflict in girls, the Electra complex, is
PSYCHOSEXUAL STAGES OF DEVELOPMENT even more controversial. Freud viewed the young girl as
wanting to replace her mother and possess her father.
Freud also theorized that during infancy and early Central to this possession is the girl’s desire for a penis, so
childhood we pass through a number of psychosexual as to be more like her father and brothers—hence the term
stages of development that have a profound and lasting penis envy. According to Freud, the conflict is successfully
impact. This makes Freud one of the first to take a resolved when females develop healthy heterosexual
developmental perspective on the study of abnormal relationships and look forward to having a baby, which he
behavior. viewed as a healthy substitute for having a penis.
The stages—oral, anal, phallic, latency, and genital— In Freud’s view, all nonpsychotic psychological disorders
represent distinctive patterns of gratifying our basic needs resulted from underlying unconscious conflicts, the
and satisfying our drive for physical pleasure. anxiety that resulted from those conflicts, and the
Oral stage extending for approximately 2 years from birth, implementation of ego defense mechanisms. Freud called
is characterized by a central focus on the need for food. In such disorders neuroses, or neurotic disorders, from an old
the act of sucking, necessary for feeding, the lips, tongue, term referring to disorders of the nervous system.
LATER DEVELOPMENTS IN PSYCHOANALYTIC introversion (the tendency to be shy and withdrawn)
THOUGHT extroversion (the tendency to be friendly and outgoing)
Anna Freud (1895–1982), Freud’s daughter, concentrated Adler focused on feelings of inferiority and the striving for
on the way in which the defensive reactions of the ego superiority; he created the term inferiority complex. Adler
determine our behavior. In so doing, she was the first also believed that the basic quality of human nature is
proponent of the modern field of ego psychology. Her book positive and that there is a strong drive toward self-
Ego and the Mechanisms of Defense (1946) is still actualization (realizing one’s full potential). Jung and
influential. According to Anna Freud, the individual slowly Adler believed that by removing barriers to both internal
accumulates adaptational capacities, skill in reality testing, and external growth the individual would improve and
and defenses. Abnormal behavior develops when the ego is flourish.
deficient in regulating such functions as delaying and
Others took psychoanalytical theorizing in different
controlling impulses or in marshaling appropriate normal
directions, emphasizing development over the life span and
defenses to strong internal conflicts. In another somewhat
the influence of culture and society on personality.
later modification of Freud’s theories, Heinz Kohut (1913–
1981) focused on a theory of the formation of self-concept Karen Horney (1885–1952) and Erich Fromm (1900–
and the crucial attributes of the self that allow an individual 1980) are associated with these ideas, but the best-known
to progress toward health, or conversely, to develop theorist is Erik Erikson (1902–1994). Erikson’s greatest
neurosis. This psychoanalytic approach became known as contribution was his theory of development across the life
self-psychology (Kohut, 1977). span, in which he described in some detail the crises and
conflicts that accompany eight specific stages. For
NEUROSIS – psychoanalytic view of the causes of
example, in the last of these stages, the mature age,
psychological disorders (dropped from DSM in 1980).
beginning about age 65, individuals review their lives and
Object relations is the study of how children incorporate attempt to make sense of them, experiencing both
the images, the memories, and sometimes the values of a satisfaction at having completed some lifelong goals and
person who was important to them and to whom they were despair at having failed at others. Scientific developments
(or are) emotionally attached. Object in this sense refers to have borne out the wisdom of considering psychopathology
these important people, and the process of incorporation is from a developmental point of view.
called introjection. Introjected objects can become an
PSYCHOANALYTIC PSYCHOTHERAPY
integrated part of the ego or may assume conflicting roles
in determining the identity, or self. For example, your Many techniques of psychoanalytic psychotherapy, or
parents or guardians may have conflicting views on psychoanalysis, are designed to reveal the nature of
relationships or careers, which, in turn, may be different unconscious mental processes and conflicts through
from your own point of view. To the extent that these catharsis and insight. Freud developed techniques of free
varying positions have been incorporated, the potential for association, in which patients are instructed to say
conflict arises. One day you may feel one way about your whatever comes to mind without the usual socially required
career direction, and the next day you may feel quite censoring.
