CHAPTER 2 0CHAPTER OUTLINE0

I0. One-Dimensional models of mental disorders Models are analogies that scientists use to describe things they cannot directly observe. Among the models that psychologists use is the medical model, which portrays psychological disorders as diseases or the psychosocial model. This chapter will introduce the multi-path model. The case of Steven V. is presented, which describes a college student suffering from depression and violent fantasies. The biological model suggests that abnormal behavior is caused by biological factors, especially involving genetic material and the brain. Psychological explanations such as Sigmund Freuds psychodynamic model emphasizes early childhood experiences. Behavioral explanations can be traced to inappropriate learning. Social explanations look at the social environment. Sociocultural explanations look at cultural factors to explain behavior. II0. A multi-path model of mental disorders. What, then, is the best way to conceptualize the causes of mental disorders? An integrative and interacting multi-path model is a way of viewing disorders and their causes. The multi-path model is not a theory, but a way of looking at the variety and complexity of contributors to mental disorders. The etiology of mental disorders can be subsumed under four dimensions. Dimension One: Biological Factors This dimension includes genetics, brain anatomy, biochemical imbalances, central nervous system functioning, autonomic nervous system reactivity, etc. Dimension Two: Psychological Factors This dimension includes personality, cognition, emotions, learning, stress-coping, self-esteem, self-efficacy, values, developmental history, etc. Dimension Three: Social Factors This dimension includes family, relationships, social support, belonging, love, marital status, community, etc. Dimension Four: Sociocultural Factors This dimension includes race, gender, sexual orientation, religion, socioeconomic status, ethnicity, culture, etc. III0. Dimension one: biological factors. Modern biological explanations of normal and abnormal behavior continue to share certain assumptions: (1) the things that make people who they aretheir physical features, susceptibility to diseases, temperaments, and ways of dealing with stressare embedded in the genetic material of their cells; (2) human thoughts, emotions, and behaviors are associated with nerve cell activities of the brain and spinal cord; (3) a change in thoughts, emotions, or behaviors will be associated with a change in activity or structure (or both) of the brain; (4) mental disorders are highly correlated with some form of brain or other organ dysfunction; and (5) mental disorders can be treated by drugs or somatic intervention The human brain is composed of billions of neurons (nerve cells) that receive and transmit information. The brain is divided into two hemispheres, each controlling the opposite side of the body. The brain structures most relevant to abnormal behavior include the thalamus, hypothalamus, reticular activating system, limbic system, and cerebrum. Other structures in the midbrain and hindbrain manufacture chemicals that are correlated with mental disorders. Biochemical theories suggest that chemical imbalances underlie mental disorders. Neurons are composed of dendrites, which receive signals from other neurons, and axons, which send the signals to other neurons. At the end of the axon is a gap called the synapse, into which chemicals called neurotransmitters are released. Imbalances in neurotransmitters are associated with many mental disorders. Certain medications can reduce symptoms of abnormal behavior by blocking or facilitating neurotransmitter activity. Biochemistry plays an important role in understanding abnormal behavior. Genetics also plays an important part in explaining the development of disorders. A persons genotype (genetic makeup) interacts with the environment to produce physical or behavioral characteristics (the persons phenotype). The

Human Genome Project has mapped the location of all genes in the nucleus of a human cell and has completed its sequencing to provide a basic blueprint of the entire genetic material found in each cell of the human body. While single cells have been found to be responsible for a few diseases, most diseases are the result of many genes interacting with hormones, electrical signals and nutrient supplies internally, plus physical and social environments. Biology-based treatment techniques include: Psychopharmacology is the study of the effects of drugs on the mind and on behavior; it is also known as medication or drug therapy. Besides medication, electroconvulsive therapy (ECT) can be used to treat certain mental disorders. Psychosurgery is brain surgery performed for the purpose of correcting a severe mental disorder The treatment was used most often with patients suffering from schizophrenia and severe depression, although many who had personality and anxiety disorders also underwent psychosurgery. Diathesis-stress theory argues that people can inherit a vulnerability to developing an illness, but this tendency must be activated by environmental forces for the disorder to occur. IV0. Dimension Two: psychological factors. Especially important for the psychological dimension are conflicts in the mind, emotions, learned behavior, and cognitions in personality formation. Personality is a dynamic process resulting from three interacting components: the id, the ego, and the superego. The id operates on the pleasure principle, a need for immediate gratification. The ego is influenced by the reality principle. The superego is composed of the conscience and the ego ideal. Personality develops through five psychosexual stages (oral, anal, phallic, latency, and genital). Fixation at any of the stages affects emotional development. Anxiety is at the root of psychoanalytic thinking and takes three forms: realistic, moralistic, and neurotic. Defense mechanisms protect the individual from anxiety. These include, among others, repression, reaction formation, projection, rationalization, displacement, undoing and regression. Psychoanalytic therapy, or psychoanalysis, has three main goals: (1) uncovering repressed material, (2) having clients achieve insight into their inner motivations and desires, and (3) resolving childhood conflicts that affect current relationships. Psychoanalysts traditionally use four methods to achieve their therapeutic goals: free association, dream analysis, analysis of resistance and analysis of transference. Psychoanalysis has been criticized for basing its evidence on case studies, which are subject to distortion. Psychodynamic theory is biased against women and cannot be applied to a wide range of disturbed people. The behavioral models emphasize learning. The classical conditioning model involves the pairing of a neutral (conditioned) stimulus with an unconditioned stimulus that automatically produces certain responses called the unconditioned response. After repeated pairing, the conditioned stimulus alone can produce a weakened version of the response, call the conditioned response. Classical conditioning in psychopathology. These concepts can be said to explain the development of phobias and deviant sexual behavior. However, the passive nature of associative learning makes it a limited explanatory tool. Watson and the little Albert experiment are a good example. The operant conditioning model stresses the consequences of voluntary and controllable behaviors called operant behaviors. According to Thorndikes law of effect, these behaviors are more likely when they produce positive consequences and less likely when they produce negative consequences. Operant conditioning principles help explain such forms of psychopathology as self-injurious behavior. As in classical conditioning, operant concepts can be applied to treatment as well. The observational learning model suggests that an individual can acquire new behaviors simply by watching other people perform them through the process of vicarious conditioning or modeling. Observational learning in psychopathology assumes that exposure to disturbed models helps produce disturbed behavior. Behavioral models have made significant contributions to both the understanding and treatment of disorders. However, they are criticized for diminishing the importance of inner determinants of behavior. The cognitive models assume that thoughts

modify our emotional states and behavior. People differ in their mediating processes, which determine our reactions, behaviors and self-evaluations. Our schemas (how we interpret events) influence our experiences. Cognitive theorists focus on irrational beliefs (Ellis) or dysfunctional automatic thoughts (Beck). Becks work on depression helped him identify a hierarchy of cognitive content. Ellis describes an A-B-C theory of personality in which A is an event, B is a belief, and C is a consequent behavior or emotion. Beck describes six types of faulty or distorted thinking: arbitrary inference, selective abstraction, overgeneralization, magnification and exaggeration, personalization, and polarized thinking. Cognitive approaches to therapy have clients monitor their thoughts; recognize the connections between thoughts, emotions, and behaviors; examine the evidence for their assumptions; and substitute more reality-oriented interpretations. The humanistic and existential approaches emphasize the need to appreciate the world form the individual's vantage point. They also highlight freedom of choice and the wholeness of the individual. Psychologists Carl Rogers and Abraham Maslow suggested that people are motivated by the actualizing tendency to enhance the self (self-actualization). Development of abnormal behavior occurs when society imposes conditions of worth on people so that their selfconcept and actualizing tendency become incongruent. This incongruence produces behavior disorders. In Rogers person-centered therapy, people are free to grow toward their potential. The therapist uses reflection of feelings and acceptance rather than advice to help the client actively evaluate his or her experience. The existential perspective is not a systematized school of thought but a set of attitudes that is less optimistic than humanism. It views the individual within the human condition and focuses more on responsibility to others. Both approaches lack scientific grounding, are vague, and apply therapies that are ineffective with severely disturbed clients. Criticisms of the humanistic and existential approaches point to their fuzzy, ambiguous, and nebulous nature and to the restricted population in which these approaches can be applied. V0. Dimension Three: social factors. In contrast to traditional psychological models, socialrelational models emphasize how other people, especially significant others, influence our behavior. This viewpoint holds that all people are enmeshed in a network of interdependent roles, statuses, values, and norms. One of these, the family systems model, assumes that the behavior of one family member directly affects the entire family system. Criticisms of the family systems model include difficulty defining it from different cultural viewpoints and its confusion of cause and effect over the issue of family abuse. VI0. Dimension Four: sociocultural factors. Gender factors, women are consistently subjected to greater stressors than their male counterparts. Lower socioeconomic class is related to lower sense of self-control, poorer physical health, and higher incidence of depression. Early attempts to explain differences between various minority groups and their white counterparts tended to adopt one of two models. The first, the inferiority model, contends that racial and ethnic minorities are inferior in some respect to the majority population. The second modelthe deprivations or deficit modelexplained differences as the result of cultural deprivation. It implied that minority groups lacked the right culture. Both models have been severely criticized as inaccurate, biased, and unsupported in the scientific literature. The Multicultural Model is the new approach emphasizing that being culturally different does not equal deviancy, pathology, or inferiority. The model recognizes that each culture has strengths and limitations and that differences are inevitable. Criticisms of the Multicultural Model include that the multicultural model operates from a relativistic framework; that is, normal and abnormal behavior must be evaluated from a cultural perspective. The reasoning is that behavior considered disordered in one contextseeing a vision of a dead relative, for examplemight not be considered disordered in another time or place.

VII0.Implications. Each modelwhether biological, psychodynamic, behavioral, cognitive, existential-humanistic, family systems, or multiculturalrepresents different views of pathology. In practice, most clinicians recognize that models of psychopathology do not completely contradict one another on every point. As the multi-path model suggests, elements of various perspectives can complement one another to produce a broad and detailed explanation of a persons condition