differently. According to object relations theory, you tend
to see the world through the eyes of the person incorporated Free association is intended to reveal emotionally charged
into your self. Object relations theorists focus on how these material that may be repressed because it is too painful or
disparate images come together to make up a person’s threatening to bring into consciousness. Freud’s patients lay
identity and on the conflicts that may emerge. on a couch, and he sat behind them so that they would not
be distracted. This is how the couch became the symbol of
Carl Jung (1875–1961) and Alfred Adler (1870–1937) psychotherapy. Other techniques include dream analysis,
were students of Freud who came to reject his ideas and in which the therapist interprets the content of dreams,
form their own schools of thought. Jung, rejecting many of supposedly reflecting the primary-process thinking of the
the sexual aspects of Freud’s theory, introduced the concept id, and systematically relates the dreams to symbolic
of the collective unconscious, which is a wisdom aspects of unconscious conflicts. This procedure is often
accumulated by society and culture that is stored deep in difficult because the patient may resist the efforts of the
individual memories and passed down from generation to therapist to uncover repressed and sensitive conflicts and
generation. Jung also suggested that spiritual and religious may deny the interpretations. The goal of this stage of
drives are as much a part of human nature as are sexual therapy is to help the patient gain insight into the nature of
drives. the conflicts.
The relationship between the therapist, called the (6) an emphasis on the therapeutic relationship;
psychoanalyst, and the patient is important. In the context
(7) an exploration of patients’ wishes, dreams, or fantasies
of this relationship as it evolves, the therapist may discover
the nature of the patient’s intrapsychic conflict. This is Two additional features characterize psychodynamic
because, in a phenomenon called transference, patients psychotherapy.
come to relate to the therapist much as they did to important
figures in their childhood, particularly their parents. ➢ First, it is significantly briefer than classical
Patients who resent the therapist but can verbalize no good psychoanalysis.
reason for it may be reenacting childhood resentment ➢ Second, psychodynamic therapists deemphasize the
toward a parent. More often, the patient will fall deeply in goal of personality reconstruction, focusing instead on
love with the therapist, which reflects strong positive relieving the suffering associated with psychological
feelings that existed earlier for a parent. In the phenomenon disorders
of countertransference, therapists project some of their Psychoanalytic concepts and observations have been
own personal issues and feelings, usually positive, onto the valuable to the study of psychopathology and
patient. Therapists are trained to deal with their own psychodynamic psychotherapy and also to the history of
feelings as well as those of their patients, whatever the ideas in Western civilization. Careful scientific studies of
mode of therapy, and it is strictly against all ethical canons psychopathology have supported the observation of
of the mental health professions to accept overtures from unconscious mental processes, the notion that basic
patients that might lead to relationships outside therapy. emotional responses are often triggered by hidden or
Classical psychoanalysis requires therapy four to five times symbolic cues, and the understanding that memories of
a week for 2 to 5 years to analyze unconscious conflicts, events in our lives can be repressed and otherwise avoided
resolve them, and restructure the personality to put the ego in a variety of ingenious ways. The relationship of the
back in charge. Reduction of symptoms (psychological therapist and the patient, called the therapeutic alliance, is
disorders) is relatively inconsequential because they are an important area of study across most therapeutic
only express underlying intrapsychic conflicts that arise strategies.
from psychosexual developmental stages. Thus, In early years, the source of good and evil and of urges and
eliminating a phobia or depressive episode would be of little prohibitions was conceived as external and spiritual,
use unless the underlying conflict was dealt with usually in the guise of demons confronting the forces of
adequately, because another set of symptoms would almost good. From the psychoanalytic point of view, we ourselves
certainly emerge (symptom substitution). Because of the became the battleground for these forces, and we are
high cost of classical psychoanalysis and the lack of inexorably caught up in the battle, sometimes for better and
evidence that it is effective in alleviating psychological sometimes for worse.
disorders, this approach is seldom used today.
HUMANISTIC THEORY
Psychoanalysis is still practiced, particularly in some large
cities, but many psychotherapists employ a loosely related Freud portrayed life as a battleground where we are
set of approaches referred to as psychodynamic continually in danger of being overwhelmed by our darkest
psychotherapy. Although conflicts and unconscious forces. Jung and Adler, by contrast, emphasized the
processes are still emphasized and efforts are made to positive, optimistic side of human nature. Jung talked about
identify trauma and active defense mechanisms, therapists setting goals, looking toward the future, and realizing one’s
use an eclectic mixture of tactics, with a social and fullest potential. Adler believed that human nature reaches
interpersonal focus. its fullest potential when we contribute to the welfare of
other individuals and to society as a whole. He believed that
(1) a focus on affect and the expression of patients’ we all strive to reach superior levels of intellectual and
emotions; moral development. Their general philosophies were
(2) an exploration of patients’ attempts to avoid topics or adopted in the middle of the century by personality theorists
engage in activities that hinder the progress of therapy; and became known as humanistic psychology.

(3) the identification of patterns in patients’ actions, Self-actualizing was the watchword for this movement.
thoughts, feelings, experiences, and relationships; The underlying assumption is that all of us could reach our
highest potential, in all areas of functioning, if only we had
(4) an emphasis on past experiences;
the freedom to grow. Inevitably, a variety of conditions may
(5) a focus on patients’ interpersonal experiences; block our actualization. Because every person is basically
good and whole, most blocks originate outside the
individual. Difficult living conditions or stressful life or In his classic study examining why dogs salivate before the
interpersonal experiences may move you away from your presentation of food, physiologist Ivan Petrovich Pavlov
true self. (1849–1936) of St. Petersburg, Russia, initiated the study of
classical conditioning, a type of learning in which a neutral
Abraham Maslow (1908–1970) was most systematic in
stimulus is paired with a response until it elicits that
describing the structure of personality. He postulated a
response. The word conditioning (conditioned response)
hierarchy of needs, beginning with our most basic physical
resulted from an accident in translation from the original
needs for food and sex and ranging upward to our needs for
Russian. Pavlov was really talking about a response that
self-actualization, love, and self-esteem. Social needs such
occurred only on the condition of the presence of a
as friendship fall somewhere between. Maslow
particular event or situation (stimulus)— in this case, the
hypothesized that we cannot progress up the hierarchy until
footsteps of the laboratory assistant at feeding time. Thus,
we have satisfied the needs at lower levels.
“conditional response” would have been more accurate.
Carl Rogers (1902–1987) is, from the point of view of Conditioning is one way in which we acquire new
therapy, the most influential humanist. Rogers (1961) information, particularly information that is somewhat
originated client-centered therapy, later known as person- emotional in nature. This process is not as simple as it first
centered therapy. In this approach, the therapist takes a seems. But it can be quite automatic.
passive role, making as few interpretations as possible. The
Psychologists working in oncology units have studied a
point is to give the individual a chance to develop during
phenomenon well known to many cancer patients, their
the course of therapy, unfettered by threats to the self.
nurses and physicians, and their families. Chemotherapy, a
Humanist theorists have great faith in the ability of human
common treatment for some forms of cancer, has side
relations to foster this growth. Unconditional positive
effects including severe nausea and vomiting. But these
regard, the complete and almost unqualified acceptance of
patients often experience severe nausea and, occasionally,
most of the client’s feelings and actions, is critical to the
vomiting when they merely see the medical personnel who
humanistic approach. Empathy is the sympathetic
administered the chemotherapy or any equipment
understanding of the individual’s particular view of the
associated with the treatment, even on days when their
world. The hoped-for result of person-centered therapy is
treatment is not delivered. For some patients, this reaction
that clients will be more straightforward and honest with
becomes associated with a variety of stimuli that evoke
themselves and will access their innate tendencies toward
people or things present during chemotherapy—anybody in
growth.
a nurse’s uniform or even the sight of the hospital. The
Like psychoanalysis, the humanistic approach has had a strength of the response to similar objects or people is
substantial effect on theories of interpersonal relationships. usually a function of how similar these objects or people
For example, the human potential movements so popular in are. This phenomenon is called stimulus generalization
the 1960s and 1970s were a direct result of humanistic because the response generalizes to similar stimuli. In any
theorizing. This approach also emphasized the importance case, this particular reaction is distressing and
of the therapeutic relationship. Rather than seeing the uncomfortable, particularly if it is associated with a variety
relationship as a means to an end (transference), humanistic of objects or situations.
therapists believed that relationships, including the
The classical conditioning process begins with;
therapeutic relationship, were the single most positive
influence in facilitating human growth. In fact, Rogers unconditioned stimulus (UCS) – a stimulus that would
made substantial contributions to the scientific study of elicit a response in almost anyone and requires no learning
therapist–client relationships. Maslow noted, the no conditions must be present for the response to occur.
humanistic model found its greatest application among (food or chemotherapy)
individuals without psychological disorders.
unconditioned response (UCR) – natural or unlearned
THE COGNITIVE-BEHAVIORAL MODEL response to this stimulus (salivation or nausea)
Cognitive-behavioral model combines insights from the conditioned stimulus (CS) – the nurse associated with the
behavioral model, the cognitive model, and the social chemotherapy
learning model. These models revolutionized the field
conditioned response (CR) – the response elicited by the
because they brought the systematic development of a more
conditional. (The nauseous sensation upon seeing the
scientific approach to psychological aspects of
nurse).
psychopathology.
PAVLOV AND CLASSICAL CONDITIONING
With unconditioned stimuli as powerful as chemotherapy, a producing fear of an object not previously feared. Albert
CR can be learned in one trial. Most learning of this type, may have also had some neurological impairment that could
however, requires repeated pairing of the UCS (for have contributed to developing fear, the study remains a
example, chemotherapy) and the CS (for instance, nurses’ classic one.
uniforms or hospital equipment). When Pavlov began to
Another student of Watson’s, Mary Cover Jones (1896–
investigate this phenomenon, he substituted a metronome
1987), thought that if fear could be learned or classically
for the footsteps of his laboratory assistants so that he could
conditioned in this way, perhaps it could also be unlearned
quantify the stimulus more accurately and, therefore, study
or extinguished. She worked with a boy named Peter, who
the approach more precisely. What he also learned is that
at 2 years, 10 months, old was already quite afraid of furry
presentation of the CS (metronome) without the food for a
objects. Jones decided to bring a white rabbit into the room
long enough period would eventually eliminate the CR to
where Peter was playing for a short time each day. She also
the food. In other words, the dog learned that the
arranged for other children, whom she knew did not fear
metronome no longer meant that a meal might be on the
rabbits, to be in the same room. She noted that Peter’s fear
way. This process was called extinction.
gradually diminished. Each time it diminished, she brought
Because Pavlov was a physiologist (he won the Nobel Prize the rabbit closer. Eventually Peter was touching and even
in physiology in 1904 for his studies on the digestive playing with the rabbit, and years later the fear had not
system), it was natural for him to study these processes in a returned.
laboratory and to be quite scientific about it. Early
THE BEGINNINGS OF BEHAVIOR THERAPY
psychonalaysts relied on examinations of their own inner
processes. Even early experimental psychologists such as The implications of Jones’s research were largely ignored
Edward Titchener (1867–1927) emphasized the study of for two decades, given the fervor associated with more
introspection. Subjects simply reported on their inner psychoanalytic conceptions of the development of fear. But
thoughts and feelings after experiencing certain stimuli, but in the late 1940s and early 1950s, Joseph Wolpe (1915–
the results of this “armchair” psychology were inconsistent 1997), a pioneering psychiatrist from South Africa, became
and discouraging to many experimental psychologists. dissatisfied with prevailing psychoanalytic interpretations
of psychopathology and began looking for something else.
WATSON AND THE RISE OF BEHAVIORISM
He turned to the work of Pavlov and became familiar with
American psychologist, John B. Watson (1878–1958), is the wider field of behavioral psychology. He developed a
considered the founder of behaviorism. Strongly influenced variety of behavioral procedures for treating his patients,
by the work of Pavlov, Watson decided that to base many of whom suffered from phobias. His best-known
psychology on introspection was to head in the wrong technique was termed systematic desensitization. In
direction, that psychology could be made as scientific as principle, it was similar to the treatment of little Peter:
physiology, and that psychology needs introspection or Individuals were gradually introduced to the objects or
other nonquantifiable methods no more than chemistry and situations they feared so that their fear could decline; that
physics do. This point of view is reflected in a famous is, they could test reality and see that nothing bad happened
quotation from a seminal article published by Watson in in the presence of the phobic object or scene. Wolpe added
1913: “Psychology, as the behaviorist views it, is a purely another element by having his patients do something that
objective experimental branch of natural science. Its was incompatible with fear while they were in the presence
theoretical goal is the prediction and control of behavior. of the dreaded object or situation. Because he could not
Introspection forms no essential part of its methods” always reproduce the phobic object in his office, Wolpe had
his patients carefully and systematically imagine the phobic
Watson spent developing behavioral psychology as a
scene, and the response he chose was relaxation because it
radical empirical science. In 1920, he and a student, Rosalie
was convenient. For example, Wolpe treated a young man
Rayner, presented an 11-month-old boy named Albert
with a phobia of dogs by training him first to relax deeply
with a harmless fluffy white rat to play with. Albert was not
and then imagine he was looking at a dog across the park.
afraid of the small animal and enjoyed playing with it.
Gradually, he could imagine the dog across the park and
Every time Albert reached for the rat, however, the
remain relaxed, experiencing little or no fear. Wolpe then
experimenters made a loud noise behind him. After only
had him imagine that he was closer to the dog. Eventually,
five trials, Albert showed the first signs of fear if the white
the young man imagined that he was touching the dog while
rat came near. The experimenters then determined that
maintaining a relaxed, almost trancelike state.
Albert displayed mild fear of any white furry object, even a
Santa Claus mask with a white fuzzy beard. This was one Systematic desensitization is one of the first wide-scale
of the first examples ever recorded in a laboratory of applications of the new science of behaviorism to
psychopathology. Wolpe, working with fellow pioneers of our physical environment, although the consequences
Hans-Jürgen Eysenck and Stanley Rachman in London, may be long term (polluting the air eventually will poison
called this approach behavior therapy. Although Wolpe’s us). Skinner preferred the term reinforcement to “reward”
procedures are seldom used today, they paved the way for because it connotes the effect on the behavior. Skinner once
modern-day fear and anxiety reduction procedures in which said that he found himself a bit embarrassed to be talking
severe phobias can be eliminated in as little as 1 day. continually about reinforcement. But he pointed out that all
of our behavior is governed to some degree by
B. F. SKINNER AND OPERANT CONDITIONING
reinforcement, which can be arranged in an endless variety
Burrhus Frederic (B. F.) Skinner (1904–1990) In 1938 he of ways, in schedules of reinforcement. Skinner wrote a
published The Behavior of Organisms, in which he laid whole book on different schedules of reinforcement. He
out, in a comprehensive manner, the principles of operant also believed that using punishment as a consequence is
conditioning, a type of learning in which behavior changes relatively ineffective in the long run and that the primary
as a function of what follows the behavior. Skinner way to develop new behavior is to positively reinforce
observed early on that a large part of our behavior is not desired behavior. Skinner simply explained these
automatically elicited by a UCS. Skinner did not confine his phenomena as relatively inconsequential side effects of a
ideas to the laboratories of experimental psychology. He particular history of reinforcement.
ranged far and wide in his writings, describing, for example,
The subjects of Skinner’s research were usually animals,
the potential applications of a science of behavior to our
mostly pigeons and rats. Using his new principles, Skinner
culture. Some best-known examples of his ideas are in the
and his disciples taught the animals a variety of tricks,
novel Walden Two (Skinner, 1948), in which he depicts a
including dancing, playing Ping-Pong, and playing a toy
fictional society run on the principles of operant
piano. To do this he used a procedure called shaping, a
conditioning. In another well-known work, Beyond
process of reinforcing successive approximations to a final
Freedom and Dignity (1971), Skinner lays out a broader
behavior or set of behaviors. For example, if you want a
statement of problems facing our culture.
pigeon to play Ping-Pong, first you provide it with a pellet
Skinner was strongly influenced by Watson’s conviction of food every time it moves its head slightly toward a Ping-
that a science of human behavior must be based on Pong ball tossed in its direction. Gradually, you require the
observable events and relationships among those events. pigeon to move its head ever closer to the Ping-Pong ball
The work of psychologist Edward L. Thorndike (1874– until it touches it. Finally, receiving the food pellet is
1949) also influenced Skinner. Thorndike is best known for contingent on the pigeon hitting the ball back with its head.
the law of effect, which states that behavior is either
This model is incomplete and inadequate to account for
strengthened (likely to be repeated more frequently) or
what we now know about psychopathology. In the past,
weakened (likely to occur less frequently) depending on the
there was little or no room for biology in behaviorism
consequences of that behavior. Skinner took the simple
because disorders were considered, for the most part,
notions that Thorndike had tested in the animal laboratories,
environmentally determined reactions. The model also fails
using food as a reinforcer, and developed them in a variety
to account for development of psychopathology across the
of complex ways to apply to much of our behavior. For
life span. Recent advances in our knowledge of how
example, if a 5-year-old child starts shouting at the top of
information is processed, both consciously and
their lungs in a restaurant, much to the annoyance of the
subconsciously, have added a layer of complexity.
people around them, it is unlikely that their behavior was
automatically elicited by a UCS. They will be less likely to The behavioral model moved psychology into the realm of
do it in the future if their parents scold them, take them out science. Both research and therapy focus on things that are
to the car to sit for a bit, or consistently reinforce more measurable, including such techniques as systematic
appropriate behavior. Then again, if the parents think their desensitization, reinforcement, and shaping
behavior is cute and laugh, chances are they will do it again.
THE SCIENTIFIC METHOD AND AN
Skinner coined the term operant conditioning because INTEGRATIVE APPROACH
behavior operates on the environment and changes it in
Three traditions or ways of thinking about causes of
some way. For example, the child’s behavior affects their
psychopathology: the supernatural, the biological, and the
parents’ behavior and probably the behavior of other
psychological (further subdivided—psychoanalytic and
customers. Therefore, the child changes their environment.
behavioral).
Most things that we do socially, provide the context for
other people to respond to us in one way or another, thereby Supernatural explanations of psychopathology are still
providing consequences for our behavior. The same is true with us. Superstitions prevail, including beliefs in the
effects of the moon and the stars on our behavior. This before the wisdom of his advice was fully recognized in the
tradition has little influence on scientists and other field.
professionals, however. Biological, psychoanalytic, and
By 2000, a veritable explosion of knowledge about
behavioral models, by contrast, continue to further our
psychopathology was occurring. The young fields of
knowledge of psychopathology.
cognitive science and neuroscience began to grow
Each tradition has failed in important ways. First, scientific exponentially as we learned more about the brain and about
methods were not often applied to the theories and how we process, remember, and use information. At the
treatments within a tradition, mostly because methods that same time, startling new findings from behavioral science
would have produced the evidence necessary to confirm or revealed the importance of early experience in determining
disprove the theories and treatments had not been later development. It was clear that a new model was
developed. Lacking such evidence, many people accepted needed that would consider biological, psychological, and
various fads and superstitions that ultimately proved to be social influences on behavior. This approach to
untrue or useless. New fads often superseded truly useful psychopathology would combine findings from all areas
theories and treatment procedures. King Charles VI was with our rapidly growing understanding of how we
subjected to a variety of procedures, some of which have experience life during different developmental periods,
since been proved useful and others that were mere fads or from infancy to old age.
even harmful.
This development is in line with the Strategic Plan for
Second, health professionals tend to look at psychological Research of the National Institute of Mental Health
disorders narrowly, from their own point of view alone. (NIMH), the main funding agency for research on mental
Grey assumed that psychological disorders were the result health (NIMH, 2020). This plan specifically states four
of brain disease and that other factors had no influence. goals:
Watson assumed that all behaviors, including disordered
(1) to define the brain mechanisms underlying complex
behavior, were the result of psychological and social
behaviors,
influences and that the contribution of biological factors
was inconsequential. (2) to examine mental illness trajectories across the
lifespan,
In the 1990s, two developments came together as never
before to shed light on the nature of psychopathology: (3) to strive for prevention and cures, and
(1) the increasing sophistication of scientific tools and (4) to strengthen the public health impact of research.
methodology and
It still includes but less strongly emphasizes the earlier so-
(2) the realization that no one influence—biological, called Research Domain Criteria (RDoC) framework.
behavioral, cognitive, emotional, or social—ever occurs in The goal of this previous NIMH initiative was to offer an
isolation. alternative to the DSM by utilizing brain circuits and basic
biology processes to describe and understand mental
Literally, every time we think, feel, or do something, the
disorders. This approach did not turn out to be practically
brain and the rest of the body are hard at work. Perhaps not
feasible.
as obvious, however, is that our thoughts, feelings, and
actions inevitably influence the function and even the In the remainder of this book, we explore the reciprocal
structure of the brain, sometimes permanently. In other influences among neuroscience, cognitive science,
words, our behavior, both normal and abnormal, is the behavior science, and developmental science and
product of a continual interaction of psychological, demonstrate that the only currently valid model of
biological, and social influences. psychopathology is multidimensional and integrative.
The view that psychopathology is multiply determined had With the increasing sophistication of our scientific tools,
its early adherents. Adolf Meyer (1866–1950), often and new knowledge from cognitive science, behavioral
considered the dean of American psychiatry. Whereas most science, and neuroscience, we now realize that no
professionals during the first half of the century held narrow contribution to psychological disorders ever occurs in
views of the cause of psychopathology, Meyer steadfastly isolation. Our behavior, both normal and abnormal, is a
emphasized the equal contributions of biological, product of a continual interaction of psychological,
psychological, and sociocultural determinism. Although biological, and social influences.
Meyer’s ideas had some proponents, it took 100 years